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The causes for forearc basin and megathrust rupture zone segmentation are controversial. The Nankai forearc, Japan, is separated into five domains based on topography: Enshu, Kumano, Muroto, Tosa, and Hyuga. The boundaries of these domains correspond to the rupture limits of large earthquakes. We examined the geologic structure of the boundary region between the Kumano and Muroto domains off the Kii Peninsula using multichannel seismic reflection data to evaluate the role of upper plate composition in controlling segmentation. The results suggest that thick cover sediments and underlying accretionary prism are obliquely thrust landward over the igneous basement complex rock in the region of offshore of Cape Shionomisaki and separate the forearc basin. The igneous basement complex rocks directly overlying the plate interface in the hypocentral regions of 1944 Tonankai and 1946 Nankai earthquakes. The 1944 earthquake originated at the base of the complex, and the rupture extent slipped past its basement boundary, whereas the 1946 event nucleated at the updip boundary of the basement complex. The dense igneous rocks might have worked as a heavily loaded barrier on the seismogenic megathrust and separated the rupture area of both the earthquakes. Upper plate geology may be an important factor in controlling seismogenesis in the Nankai Trough and may serve as an example for understanding the controls on megathrust slip in other subduction zones. Plain Language Summary: The Nankai Trough, Japan is the place where quakes nucleate in the margin and tsunamis repeatedly devastated circum‐Pacific societies. When, where, why, and how the quakes were started in the trench is a central scientific question but unsolved. The historical records of earthquakes suggest that the rupture started around Cape Shionomisaki of the Kii Peninsula, where there is also a topographic segment boundary of the ∼2,000 m deep basin in the middle continental slope. Our research of the geologic structure beneath the earthquake epicenters indicates a dense and hard rock mass situated upon the hypocenters of 1944, and 1946 megaquakes off Cape Shionomisaki. The rock mass might have worked as a heavy load and barrier on the low angle dipping plate boundary fault when the fault slipped the large rupture was propagated in the Nankai Trough. Key Points: The Nankai forearc basin is separated off the Kii Peninsula owing to the existence of middle Miocene igneous basement in the upper plateThe rupture areas of the 1944 Tonankai, 1946 Nankai, and 2016 off‐Mie earthquakes appear to be controlled by the igneous basementThe shallow distribution of very low‐frequency earthquakes and tremors are related to the geological heterogeneity of the upper plate [ABSTRACT FROM AUTHOR]

Aim: This is a cross-sectional study of relation between metabolic syndrome and cognitive function in community-dwelling non-demented older adults in Japan. We examine the effect of metabolic syndrome and its components on global cognitive function. We also aim to clarify differences of specific cognitive domains between the subjects with and without metabolic syndrome. Methods: We studied 2150 subjects aged between 60 and 90 years whose scores on mini mental state examination (MMSE) were over 23 points. We analyzed difference in MMSE scores between the subjects with and without metabolic syndrome. Logistic regression analysis was performed with MMSE score as the dependent variable and metabolic syndrome components as the independent variable adjusted with age. We also examined differences in attention, logical memory, and verbal and category fluency between the subjects with and without metabolic syndrome. Results: MMSE scores were not significantly different between subjects with and without metabolic syndrome. In logistic regression analysis, the score of MMSE was significantly negatively associated with triglycerides in males and significantly negatively associated with abdominal circumference in females. Subjects with metabolic syndrome showed significantly lower performance of attention tasks compared to subjects without metabolic syndrome. Conclusions: Our results suggest that in community-dwelling non-demented Japanese older adults, attention but not global cognitive function may be impaired by metabolic syndrome. Inverted association between some components of metabolic syndrome and global cognitive function indicate necessity of further studies on the relation between undernutrition and cognitive function. [ABSTRACT FROM AUTHOR]

Many significant geological features in central Japan reflect the history of tectonic events such as volcanic eruptions, fault ruptures, and the collision of the Izu‐Bonin arc. Because most previous studies focused on deep, large‐scale structures at relatively low resolution or on local structures using high‐resolution data (e.g., active source seismic data), tectonic structures over a wide area throughout central Japan have not been characterized in detail. In this study, we estimated 3D S wave velocity structures with high spatial resolution by extracting surface waves from 1‐year‐long ambient seismic data recorded by the Hi‐net high‐sensitivity seismograph network. We computed cross spectra of ambient noise data between station pairs and then extracted phase velocity dispersion curves using a frequency domain method. We developed an algorithm to calculate phase velocity and obtained numerous dispersion data. We then estimated the 3D S wave velocity structure by applying a direct surface‐wave inversion method. Our results clearly mapped heterogeneous features such as tectonic lines, sedimentary plains, and volcanic systems. We observed some low‐velocity anomalies below volcanoes. Active fault zones identified as low‐velocity zones were consistent with features on seismic reflection profiles. Several geological blocks that are related to the Izu collision were observed around the Izu Peninsula. We observed previously unreported geological features of the island of Honshu. Our high‐resolution S wave velocity model can be used for not only interpretation of geological structures but also hazard assessment of earthquake. Plain Language Summary: Techniques based on the speed of seismic waves are used to observe features of the Earth's interior in Japan, but most studies using them have focused on deep structures (tens or hundreds of kilometers deep) over a wide area or on local structures with high‐resolution data. The tectonic structures over a wide area throughout central Japan have therefore not been well characterized. Studies of detailed, shallow structures typically use artificial seismic waves; however, these are difficult to do over wide areas due to the cost, safety considerations. In this study, we used only passive sources, generated by ambient (background) vibrations of the Earth, to extract details of the shallow crust and construct a three‐dimensional geologic model based on seismic wave speeds in central Japan. Our results clearly mapped geological features such as tectonic lines, sedimentary plains, and volcanoes. An active fault zone was identified as a low‐speed zone that agreed with features identified in previous studies using active sources. Several geological blocks were identified around the Izu Peninsula, and the features observed on our results reflected processes of the tectonic evolution. Our results can also be used to predict how earthquake waves propagate and thereby contribute to disaster evaluation. Key Points: We estimated a 3D S wave velocity structure for central Japan using surface waves extracted from ambient noiseOur velocity model reflects small‐scale geological features and deformation over a wide areaLow‐velocity anomalies were observed that continue down the dip direction of active reverse faults [ABSTRACT FROM AUTHOR]

Although seafloor massive sulfide (SMS) deposits are crucially important metal resources that contain high‐grade metals such as copper, lead, and zinc, their internal structures and generation mechanisms remain unclear. This study obtained detailed near‐seafloor images of electrical resistivity in a hydrothermal field off Okinawa, southwestern Japan, using deep‐towed marine electrical resistivity tomography. The image clarified a semi‐layered resistivity structure, interpreted as SMS deposits exposed on the seafloor, and another deep‐seated SMS layer at about 40‐m depth below the seafloor. The images reinforce our inference of a new mechanism of SMS evolution: Upwelling hydrothermal fluid is trapped under less‐permeable cap rock. The deeper embedded SMS accumulates there. Then hydrothermal fluids expelled on the seafloor form exposed SMS deposits. Plain Language Summary: Hydrothermal circulation of seawater through the permeable ocean crust engenders formation of seafloor massive sulfide (SMS) deposits, which present high potential for metal mining. Geophysical surveys using modes such as electrical and electromagnetic methods have revealed that SMS deposits exhibit lower resistivity than the surrounding host rock. However, because detailed geophysical images of internal structures of SMS deposits are lacking, the spatial distribution of SMS deposits and the evolutionary processes of SMS deposits remain unclear. For this study, we applied a deep‐towed marine electrical resistivity tomography (ERT) system to capture detailed images of electrical resistivity structures of SMS deposits in the Iheya North hydrothermal field, Okinawa Trough, southwestern Japan. An optimal sub‐seafloor resistivity section reveals a semi‐layered structure consisting of double low‐resistivity SMS layers: exposed and deep‐seated ones. Between the SMS layers, a cap rock layer is recognized as a moderately resistive zone. This detailed structure offers an explanation of how the SMS deposits accumulate: Hydrothermal fluids upwelling from the deep crust are trapped by less‐permeable cap rock, which results in the precipitation and accumulation of SMS deposits below the cap rock. Then fluids passing through the cap rock to the seafloor produce SMS deposits on the seafloor. Key Points: Deep‐towed marine electrical resistivity tomography revealed massive sulfide deposits on the seafloor as low‐resistivity zonesLow‐resistivity zones are semi‐layered with deposits exposed on the seafloor and other deposits at 40‐m depth below the seafloorDetailed near‐seafloor images of electrical resistivity offer an explanation of how the SMS deposits accumulate [ABSTRACT FROM AUTHOR]

