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•We examined associations between nighttime skin temperature (ST) and sleep quality.•Nighttime ST was lower in patients with Parkinson's disease (PD).•There were interactions between nighttime ST and PD for various sleep measurements.•Within-individual changes in nighttime ST were linked to actigraphic sleep changes.•Enhancing heat dissipation may improve sleep quality in patients with PD.

•What is the primary question addressed by this study?Whether passive body heating by hot water bathing improves depressive symptoms among older adults is unknown, although previous studies suggested the antidepressant effect of passive body heating through activating warm-sensitive neural pathways.•What is the main finding of this study?A higher frequency of hot water bathing was associated with a lower prevalence of depressive symptoms in the general older population independent of potential confounders.•What is the meaning of the finding?A shorter interval from bathing to bedtime was associated with a lower prevalence of depressive symptoms independent of hot water temperature and bathing duration.This hypothesis provides a framework for future interventional studies examining the effect of hot water bathing on depression.

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Purpose To assess skin perfusion pressure (SPP) changes after endovascular treatment (EVT) of patients with chronic limb-threatening ischemia (CLTI) and to explore preoperative factors that affect SPP changes.Materials and Methods This prospective, multicenter study recruited 147 patients (mean age 74 years; 99 men) with ischemic wounds at 6 vascular centers in Japan between July 2017 and December 2018. Over half of the patients (92, 63%) were diabetic, and 76 (52%) required dialysis. Sixty-four patients (43%) had WIfI (wound, ischemia, foot infection) wound grades of 2 or 3; 59 (40%) had foot infections. SPP was measured before and 1, 2, 7, and 30 days after EVT to establish inline flow to the ischemic foot based on the angiosome concept when feasible. The anterior and posterior tibial arteries and the peroneal artery were revascularized in 66 (45%), 50 (34%), and 30 (21%) patients, respectively.Results Both the dorsal and plantar SPPs at 1 or 2 days post-EVT were significantly higher than those at baseline (p<0.001), and both SPPs increased further at 1 month compared with those at 1 (p=0.001) or 2 days (p=0.006) post-EVT. SPP increases occurred on the dorsal and plantar surfaces of the foot regardless of the vessel revascularized. The SPP increase at 1 month after EVT was significantly lower in patients with foot infections than that in those without foot infections (p=0.003). Age, sex, diabetes, dialysis, wound severity, and direct revascularization did not affect the pattern of SPP change.Conclusion The SPP increased continuously up to 1 month after EVT, though the increase was smaller in patients with wound infections. The SPP on the dorsal and plantar surfaces increased, regardless of the vessel revascularized, which could justify indirect revascularization when direct revascularization is technically challenging.

IMPORTANCE: Cataract surgery, which increases perception of light, may increase melatonin secretion. Melatonin secretion has been associated with depression, diabetes, cognitive impairment, and breast cancer. To date, no evidence from a randomized clinical trial exists to support this cataract surgery hypothesis. OBJECTIVE: To determine whether cataract surgery modifies the melatonin secretion at 3 months after cataract surgery in 169 adult patients. DESIGN, SETTING, AND PARTICIPANTS: A parallel-group randomized clinical trial was conducted at a single referral center from July 1, 2014, to June 30, 2017. Data were analyzed from January 1, 2018, to March 31, 2019. Patients were aged 60 years or older, had no history of cataract surgery, and had cataracts with grade 2 or higher nuclear opacifications based on the Lens Opacities Classification System III. Analyses were based on intention to treat. INTERVENTIONS: Patients were randomized 1:1:1:1 to receive cataract surgery using artificial clear intraocular lens (IOL) or yellow IOL. Group 1 received prompt surgery with clear IOL, group 2, prompt surgery with yellow IOL, group 3, delayed surgery with clear IOL, and group 4, delayed surgery with yellow IOL. The intervention group consisted of groups 1 and 2, and the control group consisted of groups 3 and 4. MAIN OUTCOMES AND MEASURES: Urinary melatonin excretion in the intervention group was measured at 3 months after surgery, and urinary melatonin excretion in the control group was measured before delayed surgery. RESULTS: Of the 169 randomized patients, 97 were men (57.4%). The mean (SD) age was 75.7 (6.7) years. Mean urinary melatonin excretion was calculated as standardized urinary concentration, the ratio of urinary concentration to urinary creatinine concentration (nanograms per milligram of creatinine), in the intervention group after cataract surgery. Mean urinary melatonin excretion was significantly higher than in the control group (adjusted mean difference of creatinine concentration, 0.159 log ng/mg, 95% CI, 0.045-0.273; P = .007) independent of baseline urinary melatonin excretion and potential confounders. Subgroup analysis comparing group 1 with group 3 revealed that concentration of urinary melatonin excretion in patients who received clear IOLs was higher than the control group by creatinine concentration 0.212 log ng/mg (95% CI of the difference, 0.058-0.365; P = .008). However, the difference between patients in group 2 and group 4 was not significant (adjusted mean difference for creatinine excretion, 0.083 log ng/mg, 95% CI, –0.087 to 0.253; P = .33). The difference of concentration of mean urinary melatonin excretion between patients in group 1 and those in group 2 was not significant (95% CI of the difference for creatinine concentration, –0.19 to 0.40 log ng/mg; P = .48). CONCLUSIONS AND RELEVANCE: The findings in this study support the hypothesis that cataract surgery increases melatonin secretion. The effect of clear IOLs vs yellow IOLs on these outcomes was not shown to be different. TRIAL REGISTRATION: UMIN-CTR Identifier: UMIN000014559

