Publications by authors named "Genta Kato"

12 Publications

  • Page 1 of 1

Maternal near-miss attributable to haemorrhagic stroke in patients with hypertensive disorders of pregnancy in Japan: A national cohort study.

Pregnancy Hypertens 2021 Aug 23;25:240-243. Epub 2021 Jul 23.

Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan. Electronic address:

Objectives: To investigate the epidemiologic and clinical characteristics of maternal near-misses attributable to haemorrhagic stroke (HS) occurring in patients with hypertensive disorders of pregnancy (HDP), with a focus on severe neurological morbidity.

Methods: A national retrospective cohort study was conducted using the national database of health insurance claims for the period 2010 to 2017. The subjects were all insured women with a diagnosis of both HDP and HS. Severe neurological morbidity requiring rehabilitation, types of HDP, types of HS, and magnesium sulphate use were tabulated.

Results: The number of women with HDP who were diagnosed with HS was 3.4 per 100,000 deliveries between 2010 and 2017. Forty percent of HDP-related HS cases had neurological morbidities requiring rehabilitation (1.4 per 100,000 deliveries), and 4.4% were in a persistent vegetative state after HS. Of the HDP cases who developed HS, 69.2% were severe HDP, of which 55.6% were without eclampsia. The most common type of HS was intracerebral haemorrhage (2.5 per 100,000 deliveries), followed by subarachnoid haemorrhage due to cerebral aneurysm (1.2 per 100,000 deliveries). The frequency of magnesium sulphate use increased in all patients with HDP-related HS in the second half of the study period (2014-2017) compared with the first half (2010-2013) (p < 0.0001). This was more evident in cases of HDP-related HS with eclampsia (31.9% to 83.8%) compared to those without eclampsia (25.0% to 42.9%).

Conclusion: Of the maternal near-miss cases due to HDP-related HS, 40.0% were rehabilitated and 69.2% were HDP without either eclampsia or severe hypertension.
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http://dx.doi.org/10.1016/j.preghy.2021.07.244DOI Listing
August 2021

Decreased Administration of Life-Sustaining Treatment just before Death among Older Inpatients in Japan: A Time-Trend Analysis from 2012 through 2014 Based on a Nationally Representative Sample.

Int J Environ Res Public Health 2021 03 18;18(6). Epub 2021 Mar 18.

Department of Health Informatics, Kyoto University School of Medicine and Public Health, Kyoto 606-8501, Japan.

The administration of intensive end-of-life care just before death in older patients has become a major policy concern, as it increases medical costs; however, care intensity does not necessarily indicate quality. This study aimed to describe the temporal trends in the administration of life-sustaining treatments (LSTs) and intensive care unit (ICU) admissions just before death in older inpatients in Japan. We utilized the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). Inpatients who were aged ≥65 years and died in October of 2012, 2013, or 2014 were analyzed. The numbers of decedents in 2012, 2013, and 2014 were 3362, 3473, and 3516, respectively. The frequencies of receiving cardiopulmonary resuscitation (CPR) (11.0% to 8.3%), mechanical ventilation (MV) (13.1% to 9.8%), central venous catheter (CVC) insertion (10.6% to 7.8%), and ICU admission (9.1% to 7.8%), declined between 2012 and 2014. After adjusting for age, sex, and type of ward, the declining trends persisted for CPR, MV, and CVC insertion relative to the frequencies in 2012. Our results indicate that the administration of LST just before death in older inpatients in Japan decreased from 2012 to 2014.
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http://dx.doi.org/10.3390/ijerph18063135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002940PMC
March 2021

Quality of Care in Chronic Kidney Disease and Incidence of End-stage Renal Disease in Older Patients: A Cohort Study.

Med Care 2020 07;58(7):625-631

Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Background: The quality of care received by a growing number of older patients with chronic kidney disease (CKD) has not been adequately examined.

Objective: The objective of this study was to assess the quality of CKD care among older patients and to clarify its association with the incidence of end-stage renal disease (ESRD).

