JMA journal最新文献

Background: The globalization of economic activities has led to a significant increase in international business travelers (IBTs), exposing them to various health risks, including infectious diseases, physical and psychological stress, and inadequate access to medical care. However, comprehensive research on IBTs' health remains limited. This study aims to assess IBTs' health concerns through a scoping review, focusing on illnesses during travel, the impact on daily life and well-being, and corporate health management.

Methods: A scoping review was conducted following the Arksey and O'Malley framework and the Joanna Briggs Institute methodology. Extensive searches were performed in MEDLINE, Web of Science, and Ichushi-Web, targeting studies for studies published between 2013 and 2022. Eligible studies addressed IBTs' physical and mental health or healthcare access. A two-step screening process was applied, and relevant data were extracted and categorized.

Results: A total of 31 studies were included. Health risks for IBTs were classified into three categories: (1) travel-related illnesses, including infectious diseases and medical emergencies; (2) physical and psychological health impacts, such as sleep disturbances, obesity, and mental stress; and (3) corporate health management strategies. Limited pre-travel consultations and vaccinations were notable concerns, particularly among Japanese IBTs.

Conclusions: IBTs face significant health risks that require improved prevention strategies, including vaccination programs, corporate health policies, and psychological support. As global business travel resumes post-pandemic, comprehensive health management tailored to IBTs' needs is essential to ensure their well-being and operational efficiency.

Introduction: Despite progress in hypertension management, blood pressure (BP) control remains insufficient, and this so-called hypertension paradox is an urgent issue. Following the 2019 revision of the Guidelines for Hypertension Management, we reported that patients requiring stringent BP regulation highlight the unachieved goals of hypertension management. BP management is a basic and validated strategy for patients with chronic kidney disease (CKD) but its achievement rate has been under-reported.

Methods: We collected and compared cross-sectional data of patients with hypertension in Kanagawa, Japan for 2011 and 2014 by accessing the Japan Medical Association Database of Clinical Medicine.

Results: Patients with and without CKD were included as follows: 316/488 in 2011, 152/946 in 2014, and 396/385 in 2021, respectively. In the 2021 study, the target office BP (130/80 mmHg) and home BP (<125/75 mmHg) were achieved in 36.3% and 57.9% of patients with CKD, respectively, and this was a significant improvement over the results reported in the 2014 study (p < 0.05). In contrast, the 2021 study on patients without CKD had a significantly lower achievement rate for a stringent BP target compared to the 2014 study (p < 0.05), especially for patients without diabetes (p = 0.004). Unlike trends in patients without CKD, home BP control in patients with hypertension and CKD has improved over the past decade.

Conclusions: The stringent BP target achievement rate remains insufficient in patients with CKD, indicating that CKD campaigns or resolution of clinical inertia resulting from an insufficient number of concomitant drugs is warranted.

Ichthyosis uteri is a rare benign condition characterized by extensive squamous metaplasia of the endometrium. We present an unusual case of ichthyosis uteri with radiological features mimicking myometrial invasion of endometrial cancer, occurring in a 50-year-old postmenopausal woman who presented with persistent abnormal vaginal bleeding. Laboratory findings revealed elevated serum squamous cell carcinoma (SCC) antigen level of 11.5 ng/mL. Magnetic resonance imaging (MRI) demonstrated an intrauterine lesion with apparent myometrial invasion, initially suggesting the International Federation of Gynecology and Obstetrics stage IA endometrial cancer. The lesion showed low signal intensity on the T2-weighted image compared to normal endometrium and weak enhancement on the contrast-enhanced T1-weighted image. While the lesion showed high signal intensity on diffusion-weighted imaging, the apparent diffusion coefficient value (0.96 × 10^-3 mm²/sec) indicated no substantial diffusion restriction. Despite the biopsy showing only squamous metaplasia without malignancy, a total hysterectomy was performed due to persistent bleeding, elevated serum SCC antigen level, and suspected myometrial invasion. Pathological examination revealed extensive papillary proliferation of bland squamous epithelium extending along adenomyosis, with concurrent endometrial hyperplasia. Postoperative serum SCC antigen level normalized to 0.7 ng/mL. This case highlights a unique radiological presentation of ichthyosis uteri, where extension along adenomyotic foci mimicked myometrial invasion of endometrial cancer. The relative lack of diffusion restriction on MRI, despite the lesion's size, may serve as a valuable diagnostic clue in differentiating ichthyosis uteri from endometrial cancer.

Introduction: Poor subjective health perception is a well-known risk factor for morbidity and mortality. This study aimed to investigate the relationship between social capital (SC) and health confidence among older individuals in a community setting.

Methods: The study included 884 individuals aged 60-79 years residing in a city in the Hokuriku region (460 men and 424 women; mean age: 70.32 ± 4.03 years). The analysis considered the following variables: residential area, sex, age, presence or absence of cohabitants, SC (general trust in the community, reciprocity among community members, attachment to the region, and engagement in hobbies and other community activities), health counseling-related resources, and lack of health confidence. The multivariate logistic regression analysis used lack of health confidence as the dependent variable. Multiple models were constructed.

Results: Of the 884 participants who provided data for the analyses, 176 (19.9%) reported a lack of confidence in their health. Women and individuals aged 70-79 years had significantly higher odds ratios (ORs) for reporting lack of health confidence (OR: 1.78 and 1.60, respectively). In men, the odds for reporting lack of health confidence were significantly higher among those who reported having no access to health or care counseling resources (OR 3.58, 95% confidence interval 1.47-8.72) and those who did not participate in sports-related group or club activities (OR 2.11, 95% confidence interval 1.15-3.86). In contrast, no significant associations were observed between SC factors and lack of health confidence among women.

