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Aim: This cross-sectional study had two aims: to assess the prevalence of oral frailty (OF), according to the Oral Frailty 5-Item Checklist (OF-5), among community-dwelling older adults; and to examine the associations among oral frailty, dietary variety, social engagement, and physical frailty. Methods: We pooled data from two population-based studies (the Otassha Study and the Itabashi Longitudinal Study on Aging). With the OF-5, OF is characterized by the presence of two or more of the following: (i) fewer teeth, (ii) difficulty in chewing, (iii) difficulty in swallowing, (iv) dry mouth, and (v) low articulatory oral motor skills. We calculated the OF prevalence for each sex. We assessed dietary variety, social engagement, and physical frailty. Generalized structural equation modeling was employed to investigate the associations among oral frailty, low dietary variety (dietary variety score =3), social isolation (Lubben Social Network Scale score <12), and physical frailty (Japanese version of the Cardiovascular Health Study score =3). Results: A total of 1206 individuals (626 women and 580 men) with a mean age of 74.7 years were included. The prevalence of OF was 36.7%, and it increased with age; however, there was no significant sex difference. OF was significantly indirectly associated with physical frailty via low dietary variety (odds ratio, 1.43; 95% confidence interval, 1.04-1.97) and social isolation (odds ratio, 1.42; 95% confidence interval, 1.04-1.94). Conclusions: Two of five community-dwelling older adults exhibited OF. Low dietary variety and social isolation are potential underlying mechanisms through which OF is indirectly associated with physical frailty. [ABSTRACT FROM AUTHOR]

Epidemiological studies on hallux valgus (HV) are challenging owing to differences in sampling and diagnostic criteria across studies. This study aimed to indirectly clarify HV epidemiology using a national database. The age- and sex-stratified annual number rate of HV correction (RHVC) per 100,000 people in Japan during 2014–2019 were examined. The average annual RHVC was 3.0. RHVC had unimodal (peak, 65–79 years) and bimodal (peaks, 15–19 and 70–74 years) distributions among males and females, respectively, and increased over time in males aged 50–54 and 75–79 years and females aged 80–84 years. RHVC increases with increasing age and occurs commonly in female teens. The recent RHVC in Japan was lower than that reported in Europe and the United States, with an increasing trend among elderly people. III [ABSTRACT FROM AUTHOR]

Simple Summary: To investigate the efficacy of minimally invasive surgery (MIS) in the treatment of uterine-confined and node-negative cervical cancer in Japan, we conducted a population-based study using Osaka Cancer Registry data ranging between 2011 and 2018. A total of 2279 patients who underwent surgical treatment for uterine-confined and node-negative cervical cancer were identified. The patients were classified into groups according to surgery type (open and MIS groups) and year of diagnosis (2011–2014 and 2015–2018), and their oncologic outcomes were compared between the MIS and open groups. In the analyses including all patients, i.e., patients diagnosed in 2011–2014 and those diagnosed in 2015–2018, there were no differences in overall survival between the MIS and open groups. Our population-based cohort study provides epidemiological evidence that MIS does not compromise survival outcomes when compared with conventional open surgery in Japanese patients with FIGO 2018 stage I cervical cancer. We aimed to compare the oncological outcomes between Japanese women with uterine-confined and node-negative cervical cancer who underwent open surgery and those who underwent minimally invasive surgery (MIS). A population-based retrospective cohort study was conducted using data from the Osaka Cancer Registry that ranged from 2011 to 2018. A total of 2279 patients who underwent surgical treatment for uterine-confined and node-negative cervical cancer were identified. The patients were classified into groups according to surgery type (open and MIS groups) and year of diagnosis (group one, 2011–2014; group two, 2015–2018). The oncologic outcomes were compared between the MIS and open groups. When the MIS group (n = 225) was compared with open group (n = 2054), overall, there was no significant between-group difference in terms of overall survival. Based on Kaplan–Meier estimates, the probability of overall survival at four years was 99.5% in the MIS group and 97.2% in the open group (p = 0.1110). When examined according to the year of diagnosis, there were no significant between-group differences in the overall survival in both groups one and two. In this population-based cohort study, MIS did not compromise survival outcomes when compared with conventional open surgery in Japanese patients with uterine-confined and node-negative (FIGO 2018 stage I) cervical cancer. [ABSTRACT FROM AUTHOR]

