Vaccination, regular exercise, and prevention of chronic lung disease reduce exacerbation of COVID-19 severity in northern Okinawa, Japan: A cross-sectional study.

BACKGROUND: As at June 14, 2023, the coronavirus disease 2019 (COVID-19) pandemic had affected more than 767 million people and caused more than 6.9 million deaths worldwide. This study aimed to clarify the lifestyle factors that influence the exacerbation of COVID-19 severity. METHODS: This was a cross-sectional study of patients with COVID-19 whose severity classification of "moderate or severe" (COVID-19 exacerbation) was defined as an objective variable. The 1,353 participants were selected from 4,899 patients with COVID-19 between August 10, 2020 and December 10, 2022. Participants who underwent a specific health checkup before the date for a COVID-19 consultation were included. Using binominal logistic regression analysis, we evaluated the odds ratios (ORs) for COVID-19 exacerbation according to lifestyle-related factors. Limitations were discussed using a target trial emulation framework which clarifies problems in observational studies. RESULTS: The explanatory variables extracted as factors that exacerbated COVID-19 severity were gender (OR [man vs. woman]: 2.533, 95% confidence interval [CI] 1.484-4.322); age (OR [50s vs. 10s, 20s, or 30s]: 4.858, 95% CI 2.319-10.177; OR [60s]: 9.738, 95% CI 4.355-21.777; OR [70s + 80s + 90s]: 8.327, 95% CI 3.224-21.507); and comorbid chronic lung disease (OR ['yes' vs. 'no']: 2.892, 95% CI 1.227-6.818). The explanatory variables extracted as factors that reduce the severity of COVID-19 were hospital consultation year (OR [2022, predominantly Omicron variant prevalent vs. 2020, predominantly Alpha variant prevalent]: 0.180, 95% CI 0.058-0.559); number of vaccinations (OR [2 doses vs. 0 or one doses]: 0.223, 95% CI 0.114-0.436; OR [≥3 doses vs. 0 or one doses]: 0.090, 95% CI 0.035-0.229); regular exercise (exercising ≥2 days/week ≥30 minutes each at an intensity that causes a slight sweat for ≥1 year) (OR ['yes' vs. 'no']: 0.458, 95% CI 0.242-0.866). CONCLUSIONS: These results suggest the importance of vaccination, regular exercise, and prevention of chronic lung disease as measures against exacerbation of COVID-19 severity.

Association between lifestyle and metabolic syndrome incidence of workers in northern Okinawa, Japan: A cohort study.

In Japan, specific health checkups were implemented to prevent metabolic syndrome (MetS) and cardiovascular diseases in April 2008. This study aimed to clarify the relationship between lifestyle factors and the MetS incidence to understand how the disease can be prevented and to improve the public health policy. A retrospective cohort study was conducted using the specific health checkup data of 2,781 workers. Lifestyle factors were assessed using lifestyle-related items in the general health questionnaire included in the specific health checkups. The hazard ratio values for the incidence of MetS according to lifestyle-related items were determined from the data of the specific health checkup for 12 years. The Cox proportional hazard survival model was used to evaluate hazard ratio values after adjusting for confounding factors. The limitations of this research method are discussed using a target trial emulation framework which investigates problems such as biases in observational studies. The crude incidence rates per 1,000 person-years of MetS in women and men were 15.25 and 47.58, respectively. Three dietary lifestyle-related factors, namely "Eating snacks and sweet beverages other than breakfast, lunch, and dinner," "Eating faster than others," and "Skipping breakfast at least three times a week," were identified, with the hazard ratio values 1.262 (95 % confidence interval [CI] 1.032-1.542, p = 0.023), 1.220 (95 % CI 1.032-1.442, p = 0.020) and 1.189 (95 % CI 1.012-1.397, p = 0.036), respectively. These results suggest that lifestyle improvements related to extracted lifestyle-related items contribute to the prevention of MetS.

Cardiac auscultation skills among junior doctors: effects of sound simulation lesson.

OBJECTIVES: To evaluate the effect of a sound simulation lesson to improve cardiac auscultation skills among junior doctors. METHODS: This study is based on the design of test comparison before and after educational intervention using a convenient sample. For 50 junior doctors in Japan, diagnostic accuracy before and after a sound simulation lesson for cardiac auscultation skills was compared. There were 15 doctors who experienced cardiology rotation. The lesson used seven abnormal cardiac recordings (third heart sound, double gallop, aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, and pericardial friction rub). At tests before and after the lesson, the doctors listened to random sound outputs of the same seven recordings, chose diagnostic findings from multiple-choice items, and obtained individual diagnostic accuracy based on the total number of choosing correct findings. Top 10 doctors obtaining the greatest individual accuracy received a commendation. RESULTS: Pre-lesson diagnostic accuracy was not different between doctors with cardiology rotation training (total diagnostic accuracy of the group, 27/105 [26%]) and those without cardiology rotation (70/245 [29%]). Compared to pre-lesson, post-lesson total diagnostic accuracy significantly improved with about two-folds (97/350 [28%] vs 170/350 [61%]; McNemar Test, p<0.0001). The improvement was significant for double gallop (5/50 [10%] vs. 15/50 [30%]), mitral stenosis (0/50 [0%] vs. 6/50 [12%]), and pericardial friction rub (1/50 [2%] vs. 35/50 [70%]). CONCLUSIONS: The use of a simple sound simulation lesson may help junior doctors to learn cardiac auscultation skills. Clinician educators are encouraged to use this strategy in addition to cardiology rotation training.