We investigated the difference in relationship between muscle strength and quality of life (QOL)/fatigue in long‐term cancer survivors and healthy subjects. Thirty‐six cancer survivors and 29 healthy subjects were assessed for body composition and bone status at the calcaneus using the Osteo Sono Assessment Index. Muscle strength was evaluated via handgrip and knee extensor strength. Health‐related QOL was assessed using the Medical Outcome Study 36‐item Short‐Form Health Survey. Fatigue was measured using the brief fatigue inventory. Cancer survivors exhibited lower QOL scores in the physical functioning, physical role function, bodily pain and general health domains (p < .05). Grip and knee extension muscle strength in cancer survivors was positively correlated with the physical function and bodily pain of QOL (p < .05). The usual fatigue subscale score was only significantly higher in cancer survivors than in healthy subjects (p < .05). However, there were no correlations between muscle strength and fatigue in cancer survivors. Our results showed that muscle strength was an important factor for improving QOL in cancer survivors. We believe that the findings of this study will be relevant in the context of planning rehabilitation for cancer survivors. [ABSTRACT FROM AUTHOR]

The viscosity obtained from pressure-flow characteristics of an oxygenator may help to detect factors that change oxygenator resistance. The objective of this study was to model pressure-flow characteristics of a membrane oxygenator with an integrated arterial filter and to quantify their influence on apparent viscosity of non-Newtonian fluids. One Newtonian fluid (glycerin solution) and two non-Newtonian fluids (whole bovine blood and a human red blood cell suspension) were perfused through an oxygenator and their pressure-flow characteristics examined systematically. Four resistance parameters for the pressure gradient characteristics approximation equation were obtained by the least squares method from the relational expression of pressure-flow characteristics and viscosity. For all three fluids, a non-linear flow to pressure change was observed with a coefficient of determination of almost 1 by exponential approximation. The glycerin solution had a higher pressure gradient (10-70%) than the other fluids; the apparent viscosity of the non-Newtonian fluids was around 35% lower than the static one measured by a torsional oscillation viscometer. Overall, our study demonstrated that the influence on the apparent viscosity of non-Newtonian fluids can be quantified by pressure gradient differences in a membrane oxygenator with an integrated arterial filter. [ABSTRACT FROM AUTHOR]

Background/Objectives:We examined the association between 24-h urinary excretion of water-soluble vitamin levels and their intakes in free-living Japanese university students. The design used was cross-sectional study.Subjects/Methods:A total of 216 healthy, free-living male and female Japanese university students aged 18–27 years voluntarily participated in this study, of which 156 students were eligible for this assessment. All foods consumed for 4 consecutive days were recorded accurately by a weighed food record method. A 24-h urine sample was collected on the fourth day, and the urinary levels of water-soluble vitamins were measured.Results:Each urinary water-soluble vitamin level, except for vitamin B12, was correlated positively with its mean intake in the recent 2–4 days (vitamin B1: r=0.42, P<0.001; vitamin B2: r=0.43, P<0.001; vitamin B6: r=0.40, P<0.001; vitamin B12: r=0.06, P=0.493; niacin: r=0.35, P<0.001; niacin equivalents: r=0.33, P<0.001; pantothenic acid: r=0.47, P<0.001; folate: r=0.27, P=0.001; vitamin C: r=0.44, P<0.001). Mean estimated water-soluble vitamin intakes calculated from urinary levels and recovery rates showed 91–101% of their 3-day mean intakes, except for vitamin B12 (61%).Conclusions:These results showed that urinary water-soluble vitamin levels, except for vitamin B12, reflect their recent intakes in free-living Japanese university students, and could be used as a potential biomarker to estimate mean vitamin intake. [ABSTRACT FROM AUTHOR]

The estimation of risk due to rockfall is often done empirically. As a rational and effective method towards performance-based design of protection measures, a three-dimensional simulation method helps to describe the motion of rockfall on a slope and to consider the effect of vegetation probabilistically. This document details a typical simulation method and analyses the manner of rockfalls paired with interference of vegetation and other factors. As application, an actual slope is analyzed where rockfall occurred during the Noto Peninsula Earthquake. Finally, the validity and the benefits of the shown method are the basis for a hazard mapping for rockfall and the planning of measures. [ABSTRACT FROM AUTHOR]

To investigate the aetiological role of human papillomavirus (HPV) in breast cancer, we examined the presence, genotype, viral load, and physical status of HPV in 124 Japanese female patients with breast carcinoma. Human papillomavirus presence was examined by PCR using SPF10 primers, and primer sets targeting the E6 region of HPV-16, -18, and -33. The INNO-LiPA HPV genotyping kit was used to determine genotype. Human papillomavirus DNA was detected in 26 (21%) breast carcinomas. The most frequently detected HPV genotype was HPV-16 (92%), followed by HPV-6 (46%), HPV-18 (12%), and HPV-33 (4%). In 11 normal epithelium specimens adjacent to 11 HPV-16-positive carcinomas, 7 were HPV-16-positive. However, none of the normal breast tissue specimens adjacent to HPV-negative breast carcinomas were HPV-positive. The real-time PCR analysis suggested the presence of integrated form of viral DNA in all HPV-16-positive samples, and estimated viral load was low with a geometric mean of 5.4 copies per 10(4) cells. In conclusion, although HPV DNA was detected in 26 (21%) breast carcinomas and, in all HPV-16-positive cases, the HPV genome was considered integrated into the host genome, their low viral loads suggest it is unlikely that integrated HPV is aetiologically involved in the development of Japanese breast carcinomas that we examined. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To examine associations between rate of eating and macronutrient and dietary fiber intake, and body mass index (BMI). DESIGN:: Cross-sectional study. SUBJECTS:: A total of 1695 18-y-old female Japanese dietetic students. MEASUREMENTS:: Macronutrient intake (protein, carbohydrate, and fat) and dietary fiber intake were assessed over a 1-month period with a validated, self-administered, diet history questionnaire. Body height and weight and rate of eating (according to five categories) were self-reported. RESULTS:: Among the nutrients examined, only dietary fiber intake weakly, but significantly, and negatively correlated with BMI in a multiple regression analysis. The rate of eating showed a significant and positive correlation with BMI. The mean BMI was higher by 2.2, 1.5, 1.0, and 0.5 kg/m2 in the ‘very fast’, ‘relatively fast’, ‘medium’, and ‘relatively slow’ groups, respectively, compared with the ‘very slow’ rate of eating group. This correlation remained evident after adjustment for nutrient intake. CONCLUSIONS:: Rate of eating showed a significant and positive correlation with BMI, whereas only dietary fiber intake showed a weak correlation with BMI.International Journal of Obesity (2003) 27, 1405-1410. doi:10.1038/sj.ijo.0802425 [ABSTRACT FROM AUTHOR]

Presents a case report of three members of a Japanese family who had a hyperkeratotic verrucous type of porokeratosis of Mibelli, of which two members showed giant plaque lesions and dermal amyloid deposits beneath the porokeratosis lesions. Findings from physical examinations conducted on the patients; Similarities in the histological features of hyperkeratotic plaques of the first patient and his sister.

To develop a method for the determination of photosynthetic pigment species in individual phytoplankton cells, especially natural picophytoplankton cells, the fluorescence spectra of intact cells were studied with cultured phytoplankton. The study was made mainly with phycoerythrin-containing picophytoplankton collected off Japan in 1982 with reference to diatomal species and phycoerythrin-free cyanophycean species. The spectra were measured for cell suspensions with an ordinary spectrofluorometer, and for individual cells with a microscope spectrofluorometer, paying special attention to the effect of cell-fixation. Results indicated that: (1) the cell-fixation with the glutaraldehyde and paraformaldehyde mixture modified phycoerythrin emission from picophytoplankton markedly in its wavelength location and intensity, but (2) the emission from phycocyanin was affected far less, and (3) the emission from chlorophyll a was not altered. However, the phycoerythrin emission modified by the fixation was found to be easily distinguished from other emissions, and kept its intensity high enough for detection with a fluorescence microscope. The fluorescence properties after the fixation were kept unaltered for a long period of time. Based on the results, we propose a simple method for the determination of photosynthetic pigments in individual phytoplankton cells in seas and lakes using fluorescence microscopy. Results of our tests with natural samples of phytoplankton are presented, and problems for further improvement are also discussed. [ABSTRACT FROM AUTHOR]

The incidence of non-familial multiple primary cancer in colorectal cancer patients has increased in recent years in Japan. To clarify the characteristic genetic aberrations in such multiple cancers, we examined structural chromosomal aberrations by fluorescence in situ hybridization, using chromosome 17-specific and p53 cosmid DNA probes. We established short-term cultures of 78 surgical specimens and were able to obtain observable metaphase spreads in 23 single colorectal cancer specimens and in 6 colorectal cancer specimens from patients with double primary cancers. The frequency of chromosome 17 and/or p53 locus translocation was significantly greater in tumors with double cancer than in single colorectal cancers (P < 0.05 and P < 0.01, respectively). These aberrations in double cancers frequently appeared even at an early Dukes' stage (A and B) of colorectal carcinoma. Our results suggest that translocation of chromosome 17 and the p53 locus may be specific genetic events probably associated with carcinogenesis of multiple primary cancers in colorectal cancer. [ABSTRACT FROM AUTHOR]

