OBJECTIVE:To examine associations between occupation and overall and site-specific cancer risk in Japan. METHODS:We conducted a multicenter, hospital-based matched case-control study using the Inpatient Clinico-Occupational Survey of the Rosai Hospital Group (2005-2023), including 146,994 cancer cases and 278,244 matched controls. Conditional logistic regression was used to estimate sex-specific adjusted odds ratios by occupation. RESULTS:Occupational disparities in cancer risk were observed, with more pronounced associations among men than women. Elevated risks were identified in manual and transport-related occupations, whereas lower risks were observed in selected professional occupations. Site-specific patterns varied by cancer type and sex. CONCLUSIONS:Occupation is associated with cancer risk in Japan, showing distinct sex-specific and site-specific patterns. These findings underscore the importance of occupational context in cancer epidemiology and provide a hypothesis-generating framework highlighting behavioral and detection-related factors.

Objective The aim of the study is to develop a job-exposure matrix for sedentary behavior and assess its relationship with noncommunicable diseases. Methods We constructed a job-exposure matrix using occupational and industry classifications combined with data on daily average sitting durations from 41,718 individuals. This matrix was then applied to a cohort of 706,939 participants in a case-control study to explore the link between sedentary behavior and noncommunicable disease risks. Results The matrix effectively identified sedentary behavior across different occupational groups. Using the matrix to assess sedentary behavior, associations were found between increased sedentary activity and heightened risks of diabetes, acute myocardial infarction, and endometrial cancer, while a reduced risk was observed for stroke. Conclusions The job-exposure matrix provides valuable insights into the health impacts of sedentary behavior in the workplace, underscoring significant disease risks associated with prolonged inactivity.

Objectives While there is growing evidence that physical activity reduces the risk of hepatocellular carcinoma (HCC), the impact of occupational physical activity and sedentary behaviour remains unclear. This study aimed to investigate the associations between occupational physical activity and sedentary behaviour and HCC risk.Design Matched case-control study.Setting Nationwide multicentre, hospital-inpatient data set in Japan, from 2005 to 2021.Participants The study included 5625 inpatients diagnosed with HCC and 27 792 matched controls without liver disease or neoplasms. Participants were matched based on sex, age, admission date, and hospital.Primary measures The association between levels of occupational physical activity (low, medium, high) and sedentary time (short, medium, long) with the risk of HCC.Secondary measures Stratification of HCC risk by viral infection status (hepatitis B/C virus), alcohol consumption levels and the presence of metabolic diseases (hypertension, diabetes, dyslipidaemia, obesity).Results High occupational physical activity was not associated with HCC caused by hepatitis B/C virus infection in men. In women, high occupational physical activity was associated with a reduced risk of non-viral HCC, with ORs (95% CIs) of 0.65 (0.45–0.93). Among patients with non-viral HCC, medium occupational physical activity combined with medium alcohol intake further decreased the HCC risk in men with an OR of 0.70 (0.50–0.97), while high occupational physical activity combined with lowest alcohol intake decreased the HCC risk in women with an OR of 0.69 (0.48–0.99). Men and women with medium sedentary time had a lower HCC risk compared with those with long sedentary time, with ORs of 0.88 (0.79–0.98) in men and 0.77 (0.62–0.97) in women, respectively. In patients without viral infection or alcohol use, medium sedentary time reduced the HCC risk associated with fatty liver disease without comorbid metabolic diseases in women.Conclusions High levels of occupational physical activity and/or medium periods of sedentary time are associated with a reduced risk of HCC, particularly non-alcoholic steatohepatitis.

