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Comparing the incidence rate of in-hospital falls between patients hospitalized in window beds and nonwindow beds.Retrospective cohort study.A general hospital in Mie, Japan.A total of 2767 patients (mean age, 68.4 years) hospitalized in four-bedded rooms between January 2014 and December 2016.We identified patients' bed status (window/nonwindow) and the incidence of in-hospital falls using data on medical records and incidence reports, respectively.During an observation period of 25,450 person-days, 57 patients had in-hospital falls (incidence rate, 2.24/1000 person-days). Incidence rate for in-hospital falls was significantly lower in the window-bed group (n = 1273) than in the nonwindow-bed group (n = 1494) [incidence rate ratio (IRR) 0.49, 95% confidence interval (CI), 0.29, 0.84]. In the multivariable analysis adjusted for age, gender, BMI, smoking and drinking habit, surgical operation during hospitalization, and independence in daily living, the window-bed group exhibited significantly lower incidence rate for in-hospital falls than the nonwindow-bed group (IRR 0.54, 95% CI 0.32, 0.93). Sensitivity analysis excluding patients aged60 years suggested a consistent result: incidence rate for in-hospital falls was significantly lower in the window-bed group (n = 1123) than in the nonwindow-bed group (n = 925) (IRR 0.55, 95% CI 0.31, 0.95).The incidence rate of in-hospital falls was significantly lower among patients hospitalized in window beds than nonwindow beds. Hospitalization in window beds might be a novel, simple preventive option for in-hospital falls. Further large-scale, prospective, multicenter research is required.

Objectives Previous studies comparing objective sleep measures between patients with Parkinson's disease (PD) and control participants were limited by their small sample size. The purpose of this study was to compare objective sleep measures between large-scale cohorts of PD outpatients and community-based older adults. Methods In this cross-sectional study, we measured sleep parameters for 157 PD patients using an actigraph on the non-dominant wrist for six consecutive nights (95 Hoehn–Yahr stage I/II; 62 Hoehn–Yahr stage III–V). Moreover, two consecutive nights of actigraphy were performed on 1101 community-based control participants aged ≥60 years. Results In multivariable analysis, sleep efficiency (SE) was significantly lower in patients with late-stage PD by 17.5% [95% confidence interval: 15.3%–19.7%] and early-stage PD by 9.4% [7.6%–11.1%] compared to the controls (67.1% and 75.3% vs. 84.6%, respectively). Similar results were observed for wake after sleep onset (WASO) and fragmentation index (FI). Total sleep time and sleep onset latency (SOL) were significantly shorter in patients with late- and early-stage PD stage compared to the controls. Among PD patients, significant association trends between advancement of individual Hoehn–Yahr stages and worsened sleep measures of SE, WASO, and FI were observed independently of age, gender, levodopa equivalent dose, and motor function parameter. Conclusion This study demonstrated significant and quantitative differences in objective sleep quality and quantity between PD patients and control participants. Furthermore, with advancement of disease stages, objectively measured sleep quality worsened in PD patients.

Background: Higher smoking prevalence in less educated persons and manual workers is well known. This study examines the independent relationship of education and occupation with tobacco use. Methods: We used anonymized data from a nationwide population survey (30,617 men and 33,934 women). Education was divided into junior high school, high school, or university attainment. Occupation was grouped into upper non-manual, lower non-manual, and manual. Poisson regression models stratified by age and gender were used to estimate adjusted prevalence ratio (PR) and 95% confidence interval (CI) for current smoking. Results: After adjustment for covariates, education, and occupation, education was significantly related to current smoking in both genders; compared to university graduates, PRs of junior high school graduates aged 20–39, 40–64, and ≥65 were 1.74 (95% CI, 1.53–1.98), 1.50 (95% CI, 1.36–1.65), and 1.28 (95% CI, 1.08–1.50) among men, and 3.54 (95% CI, 2.92–4.30), 2.72 (95% CI, 2.29–3.23), and 1.74 (95% CI, 1.14–2.66) among women, respectively. However, significantly higher smoking prevalence in manual than in upper non-manual was found only in men aged 20–64; compared to upper non-manual, the PRs of manual workers aged 20–39, 40–64, and ≥65 were 1.11 (95% CI, 1.02–1.22), 1.18 (95% CI, 1.10–1.27), and 1.10 (95% CI, 0.89–1.37) among men, and 0.95 (95% CI, 0.75–1.20), 0.92 (95% CI, 0.75–1.12), and 0.46 (95% CI, 0.22–0.95) among women, respectively. Conclusions: Independent of occupation, educational disparities in smoking existed, regardless of age and gender. Occupation-smoking relationship varied with age and gender. Our study suggests that we should pay attention to social inequality in smoking as well as national smoking prevalence.

Background Participation in leisure activities (LA) is essential for successful aging. Our aim was to investigate the cross-sectional association of types of LA with self-rated health (SRH) by gender and work status. Methods The target population was all residents aged ≥65 years in a municipality (n = 16,010; response rate, 62.5%). We analyzed 4,044 men and 4,617 women without disabilities. LA were categorized into 14 types. SRH was assessed through the SF-8. Excellent or very good SRH was defined as positive SRH. Covariates included age, marital status, education, subjective economic status, body mass index, chronic diseases, alcohol, smoking, walking time, depression, and cognitive functioning. Multiple logistic regressions were used to calculate the odds ratio (OR) and 95% confidence interval (CI) for positive SRH, with non-participation as the reference. Results After adjustment for covariates and mutual adjustment for other LA, participation in the following types of LA was positively associated with positive SRH: sports activities among working men (OR 1.46; 95% CI, 1.07-2.00), non-working men (OR 1.33; 95% CI, 1.04-1.69), and non-working women (OR 1.74; 95% CI, 1.41-2.15); cooking among non-working men (OR 1.65; 95% CI, 1.18-2.33) and non-working women (OR 1.28; 95% CI, 1.03-1.60); musical activities among working men (OR 1.44; 95% CI, 1.01-2.05) and non-working women (OR 1.59; 95% CI, 1.29-1.95); and technology usage only among working men (OR 1.41; 95% CI, 1.01-1.96). In contrast, TV watching was negatively associated with positive SRH among non-working women (OR 0.69; 95% CI, 0.56-0.85). Conclusions Our results suggest that encouraging older adults to participate in types of LA appropriate to their gender and work status might be a key to positive SRH.

Background To examine the relationship of working history from early adulthood through old age with instrumental activities of daily living (IADL). Methods Analyzed participants were 5,857 community-dwelling older Japanese people aged ≥65 years. Using the Tokyo Metropolitan Institute of Gerontology Index of Competence, IADL decline was defined as individuals who had no IADL dependence at baseline but were deemed as dependent in IADL at follow-up. Work history was based on working status at baseline, total working years, and information concerning the longest held job, including occupation, employment pattern, and workplace size (number of employees). We conducted multiple logistic regression analyses and estimated the odds ratios (ORs) for IADL decline with 95% confidence intervals (CIs) by gender. Results At the 33-month follow-up, 428 men (16.6%) and 275 women (8.4%) developed IADL decline. After covariate adjustments, men with unstable employment reported significantly increased IADL decline (OR 1.52; 95% CI, 1.19-1.95) compared to men with stable employment, and men who worked in small workplaces with 1-49 employees had an increased risk for IADL decline (OR 1.53; 95% CI, 1.21-1.93) compared to men in large-sized workplaces with ≥50 employees. After mutual adjustment for all working history items, only the association between small workplaces and IADL decline remained significant in men (OR 1.37; 95% CI, 1.03-1.84). Among women, none of the working history items were associated with IADL decline. Conclusion Our results suggest that not only promoting older people's workforce participation, but also providing workers employed at small workplaces with sufficient occupational health services, may be effective in helping men retain IADL in later life.

Hot water bathing – a Japanese traditional practice – has not been evaluated for its association with night- and sleep-time blood pressure (BP) in large population. In this longitudinal analysis, bathing parameters and ambulatory BP were repeatedly measured for 2 nights in 758 Japanese elderly individuals. Participants were divided into three groups according to tertile values of time soaked in the bathtub (Duration: tertile value, 11 and 15 min), time from bathing-end to bedtime (Time before bedtime: tertile value, 42 and 106 min), and temperature of hot water in the bathtub (Water temp: tertile value, 40.3 and 41.2 °C). Participants’ mean age was 70.9 years, and mean night- and sleep-time systolic BP (SBP) and dipping were 115.1 ± 16.1, 114.2 ± 16.2 mmHg, and 14.2 ± 8.8%, respectively. Multivariable mixed-effect linear regression models adjusted for potential confounding factors suggested that nighttime SBP was significantly lower in the intermediate Time before bedtime group by 1.7 mmHg (95% CI, 0.2–3.1) and in the short group by 1.9 mmHg (95% CI, 0.1–3.7) than that in the long group. Dipping was significantly greater in the intermediate Time before bedtime group by 1.8% (95% CI, 0.7–2.9) and in the short group by 1.8% (95% CI, 0.6–3.1) than that in the long group. These associations were consistent regarding sleep-time SBP. Conversely, Water temp and Duration did not significantly associate with any ambulatory BP parameter. Remarkably, Time before bedtime significantly prolonged with increases in tertiles of Water temp (P for trend = 0.006). In conclusion, the findings of this study revealed that Japanese hot water bathing, especially the short time from bathing-end to bedtime, was associated with lower night- and sleep-time BP and greater dipping in an elderly population., 博士（医学）・甲第751号・令和2年9月30日, This is a post-peer-review, pre-copyedit version of an article published in Chronobiology international. The final authenticated version is available online at: https://doi.org/10.1080/07420528.2019.1675685.