Abstract: The past two decades have seen the reporting of microbial fossils within ancient oceanic basalts that could be identical to microbes within modern basalts. Here, we present new petrographic, mineralogical, and stable isotopic data for metabasalts containing filamentous structures in a Jurassic accretionary complex within the northern Chichibu Belt of the Yanadani area of central Shikoku, Japan. Mineralized filaments within these rocks are present in interstitial domains filled with calcite, pumpellyite, or quartz, and consist of iron oxide, phengite, and pumpellyite. δ13CPDB values for filament-bearing calcite within these metabasalts vary from −2.49‰ to 0.67‰. A biogenic origin for these filamentous structures is indicated by (1) the geological context of the Yanadani metabasalt, (2) the morphology of the filaments, (3) the carbon isotope composition of carbonates that host the filaments, and (4) the timing of formation of these filaments relative to the timing of low-grade metamorphism in a subduction zone. The putative microorganisms that formed these filaments thrived between eruption (Late Paleozoic) and accretion (Early Jurassic) of the basalt. The data presented here indicate that cryptoendolithic life was present within water-filled vesicles in pre-Jurassic intraplate basalts. The mineralogy of the filaments reflects the low-grade metamorphic recrystallization of authigenic microbial clays similar to those formed by the encrustation of prokaryotes in modern iron-rich environments. These findings suggest that a previously unusual niche for life is present within intraplate volcanic rocks in accretionary complexes. [Copyright &y& Elsevier]

The International Commission on Radiation Units and Measurements (ICRU) has proposed to change the definitions of the operational quantities used for the area and individual monitoring of external exposure in ICRU Report 95. Since introducing new operational quantities into the radiation monitoring may affect the dose assessment using the present personal dosimeters, precise assessments of the influence on monitoring are necessary by characterizing the energy spectrum in the workplace and the energy dependency of the dosimeters to be used. This study measured photon spectra using a NaI(Tl) scintillation detector or a LaBr 3 (Ce) scintillation detector at the Japan Research Reactor No. 3 (JRR-3) and Japan Proton Accelerator Research Complex (J-PARC) workplaces at the Japan Atomic Energy Agency (JAEA). The photon energy spectra were obtained by unfolding the pulse height distributions measured at each workplace. The present and new operational quantities were then evaluated and compared using the spectra measured at the workplaces. In JRR-3, the photon energy spectra were measured at the workplaces in the reactor room and thermal neutron beam hall while the reactor was operated. The ambient dose equivalent rates H ˙ *(10) at the workplaces were 0.2 μSv·h−1 – 13 μSv·h−1. High energy gamma-rays of 6–7 MeV from 16N were observed near the fuel failure detection system in the reactor room. Those of 7–8 MeV produced by the thermal neutron capture of iron were observed in the reactor room and the beam hall. In J-PARC, the photon energy spectra were measured at the workplaces in the beam tunnel of the 3 GeV synchrotron beam ring five days after the operation. The ambient dose equivalent rates H ˙ *(10) at the workplaces were 35 μSv·h−1 –430 μSv·h−1. It was found that the new personal doses, H p , were 10%–20% smaller than the present personal dose equivalents, H p (10), at the workplaces. • Photon energy spectra were measured at Japan Research Reactor No. 3 and the Japan Proton Accelerator Research Complex workplaces. • Present and new operational quantities for environmental and individual monitorings were compared at workplaces. • The new personal doses, H p , were 10%–20% smaller than the present personal dose equivalents, H p (10), at the workplaces. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the association between different intensities and frequencies of non-occupational physical activity (PA) and the risk of dementia among Japanese older adults. This was a prospective cohort study. A total of 2194 participants aged ≥65 years from the Japan Gerontological Evaluation Study were followed up between 2010 and 2016. The standardised dementia scale of the long-term care insurance system was used to identify incident dementia, whereas non-occupational PA (<2 or ≥2 times/week on each intensity: light, moderate and vigorous) was assessed using a questionnaire. Cox regression was used to compute the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident dementia. After adjustment for sociodemographic and medical characteristics, the following frequencies and intensities of non-occupational PA, compared with no non-occupational PA at all, were associated with a reduced risk of dementia: light PA ≥2 times/week (HR = 0.61, 95% CI: 0.38–0.97), moderate PA <2 times/week (HR = 0.46, 95% CI: 0.28–0.76), moderate PA ≥2 times/week (HR = 0.57, 95% CI: 0.36–0.91), vigorous PA <2 times/week (HR = 0.40, 95% CI: 0.21–0.74) and vigorous PA ≥2 times/week (HR = 0.29, 95% CI: 0.15–0.57). In the sex-specific analysis, moderate PA <2 times/week and vigorous PA ≥2 times/week were associated with a reduced risk of dementia in men, whereas light and moderate PA ≥2 times/week and all frequencies of vigorous PA were associated with a reduced risk of dementia in women. Practicing non-occupational PA was associated with a reduced risk of dementia among Japanese older adults. [ABSTRACT FROM AUTHOR]

Aim: Preventing functional disability benefits the quality of life of older adults and mitigates the economic burden of an aging society. However, the most effective physical performance tests and optimal cut points for identifying older adults at risk of functional disability remain unclear, and Japan lacks physical function-based assessment tools. We aimed to identify the physical performance tests related to functional disability and to develop a predictive test battery for it., Methods: We included 975 older adults (mean 72.8 ± 5.2 years, 55.4% women) in Kasama City, Japan. Functional disability was defined as certification of care level 2 or above based on the long-term care insurance system. Cox proportional hazards analysis examined the association between physical performance tests and incident functional disability., Results: During a mean follow-up of 8.6 years (maximum 14 years), 236 participants (24.2%) developed functional disability. After adjusting for covariates, higher performances in grip strength, single-leg balance with eyes open (SLB), timed up-and-go (TUG), five-repetition sit-to-stand (5-STS), and 5-m habitual walk were significantly associated with a lower risk of functional disability. In a stepwise model, SLB, TUG, and 5-STS were key predictors of functional disability. Receiver operating characteristic analysis determined optimal cut points of 32.6/32.7 s for SLB, 6.5/6.6 s for TUG, and 7.8/7.9 s for 5-STS. We developed a predictive battery combining these cut points (area under the curve = 0.78)., Conclusions: The developed battery of physical performance tests predicts future functional disability and is useful for screening older adults at high risk. Geriatr Gerontol Int 2024; 24: 1343-1349., (© 2024 Japan Geriatrics Society.)