Research Design: This was a population-based cohort study.

Subjects: Older (65 y and above) CKD patients diagnosed between October 2010 and September 2014 from the National Database of Health Insurance Claims of Japan.

Measures: A composite quality score (QS) of 3 quality measures for CKD care during the 6 months after CKD diagnosis was computed. The validated quality measures included urine testing for proteinuria, nutritional guidance, and nonsteroidal anti-inflammatory drugs avoidance. To assess the association between the QS and ESRD incidence, we used instrumental variable analysis after stratification for the history of diabetes.

Results: Among the 890,773 older CKD patients, 2.9% progressed to ESRD (incidence rate of 12.5 per thousand person-years). In total, 59.9% underwent urine testing, 4.5% received nutritional guidance, and 91.2% avoided regular use of nonsteroidal anti-inflammatory drugs. An instrumental variable analysis revealed that a higher QS was associated with-lower ESRD incidence in patients diagnosed with diabetes (hazard ratio: 0.25, 95% confidence interval: 0.24-0.27 for each point higher score) but not in patients without a diagnosis of diabetes (hazard ratio: 0.99, 95% confidence interval: 0.92-1.05).

Conclusion: Among older CKD patients, quality of CKD care varied between patients, and better quality of CKD care was associated with a lower ESRD incidence in patients with diabetes but not in nondiabetic patients.
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http://dx.doi.org/10.1097/MLR.0000000000001301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289129PMC
July 2020

A survey of clarithromycin monotherapy and long-term administration of ethambutol for patients with MAC lung disease in Japan: A retrospective cohort study using the database of health insurance claims.

Pharmacoepidemiol Drug Saf 2020 04 25;29(4):427-432. Epub 2019 Dec 25.

Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan.

Background: The number of patients with nontuberculous mycobacteriosis (NTM) has increased exponentially in recent years. In Japan, approximately 88.8% of patients with NTM suffer from Mycobacterium avium-intracellulare complex (MAC) lung disease. Incidence of MAC lung disease is increasing in particularly among the middle-aged and elderly women owing to a rapid increase in nontuberculous mycobacterial infections. General treatment for MAC lung disease is chemotherapy. The type of chemotherapy recommended by specialists to prevent the development of a drug-resistant strain of the bacteria consists of a combination of clarithromycin (CAM), rifampicin, and ethambutol (EB). CAM monotherapy is contraindicated by specialists owing to its high potential to induce drug-resistant bacterial strains in patients with MAC lung disease. In addition, administering EB at doses not less than 1000 mg d is not recommended to avoid adverse drug reactions. However, it is unclear how much such treatment cases exist in real world clinical settings. This is because no long-term investigation has been carried out.

Materials And Methods: This study investigated treatment with these drugs from 2005 to 2017, by studying 1135 patients with MAC lung disease based on health insurance claims database.

Results: Results showed that approximately 9.2% (101 cases) were prescribed long-term CAM monotherapy for 3 months or longer and approximately 3.6% (18 cases) were prescribed high doses of EB.

Conclusion: CAM monotherapy over a long period of time is potentially detrimental to some patients. Better awareness of the types of treatments and their potential negative effects will be beneficial to clinical practitioners.
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http://dx.doi.org/10.1002/pds.4951DOI Listing
April 2020

Absolute risk of acute coronary syndrome after severe hypoglycemia: A population-based 2-year cohort study using the National Database in Japan.

J Diabetes Investig 2020 Mar 7;11(2):426-434. Epub 2019 Nov 7.

Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan.

Aims/introduction: Although the epidemiological relationship between hypoglycemia and increased risk of acute coronary syndrome (ACS) has been well established, the time period for increased risk of ACS after a severe hypoglycemic episode remains unknown. The present study aimed to determine the ACS risk after a severe hypoglycemic episode.

Materials And Methods: We carried out a retrospective population-based cohort study based on national claims data in Japan. We retrieved data of diabetes patients aged ≥35 years collected from April 2014 to March 2016. The absolute risk of ACS was defined as the occurrence of an emergency percutaneous coronary intervention after a severe hypoglycemic episode.