Background Decreased light reception because of cataracts leads to potential circadian misalignment, resulting in exacerbation of atherosclerosis; however, little is known about the association between cataracts and atherosclerosis in populations.Methods and Results:In this cross-sectional study, cataracts were graded using slit lamp biomicroscopy with the Lens Opacities Classification System III and carotid atherosclerosis was assessed based on carotid intima-media thickness (IMT) measured using ultrasonography of the common carotid artery in 442 elderly participants (mean age, 70.0 years). Cataract was defined as nuclear cataract grade ≥3.0, cortical cataract grade ≥2.0, or posterior subcapsular cataract grade ≥2.0 in both eyes. The mean and maximal carotid IMT was 0.86±0.15 mm and 1.07±0.29 mm, respectively. In multivariable analysis adjusted for potential confounders, the mean and maximal carotid IMT were significantly greater in the cataract group than in the non-cataract group by 0.04 mm (95% confidence interval (CI), 0.01-0.06) and 0.07 mm (95% CI, 0.01-0.12), respectively. Logistic regression analysis adjusted for confounders revealed a significantly higher odds ratio for carotid atherosclerosis (maximal carotid IMT ≥1.1 mm) in the cataract group than in the non-cataract group (odds ratio, 1.78; 95% CI, 1.14-2.78). Conclusions Cataracts may be independently associated with subclinical carotid atherosclerosis in the elderly population, indicating a need for further prospective studies.

Objective Passive body heating can have an antidepressant effect by activating warm-sensitive neural pathways associated with affective functions. Interventional studies showed that patients with depression had reduced depressive symptoms after passive body heating. However, the effect of hot water bathing at home on depressive symptoms in the general population remains unclear. Thus, we evaluated the association between objectively measured hot water bathing and depressive symptoms among older adults. Design Cross-sectional analysis. Setting A baseline survey of community-based cohort study in Japan. Participants Community-dwelling older volunteers (n = 1,103; mean age: 72.0 years). Measurements The authors evaluated bathing conditions and distal skin temperature for 2 consecutive days. Depressive symptoms were defined as the 15-item Geriatric Depression Scale score of ≥6. Results Logistic regression showed that the no bathing group (adjusted odds ratio [OR] 2.60, 95% confidence interval [CI] 1.36–4.95, χ² = 8.40, degrees of freedom [df] = 1) and the either-day bathing group (adjusted OR 1.68, 95% CI 1.11–2.56, χ² = 5.89, df = 1) had higher odds of depressive symptoms than the both-day bathing group independent of potential confounders including age, sex, body mass index, alcohol intake, income, living alone, hypnotic use, diabetes, and physical activity. Shorter interval from bathing to bedtime was significantly associated with lower odds of depressive symptoms and higher nighttime distal skin temperature after adjusting for water temperature and duration. Conclusion A higher frequency of hot water bathing and shorter interval from bathing to bedtime were associated with lower odds of depressive symptoms.

Background Several studies have examined the association between physical performance and fracture in women, but few such studies have targeted elderly men. This study aimed to determine whether the combined results of several physical performance tests can predict the subsequent incidence of fractures in elderly men after adjusting for confounding factors. Methods Of the 2174 elderly men who participated in this study, 2012 completed the baseline study visit, including physical performance tests (walking speed, hand grip strength, and one-leg standing) and measurement of bone mineral density by dual-energy X-ray absorptiometry. Follow-up study visits were conducted five and ten years later, during which incident fractures were identified by detailed interviews. We excluded 140 men with diseases or who took medications known to affect bone metabolism at baseline, 185 with missing values for predictors and potential confounding factors, and one who did not participate in any of the follow-up study visits. The remaining 1686 men were analyzed. Each physical performance test was analyzed by quartiles. Poor performance was defined as belonging to the worst quartile of performance. The association between physical performance and fracture was assessed using Cox proportional hazards models. Results We identified 175 clinical fractures (osteoporotic fracture: 77, major osteoporotic fracture: 48) in 1686 men during a mean follow-up period of 8.4 years. After adjusting for potential confounding factors including bone mineral density, men who performed poorly on all three physical performance tests had a 3.7-fold higher risk of osteoporotic fracture and a 6.6-fold higher risk of major osteoporotic fracture than men who did not perform poorly on any of the tests. Conclusions Japanese elderly men who performed poorly on all three physical performance tests had a significantly higher risk of incident osteoporotic fracture independently of bone mineral density. The combined results of several physical performance tests may be useful for predicting incident fractures in elderly men.

STUDY OBJECTIVES: Passive body heating in controlled settings could shorten sleep onset latency (SOL). The hypothesized mechanism is vasodilation-induced heat loss before bedtime. However, this evidence is based on small sample–sized studies in specific populations. Thus, we analyzed the association of hot-water bathing and its before-bedtime timing with SOL and heat loss in a large study population of older adults. METHODS: We conducted a longitudinal analysis using repeated measurements of hot-water bathing and sleep among 1,094 older adults (mean age, 72.0 years). SOL was recorded using actigraphy and self-reported sleep estimates and was categorized into conditions (intervals of 1–60, 61–120, 121–180, and > 181 minutes between hot bath and bedtime) and compared with the control condition of no bathing. The heat-loss indicator, distal-proximal skin temperature gradient, was examined in the same categorization. RESULTS: Mixed-effects linear regression models suggested that the bathing conditions of 61–120 minutes and 121–180 minutes showed significantly shorter log-transformed actigraphic SOL by 0.23 log-minutes (95% confidence interval (CI), 0.03–0.42) and 0.32 log-minutes (95% CI, 0.09–0.56), shorter self-reported SOL by 0.16 log-minutes (95% CI, 0.02–0.30) and 0.18 log-minutes (95% CI, 0.01–0.35), and higher distal-proximal skin temperature gradient for 30 minutes before bedtime by 0.49°C (95% CI, 0.22–0.75) and 0.51°C (95% CI, 0.20–0.83), respectively, independent of potential confounders. CONCLUSIONS: Hot-water bathing before bedtime is significantly associated with shorter SOL and higher distal-proximal skin temperature gradient among the large-scale older population. This finding could enhance the generalizability of hot-water bathing habits for ameliorating sleep initiation difficulty. CITATION: Tai Y, Obayashi K, Yamagami Y, et al. Hot-water bathing before bedtime and shorter sleep onset latency are accompanied by a higher distal-proximal skin temperature gradient in older adults. J Clin Sleep Med. 2021;17(6):1257–1266.

Introduction Cross-sectional studies have shown that patients with type 2 diabetes mellitus (T2DM) have low circulating levels of osteocalcin (OC) and undercarboxylated OC (ucOC). This longitudinal study aimed to examine whether low OC or ucOC levels at baseline are associated with the risk of incident T2DM. Methods We examined 1700 community-dwelling Japanese men (≥65 years) after excluding those with history of diseases (other than T2DM) or medications that affect bone and glucose metabolism. T2DM was defined as fasting plasma glucose (FPG) ≥126 mg/dl or glycated hemoglobin A1c (HbA1c) ≥6.5%. Participants without prevalent T2DM at baseline were invited to follow-up surveys 5 and 10 years after baseline. Results Among the participants, 309 with prevalent T2DM showed significantly lower serum OC and ucOC levels at baseline than those without. After excluding these participants, 46 and 57 participants with incident T2DM were identified in the first and second follow-up surveys, respectively. These participants did not show significantly different OC and ucOC levels at baseline relative to those without T2DM, although their FPG and HbA1c levels at baseline were significantly higher compared to those without incident T2DM. Increase in glycemic indices preceded decrease in OC and ucOC levels. OC and ucOC levels at baseline were not significantly associated with the risk of incident T2DM identified in the follow-up surveys. Conclusions OC and ucOC levels at baseline were not significantly associated with the risk of incident T2DM. Our results do not support the findings of animal studies that ucOC is a hormone regulating glucose metabolism.