Adolescents with high autistic traits are at increased risk of depression. Despite the importance of seeking help for early intervention, evidence on help-seeking intentions amongst this population is scarce. Using a population-based cohort in Japan, we examined adolescents' help-seeking intentions and preferences by the level of autistic traits and tested its mediating role on the association between high autistic traits and depressive symptoms. At age 12, we measured parent-rated autistic traits using the short version of the Autism Spectrum Quotient and classified the adolescents into two groups (≥ 6 as AQhigh, < 6 as AQlow); help-seeking intentions and preferences were assessed through a depression vignette. At age 14, depressive symptoms were self-rated using the Short Mood and Feelings Questionnaire. Hypothesised associations between autistic traits and help-seeking intentions or depressive symptoms were tested applying multivariable regression modelling, while mediation was tested with structural equation modelling. Of the 2505 adolescent participants, 200 (8%) were classified as AQhigh. In both groups, the main source of help-seeking was their family; however, 40% of the AQhigh group reported having no help-seeking intentions compared to 27% in the AQlow. The AQhigh group was at increased risk of not having help-seeking intentions (OR 1.84, 95% CI 1.35–2.50) and higher depressive symptoms (b coefficient 1.06, 0.33–1.79). Help-seeking intentions mediated 18% of the association mentioned above. Interventions to promote help-seeking intentions among adolescents with high autistic traits could reduce their subsequent depressive symptoms. Ideally, such interventions should be provided prior to adolescence and with the involvement of their parents. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the longitudinal association between yogurt product intake and oral health in a population‐based study. Materials and Methods: This study included 1967 Japanese residents aged 40–79 years who underwent dental examinations in 2012. Among them, 1469 participants were followed up in 2017 for the incidence of tooth loss, which was defined as two or more teeth lost over 5 years. The intake of yogurt products, defined as yogurt and lactic acid beverages, was estimated using a semi‐quantitative food frequency questionnaire. The composition of the salivary microbiota was evaluated. Results: The Poisson regression model showed that a higher intake of yogurt products was negatively associated with the incidence of tooth loss (p for trend =.020), adjusted for potential confounding factors. Mediation analysis confirmed that periodontal condition partly mediated the effect of yogurt product intake on tooth loss, while dental caries experience did not. Additionally, we confirmed the association of a high intake of yogurt products with a low percentage of the salivary microbiota pattern, which was associated with poor oral health. Conclusion: These findings suggest that the intake of yogurt products is associated with a lower risk of tooth loss resulting from periodontal disease, probably via modulation of the oral microbiome composition. [ABSTRACT FROM AUTHOR]

Aim: Although poor childhood rearing environment is known to negatively impact late‐life cognitive function, there is a scarcity of evidence on the contribution of positive parenting behaviors. The present study investigates the association between parental involvement in childhood and late‐life cognitive function. Methods: A total of 266 older adults aged between 65 and 88 years living in Wakuya City, Miyagi Prefecture, Japan, without indication of mild cognitive impairment or dementia, participated in a survey. Parental involvement in childhood was assessed by a questionnaire, and late‐life cognitive function was measured by the Japanese version of the Quick Mild Cognitive Impairment (QMCI) screening test (range: 0–100). Multiple regression analysis was performed to investigate the association, adjusting for potential confounders and mediators. Results: After adjusting for age, sex, other child‐rearing environment, and academic performance in grade 6, older adults with a high level of positive parental involvement in childhood scored 6.00 (95% CI: 2.39, 9.61) points higher for the QMCI total score than those without. Parental involvement in childhood showed significant dose–response positive associations with the QMCI total score (P < 0.001), clock‐drawing test score (P < 0.05), and verbal fluency score (P < 0.001). Among the six types of positive parental involvement, book reading showed a significant independent positive association with QMCI total score (P < 0.01) and logical memory score (P < 0.01). Conclusions: Greater parental involvement in childhood, particularly book reading, was associated with better late‐life cognitive function. Geriatr Gerontol Int 2021; 21: 794–801. [ABSTRACT FROM AUTHOR]

