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Introduction: In Japan, telemedicine has gradually expanded due to deregulation in response to the COVID-19 pandemic. However, its current status remains unclear, as it is primarily provided by general practitioners. This study aims to examine the use of telemedicine in sublingual immunotherapy (SLIT) for patients with Japanese cedar pollen allergy and/or house dust mite allergic rhinitis. Methods: We conducted a retrospective analysis of medical record data from seven otorhinolaryngology clinics and performed an exploratory evaluation between a group that combined telemedicine and in-person visits during the initial 6 months of SLIT and another group with only in-person visits. Results: Following propensity score matching, 51 and 82 patients were eligible for the telemedicine and in-person groups, respectively, with 33 cases in both groups. Both groups had similar characteristics after matching. No significant difference was found in the withdrawal rate at 6 months from the start of SLIT (6.1% and 9.1% in each group; p = 1.00), side effects, or treatment efficacy between the two groups. The average copayment for patients tended to be significantly higher in the telemedicine group after one, three, and 6 months following SLIT initiation. Discussion: The situation of patients who receive an appropriate combination of telemedicine and in-person visits is not significantly different from patients who receive in-person visits alone. This study may help indicate the actual status of telemedicine in Japan. Further investigation at more facilities is necessary in the future to dispel concerns in the practice setting. more...

Background: Previous studies have shown that Japanese dietary patterns are associated with high nutrient density. However, these studies were limited to the Japanese population. We examined this association in the US population., Methods: A cross-sectional analysis was conducted using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018. We included 3138 people aged 20-79 years. Food and nutrient intake data were based on the 24 h recall method. Three Japanese diet indices were used: (1) Japanese Diet Index (JDI, based on 9 food items), (2) modified JDI (mJDI, based on 12 food items), and (3) weighted JDI (wJDI, selected and weighted from mJDI food items). The nutrient density (ND) score was calculated based on the Nutrient-Rich Food Index 9.3. Spearman's rank correlation coefficients were calculated., Results: The correlation coefficients with the ND score were 0.24 ( p < 0.001) for the JDI and 0.38 ( p < 0.001) for the mJDI. The correlation coefficient between the wJDI and ND score was 0.48 ( p < 0.001). The three Japanese diet indices were correlated with the ND score in all racial groups ( p < 0.001)., Conclusions: Even among the US population, higher degrees of Japanese diet defined by the JDI or mJDI were associated with higher nutrient density. more...

In tidal flats, which are located at the transition zone between terrestrial and marine ecosystems, environmental factors such as temperature, sediment particle size, and tidal range exhibit geographic variation. Accordingly, the composition and structure of the microbial communities in the tidal flats are likely to vary in geographically different habitats. To clarify these differences with environmental factors causing them, we analyzed microbial communities consisting of bacteria and ciliates in sediments collected from nine tidal flats in geographical diverse region from Hokkaido to Kagoshima, Japan. The results confirmed that the community structures of bacteria and ciliophora in tidal flat sediments differed at the geographical scale of the Japanese archipelago. However, the variation could not be explained by the physical distance between the tidal flats nor by the differences in the trophic conditions among the tidal flats. Instead, the OTU richness of both the bacterial and ciliophoran communities was significantly related to the tidal range. The results also showed that bacteria and ciliophora tended to form similar communities among the tidal flats with similar median particle sizes. Furthermore, ciliophoran communities were similar among the tidal flats with similar bacterial communities. The results suggest that bacteria and ciliophora interact each other through trophic relationships or physical and chemical processes in the sediment habitats. more...

The association of Japanese and Mediterranean dietary patterns with muscle weakness in middle-aged and older Japanese individuals is unclear. This cross-sectional study investigated the association between Japanese and Mediterranean dietary patterns and muscle weakness in community-dwelling, middle-aged, and older Japanese individuals (enrolled from 2007 to 2011). Based on the dietary consumption information obtained from the brief self-administered diet history questionnaire, we assessed adherence to the Japanese (12-component revised Japanese diet index (rJDI12)) and Mediterranean (alternate Mediterranean diet (aMed) score) dietary patterns. Muscle weakness was defined as handgrip strength <28 and <18 kg for men and women, respectively. Logistic regression was used to ascertain the relationship between dietary pattern and muscle weakness. In our study, with 6031 participants, the Japanese, but not Mediterranean, dietary pattern was inversely associated with muscle weakness ( p for trend = 0.031 and 0.242, respectively). In the model adjusted for confounders, including energy intake, the highest quartile of rJDI12 scores (9-12 points), and the rJDI12 scores, entered as continuous variables, showed an independent association (odds ratio (95% CI), 0.703 (0.507-0.974), and 0.933 (0.891-0.977), respectively). Our findings showed that adherence to the Japanese dietary pattern is associated with a low prevalence of muscle weakness. more...

