Hepatitis B virus (HBV) infection poses a persistent public health challenge globally, with chronic cases often leading to severe liver diseases and associated comorbidities. In Japan, where the prevalence of chronic HBV remains substantial in the elderly population, the burden of comorbidities and polypharmacy in patients receiving nucleos(t)ide analogue (NUC) therapy is not well characterized. The aim of the present study was to evaluate the prevalence of chronic comorbidities and concomitant medication use in chronic hepatitis B (HBV) patients on NUC therapy in Japan. A retrospective, cross-sectional, observational study using a nationwide hospital claims database was conducted. Data were obtained from the Medical Data Vision (MDV) database, comprising 480 hospitals in Japan from 2008 to 2023. Patients with chronic HBV were defined by ICD-10 code plus NUC prescription for HBV; controls had no HBV-related diagnoses or NUC prescriptions. Controls were first selected 1:3 by same age, sex, and visit month, and then propensity score-matched to cases on age, sex, and hospital bed size (caliper 0.2). A total of 25,199 chronic HBV patients on NUC therapy were compared with 134,597 age- and sex-matched non-HBV patients using propensity score matching. Mean ages were 63.7 (SD 12.9) years and 64.3 (SD 15.8) years, respectively; 59.2

In 2023, non-alcoholic fatty liver disease (NAFLD) was defined as metabolic dysfunction-associated steatotic liver disease (MASLD) to avoid stigmatizing terminology. Although recent studies have suggested an association between MASLD and serum uric acid (SUA), the evidence remains limited. In this study, we aimed to assess the association between MASLD and SUA in Japanese participants. This cross-sectional study included 3,264 eligible participants (1,917 men and 1,347 women) who underwent voluntary health checkups at Juntendo University Hospital, Tokyo, Japan, between January 2021 and December 2023. Data on basic characteristics, anthropometric indices, blood pressure, glycemic and lipid markers, SUA levels, and medical histories were collected. Steatosis was assessed by computed tomography or ultrasound. MASLD was defined as imaging-confirmed steatosis plus at least one metabolic dysfunction criterion. The participants were stratified into sex-specific SUA quartiles. Associations between MASLD and SUA quartiles were evaluated by multivariable logistic and Poisson regression, adjusted for age, alcohol consumption, smoking, estimated glomerular filtration rate, urate-lowering medication use, and body mass index. The results are reported as adjusted odds ratios (AORs) or prevalence ratios (PRs) with 95

[This corrects the article DOI: 10.31662/jmaj.2023-0148.].

OBJECTIVES:Fibrates are suitable for the treatment of patients with high triglyceride (TG) levels. Although pemafibrate (PEMA) has been reported to have beneficial and pleiotropic actions, clinical examinations of the efficacy of PEMA for Japanese patients with hypertriglyceridemia are still limited in actual clinical settings. The aim was to evaluate the efficacy of PEMA by analyzing data from diabetic patients treated with PEMA in clinical practice. METHODS:Patients with type 2 diabetes mellitus and hypertriglyceridemia who were started on PEMA for at least 3 months were included in the analysis. Changes in lipid metabolism, liver function, renal function, and blood tests from before to after 3 months of PEMA treatment were evaluated. RESULTS:A total of 100 eligible patients were included in the analysis (72 males, mean age 52.9 years). TG levels decreased significantly, and high-density lipoprotein cholesterol levels increased significantly after 3 months of therapy. Low-density lipoprotein cholesterol levels were not significantly changed. Liver-related parameters showed a significant decrease. In addition, a significant decrease in creatinine levels was found in patients switching from other fibrates. There were no severe adverse events. CONCLUSION:PEMA showed beneficial effects on lipid metabolism and liver function. The improvement of lipid metabolism was found in patients switching from other fibrates. It is possible that PEMA may improve lipid metabolism in patients with hypertriglyceridemia. CLINICAL TRIAL NUMBER:Not applicable.

[This corrects the article DOI: 10.3389/fmed.2024.1329922.].

