BACKGROUND: The neurotoxicity of general anesthesia to the developing human brains is controversial. We assessed the associations between surgery under general anesthesia in infancy and development at age 1 year using the Japan Environment and Children's Study (JECS), a large-scale birth cohort study. METHODS: In the JECS, 103,062 pregnancies and 104,065 fetuses were enrolled between January 2011 and March 2014. Of the 100,144 registered live births, we excluded preterm or post-term infants, multiple births, and infants with chromosomal anomalies and/or anomalies of the head or brain. Data on surgical procedures under general anesthesia in infancy were collected from self-administered questionnaires by parents at the 1-year follow-up. Developmental delay at age 1 year was assessed using the Japanese translation of the Ages and Stages Questionnaires, Third Edition (J-ASQ-3), comprising five developmental domains. RESULTS: Among the 64,141 infants included, 746 infants had surgery under general anesthesia once, 90 twice, and 71 three or more times. The percentage of developmental delay in the five domains of the J-ASQ-3 significantly increased with the number of surgical procedures. After adjusting for potential confounding factors, the risk of developmental delays in all five domains was significantly increased in infants who had surgery under general anesthesia three times or more (adjusted odds ratios: for communication domain 3.32; gross motor domain 4.69; fine motor domain 2.99; problem solving domain 2.47; personal-social domain 2.55). CONCLUSIONS: Surgery under general anesthesia in infancy was associated with an increased likelihood of developmental delay in all five domains of the J-ASQ-3, especially the gross motor domain at age 1 year. The neurodevelopment with the growth should be further evaluated among the children who had surgery under general anesthesia. TRIAL REGISTRATION UMIN Clinical Trials Registry (number: UMIN000030786 ).
Anesthesia, General ; adverse effects ; Anesthetics, General ; adverse effects ; Child Development ; drug effects ; Cohort Studies ; Female ; Humans ; Infant ; Infant, Newborn ; Japan ; Male

BACKGROUND: Children in Ulaanbaatar are exposed to air pollution, but few epidemiological studies have been conducted on the effects of environmental risk factors on children's health. Also, no studies have yet examined the prevalence of respiratory symptoms in children in suburban areas, where air quality-monitoring stations have not yet been installed. This cross-sectional study evaluated the associations between outdoor air pollution and respiratory symptoms among schoolchildren in urban and suburban districts of Ulaanbaatar. METHODS: The ATS-DLD-78 C questionnaire was used to investigate the respiratory symptoms of schoolchildren aged 6-12 years (n = 1190) who lived in one of three urban districts or a suburban district of Ulaanbaatar. In each district, the outdoor concentrations of nitrogen dioxide (NO) and sulfur dioxide (SO) were measured at two sites (at ≤100 m and > 100 m from the nearest major road) in the 2-year period from 2015 to 2016. The associations between health outcomes and exposure to air pollutants were estimated using the multinomial logistic regression method. RESULTS: The outdoor concentration of SO was significantly associated with persistent cough symptom (OR = 1.12, 95% CI 1.04-1.22). Furthermore, the outdoor concentration of NO was significantly associated with the current wheezing symptom (OR = 1.33, 95% CI 1.01-1.75) among children in urban and suburban. CONCLUSIONS The prevalence of persistent cough symptom was markedly high among the schoolchildren in urban/suburban districts of Ulaanbaatar. Overall, the increases in the prevalence of respiratory symptoms among children might be associated with ambient air pollution in Ulaanbaatar.

BACKGROUND: Over the past few decades, the Japanese Ministry of the Environment has been biomonitoring dioxins in the general Japanese population and, in response to public concerns, has taken measures to reduce dioxin exposure. The objectives of this study were to assess the current dioxin dietary intake and corresponding body burden in the Japanese and compare Japanese dioxin data from 2011 to 2016 and 2002-2010 surveys. We also examined the relationship between blood dioxins and health parameters/clinical biomarkers. METHODS: From 2011 to 2016, cross-sectional dioxin surveys were conducted on 490 Japanese (242 males and 248 females, aged 49.9 ± 7.6 years) from 15 Japanese prefectures. Blood (n = 490) and food samples (n = 90) were measured for 29 dioxin congeners including polychlorinated dibenzo-para-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and coplanar polychlorinated biphenyls (Co-PCBs) using gas chromatography coupled with high-resolution mass spectrometry. Using the 2006 World Health Organization toxic equivalence factors, the toxic equivalents (TEQs) were calculated. Clinical biomarkers and anthropometric parameters were also measured and information on lifestyle behaviours collected. Data imputations were applied to account for blood dioxins below the detection limit. RESULTS: The median (95% confidence interval or CI) blood levels and dioxin dietary intake was respectively 9.4 (8.8-9.9) pg TEQ/g lipid and 0.3 (0.2-0.4) pg TEQ/kg body weight/day. The median blood dioxin level in the 2011-2016 survey was found to have decreased by 41.3% compared to the 2002-2010 surveys. Participants who were older were found to be more likely to have higher dioxin levels. Blood dioxins were also significantly associated with body mass index, triglycerides, docosahexaenoic acid, eicosapentaenoic acid, and dihomo-gamma-linoleic acid levels in blood. Furthermore, associations between blood dioxin and dietary dioxin intake were evident in the unadjusted models. However, after adjusting for confounders, blood dioxins were not found to be associated with dietary dioxin intake. CONCLUSIONS Blood dioxin levels declined over the past decade. This study showed that the measures and actions undertaken in Japan have possibly contributed to these reductions in the body burden of dioxins in the Japanese population.
Adult ; Aged ; Analysis of Variance ; Biomarkers ; blood ; Body Mass Index ; Cross-Sectional Studies ; Diet ; Dioxins ; analysis ; Environmental Exposure ; analysis ; Environmental Monitoring ; methods ; Female ; Food ; Food Analysis ; Food Contamination ; analysis ; Gas Chromatography-Mass Spectrometry ; Humans ; Japan ; Male ; Middle Aged ; Surveys and Questionnaires ; Young Adult