Purpose:To evaluate the effect of vessel calcification on in-stent restenosis (ISR) after drug-coated stent (DCS) placement in the femoropopliteal segment. Materials and Methods:A retrospective multicenter study was undertaken involving 220 consecutive symptomatic patients (mean age 73.1±8.3 years; 175 men) with femoropopliteal lesions in 230 limbs treated with the Zilver PTX DCS and having duplex surveillance after the endovascular procedures. Mean lesion length was 16.4±9.8 cm (range 2–40); there were 104 (45.2%) total occlusions and 68 (29.6%) in-stent restenoses (ISR). Twenty (8.7%) vessels had no runoff. The majority of lesions (148, 64.3%) were calcified according to the peripheral arterial calcium scoring system (PACSS). Primary patency was evaluated by duplex. Lesions were classified as either PACSS 0–2 (none or unilateral wall calcification) or PACSS 3 and 4 (bilateral wall calcification). Multivariate analysis was performed to identify variables associated with ISR; the results are given as the hazard ratio (HR) and 95% confidence interval (CI). Results:The 1-, 2-, and 5-year primary patency and freedom from clinically-driven target lesion revascularization estimates were 75.9%, 63.6%, and 45.0%, and 84.7%, 73.7%, and 54.2%, respectively. Major amputations were performed on 4 limbs during follow-up. In multivariate analysis, vessel calcification (adjusted HR 1.718, 95% CI 1.035 to 2.851, p=0.036) was significantly correlated with the occurrence of ISR, along with lesion length (adjusted HR 1.041, 95% CI 1.013 to 1.070, p=0.003), and cilostazol administration (adjusted HR 0.476, 95% CI 0.259 to 0.876, p=0.017). Conclusion:This study suggested that bilateral vessel wall calcification was an independent risk factor for ISR in complex femoropopliteal lesions after Zilver PTX DCS placement, along with lesion length; cilostazol administration had a protective effect.

BackgroundGlaucoma may cause physiological and behavioural circadian misalignment because of the loss of intrinsically photosensitive retinal ganglion cells, the primary receptors of environmental light. Although studies have suggested a high prevalence of depression in patients with glaucoma, it is unclear whether the association is independent of the light exposure profiles as an important confounding factor.MethodsIn this cross-sectional study of a community-based cohort of 770 elderly individuals (mean age, 70.9 years), glaucomatous optic discs were assessed using fundus photographs and depressive symptoms were assessed using the short version of the Geriatric Depression Scale (GDS). Daytime and night-time ambient light exposures were objectively measured for 2 days.ResultsDepressive symptoms (GDS score ≥6) were observed in 114 participants (prevalence, 14.8%) and glaucomatous optic discs were detected in 40 participants (prevalence, 5.2%). The prevalence of depressive symptoms was significantly higher in the group with glaucomatous optic disc than in the group without it (30.0% vs 14.0%, respectively; p=0.005). Multivariable logistic regression analysis adjusted for potential confounding factors, including daytime and night-time light exposures, revealed that the OR for depressive symptoms was significantly higher in the group with glaucomatous optic disc than in the group without it (OR 2.45, 95% CI 1.18 to 5.08; p=0.016).ConclusionsIn this general elderly population, glaucomatous optic disc was significantly associated with higher prevalence of depressive symptoms independent of a number of potential confounding factors, including daily light exposure profiles.

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Excess mortality from cardiovascular disease during cold seasons is a worldwide issue. Although some physiologic studies suggests that platelet activation via cold exposure may cause an increased incidence of cardiovascular disease in winter, the influence of indoor cold exposure in real-life situations on platelet (PLT) count remains unclear.