Aims To investigate the association between B-type natriuretic peptide (BNP) and nocturia among community-dwelling males and females. Methods A total of 1096 participants (mean age 71.9 ± 7.1 years, 518 [47.2%] males) were included in the study. The number of nocturnal voids was recorded in a self-reported urination diary, and nocturia was defined as two or more voids per night. Daytime serum concentration of the N-terminal fragment of BNP precursor (NT-proBNP) was measured. Multivariable logistic regression analysis was performed to determine the association between NT-proBNP and nocturia. Results Nocturia was observed in 23.5% of females and 37.1% of males. Higher NT-proBNP (log pg/ml) was associated with nocturia in both gender groups (females: odds ratio [OR]: 1.67, 95% confidence interval [95% CI], 1.21-2.34, p = .002; males: OR: 1.26, 95% CI, 1.01-1.59, p = .046), independent of confounding variables including night-time blood pressure, mean voided volume, and chronic kidney disease. Although the increase in prevalence of nocturia with higher NT-proBNP was equivalent in both genders, some effect of gender on the relationship between NT-proBNP and nocturia was observed (p = .037). Nocturnal urine volume was also significantly and independently associated with NT-proBNP level (females: β = 32.9 ml, 95% CI, 5.63-60.2, p = .018; males: β = 34.6 ml, 95% CI, 9.40-59.9, p = .007). Conclusions This study revealed higher serum NT-proBNP is significantly and independently associated with the prevalence of nocturia in both males and females. This is an exploratory cross-sectional study and the analyses are post hoc, so further research works are needed to clarify the causality and clinical value.

Purpose The association between serum concentrations of uric acid (UA), a potent endogenous antioxidant, and fracture risk has not yet been examined for morphometric vertebral fracture (VF). This study aimed to determine whether serum UA concentrations are associated with risks of clinical osteoporotic fracture (OPF) and morphometric VF after adjusting for confounding factors including UA-lowering medications (ULMs). Materials and methods A total of 2012 Japanese men aged ≥65 years completed the baseline study, which included serum UA measurement and X-ray absorptiometry-based VF assessment. We conducted a follow-up study five years later to identify incident OPFs and VFs. OPF was identified through interviews. Incident VF was defined as a vertebra which showed reduction in any of its anterior, central, or posterior heights by ≥20% during follow-up, and satisfied grade one or higher fracture criteria in Genant's method on follow-up images. Bone mineral density (BMD) of the hip and spine was measured by dual-energy X-ray absorptiometry at baseline and follow-up. Results We identified 45 clinical OPFs from 2000 men and 39 VFs from 1530 men during a mean follow-up period of 4.3 years. Hip BMD was significantly higher in higher UA concentration groups after adjusting for age and body mass index. A significantly decreased multivariate-adjusted odds ratio (OR) of incident VF was observed for the highest quartile groups of serum UA concentrations compared with the lowest quartile group (OR: 0.17, 95% confidence interval: 0.05–0.62). This OR remained significant after further adjusting for ULM use. ULM users in the lowest quartile group of serum UA concentrations had a significantly higher incidence rate of VF compared to the other quartile groups. Conclusions Higher serum UA concentrations were associated with a lower risk of morphometric VF independently of ULM in Japanese elderly men. Excessive reduction of serum UA concentrations by ULM might increase VF risk.

Objective Circadian disruptions in Parkinson's disease (PD) are characterized as amplitude reduction rather than as phase shift; however, large-scale studies evaluating circadian rhythms between PD patients and non-PD older adults have not been performed. The present study aimed to compare the circadian activity rhythm (CAR) between PD patients and non-PD older adults. Methods In this cross-sectional study on 157 PD outpatients and 1111 community-dwelling older adults (controls), physical activity was measured using actigraphy at 1-min intervals over 6 days in PD patients and 2 days in non-PD older adults. Data were base-10 log-transformed and regretted to the sigmoidally transformed cosine curve. Results The mean amplitude (log counts/min) and acrophase were 1.85 (SD, 0.52) and 14:19 (SD, 1:15), respectively, in the controls (n = 1111); 1.42 (0.48) and 14:24 (1:20), respectively, in the early-stage (Hoehn–Yahr I and II) PD patients (n = 95); and 1.23 (0.54) and 13:41 (1:56), respectively, in the late-stage (Hoehn–Yahr III–V) PD patients (n = 62). Multivariable analysis revealed significantly lower amplitude in the early-stage and late-stage PD groups than in the controls. The acrophase significantly advanced in the late-stage PD group than in the controls. With the advancement of PD stage, amplitude and peak significantly decreased; trough increased; acrophase and active offset advanced; and robustness weakened. Conclusions Compared with non-PD older adults, PD patients exhibited a phase advance in CAR, along with amplitude reduction. With an advanced stage of PD, a phase advance in CAR also occurred, along with amplitude reduction and weakened robustness.

Light information received by the brain influences human circadian timing and metabolism; low-level light at night (LAN) significantly increased body mass and led to prediabetes in mice. We hypothesized that LAN exposure increases the diabetes risk in humans. The aim of the present study was to evaluate a longitudinal association between LAN exposure and the incidence of diabetes in a general population.In our prospective cohort study, bedroom light intensity was measured at 1-min intervals in 678 elderly participants without diabetes at baseline. The average light intensity recorded between bedtimes and rise times over two consecutive nights was used in the analysis.During follow-up (median, 42 months), 19 of the 678 participants (mean age, 70.6 years) developed diabetes. Poisson regression models revealed that the incidence rate for diabetes was significantly higher in the LAN group (average ≥ 5 lux, N = 128) than the dark group (average 5 lux, N = 550) (incidence rate ratio, 3.74; 95% confidence interval (CI), 1.55-9.05; p = 0.003). Further propensity score adjustments in relation to LAN produced consistent results (incidence rate ratio, 3.19; 95% CI, 1.38-7.35; p = 0.007). When the cut-off value of LAN was decreased to 3 lux, the relationship remained significant (incidence rate ratio 2.74; 95% CI, 1.19-6.33; p = 0.018).Our findings suggest that LAN exposure increases the incidence of diabetes in a general elderly population. Further research involving a large cohort with new-onset diabetes is warranted to elucidate these findings.

Objective Reportedly, melatonin protects the pancreatic islets and decreases insulin resistance; thus, it may contribute to preventing diabetes. Epidemiological data suggested that lower melatonin secretion is associated with higher incidence of diabetes in female nurses. Such associations are unknown in the general population. We evaluated the association between melatonin secretion and diabetes in a general population, including both genders. Design Cross-sectional study. Participants A total of 1096 community-based elderly males (n = 519) and females (n = 577) (mean age, 71.8 years) were enrolled. Measurements Overnight urinary 6-sulfatoxymelatonin excretion (UME) and diabetes prevalence were measured. Results The median UME was 6.7 μg (interquartile range, 4.0-10.5); the prevalence of diabetes was 17.5% in males and 10.7% in females. The prevalence of diabetes decreased with increasing UME quartiles among males (P for trend = 0.009) but not among females (P for trend = 0.96). In a multivariable logistic regression analysis adjusting for potential confounding factors, such as age, smoking and drinking habits, economic status, caloric intake, and physical activity, the odds ratio (OR) for diabetes was significantly lower in the highest UME quartile group compared with the lowest quartile group among males (OR, 0.35; 95% CI, 0.17-0.70; P = 0.003) but not females (OR, 0.94; 95% CI, 0.45-1.95; P = 0.87). Consistent results were observed in the analysis after adjusting for clinical parameters or using continuous UME data. Conclusions Melatonin secretion was significantly and inversely associated with diabetes in males but not in females. This association was independent of several important confounding factors.

Purpose Patients with type 2 diabetes mellitus (T2DM) have an increased fracture risk despite having higher areal bone mineral density (aBMD). This study aimed to clarify the association between glycemic and insulin resistance status and bone microarchitecture, and whether pentosidine and bone turnover markers play any roles in the association. Methods A total of 2012 community-dwelling men aged ≥ 65 years completed baseline measurements of spine aBMD, fasting plasma glucose (FPG) and serum insulin, hemoglobin A1c (HbA1c), osteocalcin, type I procollagen N-terminal propeptide, type I collagen C-terminal crosslinking telopeptide, tartrate-resistant acid phosphatase isoenzyme 5b, pentosidine, height and weight and an interview regarding past disease history. Homeostasis model assessment-insulin resistance (HOMA-IR) was also calculated. T2DM was defined as physician-diagnosed middle age or elderly-onset diabetes mellitus, or according to biochemical test results. To evaluate bone microarchitecture, trabecular bone score (TBS) was calculated at the same vertebrae as those used for aBMD measurement. Results After excluding participants who had a disease history and/or were taking medications affecting bone metabolism, 1683 men (age, 72.9 ± 5.2 years) were analyzed. Men with T2DM had significantly higher aBMD compared to those without T2DM. There was no significant difference in TBS. However, FPG, HbA1c and HOMA-IR levels were significantly inversely correlated with TBS after adjusting for age, BMI and aBMD. Multivariate linear regression analyses revealed that glycemic indices (FPG and HbA1c) were significantly associated with increased aBMD and decreased TBS, and that HOMA-IR was associated only with TBS. These associations did not change after further adjusting for bone turnover makers and pentosidine levels. Conclusions Hyperglycemia and elevated insulin-resistance were associated with low TBS independently of bone turnover and pentosidine levels.