The extent to which long disability-free survival (DFS) time can be extended according to the amount of time spent walking has not been investigated. The aim of this study was to examine the association between time spent walking per day and DFS time in older adults. We conducted a cohort study of 14 342 disability-free individuals (aged ≥ 65 years) living in Ohsaki City, Japan. The amount of time spent walking per day (<0.5 h, 0.5-1 h, ≥1 h) by each individual in 2006 was assessed by a self-reported questionnaire. Data on 11-year incident functional disability were retrieved from the public Long-Term Care Insurance database. After estimating the multivariable-adjusted hazard ratios (HRs) of the composite outcome (incident functional disability or death), the multivariable-adjusted 50th percentile differences (50th PDs; difference in the period until the first 50% of the composite outcome occurred) were estimated according to time spent walking. Among 114 764 person-years, the composite outcome occurred in 7761 persons (67.6 per 1000 person-years). The HRs (95% confidence intervals) of the composite outcome were 1.00 (reference) for <0.5 h, 0.84 (0.79, 0.88) for 0.5-1 h, and 0.78 (0.74, 0.83) for ≥1 h (p-trend < 0.001). The 50th PDs (95% confidence intervals) of DFS time were 238 (155, 322) days longer for 0.5-1 h and 360 (265, 454) days longer for ≥1 h, in comparison with <0.5 h. The results suggest that longer time spent walking per day contributes to longer DFS time., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.) more...

The Japanese dietary pattern has long been discussed as one of the factors behind the longevity of Japanese people. However, the health benefits of the Japanese dietary pattern have not been fully elucidated. We published the first report in the world regarding the relation between the Japanese dietary pattern and cardiovascular disease mortality in 2007 using cohort studies including Japanese residents of Ohsaki City, Miyagi Prefecture, Japan. Since then, we have developed the Japanese Diet Index (JDI) that was based on previous findings to assess the degree of the Japanese dietary pattern and to advance the evidence on the health effects of the Japanese dietary pattern. So far, we have explored the associations between the JDI score (in quartiles) and various outcomes. For all-cause mortality, in comparison to Q1 (the lowest), the multivariable hazard ratios (HRs) and 95% confidence intervals (95%CIs) were 0.92 (0.85-1.00) for Q2, 0.91 (0.83-0.99) for Q3, and 0.91 (0.83-0.99) for Q4 (the highest). For functional disability, the multivariable HRs (95%CIs) were 0.94 (0.81-1.09) for Q2, 0.90 (0.77-1.05) for Q3, and 0.79 (0.68-0.92) for Q4. For dementia, the multivariable HRs (95%CIs) were 0.88 (0.74-1.05) for Q2, 0.87 (0.73-1.04) for Q3, 0.79 (0.66-0.95) for Q4. In addition, people with higher adherence to the Japanese dietary pattern also showed decreases in disability and dementia risks. The purpose of this article was to review all six papers, summarize the health effects of the Japanese dietary pattern, and discuss implications for future research. more...

The influence of public health measures against COVID-19 in Japan on child mental health by household type is unknown. This study aimed to investigate whether COVID-19 and the declaration of a state of emergency in Japan affected children's mental health between single-parent and two-parent households disproportionately. A large cross-sectional online survey was conducted from August to September 2020. The study included 3365 parents with children aged 0-14 years old who reported their children's mental status during the declared state of emergency. Emotional instability was reported dichotomously by parents. As the primary result, the probability of emotional instability was higher in single-parent households compared with that in two-parent households after adjustments for potential covariates; the adjusted prevalence ratio (95% CI) was 1.26 (1.07-1.49). Our findings suggest a disproportionate impact on children's mental health due to the pandemic. more...