Context:Previous epidemiological studies have suggested an association between nighttime light levels and the prevalence of obesity, although evidence is limited to cross-sectional studies.Objective:To evaluate the longitudinal association between ambient light exposure and the subsequent changes in obesity parameters.Design and Participants:Data from 1110 elderly participants at baseline (mean age, 71.9 years) and data from 766 at follow-up (median, 21 months) were included in this prospective population-based study.Measures:Time-dependent ambient light exposure based on objective measurements and changes in the waist-to-height ratio (WHtR) and body mass index (BMI) were measured.Results:Multivariable mixed-effect linear regression models showed a significant association between light exposure and the %WHtR gain; this was independent of potential confounders (eg, caloric intake, physical activity, and sleep/wake parameters). Nighttime or evening exposure to higher light intensity was significantly associated with subsequent %WHtR gain. Morning exposure to a longer time ≥500 lux or nighttime exposure to a longer time <3 lux was significantly associated with subsequent %WHtR loss. These association trends were nearly consistent when the BMI was used as an obesity parameter. Increased nighttime light exposure (mean ≥3 vs <3 lux) was estimated to correspond to a 10.2% WHtR gain and a 10.0% increase in BMI over 10 years.Conclusions:Ambient light exposure, such as increased nighttime or evening light exposure and decreased morning light exposure, was independently associated with subsequent increases in obesity parameters. Further interventional studies are warranted to establish an optimal controlled lighting environment as a preventive option against obesity.

Context:In contrast with randomized controlled trials, observational studies have suggested that physiological levels of melatonin are reduced in patients with dementia or depression, but the relationship has not been evaluated in large populations.Objective:The objective was to determine the relationships between physiological levels of melatonin and cognitive function and depressive symptoms.Design and Participants:A cohort of 1105 community-dwelling elderly individuals was enrolled in this cross-sectional study (mean age, 71.8 ± 7.1 y).Measures:Urinary 6-sulfatoxymelatonin excretion (UME) and Mini-Mental State Examination (MMSE; n = 935) and Geriatric Depression Scale (GDS; n = 1097) scores were measured as indices of physiological melatonin levels, cognitive function, and depressive symptoms, respectively.Results:With increases in UME quartiles, the prevalence of cognitive impairment (MMSE score ≤ 26) and depressed mood (GDS score ≥ 6) significantly decreased (Pfor trend = .003 and .012, respectively). In multivariate logistic regression models, after adjusting for confounders such as age, gender, socioeconomic status, physical activity, and sleep/wake cycles, higher UME levels were significantly associated with lower odds ratios (ORs) for cognitive impairment and depressed mood (ORs: Q1 = 1.00; Q2 = 0.88 and 0.76; Q3 = 0.66 and 0.85; Q4 = 0.67 and 0.53; Pfor trend = .023 and .033, respectively). In addition, the highest UME group showed a significantly lower OR for depressed mood than the lowest UME group (Q4 vs Q1: OR, 0.53; 95% confidence interval, 0.32–0.89; P= .033). UME levels above the median value were significantly associated with a lower OR for cognitive impairment, even after further adjustment for depressive symptoms (OR = 0.74; 95% confidence interval, 0.55–0.99; P= .043).Conclusions:Significant associations of higher physiological melatonin levels with lower prevalence of cognitive impairment and depressed mood were revealed in a large general elderly population. The association between physiological melatonin levels and cognitive function was independent of depressive symptoms.

Work‐related Aggression and Violence Committed by Patients and Its Psychological Influence on Doctors: Keigo Saeki, et al. Department of Community Health and Epidemiology, Nara Medical University School of Medicine To determine the incidence rate of work‐related aggression and violence (WRAV) against doctors and investigate risk factors and psychological Influences of WRAV doctors. We sent a self‐administered questionnaire on WRAV committed by patients and their associates to 1,148 doctors in Nara Prefecture, Japan. We calculated the incidence rate of WRAV using the number of incidents encountered during the previous 12 mo and the doctor�s average weekly working hours. Risk factors for the incidence WRAV were analyzed by Poisson regression, and the Influence of WRAV on the symptoms of post‐traumatic stress disorder (PTSD) was evaluated by multiple logistic regression analysis. A total of 758 (66.0%) doctors returned the questionnaire. The incidence rate of WRAV was 0.20 [95% CI: 0.17‐0.24]�10‐3 per practice hour. Adjusted incidence rate ratios of WRAV were significantly increased among doctors 1) with a shorter career (11.0; 95% CI: 5.0‐24.2), 2) working in a region with the lowest average taxable income (1.6; 1.1‐2.4), and 3) whose specialties were dermatology (3.8; 2.3‐6.3), psychiatry (2.7; 1.3‐5.6) and ophthalmology (1.9; 1.2‐3.2). Of 289 subjects who had encountered WRAV at least once during their career, 26 doctors (8.2%) had symptoms suggestive of PTSD due to the most severe incident. Conclusions: Doctors encountered WRAV at an incidence rate of 0.20�10‐3 per practice hour, and some of them might develop PTSD. Countermeasures are required to maintain sound health and safe workplaces for doctors.