Context Although the endogenous secretory receptor for advanced glycation end products (esRAGE) has been associated with reduced activity of pentosidine (PEN), the association between PEN, esRAGE, and fracture is poorly understood. Objectives To evaluate the ability of serum PEN and esRAGE levels to predict fragility fractures. Methods A cohort of 1285 Japanese men aged ≥65 years old participated in a 2007 to 2008 Fujiwara-kyo Osteoporosis Risk in Men study baseline survey, as part of the Fujiwara-kyo prospective cohort study. Those participants provided information regarding any fractures they experienced during 5 years. The baseline bone mineral density (BMD) was measured. Hazard ratios (HRs) per one standard deviation increase of log-transformed serum levels of PEN, esRAGE, and esRAGE-to-PEN ratio were estimated at baseline. Results Twenty-five participating men suffered incident clinical fragility fractures. The crude HRs (95% confidence interval) for PEN, esRAGE, and esRAGE-to-PEN ratio were 1.56 (1.05 to 2.31), 0.79 (0.54 to 1.15), and 0.65 (0.44 to 0.95), respectively. HRs for PEN adjusted for age, esRAGE, and T score of BMD at femoral neck (FN) and lumbar spine (LS) were 1.48 (1.00 to 2.18) and 1.51 (1.03 to 2.21), respectively. The marginal significance adjusted for BMD at FN and the statistical significance adjusted for BMD at LS were attenuated after additional adjustment for glycated hemoglobin A1c level (P = 0.111 and 0.072, respectively). The HRs for esRAGE-to-PEN ratio adjusted for age, glycated hemoglobin A1c, and T-score of BMD at FN and LS were 0.67 (0.45 to 0.98) and 0.64 (0.43 to 0.95). Conclusions Higher esRAGE-to-PEN ratios were associated with decreased risk of fragility fractures independent of BMD among elderly Japanese men.

Previous studies have indicated that minimal exposure to light at night (LAN) increases depression risk, even at 5 lux, in nocturnal and diurnal mammals. Although such low-level LAN may affect human circadian physiology, the association between exposure to LAN and depressive symptoms remains uncertain. In the present study, bedroom light intensity was measured objectively, and depressive symptoms were assessed, during 2010-2014 in Nara, Japan. Of 863 participants (mean age = 71.5 years) who did not have depressive symptoms at baseline, 73 participants reported development of depressive symptoms during follow-up (median, 24 months). Compared with the "dark" group (average of

BACKGROUND Platelet (PLT) transfusions are probably harmful in patients with acquired idiopathic thrombotic thrombocytopenic purpura (aTTP). Introduction of a rapid assay for ADAMTS13 activity should reduce the time to definite diagnosis of aTTP, reduce the amount of inappropriately transfused PLT concentrates, and improve mortality and morbidity. STUDY DESIGN AND METHODS We selected 265 aTTP patients with severe ADAMTS13 deficiency. Of these, 91 patients were diagnosed by March 2005 (Period 1), when ADAMTS13 activity was measured by von Willebrand factor multimer assay, which took 4 to 7 days until the result was reported. An additional 174 patients were diagnosed after April 2005 (Period 2), when the activity was measured by a chromogenic enzyme-linked immunosorbent assay, which took 1 to 2 days. RESULTS We found no significant differences in 30-day survival rate between the two periods. Overall, 48 patients received PLT transfusions. Mortality was slightly greater between patients with (22.9%) versus without PLT transfusion (17.7%), but not significant. In Period 1, Cox proportional hazards regression analysis showed that older age (≥60 years) and PLT transfusion administration were independent factors associated with higher risks of 30-day mortality. In contrast, in Period 2, lower Rose-Eldor TTP severity score and use of plasma exchange and corticosteroid therapy were independent factors associated with higher survival rates while nonadministration of PLT transfusions was not. CONCLUSION Our results indicate that PLT transfusions are harmful for aTTP patients when the definite diagnosis of severe ADAMTS13 deficiency is delayed. If it can be done as soon as possible, PLT transfusions for severe bleeding or surgical interventions might be allowed with subsequent plasmapheresis.

BackgroundAlthough many governments are promoting workforce participation (WP) by older people, evidence of WP's effects on active aging is inadequate. We examined whether there is a gender-specific beneficial effect of lifetime WP from adulthood though old age against self-reported cognitive decline (CD) among community-dwelling older adults.MethodsWe used data from a community-based prospective study of 2,422 men and 2,852 women aged ≥65 with neither poor cognition nor disability in basic activities of daily living at baseline. Self-reported CD was measured using the Cognitive Performance Scale. Lifetime WP evaluated the presence or absence of WP at baseline, the longest-held occupation, and lifetime working years (total working years throughout lifetime). Generalized estimating equations of the multivariable Poisson regression model were applied to evaluate a cumulative incidence ratio (CIR) for self-reported CD and a 95% confidence interval (CI), controlled for age, education, self-perceived economic status, chronic medical conditions, smoking history, physical activity, depression, and instrumental activities of daily living. To examine any gender-specific association, stratified analyses by gender were performed.ResultsThe 33-month cumulative incidence of self-reported CD was 15.7% in men and 14.4% in women. After covariate adjustments and mutual adjustment for three items of lifetime WP, men who had their longest held job in a white-collar occupation reported significantly decreased self-reported CD compared to men engaged in blue-collar jobs (CIR 0.72; 95% CI, 0.57-0.91), and women had a significant dose-response relationship between longer lifetime working years and less decline in subjective cognitive functioning (P for trend ConclusionsOur results suggest that lifetime WP, especially lifetime principal occupation in men and lifetime working years in women, may play a more prominent role in preventing self-reported CD than later-life WP.

Background Maintenance of instrumental activities of daily living (IADL) and social role (SR) is crucial to keep independent life because the decline in SR and IADL was a significant predictor of dependence in basic ADL in later. The independent effect of physical and cultural leisure activities and their effect modification on the IADL remains unknown. Methods We prospectively observed 3241 elderly with intact IADL at baseline for 5 years. Higher level functional capacity such as IADL and SR was assessed using the Tokyo Metropolitan Institute of Gerontology Index of competence (TMIG index). Results The mean age of the participants was 72.3 years (standard deviation 5.1), and 46.9% were male, and 90.9% of them received a follow-up assessment. Of the participants, 10.4% developed an IADL decline. Engagement in leisure physical activity was associated with a significantly lower risk of IADL decline (adjusted risk ratio, 0.73; 95% confidence interval [CI], 0.60 to 0.89), and cultural leisure activity was also associated with lower risk of IADL decline (adjusted risk ratio, 0.77; 95% CI, 0.63 to 0.95) independent of potential confounders. We also found significant and positive interaction between physical and cultural leisure activities at risk for IADL decline (P = 0.024) and SR decline (P = 0.004). Conclusions We found an independent association of physical and cultural leisure activities with a lower risk for functional decline in IADL and SR with positive interaction. Combined engagement in physical and cultural activities may effectively prevent from IADL decline and SR decline.

OBJECTIVES Prognostically, night-time blood pressure (BP) is more important than other BP parameters. Previous physiological studies suggested physical exercise continuously decreases subsequent BP levels, although the association between daytime physical activity and night-time BP has not been evaluated in large populations. METHODS This cross-sectional study of 1111 older adults (mean age, 71.8 years) measured physical activity using actigraphy and ambulatory BP parameters. RESULTS The mean night-time SBP and DBP were 115.9 mmHg (SD, 16.2) and 67 mmHg (8.6), respectively, and the mean average daytime physical activity was 299.2 counts/min (104.3). A multivariable linear regression analysis, adjusted for potential confounders, suggested greater average daytime physical activity was significantly associated with lower night-time SBP (regression coefficient per 100 counts/min increment, -1.18; 95% CI -2.10 to -0.26), and DBP (-0.69; 95% CI -1.17 to -0.17). Significant associations between time above activity thresholds and night-time SBP were consistently observed (≥500 counts/min: regression coefficient per log min increment, -1.61, 95% CI -3.14 to -0.08; ≥1000 counts/min: -1.00, 95% CI -1.97 to -0.03; ≥1500 counts/min: -1.13, 95% CI -2.11 to -0.14). A subgroup analysis without antihypertensive medications (n = 619) strongly associated time above activity thresholds with night-time SBP (≥500 counts/min: -2.94; 95% CI -5.20 to -0.68). These results were consistent in the analysis using dipping as a dependent variable. CONCLUSION Objectively measured daytime physical activity was significantly and inversely associated with night-time BP in older adults. Further longitudinal studies would ascertain effects of physical activity on night-time BP.