BACKGROUND:Demonstrating mortality reduction in new colorectal cancer (CRC) screening programs through randomized clinical trials (RCTs) is challenging. We systematically reviewed single-round program performance outcomes using a stepwise approach proposed by the World Endoscopy Organization CRC Screening Committee framework. METHODS:The MEDLINE, EMBASE, Central, and Ichushi Web databases were searched until October 28, 2024, to find RCTs comparing guaiac-based and immunochemical fecal occult blood testing (gFOBT and FIT), flexible sigmoidoscopy (FS), computed tomographic colonography (CTC), and total colonoscopy (TCS). Paired reviewers screened studies, extracted data, and assessed bias risk. A Bayesian random-effects network meta-analysis was conducted, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. The primary outcome was advanced neoplasia (AN) detection, and the secondary outcomes were participation and colorectal cancer (CRC) detection, all during the first screening round. RESULTS:Eighteen RCTs (437,072 invitees) were included. The risk of bias was low or raised some concerns for screening participation, but it was high for detection outcomes. In the network meta-analysis of 15 RCTs not allowing crossover, the FIT-based program had a higher AN detection rate than the gFOBT-based program (relative risk [RR] 2.48; 95% credible interval [CrI] 1.52-4.21; moderate certainty). AN detection rates were not different in the CTC- (RR 1.01; CrI 0.43-2.23; very low certainty) and TCS-based (RR 1.03; CrI 0.54-1.78; low certainty) programs compared with the FS-based program. All the visualization modality programs had higher AN detection rates than the FIT-based program (FS: RR 2.13 [CrI 1.38-3.77]; CTC 2.16 [1.11-4.51]; and TCS 2.19 [1.43-3.48]; all with low certainty). Low event rates precluded definitive conclusions regarding CRC detection (very low to low certainty). The TCS-based program had the worst participation rate (very low to low certainty). Comparative data allowing crossover were limited. CONCLUSIONS:This is the first network meta-analysis that evaluates program-level initial performance indicators. FIT-based programs likely detect more AN cases than gFOBT-based programs, while FS-, CTC-, and TCS-based programs may outperform FIT. Due to limitations in first-round results, long-term outcomes should be assessed after 10-15 years.

BACKGROUND:This study aimed to identify the occupational class and specific occupations associated with hospitalisations due to alcohol-related liver disease and alcoholic liver cirrhosis, based on the distribution of alcohol consumption. METHODS:This matched case-control study used a nationwide, multicentre, inpatient dataset from the Inpatient Clinico-Occupational Database of the Rosai Hospital Group in Japan. A total of 5,490 cases with alcohol-related liver disease and 10,961 controls were included in this study. Participants were categorised according to occupational class (blue-collar, service, professional, and manager) and industrial sector (blue-collar, service, and white-collar). Professionals in white-collar industries were set as the reference group. We calculated the odds ratios (ORs) and confidence intervals (CIs) of alcohol-related liver disease and alcoholic liver cirrhosis using conditional logistic regression models. RESULTS:Blue-collar workers and service workers in both the service and blue-collar industries had a higher risk of hospitalisations due to alcohol-related liver disease: The ORs (95% CIs) for alcohol-related liver disease were 1.33 (1.15-1.55) for blue-collar workers in the blue-collar industry, 1.21 (1.03-1.42) for service workers in the blue-collar industry, 1.23 (1.01-1.51) for blue-collar workers in the service industry, and 1.47 (1.25-1.72) for service workers in the service industry. Among service workers, food and drink preparatory workers and customer service workers had a higher risk of hospitalisations due to alcohol-related liver disease and alcoholic liver cirrhosis compared to professionals (reference group), with ORs of 2.28 (1.81-2.89) and 2.18 (1.64-2.89), respectively, for alcohol-related liver disease. Among blue-collar workers, skeleton construction workers had a higher risk of hospitalisations due to alcohol-related liver disease, with an OR of 2.31 (1.63-3.3). Workers in occupations with a high risk of hospitalisations due to alcohol-related liver disease had higher percentages of alcohol consumption compared to professionals. CONCLUSIONS:Occupational class and specific jobs were associated with the risk of hospitalisations due to alcohol-related liver disease and alcoholic liver cirrhosis, with alcohol consumption patterns contributing to this increased risk.