Background: Our study examined the association between social participation and healthy aging using a community-based cohort study among Japanese older adults., Methods: This prospective study was conducted in Ohsaki City, Japan, and included 7226 participants aged ≥65 years at the baseline survey in 2006. We obtained information on frequency of participation in 3 types of community activities (ie, neighborhood activities, hobbies, and volunteer activities) at baseline. Exposure was measured by the number of types of community activities participated in and participants were categorized into 4 groups (ie, none, 1 type, 2 types, and 3 types). The primary outcome was healthy aging as assessed by a questionnaire survey conducted in 2017, and was defined as meeting the following 4 criteria: free of disability, free of depression, high health-related quality of life, and high life satisfaction. We used multiple logistic regression models to calculate the corresponding odds ratios and 95% confidence intervals., Results: During 11 years of follow-up, 574 (7.9%) participants attained healthy aging. Compared with participants not participating in any activity, the multivariable-adjusted odds ratios (95% confidence intervals) were 1.90 (1.40, 2.59) for those participating in 1 type, 2.49 (1.84, 3.38) for 2 types, and 3.06 (2.30, 4.07) for 3 types (p for trend < .0001). Furthermore, for each type of community activity, a higher frequency of participation was related to higher probability of healthy aging., Conclusions: Our study suggests that social participation is associated with the promotion of healthy aging, and that the benefits were observed across different types of community activities., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.) more...

FOLFOXIRI (fluorouracil, leucovorin, oxaliplatin, and irinotecan) plus bevacizumab is the preferred first-line treatment for right-sided metastatic colorectal cancer with RAS mutation. However, severe adverse events are common in Japanese patients. We report the successful management of multiple stage IV colorectal cancers in a patient who received multidisciplinary treatment, including chemotherapy and Japanese Kampo medicine. A 68-year-old man presented with epigastralgia and appetite loss and was diagnosed with multiple stage IV colorectal cancers. Colonoscopy identified type II tumors in the ascending colon, sigmoid colon, and upper rectum. Histopathological examination of a biopsy specimen revealed well- to moderately differentiated tubular adenocarcinoma. Enhanced computed tomography of the thorax and abdomen showed multiple pulmonary nodules and para-aortic lymph node swelling. Laparoscopic loop-ileostomy was performed to avoid bowel obstruction due to severe stenosis of ascending colon cancer. Intraoperative observation revealed two white nodules suggestive of metastasis in the lateral area of the liver. Therefore, we diagnosed multiple stage IV colorectal cancers with multiple metastases (lung, liver, and distant lymph nodes). His postoperative course was uneventful, and chemotherapy was started. Since the cancer cells harbored a RAS mutation, he received FOLFOXIRI plus bevacizumab. Japanese Kampo medicine consisting of Hangeshashinto and Juzen-taiho-to, to prevent diarrhea and fatigue, was administered daily. After 12 courses of chemotherapy, though circumferential stenosis still existed in the ascending colon, the tumors in the sigmoid colon and upper rectum were unclear. Enhanced computed tomography showed shrinkage of the pulmonary nodules and para-aortic lymph node; therefore, laparoscopic-assisted ileocecal resection was performed. The postoperative histopathological examination revealed moderately differentiated adenocarcinoma. The patient recovered uneventfully, and Kampo medicine consisting of Ninjin'yoeito was administered for postoperative weakness. Administration of adjuvant chemotherapy in this patient led to a near complete response that has been maintained without recurrence for 2 years and 8 months without reduced quality of life., (Copyright © 2021. Published by Elsevier Ltd.) more...

Aim: Arterial stiffness results in elevated left ventricular filling pressure and can promote atrial remodeling due to chronic pressure overload. However, the impact of arterial stiffness on the process of atrial remodeling in association with atrial fibrillation (AF) has not been fully evaluated., Methods: We enrolled 237 consecutive patients diagnosed with AF who had undergone ablation; data from 213 patients were analyzed. Cardio-ankle vascular index (CAVI) was used as a marker of arterial stiffness. The left atrial (LA) and right atrial (RA) volumes were determined by computed tomography imaging; atrial conduction and voltage amplitude were evaluated using a three-dimensional electromapping system used to guide the ablation procedure., Result: In univariate analysis, CAVI significantly correlated with atrial structural and electrical remodeling (LA volume index, r=0.297, P=0.001; RA volume index, r=0.252, P=0.004; LA conduction velocity, r=0.254, P= 0.003; LA mean voltage, r=-0.343, P=0.001, RA mean voltage; r=-0.245, P=0.015). Multivariate regression analysis revealed that CAVI and plasma levels of N-terminal B-type natriuretic peptide were independent determinants of LA and RA remodeling, respectively. On the other hand, age and LA conduction velocity were independent variables with respect to CAVI. Age-adjusted CAVI was highest in long-standing persistent AF when compared with measures of persistent or paroxysmal AF., Conclusion: CAVI was closely associated with biatrial remodeling in patients diagnosed with AF. These results suggest that arterial stiffness may play a significant role with respect to disease progression. more...