Background: Globally, the number of deaths is estimated to increase to 74 million per year by 2030. Place of death (PoD) is increasingly being recognized as an important aspect of end-of-life care. However, recent trends in PoD in Japan, one of the super-aged societies, are unknown. Objective: To analyze trends in PoD in Japan over two decades. Design: Population-based retrospective observational study. Setting: All deaths reported in Japan, 1998–2017. PoD was defined as hospital, nursing home, or own home. Results: All Japanese decedents (∼22.6 million) over the past 20 years were analyzed. The proportion of hospital deaths was consistently high (>80%), with a significant decreasing trend from the mid-2000s. Although the proportion of deaths at home decreased in the first half of the study period, they later increased. There was a low proportion of deaths in nursing homes compared to other places of death; however, the proportion increased continually throughout the study period, particularly among women. In 2015, more women died in nursing homes than at home. Although the proportion of hospital deaths declined in the second half of the study period, their overall number continued to increase, reflecting an increase in total deaths in Japan. Conclusions: This study highlighted rapid changes in trends in PoD in Japan, and the need to consider affordable end-of-life care in Japan as well as other countries with aging populations. The findings from this long-term epidemiological study provide important insights on this issue. [ABSTRACT FROM AUTHOR]

Aim: To clarify whether the incidence of uterine fundal pressure (UFP) maneuver at delivery and consequent uterine rupture were declined. Methods: Population‐based postal questionnaire study was conducted. A questionnaire was sent to obstetric institutions across Japan. Questions were included the total number of deliveries, UFP and uterine ruptures associated with UFP in 2012 and 2017. As the primary outcome, frequencies of the UFP and uterine rupture were compared between 2012 and 2017. The secondary outcomes were included improved managements of delivery regarding UFP. Results: A number of vaginal deliveries were significantly declined from 80.4% in 2012 to 78.1% in 2017 (P < 0.001). Frequencies of UFP per vaginal deliveries were also significantly declined 11.2% (38 973/347771) in 2012 to 9.5% (35 205/404444) in 2017 (<0.001). Number of uterine ruptures were 6 cases in 2012 (1:6496) and 11 cases in 2017 (1:3473) (P = 0.210). Compared to situation in 2012, informed consent was more frequently obtained for UFP in 2017. Written informed consent for UFP became to be obtained in 12% of institutions in 2017 from only 3% in 2012. More than 80% of institutions are performing UFP within 3 times. Regarding to uterine rupture, try of labor after the cesarean section, UFP and augmentation were improved in more than 10% of institutions. Most impact vehicle changing behavior was OBGY clinical guideline. Conclusion: Although significant declined incidence of uterine rupture after UFP could not be demonstrated, frequency of UFP was decreased recent 5 years. This is due to improvement of obstetric management by obstetric caregivers throughout Japan. [ABSTRACT FROM AUTHOR]

Objectives: Social relationships are important for diffusion of information and behaviours. Access to preventive dental care is more difficult than access to curative dental care under the Japanese universal healthcare system. Our objective was to examine whether social relationships were differentially associated with curative and preventive dental care use in Japan. Methods: A questionnaire survey was conducted between 2010 and 2011 among residents aged 25‐50 years in Japanese metropolitan areas. Valid responses were obtained from 1919 men and 2207 women. Social relationships included social networks (membership of organizations and number of close ties) and social support (informational support and instrumental support). Poisson regression analyses with robust variance estimators were conducted to examine associations between each social relationship variable and curative dental care use or preventive dental care use, adjusted for covariates. Results: While 38.4% of men and 42.0% of women used curative dental care, 22.9% of men and 32.5% of women used preventive dental care in the past year. No measures of social relationships were associated with curative dental care use among men and women, except the number of close ties among men. By contrast, all measures of social relationships were associated with preventive dental care use among men; the multivariate‐adjusted prevalence ratios (95% confidence intervals) of the highest compared with the lowest level of social relationships were 1.58 (1.18‐2.13) for membership of organizations, 1.58 (1.24‐2.00) for the number of close ties, 1.41 (1.10‐1.82) for informational support and 1.30 (1.01‐1.68) for instrumental support. Among women, no measures of social relationships were associated with preventive dental care use. Conclusions: Social relationships were associated with preventive dental care use among men but not among women, while these were not associated with curative dental care use. [ABSTRACT FROM AUTHOR]