Background: Few studies have shown that relatively younger children and adolescents (those born later in the same school year) were less likely to engage in physical activity in a phenomenon termed the relative age effect. Although these studies mainly targeted elementary and middle school students, no study has reported on the relative age effect on physical activity in ordinary high school students. Moreover, the relative age effect on sedentary behavior might show an opposite association with physical activity. Therefore, we aimed to clarify the relative age effects on physical activity and sedentary behavior across different school stages in Japanese children and adolescents., Methods: A cross-sectional questionnaire survey was conducted with 21,491 children and adolescents (elementary, middle, and high school students aged 10-18 years) in various Japanese regions from January 2018 to July 2019. Overall, 18,281 children and adolescents (10,299 boys and 7,982 girls) were finally included in our analysis. Data on the birth month, frequency and duration of their physical activity (vigorous, moderate, and moderate-to-vigorous intensity), and sedentary behavior (weekday and weekend total sedentary time, television viewing, playing video games, and Internet use) were obtained. We utilized two-part model regression analyses. Statistically significant association with birth month indicated that a relative age effect was observed., Results: The relatively younger individuals were less likely to engage in physical activity (especially vigorous physical activity (VPA)); this association was observed in middle and high school students. Conversely, the relatively younger boys spent more time during weekends with sedentary behaviors and Internet use. Based on school stage, the relative age effect on VPA time was observed in middle school boys (average margin effect (AME) = -0.74, p < 0.01) and high school students (boys: AME = -0.69, p < 0.01; girls: AME = -0.53, p < 0.05). The relative age effect on sedentary behavior was observed during weekends with sedentary behaviors (AME = 3.55, p < 0.01), playing video games (AME = 0.72, p < 0.05) and Internet use (AME = 2.46, p < 0.01) for male high school students and on television viewing (AME = 1.12, p < 0.05) for female middle school students., Conclusion: The relative age effect on physical activity can persist after middle school, and the relatively younger individuals are more likely to replace physical activity with sedentary behavior., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval was obtained from the Ethics Committee of Doshisha University (approval number: 17095). The purpose, methods, benefits, and risks of our study were explained to the principals of the schools. We also obtained participants and their guardians by explaining that we would protect their personal information and that their answers were never related to their school records. Informed consent was obtained from all the participants and their legal guardians. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objectives　The Ministry of Land, Infrastructure, Transport and Tourism is promoting the introduction of green slow mobility (GSM) vehicles (can drive up to 20 km/h on public roads) for mobility assistance and potential long-term care prevention. We identified four key factors to pinpoint the challenges and enhance opportunities for introducing GSM; GSM's operational achievements, a comparison of the characteristics of GSM users and non-users, purpose for using GSM, and observation of GSM's contribution to long-term care prevention among older adults.Methods　A pilot GSM study was conducted in Ikeda City, Osaka Prefecture, from October to December 2022. The service included three routes, operating six times daily on a fixed schedule, and was provided by 10 volunteer drivers. Passengers signaled for boarding, and service details were provided through leaflets. A self-administered mail survey was conducted before and after the demonstration test with 674 respondents to the post-questionnaire, and 502 respondents were asked at both time points about issues related to the service, user characteristics, and care prevention. To assess care prevention, we examined the percentage of favorable changes triggered by GSM based on "opportunities to go out," "personal and behavioral aspects," "social relations," and "psychological aspects." Additionally, we examined whether the health indices in the post-hoc survey were better among GSM users than non-users.Results　Of the 223 scheduled GSM services, 214 (96.0%) were operated by 10 volunteers driving an average of 3.1 (SD 2.4) times weekly (0-11 times), indicating an uneven distribution of driving responsibilities. Among the users, 65 (9.6%) were more engaged in community activities and emotional support than non-users. The main purposes for using GSM services were shopping and medical visits, with approximately 70% of users finding it easier to go out owing to these services. The percentage of favorable changes were noted in 3.1-26.2% and 0.2-1.5% of users and non-users, respectively. In the post-test survey, users showed higher independence on the instrumental self-maintenance subscale than non-users.Conclusion　GSM facilitates outings among older adults and may reduce the need for potential long-term care. However, a system is required to ensure that the service burden does not decrease even for a few driving volunteers. Additionally, GSM users are often socially active. Thus, strategies to increase service awareness among less active individuals should be developed.

Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST-segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018 and updated in 2022. Recently, the European Society of Cardiology (ESC) published the guidelines for the management of acute coronary syndrome in 2023. Major new updates in the 2023 ESC guideline include: (1) intravascular imaging should be considered to guide PCI (Class IIa); (2) timing of complete revascularization; (3) antiplatelet therapy in patient with high-bleeding risk. Reflecting rapid advances in the field, the Task Force on Primary PCI of the CVIT group has now proposed an updated expert consensus document for the management of ACS focusing on procedural aspects of primary PCI in 2024 version., (© 2024. The Author(s).)

Background: Prehabilitation during neoadjuvant therapy has the potential to improve clinical outcomes. However, information on its global dissemination status is limited. This Japanese nationwide survey investigated the implementation status of and barriers to prehabilitation during neoadjuvant chemotherapy (NAC) for patients with locally advanced esophageal cancer in hospitals., Methods: This multicenter nationwide survey was conducted by post. The eligible facilities were 155 Japanese hospitals that had been certified within the last 10 years as authorized institutes for board-certified esophageal surgeons by the Japan Esophageal Society. We administered an original questionnaire to investigate the current status of prehabilitation during NAC., Results: The response rate was 75% (117/155 facilities). Forty-six facilities (39%) provided prehabilitation during NAC. The most frequently selected reasons for not providing or providing insufficient prehabilitation were lack of human resources, issues with the reimbursement of medical fees, difficulty in providing continuous prehabilitation during repeated inpatient and outpatient care, the lack of established standard prehabilitation programs, challenges in providing multidisciplinary prehabilitation, and difficulty in managing physical symptoms., Conclusion: We observed that the implementation rate of prehabilitation during NAC was low. Critical reasons were not only the lack of medical resources but also the lack of evidence-based standard prehabilitation programs during NAC and the lack of evidence for how to continuously deliver prehabilitation during NAC to patients with physical symptoms., (© 2024. The Author(s) under exclusive licence to The Japan Esophageal Society.)

A dosimeter should ideally be calibrated in a reference field with similar energy and doserate to that which the dosimeter is being used to measure. Environments around nuclear reactors and radiation therapy facilities have high-energy photons with energies exceeding that of 60 Co gamma rays, and controlling exposure to these photons is important. The Japan Atomic Energy Agency and National Metrology Institute of Japan have high-energy reference fields with energies above several megaelectronvolts for different types of accelerators. Their reference fields have different fluence-energy distributions. In this study, the energy dependencies of the two-cavity ionization chambers, which are often used by secondary standard laboratories, were experimentally and computationally evaluated for each high-energy field. These results agreed well within the relative expanded uncertainties ( k = 2), and their capabilities for air kerma measurements in each high-energy reference field were confirmed. Therefore, the capabilities of the air-kerma measurements were verified in the two high-energy reference fields., (© 2024 Society for Radiological Protection. Published on behalf of SRP by IOP Publishing Limited. All rights, including for text and data mining, AI training, and similar technologies, are reserved.)

A 20-year-old man was brought to the emergency room with chief complaints of dysarthria and vomiting after placing several drops of an inhalation liquid containing hexahydrocannabiphorol (HHCP) under his tongue. During ambulance transport, the patient had a post-vomiting convulsion that lasted approximately 1 minute. Upon arrival at the hospital, he was agitated, had dysarthria to the extent that he was in danger of falling from the stretcher, and was having visual hallucinations. Blood tests showed acidosis and a high lactic acid concentration. The patient was urgently admitted to the hospital with a diagnosis of acute poisoning and was started on supplemental intravenous fluids. The patient was able to communicate from the second day, started eating on the third day, finished receiving supplemental fluids on the fourth day, and was discharged from the hospital on the fifth day. HHCP was not illegal in Japan at the time and was distributed mainly through mail order. Clinical information on HHCP is lacking, but this case shows that the drug causes health problems. Although HHCP has been regulated by law in Japan since January 2024, clinicians and the general public should be aware that similar cases may occur in the future.

A 241Am gamma (γ)-ray calibration field that meets the requirements for a γ-ray reference field as specified in the ISO 4037 standard series was established in the Facility of Radiation Standards of the Japan Atomic Energy Agency. The reference air kerma rates were measured using a reference ionization chamber calibrated by the N-80 quality X-ray calibration field of the national metrology standard in Japan and with a correction to account for differences in photon energy due to the calibration field. Conversion coefficients for the 241Am γ-ray calibration field, including those not listed in the ISO 4037 standard series, were calculated based on the measured γ-ray fluence rate spectra., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Importance: It is widely known that individuals with adverse childhood experiences (ACEs) have an increased risk of abusing their own children, thereby perpetuating the cycle of violence. However, the association between ACEs and elder abuse perpetration has not been fully examined., Objective: To examine the association between ACEs and elder abuse and the mediating factors., Design, Setting, and Participants: This cross-sectional study used data collected via the self-administered Japan COVID-19 and Society Internet Survey from September 12 to October 19, 2022. Men and women aged 20 to 64 years who responded to related questions were included. Data were analyzed from July 2023 to April 2024., Exposures: ACEs, defined as the experience of any of 7 items-interpersonal loss (parental loss and parental divorce), family psychopathology (parental mental disease and violence in family), abuse (physical and psychological abuse), and neglect-before the age of 18 years., Main Outcomes and Measures: The primary outcome was the perpetration of physical and/or psychological abuse against an older person (aged ≥65 years) self-reported via questionnaire. The direct and indirect effect estimates were determined using logistic regression analyses., Results: Of a total of 13 318 participants (mean [SD] age, 41.1 [12.1] years; 6634 female [49.8%]), 1133 (8.5%) reported perpetrating violence against older adults. Compared with individuals without ACEs, the odds ratios (ORs) for perpetrating violence were 3.22 (95% CI, 2.74-3.79) for those with 1 ACE and 7.65 (95% CI, 6.41-9.13) for those with 2 or more ACEs. In the mediation analysis, factors with large indirect effect estimates included depression (OR, 1.13; 95% CI, 1.11-1.14; proportion mediated [PM], 18.6%), mental illness other than depression (OR, 1.12; 95% CI, 1.10-1.14; PM, 17.3%), and self-rated health (OR, 1.04; 95% CI, 1.03-1.05; PM, 6.0%)., Conclusions and Relevance: These findings suggest that intergenerational cycles of violence may extend to any vulnerable group, not only children but also older adults. Further research into the prevention of ACEs and breaking these cycles of violence is warranted.