While electrical muscle stimulation during hemodialysis has been reported to improve physical performance in middle-aged patients, clinical evidence regarding its efficacy in older patients with frailty remains limited. In this crossover trial, we randomly assigned 18 older patients (aged ≥ 65 years) with frailty receiving maintenance hemodialysis in a 1:1 ratio to the study intervention. Group 1 underwent electrical muscle stimulation first, followed by a five-week washout period, and then the control session without electrical muscle stimulation. Group 2 received the control session first, followed by the electrical muscle stimulation sessions. Eligible patients had physical frailty defined by a Short Physical Performance Battery (SPPB) score of 4–9 points. Electrical muscle stimulation was conducted for 30–40 min per day, 3 days a week, over 5 weeks, during hemodialysis sessions. The primary outcome was the difference in quadriceps isometric strength before and after the treatment period. Among 18 patients who were randomized, 16 patients were included in the intention-to-treat analysis (median age: 76 years [Q1 to Q3, 72 to 79]; men: 38

OBJECTIVES:Bowel preparation for colonoscopy can lead to serious adverse events (AEs), raising significant safety concerns in colorectal cancer (CRC) screening. A systematic review of these serious AEs in Japan was performed to explore potential management strategies. METHODS:The Ovid-MEDLINE and Ichushi databases were searched from inception to March 2024. Domestic studies that reported serious AEs in adults aged 18 years and older who were administered bowel cleansing agents or laxatives for a scheduled colonoscopy, regardless of its purpose, were extracted. Serious AEs were defined as those requiring hospitalization or extended hospital stays. Selected studies were assessed for quality verification using the established checklist. RESULTS:A total of 5049 articles were identified through database searches, and 54 articles were extracted based on selection criteria. Reports of the frequency of serious AEs were based on one case series study, which found 13.9 cases of bowel obstruction and 2.3 cases of bowel perforation per 100,000 colonoscopies. Multiple serious AEs caused by different agents were identified in 78 cases across 54 articles. These AEs were predominantly observed in elderly individuals and those with comorbidities. Though most cases were associated with diagnostic tests for symptomatic patients, some were also observed in primary screening or fecal test-positive individuals. The most common AE was induced by bowel obstruction, primarily in abdominally symptomatic patients, including one fatality. CONCLUSION:The frequency and characteristics of serious AEs associated with bowel preparation for colonoscopy in Japan were presented. These findings may contribute to managing these AEs, specifically in CRC screening.

OBJECTIVES:To investigate the association between occupation and Parkinson's disease (PD) risk and whether patients with PD change occupation after onset. DESIGN:A matched case-control study using secondary analysis of the Inpatient Clinico-Occupational Survey of the Rosai Hospital Group in Japan. SETTING:A nationwide multicentre inpatient dataset in Japan from 2005 to 2021. PARTICIPANTS:The PD group comprised 2205 inpatients diagnosed with PD (International Statistical Classification of Diseases and Related Health Problems, 10th Revision code G20) and 10 436 matched controls without PD, matched for age, sex, year of admission and hospital. PRIMARY OUTCOME MEASURE:Associations between the longest-held occupation-classified by industry (blue-collar, service, white-collar) and occupational class (blue-collar workers, service workers, professionals, managers)-and PD risk. SECONDARY OUTCOME MEASURE:Occupations and industries with increased PD risk; occupational changes before and after diagnosis among participants aged <60 years; and associations of PD risk with chemical exposure, smoking status and sex. RESULTS:After adjustment for smoking and alcohol, professionals in the service (OR=2.01, 95% CI 1.24 to 3.25) and white-collar (OR=1.33, 95% CI 1.10 to 1.61) industries had higher PD risk than service workers. Doctors, dentists, veterinarians and pharmacists showed elevated risk. Among 160 PD patients, 47% were unemployed, 20% left voluntarily and 30% continued working after diagnosis. Chemical handling was not associated with PD risk after adjustment of multiple comparisons. Former or current smokers among blue-collar and service workers in blue-collar industry had a decreased risk of PD. CONCLUSIONS:Professionals in the service and white-collar industries, particularly those in healthcare occupations, had a higher risk of PD. Approximately 20% became unemployed after diagnosis.

