Background : With the recent progression of the aging society in Japan, what is now seen as important is not simply treatment of disease alone, but also increased quality of life. We have investigated the correlation between the feeling of subjective health and mortality after mean 3.8 year among local residents.
Methods : In fiscal 2008, a self-recording questionnaire survey was conducted by mailing the questionnaire to 2,657 local residents. Correlation with deaths after mean 3.8 years was investigated based on the Resident Register. With regard to the evaluation items, as background factors related to death, social life conditions (gender·age), health conditions (history of cardiovascular disease, state of depression, subjective happiness, subjective health)and basic activities of daily living (BADL : walking, diet, excretion, bathing, dressing, and ambulation)were evaluated using a 4-point scale ranging from total assistance to completely independent. The Tokyo Metropolitan Institute of Gerontology (TMIG : instrumental independence, intellectual activity, and social role)was used to evaluate the lifestyle factors.
Results : Of 1825 subjects, 767 males (mean age : 67±13 years)and 1058 females (mean age : 68±11 years), could be analyzed. There were 91 deaths from 2008 to 2012. Investigation of factors that increased subjective health revealed that age, cardiovascular disease, state of depression, intellectual activities, and subjective happiness were items that showed significant correlation. Multivariate logistic regression analysis revealed that subjective health was a significant explanatory variable of death.
Conclusion : How one personally feels about one's state of health and how one recognizes that, are important. Though not seen physically, they can be considered as important parameters that predict prognosis.

Inflammatory bowel disease (IBD), with its 2 subtypes, Crohn’s disease and ulcerative colitis, is a complex chronic condition. A precise definition of disease activity and appropriate drug management greatly improve the clinical course while minimizing the risk or cost. Artificial intelligence (AI) has been used in several medical diseases or situations. Herein, we provide an overview of AI for endoscopy in IBD. We discuss how AI can improve clinical practice and how some components have already begun to shape our knowledge. There may be a time when we can use AI in clinical practice. As AI systems contribute to the exact diagnosis and treatment of human disease, we should continue to learn best practices in health care in the field of IBD.

Background/Aims: Endoscopic activity confirmed by enteroscopy is associated with poor clinical outcome in Crohn’s disease (CD). We investigated which of the existing biomarkers best reflects endoscopic activity in CD patients including the small bowel, and whether their combined use can improve accuracy. Methods: One hundred and four consecutive patients with ileal and ileocolonic type CD who underwent balloon-assisted enteroscopy (BAE) from October 2021 to August 2022 were enrolled, with clinical and laboratory data prospectively collected and analyzed. Results: Hemoglobin, platelet count, C-reactive protein, leucine-rich alpha-2 glycoprotein (LRG), fecal calprotectin, and fecal hemoglobin all showed significant difference in those with ulcers found on BAE. LRG and fecal calprotectin showed the highest areas under the curve (0.841 and 0.853) for detecting ulcers. LRG showed a sensitivity of 78% and specificity of 80% at a cutoff value of 13 μg/mL, whereas fecal calprotectin showed a sensitivity of 91% and specificity of 67% at a cutoff value of 151 μg/g. Dual positivity for LRG and fecal calprotectin, as well as LRG and fecal hemoglobin, both predicted ulcers with an improved specificity of 92% and 100%. A positive LRG or fecal calprotectin/hemoglobin showed an improved sensitivity of 96% and 91%. Positivity for LRG and either of the fecal biomarkers was associated with increased risk of hospitalization, surgery, and relapse. Conclusions The biomarkers LRG, fecal calprotectin, and fecal hemoglobin can serve as noninvasive and accurate tools for assessing activity in CD patients confirmed by BAE, especially when used in combination.