Background: Tracheostomy procedures inhibit swallowing, although details of subsequent recovery of oral intake remain unknown. This retrospective cohort study aimed to investigate factors influencing dysphagia improvement in patients with subacute stroke after tracheostomy., Methods and Results: The study included 117 patients who underwent tracheostomy after subacute stroke, cerebral hemorrhage, or endogenous subarachnoid hemorrhage and received care at 2 convalescent rehabilitation wards in urban and suburban Japan between 2015 and 2022. The primary outcome measure was the achievement of complete oral intake. Patient demographics, Functional Independence Measure scores, body mass index, food intake level scale scores, and the presence of severe white matter hyperintensities on imaging were retrospectively collected from medical records. Statistical analysis involved univariate logistic regression to identify potential predictors and multivariate logistic regression to refine the model while accounting for multicollinearity. In total, 47% of patients achieved complete oral intake on discharge. Sex, days from onset to admission, Functional Independence Measure motor and cognitive scores, body mass index, food intake level scale scores, and severe white matter hyperintensities were identified as potential predictors in the univariate analysis. However, multivariate logistic regression identified only food intake level scale scores (odds ratio [OR], 3.687 [95% CI, 1.519-8.949]; P =0.004) and severe white matter hyperintensities (OR, 0.302 [95% CI, 0.096-0.956]; P =0.042) as significant predictors of complete oral intake., Conclusions: In patients with subacute stroke undergoing tracheostomy, the level of oral intake on admission and severe white matter hyperintensities on imaging may be better predictors of complete oral intake. However, prospective studies with larger sample sizes and more comprehensive data are warranted to confirm these findings.

Background: Information regarding the status of surgical antimicrobial prophylaxis (SAP) in Japanese hospitals is lacking. This study aimed to explore the status of SAP prescriptions for surgeries and adherence to Japanese SAP guidelines., Methods: From February to July 2020, a 1-day multicentre point prevalent survey was conducted at 27 hospitals in Aichi Prefecture, Japan. Patients prescribed SAP were included in this study. The appropriateness of the SAP was evaluated based on the guidelines for selection of antimicrobials and their duration. Surgery was defined as appropriate when all the items were appropriate., Results: A total of 728 patients (7.1 %; 728/10,199) received antimicrobials for SAP. Among them, 557 patients (76.5 %, 557/728) underwent the surgeries described in the guidelines. The overall appropriateness of all surgeries was 33.9 % (189/557). The appropriate selection of antimicrobial before/during and after surgery and their durations were 67.5 % (376/557), 67.5 % (376/557), and 43.3 % (241/557), respectively. The overall appropriateness ranged from 0 % (0/37, oral and maxillofacial surgery) to 58.7 % (88/150, orthopaedic surgery) and 27.7 % (36/130, community hospitals with 400-599 beds) to 47.2 % (17/36, specific hospitals). Cefazolin was the most prevalent antimicrobial prescribed before/during (55.5 %, 299/539), and after (45.1 %, 249/552) surgery. In total, 101 oral antimicrobials were prescribed postoperatively., Conclusions: SAP adherence by specific surgical fields and hospitals was shown in this study. Intensive intervention and repeated surveillance are necessary to improve SAP prescriptions in Japanese hospitals., Competing Interests: Declaration of competing interest All authors declare no conflicts of interest relevant to this article., (Copyright © 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.)

Background: Various factors contribute to the development of infection-related acute encephalopathy (AE) in children, such as infectious agents and chronic underlying disorders. We studied underlying disorders in children with AE to identify predisposing factors of AE., Methods: We investigated underlying disorders or past histories in patients with two types of AE from the database in the Tokai area of Japan between 2009 and 2022: 204 patients with AE with reduced subcortical diffusion (AED) and 137 with clinically mild encephalopathy with a reversible splenial lesion (MERS). We compared them with 89 patients with acute disseminated encephalomyelitis (ADEM) to clarify the specific disorders in the two AE types., Results: The prevalence of underlying disorders in AED (34%, 70 patients) was significantly higher than that in ADEM (12%, 11 patients) (P < 0.01). The prevalence of underlying disorders in MERS was 23% (32 patients). The underlying disorders included seizure disorders, premature birth, genetic/congenital disorders, and endocrine/renal diseases. In patients with seizure disorders in AED, five patients (18%) had Dravet syndrome and four (15%) had West syndrome, whereas none with MERS had these syndromes. Twenty-five (12%) of 204 patients with AED, three (2%) with MERS, and one (1%) with ADEM were preterm or low birth weight., Conclusions: The high prevalence of seizure disorders suggests that seizure susceptibility is an important predisposing factor in AED. Premature birth also has an impact on the development of AED. Caution is required regarding the development of AE in patients with chronic seizure disorders or premature birth., Competing Interests: Declaration of competing interest Jun Natsume belongs to the Department of Developmental Disability Medicine at Nagoya University Graduate School of Medicine, which is the laboratory endowed by Aichi Prefecture. The remaining authors declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Japan, which has the world's longest life expectancy, has been reporting rejuvenation of physical function among its older adult population. However, evidence for the incidence of functional disability is limited. This study aimed to investigate the comparison in the incidence of functional disability., Design: We used data from the Japan Gerontological Evaluation Study., Setting and Participants: The participants were 2 nonoverlapping cohorts of 22,522 (2010-2013 cohort) and 26,284 (2016-2019 cohort) individuals aged 65 years and older from 5 municipalities who were followed for 3 years each., Methods: The incidence rates of functional disability during the 3-year follow-up period were compared between cohorts. To examine the incident differences between the cohorts, we adjusted for social participation and 9 additional factors that would be expected to improve with social participation using the Weibull survival models adjusting for municipalities as random effects. The analysis was stratified by age groups (65-74 years old and ≥75)., Results: The incidence rate of functional disability per 10,000 person-years decreased from 68.6 (2010-2013 cohort) to 51.4 (2016-2019 cohort) in the 65 to 74 years old group and 380.0 (2010-2013 cohort) to 282.6 (2016-2019 cohort) in the ≥75 group; the hazard ratios (95% CIs) were 0.75 (0.64-0.89) and 0.73 (0.67-0.80), respectively. However, these significant decreases disappeared with adjustments for social participation and additional factors., Conclusions and Implications: The incidence of functional disability decreased in a recent cohort, which may be explained by social participation and possibly related factors. Promoting social participation could contribute to a decreasing incidence of functional disability among older adults., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Community-level group sports participation is a structural aspect of social capital that can potentially impact individual health in a contextual manner. This study aimed to investigate contextual relationship between the community-level prevalence of group sports participation and the risk of all-cause, cardiovascular disease (CVD), and cancer mortality in older adults., Methods: In this 7-year longitudinal cohort study, data from the Japan Gerontological Evaluation Study, a nationwide survey encompassing 43,088 functionally independent older adults residing in 311 communities, were used. Cause of death data were derived from the Japanese governmental agency, The Ministry of Health, Labour and Welfare, for secondary use. "Participation" was defined as engaging in group sports for one or more days per month. To analyze the data, a two-level survival analysis was employed, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated., Results: Among the participants, 5,711 (13.3%) deaths were identified, with 1,311 related to CVD and 2,349 to cancer. The average group sports participation rate was 28.3% (range, 10.0-52.7%). After adjusting for individual-level group sports participation and potential confounders, a higher community-level group sports participation rate was found to be significantly associated with a lower risk of both all-cause mortality (HR: 0.89, 95% CI: 0.83-0.95) and cancer mortality (HR: 0.89, 95% CI: 0.81-0.98) for every 10% point increase in the participation rate. For CVD mortality, the association became less significant in the model adjusted for all covariates (HR: 0.94, 95% CI: 0.82-1.09)., Conclusions: Our findings support the existence of a preventive relationship between community-level group sports participation and the occurrence of all-cause and cancer mortality among older individuals. Promoting group sports within communities holds promise as an effective population-based strategy for extending life expectancy, regardless of individual participation in these groups., (© 2024. The Author(s).)