Tea intake has been associated with health benefits, including potential beneficial effects of catechin-containing teas on allergic symptoms. However, large-scale epidemiological studies on the relationship between tea intake and allergic symptoms have been limited. The present study aimed to examine the relationship between the frequency of tea intake and cedar pollen allergy, which is a major cause of seasonal hay fever in Japan, in a large Japanese epidemiological cohort. Data on cedar pollen antibody levels assessed by blood tests and frequency of tea intake (green tea, coarse tea, oolong tea, and black tea) by a self-administered questionnaire from 16,623 residents in the Tohoku region of Japan were used in this study. The association between frequency of tea intake (less than once a week, 1-6 times/week, and more than once a day) and serum levels of cedar pollen-specific IgE (lumicount, LC: negative, 0-1.39; positive, >= 1.40) was analysed using a logistic regression model. Green tea intake (>= vs. <1/day) was inversely associated with cedar pollen-specific IgE (adjusted OR = 0.81, 95% CI, 0.70, 0.94). No statistically significant association between cedar pollen-specific IgE and frequency of tea intake was found for other types of tea. Our results suggest that green tea intake may be associated with lower cedar pollen-specific IgE positivity.

Antibody tests are used as surveillance tools for informing health policy making. However, results may vary by type of antibody assay and timing of sample collection following infection. Long-term longitudinal cohort studies on antibody assay seropositivity have remained limited, especially among Asian populations. Using blood samples obtained at health physicals (2020–2022) of healthcare workers (mass vaccinated with mRNA COVID-19 vaccines) at a Japanese medical center, we measured N-specific antibodies using two commercially available systems. Roche Elecsys Anti-SARS-CoV-2 measures total antibodies and Abbott Alinity SARS-CoV-2 IgG measures only IgG. Among 2538 participants, seroprevalence was found to be 16.6% via total antibody assay versus 12.9% by IgG-only (including grayzone) by mid-June 2022. For 219 cases with a previous PCR-confirmed infection, positivity was 97.3% using total antibody assay versus 76.3% using IgG-only assay at the 2022 health physical. Using PCR positive test date as day 0, while the positivity of the total antibody assay was retained for the entire study period (until more than 24-months post-infection), the IgG-only assay’s positivity declined after month 4. The Mantel–Haenszel test found a significant difference in the two assays’ seropositivity, between stratified groups of “within 3 months” and “4 months or more” from infection (P < 0.001). Our study found significant differences in seropositivity over time of total antibody versus IgG-only assays, suggesting an optimal assay for retaining sensitivity over the entire infection period when designing seroprevalence studies.

Background Although these findings suggest that oral semaglutide may be a suitable treatment option for obese patients with type 2 diabetes mellitus inadequately responsive to dipeptidyl peptidase (DPP)-4 inhibitor–based therapy, evidence from actual clinical settings remains limited. Objective The objective of this study was to investigate the effect of oral semaglutide in obese patients with type 2 diabetes mellitus who had an inadequate response to DPP-4 inhibitor–based therapy. Methods This study was a retrospective, single-center study in which outpatients with type 2 diabetes were (1) aged 20 years or older at the time of oral semaglutide administration, (2) treated with an existing DPP-4 inhibitor for 3 months and/or longer at the time of oral semaglutide administration, and (3) had a hemoglobin A1c (HbA1c) level of ≥ 6.5% and/or a body mass index (BMI) ≥ 25.0 kg/m 2 . The primary endpoints were changes in HbA1c and body weight from baseline to 6 months after oral semaglutide treatment switching from DPP-4 inhibitor. Results In the 48 patients studied, HbA1c was 7.01 ± 0.54%, and BMI was 26.7 ± 3.6 kg/m 2 at baseline. HbA1c significantly decreased by 0.68 ± 0.36%, and body weight significantly decreased by 3.4 ± 2.3 kg (p < 0.001 for each). Improvements in indices of lipid metabolism and liver function were observed. Non-serious nausea and loss of appetite were observed in many patients, but these symptoms resolved in approximately 3 months. Mild constipation was also observed. Conclusion Oral semaglutide appears to be a promising alternative to DPP-4 inhibitors as a means of glycemic and weight control in obese type 2 diabetes.

