Knowledge Does Not Correlate with Behavior toward Deceased Organ Donation: A Cross-Sectional Study in Japan.

BACKGROUND Although knowledge is an important factor that influences decisions regarding deceased organ donation, the associations of knowledge with attitude and behavior regarding organ donation remain uncertain in countries with low organ donation rates like Japan. MATERIAL AND METHODS We conducted a cross-sectional survey of hospital medical and non-medical staff in 15 Japanese medical facilities. The questionnaire included items on knowledge, attitude, and behavior toward deceased organ donation and transplantation. Participants were divided into 3 groups according to the tertile of knowledge score. Modified Poisson regression models were used for associations of knowledge score with organ donor registration and willingness to become an organ donor after death. RESULTS Of the 1967 staff, 1275 returned the questionnaires (response rate, 64.8%). There were 1190 study subjects with complete data for analysis. For the lowest (n=512), middle (n=428), and highest (n=250) tertile knowledge groups, the proportions of participants who registered and expressed willingness to donate organs were 20.1%, 23.4%, and 28.4% and 31.1%, 38.3%, and 44.0%, respectively. The adjusted proportion ratios for organ donor registration were 0.90 (95% CI, 0.73-1.10) for the middle and 1.00 (0.80-1.26) for the highest tertile of knowledge, compared with the lowest tertile. However, participants with the highest tertile of knowledge score expressed higher willingness for organ donation than the lowest tertile (adjusted proportion ratio, 1.37; 95% CI, 1.13-1.66). CONCLUSIONS For hospital staff in Japanese medical facilities, high knowledge about organ donation and transplantation was not associated with donor registration, but was associated with willingness to become an organ donor.

Hyperuricemia predicts the risk for developing hypertension independent of alcohol drinking status in men and women: the Saku study.

Hyperuricemia has been reported to be a risk factor for hypertension, but this association may be affected by alcohol consumption. This study aimed to investigate whether hyperuricemia remains a risk factor for hypertension after eliminating the effect of alcohol consumption. This study comprised 7848 participants (4247 men and 3601 women) aged 30-74 years without hypertension who had undergone a medical checkup between April 2008 and March 2009 at Saku Central Hospital, Nagano Prefecture, Japan. Hyperuricemia was defined as uric acid >7.0 mg/dl in men, ≥6.0 mg/dl in women, and/or receiving treatment for hyperuricemia or gout. The incidence of hypertension was defined as the first diagnoses of blood pressure ≥140/≥ 90 mmHg and/or initiations of antihypertensive drug treatment. Multivariable-adjusted hazard ratios (HRs) of hyperuricemia for the incidence of hypertension after adjustment for and classification by alcohol consumption were estimated using the Cox proportional hazard model. During a mean of 4.0 years of follow-up, 1679 individuals developed hypertension. After adjustment for alcohol consumption, the HRs (95% confidence interval) associated with hyperuricemia were 1.37 (1.19-1.58) in men and 1.54 (1.14-2.06) in women. Among nondrinkers, the HR was 1.29 (0.94-1.78) in men with hyperuricemia compared with men without, and the corresponding HR was 1.57 (1.11-2.22) in women. The corresponding HR was 1.88 (1.27-2.86) in all participants with baseline blood pressure <120/80 mmHg. The interactions between hyperuricemia and sex (P = 0.534) and between drinking and sex (P = 0.713) were not significant. In conclusion, hyperuricemia predicts the risk for developing hypertension independent of alcohol drinking status.

Fasting Blood Glucose Predicts Incidence of Hypertension Independent of HbA1c Levels and Insulin Resistance in Middle-Aged Japanese: The Saku Study.

BACKGROUND: Relationships between blood glucose (BG) levels and insulin action, and incidence of hypertension have not been well known epidemiologically. This study aimed to investigate the association between indices of diabetes and the incidence of hypertension and compare the predictive powers of these indices in middle-aged Japanese. METHODS: This 5-year cohort study included 2,210 Japanese aged 30-64 years without hypertension. Hazard ratios of high fasting blood glucose (FBG) levels, high post-loaded BG levels, high glycated hemoglobin (HbA1c) levels, insulin resistance (defined by homeostasis model assessment of insulin resistance [HOMA-IR]) and impaired insulin secretion at baseline for the incidence of hypertension were estimated using multivariable-adjusted Cox proportional hazard models. Hypertension was defined as blood pressure ≥ 140/90 mm Hg or receiving antihypertensive treatment. RESULTS: During the follow-up, 456 participants developed hypertension. After adjustment for HbA1c and HOMA-IR, FBG was independently and significantly associated with hypertension. The hazard ratio of participants with FBG ≥ 7.0 mmol/l was 1.79 compared with those with FBG < 5.6 mmol/l. Even among those with HbA1c < 6.5%, HOMA-IR < 2.5, body mass index < 25 kg/m2, age < 55 years old, blood pressure < 130/80 mm Hg or non- and moderate drinking, the results were similar. High 120-minute BG level and impaired insulin secretion did not increase the risk for hypertension. CONCLUSIONS: FBG was a predictable index for future incidence of hypertension in middle-aged Japanese men and women. This is the first study comparing predictive powers of indices of diabetes for the incidence of hypertension.

