Identification of LEF1 as a Susceptibility Locus for Kawasaki Disease in Patients Younger than 6 Months of Age

Kawasaki disease (KD) is an acute febrile vasculitis predominately affecting infants and children. The dominant incidence age of KD is from 6 months to 5 years of age, and the incidence is unusual in those younger than 6 months and older than 5 years of age. We tried to identify genetic variants specifically associated with KD in patients younger than 6 months or older than 5 years of age. We performed an age-stratified genome-wide association study using the Illumina HumanOmni1-Quad BeadChip data (296 cases vs. 1,000 controls) and a replication study (1,360 cases vs. 3,553 controls) in the Korean population. Among 26 candidate single nucleotide polymorphisms (SNPs) tested in replication study, only a rare nonsynonymous SNP (rs4365796: c.1106C>T, p.Thr369Met) in the lymphoid enhancer binding factor 1 (LEF1) gene was very significantly associated with KD in patients younger than 6 months of age (odds ratio [OR], 3.07; p(combined) = 1.10 × 10⁻⁵), whereas no association of the same SNP was observed in any other age group of KD patients. The same SNP (rs4365796) in the LEF1 gene showed the same direction of risk effect in Japanese KD patients younger than 6 months of age, although the effect was not statistically significant (OR, 1.42; p = 0.397). This result indicates that the LEF1 gene may play an important role as a susceptibility gene specifically affecting KD patients younger than 6 months of age.

Difficulties of pregnancy, delivery, and child raising for immigrant women in Japan and their strategies for overcoming them / 国際保健医療

<B>Objectives</B><br>The study aims to clarify the difficulties of pregnancy, delivery, and child raising for immigrant women in Japan and their strategies for overcoming them.<br><B>Methods</B><br>The semi-structured interviews were conducted with 18 immigrant women who have experience of delivery or child raising in Japan. The participants were asked about their experiences and difficulties faced during pregnancy, delivery, and child raising, and how they overcame them. The data were analyzed in a qualitative and descriptive manner.<br><B>Results</B><br>Seven core categories of difficulties were extracted:«anxiety about child raising»,«problems with relationships with others»,«socio-economic problems»,«anxiety about pregnancy, delivery, and diseases»,«problems caused by illiteracy»,«lack of understanding about Japanese health system»,«choice of the delivery country». Women's«making efforts to manage»is supported by family members and it leads to«use of the Japanese health system». Getting support from friends and neighbors, and the use of an interpreter also leads to this. Some women try to overcome the difficulties by«using a non- Japanese health system»or«doing nothing».<br><B>Conclusions</B><br>When foreigners access health services, not only literacy but also health literacy, such as understanding medical terms or health systems are necessary. Many immigrant women got support from family and friends to overcome the difficulties. However, some women could not get such support and it is necessary for them to make a support network. Foreign women who take negative strategies and use non-Japanese health systems may be in the process of adjusting to Japanese society. Health providers should not deny such strategies, but understand them as a way of decreasing anxiety.