The prognostic significance of white-coat hypertension (WCHT) is controversial, and different findings on self-measured home measurements and 24-h ambulatory monitoring make identifying WCHT difficult. We examined whether individuals with partially or completely defined WCHT, as well as masked hypertension, as determined by different out-of-office blood pressure measurements, have a distinct long-term stroke risk. We followed 1464 participants (31.8% men; mean age, 60.6±10.8 years) in the general population of Ohasama, Japan, for a median of 17.1 years. A first stroke occurred in 212 subjects. Using sustained normal blood pressure (events/n=61/776) as a reference, adjusted hazard ratios for stroke (95% confidence intervals; events/n) were 1.38 (0.82–2.32; 19/137) for complete WCHT (isolated office hypertension), 2.16 (1.36–3.43; 29/117) for partial WCHT (either home or ambulatory normotension with office hypertension), 2.05 (1.24–3.41; 23/100) for complete masked hypertension (both home and ambulatory hypertension with office normotension), 2.08 (1.37–3.16; 38/180) for partial masked hypertension (either home or ambulatory hypertension with office normotension), and 2.46 (1.61–3.77; 42/154) for sustained hypertension. When partial WCHT and partial masked hypertension groups were further divided into participants only with home hypertension and those only with ambulatory hypertension, all subgroups had a significantly higher stroke risk (adjusted hazard ratio ≥1.84, P ≤0.04). In conclusion, impacts of partial WCHT as well as partial masked hypertension for long-term stroke risk were comparable to those of complete masked hypertension or sustained hypertension. We need both home and 24-h ambulatory blood pressure measurements to evaluate stroke risk accurately.

BackgroundPrevious studies have investigated the impact of occupational risk factors on health outcomes among physicians. However, few studies have investigated the effects on pregnancy outcomes among physicians. In this study, we examined the association between working hours during pregnancy and pregnancy complications among physicians.MethodsA cross-sectional study was based on a survey conducted in 2009-2011 of 1,684 alumnae (mean age, 44 ± 8 years) who had graduated from 13 private medical schools in Japan. Data on threatened abortion (TA), preterm birth (PTB), and the number of working hours during the first trimester of pregnancy were obtained via retrospective assessments.ResultsOf the 939 physicians with a first pregnancy, 15% experienced TA and 12% experienced PTB. Women who experienced TA (mean weekly working hours: 62 h vs. 50 h, P < .0001) or PTB (62 h vs. 50 h, P < .0001) had longer weekly working hours during the first trimester than did those without pregnancy complications. Compared with women who worked 40 hours or less per week, women who worked 71 hours or more per week had a three-fold higher risk of experiencing TA (95% confidence interval (CI): 1.7-6.0) even after adjusting for medical specialty, maternal age, and current household income. The risk of experiencing PTB was 2.5 times higher (95% CI:1.2-5.2) in women who worked 51-70 hours and 4.2 times higher (95% CI: 1.9-9.2) in women who worked 71 hours or more even after adjusting for specialty, maternal age, and current household income. The trend in the P statistic reflecting the effect of the quartile of hours worked per week (40 hours, 41-50 hours, 51-70 hours, ≥71 hours) on TA or PTB was 0.0001 in the multivariate logistic regression models.ConclusionThese results suggest that working long hours during the first trimester of pregnancy is associated with TA and PTB.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-245) contains supplementary material, which is available to authorized users.

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S troke continues to be a major public health concern worldwide. As with other developed countries, it is the leading cause of death and a major neurological cause of long-term disability in Japan.1 Therefore, stroke prevention is a public health priority.Limitations in functional capacity after stroke are prevalent 2 because strokes often affect the memory and physical capabilities required to perform activities of daily living. A small but growing number of studies have challenged the conventional view that disability emerges after acute onset conditions, including stroke; that is, what is often thought of as stroke-related disability actually precedes stroke incidence.3-5 These studies measured disability by assessing basic activities of daily living (BADL), such as feeding, bathing, dressing, toileting, transferring, and continence 3,4 or cognitive function. 5Background and Purpose-Functional capacity is a predictor, as well as a consequence, of stroke. However, little research has been done to examine whether higher-level functional capacity above basic activities of daily living is a predictor of stroke. Methods-We followed 1493 Japanese community-dwelling adults aged ≥60 years (mean age, 70.1 years) who were independent in basic activities of daily living and had no history of stroke. Baseline data were collected using a selfadministered questionnaire. Higher-level functional capacity was measured using the total score and 3 subscales (instrumental activities of daily living, intellectual activity, and social role) derived from the Tokyo Metropolitan Institute of Gerontology Index of Competence. Adjusted hazard ratios and 95% confidence intervals were calculated by the Cox proportional hazards model. Results-During a mean follow-up of 10.4 years, 191 participants developed a first stroke. Impaired higher-level functional capacity based on total score of the Tokyo Metropolitan Institute of Gerontology Index of Competence was significantly associated with stroke (hazard ratio, 1.64; 95% confidence interval, 1.15-2.33). Among the 3 subscales, only intellectual activity was significantly associated with stroke (hazard ratio, 1.64; 95% confidence interval, 1.21-2.22). Social role was significantly associated with stroke only among those aged ≥75 years (hazard ratio, 1.78; 95% confidence interval, 1.07-2.98). Conclusions-Impaired higher-level functional capacity, especially in the domain of intellectual activity, was a predictor of stroke, even among community-dwelling older adults with independent basic activities of daily living at baseline. Lawton defined and systematized 7 stages of competence (ie, functional capacity) from the lowest and most basic function to the highest. 6 The stages were, in ascending order of complexity, life maintenance, functional health, perception and cognition, physical self-maintenance (corresponding to BADL), instrumental self-maintenance (instrumental activities of daily living [IADL]), effectance, and social role.6 Of these stages, the complex capacity to cover the last 3 stag...