Collection and cooking of wild vegetables have provided seasonal enjoyments for Japanese local people as provisioning and cultural ecosystem services. However, the Fukushima Daiichi Nuclear Power Plant accident in March 2011 caused extensive radiocesium contamination of wild vegetables. Restrictions on commercial shipments of wild vegetables have been in place for the last 10 years. Some species, including buds of Aralia elata, are currently showing radiocesium concentrations both above and below the Japanese reference level for food (100 Bq/kg), implying that there are factors decreasing and increasing the 137Cs concentration. Here, we evaluated easy-to-measure environmental variables (dose rate at the soil surface, organic soil layer thickness, slope steepness, and presence/absence of decontamination practices) and the 137Cs concentrations of 40 A. elata buds at 38 locations in Fukushima Prefecture to provide helpful information on avoiding collecting highly contaminated buds. The 137Cs concentrations in A. elata buds ranged from 1 to 6,280 Bq/kg fresh weight and increased significantly with increases in the dose rate at the soil surface (0.10-6.50 μSv/h). Meanwhile, the 137Cs concentration in A. elata buds were not reduced by decontamination practices. These findings suggest that measuring the latest dose rate at the soil surface at the base of A. elata plants is a helpful way to avoid collecting buds with higher 137Cs concentrations and aid in the management of species in polluted regions., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Sakai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To examine the associations of sedentary behavior (SB) and the combination of moderate-to-vigorous intensity physical activity (MVPA) with dementia, functional disability, and mortality in older adults, and the heterogeneity in different subpopulations., Methods: Nation-wide cohort with 90,471 individuals aged ≥65 years in Japan. SB (<3, 3-<8, and ≥ 8 h per day [h/d]) and MVPA (0, 0 < MVPA<1, and ≥ 1 h/d) were measured in 2016. Long-term care registry-based incidence of outcomes was ascertained through 2021. Cox proportional hazard models were performed., Results: Compared with SB < 3 h/d group, SB ≥ 8 h/d was associated with higher risks of dementia, functional disability, and mortality with hazard ratios (95% confidence interval) of 1.36 (1.22-1.52), 1.32 (1.19-1.48), and 1.31 (1.18-1.45). The combination of MVPA and SB demonstrated a dose-respond trend of increasing risks of dementia, functional disability, and mortality with increased SB and decreased MVPA, where participants who spent no MVPA with SB ≥ 8 h/d had the highest risks. High MVPA attenuated but didn't eliminate the risks. Participants who spent MVPA≥1 h/d with SB ≥ 8 h/d had comparable risks to those who spent no MVPA with SB < 3 h/d. No heterogeneity was found by MVPA levels, sex, education, comorbidity, and depression conditions., Conclusions: Prolonged daily SB was associated with higher risks of dementia, functional disability, and mortality in older adults, regardless of MVPA, sex, education, and chronic conditions. Individuals with high MVPA also face considerable risks when engaging in high SB. High MVPA with high SB revealed a comparable risk to no MVPA with low SB., Competing Interests: Declaration of competing interest None declared., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: The association between socioeconomic status (SES) and the onset of depressive symptoms has attracted considerable attention. However, few studies have simultaneously examined the association of multiple SES indicators, including "assets," with the onset of depressive symptoms. Therefore, this study examined the association of four SES indicators in old age ('years of education' 'equivalent income,' 'equivalent assets,' and 'the longest-held job') with new-onset depressive symptoms in a large Japanese dataset., Methods: This longitudinal study used panel data of cognitively and physically independent older adults from the Japan Gerontological Evaluation Study (JAGES) conducted in 2013 and 2016. Multivariate logistic regression analysis was conducted to examine the association of each SES indicator with new-onset depressive symptoms, and odds ratios and 95% confidence intervals (CIs) were calculated., Results: We analyzed the data of 40,257 older adults, with a mean age (± standard deviation) of 72.9 (±5.5) years. In the follow-up survey, 4292 older adults had new-onset depression symptoms (10.7%). 39.3% had 10-12 years of education. 36.9% had an equivalent income of up to JPY 1.99 million. 24.4% had equivalent assets of JPY 4-17.99 million. Most had a clerical job for the long time. Furthermore, fewer years of education (males: OR = 1.42, 95% CI = 1.22-1.64, p-value <0.001/females: 1.26, [1.09-1.47], p = 0.002), lower income (males: 1.64, [1.34-2.01], p < 0.001/females: 1.82, [1.49-2.22], p < 0.001), and fewer assets (males: 1.40, [1.16-1.68], p < 0.001/females: 1.21, [1.02-1.42], p = 0.025) resulted in higher odds of having new-onset depressive symptoms, even when other SES indicators were entered simultaneously., Conclusions: All four SES indicators have an independent association with the development of new-onset depressive symptoms among older adults, reflecting different aspects of SES. The association between the "longest-held job" and new-onset depressive symptoms can be largely explained by other SES indicators. A multifaceted and lifetime approach is required to prevent the onset of depressive symptoms in old age., (© 2024 John Wiley & Sons Ltd.)

Objective: We investigated the role of rapid response systems (RRSs) in limitations of medical treatment (LOMT) planning among children, their families, and health care providers. Methods: This multicenter retrospective cohort study examined children with clinical deterioration using the Japanese RRS registry between 2012 and 2021. Results: Children ( n  = 348) at 28 hospitals in Japan who required RRS calls were analyzed. Eleven (3%) of the 348 patients had LOMT before RRS calls and 11 (3%) had newly implemented LOMT after RRS calls. Patients with LOMT were significantly less likely to be admitted to an intensive care unit compared with those without (36% vs. 61%, p  < 0.001) and were more likely to die within 30 days (45% vs. 11%, p  < 0.001). Conclusions: LOMT issues existed in 6% of children who received RRS calls. RRS calls for clinically deteriorating children with LOMT were associated with less intensive care and higher mortality.

Context: Physical symptoms such as pain and cancer-related fatigue limit physical function and activities of daily living among patients with terminal cancer, which can lead to a decline in quality of life. Therefore, comprehensive functional impairments should be evaluated to determine the progression of the disease and the effectiveness of palliative treatment., Objective: To validate the psychometric properties of the Japanese version of the Edmonton Functional Assessment Tool 2 (EFAT2-J)., Methods: We developed a Japanese version of the EFAT-2 in accordance with international guidelines. To verify the reliability and validity of the EFAT2-J, patients were evaluated by a physiotherapist and a nurse separately, and correlations with existing evaluation scales for physical function, physical symptoms, and quality of life were analyzed, respectively. The significance level was set at 5%., Results: Twenty patients participated in the reliability measurement. The average EFAT2-J scores were 7.95 ± 4.12 for physical therapists and 7.20 ± 4.23 for nurses, and the intraclass correlation coefficient was 0.95. The weighted kappa coefficient (κ) for each item was 0.57-1.00. Fifty-five patients participated in the validity measurement. The EFAT2-J showed significant correlations with Eastern Cooperative Oncology Group Performance Status and the Karnofsky Performance Scale, Barthel Index, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care sub-item "physical function.", Conclusion: These results indicate that the EFAT2-J has robust psychometric properties and is useful for evaluating physical function in patients with terminal cancer, and thus may be an acceptable clinical instrument in research and practice., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

The aim of the "Japanese Clinical Practice Guidelines for Head and Neck Cancer - 2022 Update" is to review the latest evidence regarding head and neck cancer and to present the current standard approaches for diagnosis and treatment. These evidence-based recommendations were created with the consensus of the Guideline Committee, which is composed of otorhinolaryngologists and head and neck surgeons, together with radiologists, radiation oncologists, medical oncologists, plastic surgeons, dentists, palliative care physicians, and rehabilitation physicians. These guidelines were created by the Clinical Practice Guideline Committee of the Japan Society for Head and Neck Cancer based on the "Head and Neck Cancer Treatment Guidelines 2018 Edition," and the revised draft was compiled after evaluation by the Assessment Committee and public comments. The 'Clinical questions and recommendations' section consists of 13 categories, and 59 clinical questions are described in total. Here we describe 6 clinical questions specific to other sets of guidelines with recommendations and comments., (Copyright © 2023. Published by Elsevier B.V.)

Background: No municipal-level study has elucidated the social determinants associated with multimorbidity prevalence (MP)., Objective: This article aimed to determine the differences in MP among municipalities and investigate factors associated with such differences through an ecological study of data obtained from a nationwide survey. This article focused on social participation and household income, which are associated with single chronic diseases, such as hypertension., Methods: Study design was a cross sectional study, which used the data from the Japan Gerontological Evaluation Study, a population-based gerontological study among functionally independent older adults aged ≥65 years in Japan. Overall, 152 212 participants from 2016 to 2017 across 91 municipalities were included in the final analysis. Multiple regression analysis was performed with MP as objective variable; social participation or household income were explanatory variables, and education, population density, and health check-ups were adjustment variables., Results: Intermunicipal differences in MP were 28.4% to 43.1% and 23.2% to 38.8% among men and women, respectively. Significant negative correlation was observed between MP and proportion of social participation (non-standardized coefficient [ B ] = -.18 for men and women). A significant positive correlation was noted between MP and equivalent household income of ≤2 million yen in women ( B  = .21)., Conclusion: Considerable differences in MP existed among municipalities. Areas with high proportion of social participation showed significantly lower MP. Considering the difficulty in managing multimorbidity within the primary care field and limited evidence on effective interventions, community-level interventions encouraging social participation among older individuals might reduce MP. Primary care physicians should consider a community health approach for multimorbidity., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Living a happy life is an essential issue for old adults. However, how eating with others contributes to happiness and whether this association is different by living arrangements or not is unknown. The current study examined the relationship between the frequency of eating with others and happiness among older adults according to their living arrangements using 3-year longitudinal data., Methods: The analyzed sample comprised 18,727 people (10,920 males and 7807 females) with low happiness (0-7 points on score of 0-10 points) from Japan Gerontological Evaluation Study (JAGES) in 2016. Our exposure was the frequency of eating with others: rarely, a few times a year, a few times a month, and a few times a week or more. We performed Modified Poisson Regression to examine the association between the frequency of eating with others and high happiness (8-10 points) in 2019 stratified by living arrangement (living alone/with others)., Results: A total of 4352 (23.2%) people showed high happiness in 2019. After adjusting for age, sex, marital status, education, household income, social participation, illnesses under treatment, and depressive symptoms in 2016, the cumulative incidence ratio (CIR) for high happiness in 2019 among people living alone was more significant, that is, 1.28 (95% confidence intervals: 0.88-1.87), 1.50 (1.05-2.14), and 1.82 (1.26-2.63), than 1.28 (1.11-1.48), 1.30 (1.12-1.50), and 1.33 (1.16-1.52) among people living with others for those who ate with others a few times a year, a few times a month, and a few times a week or more compared to those who rarely ate with others, respectively. The interaction between the frequency of eating with others and living arrangements was statistically significant. The trend test showed that higher frequency of eating with others was significantly associated with high happiness., Conclusions: Eating with others was associated with improved happiness among older adults, with such an association being stronger among people living alone., (© 2023 John Wiley & Sons Ltd.)

