Background In contemporary Western settings, higher occupational class is associated with lower risk for cardiovascular disease ( CVD ) incidence, including coronary heart disease ( CHD ) and stroke. However, in non‐Western settings (including Japan), the occupational class gradient for cardiovascular disease risk has not been characterized. Methods and Results Using a nationwide, multicenter hospital inpatient data set (1984–2016) in Japan, we conducted a matched hospital case‐control study with ≈1.1 million study subjects. Based on a standard national classification, we coded patients according to their longest‐held occupational class (blue‐collar, service, professional, manager) within each industrial sector (blue‐collar, service, white‐collar). Using blue‐collar workers in blue‐collar industries as the referent group, odds ratios and 95% CI s were estimated by conditional logistic regression with multiple imputation, matched for sex, age, admission date, and admitting hospital. Smoking and drinking were additionally controlled. Higher occupational class (professionals and managers) was associated with excess risk for CHD . Even after controlling for smoking and drinking, the excess odds across all industries remained significantly associated with CHD , being most pronounced among managers employed in service industries (odds ratio, 1.19; 95% CI , 1.08–1.31). On the other hand, the excess CHD risk in higher occupational class was offset by their lower risk for stroke (eg, odds ratio for professionals in blue‐collar industries, 0.77; 95% CI , 0.70–0.85). Conclusions The occupational “gradient” in cardiovascular disease (with lower risk observed in higher status occupations) may not be a universal phenomenon. In contemporary Japanese society, managers and professionals may experience higher risk for CHD .

Prostaglandin E synthase (PGES) is a recently identified terminal enzyme that acts downstream of cyclooxygenase and catalyzes the conversion of prostaglandin (PG) H2 to PGE2. At least three isozymes have been cloned so far, which are called membrane-associated PGES (mPGES)-1, mPGES-2, and cytosolic PGES. Among them, mPGES-1 is induced by various inflammatory stimuli in some cells and tissues. Induction of mPGES-1 in the component of articular tissues of patients with rheumatoid arthritis and osteoarthritis has been demonstrated in vitro. Recent studies using adjuvant induced arthritis model have shown the increase of mPGES-1 expression resulted in the increase of PGE2 production at the sites of inflammation. In addition, reports of mPGES-1-deficient mice clearly suggest the role of mPGES-1 in the process of chronic inflammation such as collagen-induced arthritis and collagen antibody induced arthritis in vivo. Thus, recent in vitro and in vivo findings suggest that mPGES-1 may be a novel therapeutic target for arthritis. This paper introduces recent advances in research about the role of PGES in the pathophysiology of arthritis.

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Background: Advanced Life Support (ALS) is regarded to be associated with improved survival in pre-hospital trauma care when compared to Basic Life Support (BLS) irrespective of lack of evidence. The aim of this study is to ascertain ALS improves survival for trauma in prehospital settings when compared to BLS.Methods: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for published controlled trials (CTs), and observational studies that were published until Aug 2017. The population of interest were adults (>18 years old) trauma patients who were transported by ground transportation and required resuscitation in prehospital settings. We compared outcomes between the ALS and BLS groups. The primary outcome was in-hospital mortality and secondary outcomes were neurological outcome and time spent on scene.Results: We identified 2,502 studies from various databases and 10 studies were included in the analysis (two CTs, and eight observational studies). The outcomes were not statistically significant between the ALS and BLS groups (pooled OR 1.14; 95% CI 0.95 to 1.36 for mortality, pooled OR 1.12; 95% CI 0.88 to 1.42 for good neurological outcomes, pooled mean difference −0.96; 95% CI−6.64 to 4.72 for on-scene time) in CTs. In observational studies, ALS prolonged on-scene time and increased mortality (pooled OR 1.56; 95% CI: 1.31 to 1.86 for mortality, and pooled mean difference, 1.26; 95% CI: 0.07 to 2.45 for on-scene time).Conclusions: In prehospital settings, the present study showed no advantages of ALS on the outcomes in patients with trauma compared to BLS.

Developing an adequate disaster response capacity involves an assessment of available resources in areas that are vulnerable to disaster. Here, we sought to evaluate the gap between predicted damage in a foreseeable major earthquake versus existing municipalitylevel resources in Tokyo, Japan. Methods Our study focused on the 53 municipalities in Tokyo to evaluate the relationships between the predicted number of severe casualties per 1,000 population from a future earthquake, community characteristics, and inpatient bed supply in local hospitals. Correlation analysis and supply-demand balance estimations were carried out at the municipality level, and the results were geographically visualized using choropleth maps. Results The correlation analysis showed that higher casualties were correlated with municipalities with faster population increase, higher taxable incomes, lower unemployment rates, and higher bed volumes in disaster base hospitals. Under a maximal damage scenario in a future earthquake, we predict a shortage of 2,780 beds for the treatment of severe casualties across Tokyo. Even under a scenario of cooperation among neighboring municipalities, a shortage of 7,107 beds would remain. Conclusions Tokyo is located in a zone where major earthquake damage is anticipated. Cooperation between neighboring municipalities may not suffice to address the undersupply of beds during the acute phase of a disaster. Hence, existing disaster preparedness plans require further reinforcement with a focus on local vulnerabilities.

The integration of external staff into a hospital’s disaster response can present technical challenges. Although hospitals will always prefer to use their own staff in disaster response, there have been many historical examples where external staffing is required. During the 2016 Kumamoto Earthquakes, the Oita Prefectural Hospital required medical professionals to expand disaster response staff. They were able to identify 2 appropriate emergency physicians belonging to a remote hospital who had previously worked at the Oita Prefectural hospital. The physicians were effectively able to supplement the hospital staff, providing care for additional patients, and giving the existing on-duty staff some respite. Based on our experience, we suggest that hospital coalitions and disaster response authorities explore mechanisms of cross-credentialing and cross-training staff to make it easier to share staff in a disaster.

Delivering adequate healthcare in the setting of the ongoing pandemic is challenging. Due to 2019 coronavirus disease (COVID-19), the Tokyo Metropolitan government has been forced to expand their acute healthcare capacity corresponding to infectious diseases within a short period. Responding to this situation, health emergency and disaster experts of the Tokyo Disaster Medical Assistance Team took the initiative in creating a brief education course. We established the course for expanding infectious disease care capacity by a dedicated hands-on lecture for health professionals who are unfamiliar with infectious disease care in ordinary circumstances. Our lecture included the typical course of COVID-19, usage of personal protective equipment, environmental sterilization, medical-ward zoning, and safe caregiving. Hospitals that received customized lectures reported via a questionnaire that the lectures were well suited to their needs. Currently, the healthcare system in Tokyo has increased its capacity to meet the demand and has not been affected by COVID-19. Our experience shows that health emergency and disaster experts can assist hospitals in crisis by providing educational materials.

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