Background/Aims: The efficacy and safety of tofacitinib for the treatment of refractory ulcerative colitis (UC) has been demonstrated in clinical trials. Although, a series of reports with real-world evidence of its short-term efficacy and safety profiles have already been published, reports of long-term real-world data have been limited. We aimed to show our 3-year evidence on the clinical use of tofacitinib for the treatment of UC, focusing on its efficacy and safety profiles. Methods: A retrospective observational study was conducted on patients who started tofacitinib for active refractory UC at our hospital. The primary outcome was the retention rate until 156 weeks after initiating tofacitinib. The secondary outcomes were short-term efficacy at 4, 8, and 12 weeks; long-term efficacy at 52, 104, and 156 weeks; prognostic factors related to the cumulative retention rate; loss of response; and safety profile, including adverse events. Results: Forty-six patients who were able to be monitored for up to 156 weeks after tofacitinib initiation, were enrolled in this study. Continuation of tofacitinib was possible until 156 weeks in 54.3%, with > 50% response rates and > 40% remission rates. Among patients in whom response or remission was achieved and tofacitinib was deescalated after 8 weeks of induction treatment, 54.3% experienced relapse but were successfully rescued by and retained on reinduction treatment, except for 1 patient. No serious AEs were observed in the study. Conclusions Tofacitinib is effective and safe as long-term treatment in a refractory cohort of UC patients in real-world clinical practice.

The dawn of Japan’s super-aged society is accompanied by various problems, including increased social security expenditures and greater nursing care burden as well as reduced labor force. Targeting 2025, when Japan’s baby-boomer generation will be aged ≥75 years, the government’s Ministry of Health, Labour and Welfare is promoting the establishment of local comprehensive support and service provision systems (Comprehensive Community Care Systems). Although such comprehensive community care systems will require medical professionals to provide treatment through collaborative interprofessional cooperation with colleagues in other fields, effective cooperation has currently not been established because of a lack of understanding regarding the roles and functions of other occupations. Considering that the promotion of interprofessional-based collaborative learning prior to university graduation will be important for resolving this problem, we organized a workshop for medical students based in Ehime Prefecture and evaluated its usefulness based on questionnaire surveys administered before and after the workshop. Consequently, it was ascertained that pharmacy, medical, and nursing students had a heightened awareness of “the importance of interprofessional collaboration” after the workshop as against before the workshop. Students’ degree of comprehension of the nature of the work in each category increased significantly. These results demonstrate the importance and effectiveness of students familiarizing themselves with the learning and work content of other fields by working with colleagues in different medical fields as observed in this workshop. They also expect that student-led study groups will contribute to promote the comprehensive community care systems.

BACKGROUND: Epidemiological evidence for the relationship between education and income and carotid intima-media thickness (CIMT) has been limited and inconsistent. The present cross-sectional study investigated this issue using baseline data from the Aidai Cohort Study. METHODS: Study subjects were 2012 Japanese men and women aged 34-88 years. Right and left CIMT were measured at the common carotid artery using an automated carotid ultrasonography device. Maximum CIMT was defined as the largest CIMT value in either the left or right common carotid artery. Carotid wall thickening was defined as a maximum CIMT value > 1.0 mm. RESULTS: The prevalence of carotid wall thickening was 13.0%. In participants under 60 years of age (n = 703) and in those aged 60 to 69 years (n = 837), neither education nor household income was associated with carotid wall thickening or with maximum CIMT. Among those aged 70 years or older (n = 472), however, higher educational level, but not household income, was independently related to a lower prevalence of carotid wall thickening: the multivariate-adjusted odds ratio for high vs. low educational level was 0.43 (95% confidence interval 0.21-0.83, p for trend = 0.01). A significant inverse association was observed between education, but not household income, and maximum CIMT (p for trend = 0.006). CONCLUSIONS Higher educational level may be associated with a lower prevalence of carotid wall thickening and a decrease in maximum CIMT only in participants aged 70 years or older.
Adult ; Aged ; Aged, 80 and over ; Carotid Intima-Media Thickness ; Cohort Studies ; Cross-Sectional Studies ; Educational Status ; Female ; Humans ; Income ; Japan/epidemiology* ; Male ; Middle Aged ; Odds Ratio ; Prevalence