BACKGROUND: As society is aging, the number of elderly patients with psychiatric disorder, such as dementia, is increasing. The hospitalization period of elderly patients in psychiatric wards tends to be prolonged. In this study, we have determined the factors that inhibit early discharge from the psychiatric emergency ward for elderly patients in Japan. METHODS: The information was collected from patients admitted to our hospital's emergency ward for elderly patients with psychiatric disorders between May 2015 and April 2016. We compared various factors between the early discharge group and the non-early discharge group. In addition, we used a multiple logistic regression model to clarify the risk factors for non-early discharge. RESULTS: Of the 208 elderly patients, body mass index (BMI) and serum albumin level were significantly lower in the non-early discharge group. In addition, we also showed that higher serum C-reactive protein (CRP) (> 0.5 mg/dL) and use of seclusion or physical restraint significantly inhibited the early discharge of patients. The results of multiple logistic analysis showed that the BMI ≤ 17.5 kg/m (OR, 2.41 [95% confidence interval (CI) 1.06-5.46]), serum albumin level ≤ 30 g/L (OR, 3.78 [95% CI 1.28-11.16]), and use of seclusion or physical restraint (OR 3.78 [95% CI 1.53-9.37]) are particularly important explanatory factors. CONCLUSIONS Hypoalbuminemia, low BMI, and the use of seclusion or physical restraint were identified as the factors that inhibit early discharge from the psychiatric emergency ward for elderly patients. These factors reflect malnutrition and extremely serious psychiatric symptoms.
Aged ; Aged, 80 and over ; Dementia ; diagnosis ; psychology ; therapy ; Emergency Service, Hospital ; statistics & numerical data ; Female ; Hospitalization ; statistics & numerical data ; Hospitals, Psychiatric ; statistics & numerical data ; Humans ; Japan ; Length of Stay ; statistics & numerical data ; Male ; Patient Discharge ; statistics & numerical data ; Risk Factors

BACKGROUND: The health effects of biological aerosols on the respiratory system are unclear. The purpose of this study was to clarify the association of airborne particle, protein, and endotoxin with emergency department visits for asthma in Kyoto City, Japan. METHODS: We collected data on emergency department visits at a hospital in Kyoto from September 2014 to May 2016. Fine (aerodynamic diameter ≤ 2.5 μm) and coarse (≥ 2.5 μm) particles were collected in Kyoto, and protein and endotoxin levels were analyzed. The association of the levels of particles, protein, endotoxin, and meteorological factors (temperature, relative humidity, wind speed, and air pressure) with emergency department visits for asthma was estimated. RESULTS: There were 1 to 15 emergency department visits for asthma per week, and the numbers of visits increased in the autumn and spring, namely many weeks in September, October, and April. Weekly concentration of protein in fine particles was markedly higher than that in coarse particles, and protein concentration in fine particles was high in spring months. Weekly endotoxin concentrations in fine and coarse particles were high in autumn months, including September 2014 and 2015. Even after adjusting for meteorological factors, the concentrations of coarse particles and endotoxin in both particles were significant factors on emergency department visits for asthma. CONCLUSIONS Our results suggest that atmospheric coarse particles and endotoxin are significantly associated with an increased risk of asthma exacerbation.
Adolescent ; Adult ; Aged ; Air Pollutants ; analysis ; Asthma ; epidemiology ; Child ; Emergency Service, Hospital ; statistics & numerical data ; Endotoxins ; analysis ; Female ; Humans ; Japan ; epidemiology ; Male ; Middle Aged ; Particle Size ; Particulate Matter ; analysis ; Proteins ; analysis ; Seasons ; Weather ; Young Adult