Objective: To investigate the association between participation in government subsidies for domestic travel (subsidise up to 50% of all travel expenses) introduced nationally in Japan on 22 July 2020 and the incidence of symptoms indicative of COVID-19 infections., Design: Cross-sectional analysis of nationally representative survey data., Setting: Internet survey conducted between 25 August and 30 September 2020 in Japan. Sampling weights were used to calculate national estimates., Participants: 25 482 survey respondents (50.3% (12 809) women; mean (SD) age, 48.8 (17.4) years)., Main Outcome Measures: Incidence rate of five symptoms indicative of the COVID-19 infection (high fever, sore throat, cough, headache, and smell and taste disorder) within the past month of the survey, after adjustment for characteristics of individuals and prefecture fixed effects (effectively comparing individuals living in the same prefecture)., Results: At the time of the survey, 3289 (12.9%) participated in the subsidy programme. After adjusting for potential confounders, we found that participants in the subsidy programme exhibited higher incidence of high fever (adjusted rate, 4.7% for participants vs 3.7% for non-participants; adjusted OR (aOR) 1.83; 95% CI 1.34 to 2.48; p<0.001), sore throat (19.8% vs 11.3%; aOR 2.09; 95% CI 1.37 to 3.19; p=0.002), cough (19.0% vs 11.3%; aOR 1.96; 95% CI 1.26 to 3.01; p=0.008), headache (29.2% vs 25.5%; aOR 1.24; 95% CI 1.08 to 1.44; p=0.006) and smell and taste disorder (2.6% vs 1.8%; aOR 1.98; 95% CI 1.15 to 3.40; p=0.01) compared with non-participants. These findings remained qualitatively unaffected by additional adjustment for the use of 17 preventative measures (eg, social distancing, wearing masks and handwashing) and fear against the COVID-19 infection., Conclusions: The participation of the government subsidy programme for domestic travel was associated with a higher probability of exhibiting symptoms indicative of the COVID-19 infection., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.) more...

Purpose: The present study aimed to examine the association between adherence to the Japanese diet and the subsequent risk of all-cause and cause-specific mortality using a large-scale cohort from settings all over Japan., Methods: We analyzed data from a cohort study of 92,969 Japanese adults aged 45-74 years, covering 11 public health center areas nationwide. We collected dietary information using a validated 147-item food frequency questionnaire. Adherence to the Japanese diet consisting of eight components (high intake of rice, miso soup, seaweeds, pickles, green and yellow vegetables, fish, and green tea; low intake of beef and pork) was assessed using 8-item Japanese Diet Index (JDI8) score, with scores ranging from 0 to 8. The Cox proportional hazards model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for all-cause and cause-specific mortality., Results: During a median follow-up of 18.9 years, we documented 20,596 deaths. A higher JDI8 score was significantly associated with a lower risk for all-cause and cardiovascular disease (CVD) mortality. The multivariable-adjusted HR of all-cause and CVD mortality for the highest JDI8 score group (score of 6-8) versus the lowest JDI8 score group (score of 0-2) were 0.86 (95% CI 0.81-0.90, P trend < 0.001), and 0.89 (95% CI 0.80-0.99, P trend = 0.007), respectively., Conclusions: Adhering to the Japanese diet, as assessed by the JDI8, was associated with a decreased risk of all-cause and CVD mortality among adults living in multiple areas across Japan. more...