Background There is a paucity of studies on self-assessed generic health-related quality of life (HRQOL) in children with epilepsy. The purpose of this study was to investigate generic HRQOL and associated factors among Japanese children with epilepsy. Methods In this clinic-based study, 277 children (aged 8–18 years) with epilepsy and 429 children without any chronic illnesses were recruited. HRQOL was evaluated using the Japanese version of the KIDSCREEN-52 self-reported questionnaire, which consisted of 52 items categorized into 10 dimensions related to the environment surrounding children. Multiple regression analysis was applied to explore related factors with low HRQOL in each dimension. Results We obtained the questionnaire from 171 (61.7%) and 306 (71.3%) children in the epilepsy and control groups, respectively. Short treatment period ( 30 min, and post-ictal symptoms were associated with a low HRQOL for School Environment (OR: 3.81; 95% CI: 1.34–10.86), Moods & Emotions (OR: 3.82; 95% CI: 1.67–8.78), and Parent Relations & Home Life (OR: 3.53; 95% CI: 1.29–9.72) dimensions, respectively. Complex neurodevelopmental disorders were associated with a low HRQOL for Social Support & Peers (OR: 3.59; 95% CI: 1.33–9.66), School Environment (OR: 2.49; 95% CI: 1.07–5.77), and Psychological Well-being (OR: 3.47; 95% CI: 1.20–10.00) dimensions. Conclusions Our results suggest that early psychosocial support and better management of epilepsy may improve HRQOL. More support in school environments may be required for children with epilepsy and neurodevelopmental disorders.

Background Previous studies have shown that regular dental visits can affect the relationship of tooth loss with mortality and functional disability. However, the independent association between regular dental visits and incident functional disability is unclear. Methods Our study participants were community-dwelling individuals aged ≥65 years, without disability at baseline. The outcome was the level of incident functional disability, as defined in a new certification of the public long-term care insurance. We defined no disability as no certification at follow-up, mild disability as support levels 1–2 and care level 1 (i.e., independent in basic ADL, but requiring some help in daily activities), and severe disability as care levels 2–5 (i.e., dependent in basic ADL). The exposure variable, based on the questionnaire, was regular dental visits at baseline. Covariates included gender, age, socio-economic status, health status, lifestyle habits, physical and mental functioning, and oral health variables. Using multinomial logistic regression, we calculated adjusted odds ratio (aOR) and 95 % confidence interval (CI) for mild disability and severe disability, with no disability as a reference category. Results Among 8,877 participants, the 33-month cumulative incidence of mild and severe disability was 6.0 % and 1.8 %, respectively. After controlling for all covariates, regular dental visits at baseline were significantly associated with a lower risk of incident severe disability (aOR 0.65; 95 % CI, 0.46–0.91) but not the incidence of mild disability (aOR 0.96; 95 % CI, 0.79–1.17). Conclusions Encouraging dental visits may contribute to prevention of severe functional disability and extension of healthy life expectancy among community-dwelling older adults.

Introduction Assessing health-related quality of life (HRQOL) is critical for providing comprehensive clinical care to patients with haemophilia. HRQOL in individuals with similar cultural backgrounds should be compared using internationally standardized, generic questionnaires. Aim To evaluate self-/parent-assessed HRQOL in Japanese children and adolescents with haemophilia A or B. Methods Children and adolescents aged 8-18 years were enrolled. The haemophilia group comprised families with haemophilia, and the control group comprised those without chronic illness. HRQOL was assessed using the self-/parent-reported questionnaire KIDSCREEN-52, the Japanese version. The Oslo 3-Item Social Support Scale was investigated. Results The questionnaire was completed by 36 families in the haemophilia group and 160 parents and children in the control group. Haemophilia children aged 8-12 years had lower scores for 'moods and emotions' than control children; the parents had lower scores in the haemophilia group than in the control group for 'moods and emotions', 'social support and peers', and 'school environment'. No significant differences in HRQOL were observed between both groups of adolescents aged 13-18 years or their parents. Neck-shoulder pain was associated with a low psychological state, including 'self-perception', but other joint pains did not affect the outcomes of the HRQOL indices. Social support weaknesses were associated with low physical and psychological states, whereas unexpected hospital visits identified low values for 'self-perception', 'autonomy', and 'school environment'. Conclusion Proactive mental and clinical care in haemophilia families, especially with young children, will foster a better environment for patients and their parents and ease concerns about progress in haemophilia.

Exposure to light at inappropriate times in relation to the solar cycle can disturb circadian endocrine and metabolic rhythms. Previous studies have suggested an association between light exposure at night (LAN) and obesity, an important risk factor of atherosclerosis, although it remains unclear whether LAN associates with progression of atherosclerosis. To evaluate the longitudinal association between bedroom LAN intensity and progression of carotid atherosclerosis, light intensity in the bedroom at baseline and carotid artery intima-media thickness (IMT) at baseline and follow-up were measured in 989 elderly participants (945 at baseline and 780 at a median follow-up time of 34 months). The mean age of the participants was 71.4 ± 6.9 years. The average mean and maximal carotid IMT at baseline were 0.88 ± 0.15 and 1.10 ± 0.32 mm, respectively. The median intensity of bedroom LAN was 0.68 lx (IQR, 0.07–3.29). In multivariable analysis adjusted for potential confounders, the highest LAN group exhibited a significant increase in mean carotid IMT (adjusted β, 0.028; 95% CI, 0.005–0.052; P = 0.019) compared with the lowest LAN quartile group. A similar relationship was found between LAN and maximal carotid IMT (adjusted β, 0.083; 95% CI, 0.037–0.129; P

Occupational asbestos exposure occurs in many workplaces and is a well‐known cause of mesothelioma and lung cancer. However, the association between nonoccupational asbestos exposure and those diseases is not clearly described. The aim of this study was to investigate cause‐specific mortality among the residents of Amagasaki, a city in Japan with many asbestos factories, and evaluate the potential excess mortality due to established and suspected asbestos‐related diseases. The study population consisted of 143 929 residents in Amagasaki City before 1975 until 2002, aged 40 years or older on January 1, 2002. Follow‐up was carried out from 2002 to 2015. Standardized mortality ratio (SMR) with its 95% confidence interval (CI) was calculated by sex, using the mortality rate of the Japanese population as reference. A total of 38 546 deaths (including 303 from mesothelioma and 2683 from lung cancer) were observed. The SMRs in the long‐term residents’ cohort were as follows: death due to all causes, 1.12 (95% CI, 1.10‐1.13) in men and 1.07 (95% CI, 1.06‐1.09) in women; lung cancer, 1.28 (95% CI, 1.23‐1.34) in men and 1.23 (95% CI, 1.14‐1.32) in women; and mesothelioma, 6.75 (95% CI, 5.83‐7.78) in men and 14.99 (95% CI, 12.34‐18.06) in women. These SMRs were significantly higher than expected. The increased SMR of mesothelioma suggests the impact of occupational asbestos exposure among men and nonoccupational asbestos exposure among women in the long‐term residents’ cohort. In addition, the high level of excess mortality from mesothelioma has persisted, despite the mixture of crocidolite and chrysotile no longer being used for three or four decades.

Background: Several studies have suggested that periodontal disease can exacerbate the pro-inflammatory status of the brain. Tooth loss is one of the alternative evaluation indices of periodontal disease. There are few data on the relationship between tooth loss and memory impairment, depending on the apolipoprotein E (APOE) ɛ4 genotype. Objective: To determine if tooth loss is associated with mild memory impairment (MMI) and if this association is modified by the presence of the APOE ɛ4 allele. Methods: A nested case-control study was conducted from 2007 to 2012 in Japan. Five hundred and thirty-seven Japanese subjects aged 65 years and over who were cognitively intact at baseline were analyzed. MMI at follow-up was evaluated. Results: The median number of teeth at baseline was significantly lower in MMI participants (n = 179) than in controls (n = 358) (MMI: median 21.0, interquartile range 10.0–25.0 versus controls: 24.0, 14.0–27.0). After adjustment for demographics, vascular risk factors, and APOE ɛ4 allele, the multivariate adjusted odds ratio (OR) of ≤8 teeth was 1.97 (95% confidence interval [CI], 1.13–3.44) compared to 25–32 teeth. Participants with both the presence of at least 1 APOE ɛ4 allele and ≤8 teeth had a higher risk of MMI compared with those with neither (OR, 2.82; 95% CI, 1.15–6.91). Those with either risk factor alone did not have a higher risk of MMI. Conclusions: A lower number of teeth is related to risk of MMI. This may be primarily true for those individuals with an APOE ɛ4 allele.