Results: In total, data of 7,909,626 patients were included in the analysis. The absolute risk of ACS was 2.9 out of 1,000 person-years in all patients. ACS risk in patients with severe hypoglycemic episodes was 3.0 out of 1,000 person-years. Severe hypoglycemic episodes increased the absolute risk of ACS in patients aged ≥70 years, but not in patients aged <70 years. The absolute risk of ACS was 10.6 out of 1,000 person-years within 10 days of a severe hypoglycemic episode. There was a significant trend between shorter duration after an episode and higher ACS risk.

Conclusions: Severe hypoglycemia was associated with an increased risk of ACS in elderly diabetes patients. ACS risk increased with a shorter period after a severe hypoglycemic episode, suggesting that severe hypoglycemia leads to an increased risk of ACS in diabetes patients. These findings show that it is important to avoid severe hypoglycemia while treating diabetes, particularly in elderly patients.
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http://dx.doi.org/10.1111/jdi.13153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7078084PMC
March 2020

Potentially Inappropriate Medication Prescribing and Risk of Unplanned Hospitalization among the Elderly: A Self-Matched, Case-Crossover Study.

Drug Saf 2018 10;41(10):959-968

Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.

Introduction/objectives: An association between potentially inappropriate medication (PIM) use and adverse events has been established. However, PIM criteria for elderly patients and medical circumstance vary in different countries. We investigated the association between PIM use according to Japanese guidelines and unplanned hospitalization among elderly patients.

Design: A case-crossover study was conducted.

Setting/participants: We used the Japanese Medical Data Vision database of 17.9 million people from 270 acute care hospitals across Japan. Records from 247,897 patients aged ≥ 65 years with unscheduled admissions between January 2009 and December 2015 were analyzed.

Measurements: We defined PIM use according to the Japanese Guidelines for Medical Treatment and Its Safety in the Elderly and used conditional logistic regression analysis to fit self-matched case-crossover models and compared each patient's PIM use over five case periods (1, 2, 4, 8, and 12 weeks) prior to each unplanned hospitalization.

Results: We found the highest odds ratios (ORs) of unscheduled admission related to PIM use in the 1-week case period [OR 4.15; 95% confidence interval (CI) 4.05-4.25], followed by the 2-week (OR 3.01; 95% CI 2.95-3.07), 4-week (OR 3.91; 95% CI 3.83-4.00), 8-week (OR 2.00; 95% CI 1.96-2.05), and 12-week case periods (OR 1.48; 95% CI 1.44-1.51).

Conclusions: Elderly patients commonly used PIMs, especially antidiabetics and diuretics. PIM use was associated with a 1.5- to 4-fold increase in the ORs of unplanned hospitalization among them.
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http://dx.doi.org/10.1007/s40264-018-0676-9DOI Listing
October 2018

Nationwide survey of severe postpartum hemorrhage in Japan: an exploratory study using the national database of health insurance claims.

J Matern Fetal Neonatal Med 2019 Nov 26;32(21):3537-3542. Epub 2018 Apr 26.

c Solutions Center for Health Insurance Claims, Kyoto University Hospita , Kyoto , Japan.

The aim of this study was to investigate epidemiological and clinical aspects of severe postpartum hemorrhage (PPH) in Japan. We used national health insurance claims from 2011 to 2014 provided by the Ministry of Health, Labour and Welfare. The data included randomly selected claims that covered 10% of all inpatients in October, a so-called sampling dataset (covering 1/120 inpatients per year). We extracted claims for transfused blood, and further narrowed down the claims by names of diseases linked to PPH. As most referral obstetric facilities have adopted the diagnosis procedure combination (DPC)-based payment system while small-scale obstetric facilities have not (non-DPC facilities), the claims were also analyzed separately for DPC and non-DPC facilities. We assessed the incidence and causes of PPH, transfusion volume of red blood cells (RBC) and fresh frozen plasma (FFP), and surgical hemostatic management. The number of PPH cases that required blood transfusion in the sampling dataset was 29, 29, 32, and 36 in 2011, 2012, 2013, and 2014, respectively. The leading cause of PPH was uterine atony followed by placental abruption. Although no specific trends were observed for the volume of transfused RBC (1467 ± 234 ml in 2014), there was a steady increase in the rate of FFP utilization in non-DPC facilities from 37% to 79% over the 4-year sampling period. Intrauterine balloon tamponade emerged in 2014. This nationwide survey indicates that the annual incidence of severe PPH is increasing. Furthermore, FFP has become more prevalent in small-scale obstetric facilities.
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http://dx.doi.org/10.1080/14767058.2018.1465921DOI Listing
November 2019

