The interaction of Apolipoprotein A5 gene promoter region T-1131C polymorphism (rs12286037) and lifestyle modification on plasma triglyceride levels in Japanese

BACKGROUND/OBJECTIVE: Apolipoprotein A5 gene promoter region T-1131C polymorphism (APOA5 T-1131C) is known to be associated with elevated plasma TG levels, although little is known of the influence of the interaction between APOA5 T-1131C and lifestyle modification on TG levels. To investigate this matter, we studied APOA5 T-1131C and plasma TG levels of subjects participating in a three-month lifestyle modification program. SUBJECTS/METHODS: A three-month lifestyle modification program was conducted with 297 participants (Age: 57 +/- 8 years) in Izumo City, Japan, from 2001-2007. Changes in energy balance (the difference between energy intake and energy expenditure) and BMI were used to evaluate the participants' responses to the lifestyle modification. RESULTS: Even after adjusting for confounding factors, plasma TG levels were significantly different at baseline among three genotype subgroups: TT, 126 +/- 68 mg/dl; TC, 134 +/- 74 mg/dl; and CC, 172 +/- 101 mg/dl. Lifestyle modification resulted in significant reductions in plasma TG levels in the TT, TC, and CC genotype subgroups: -21.9 +/- 61.0 mg/dl, -20.9 +/- 51.0 mg/dl, and -42.6 +/- 78.5 mg/dl, respectively, with no significant differences between them. In a stepwise regression analysis, age, APOA5 T-1131C, body mass index (BMI), homeostasis model assessment-insulin resistance (HOMA-IR), and the 18:1/18:0 ratio showed independent association with plasma TG levels at baseline. In a general linear model analysis, APOA5 T-1131C C-allele carriers showed significantly greater TG reduction with decreased energy balance than wild type carriers after adjustment for age, gender, and baseline plasma TG levels. CONCLUSIONS: The genetic effects of APOA5 T-1131C independently affected plasma TG levels. However, lifestyle modification was effective in significantly reducing plasma TG levels despite the APOA5 T-1131C genotype background.

Practical Patient Safety Education for Medical Students at the Yokohama City University School of Medicine / 医学教育

In autumn 2005, a 15-hour patient-safety education program was incorporated into the core curriculum for fourth-year medical students at the Yokohama City University School of Medicine. Sixty students took part in the program. The goals of the curriculum are for students to understand the prevalence and origins of medical errors and to increase awareness of the physician's responsibility for patient safety. Because typical learning methods, such as didactic lectures, might not be effective, we developed an experimental or case-based learning method. Educational modalities included small-group discussion of medical errors, role-playing of medical error disclosure, and experience operating infusion pumps. In addition, to bridge the gap between educational systems and hospital systems, we collaborated with other healthcare workers, such as nurses and hospital pharmacists. Students evaluated the program favorably; most recommended continuing the curriculum for future medical student classes.

A Survey on Residents' Awareness of Patient Safety at the End of the First Year of Residency / 医学教育

A survey was performed to examine residents' awareness of patient safety. Sixty-two residents who had just finished their first year of residency participated in the study. Of the 62 residents, 30 were training at Yokohama City University Hospital and 32 were training at other hospitals. Although all residents knew about the serious medical mishap ( “surgical mix-up” ) that had occurred at Yokohama City University Hospital in 1999, only 53% knew about the judicial verdict in this case. The residents most often believed that the mishap was the fault of the hospital and its system (82%), followed by nurses (73%), supervising doctors (62%), and residents (45%). Seventy percent of the residents knew about the “Incident Reporting System, ” but only 20% had written an incident report. Incidents experienced or observed by residents were most often medication-related. No significant differences in the results of the survey were found between residents of Yokohama City University Hospital and those of other hospitals. In conclusion, although residents recognize the importance of patient safety at the end of the first year of their residency program, they still cannot deal properly with incidents.

Weight Loss and Improvement of Metabolic Syndrome by Interventional Program Based on Health Education / 日本農村医学会雑誌

A cluster of insulin resistance, dyslipidemia and hypertension has been labeled as a metabolic syndrome. Asians have a lower rate of obesity than Caucasians, but have recently become increasingly prone to obesity and the metabolic syndrome, especially in rural communities in Japan. Although weight loss has been considered to be effective for improvement of the metabolic syndrome, most data are based on studies in Western countries with only limited information derived from Japanese populations. We conducted a study of 188 subjects who participated in our interventional program for obesity based on health education and self-determination in 2000-2003. The intervention induced significant decreases in caloric intakes and increases in physical activity in the participants, and then resulted in a significant 1.3kg reduction in weight on the average. Weght-loss was significantly associated with indexes of obesity, values of total cholesterol, triglyceide and HDL cholesterol levels, but was not related with blood pressure and LDL cholesterol, which were significantly decreased by our intervention. Furthermore a simple regression analysis was carried out to verify whether weight loss and metabolic syndrome parameters were related. Weight loss was determinantsexplaining less than a total of 10% of the variance in triglyceride and total cholesterol for the participants. Future studies of weight loss for metabolic syndrome should incorporate Asian ethnic factors, such as dietary habits and genetic influences.