Background: Population-based data examining the relationship between social participation (SP) and instrumental activities of daily living (IADL) are scarce. This study examined the cross-sectional relationship between SP and IADL in community-dwelling elderly persons. Methods: Self-administered questionnaires were mailed to 23 710 residents aged ≥65 years in Nara, Japan (response rate: 74.2%). Data from 14 956 respondents (6935 males and 8021 females) without dependency in basic activities of daily living (ADL) were analyzed. The number, type, and frequency of participation in social groups (SGs) were used to measure SP. SGs included volunteer groups, sports groups, hobby groups, senior citizens’ clubs, neighborhood community associations, and cultural groups. IADL was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Logistic regression models stratified by gender were used. Results: After adjustment for putative confounding factors, including demographics, health status, life-style habits, ADL, depression, cognitive function, social networks, social support, and social roles, participation in various SGs among both genders was inversely associated with poor IADL, showing a significant dose-response relationship between an increasing number of SGs and a lower proportion of those with poor IADL (P for trend

Chronic low-grade systemic inflammation increases cardiovascular risk and mortality. Subjective assessment of sleep quality in previous observational studies has demonstrated associations with biomarkers of systemic inflammation, although the results are conflicting. In this cross-sectional study on 1098 elderly individuals, circulating white blood cell (WBC) count and actigraphic sleep quality were measured as indices of systemic inflammation and objective sleep quality, respectively. Lower sleep efficiency (SE) and longer wake after sleep onset (WASO) were significantly associated with increased WBC count in females (n=581) but no significant associations were observed in the association between WBC count and all objective sleep parameters in males (n=517). The associations of lower SE and longer WASO with increased WBC count in females remained significant in multivariable models adjusted for potential confounding factors. These results indicated that a 1-standard deviation increase in SE (8.0%) and WASO (27.7min) corresponded to a 0.16×10(9)/L (95% confidence interval: 0.05 to 0.27×10(9)/L) decrease and 0.14×10(9)/L (95% confidence interval: 0.03 to 0.25×10(9)/L) increase in circulating WBC count, respectively. In contrast, total sleep time and sleep onset latency were not significantly associated with WBC count in multivariable models. In conclusion, decrease in objectively measured sleep quality was significantly associated with increased circulating WBC count in females but not males, independently of known factors related to systemic inflammation including age, obesity, smoking, hypertension, diabetes, and physical inactivity.

Breakfast skipping is reported to be associated with obesity in children and younger populations; however, few studies report the association among elderly. The purpose of this study was to investigate the relationships between breakfast skipping and obesity prevalence among elderly. Cross-sectional study. Community-dwelling elderly in Nara, Japan. 1052 elderly participants (mean age: 71.6 years). Obesity and breakfast skipping were defined as body mass index of ≥25 kg/m2 and skipping breakfast one or more times per week, respectively. Two hundred and seventy-two participants (25.9%) were classified as obese and forty-one (3.9%) were as breakfast skippers. Obesity prevalence was significantly higher in breakfast skippers than in breakfast eaters (43.9% vs. 25.1%, P = 0.007). In multivariable logistic regression analysis adjusted for potential confounders (age, sex and alcohol consumption), breakfast skippers showed significantly higher odds ratio (OR) for obesity than breakfast eaters (OR, 2.23; 95% confidence interval, 1.17–4.27; P = 0.015), which continued to be significant after further adjustment for socioeconomic status. In addition, breakfast skippers showed significantly lower daily potassium (P

Benzidine (BZ) and beta-naphthylamine (BNA) have been classified as definite human carcinogens for bladder cancer by the International Agency for Research on Cancer. However, the epidemiological evidence for an association between exposure to BZ and/or BNA and lung cancer has been inconclusive. We conducted a systematic review and meta-analysis to determine the risk for lung cancer among workers exposed to BZ/BNA. A systematic literature search was conducted to identify studies that had reported occupational BZ/BNA exposure and the outcome of interest (lung cancer death and/or incidence). Meta-analyses were performed using random effects models to combine standardized mortality ratios (SMRs) or standardized incidence ratios (SIRs). We identified 23 retrospective cohort studies including 1745 cases of lung cancer; only one study reported smoking-adjusted lung cancer risk. A significantly increased lung cancer risk (pooled SMR/SIR 1.28; 95% CI, 1.14–1.43) was observed by combining all studies, with significant heterogeneity among studies (I2 = 64.1%, P < 0.001). Effect estimates were higher for studies with direct BZ/BNA exposure (ie, dyestuff and manufacturing industries) (pooled SMR/SIR 1.58; 95% CI, 1.31–1.89), and studies that identified BZ/BNA-associated bladder cancer with SMR/SIR ≥4.7 (pooled SMR/SIR 1.68; 95% CI, 1.35–2.09). Effect estimates were similar for studies with and without concomitant occupational exposure to chromium, asbestos, arsenic, or bis(chloromethyl) ether. The cumulative meta-analysis showed that the evidence of association between occupational BZ/BNA exposure and lung cancer has been stable since 1995. Although the results of this meta-analysis have the potential for confounding by smoking and heterogeneity, our findings suggest that a finding of lung cancer following occupational BZ/BNA exposure should be considered to be a potential occupational disease., Copyright © 2016 Kimiko Tomioka et al. This is an open access article distributed under the terms of Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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 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.

Cataract surgery improves visual acuity and drastically increases the capacity for light reception to the retina. Although previous studies suggested that both light exposure and visual acuity were associated with cognitive function, the relationships between cataract surgery, visual acuity, and cognitive function have not been evaluated in large populations. In this cross-sectional study, we measured cognitive function using the Mini-Mental State Examination and best-corrected visual acuity in pseudophakic (previous cataract surgery) and phakic (no previous cataract surgery) elderly individuals. Of 945 participants (mean age 71.7 years), 166 (17.6%) had pseudophakia and 317 (33.5%) had impaired cognitive function (score ≤26). The pseudophakic group showed significantly better visual acuity than the phakic group (p = 0.003) and lower age-adjusted odds ratio (ORs) for cognitive impairment (OR 0.66; p = 0.038). Consistently, in multivariate logistic regression models, after adjusting for confounding factors, including visual acuity and socioeconomic status, ORs for cognitive impairment were significantly lower in the pseudophakic group than in the phakic group (OR 0.64; 95% confidence interval 0.43-0.96; p = 0.031). This association remained significant in sensitivity analysis, excluding participants with low cognitive score ≤23 (n = 36). In conclusion, in a general elderly population, prevalence of cognitive impairment was significantly lower in pseudophakic individuals independently of visual acuity. The association was also independent of several major causes of cognitive impairment such as aging, gender, obesity, socioeconomic status, hypertension, diabetes, sleep disturbances, depressive symptoms, and physical inactivity.

BACKGROUND Decreased muscle strength is associated with functional limitation and disability and is a predictor of cardiovascular and all-cause mortality. Recently, oxidative stress and inflammation have been shown to contribute to the loss of muscle strength, and although melatonin has antioxidative and anti-inflammatory properties, the association between melatonin secretion and muscle strength remains unclear. METHODS In this cross-sectional study of 760 community-based elderly individuals (mean age, 71.0 years), we measured overnight urinary 6-sulfatoxymelatonin excretion (UME) and grip strength and quadriceps strength. RESULTS Median UME was 7.0 μg (interquartile range, 4.2-11.1), and mean grip and quadriceps strength were 27.5±8.4kg and 162.6±80.1 Nm, respectively. On dividing participants into quartiles by their UME level (lowest-highest UME, Q1-Q4), higher quartiles were significantly associated with increased grip strength and quadriceps strength (p for trend < .001, both). Multivariable analyses adjusted for potential confounders (age, gender, body mass index, smoking and drinking statuses, renal function, hypertension, diabetes, physical activity, depressed mood, cognitive impairment, bedtime, sleep duration, and day length) revealed that both grip and quadriceps strength were significantly increased in Q4 compared with that in Q1 (adjusted mean difference, Q4 - Q1: grip strength, 1.5kg; 95% confidence interval [CI], 0.4-2.6kg; p = .006; quadriceps strength, 14.2 Nm; 95% CI, 1.3-27.1 Nm; p = .031). CONCLUSIONS Melatonin secretion was significantly associated with muscle strength in this elderly population. Further longitudinal studies are needed to ascertain the effect of melatonin levels on muscle strength.

This study aimed to assess the reliability and validity of Japanese versions of the KIDSCREEN-27 (J-KIDSCREEN-27) and KIDSCREEN-10 (J-KIDSCREEN-10) questionnaires, which are shorter versions of the KIDSCREEN-52 (J-KIDSCREEN-52). The present analyses are based on a pre-existing dataset of the J-KIDSCREEN-52 validation study, including 1564 children and adolescents aged 8–18 years and their 1326 parents. All were asked to complete the J-KIDSCREEN and Pediatric Quality of Life Inventory (PedsQL) questionnaires. Test–retest reliability was assessed with Intraclass Correlation Coefficients (ICCs) in a one-way random effects model, and internal consistency reliability was measured using Cronbach’s alpha coefficients. Agreement between child and parent scores was evaluated using ICCs in a two-way mixed effects model. To assess concurrent validity, a sub-sample of 535 parents evaluated their child’s mental health status using the Strengths and Difficulties Questionnaire (SDQ). For children, test–retest ICCs were ≥0.60 and Cronbach’s alpha ≥0.70 for every dimension of both instruments. Correlations of corresponding dimensions between the J-KIDSCREEN-27 or -10 and the PedsQL were acceptable. For parents, test–retest ICCs were ≥0.60, Cronbach’s alpha ≥0.70, and ICCs between child and parent scores ≥0.41 in every dimension of both instruments. In multivariate logistic regression models, after adjusting for confounders, lower health-related QOL in every dimension of both instruments, except Physical Well-being, was significantly associated with higher odds ratios for borderline and clinical ranges of the SDQ. The child/adolescent and parent/proxy versions of the J-KIDSCREEN-27 and J-KIDSCREEN-10 demonstrated acceptable levels of reliability and validity.