The first report of Japanese antimicrobial use measured by national database based on health insurance claims data (2011-2013): comparison with sales data, and trend analysis stratified by antimicrobial category and age group.

Infection 2018 Apr 22;46(2):207-214. Epub 2017 Dec 22.

Department of infectious Diseases, Nagoya University Hospital, Nagoya, Aichi, Japan.

Purpose: Our objective was to evaluate the utility of the national database (NDB) based on health insurance claims data for antimicrobial use (AMU) surveillance in medical institutions in Japan.

Methods: The population-weighted total AMU expressed as defined daily doses (DDDs) per 1000 inhabitants per day (DID) was measured by the NDB. The data were compared with our previous study measured by the sales data. Trend analysis of DID from 2011 to 2013 and subgroup analysis stratified by antimicrobial category and age group were performed.

Results: There was a significant linear correlation between the AMUs measured by the sales data and the NDB. Total oral and parenteral AMUs (expressed in DID) were 1.04-fold from 12.654 in 2011 to 13.202 in 2013 and 1.13-fold from 0.734 to 0.829, respectively. Percentage of oral form among total AMU was high with more than 94% during the study period. AMU in the children group (0-14 years) decreased from 2011 to 2013 regardless of dosage form, although the working age group (15-64 years) and elderly group (65 and above years) increased. Oral AMU in the working age group was approximately two-thirds of those in the other age groups. In contrast, parenteral AMU in the elderly group was extremely high compared to the other age groups.

Conclusions: The trend of AMU stratified by antimicrobial category and age group were successfully measured using the NDB, which can be a tool to monitor outcome indices for the national action plan on antimicrobial resistance.
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http://dx.doi.org/10.1007/s15010-017-1097-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871632PMC
April 2018

Analysis of the evidence-practice gap to facilitate proper medical care for the elderly: investigation, using databases, of utilization measures for National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB).

Environ Health Prev Med 2017 Jun 6;22(1):51. Epub 2017 Jun 6.

Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

As Japan becomes a super-aging society, presentation of the best ways to provide medical care for the elderly, and the direction of that care, are important national issues. Elderly people have multi-morbidity with numerous medical conditions and use many medical resources for complex treatment patterns. This increases the likelihood of inappropriate medical practices and an evidence-practice gap. The present study aimed to: derive findings that are applicable to policy from an elucidation of the actual state of medical care for the elderly; establish a foundation for the utilization of National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), and present measures for the utilization of existing databases in parallel with NDB validation.Cross-sectional and retrospective cohort studies were conducted using the NDB built by the Ministry of Health, Labor and Welfare of Japan, private health insurance claims databases, and the Kyoto University Hospital database (including related hospitals). Medical practices (drug prescription, interventional procedures, testing) related to four issues-potential inappropriate medication, cancer therapy, chronic kidney disease treatment, and end-of-life care-will be described. The relationships between these issues and clinical outcomes (death, initiation of dialysis and other adverse events) will be evaluated, if possible.
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http://dx.doi.org/10.1186/s12199-017-0644-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664421PMC
June 2017

Functional interactions between BLM and XRCC3 in the cell.

J Cell Biol 2007 Oct;179(1):53-63

Molecular Cell Biology Laboratory, Graduate School of Pharmaceutical Science, Tohoku University, Sendai 980-8578, Japan.

