桑原 政成

BACKGROUND: This study investigated the association between the development of sarcoidosis and environmental factors, focusing on the childhood hygiene environment. METHODS: This case-control study used a questionnaire administered to patients with sarcoidosis and residence-matched controls (age 18 to <90 years) in 7 prefectures between 2018 and 2020. Logistic regression analysis was performed to identify risk factors, including adulthood lifestyle history, childhood hygiene environment, and history of infections. RESULTS: One hundred sixty-four patients with sarcoidosis and 1779 controls (641 men, 1138 women) were enrolled. Multivariate analysis showed that smoking history during adulthood was associated with developing sarcoidosis (odds ratio [OR], 2.09; 95 % confidence interval [CI], 1.16-3.75). For the childhood hygiene environment, attending nursery school (OR, 2.76; 95 % CI, 1.57-4.84) and use of well water (OR, 2.89; 95 % CI, 1.65-5.07) at age 0-2 years were associated with developing sarcoidosis. The OR of attending nursery school at age 3-6 years (OR, 1.79; 95 % CI, 0.89-3.61) was lower than that at age 0-2 years, but the OR of use of well water at age 3-6 years (OR, 2.89; 95 % CI, 1.59-5.26) was still high. By contrast, the risk of developing sarcoidosis was lower for being breastfed (OR, 0.36; 95 % CI, 0.15-0.88). Development of sarcoidosis was associated with history of tuberculosis (OR, 5.82; 95 % CI, 1.28-26.53). CONCLUSIONS: Both adulthood lifestyle history and childhood hygiene environment were associated with sarcoidosis. Daily direct exposure to diverse microorganisms during childhood may increase the likelihood of antigens for granuloma formation entering the body and also modify susceptibility to sarcoidosis.

INTRODUCTION: The Japanese Society of Gout, Uric, and Nucleic Acid developed the Japanese Guideline for Management of Hyperuricemia and Gout (JGMHG) third edition, which contains seven clinical questions (CQs) and corresponding recommendations. Questionnaire surveys were conducted to clarify how recommendations regarding CQs influence decision-making in clinical practice. METHODS: The surveillances were conducted twice in 2018, just after the publication of JGMHG, and in 2020, 2 years later. The participants were members of the Japanese Society of Gout, Uric, and Nucleic Acid. While the 2018 surveys contained questionnaires on the recommendations of seven CQs as well as three questionnaires on the status of their use, the 2020 surveys contained those regarding their recommendations of seven CQs and seven questionnaires on the status of their use. The answers from 74 (response rate: 16%) and 61 (response rate: 14%) participants in 2018 and 2020, respectively, were analyzed using the chi-square test or Fisher's exact test. RESULTS: The proportion of respondents in 2020 who agreed to reduce serum uric acid levels below 6 mg/dL in gout patients with tophi significantly increased compared to 2018. The agreement in 2020 with the long-term use of colchicine to reduce the recurrence of gout flares when initiating urate-lowering agents (ULAs) significantly increased compared to 2018. There were no significant differences between 2018 and 2020 in clinicians' attitudes toward support for the third JGMHG in daily practice, support for the use of recommendations toward each CQ, or support for finding themes for research or important clinical issues. CONCLUSIONS: The third JGMHG plays an important role in popularizing recommendations for serum uric acid levels in patients with tophi and the long-term use of colchicine for prophylaxis of gout flares when initiating ULA, although it did not influence the distribution of responses regarding clinicians' attitudes toward its support.

Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality worldwide, including in Japan, where the aging population intensifies its impact. This review evaluated the potential impact of digital healthcare on the prevention and management of ASCVD, covering both primary and secondary prevention strategies. Digital health tools, such as risk assessment applications remote monitoring, lifestyle modification support, and remote rehabilitation, have shown promise in improving patient engagement, adherence, and outcomes. However, while digital health interventions demonstrate significant benefits, challenges persist, including interoperability issues, privacy concerns, low digital literacy among older adults, and limited health insurance coverage for digital interventions. Through an analysis of recent advancements and case studies, this review demonstrates the need for user-centered design, enhanced regulatory frameworks, and expanded insurance support to facilitate the effective integration of digital health in ASCVD care. Furthermore, emerging technologies such as personalized healthcare modules offer promising directions for tailored and impactful care. Addressing these barriers is critical to unleashing the full potential of digital healthcare to reduce the burden of ASCVD and enhance patient outcomes.