Background Many studies have reported that housing tenure (HT) is associated with health, but little is known about its association in Japan. We investigated the cross-sectional association between HT and self-rated health (SRH) among Japanese adults, taking demographic characteristics and socioeconomic status (SES) into consideration. Methods We used data from a nationally representative survey conducted by the Japanese Ministry of Health, Labour and Welfare (28,641 men and 31,143 women aged ≥20 years). HT was divided into five categories: owner-occupied, privately rented, provided housing, publically subsidized, and rented rooms. SRH was evaluated using a single-item inventory and dichotomized into poor (very poor/poor) and good (very good/good/fair). We calculated adjusted odds ratios (OR) and their 95% confidence intervals (CI) for poor SRH with logistic regression models. Covariates included demographic factors (i.e., age, gender, marital status, family size, smoking status, and chronic medical conditions) and SES factors (i.e., education, equivalent household expenditures, and occupation). Results Among analyzed participants, 75.9% were owner-occupiers and 14.6% reported poor SRH. After adjustment for all covariates, compared with owner-occupiers, private renters (OR = 1.36, 95% CI = 1.26–1.47), publically subsidized renters (OR = 1.33, 95% CI = 1.19–1.48), and residents in rented rooms (OR = 1.41, 95% CI = 1.22–1.62) were more likely to report poor SRH. Stratified analyses by SES factors showed that the association between HT and poor SRH was stronger in the socially disadvantaged than in the higher socioeconomic group. Conclusions Our results show a significant association between HT and SRH, independent of socio-demographic factors. HT may deserve greater attention as an indicator of socioeconomic position in Japan.

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

Patients with type 2 diabetes mellitus have an increased fracture risk. However, population-based studies on the association between glycemic status and fracture risk are scarce, and none have targeted a Japanese population. In addition, patients in the lowest category of hemoglobin A1c (HbA1c) do not always show the lowest risk. This study aimed to clarify the association between glycemic status and fracture risk in community-dwelling elderly Japanese men.A total of 1992 men aged ≥65 years completed baseline measurements including fasting plasma glucose (FPG), HbA1c, bone density, and an interview regarding past disease history. Osteoporotic fractures (OPFs) that occurred during the 5-year follow-up period were determined through interviews. An OPF at the spine, hip, proximal humerus, or distal radius was defined as a major OPF (MOF).After excluding participants who had a history of type 1 diabetes mellitus and thiazolidinedione therapy, 1951 men were analyzed. Men with hyperglycemia in the diabetic range had a significantly higher risk of OPF compared with those with normoglycemia, after adjusting for confounding factors including insulin therapy (hazard ratio (HR): 2.76, 95% confidence interval (CI): 1.17, 6.50 in FPG ≥ 126 mg/dl; HR: 2.49, 95% CI: 1.07, 5.77 in HbA1c ≥ 6.5%). An elevated risk of MOF was observed in participants in the prediabetic HbA1c category (HR: 2.15, 95% CI: 1.00, 4.62 in 5.7% ≤ HbA1c 6.5%) in addition to those in the diabetic category. The intermediate glycemic status group showed intermediate risk, suggesting that the association was linear.Hyperglycemia was associated linearly with elevated fracture risk in community-dwelling elderly men. MOF risk may be elevated in Japanese elderly men with prediabetic glycemic status.

Objectives To evaluate the associations between pre-awake light (PAL) exposure and subjective and objective measures of sleep quality. Methods In this cross-sectional study of 1108 elderly participants (mean age, 71.9 years), we measured bedroom light intensity using a bedside light meter for two nights and sleep quality using actigraphy and a questionnaire. PAL was determined as the 2h-average light intensity before rise time, and sleep disturbance was defined as the Pittsburgh sleep quality index score ≥6. Results Sleep disturbance prevalence increased with increased PAL exposure (P = 0.002). In multivariable models adjusted for potential confounders, the odds ratio (OR) for sleep disturbances was significantly higher in the highest quartile PAL group (Q4) than in the lowest quartile group (Q1) (OR, 1.65; 95% CI, 1.16–2.34). This association occurred independent of post-bedtime light exposure; and was stronger in the later chronotype group (n = 556) (OR, 1.80; 95% CI, 1.05–3.09) than in the earlier chronotype group (n = 552) (OR, 1.64; 95% CI, 1.01–2.64). Actigraphic sleep efficiency in the Q4 group was significantly lower by 2.6% (95% CI, 1.3–3.8) than that in the Q1 group. Moreover, longer wake after sleep onset by 7.5 min (95% CI, 2.8–12.2) and sleep onset latency by 0.2 log min (95% CI, 0.1–0.4) were observed in the Q4 group than the Q1 group. Conclusions Higher PAL exposure was significantly associated with a higher prevalence of sleep disturbances, independent of post-bedtime light exposure. Consistent results were observed in the actigraphy analysis.

Background Although social participation (SP) is valid in active aging, it is vague which types and the frequency of SP are effective in maintaining instrumental activities of daily living (IADL). We conducted a community-based prospective cohort study and investigated the association of the types and frequency for SP with IADL decline in community-dwelling older adults. Methods The target population were all individuals aged ≥65 living in a commuter town in Nara, Japan. A total of 6,013 participants with independent IADL at baseline were analyzed. IADL was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Six SP types were assessed: volunteer groups, sports groups, hobby clubs, senior citizens’ clubs, neighborhood community associations, and cultural clubs. The frequency of SP was categorized into frequent (i.e., weekly or more), moderate (i.e., monthly or yearly), and non-participation. Using multiple logistic regression models, the odds ratio (OR) and a 95% confidence interval (CI) for IADL decline were calculated. Covariates included age, marital status, education, subjective economic status, work status, body mass index, chronic medical conditions (i.e., hypertension, diabetes mellitus, heart disease, and cerebrovascular disease), lifestyle factors (i.e., alcohol, smoking, and exercise), self-rated health, depression, and cognitive functioning. To examine gender differences, stratified analyses by gender were performed. Results During the 33-month follow-up, 16.4% of men and 8.7% of women exhibited IADL decline. After adjustment for all covariates, compared to those who never participated, women with moderate participation had significantly lower odds of IADL decline in volunteer groups (OR = 0.53, 95% CI = 0.31–0.88), hobby clubs (OR = 0.55, 95% CI = 0.38–0.79), neighborhood community associations (OR = 0.58, 95% CI = 0.42–0.81), and cultural clubs (OR = 0.51, 95% CI = 0.31–0.82), and women with frequent participation had lower odds of IADL decline in hobby clubs (OR = 0.63, 95% CI = 0.43–0.93). In contrast, among men, the significant association between SP and less risk of IADL decline was limited to moderate participation in neighborhood community associations (OR = 0.79, 95% CI = 0.63–0.99), and there were no differences between frequent participation and non-participation in all types of SP. Regarding volunteer groups, compared to women with frequent participation, women with moderate participation had a significantly lower risk of IADL decline (OR = 0.37, 95% CI = 0.18–0.77). The results of additional stratified analyses by self-rated health, depression, and cognitive functioning showed that the associations of the type and frequency of SP with IADL decline varied according to physical and mental functioning. Conclusions Several types of SP have a favorable effect on IADL through moderate participation rather than frequent participation, and women with moderate participation in volunteer groups have a more beneficial effect on IADL than women with frequent participation. When advising community-dwelling older adults on SP for IADL maintenance, health professionals may need to take into account plateau effects, gender differences, and physical and mental functioning.

Background There is insufficient evidence regarding the relationship of home environment with functional capacity among community-dwelling older people without disabilities. We conducted a population-based longitudinal cohort study and examined whether stairs in the home were associated with capability to perform instrumental activities of daily living (IADL) in community-dwelling high-functioning older adults. Methods The target population was individuals aged 65 years or older living in two municipalities in Nara Prefecture in Japan. At the baseline survey, residents who were independent in IADL (n = 6722) were included as survey subjects. Subjects were divided into three groups according to their home type; one-storey residences, walk-up residences, or residences with an elevator. IADL was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Multiple logistic regression analyses stratified by gender were used to calculate the odds ratio (OR) and a 95% confidence interval (CI) for a decline in IADL, with one-storey residences as a reference. Age, studied area, marital status, working status, self-perceived economic status, body mass index, chronic diseases, smoking, drinking, eating habits, basic activities of daily living, cognitive functioning, depression, self-rated health, and social participation were used as covariates. Results During the 3-year follow-up, 11.6% of the subjects showed a decline in IADL. After adjusting for covariates, women who lived in walk-up residences had a lower risk for IADL decline (adjusted OR = 0.72, 95% CI = 0.52–0.99), while living in a home with an elevator was not associated with IADL decline (adjusted OR = 0.94, 95% CI = 0.49–1.77). In contrast, there was no association between home type and IADL decline in men (walk-up residences, adjusted OR = 0.90, 95% CI = 0.71–1.14; residences with an elevator, adjusted OR = 0.82, 95% CI = 0.39–1.72). Conclusions The presence of stairs in the home was associated with prevention of IADL decline over a 3-year period in older women without disabilities. Although a barrier-free house is recommended for older people, our findings indicate that a home with stairs may maintain the capability to perform IADL among older adults without disabilities. Electronic supplementary material The online version of this article (10.1186/s12877-018-0830-3) contains supplementary material, which is available to authorized users.