Bloom's syndrome (BS), which is caused by mutations in the BLM gene, is characterized by a predisposition to a wide variety of cancers. BS cells exhibit elevated frequencies of sister chromatid exchanges (SCEs), interchanges between homologous chromosomes (mitotic chiasmata), and sensitivity to several DNA-damaging agents. To address the mechanism that confers these phenotypes in BS cells, we characterize a series of double and triple mutants with mutations in BLM and in other genes involved in repair pathways. We found that XRCC3 activity generates substrates that cause the elevated SCE in blm cells and that BLM with DNA topoisomerase IIIalpha suppresses the formation of SCE. In addition, XRCC3 activity also generates the ultraviolet (UV)- and methyl methanesulfonate (MMS)-induced mitotic chiasmata. Moreover, disruption of XRCC3 suppresses MMS and UV sensitivity and the MMS- and UV-induced chromosomal aberrations of blm cells, indicating that BLM acts downstream of XRCC3.
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http://dx.doi.org/10.1083/jcb.200702183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2064734PMC
October 2007

WRN counteracts the NHEJ pathway upon camptothecin exposure.

Biochem Biophys Res Commun 2007 Apr 7;355(2):477-82. Epub 2007 Feb 7.

Molecular Cell Biology Laboratory, Graduate School of Pharmaceutical Sciences, Tohoku University, Aoba 6-3, Aramaki, Aoba-ku, Sendai 980-8578, Japan.

We investigated the function of the interaction between WRN (Werner syndrome gene product) and Ku70 and between WRN and DNA-PKcs, which are components of the DNA-PKcs/Ku70/Ku80 complex, by generating KU70(-/-)/WRN(-/-) and DNA-PKcs(-/-/-)/WRN(-/-) double-gene knockout chicken DT40 cells. When treated with camptothecin (CPT), an inhibitor of DNA topoisomerase I, WRN(-/-) cells showed higher sensitivity than wild-type cells, whereas KU70(-/-) and DNA-PKcs(-/-/-) cells showed hyper-resistance. Disruption of KU70 or DNA-PKcs suppressed the sensitivity of WRN(-/-) cells to CPT, rendering them as resistant to CPT treatment as KU70(-/-) and DNA-PKcs(-/-/-) cells. On the other hand, CPT sensitivity of BLM(-/-) cells, which are defective in a RecQ helicase similar to WRN, was enhanced by deletion of KU70. The implications for the function of WRN in the non-homologous end-joining pathway of DNA repair involving Ku70 and DNA-PKcs, which may be the cause of lethality in the presence of CPT, will be discussed.
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http://dx.doi.org/10.1016/j.bbrc.2007.01.175DOI Listing
April 2007

Bloom helicase and DNA topoisomerase IIIalpha are involved in the dissolution of sister chromatids.

Mol Cell Biol 2006 Aug;26(16):6299-307

Molecular Cell Biology Laboratory, Graduate School of Pharmaceutical Sciences, Tohoku University, Aoba 6-3, Aramaki, Aoba-ku, Sendai 980-8578, Japan.

Bloom's syndrome (BS) is an autosomal disorder characterized by predisposition to a wide variety of cancers. The gene product whose mutation leads to BS is the RecQ family helicase BLM, which forms a complex with DNA topoisomerase IIIalpha (Top3alpha). However, the physiological relevance of the interaction between BLM and Top3alpha within the cell remains unclear. We show here that Top3alpha depletion causes accumulation of cells in G2 phase, enlargement of nuclei, and chromosome gaps and breaks that occur at the same position in sister chromatids. The transition from metaphase to anaphase is also inhibited. All of these phenomena except cell lethality are suppressed by BLM gene disruption. Taken together with the biochemical properties of BLM and Top3alpha, these data indicate that BLM and Top3alpha execute the dissolution of sister chromatids.
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http://dx.doi.org/10.1128/MCB.00702-06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592785PMC
August 2006
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