Importance Although participation in physical and cognitive activities is encouraged to reduce the risk of dementia, the preventive efficacy of these activities for patients with mild cognitive impairment is unestablished. Objective To compare the cognitive and mobility effects of a 40-week program of combined cognitive and physical activity with those of a health education program. Design A randomized, parallel, single-blind controlled trial. Setting A population-based study of participants recruited from Obu, a residential suburb of Nagoya, Japan. Participants Between August 2011 and February 2012, we evaluated 945 adults 65 years or older with mild cognitive impairment, enrolled 308, and randomly assigned them to the combined activity group (n = 154) or the health education control group (n = 154). Interventions The combined activity program involved weekly 90-minute sessions for 40 weeks focused on physical and cognitive activities. The control group attended 90-minute health promotion classes thrice during the 40-week trial period. Measurement The outcome measures were assessed at the study's beginning and end by personnel blinded to mild cognitive impairment subtype and group. The primary endpoints were postintervention changes in scores on (1) the Mini-Mental State Examination as a measure of general cognitive status and memory, (2) the Wechsler Memory Scale-Revised–Logical Memory II, and (3) the Rey Auditory Verbal Learning Test. We applied mobility assessments and assessed brain atrophy with magnetic resonance imaging. Results Compared with the control group, the combined activity group showed significantly greater scores on the Mini-Mental State Examination (difference = 0.8 points, P  = .012) and Wechsler Memory Scale-Revised–Logical Memory II (difference = 1.0, P  = .004), significant improvements in mobility and the nonmemory domains and reduced left medial temporal lobe atrophy in amnestic mild cognitive impairment ( Z- score difference = −31.3, P  < .05). Conclusion Combined physical and cognitive activity improves or maintains cognitive and physical performance in older adults with mild cognitive impairment, especially the amnestic type. [ABSTRACT FROM AUTHOR]

What is known and objective Midazolam ( MDZ) is commonly used for sedating critically ill patients. The daily dose required for adequate sedation increases in increments over 100 h after administration. The objectives of this study were to characterize the MDZ pharmacokinetics in critically ill patients and to describe the phenomenon of increasing daily dose by means of population pharmacokinetic analysis. Methods Data were obtained from 30 patients treated in an intensive care unit. The patients received MDZ intravenously as a combination of bolus and continuous infusion. Serum MDZ concentration was assayed by high-performance liquid chromatography. Population pharmacokinetic analysis was performed using the NONMEM software package. The alteration of clearance unexplained by demographic factors and clinical laboratory data was described as an autoinduction of MDZ clearance using a semi-mechanistic pharmacokinetic-enzyme turnover model. Results and discussion The final population pharmacokinetic model was a one-compartment model estimated by incorporating a semi-mechanistic pharmacokinetic-enzyme turnover model for clearance, taking autoinduction into account. A significant covariate for MDZ clearance was total bilirubin. An increase in total bilirubin indicated a reduction in MDZ clearance. From simulation using the population pharmacokinetic parameters obtained in this study, MDZ clearance increased 2·3 times compared with pre-induced clearance 100 h after the start of 12·5 mg/h continuous infusion. What is new and conclusion Autoinduction and total bilirubin were significant predictors of the clearance of MDZ in this population. Step-by-step dosage adjustment using this population pharmacokinetic model may be useful for establishing a MDZ dosage regimen in critically ill patients. [ABSTRACT FROM AUTHOR]