BACKGROUND/AIMS: Few studies are available that have investigated the risk factors for overlapping irritable bowel syndrome (IBS)-like symptoms in patients with inactive inflammatory bowel disease (IBD). The present study has 3 objectives: (1) to assess the prevalence of IBS-like symptoms in Japanese patients with inactive IBD using Rome III criteria, (2) to examine the relationship of IBS-like symptoms to health related quality of life (HR-QOL), and (3) to investigate associations for developing IBS-like symptoms in patients with inactive IBD. METHODS: IBS-like symptoms were evaluated using the Rome III questionnaire for functional gastrointestinal disorders. HR-QOL and hospital anxiety and depression scale were evaluated. RESULTS: IBS-like symptoms were found in 17.5% (7/40) of patients with inactive ulcerative colitis, 27.1% (29/107) of patients with inactive Crohn’s disease (CD), and 5.3% (23/438) of healthy control subjects. The QOL level was significantly lower and anxiety score was significantly higher in inactive CD patients with IBS-like symptoms than in those without such symptoms (P = 0.003, P = 0.009). Use of anti-anxiety drugs was associated with the presence of IBS symptoms (P = 0.045). HR-QOL score was lower and anxiety score was higher in patients with inactive ulcerative colitis, but the difference was not statistically significant. CONCLUSIONS: The prevalence of IBS-like symptoms in inactive IBD patients was significantly higher than in healthy controls. Inactive CD patients with IBS-like symptoms has low QOL and anxiety; suggesting that anxiety may be associated with symptom development in such patients.
Anti-Anxiety Agents ; Anxiety ; Asian Continental Ancestry Group* ; Colitis, Ulcerative ; Depression ; Gastrointestinal Diseases ; Humans ; Inflammatory Bowel Diseases* ; Irritable Bowel Syndrome ; Prevalence* ; Quality of Life ; Risk Factors

OBJECTIVETo evaluate the acute effects of indoor and outdoor particulate matter on lung function and respiratory symptoms of college students in winter.

METHODSA panel of 37 college students aged 19-21 in Wuhan were included and the investigation was carried out from 12/23/2009 to 01/05/2010. Daily morning/evening forced expiratory volume in one second (FEV1) and respiratory symptoms (cough, phlegm and runny) were measured and reported by subjects, respectively. Meanwhile, daily data of indoors and outdoors PM10, PM2.5, temperature, and relative humidity were collected. Generalized Estimating Equations (GEEs) were used to estimate the association between particulate matters exposure and respiratory symptoms and FEV1).

RESULTSAverage daily concentrations of indoor, outdoor PM2.5 during the study period were (110.6 ± 42.3), (143.5 ± 51.2) µg/m³, (148.2 ± 43.2) and (239.1 ± 71.3) µg/m³ for indoor, outdoor PM10, respectively. Outdoor exposure to PM2.5 on lag 0 had little effect on evening FEV1). However, researchers observed a significant lagging effect (lag 1 d) and accumulative effect (lag 0-1 d and lag 0-2 d). A rise in the PM2.5 concentration of 10 µg/m³ resulted in the change of evening FEV1) of -0.28% (95% CI: -0.52%, -0.03%), -0.45% (95% CI: -0.81%, -0.08%) and -0.63% (95% CI: -1.15%, -0.11%), respectively. For respiratory symptoms of coughing up phlegm, 10 mg/m³ increase of indoor/outdoor PM2.5 concentration were associated with odds ratio of 1.18 (95% CI: 1.02-1.36) and 1.08 (95% CI: 0.97-1.19), respectively. Moreover, risk of coughing up phlegm increased with lagging time, and accumulative time of indoor and outdoor PM2.5 and PM10.

CONCLUSIONOur study suggested that short-term exposure to particulate matters in winter was significantly associated with acute changes of respiratory symptoms and FEV1) of college students in Wuhan. Moreover, the effects of particulate matters tended to be larger as the increase of lagged and accumulative days.

Air Pollutants ; Cough ; Forced Expiratory Volume ; Humans ; Humidity ; Mucus ; Particulate Matter ; Respiratory Tract Diseases ; Seasons ; Students ; Temperature