Abstract Introduction This study investigates the association of occupational class with Parkinson’s disease (PD). Methods This was a nationwide, multicenter, hospital-based matched case-control study included patients with PD (ICD–10, G20) and controls without mental/ behavioral disorders or nervous system diseases (ICD–10, F, G), aged ≥ 20 years who were initially hospitalized between 2005 and 2020. 10 controls matched by age, sex, admission year and hospital were selected for each case. Participants were grouped into the 12 longest-held occupational class by the Japanese Standard Occupational Classification and Japanese Standard Industrial Classification. We conducted conditional logistic regressions to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for risks of PD adjusted for alcohol consumption and smoking status. Results There were 2,077 cases and 20,368 controls. Service workers in service industry were set as reference. Professionals in service industry and white-collar industry showed higher risk of PD (ORs=2.35 (1.48–3.73) and 1.35 (1.15–1.59)). Stratified with smoking status, professionals in service industry remained an increased risk of PD in current smokers. Current and former smokers had lower risks of PD (0.36 (0.30–0.43) and 0.73 (0.66–0.80)). Furthermore, researchers (2.97 (1.06–8.28)), doctors/ dentists/veterinarians/ pharmacists (1.84 (1.17–2.87)), religious workers (2.31 (1.09–4.91)), musicians and stage designers (4.55 (1.39–14.8)) showed higher risk of PD. Discussion Although smoking had an inhibitory effect on PD, there were risk in specific professionals. It is significant to clarify the occupational factors that increase risk of PD. Conclusion Occupational class was possibly associated with PD risk.

PURPOSE:This network meta-analysis (NMA) of randomized controlled trials (RCTs) aimed to identify effective initial conservative treatment strategies for patients with temporomandibular joint disorders (TMD). STUDY SELECTION:RCTs comparing treatment options for TMD published between January 2000 and July 2021 were retrieved from the databases of PubMed and Embase via a comprehensive electronic search. Patients diagnosed with myalgia (muscle pain) or arthralgia (joint pain) according to pain-related Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were eligible for inclusion. Twelve treatment options and a placebo were included in the mutual comparisons. The risk of bias was assessed using Risk of Bias 2.0. Forest plots of direct comparisons between individual studies were created using MetaInsight. NMA was performed using R statistical software (netmeta). RESULTS:Twenty-four RCTs involving 1336 patients assessing pain and 12 RCTs involving 614 patients assessing maximal mouth opening were identified. Low-level laser therapy (standard mean difference [SMD]: -2.12, 95% confidence interval [CI]: -3.18, -1.06), self-exercise (SMD: -1.51, 95% CI: -2.82, -0.2), and stabilization splints (SMD: -1.16, 95% CI: -2.02, -0.29) were effective in improving pain; however, the certainty of evidence was very low. Self-exercise (SMD: 0.71, 95% CI: -0.58, 2.01), stabilization splints (SMD: 0.65, 95% CI: -0.09, 1.39), and low-level laser therapy (SMD: 0.63, 95% CI: -0.34, 1.6) were effective in improving maximal mouth opening; however, the certainty of evidence was very low. CONCLUSIONS:Stabilization splints, self-exercise, and low-level laser therapy may be effective in the initial treatment of TMD.

After developing job-exposure matrices (JEMs) for screen and sedentary time, we aimed to assess the associations between the JEM-derived exposures and various ocular diseases. We collected data from patients hospitalized from 2005 to 2021. JEMs were developed from 41,718 patients with occupational information and screen and sedentary times. The adjusted means of screen and sedentary time were calculated for 143 occupational groups and categorized into three classes based on the tertiles. The associations between ocular diseases and these JEM-derived exposures were examined using multivariable conditional logistic regression for 727,589 patients. The odds ratios of the class with highest screen time were 1.05 (95% confidence interval, 1.01-1.09) for cataract, 1.24 (1.06-1.45) for primary open-angle glaucoma (POAG), 1.26 (1.06-1.49) for rhegmatogenous retinal detachment (RRD), 1.49 (1.26-1.76) for ptosis, and 0.39 (0.27-0.57) for pterygium. The odds ratios of the class with highest sedentary time were 1.05 (1.01-1.09) for cataract, 1.24 (1.05-1.46) for RRD, 1.68 (1.42-1.99) for ptosis, and 0.60 (0.42-0.84) for pterygium. Both screen and sedentary time were positively associated with cataract, RRD and ptosis. Interestingly, POAG had a positive association with only screen time. Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary."I have confirmed that the content is correct. No amendments are necessary.Please check article title if captured correctly."?>"I have confirmed that the content is correct. No amendments are necessary.

