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Evidence of an association between carbohydrate intake and atrial fibrillation (AF) incidence remains limited. We investigated the association between carbohydrate and staple food consumption and AF risk in a Japanese urban population.
Our population-based prospective cohort study included 5229 adult participants (mean age 56.9 years; 46.5% men) who completed a Food Frequency Questionnaire. Multivariable-adjusted Cox regression models were used to assess the association between carbohydrate intake (g/day) and staple food consumption (rice, noodles and bread) and AF incidence after adjusting for confounding factors. During 68 668 person-years of follow-up (mean, 13.1 years), 226 individuals developed AF. Total and simple carbohydrate intakes were associated with an increased AF risk in men (HR and 95% CI for Q4 vs Q1 were 2.51 (1.06 to 5.96) and 3.29 (1.33 to 8.13), respectively). In contrast, there were no significant associations between total carbohydrate, simple or complex carbohydrate intake and AF risk in women (HR and 95% CI for Q4 vs Q1 were 1.33 (0.27 to 6.65), 2.75 (0.74–10.26) and 1.04 (0.38-2.83), respectively). We found no association between staple foods and AF risk in men or women.
Our findings imply that the association between carbohydrate intake and AF risk is influenced by the type of carbohydrates. We found a positive association between high intake of simple carbohydrates and AF risk in men whereas the association was negative for complex carbohydrate intakes. Meanwhile, the results in the women’s group were inconclusive.
Methadone exerts analgesic effects through μ-opioid receptor affinity and N-methyl-D-aspartate receptor antagonism, which may benefit refractory cancer pain with neuropathic components. Methadone can be introduced by the ‘stop-and-go’ (SAG) method or the ‘add-on’ (AO) method, in which low-dose methadone is added to existing opioids. Observational studies suggest AO may improve pain control but no double-blind randomised controlled trial (RCT) has evaluated this approach. Therefore, the primary aim of this study is to assess the feasibility of conducting a double-blind RCT comparing methadone AO therapy with opioid dose escalation according to standard practice for refractory cancer pain while also exploring safety and preliminary efficacy signals.
A two-centre, randomised, double-blind, two-arm feasibility trial will enrol 22 patients with advanced or recurrent cancer and inadequately controlled pain (oral morphine equivalent daily dose 60–300 mg). Participants will be allocated 1:1 to the methadone AO or opioid-escalation group using a web-based randomisation system with the minimisation method. The primary endpoint is the completion rate of the 2-week study treatment. Secondary outcomes include pain intensity (Brief Pain Inventory), time to adequate pain control, achievement of a personalised pain goal, adverse events (Common Terminology Criteria for Adverse Events (CTCAE)/Patient-Reported Outcomes version of the CTCAE) and quality of life (European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire Core 15-PAL). Feasibility will be determined based on achieving a treatment completion rate of 70% or higher.
The protocol was approved by the Certified Review Board of the National Cancer Centre Hospital (CRB3180008). Written informed consent will be obtained from all participants. The trial is registered in the Japan Registry of Clinical Trials. Results will be published in peer-reviewed journals and presented at international conferences.
jRCTs031240220.
To describe preconception care health literacy among medical students and examine knowledge–behaviour gaps across academic years and by future parenthood intention.
Cross-sectional online survey.
Kawasaki Medical School, Japan.
Medical students in years 1–6. A total of 613 students were included in the analysis.
Preconception care health literacy was assessed using a validated Japanese preconception care-specific scale comprising a knowledge domain (13 true/false/do not know items; total score 0–13) and a behaviour/skills domain (25 4-point Likert items; total score 25–100). Domain scores were compared across academic years and future parenthood intention groups. Multivariable linear regression analyses were performed adjusting for age.
The mean age of participants was 22.53 years (SD 2.19). The mean knowledge score was 9.99 (SD 2.60) and the mean behaviour/skills score was 73.66 (SD 12.25). Knowledge scores increased with academic progression (year 1, 8.47 (SD 3.00); year 6, 11.14 (SD 1.34); p
Integrating skills-based training and reflective life-planning components into medical curricula may help strengthen preconception-related behaviours in medical students and may have indirect implications for their future readiness to support preconception care.
by Toshiko Mori, Hiroyuki Ito, Taiki Kozasa, Chizuko Yukawa, Suzuko Matsumoto, Hideyuki Inoue, Shinichi Antoku
AimsConventional biomarkers such as estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (uACR) primarily reflect glomerular damage and often fail to detect early tubular injury. Consequently, patients with “non-albuminuric diabetic kidney disease (DKD)” may be overlooked. This study evaluated the independent association between urinary post-translationally modified fetuin-A fragments (uPTM-FetA) and DKD risk stratification in Japanese patients with type 2 diabetes.
MethodsWe conducted a cross-sectional study of 219 outpatients with type 2 diabetes between November 2023 and February 2024 at Edogawa Hospital. First-morning urine samples were analyzed for uPTM-FetA and urinary liver-type fatty acid-binding protein (uL-FABP) using enzyme-linked immunosorbent assays. DKD risk was classified into four categories based on the KDIGO guidelines. The association between uPTM-FetA and higher DKD-risk (categories 2 + 3 + 4) was assessed using multiple logistic regression and restricted cubic spline (RCS) analyses, validated by bootstrapping.