Conclusions: The findings suggest that, particularly among men, access to health counseling resources and participation in community activities contribute to greater confidence in own health.

Introduction: This study aimed to determine the association between long-term care (LTC) risk and nonresponse to a subsequent survey.

Methods: Community-dwelling older adults aged ≥75 years without certified care needs residing in Hachioji City, Tokyo, who participated in the annual frailty screening program, were evaluated. Among the fiscal year (FY) 2020 survey respondents, those invited to the FY 2021 survey were included. The exposures of interest were LTC risk assessed using the seven domains of the Kihon Checklist (KCL) and frailty status in the FY 2020 survey. Frailty status was categorized based on total KCL scores. The outcome of interest was nonresponse to the FY 2021 survey. We conducted multivariable logistic regression analysis to evaluate these associations.

Results: Among 35,425 participants, 9,456 (26.7%) did not respond to the subsequent survey. Among seven KCL domains, activities of daily living limitation (adjusted odds ratio, 95% confidence interval 1.38, 1.27-1.50), low physical strength (1.17, 1.10-1.26), isolation (1.32, 1.22-1.44), memory decline (1.23, 1.17-1.30), and depressive mood (1.10, 1.04-1.16) were associated with nonresponse to the subsequent survey. In addition, frailty status was associated with nonresponse in a dose-responsive manner (prefrailty: 1.19, 1.12-1.26; frailty: 1.63, 1.53-1.73).

Conclusions: Although the annual frailty screening program aimed to identify those with high LTC risk, older adults with LTC risk were less likely to respond to the survey. Thus, conventional survey methods may need to be modified or different approaches may need to be adopted to identify older adults with high LTC risk.

Introduction: Numerous reports have suggested a relationship between asthma and migraine. We have encountered patients who presented with migraine attacks in association with asthma attacks.

Methods: In this study, we retrospectively evaluated the relationship between the condition of asthma (controlled or not) and the intensity of migraine attacks in 35 patients with asthma and migraine. We investigated the degree of changes in symptoms (change in fractional exhaled nitric oxide [FeNO], change in peak expiratory flow [PEF], and change in Asthma Control Test [ACT]) during exacerbation of asthma and observed the intensity of the headache (change in visual analog scale [∆VAS]). Next, we investigated the correlation between ∆VAS and biomarkers of bronchial asthma.

Results: When migraine was aggravated, indexes of asthmatic symptoms (ACT, PEF, and FeNO) were also exacerbated. We found a linkage between insufficiently controlled asthma and aggravation of migraine. Moreover, the three indexes of asthma (ACT, PEF, and FeNO) reviewed in this study showed a close correlation. There was a positive correlation between the degree of exacerbation of migraine symptoms and the degree of change in the three indexes. In 14 of 35 patients, administration of a short-acting β2 agonist for asthma attacks indirectly relieved headache.

Conclusions: here is a close correlation between the condition of asthma attacks and the intensity of migraine attacks.

Cow's milk-induced non-IgE-mediated gastrointestinal food allergies (non-IgE-GIFAs) are common and generally considered to have a favorable prognosis; however, severe cases can occur. We report a case of a neonate who presented with hypovolemic shock and subsequently developed cerebral infarction due to deep medullary venous thrombosis. A female infant, born at 35 weeks of gestation, was initially fed formula but transitioned to exclusive breastfeeding within a few days. After discharge on day 17, mixed feeding was resumed, leading to frequent pale-colored diarrhea. On day 19, she developed hypovolemic shock and was admitted to the intensive care unit. Her symptoms improved with nil per os management; however, on day 20, her hemoglobin levels declined despite no signs of bleeding on ultrasonography. She was treated with red blood cell transfusion and intravenous vitamin K. An amino acid-based formula was introduced on day 22 without adverse events, which suggested a possibility of non-IgE-GIFAs. However, the patient developed intermittent transient fevers thereafter; a cranial ultrasound performed on day 41 revealed a low-echoic area in the right frontal lobe. Subsequent magnetic resonance imaging revealed a cystic lesion in the right frontal lobe accompanied by surrounding parenchymal degeneration, leading to a diagnosis of venous infarction due to deep medullary vein thrombosis. Blood tests ruled out vitamin K deficiency and protein C or S defects. Despite this neurologic complication, she exhibited no neurologic symptoms throughout the clinical course. At 10 months of age, her neurodevelopment remains normal without any delays. This case highlights the potential for severe complications, including cerebral venous infarction, in neonatal non-IgE-GIFAs. Close monitoring for systemic complications is crucial in severe cases.

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare, non-infectious autoinflammatory bone disorder that predominantly affects children. Some studies have reported cases of CRMO in patients with autoimmune diseases such as inflammatory bowel disease (IBD). We encountered a rare pediatric case of CRMO in a patient with both IBD and primary sclerosing cholangitis (PSC). The patient was a 14-year-old male with a history of ulcerative colitis and PSC, both controlled with vedolizumab, who developed recurrent right wrist pain. Imaging revealed bone marrow edema suggestive of osteomyelitis. Initially suspected to be bacterial osteomyelitis, the patient was treated with antibiotics; however, symptoms recurred, and new lesions appeared on the heel, ultimately leading to a diagnosis of CRMO. The patient was successfully managed with analgesics alone, without antibiotics, and no long-term complications were observed. This is a rare pediatric case of CRMO occurring in the context of both IBD and PSC. Clinicians should consider CRMO in patients with IBD and PSC who present with musculoskeletal symptoms to avoid unnecessary antibiotic use. Early-stage diagnosis of CRMO can be achieved by detecting multifocal lesions on magnetic resonance imaging.