BACKGROUND: The immunological mechanisms of asthma remission remain unclear although several reports have suggested that balance between T helper (Th) 2 cytokines and regulatory cytokines is related. OBJECTIVE: To study the balance between interleukin (IL) 10 and IL-5 in asthma clinical remission. METHODS: We measured the numbers of IL-5 and IL-10 producing cells in peripheral blood mononuclear cells stimulated with mite antigen obtained from patients with active asthma (group A, n = 18), patients in clinical remission (group R, n = 15) and nonatopic healthy controls (group H, n = 14). RESULTS: The numbers of IL-5 producing cells in groups A and R were significantly higher than in group H. The number of IL-5 producing cells was lower in group R than in group A, although the difference was not statistically significant. The number of IL-10 producing cells was higher in group R than in group A, although again the difference was not statistically significant. There was a significant difference in the number of IL-10 producing cells between groups A and H but not between groups R and H. The ratio of the number of IL-10 to IL-5 producing cells was highest in group H followed by groups R and A, and the differences were statistically significant for each pair of groups. CONCLUSION: Our study suggests that the IL-10/IL-5 balance is related to clinical asthma. The balance differs between patients in clinical remission and healthy controls, suggesting that allergic inflammation may continue even after clinical asthma remission.
Asthma ; Child ; Cytokines ; Humans ; Inflammation ; Interleukin-10 ; Interleukin-5 ; Interleukins ; Mites ; Prognosis

Objective To evaluate the acute effects of indoor and outdoor particulate matter on lung function and respiratory symptoms of college students in winter. Methods A panel of 37 college students aged 19-21 in Wuhan were included and the investigation was carried out from 12/23/2009 to 01/05/2010. Daily morning/evening forced expiratory volume in one second(FEV1) and respiratory symptoms (cough, phlegm and runny) were measured and reported by subjects, respectively. Meanwhile, daily data of indoors and outdoors PM10, PM2.5, temperature, and relative humidity were collected. Generalized Estimating Equations(GEEs) were used to estimate the association between particulate matters exposure and respiratory symptoms and FEV1. Results Average daily concentrations of indoor, outdoor PM2.5 during the study period were(110.6 ± 42.3),(143.5 ± 51.2) μg/m3,(148.2 ± 43.2) and(239.1 ± 71.3) μg/m3 for indoor, outdoor PM10, respectively. Outdoor exposure to PM2.5 on lag 0 had little effect on evening FEV1. However, researchers observed a significant lagging effect(lag 1 d) and accumulative effect(lag 0-1 d and lag 0-2 d). A rise in the PM2.5 concentration of 10μg/m3 resulted in the change of evening FEV1 of-0.28%(95%CI:-0.52%,-0.03%),-0.45%(95%CI:-0.81%,-0.08%) and-0.63%(95%CI:-1.15%,-0.11%), respectively. For respiratory symptoms of coughing up phlegm, 10 mg/m3 increase of indoor/outdoor PM2.5 concentration were associated with odds ratio of 1.18(95%CI:1.02-1.36) and 1.08(95%CI:0.97-1.19), respectively. Moreover, risk of coughing up phlegm increased with lagging time, and accumulative time of indoor and outdoor PM2.5 and PM10. Conclusion Our study suggested that short-term exposure to particulate matters in winter was significantly associated with acute changes of respiratory symptoms and FEV1 of college students in Wuhan. Moreover, the effects of particulate matters tended to be larger as the increase of lagged and accumulative days.

Objective To evaluate the acute effects of indoor and outdoor particulate matter on lung function and respiratory symptoms of college students in winter. Methods A panel of 37 college students aged 19-21 in Wuhan were included and the investigation was carried out from 12/23/2009 to 01/05/2010. Daily morning/evening forced expiratory volume in one second(FEV1) and respiratory symptoms (cough, phlegm and runny) were measured and reported by subjects, respectively. Meanwhile, daily data of indoors and outdoors PM10, PM2.5, temperature, and relative humidity were collected. Generalized Estimating Equations(GEEs) were used to estimate the association between particulate matters exposure and respiratory symptoms and FEV1. Results Average daily concentrations of indoor, outdoor PM2.5 during the study period were(110.6 ± 42.3),(143.5 ± 51.2) μg/m3,(148.2 ± 43.2) and(239.1 ± 71.3) μg/m3 for indoor, outdoor PM10, respectively. Outdoor exposure to PM2.5 on lag 0 had little effect on evening FEV1. However, researchers observed a significant lagging effect(lag 1 d) and accumulative effect(lag 0-1 d and lag 0-2 d). A rise in the PM2.5 concentration of 10μg/m3 resulted in the change of evening FEV1 of-0.28%(95%CI:-0.52%,-0.03%),-0.45%(95%CI:-0.81%,-0.08%) and-0.63%(95%CI:-1.15%,-0.11%), respectively. For respiratory symptoms of coughing up phlegm, 10 mg/m3 increase of indoor/outdoor PM2.5 concentration were associated with odds ratio of 1.18(95%CI:1.02-1.36) and 1.08(95%CI:0.97-1.19), respectively. Moreover, risk of coughing up phlegm increased with lagging time, and accumulative time of indoor and outdoor PM2.5 and PM10. Conclusion Our study suggested that short-term exposure to particulate matters in winter was significantly associated with acute changes of respiratory symptoms and FEV1 of college students in Wuhan. Moreover, the effects of particulate matters tended to be larger as the increase of lagged and accumulative days.