BackgroundAs the life expectancy of people living with human immunodeficiency virus (HIV) (PLWH) has improved, chronic disease burden and polypharmacy have increased in PLWH. Simplification of the antiretroviral therapy (ART) regimen for PLWH has become crucial. The real-world treatment patterns and medication persistence of the 2-drug single-tablet regimen (STR), dolutegravir/lamivudine (DTG/3TC), compared to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) prescribed were investigated.MethodsThis retrospective, database study extracted data from a hospital-based medical claims database in Japan. The changes in ART distributions by year during the identification period between January 1, 2018 and December 31, 2021 were observed. Patients with disease record of HIV-1 infection and prescribed DTG/3TC or BIC/FTC/TAF as the first prescription of STR during the identification period were divided into two cohorts; DTG/3TC cohort and BIC/FTC/TAF cohort, respectively. Patient without medication records more than 3 months and no future data more than 6 months were excluded. Patients’ characteristics were compared between the DTG/3TC cohort and the BIC/FTC/TAF cohort by Mantel–Haenszel test to adjust for age. Medication persistence was compared between the two cohorts by evaluating the continuation rates using Kaplan–Meier methods, using the log-rank test to assess the difference between the Kaplan–Meier curves. The median time-to-first prescription was compared between the two cohorts by Kaplan–Meier methods.ResultsPrescriptions of DTG/3TC and BIC/FTC/TAF increased steadily from 2019 to 2021 after the release year of each STR. There was no significant difference in the time-to-first prescription (p = 0.3). A total of 959 patients were included, with 120 patients and 839 patients on DTG/3TC and BIC/FTC/TAF, respectively. The proportion of dyslipidemia at baseline was significantly higher in the DTG/3TC cohort than in the BIC/FTC/TAF cohort after adjusting for mean age (p = 0.002). There was no significant difference in medication persistence between the two cohorts (p = 0.91).ConclusionThis study showed that DTG/3TC was likely to be selected for elderly patients and those with chronic disease in real-world clinical practice, which seems in accordance with the treatment strategy recommended by guidelines. Comparable medication persistence was observed with both regimens, aligning with findings from other countries. The 2-drug single-tablet regimen DTG/3TC may be an important ART regimen for PLWH with multiple morbidities and polypharmacy in an aging society. Due to the limitations of the database, further research to assess viral loads, emergence of resistance and adverse events will be encouraged.

Introduction:Health literacy (HL) is a crucial indicator for health promotion and diabetes care improvement, but the available measurements are mostly in English. This study aimed to translate and validate the 14-item Health Literacy Scale (HLS-14) questionnaire from English to Vietnamese for patients with diabetes in Vietnam.Methods:We translated HLS-14 into Vietnamese in accordance with the World Health Organization guidelines and conducted a cross-sectional survey among 571 outpatients with type 2 diabetes using the HLS-14 Vietnamese version (HLS-14 VN). The reliability and validity of the tool were assessed using Cronbach's alpha, composite reliability (CR), average variance extracted (AVE), and maximum shared variance (MSV), and confirmatory analysis was conducted.Results:Cronbach's alpha coefficients for the three subscales as in the original version were 0.931, 0.810, and 0.928 for functional HL, communicative HL, and critical HL, respectively. However, AVE for critical HL was 0.488, which improved to 0.516 after the removal of one item in the communicative HL. For all subscales in the revised 13-item version (HLS-13 VN), CR was above 0.8, AVE was above 0.5, and MSV was less than AVE. Confirmatory analysis of HLS-13 VN revealed an acceptable fit with comparative fit index of 0.983, goodness-of-fit index of 0.963, and root mean squared error of approximation of 0.058.Conclusions:The reliability and validity of HLS-13 VN were confirmed. The tool is suitable for use in clinical settings in Vietnam to assess multidimensional HL in patients with type 2 diabetes.

Background: It has been reported that zinc deficiency is related to severe inflammatory conditions especially those of respiratory diseases. However, studies that have examined the association between the serum zinc concentration and the severity of coronavirus disease 2019 (COVID-19) are still limited. The aim of this study was to assess that association in Japanese inpatients with COVID-19. Methods: This cross-sectional study, conducted from April 2020 to August 2021, included 467 eligible adult inpatients with COVID-19 whose serum zinc concentration was measured. Serum zinc concentration categories were defined as deficiency (< 60 mu g/dL), marginal deficiency (>= 60 to < 80 mu g/dL), and normal (>= 80 mu g/dL). Multivariate logistic regression was used to assess the association between serum zinc deficiency and severe COVID-19. Serum zinc concentration levels were compared between mild and other severities of COVID-19 by Dunnett's method. The P for trend was estimated using the Jonckheere-Terpstra test. Results: The proportions of subjects with serum zinc deficiency (< 60 mu g/dL) and marginal zinc deficiency (>= 60 to < 80 mu g/dL) were 39.5% and 54.3% in women, and 36.4% and 57.0% in men, respectively. Serum zinc deficiency was significantly associated with severe COVID-19 compared to marginal deficiency and normal (odds ratio = 3.60, 95% confidence interval = 1.60- 8.13, P < 0.01) after adjusting for confounders. An increase in severity of COVID-19 was inversely related to increases in serum zinc concentration levels (P < 0.01 for trend). Each serum zinc concentration of moderate and severe cases was also significantly lower compared with mild cases (P < 0.01). Conclusion: The severity of COVID-19 was significantly related to serum zinc concentration levels. These results suggest the importance of considering the serum zinc concentration when treating patients with COVID-19.

