Ryo Kawasaki

Background: Quick accomplishment and responsiveness are behaviors related to time management by perceived control of time, such as a positive feeling of using one's time well. In recent years, positive psychological states have been associated with a lower risk of cardiovascular disease (CVD). Thus, we investigated the associations of quick accomplishment and responsiveness with CVD mortality in a large cohort study. Methods: The study participants were 75,049 (30,901 men and 44,148 women) aged 40-79 between 1988 and 1990 and followed until the end of 2009. Hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality from CVD according to quick accomplishment, responsiveness, and their combination were calculated after adjustment for potential confounding factors using the Cox proportional hazard model. Results: Quick accomplishment was associated with a lower risk of CVD mortality in women; a similar but marginally significant association was observed in men; the respective multivariable HR (95%CI) was 0.91 (0.83-0.99) and 0.93 (0.86-1.01). The presence of both quick accomplishment and responsiveness was associated with lower risk in men, which was confined to men aged 60-79; the respective multivariable HR (95%CI) was 0.88 (0.78-0.99) and 0.83 (0.72-0.96). Conclusions: Quick accomplishment was associated with a lower risk of CVD mortality. Quick accomplishment and responsiveness combined were inversely associated with CVD mortality risk among older men.

The association between salt and salted food consumption and oral, pharyngeal, and oesophageal cancers remains inconclusive. To address this, we conducted a large-scale nationwide cohort study in Japan, a region globally recognised for its high-salt consumption. In a baseline survey conducted from 1988 to 1990, salt consumption was evaluated using a self-administered food frequency questionnaire in a sample of 42,535 participants aged 40-79 years. Over a median 14.4-year follow-up period, 145 incident cases of oral (n=43), pharyngeal (n=17), and oesophageal (n=85) cancers were observed. A Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) after adjusting for age, sex, smoking status, alcohol consumption, and fruit and vegetable consumption. High-salt consumption was associated with a higher risk of oral, pharyngeal, and oesophageal cancers combined; the multivariable HR for the highest versus lowest tertiles of salt consumption was 1.67 (95% CI: 1.08-2.61, P-trend = 0.01). An excess risk was primarily observed for oral and oesophageal cancers. Among the salt sources, miso soup consumption was positively associated with the combined risk of oral, pharyngeal, and oesophageal cancers; however, the consumption of other high-salt foods was not. In conclusion, high-salt consumption was associated with a higher combined risk of oral, pharyngeal, and oesophageal cancers.

Background: Nonarteritic anterior ischemic optic neuropathy (NAION) is an untreatable condition often causing severe and irreversible visual loss in the affected eye. As it has recently been implied that the use of semaglutide associates with NAION, the aim of the present study was to evaluate this risk prospectively in all persons with type 2 diabetes (T2D) in Denmark. Methods: In a five-year longitudinal cohort study, we identified all persons with T2D in Denmark (n = 424,152) between 2018 and 2024. Patients were stratified according to exposure (n = 106,454) or non-exposure (n = 317,698) to once-weekly semaglutide, and incidence rates and hazard ratios (HR) of NAION were estimated in a multivariable Cox proportional hazard regression model. Results: At baseline, median age and hemoglobin A1c were 65 years and 50 mmol/mol, and 54·5% were male. During 1,915,120 person-years of observation, 218 persons developed NAION. Semaglutide exposure was associated with a higher incidence rate (0·228 vs. 0·093 per 1000 person-years, p < 0·001) and independently predicted a higher risk of upcoming NAION (HR 2·19, 95% confidence interval 1·54 - 3·12), even when multiple other factors were taken into account. Overall, 67 persons exposed to semaglutide developed NAION with a median time from first prescription to event of 22·2 months (interquartile range 10·2-37·8 months). Conclusions: During five years of observation of all persons with T2D in Denmark, use of once-weekly semaglutide independently more than doubled the risk of NAION. Given the irreversible nature of NAION, it is important to acknowledge this risk, and upcoming studies should aim to identify high-risk subgroups.

Objective: We evaluated the cost-effectiveness of artificial intelligence (AI)-based diabetic retinopathy (DR) screening in Japan. This evaluation compared the simultaneous introduction of AI in nationwide health checkups, namely "specific health check-ups in Japan" (SHC), and diabetes complication management (AI-case) with the current situation where AI is not being introduced (conventional-case) from the healthcare payer's perspective. Methods: A cost-effectiveness analysis was conducted using a new individual-based state transition model. Model parameters, including the incidence and progression of DR, health utility values, and costs of screening and treatment, were based on literature data and expert opinion. The analysis estimated quality-adjusted life years (QALYs), cumulative costs, and incremental cost-effectiveness ratios (ICER). Results: The ICER comparing the AI-case with conventional-case was estimated to be JPY 1,598,244/QALY (USD 11,375/QALY), which is below the willingness-to-pay threshold of JPY 5 million/QALY (USD 35,584/QALY). Scenario analyses revealed that ICERs for the AI-based DR screening in SHC-only condition was JPY 1,895,226/QALY (USD 13,488/QALY) and JPY 3,960,839/QALY (USD 28,189/QALY) in diabetes management-only condition. Conclusions: The introduction of AI-based DR screening for SHC and diabetes management was cost-effective compared to the current situation in Japan.

Objective: To assess the quality of life in Japanese patients with Fuchs endothelial corneal dystrophy (FECD) using The National Eye Institute Visual Function Questionnaire. Methods: Here, 34 patients with FECD (FECD group) and 13 healthy individuals (control group) completed the National Eye Institute Visual Function Questionnaire Japanese version by interview format. The association between dominant eye corrected distance visual acuity and composite score (component 11) or subscales in the FECD group was evaluated using Spearman rank correlation coefficient. Results: The average age was 65.8±11.9 and 60.1±7.9 years in the FECD and control groups, respectively. Corrected distance visual acuity was significantly lower in the FECD group (0.021±0.21 logarithm of the minimum angle of resolution) than in the control group (-0.61±0.055 logarithm of the minimum angle of resolution) ( P <0.0001). Composite scores were significantly lower in the FECD group (77.6±11.0) than in the control group (89.2±7.0) ( P =0.0006). All subscale scores were lower in the FECD group, particularly for distance vision and mental health (81.4±13.1 and 84.0±15.6, respectively) than in the control group (90.7±12.0 and 95.7±5.7) ( P =0.022 and P =0.0046, respectively). Corrected distance visual acuity in the dominant eye did not significantly correlate with composite scores or subscales in the FECD group. Conclusions: Quality of life is lower in patients with FECD than in healthy individuals, particularly regarding distance vision and mental health.