The present study aimed to determine the relationship between cataract subtypes and circadian blood pressure (BP) variability in elderly individuals. In this cross-sectional study of a community-based cohort, we assessed bilateral lens opacity using slit lamp photographs of 458 elderly individuals (mean age, 69.1 years). Cataract status was defined as a bilateral Lens Opacities Classification System III grade of ≥3 for nuclear cataract, ≥2 for cortical cataract, and ≥2 for posterior subcapsular cataract (PSC). Ambulatory BP monitoring was performed at 30-min intervals for 48 h. A nondipper pattern of BP was defined as a

Bright light therapy and exercise interventions are effective methods for treating seasonal and non-seasonal affective disorders. Synchronization of internal circadian rhythms with the external environment by light therapy and physical activity may partly explain its efficacy. In the present study, we objectively measured daytime light exposure and physical activity in real life situations with elderly participants, and investigated the association between farming habits and the prevalence of depressive symptoms.This cross-sectional was conducted among 1005 participants (mean age: 71.5) of a community-based cohort study. Depressive symptoms were assessed by the Geriatric Depression Scale (GDS score ≥ 6) and administration of antidepressant.Farming habit with long duration ( 7.0 h/week) showed significantly lower odds ratios (OR) for depressive symptoms (adjusted OR 0.63, 95% confidential interval,0.41 to 0.96) compared with participants without farming habit independent of confounders such as age, gender, body mass index smoking, drinking, daytime ambulatory systolic blood pressure, diabetes, living alone, education, income, and daylength. Even in farming with short duration (≤ 7.0 h/week), we found significant association with lower OR for depressive symptoms (adjusted OR 0.64, 95%CI, 0.42 to 0.97). Light exposure and daytime physical activity measured by wrist actigraphy were significantly higher among participants with longer farming habits (p for trend 0.01). Physical activity mediated 12.0% of association between farming habit and depressive symptoms.A cross-sectional association may be found because the participants with depressive symptoms tended to avoid farming. A longitudinal study is warranted to determine the direction of causality.Participants with farming habit showed significantly lower OR for depressive symptoms than those without farming habit, and it was partly mediated by physical activity.

Muscle strength and gait speed are related with functional limitations and disabilities and also predict cardiovascular and all-cause mortality. Nitric oxide (NO) plays an important role in regulating physiological process in skeletal muscles; however, the association between serum asymmetric dimethylarginine (ADMA) level, an endogenous competitive inhibitor of NO synthesis, and physical performance has not yet been studied. We investigated the associations of serum ADMA level with muscle strength and usual gait speed in a cross-sectional study of 550 elderly individuals (mean age, 71.2 ± 6.6 years). Mean ADMA level was 0.45 ± 0.06 µmol/L; mean grip and quadriceps strengths were 27.7 ± 8.4 kg and 165.1 ± 81.6 Nm, respectively; and mean gait speed was 1.37 ± 0.30 m/s. In multivariate linear regression analysis adjusted for potential confounding factors (age, gender, body weight, smoking and drinking status, household income, hypertension, diabetes, renal function, and physical activity), higher serum ADMA level was significantly associated with lower grip and quadriceps strengths and slower gait speed (grip strength: β, -1.257; 95% confidence interval [CI], -1.990 to -0.525; p = 0.001; quadriceps strength: β, -11.730; 95% CI, -20.924 to -2.536; p = 0.012; gait speed: β, -0.065; 95% CI, -0.108 to -0.022; p = 0.003). Our findings indicate the significant association between serum ADMA level and physical performance among elderly individuals, which was independent of the important potential confounders. © 2015 American Society for Bone and Mineral Research.

Background: This study’s aim was to clarify the relationship of having hobbies and a purpose in life (PIL; in Japanese, ikigai) with mortality and a decline in the activities of daily living (ADL) and instrumental ADL (IADL) among the community-dwelling elderly. Methods: Prospective observational data from residents aged ≥65 years who were at increased risk for death (n = 1853) and developing a decline in ADL (n = 1254) and IADL (n = 1162) were analyzed. Cox proportional hazard models were used for mortality analysis of data from February 2011 to November 2014. ADL and IADL were evaluated using the Barthel Index and the Tokyo Metropolitan Institute of Gerontology Index of Competence, respectively. ADL and IADL were assessed at baseline and follow-up and were evaluated using logistic regression models. Fully adjusted models included terms for age, gender, BMI, income, alcohol intake, smoking history, number of chronic diseases, cognitive function, and depression. Results: During the follow-up of eligible participants, 248 had died, 119 saw a decline in ADL, and 178 saw a decline in IADL. In fully adjusted models, having neither hobbies nor PIL was significantly associated with an increased risk of mortality (hazard ratio 2.08; 95% confidence interval [CI], 1.47–2.94), decline in ADL (odds ratio 2.74; 95% CI, 1.44–5.21), and decline in IADL (odds ratio 1.89; 95% CI, 1.01–3.55) compared to having both hobbies and PIL. Conclusions: Although effect modifications by cognitive functioning and depression cannot be ruled out, our findings suggest that having hobbies and PIL may extend not only longevity, but also healthy life expectancy among community-dwelling older adults.

Background Cataract surgery (CS) drastically increases the capacity for light reception to the retina. Several previous studies have suggested the beneficial effect of CS on subjectively measured sleep quality; however, the association between CS and objectively measured sleep quality remains uncertain. Methods To evaluate the association between CS and objectively measured sleep quality in home settings, we conducted a cross-sectional study in 1037 elderly individuals (mean age, 71.9 years). We evaluated actigraphically measured sleep quality, urinary 6-sulfatoxymelatonin excretion, and ambulatory light levels, in addition to CS status. Results The CS group (n = 174) showed significantly higher sleep efficiency and shorter wake after sleep onset than the no CS group (n = 863), even after adjustment for age, gender, body mass index, current smoking status, alcohol consumption, hypertension, diabetes, sleep medication, bedtime, rising time, daytime physical activity, daytime and nighttime light exposure, and urinary 6-sulfatoxymelatonin excretion (sleep efficiency: 85.8% in the CS group vs 84.4% in the no CS group, P = 0.042; wake after sleep onset: 45.7 min vs 50.6 min, respectively, P = 0.033). In contrast, urinary 6-sulfatoxymelatonin excretion, sleep onset latency, total sleep time, and sleep-mid time did not differ significantly between the CS and no CS groups. Conclusions Among a community-dwelling elderly population, CS is significantly associated with objectively measured sleep quality, but urinary levels of melatonin metabolite do not differ between individuals with and without CS. These associations are independent of daily light exposure profiles.

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 (P for 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; P for 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.

A significant association between nocturia and subjective sleep quality has previously been reported; however, the association between nocturia and objective sleep quality remains unclear. The purpose of this study was to evaluate the quantitative association between nocturnal voiding (NV) frequency and objective sleep quality in a large, general, elderly population.Nocturnal voiding frequency, objective sleep quality, and subjective sleep quality were measured among 1086 community-based elderly individuals using actigraphy and the Pittsburgh Sleep Quality Index (PSQI) questionnaire.In multivariate analyses adjusted for potential confounding factors (such as age, gender, body mass index, medication use, renal function, bedtime, rising time, daytime physical activity, endogenous melatonin levels, and bedroom light levels), increased NV frequency, ranging from zero, one, two, three or more voids, was significantly associated with poorer objective sleep quality, including lower sleep efficiency (SE) and longer wake after sleep onset (WASO) (mean SE, 86.3, 84.8, 83.6, and 81.2%, respectively; p for trend0.001; mean WASO: 42.6, 49.0, 53.6, and 66.1 min, respectively; p for trend0.001), but shorter sleep onset latency (SOL) (mean SOL, 3.0, 3.0, 2.8, and 2.8 log min, respectively; p for trend = 0.018). In addition, an increased NV frequency was significantly associated with poorer subjective sleep quality in a multivariate model (mean PSQI global score, 4.60, 4.86, 5.22, and 5.48, respectively; p for trend 0.012).The present study revealed a quantitative association between NV frequency and objective sleep quality in the general elderly population.