Background: Individual-level social capital prevents cognitive decline. However, a few studies have focused on the effects of community-level social capital on dementia. Therefore, we investigated the association between community-level social capital and dementia onset based on longitudinal study data on older adults in Japan., Methods: We used longitudinal data from the Japan Gerontological Evaluation Study, obtained over nine years (2010-2019). In total, 35,921 physically and cognitively independent individuals (16,848 males and 19,073 females) aged ≥65 years and nested within 308 communities in seven municipalities participated in the study. Dementia onset was assessed using the public long-term care insurance registration. Social capital was assessed using three dimensions: civic participation, social cohesion, and reciprocity. We performed a two-level multilevel survival analysis stratified by sex, calculated hazard ratios (HRs), and 95% confidence intervals (CIs)., Results: During the follow-up, 6245 (17.4%) dementia onset cases were identified. The cumulative incidence of dementia was 16.2% in males and 18.4% in females. After adjusting for covariates, individual-level civic participation was associated with a lower incidence of dementia in both males and females (HR, 0.84; 95% CI, 0.77-0.92; HR, 0.78; 95% CI, 0.73-0.84). Community-level civic participation and social cohesion were associated with a lower incidence of dementia among females (HR, 0.96; 95% CI, 0.93-0.99; HR, 0.93; 95% CI, 0.88-0.98) and cross-level interaction on social cohesion among females (HR, 0.95; 95% CI, 0.90-0.99)., Conclusions: Living in a community with high civic participation and social cohesion is associated with a lower incidence of dementia among older females. Therefore, promoting civic participation and social cohesion in the community may be a useful population-based strategy to delay or prevent the onset of dementia., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objectives: The purpose of this study was to investigate the association between subjective built environment and the onset of frailty in older adults living in the community. In addition, we examined whether daily walking time, depressive symptoms, and social support from neighbors and friends are mediating factors., Design: This was a longitudinal study using prospective cohort data from the 2013 Japan Gerontological Evaluation Study., Setting and Participants: Participants included 38,829 older adults who were not frail recruited from 22 cities and towns., Methods: The dependent variable, frailty, was assessed using the Kihon checklist. The explanatory variables were 5 items for the subjective built environment. The mediating variables were walking time of at least 30 minutes per day, a Geriatric Depression Scale (GDS) score of at least 5 points, and social support from neighbors and friends. We performed a causal mediation analysis of mediating effects between each built environment and frailty onset. Furthermore, the proportion of mediation was estimated., Results: After 3 years of follow-up, frailty emerged in 2232 adults (6.7%) in 2016. Access to parks and sidewalks, access to fresh food stores, houses or facilities where people feel free to drop in, and fascinating views, or buildings reduced the onset of frailty. Mediators significantly associated with the built environment and onset of frailty were access to parks and sidewalks (walking time: 5.9%, GDS: 22.9%, social support: 5.9%), access to fresh food stores (GDS: 31.9%, social support: 4.0%), hills and steps (GDS: 20.6%), houses or facilities where people feel free to drop in (walking time: 4.0%, GDS 28.0%, social support: 10.4%), and fascinating views, or buildings (walking time: 7.8%, GDS: 42.1%, social support: 12.0%)., Conclusions and Implications: We found that walking time, depression, and social support were mediating factors in the relationship between built environment and the onset of frailty., (Copyright © 2023 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Extravasation occurs when injectable drugs leak out of the blood vessels, damaging the surrounding tissues and causing a variety of skin injuries. This study aimed to comprehensively analyze extravasation risk, skin injury profiles, and outcomes for suspect drugs from the Japanese Adverse Drug Event Report (JADER) database. Adverse events were defined according to the Medical Dictionary for Regulatory Activities/Japanese version; the term extravasation (Standardized MedDRA Query Code: 20000136) was used in this analysis. The names of adverse events were entered as unified preferred terms and redefined to evaluate skin injury profiles. In addition, skin injury outcomes were divided into 2 broad categories: "improvement" and "no improvement." Reporting odds ratios were used to detect signals for adverse events. A total of 656 cases of extravasation-related adverse events were reported between April 2004 and January 2022. Signals for extravasation-related adverse events were detected from 11 drugs. Then, their respective skin injury profiles and outcomes were determined. These results suggest a relationship between adverse events associated with extravasation and 11 drugs and identify the characteristics of each skin injury and their outcomes. These findings will contribute to improving the quality of infusion management in clinical practice., Competing Interests: Conflict of interest: All authors have no conflicts of interest to declare., (Copyright © 2023 Infusion Nurses Society.)

This study aimed to determine how behavioural restrictions due to the emergency declaration following the coronavirus disease 2019 (COVID-19) pandemic affect exercise tolerance and its outcomes in patients in Phase III cardiac rehabilitation programme. This is a multicenter retrospective cohort study. Participants in outpatient cardiac rehabilitation programmes and cardiopulmonary exercise testing before and after the emergency declarations were included. A total of 90 participants were included (median age 75.0 years, 69% male), and the changes in physical function and exercise tolerance were compared before and after the emergency declaration. Patients were divided into a decline-in-peak oxygen uptake (VO 2 ) group and a nondecline-in-peak VO 2 group. Comparison before and after the emergency declaration showed that the anaerobic threshold declined significantly and peak VO 2 exhibited a downward trend. The decline-in-peak VO 2 group consisted of 16 patients (17%) with better exercise tolerance, multiple comorbidities, and declined lower extremity muscle strength. These patients also had a higher rate of subsequent composite events (hazard ratio, 5.2; 95% confidence interval, 1.4-18.8, p = 0.01). Before and after the emergency declaration, the patient's exercise tolerance may decline, leading to a poor prognosis. This study suggests the importance of maintaining exercise tolerance during the COVID-19 pandemic., (© 2023 Scandinavian Society of Clinical Physiology and Nuclear Medicine.)

Social participation is effective for preventing functional decline in older people. However, researchers have not fully explored how different frequencies of social participation by type. We aimed to clarify the relationship between the frequency of social participation by type and functional decline. We used data from the Japan Gerontological Evaluation Study, which consists of individuals aged 65 years and older who were not eligible to receive public long-term-care insurance benefits. From 13 municipalities, 51,968 respondents who met the criteria were included in the analysis. We used a sex-stratified Cox proportional hazards model. The outcome was the new incidence of functional decline during a six-year follow-up, and the exposure was the frequency of social participation of one of the following six types: sports, hobbies, volunteering, neighborhood, senior clubs, and industry groups. The frequency was categorized as "never," "a few times a year," "once or twice a month," and "once a week or more." We set non-participation in each activity as the reference, and we adjusted for 12 potential confounders (i.e., sociodemographic and health-related factors). After we adjusted for confounders, participation in sports and hobbies once or twice a month, once a week or more was protectively associated with functional decline. We found a similar association for participation in neighborhood a few times a year. Our findings demonstrate the importance of considering the effects of different types and frequencies of activities when promoting social participation among older people as part of public health policies., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023. Published by Elsevier B.V.)