Aims: To compare the factors associated with survival after out-of-hospital cardiac arrests (OHCAs) among three time-distance areas (defined as interquartile range of time for emergency medical services response to patient's side).Methods: From a nationwide, prospectively collected data on 716,608 OHCAs between 2007 and 2012, this study analyzed 193,914 bystander-witnessed OHCAs without pre-hospital physician involvement.Results: Overall neurologically favourable 1-month survival rates were 7.4%, 4.1% and 1.7% for close, intermediate and remote areas, respectively. We classified BCPR by type (compression-only vs. conventional) and by dispatcher-assisted CPR (DA-CPR) (with vs. without); the effects on time-distance area survival were analyzed by BCPR classification. Association of each BCPR classification with survival was affected by time-distance area and arrest aetiology (p<0.05). The survival rates in the remote area were much higher with conventional BCPR than with compression-only BCPR (odds ratio; 95% confidence interval, 1.26; 1.05-1.51) and with BCPR without DA-CPR than with BCPR with DA-CPR (1.54; 1.29-1.82). Accordingly, we classified BCPR into five groups (no BCPR, compression-only with DA-CPR, conventional with DA-CPR, compression-only without DA-CPR, and conventional without DA-CPR) and analyzed for associations with survival, both cardiac and non-cardiac related, in each time-distance area by multivariate logistic regression analysis. In the remote area, conventional BCPR without DA-CPR significantly improved survival after OHCAs of cardiac aetiology, compared with all the other BCPR groups. Other correctable factors associated with survival were short collapse-to-call and call-to-first CPR intervals.Conclusion: Every effort to recruit trained citizens initiating conventional BCPR should be made in remote time-distance areas. [ABSTRACT FROM AUTHOR]

Objectives To clarify the factors associated with risk for assisted living among community-dwelling older people, we conducted a large-scale survey in an urban city in Japan. Design Population-based cross-sectional study. Setting A mid-sized urban city in western Japan with a population of approximately 410,000. Participants Nondisabled and nondemented community-dwelling older people (≥65 years). Measurements A self-administered postal questionnaire, including a health checklist for the screening of older people at high risk for assisted living, as well as demographic/sociodemographic questions on sex, age, present illness, living alone, duration of residence within the current city, community participation, and employment status, was distributed. Results There were 41,796 returned questionnaires (response rate: 73.8%, average age: 72.0). Participants who were at high risk for assisted living accounted for 25.2%. The independent factors associated with risk for men and women were higher age, present illness, lack of community participation, unemployment, and <20 years of residence. Living alone was a significant factor for men, whereas it was insignificant among women. The types of illnesses among people at risk were different between men and women. Conclusion Higher age, present illness, and several social factors were independently associated with high-risk status for assisted living in the large-scale whole community survey, and there was a sex difference. Our results may provide basic information for the further application of effective preventive intervention in the community. [ABSTRACT FROM AUTHOR]

Objective To investigate neurological development in small for gestational age (SGA) infants, with a focus on full-term SGA infants. Methods We analyzed data from a large, Japanese, nationwide, population-based longitudinal survey started in 2001. We restricted the study to participants born before 42 weeks of gestation ( n = 46,563). Parents were asked questions about motor and language development when the children were 2.5 years old, and about behavioral development at 5.5 years. We analyzed the relationships between SGA status and development by logistic regression. Odds ratios (ORs) and 95% confidence intervals (95% CI) were calculated for each outcome for full-term and preterm births, adjusting for potential infant- and parent-related confounding factors. We also calculated the population-attributable fractions to estimate the public impact of SGA births. Results SGA full-term children were more likely to demonstrate developmental delays at 2.5 years, e.g., being unable to walk alone (OR 3.0, 95% CI: 1.7, 5.3), compose a two-phrase sentence (OR 1.5, 95% CI: 1.2, 1.8), or use a spoon to eat (OR 1.5, 95% CI: 1.1, 1.9). SGA status also had some degree of negative impacts on behavioral problems at 5.5 years among term children, e.g., being unable to listen without fidgeting (OR 1.2, 95% CI: 1.1, 1.3), or remain patient (OR 1.1, 95% CI: 1.0, 1.2). The public health impacts were comparable between full-term and preterm SGA children at 2.5 years. Conclusion SGA is a risk factor for developmental delay, even in full-term infants, with non-negligible public health impacts. [ABSTRACT FROM AUTHOR]