The association between glycemic control and lung function impairment in individuals with diabetes: the Saku study.

AIM: Though diabetes is a risk factor for lung function impairment, whether the glycemic control level affects lung function in individuals with diabetes remains unclear. The present study aimed to assess the association between glycemic control level and restrictive or obstructive lung function impairment in individuals with diabetes. METHODS: This cross-sectional study included 1028 individuals with diabetes, aged 40-69 years, who underwent a medical checkup between April 2008 and March 2014. Hemoglobin A1c (HbA1c) was categorized as  < 6.9%, 7.0-7.9%, and  ≥ 8.0%. Restrictive and obstructive lung function impairment was defined by a forced vital capacity (FVC) < 80% predicted and a forced expiratory volume in 1 s to FVC ratio < 0.70. RESULTS: Of the participants, 8.7% and 6.3% were classified as having restrictive and obstructive lung function impairment, respectively. The multivariable-adjusted odds ratios and 95% confidence intervals for restrictive lung function impairment were 1.43 (0.84-2.42) in individuals with HbA1c 7.0-7.9%, and 2.42 (1.38-4.26) in individuals with HbA1c ≥ 8.0%, compared with those who had HbA1c < 6.9% (p for trend = 0.002). In contrast, glycemic control level was not associated with obstructive lung function impairment (p for trend = 0.749). CONCLUSIONS: Poor glycemic control was associated with restrictive lung function impairment in individuals with diabetes. Good glycemic control would be important to minimize restrictive lung function impairment in individuals with diabetes.

Risk of developing type 2 diabetes according to blood pressure levels and presence or absence of hypertensive treatment: the Saku study.

The aim was to investigate the risk of developing type 2 diabetes according to blood pressure (BP) levels and presence or absence of hypertensive treatment. This 5-year cohort study comprised 3508 Japanese adults aged 30-74 years without diabetes who had undergone a medical checkup including a 75-g oral glucose tolerance test (OGTT) between April 2008 and March 2009 at Saku Central Hospital. Participants receiving antihypertensive treatment were categorized into controlled hypertension ( < 140/90 mmHg) or uncontrolled hypertension ( ≥ 140/90 mmHg) groups. Participants not receiving antihypertensive treatment were categorized: optimal BP ( < 120/80 mmHg), normal BP (120-129/80-84 mmHg), high-normal BP (130-139/85-89 mmHg), grade I hypertension (140-159/90-99 mmHg), and grade II/III hypertension ( ≥ 160/100 mmHg). Hazard ratios and 95% confidence intervals for the incidence of type 2 diabetes as defined by the 75-g OGTT were estimated using multivariable-adjusted Cox proportional hazard models in reference to optimal BP. During an average of 4.4 years of follow-up, 295 participants developed type 2 diabetes. Those with high-normal BP, grade I hypertension, grade II/III hypertension, and uncontrolled hypertension were at significantly higher risk for developing type 2 diabetes, with hazard ratios (95% confidence intervals) of 1.53 (1.03-2.29), 1.53 (1.02-2.32), 2.19 (1.01-4.77), and 1.81 (1.10-2.99), respectively. In conclusion, compared with those with optimal BP, individuals with BP ≥ 130/85 mmHg not receiving antihypertensive treatment and uncontrolled hypertensives with BP ≥ 140/90 mmHg receiving antihypertensive treatment were at a significantly higher risk for developing type 2 diabetes.

A prospective study of the impact of diabetes mellitus on restrictive and obstructive lung function impairment: The Saku study.

