Limited and inconsistent studies exist on the association between the intake of fish, n − 3 polyunsaturated fatty acids (PUFA) and n − 6 PUFA and breast cancer. Fish and n − 3 PUFA support various body functions and are thought to reduce the carcinogenesis risk while n − 6 PUFA may have a positive association with cancer risk. We examined the association between intake of fish, n − 3 PUFA [including eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), docosapentaenoic acid (DPA) and alpha‐linolenic acid (ALA)] and n − 6 PUFA and breast cancer with subanalyses on estrogen (ER) and progesterone receptor (PR) status. We investigated 38,234 Japanese women aged 45–74 years from the Japan Public Health Center‐based prospective study (JPHC study), and during 14.1 years of follow‐up time, 556 breast cancer cases were newly diagnosed. Breast cancer risk was not associated with the intake of total fish, n − 3 PUFA and n − 6 PUFA when analyzed in totality through multivariable Cox proportional hazards regression models with age as the time scale. Intake of total n − 6 was positively associated with the development of ER+PR+ tumors [multivariable‐adjusted HR Q4 vs. Q1 = 2.94 (95% CI: 1.26–6.89; ptrend = 0.02)]. Intake of EPA was associated with a decreased breast cancer risk for ER+PR+ tumors [multivariable‐adjusted HR Q2 vs. Q1 = 0.47 (95% CI: 0.25–0.89; ptrend =0.47)]. While the overall association between the intake of total fish, n − 3 PUFA and n − 6 PUFA and breast cancer risk is null, for ER+PR+ tumors, a positive association was seen between n − 6 intake and breast cancer, and a marginally significant inverse association was observed for EPA intake.

Anemia is a common complication for patients with chronic kidney disease (CKD) and is associated with cardiovascular comorbidities and reduced quality of life. The incidence of anemia increases as kidney function declines and affects approximately 32% of Japanese patients with stage 3-5 CKD. This review examined the current literature on anemia in CKD patients in Japan to provide an overview of the burden of anemia in CKD. Medline, Embase, and Igaku Chuo Zasshi databases were searched to identify relevant manuscripts and abstracts published from 2004 onward. The population included CKD patients with anemia, and the outcomes of interest were epidemiology, economic, humanistic, and treatment patterns. Observational studies, database analysis, and economic evaluation studies were included in the analysis. A total of 1151 references were identified, and 50 were eligible for final review. Economic burden was reported in most studies (n = 37) followed by treatment patterns (n = 26), and epidemiological (n = 25) and humanistic (n = 1) burdens. Prevalence of anemia varied largely (0-95%) based on the different definitions of anemia, and increased with CKD severity. Higher mortality was associated with erythropoiesis-stimulating agent (ESA) resistance and lower hemoglobin levels among patients treated with ESA. Drug dosage was the most reported economic burden (n = 33), followed by medical, and non-medical outcomes. Costs associated with anemia were considerable and depended on dialysis status and ESA treatment. Only one study reported data on quality of life, suggesting that further investigation on the humanistic burden of anemia in CKD is needed.

ObjectiveTo assess the medium-term indirect impact of the 2011 Fukushima Daiichi nuclear accident on cardiovascular disease (CVD) risks and to identify whether risk factors for CVD changed after the accident.ParticipantsResidents aged 40 years and over participating in annual public health check-ups from 2009 to 2012, administered by Minamisoma city, located about 10 to 40 km from the Fukushima Daiichi nuclear plant.MethodsThe sex-specific Framingham CVD risk score was considered as the outcome measure and was compared before (2009–2010) and after the accident (2011–2012). A multivariate regression analysis was employed to evaluate risk factors for CVD.ResultsData from 563 individuals (60.2% women) aged 40 to 74 years who participated in the check-ups throughout the study period was analysed. After adjusting for covariates, no statistically significant change was identified in the CVD risk score postaccident in both sexes, which may suggest no obvious medium-term health impact of the Fukushima nuclear accident on CVD risk. The risk factors for CVD and their magnitude and direction (positive/negative) did not change after the accident.ConclusionsThere was no obvious increase in CVD risks in Minamisoma city, which may indicate successful management of health risks associated with CVD in the study sample.

Aims: This article aimed to examine the cost-effectiveness of rivaroxaban in comparison to warfarin for stroke prevention in Japanese patients with non-valvular atrial fibrillation (NVAF), from a public healthcare payer's perspective. Materials and methods: Baseline event risks were obtained from the J-ROCKET AF trial and the treatment effect data were taken from a network meta-analysis. The other model inputs were extracted from the literature and official Japanese sources. The outcomes included the number of ischaemic strokes, myocardial infarctions, systemic embolisms and bleedings avoided, life-years, quality-adjusted life-years (QALYs), incremental costs and incremental cost-effectiveness ratio (ICER). The scenario analysis considered treatment effect data from the same network meta-analysis. Results: In comparison with warfarin, rivaroxaban was estimated to avoid 0.284 ischaemic strokes per patient, to increase the number of QALYs by 0.535 per patient and to decrease the total costs by ¥118,892 (e1,011.11) per patient (1 JPY ¼ 0.00850638 EUR; XE.com, 7 October 2019). Consequently, rivaroxaban treatment was found to be dominant compared to warfarin. In the scenario analysis, the ICER of rivaroxaban versus warfarin was ¥2, 873,499 (e24,446.42) per QALY. Limitations: The various sources of data used resulted in the heterogeneity of the cost-effectiveness analysis results. Although, rivaroxaban was cost-effective in the majority of cases. Conclusion: Rivaroxaban is cost-effective against warfarin for stroke prevention in Japanese patients with NVAF, giving the payer WTP of 5,000,000 JPY. ARTICLE HISTORY

(SR) was conducted using MEDLINE and EMBASE (1996-2017). Key terms included a combination of neurogenic bladder, treatment patterns and epidemiological study. The inclusion criteria for studies were: 1) published in English; 2) conducted in human subjects; 4) reporting the treatment patterns/use in NGB (any neurogenic condition listed in the EAU guidelines); 5) conducted in a real world setting. Articles were reviewed for inclusion by an independent reviewer (AJ) and 10% were cross examined by a second independent reviewer (FF). A narrative synthesis of results was conducted and percentage of treatment use was reported in ranges. Results: A total of eight studies met the inclusion criteria. Study designs, setting, and patient groups were notably heterogeneous and all data was collected before 2008. This SR found that the most commonly used management method amongst NGB patients was reflex voiding (RV) methods and catheterisation (CIC and IndUC). Data and commentary from three studies show that a notable amount of patients switched treatments. The most popular oral pharmacotherapies were alpha-blockers and antimuscarinics used for neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). One study which focused on spina bifida reported that the majority of patients underwent surgery. ConClusions: With passing time, clinicians have moved away from techniques associated with higher rates of complications and mortality. This has meant that in recent years, the survival chances of patients with NGB have increased. This suggests that current treatment patterns will be different from what was uncovered in this review. Epidemiological studies using electronic healthcare records (EHRs) are necessary to advance our understanding in how NGB patients are managed in current practice, and how well patterns relate to practice guidelines.