Kagoshima Prefecture is located in a warm climate zone in Japan. Cases of sudden death in the bath in Kagoshima Prefecture for the last two years (2006-2007) were investigated. The total number was 338 (174 males and 164 females). Average annual mortality rate (per 100,000 population) was estimated to be 9.7, suggesting that mortality rate of sudden death in the bath in Kagoshima Prefecture should be not less than the rate in other areas of Japan. As previously reported, the death occurred frequently in the aged group and in the winter season. Further, most of the death occurred in the home bath at 4-8 p.m. withlout drinking alcohol. Therefore, it is suggested that the death may often occur in a daily life of the aged. Protective activities by government and society should be developed for reducing the number of sudden death in the bath.

  In Japan, sudden death in the bathroom (‘bath-related death’) occurs particularly in the elderly population in winter. Previously, we showed that bath-related death in Kagoshima Prefecture occurs at similar frequency as that in other prefectures, despite its warm environment. In this study, we performed a retrospective review of the inquest records in Kagoshima from between 2006 and 2013 in order to compare the demographic and circumstantial factors of the following 3 groups classified by the location where the death occurred: home bathroom, spa, and nursing home bathroom. The total number of the deaths was 1533 (759 males and 774 females), which corresponds to a crude mortality rate of 11.3 per 100,000 person-years. Most of the deaths occurred at home (1319; 86.0%), followed by spa (159; 10.4%), nursing home (18; 1.2%), and others (37; 2.4%). In all 3 groups, most of the deceased were over 65 years old and were found sinking in the bathtub. The greatest number of deaths occurred in the winter at home (52.6%) and at a spa (54.7%) compared to other seasons. In contrast, death occurred most frequently in the spring at nursing homes (44.4%), when unexperienced staff begin to work in Japan. There was no significant difference in gender between home and nursing home cases, whereas significant more men died at a spa (p=0.0014). Although most deaths occurred at home between 16:00 and 20:00, a time when the elderly usually take a bath in Japan (49.4%), those at a spa and nursing home occurred earlier (12:00-16:00). The most common past history of illness was hypertension in home and spa cases, and that in nursing home cases was cardiovascular disease. Cardiac events leading to tragic results may occur more frequently in people with these illnesses than in healthy individuals while bathing. A history of drinking alcohol before bathing was observed in minor populations in home and spa cases, although it is also a known risk factor for death. However, the positive rate of spa cases was higher than that of home cases (8.2% vs. 3.3%). In all 3 groups, the most common cause of death indicated on the death certificate was heart disease such as myocardial infarction and arrhythmia (about 50%), followed by drowning. Except for 10 cases in which autopsy was performed, the cause of death in most cases was determined by only external examinations. Instead of autopsy, postmortem computed tomography (PMCT) scanning was performed in 44.9% of cases from 2010 to 2013. Cases that were diagnosed as drowning based on the findings by PMCT imaging have increased in recent years. However, PMCT is inferior to autopsy in detecting intrinsic disease and in elucidating a pathophysiological mechanism leading to drowning. In order to reduce the number of bath-related deaths, it is necessary to accumulate further evidence by increasing the number of cases undergoing autopsy, and to prompt the government and society to develop protective activities not only for known risk factors for death, but also for those peculiar to the bathing location.

Background/Aims: Crohn’s disease is a chronic disorder; therefore, it is essential to investigate long-term safety and efficacy of treatments. This study assessed the safety and effectiveness of adalimumab for up to 3 years in Japanese patients with Crohn’s disease in real-world settings. Methods: This was a multicenter, single-cohort, observational study of patients with Crohn’s disease. Safety assessments included incidence of adverse drug reactions. Effectiveness assessments included clinical remission, mucosal healing, and Work Productivity and Activity Impairment (WPAI). Results: The safety and effectiveness analysis populations comprised 389 and 310 patients, respectively. Mean (standard deviation) exposure to adalimumab in the safety analysis population was 793.4 (402.8) days, with a 58.1% retention rate. A total of 105 patients (27.0%) and 43 patients (11.1%) experienced adverse drug reactions and serious adverse drug reactions, respectively, with no patient reporting tuberculosis or hepatitis B. Infections and serious infections were reported in 37 patients (9.5%) and 17 patients (4.4%), respectively. Malignancy was reported as an adverse drug reaction in 2 patients (0.5%). Remission rate increased from 37.8% (98/259) at baseline to 73.9% (167/226) at week 4 and remained > 70% over 3 years. Proportion of patients without mucosal ulcerations increased from 2.7% (2/73) at baseline to 42.3% (11/26) between years > 2 to ≤ 3. WPAI improvement started at 4 weeks, with the overall work impairment score improving from 42.7 (n = 102) at baseline to 26.9 (n = 84) at 4 weeks. Conclusions Results from this study confirm the long-term safety and effectiveness of adalimumab treatment in Japanese patients with Crohn’s disease in the real-world setting.

Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammatory disease of the gastrointestinal tract, with increasing prevalence worldwide. IBD Ahead is an international educational program that aims to explore questions commonly raised by clinicians about various areas of IBD care and to consolidate available published evidence and expert opinion into a consensus for the optimization of IBD management. Given differences in the epidemiology, clinical and genetic characteristics, management, and prognosis of IBD between patients in Japan and the rest of the world, this statement was formulated as the result of literature reviews and discussions among Japanese experts as part of the IBD Ahead program to consolidate statements of factors for disease prognosis in IBD. Evidence levels were assigned to summary statements in the following categories: disease progression in CD and UC; surgery, hospitalization, intestinal failure, and permanent stoma in CD; acute severe UC; colectomy in UC; and colorectal carcinoma and dysplasia in IBD. The goal is that this statement can aid in the optimization of the treatment strategy for Japanese patients with IBD and help identify high-risk patients that require early intervention, to provide a better long-term prognosis in these patients.
Asian Continental Ancestry Group ; Colectomy ; Colitis, Ulcerative ; Colorectal Neoplasms ; Consensus ; Crohn Disease ; Disease Management* ; Disease Progression ; Early Intervention (Education) ; Epidemiology ; Expert Testimony ; Gastrointestinal Tract ; Hospitalization ; Humans ; Inflammatory Bowel Diseases* ; Japan* ; Prevalence ; Prognosis