BACKGROUND: To assess the impact of diabetes on restrictive and obstructive lung function impairment. METHODS: This 5-year prospective study included 7524 participants aged 40-69years without lung function impairment at baseline who underwent a comprehensive medical check-up between April 2008 and March 2009 at Saku Central Hospital. Diabetes was defined by fasting plasma glucose ≥7.0mmol/l (126mg/dl), HbA1c≥6.5% (48mmol/mol), or a history of diabetes, as determined by interviews conducted by the physicians. Restrictive and obstructive lung function impairment were defined as forced vital capacity (FVC) <80% predicted and forced expiratory volume in 1s (FEV1) to FVC ratio (FEV1/FVC) <0.70, respectively. Participants were screened until they developed restrictive or obstructive lung function impairment or until March 2014. RESULTS: During the follow-up period, 171 and 639 individuals developed restrictive and obstructive lung function impairment, respectively. Individuals with diabetes had a 1.6-fold higher risk of restrictive lung function impairment than those without diabetes after adjusting for sex, age, height, abdominal obesity, smoking status, exercise habits, systolic blood pressure, HDL-cholesterol, log-transformed high-sensitivity C-reactive protein, and baseline lung function [multivariable-adjusted HR and 95% CI; 1.57 (1.04-2.36)]. In contrast, individuals with diabetes did not have a significantly higher risk of obstructive lung function impairment [multivariable-adjusted HR and 95% CI; 0.93 (0.72-1.21)]. CONCLUSION: Diabetes was associated with restrictive lung function impairment but not obstructive lung function impairment.

Association between alcohol consumption and incidence of impaired insulin secretion and insulin resistance in Japanese: The Saku study.

AIMS: To investigate the effect of alcohol consumption on impaired insulin secretion and insulin resistance in Japanese. METHODS: The participants in this 5-year cohort study were 2100 Japanese aged 30-74 years without type 2 diabetes mellitus, impaired insulin secretion, or insulin resistance who underwent a medical checkup including 75-g OGTT between April 2008 and March 2009 at Saku Central Hospital. Alcohol consumption was categorized as follows: non-drinker (0 g/week), light drinker (1-139 g/week in men and 1-69 g/week in women), moderate drinker (140-274 g/week in men and 70-139 g/week in women) and heavy drinker (≥275 g/week in men and ≥140 g/week in women). The hazard ratios (HRs) and 95% CIs among light to heavy drinkers for incidence of impaired insulin secretion (insulinogenic index ≤51.7) and insulin resistance (HOMA-IR ≥ 2.5), detected by an OGTT at the time of a follow-up medical checkup before the end of March 2014, were estimated by multivariable adjusted Cox proportional hazard models as reference values for non-drinkers. RESULTS: There were 708 cases of impaired insulin secretion and 191 cases of insulin resistance. The HRs (95% CIs) for impaired insulin secretion in light, moderate and heavy drinkers were 1.16 (0.96-1.40), 1.35 (1.07-1.70) and 1.64 (1.24-2.16), respectively (P for trend <0.001). For insulin resistance, the HRs were 1.22 (0.84-1.76), 1.42 (0.91-2.22) and 1.59 (0.96-2.65), respectively (P for trend = 0.044). CONCLUSION: Alcohol consumption was positively associated with the incidence of both impaired insulin secretion and insulin resistance.

Effects of structured education program on organ donor designation of nursing students and their families: A randomized controlled trial.

INTRODUCTION: Little is known about the effect of education programs on changing attitudes and behaviors of participants and their families toward deceased organ donation. METHODS: The subjects of this randomized trial were Japanese nursing students who were not previously designated organ donors. They were randomly assigned to either the education program or information booklet group. The program comprised a lecture followed by group discussion and information booklet. The primary outcome was self-reported organ donor designation. Outcomes were assessed by questionnaire. RESULTS: Data of 203 (99.0%) students were analyzed. At study end, seven of 102 students (6.9%) of the program group and one of 101 students (1.0%) of the booklet group consented to donate organs (proportion ratio 6.93 [95% CI 0.87-55.32]). There were significant between-group differences in willingness to consent for donation (54.9% vs 39.6%; proportion ratio 1.39 [95% CI 1.03-1.87]), family discussion (31.4% vs 15.9%; 1.98 [1.16-3.38]), and organ donor designation of family members (11.8% vs 2.0%; 5.94 [1.36-25.88]). No group differences were found in willingness for organ donation by students and family members. CONCLUSION: Although there were no significant between-group differences in organ donor designation, the program seems to indirectly promote consent to organ donation by their families.