Background: It is difficult to obtain detailed information on non-participants in physical and health examination checkups in community-based epidemiological studies. We investigated the characteristics of non-participants in a physical and health examination checkup for older adults in a nested study from the Japanese Kyoto-Kameoka Longitudinal Study.Methods: We approached a total of 4831 people aged ≥65 years in 10 randomly selected intervention regions. Participants responded to a mail-based population survey on needs in the sphere of daily life to encourage participation in a free face-to-face physical checkup examination; 1463 participants (706 men, 757 women) participated in the physical checkup. A multiple logistic regression model was performed to investigate the adjusted odds ratios (aOR) of non-participation based on sociodemographic status apart from psychological and physiological frailty as assessed by the validated Kihon Checklist.Results: There was a significant, inverse relationship between non-participation and frequently spending time alone among individuals who lived with someone or other family structure (aOR = 0.53, standard error [SE] 0.08 in men, aOR = 0.66, SE 0.09 in women). Very elderly (over 80 years old) women, poorer health consciousness and current smoking in both sexes and poor self-rated health in men, were significantly related to higher non-participation rates. In both sexes, individuals who did not participate in community activities were significantly more likely to be non-participants than individuals who did (aOR = 1.94, SE 0.23 in men, aOR = 3.29, SE 0.39 in women). Having low IADL and physical functioning scores were also associated with higher rates of non-participation.Conclusion: Health consciousness and lack of community activity participation were predictors of non-participation in a physical checkup examination among older adults. In addition, lower IADL and physical functioning/strength were also predictors of non-participation. On the contrary, older inhabitants living with someone tended to participate in the physical checkup examination for social interchange when they were frequently alone in the household. This study suggests the importance of considering aging especially for women and poor sociodemographic background and physical frailty for both sexes so that older people can access health programs without difficulty.Trial Registration: UMIN000008105 . Registered 26 April 2012. Retrospectively registered. [ABSTRACT FROM AUTHOR]

Aim We aimed to investigate prehospital factors associated with difficulty in hospital acceptance among elderly emergency patients. Methods We reviewed ambulance records in Osaka City from January 2013 through December 2014, and enrolled all elderly emergency patients aged ≥65 years who were transported by on-scene emergency medical service personnel to a hospital that the personnel had selected. The definition of difficulty in hospital acceptance was to the requirement for ≥4 phone calls to hospitals by emergency medical service personnel before receiving a decision from the destination hospitals. Prehospital factors associated with difficulty in hospital acceptance were examined through logistic regression analysis. Results During the study period, 72 105 elderly patients were included, and 13 332 patients (18.5%) experienced difficulty in hospital acceptance. In the simple linear regression model, hospital selection time increased significantly with an increasing number of phone calls ( R2 = 0.774). In the multivariable analysis, older age ( P for trend <0.001), calls from a healthcare facility (adjusted odds ratio [AOR] 1.23, 95% confidence interval [CI] 1.15-1.32), night-time (AOR 2.17, 95% CI 2.08-2.26) and weekend/holidays (AOR 1.43, 95% CI 1.38-1.49) were significantly associated with difficulty in hospital acceptance. A positive association was observed between gastrointestinal emergency-related symptoms and difficulty in hospital acceptance among elderly patients with symptoms of internal disease (AOR 1.71, 95% CI 1.53-1.91). Conclusions In Japan, which has a rapidly aging population, a comprehensive strategy for elderly emergency patients, especially for advanced age groups or nursing home residents, is required. Geriatr Gerontol Int 2017; 17: 2441-2448. [ABSTRACT FROM AUTHOR]