IntroductionColonoscopy screening has been suggested as a potential primary screening method for colorectal cancer (CRC). A 10-year screening interval has been recommended by some academic societies, but the scientific evidence for this needs to be more comprehensive. We performed a systematic review of interval cancer rates in colonoscopy screening in an asymptomatic population.MethodsWe searched the PubMed and Ichushi-Web bibliographic databases for papers published from inception to September 2022. The search terms were “colorectal cancer screening”, “interval cancer”, and “total colonoscopy”. Randomized controlled trials and observational studies were included. The target population was an asymptomatic average-risk population with no polyps or adenomas at the index colonoscopy. Advanced neoplasia (AN) was defined as CRC or an adenoma at least 10 mm in size with a villous component or high-grade dysplasia. The incidence rates of interval CRC and AN per 100,000 person-years (PYs) were estimated.ResultsOf the 694 potentially eligible articles, 15 were included. Rates of interval CRC and AN were reported in 15 and 11 studies, respectively. For the meta-analysis, 287,602 patients with negative colonoscopy results were included, with an average follow-up of 7.98 years. Negative colonoscopy results were defined as no adenoma present. The incidence rate per 100,000 PYs was 9.57 (95% confidence interval [CI]: 2.06, 29.94) for interval CRC and 311.5 (95%CI: 153.4, 550.7) for AN. Similar results were obtained even when a negative colonoscopy result was defined as no polyps present.Conclusions The selected studies were heterogeneous with respect to the target population, follow-up years, and patient characteristics. Although interval AN was reported in all studies, the interval cancer rate was low after a negative result at the index colonoscopy. While the screening interval might be defined as long term, a definitive screening interval could not be recommended because of insufficient evidence.

Objectives In Japan, the risk of developing cancer among workers employed in workplaces where chemical substances are handled is unclear. This study aimed to assess the association between cancer risk and employment in workplaces handling hazardous chemicals. Methods The Inpatient Clinico-Occupational Survey of the Rosai Hospital Group data of 120 278 male patients with incident cancer and 217 605 hospital controls matched for 5-year age group, hospital (34 hospitals) and year of admission (2005–2019) were analysed. Cancer risk in relation to lifetime employment in workplaces using regulated chemicals was assessed while controlling for age, region and year of diagnosis, smoking, alcohol consumption and occupation. Further analysis stratified by smoking history was performed to examine interaction effects. Results In the longest group of employment in tertiles, ORs were increased for all cancers (OR=1.13; 95% CI: 1.07 to 1.19) and lung (OR=1.82; 95% CI: 1.56 to 2.13), oesophageal (OR=1.73; 95% CI: 1.18 to 2.55), pancreatic (OR=2.03; 95% CI: 1.40 to 2.94) and bladder (OR=1.40; 95% CI: 1.12 to 1.74) cancers. Employment of 1+ years was associated with risk for lung cancer; 11+ years for pancreatic and bladder cancers; and 21+ years for all cancers and oesophageal cancer. These positive relationships were particularly obvious among patients with a history of smoking; however, no significant interaction between smoking and length of employment was observed. Conclusions There is a high risk of cancer among workers, especially smokers, employed in workplaces handling regulated chemicals in Japan. Thus, future measures for chemical management in workplaces are needed to prevent avoidable cancers.