ResultsThe optimal cutoff value for uPTM-FetA was determined to be 11.76 ng/mgCr. Multivariable analysis adjusted for potential confounders revealed that high uPTM-FetA levels were significantly and independently associated with DKD-risk categories 2 + 3 + 4 (adjusted odds ratio: 3.88; 95% CI: 2.02–7.45; P Conclusions
uPTM-FetA is independently associated with DKD severity and is elevated in a substantial proportion of patients with early-stage disease where conventional markers remain normal. Unlike uL-FABP, which increases predominantly in advanced stages, uPTM-FetA appears to identify tubular stress earlier. Thus, uPTM-FetA serves as a valuable complementary biomarker to uACR for refining DKD risk stratification.
by Toshiyuki Nakanishi, Ayaka Tani, Kei Matsumoto, Atsushi Ishikawa, Yuki Takami, Yuji Kamimura, Rina Kato, MinHye So, Kazuya Sobue
BackgroundThe i-gel® Plus, a new supraglottic airway, has a high oropharyngeal leak pressure of 32 ± 7 cmH2O in the European population. Because the i-gel® series was developed based on the laryngeal anatomy in Western populations, its performance in other regions, such as East Asia, is unknown. Therefore, we aimed to perform an initial clinical evaluation of i-gel® Plus in Japanese patients.
MethodsThis prospective observational study, conducted from March to June 2024 at a university hospital in Japan, recruited a total of 64 adult patients, 16 each of nonelderly (18–69 years) male, nonelderly female, elderly (≥ 70 years) male, and elderly female patients. Patients with a suspected high risk of aspiration or a predicted difficult airway were excluded. We recorded the oropharyngeal leak pressure (primary outcome), first-attempt success rate, and fiberoptic views of the i-gel® Plus. Continuous variables were evaluated for normality using the Shapiro–Wilk test and Q-Q plot. The groups were stratified by age and sex for exploratory analysis.
ResultsOf the 67 enrolled patients, three were excluded: one 70-year-old male because of failed ventilation and two because of missing data. Finally, 64 patients were analyzed, with 16 patients in each age-sex group. The oropharyngeal leak pressure was 23.7 ± 6.9 (mean ± standard deviation) cmH2O, which was normally distributed based on the Shapiro–Wilk normality test (P = 0.593) and Q-Q plot. The first-attempt success rate was 92% (including one failed ventilation case), and visible vocal cords were observed in 80% of cases. In exploratory comparisons by sex, male patients had lower oropharyngeal leak pressure and fewer visible vocal cords than female patients.
ConclusionsThe i-gel® Plus showed a high first-attempt success rate of 92%; however, its oropharyngeal leak pressure was lower than expected at 23.7 ± 6.9 cmH2O in this Japanese cohort.
by Helen W. Li, Jesse Kiprono Too, Sarah Nyanchama Nyariki, Charles Nathan Nessle, Sara Malone, Rachel Matsumoto, Teddy Ashibende Aurah, Jeffrey A. Blatnik, JoAnna Hunter-Squires, Ivan Seno Saruni
BackgroundCapacity for elective general surgical care is an important reflection of a health system’s ability to meet a population’s surgical needs and is currently known to be inadequate in many low- and middle-income countries. Patient agency is a key, understudied factor which shapes how and when patients ultimately decide to engage with formal care. Understanding factors which influence patient care seeking activity can have important implications for how current and future health systems may be utilized. This study aims to explore how patients approach the navigation and triage of their elective hernia condition within the Kenyan surgical care system.
MethodsWe conducted a qualitative study of 38 convenience-sampled patients diagnosed with an elective hernia condition at a tertiary referral hospital in Kenya between November 2023 and March 2024. We utilized Braun and Clarke’s six-step model of thematic analysis to generate key themes across the phases of care seeking, reaching and receiving as modeled in the Three Delays Framework.
ResultsWe identified three main cross-cutting themes including (1) the flow of power from patients to providers, and vice versa, take the form of consent or knowledge, respectively; (2) trust is a limited currency required for patients to engage with formal care; and (3) internal and external contextual factors remain the foundation for patient-provider care activities. We incorporated these themes together in a framework which illustrates the cyclical nature by which each factor feeds back on the others, ultimately affecting patient care.
ConclusionsFluctuating flows of patient power and trust interacts with existing infrastructural context to influence the ability of a health system to generate care. Recognizing the interaction of these key factors may have important bearing on the successful implementation of any larger systemic efforts or policies to improve access to elective surgical care.
To clarify how public health nurses allocate their time across various tasks and compare time-use patterns between prefectural and municipal public health nurses in Japan, where distinct administrative mandates define their roles.
A self-reported, prospective time study.
Public health nurses from two municipalities and one prefecture recorded their daily practices and time allocations using Kintone. Time allocation differences by administrative level and job position were analysed using linear mixed-effects models.
Overall, 121 participants contributed 9502 person-days of data. Participants spent an average of 463.6 min/workday on work-related activities. Municipal public health nurses dedicated more time to application paperwork (64.0 min), health examinations (57.6 min), and individual coordination (48.3 min). Prefectural public health nurses allocated more time to business management and organisational operations (69.0 min) and traveliing, particularly in rural contexts. Managers spent less time on direct care and more on administrative tasks.
This study provides the first quantitative, self-reported evidence of task distribution among public health nurses across administrative levels and positions. The findings reflect structural differences in role expectations and underscore the need to reallocate workloads to better align with each level's mandate.
Task prioritisation, information and communication technology tool integration, and administrative support are essential in optimising public health nurses' contributions to community health. These strategies can reduce non-clinical workload and enable public health nurses to focus on high-impact, value-added public health services that promote health equity.
This study closes a longstanding gap by quantifying PHNs' time allocation, revealing the hidden burden of administrative work, and providing critical insights for workforce planning and sustainable public health service delivery.
This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology guideline.
No Patient or Public Involvement.
UMIN Clinical Trials Registry; UMIN000051509 (https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_his_list.cgi?recptno=R000058761; August 1, 2023)
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