Participating in group leisure activities may lower the risk of dementia compared with doing leisure activities alone. However, only some studies have examined the differences. In this study, we sought to determine whether the incidence of dementia risk differs according to the implementation status of leisure activities (participation in a group or alone). The association between the implementation status of leisure activities and the risk of dementia was examined using Cox proportional hazards models in the 6-year (2010-2016) cohort data of 50,935 participants (23,533 males and 27,402 females) aged 65 years or older of the Japan Gerontological Evaluation Study. Over six years of follow-up, 5395 respondents (10.6%) developed dementia. After adjusting for potential confounders, such as depression and social support, the implementation status of leisure activities was associated with a lower dementia risk in participants who engaged in group leisure activities (hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.73-0.85) and a higher dementia risk in those without leisure activity (HR, 1.30; 95% CI, 1.22-1.39), in comparison with those engaging in leisure activities alone. Engagement in group leisure activities may be associated with a reduced risk of dementia., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Inc.)

Background: Non-invasive, prompt, and proper detection tools for kidney graft injuries (KGIs) are awaited to ensure graft longevity. We screened diagnostic biomarkers for KGIs following kidney transplantation using extracellular vesicles (EVs; exosomes and microvesicles) from the urine samples of patients., Methods: One hundred and twenty-seven kidney recipients at 11 Japanese institutions were enrolled in this study; urine samples were obtained prior to protocol/episode biopsies. EVs were isolated from urine samples, and EV RNA markers were assayed using quantitative reverse transcription polymerase chain reaction. Diagnostic performance of EV RNA markers and diagnostic formulas comprising these markers were evaluated by comparison with the corresponding pathological diagnoses., Results: EV CXCL9, CXCL10, and UMOD were elevated in T-cell-mediated rejection samples compared with other KGI samples, while SPNS2 was elevated in chronic antibody-mediated rejection (cABMR) samples. A diagnostic formula developed through Sparse Logistic Regression analysis using EV RNA markers allowed us to accurately (with an area under the receiver operator characteristic curve [AUC] of 0.875) distinguish cABMR from other KGI samples. EV B4GALT1 and SPNS2 were also elevated in cABMR, and a diagnostic formula using these markers was able to distinguish between cABMR and chronic calcineurin toxicity accurately (AUC 0.886). In interstitial fibrosis and tubular atrophy (IFTA) urine samples and those with high Banff chronicity score sums (BChS), POTEM levels may reflect disease severity, and diagnostic formulas using POTEM detected IFTA (AUC 0.830) and high BChS (AUC 0.850)., Conclusions: KGIs could be diagnosed with urinary EV mRNA analysis with relatively high accuracy., (© 2023. The Author(s).)

Objective　Maintaining or increasing walking provides several health benefits to older adults. However, the mid-term evaluation of Health Japan 21 [second term] showed that older adults' daily steps did not meet the goal. Therefore, this study emphasized primordial prevention, which is different from previous preventive approaches and focuses on the relationship between the built environment and physical activities, including daily steps. This study investigated the relationship between changes in the number of food stores and walking time.Methods　This longitudinal study utilized the self-administered mail survey data between 2016 and 2019 from the Japan Gerontological Evaluation Study (JAGES). Older adults aged ≥65 years and residing in 27 independent municipalities were recruited. The dependent variable was a change in the walking time at two-time points (increase or not). Our explanatory variable was the change in the number of food stores at two-time points, reported on a 5-point scale, including no store (reference), increased stores, store available, decreased stores, and I don't know. Equivalently, it was defined as the self-reported change in the number of food stores (stores that sell meats, fish, fruits, and vegetables) within the walking distance of participants' homes (within ～1 km) from 2016 to 2019. The covariates included demographic factors, health behavior factors, environmental factors, and health factors in 2016. We used Poisson regression analysis (5% significance level) to calculate the cumulative incidence rate ratio (CIRR) and 95% confidence interval (CI) for an increase in walking time compared to no increase in walking time. The multivariate normal imputation method supplemented missing data of the dependent variable, explanatory variable, and covariates. Additionally, respondents' answer of "other" for the covariates was supplemented.Results　Three years later, 13,400 (20.4%) respondents had increased their walking time. Older adults who reported increased number of stores (5,311, 8.1%) had more walking time than those who reported no stores (6,577, 10.0%) (CIRR=1.12; 95% CI: 1.03-1.21).Conclusion　Participants who reported an increase in the number of fresh food stores within the walking distance had 12% more walking time three years later. A built environment might be used to measure primordial prevention that increases the amount of walking in daily life. Our results may provide evidence for policymakers and stakeholders to consider healthy urban planning.

Background: The guidelines recommend additional gastrectomy after noncurative endoscopic resection for early gastric cancers (EGCs). However, no additional treatment might be acceptable in some patients aged ≥ 85 years. We aimed to identify this patient group using the data in a highly aged area., Methods: We enrolled patients aged ≥ 85 years after noncurative endoscopic resection for EGCs at 30 institutions of the Tohoku district in Japan between 2002 and 2017. Treatment selection and prognosis after noncurative endoscopic resection were investigated. Fourteen candidates were evaluated using the Cox model to identify risk factors for poor overall survival (OS) in patients with no additional treatment., Results: Of 1065 patients aged ≥ 85 years, 143 underwent noncurative endoscopic resection. Despite the guidelines' recommendation, 88.8% of them underwent no additional treatment. The 5-year OS rates in those with additional gastrectomy and those with no additional treatment were 63.1 and 65.2%, respectively. Multivariate analysis showed independent risk factors for poor OS in patients with no additional treatment were the high-risk category in the eCura system (hazard ratio [HR], 2.91), Charlson comorbidity index (CCI) ≥ 3 (HR, 2.78), and male (HR, 2.04). In patients with no additional treatment, nongastric cancer-specific survival was low (69.0% in 5 years), whereas disease-specific survival rates were very high in the low- and intermediate-risk categories of the eCura system (100.0 and 97.1%, respectively, in 5 years)., Conclusions: No additional treatment may be acceptable in the low- and intermediate-risk categories of the eCura system in patients aged ≥ 85 years with noncurative endoscopic resection for EGCs., (© 2023. Japanese Society of Gastroenterology.)

We recently reported the decrease in the number of gastrointestinal (GI) cancer diagnoses in 2020 due to disturbance of the healthcare system by the coronavirus disease 2019 (COVID-19) pandemic, using a hospital-based cancer registration system in Akita prefecture, Japan. In this study, we extended the research by showing the latest data (2021) on the number of cancers and examinations. Information on the occurrence and stage of esophageal, gastric, and colorectal cancers was collected from the same database. The number of GI examinations (cancer screening procedures and endoscopic examinations) was also investigated. Following the immediate decrease in the numbers of both GI examinations and GI cancer diagnoses in 2020, a rebound increase in the numbers of GI cancer diagnoses-especially colorectal cancers-was observed in 2021, resulting from an increased number of GI examinations i.e., the total number of colorectal cancers in 2021 increased by 9.0% and 6.8% in comparison to 2020 and pre-pandemic era, respectively. However, the rebound increase in 2021 was largely due to an increase in early-stage cancers, and there was no apparent trend toward the increased predominance of more advanced cancers. It therefore seems that we managed to escape from the worst-case scenario of disturbance of the healthcare system due to pandemic (i.e., an increase in the number of more advanced cancers due to delayed diagnoses). We need to continue to watch the trends in Akita prefecture, which has the highest rate of mortality from the 3 major GI cancers in Japan.

Background: The Japanese Orthopaedic Association (JOA) guideline for the management of lumbar spinal stenosis (LSS) was first published in 2011. Since then, the medical care system for LSS has changed and many new articles regarding the epidemiology and diagnostics of LSS, conservative treatments such as new pharmacotherapy and physical therapy, and surgical treatments including minimally invasive surgery have been published. In addition, various issues need to be examined, such as verification of patient-reported outcome measures, and the economic effect of revised medical management of patients with lumbar spinal disorders. Accordingly, in 2019 the JOA clinical guidelines committee decided to update the guideline and consequently established a formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline, incorporating the recent advances of evidence-based medicine., Methods: The JOA LSS guideline formulation committee revised the previous guideline based on the method for preparing clinical guidelines in Japan proposed by the Medical Information Network Distribution Service in 2017. Background and clinical questions were determined followed by a literature search related to each question. Appropriate articles based on keywords were selected from all the searched literature. Using prepared structured abstracts, systematic reviews and meta-analyses were performed. The strength of evidence and recommendations for each clinical question was decided by the committee members., Results: Eight background and 15 clinical questions were determined. Answers and explanations were described for the background questions. For each clinical question, the strength of evidence and the recommendation were both decided, and an explanation was provided., Conclusions: The 2021 clinical practice guideline for the management of LSS was completed according to the latest evidence-based medicine. We expect that this guideline will be useful for all medical providers as an index in daily medical care, as well as for patients with LSS., Competing Interests: Declaration of competing interest All guideline formulation committee members confirmed the COI through self-reporting at the time of preparation of this manuscript. Committee members with any COI declined to vote for applicable recommendation decisions. No companies or any other organizations were directly involved in any text pertaining to the guideline, including the recommendations for all CQs and BQs., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)