OBJECTIVE Although some clinical expert guidelines recommend regular monitoring of serum albumin levels in patients undergoing maintenance hemodialysis, little is known of the serum albumin trajectory patterns over time, and it is unclear how the trajectory change before death. METHODS We performed this retrospective study using data from 421 patients receiving hemodialysis in a dialysis facility. We divided patients into died and survived groups according to whether they died during the observation period. To compare the albumin trajectories during the observation period between the died and survived groups, linear mixed-effect models and a backward timescale from the year of death or study end were used. RESULTS During the observation period (median, 5.1 years; maximum, 8.4 years), 115 patients receiving dialysis died. The serum albumin level showed steeper decline 3 years before death in the died group than in the survived group. The difference in albumin between the died and survived groups became apparent 3 years before death (difference, 0.08 g/dL; 95% confidence interval [CI], 0.00-0.15 g/dL; P=0.04), and the difference widened over time (difference at 1 year before death, 0.24 g/dL; 95% CI, 0.14-0.33 g/dL; P<0.001). Furthermore, in an analysis of albumin trajectories according to cause of death, the albumin level showed a downward trend regardless of the cause of death. CONCLUSION The serum albumin trajectory differed between patients undergoing hemodialysis who died and who survived, supporting the importance of monitoring the albumin trajectory in clinical practice.

PRÉCIS:In this case-control study of the Japanese population, including 3207 glaucoma cases, alcohol consumption patterns such as frequency and quantity showed a positive association with glaucoma prevalence. PURPOSE:To examine the association between alcohol consumption patterns and glaucoma. SUBJECTS AND METHODS:This case-control study evaluated 3207 cases with glaucoma and 3207 matched controls. Patients over 40 years of age were included from 1,693,611 patients admitted to 34 hospitals in Japan. Detailed alcohol consumption patterns (drinking frequency, average daily drinks, and total lifetime drinks) were obtained, as well as various confounding factors, including smoking history and lifestyle-related comorbidities. Conditional logistic regression models were used to calculate odds ratios (ORs) and 95% CIs for glaucoma prevalence. RESULTS:Drinking frequency showed an association with glaucoma for "a few days/week" (OR, 1.19; 95% CI, 1.03-1.38) and "almost every day/week" (OR, 1.40; 95% CI, 1.18-1.66). Average daily drinks showed an association for ">0-2 drinks/day" (OR, 1.16; 95% CI, 1.03-1.32). Total lifetime drinks showed an association for ">60-90 drink-year" (OR, 1.23; 95% CI, 1.01-1.49) and ">90 drink-year" (OR, 1.23; 95% CI, 1.05-1.44). As alcohol consumption levels differed considerably between men and women, additional analyses were conducted separately for men and women. Among men, drinking frequency of "a few days/week" and "almost every day/week," average daily drinks of ">0-2 drinks/day" and ">2-4 drinks/day," and total lifetime drinks of ">60-90 drink-year" and ">90 drink-year" had an association with glaucoma. Conversely, among women, neither drinking frequency, average daily drinks, nor total lifetime drinks were associated. CONCLUSIONS:Both the frequency and quantity of alcohol consumption were associated with glaucoma. Further research on gender differences is warranted.

BackgroundLifestyle interventions in patients with type-2 diabetes contribute to reducing the incidence of chronic kidney disease. The cost-effectiveness of lifestyle interventions to prevent kidney disease in patients with type-2 diabetes remains undetermined. We aimed to develop a Markov model from a Japanese healthcare payer's perspective focusing on the development of kidney disease in patients with type-2 diabetes and examine the cost-effectiveness of lifestyle interventions.MethodsTo develop the model, the parameters, including lifestyle intervention effect, were derived from results of the Look AHEAD trial and previously published literature. Incremental cost-effectiveness ratios (ICER) were calculated from the difference in cost and quality-adjusted life years (QALY) between lifestyle intervention and diabetes support education groups. We estimated lifetime costs and effectiveness assuming patient's life span to be 100 years. Costs and effectiveness were discounted by 2% annually.ResultsICER for lifestyle intervention compared to diabetes support education was JPY 1,510,838 (USD 13,031) per QALY. Cost-effectiveness acceptability curve showed that the probability that lifestyle intervention is cost-effective at the threshold of JPY 5,000,000 (USD 43,084) per QALY gained, compared to diabetes support education, is 93.6%.ConclusionsUsing a newly-developed Markov model, we illustrated that lifestyle interventions for preventing kidney disease in patients with diabetes would be more cost-effective from a Japanese healthcare payer's perspective compared to diabetes support education. The model parameters in the Markov model must be updated to adapt to the Japanese setting.