Zinc deficiency, affecting more than 2 billion people globally, poses a significant public health burden due to its numerous unfavorable effects, such as impaired immune function, taste and smell disorders, pneumonia, growth retardation, visual impairment, and skin disorders. Despite its critical role, extensive large-scale studies investigating the correlation between patient characteristics and zinc deficiency still need to be completed. We conducted a retrospective, cross-sectional observational study using a nationwide Japanese claims database from January 2019 to December 2021. The study population included 13,100 patients with available serum zinc concentration data, excluding individuals under 20 and those assessed for zinc concentrations after being prescribed zinc-containing medication. Significant associations with zinc deficiency were noted among older adults, males, and inpatients. Multivariate analysis, adjusting for age and sex, indicated significant associations with comorbidities, including pneumonitis due to solids and liquids with an adjusted Odds Ratio (aOR) of 2.959; decubitus ulcer and pressure area (aOR 2.403), sarcopenia (aOR 2.217), COVID-19 (aOR 1.889), and chronic kidney disease (aOR 1.835). Significant association with medications, including spironolactone (aOR 2.523), systemic antibacterials (aOR 2.419), furosemide (aOR 2.138), antianemic preparations (aOR 2.027), and thyroid hormones (aOR 1.864) were also found. These results may aid clinicians in identifying patients at risk of zinc deficiency, potentially improving care outcomes.

Objective: To examine the association between habitual intake of milk and dairy products and insomnia. Design: Cross-sectional study by using cohort study data among 60,633 participants (22,721 men and 37,912 women) aged 20-74 years in eastern Japan. The data of milk and dairy products intake, sleep status and other lifestyle habits were collected by self-administered questionnaires. The question about milk and dairy products included whole milk, low-fat milk, cheese, yogurt, and lactic acid bacteria beverages, and were assessed by frequency (< 1 time/week, 1-2 times/week, 3-6 times/ week, and >= 1 time/day). Sleep status was scored with the Athens Insomnia Scale. Results: Logistic regression analysis showed that adjusted odds ratio (OR) and 95% confidence interval (95% CI) for insomnia were statistically significantly lower for whole milk intake > 1 time/day compared to < 1 time/week in all (OR: 0.91; 95% CI: 0.86-0.96; P = 0.001). The similar results were shown for women (OR: 0.90; 95% CI: 0.85-0.97; P = 0.002), not for men. In contrast, the adjusted odds for insomnia were high in the group that had frequencies of 3-6 times/week of lactic acid bacteria beverages compared to <1 time/week (OR: 1.20, 95% CI: 1.11-1.29; P < 0.001 in all; OR: 1.36; 95% CI: 1.19-1.55; P < 0.001 in men; OR: 1.13; 95% CI: 1.03-1.24; P = 0.009 in women). Conclusions: This cross-sectional study of Japanese populations showed a tendency for no insomniacs to consume whole milk more frequently.

PurposeThere are few studies in Japan evaluating informational materials about passive smoking prevention with respect to health literacy. This study applied a range of health literacy assessment tools to assess the understandability of public-sector leaflets about passive smoking prevention.MethodsWe collected 26 anti-passive smoking leaflets published online by Japanese prefectural governments. We used three internationally recognized health literacy assessment tools to evaluate their understandability: the Clear Communication Index (CCI), the Suitability Assessment of Materials (SAM), and the Patient Education Materials Assessment Tool (PEMAT, further divided into scales for understandability and actionability).ResultsAlthough none of the assessed materials met the CCI's scoring threshold for “easy to understand,” the highest-scoring leaflet, which received a top-two ranking in three of the four scales (excluding the PEMAT understandability scale), was characterized by its conciseness and its easy-to-understand structure, including the use of checklists and flowcharts to engage reader interest. There was a significant correlation between CCI and SAM, and between SAM and the PEMAT understandability scale. However, the PEMAT actionability scale did not significantly associate with the other assessment scales.ConclusionsThe understandability of written informational materials about passive smoking prevention in Japan could be improved by referring to multiple assessment scales.