Aim: Investigating the risks of diabetes complications among inpatients with diabetes associated with longest-held and current occupations. Method: Using a Japanese nationwide, multicenter, hospital inpatient dataset (2005-2015), a matched case-control study with 39,550 inpatients with diabetes was conducted. We considered both the longest-held and current occupations of the study subjects. Result: Diabetes complications such as retinopathy, nephropathy, neuropathy, and peripheral vascular complications occur more often in managers, sales workers, service workers, transportation workers, construction and mining workers and carrying, cleaning and packing workers. Among these occupations, particularly the service workers indicated consistently significant increased risks (OR = 1.36 (1.23-1.51)) in developing all the considered subtypes of diabetes complications, and the performed sensitivity analysis confirmed this conclusion. Moreover, among service workers, cooks, waiters, building service staff and other service workers were identified as having the highest risks in developing diabetes complications (ORs = 1.30 (1.12-1.51), 1.63 (1.36-1.95), 1.79 (1.21-2.67), and 2.05 (1.30-3.22), respectively). Conclusions: Our study's potential translational impact should lead to subsequent investigations on the causes connected to certain occupations of various diabetes complications and particularly to more carefully dealing with patients with diabetes who work in the identified occupational areas and their health risks.

Objective: Protein-energy wasting is prevalent among patients undergoing dialysis. Hence, identifying an optimal index is necessary for the comprehensive measurement of nutritional status. This study evaluated and compared the prognostic significance of the modi-fied creatinine index (mCI) and geriatric nutritional risk index (GNRI), with the principal aim to identify markers that are more closely asso-ciated with clinical events in patients undergoing hemodialysis. Methods: We performed a retrospective cohort study of 472 patients undergoing maintenance hemodialysis (mean age, 66.4 years; 62.9% males). We evaluated the mCI, GNRI, and their respective rates of change over a 1-year period. The outcome analysis included all-cause death, number and duration of all-cause hospitalizations, and number and duration of hospitalizations due to cardiovascular disease. In addition, we analyzed the associations of the mCI, GNRI, and their trajectories with clinical outcomes using Cox proportional hazard regression and negative binomial regression. Results: Over a median 3.6-year follow-up, both the lower mCI (hazard ratio 3.00; 95% confidence interval 2.19, 4.09) and lower GNRI (hazard ratio 1.76; 95% confidence interval 1.45, 2.13) per 1 standard deviation decrease were associated with a higher risk of all-cause death. However, a lower mCI was consistently associated with a higher risk of hospitalization, whereas the GNRI was poorly associated with the risk of hospitalization after adjusting for covariates. Furthermore, although a decline in the mCI over time was associated with a higher risk of each adverse event, a significant association between the change in GNRI and clinical events was not detected. Conclusion: The mCI at one timepoint and its trajectory had consistently stronger associations with clinical events than the GNRI in patients undergoing hemodialysis. This study further emphasizes the importance of risk screening using a marker of nutritional status in patients undergoing hemodialysis. (c) 2021 by the National Kidney Foundation, Inc. All rights reserved.

To examine the risk of incident cataract surgery associated with alcohol use patterns among Japanese adults. This was a case–control study evaluating 14,861 patients with incident cataract surgery and 14,861 matched controls. Subjects admitted to any of the 34 hospitals in Japan and aged between 40 and 69 years were included. Drinking patterns (drinking frequency, daily average drinks, and total amount of lifetime drinking), smoking history, lifestyle-related comorbidities, and occupational factors were surveyed by trained interviewers. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression models. For drinking frequency, ORs in the 1–3 days/week and 4–7 days/week groups were 1.10 (95% CI 1.03–1.17) and 1.30 (1.21–1.40), respectively. For average drinks, ORs in > 0–2 drinks/day, > 2–4 drinks/day, and > 4 drinks/day were 1.13 (1.06–1.20), 1.23 (1.12–1.35), and 1.16 (1.03–1.31), respectively. Both men and women had an increased risk of incident cataract surgery with increased total lifetime drinking, with a significant increase in risk occurring at > 90 drink-years for men and > 40 drink-years for women. A positive dose–response relationship was observed between alcohol consumption and cataract. Restricted drinking may help to reduce the progression of cataracts.