Abstract The authors examined the sex‐specific association between serum uric acid (SUA) levels and achievement of target blood pressure among Japanese patients with hypertension. This cross‐sectional study was conducted between January 2012 and December 2015 and examined 17 113 eligible participants (6499 men; 10 614 women) with hypertension among 66 874 Japanese community residents who underwent voluntary health checkups. Multivariate analysis was used to estimate the association between high SUA level (≥7.0 mg/dL for men and ≥6.0 mg/dL for women) and “therapeutic failure” in achieving target blood pressure (BP) of 140/90 and 130/80 mmHg in both sexes. Multivariate analysis revealed that high SUA level was significantly associated with failure to achieve the 130/80 mmHg treatment goal among men (AOR = 1.24, 95% CI = 1.03–1.50, p = .03). Among women, high SUA level was significantly associated with failure to achieve both the 130/80 and 140/90 mmHg treatment goals (AOR = 1.33, 95% CI = 1.20–1.47, p < .01 and AOR = 1.17, 95% CI = 1.04–1.32, p < .01, respectively). Each increase in SUA quartile was positively associated with increases in systolic BP (SBP) and diastolic BP (DBP) (p < .01 for trend) in both sexes. SBP and DBP in each quartile (Q2–Q4) were also significantly higher compared with those of Q1 in both sexes (p < .01). Our data confirms the difficulties in maintain goal BP control in those with elevated SUA.

Abstract Antibody tests are used as surveillance tools for informing health policy making. However, results may vary by type of antibody assay and timing of sample collection following infection. Long-term longitudinal cohort studies on antibody assay seropositivity have remained limited, especially among Asian populations. Using blood samples obtained at health physicals (2020–2022) of healthcare workers (mass vaccinated with mRNA COVID-19 vaccines) at a Japanese medical center, we measured N-specific antibodies using two commercially available systems. Roche Elecsys® Anti-SARS-CoV-2 measures total antibodies and Abbott AlinityⓇ SARS-CoV-2 IgG measures only IgG. Among 2,538 participants, 16.6% tested positive via total antibody assay versus 12.9% by IgG-only (including grayzone) by mid-June 2022. For 219 cases with a previous PCR-confirmed infection, positivity was 97.3% using total antibody assay versus 76.3% using IgG-only assay. During the first 16 weeks after infection, both assays demonstrated high positivity. However, while positivity of the total antibody assay was retained for the entire study period (until week 113 post-infection), IgG-only assay positivity declined after week 16. Our study found significant differences in the performance of total antibody versus IgG-only assays, suggesting an optimal assay for retaining sensitivity over the entire infection period when designing seroprevalence studies.

Introduction Clear and effective health information is necessary for the prevention and control of diabetes in Vietnam, and written materials are playing an ever-greater role in educating patients. The Vietnamese government stated that access to health information is critically important in improving people’s health overall. However, there are few practical instructions for designing clear and easy-to-understand written materials. We aimed to evaluate the clarity and understandability of Vietnamese written materials on diabetes and healthy lifestyles.

CO2 insufflation has proven effective in reducing patients’ pain after colonoscopies but has not been examined in esophagogastroduodenoscopies. Therefore, we examined the effect of CO2 insufflation in examinees who underwent transnasal endoscopies without sedation. This study is a single-center, prospective, double-blind, case-control trial conducted between March 2017 and August 2018. Subjects were assigned weekly to receive insufflation with either CO2 or air. The primary outcome was improvement of abdominal pain and distension at 2 h and 1-day postprocedure. In total, 336 and 338 examinees were assigned to the CO2 and air groups, respectively. Visual analog scale (VAS) scores for abdominal distension (15.4 vs. 25.5; p < 0.001) and distress from flatus (16.0 vs. 28.8; p < 0.001) at 2 h postprocedure were significantly reduced in the CO2 group. VAS scores for pain during the procedure (33.5 vs. 37.1; p = 0.059) and abdominal pain after the procedure (3.9 vs. 5.7; p = 0.052) also tended to be lower at 2 h postprocedure, but all parameters showed no significant difference at 1-day postprocedure. All procedures were safely completed through the planned program, and no apparent adverse events requiring treatment or follow-up occurred. In conclusion, CO2 insufflation may reduce postprocedural abdominal discomfort from transnasal esophagogastroduodenoscopies. (UMIN000028543).