Animal carcasses are often brought into tidal flats where they are at the boundary between terrestrial and marine ecosystems. Since these carcasses act as microhabitats with large amounts of energy and nutrients, they likely develop unique bacterial assemblages in the ambient sediment, which in turn may stimulate colonization of other organisms such as protozoans. However, little is known about the microbial assemblages colonized in sediment around animal carcasses in the tidal zone. Herein we examined the bacterial and ciliophoran assemblages developed in association with fish carcasses by incubating the carcasses in the Higashiyachi tidal flat (Sendai, Japan). We collected sediment samples at 2, 9, and 42 days of incubation and analyzed the bacterial and ciliophoran assemblages by 16S and 18S rRNA gene amplicon sequencing. We observed significant differences in the composition and relative abundance of bacterial and ciliophoran operational taxonomic units (OTUs) between the sediments with and without the carcasses. Our analyses suggest that these unique assemblages were created through the direct effects of the carcass and indirect effects through interactions between bacteria and ciliophorans. These results also suggest that animal carcasses developed a temporally unique microbial food web in the sediments close to the carcasses, although it disappeared for several weeks., Competing Interests: This study was funded by the Mitsui & Co. Environment Fund. We declare as the authors that this funding source does not alter our adherence to PLOS ONE policies on sharing data and materials. more...

Hyperammonemia is a rare adverse event of 5-FU. Here, we report a case of hyperammonemia with disturbance of consciousness during 5-FU plus nedaplatin therapy for esophageal cancer and present a literature review. A 69-year-old man was diagnosed with cT2N2M0, cStage Ⅲ esophageal cancer. He was administered with DCF therapy as the first-line neoadjuvant chemotherapy. After the first course, he showed renal dysfunction. Therefore, as the second-line neoadjuvant chemotherapy, he was administered with 5-FU plus nedaplatin. He vomited on treatment day 5 and suddenly presented with disturbance of consciousness on treatment day 6. Blood tests showed hyperammonemia(114 μg/dL). He was treated with rehydration and branched-chain amino acid solutions, resulting in a gradual improvement of symptoms. Hyperammonemia has been reported in patients with colorectal cancer but rarely in patients with esophageal cancer. A case of hyperammonemia during the 5-FU plus nedaplatin therapy has never been reported in Japan. We should be aware that 5-FU may cause hyperammonemia and resultant disturbance of consciousness during chemotherapy with 5-FU. more...

Objective: The aim of this study was to investigate the effect of a financial incentive on the number of daily walking steps among community-dwelling adults in Japan., Study Design: Two-arm, parallel-group randomised controlled trial., Setting/participants: We recruited physically inactive community-dwelling adults from Sendai city, Japan. Eligible participants were randomly allocated to an intervention or a wait list control group. Pedometers were used to assess the mean number of daily steps in three periods: baseline (weeks 1-3), intervention (weeks 4-6) and follow-up (weeks 7-9)., Intervention: The intervention group was offered a financial incentive (shopping points) to meet the target number of increased daily steps in the intervention period., Main Outcome Measures: The primary outcome was an increase in the mean number of daily steps in the intervention and follow-up periods compared with baseline., Results: Seventy-two participants (69.4% women; mean age, 61.2±16.2 years; mean number of daily steps at baseline, 6364±2804) were randomised to the intervention (n=36) and control groups (n=36). During the intervention period, the increase in mean daily steps was significantly higher in the intervention group (1650, 95% CI=1182 to 2119) than in the control group (514, 95% CI=136 to 891; p<0.001). However, the difference between groups was not significant at follow-up after the incentives were removed (p=0.311). In addition, compared with controls, a significantly higher proportion of participants in the intervention group showed an increase in mean daily steps of ≥1000 (69.4% vs 30.6%, respectively; OR=5.17, 95% CI=1.89 to 14.08). There were no adverse effects from the intervention., Conclusions: The present results suggest that financial incentives are effective in promoting short-term increases in physical activity., Trial Registration Number: UMIN000033276., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.) more...

To investigate the association of smoking status and years since smoking cessation with the risk of incident dementia among elderly Japanese. We conducted a longitudinal analysis of smoking status and smoking cessation with dementia in prospective cohort study of 12,489 Japanese individuals aged ≥ 65 years who were followed up for 5.7 years. Information on smoking status and other lifestyle factors was collected via a questionnaire in 2006. Data on incident dementia were retrieved from the public Long-term Care Insurance Database. The Cox proportional hazards model was used to estimate the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident dementia. During 61,613 person-years of follow-up, 1110 cases (8.9%) of incident dementia were documented. Compared with individuals who had never smoked, current smokers showed a higher risk of dementia (HR 1.46, 95% CI 1.17, 1.80). Among ex-smokers, the risk for those who had stopped smoking for ≤ 2 years was still high (HR 1.39, 95% CI 0.96, 2.01), however, quitting smoking for 3 years or longer mitigated the increased risk incurred by smokers; the multivariable HRs (95% CIs) were 1.03 (0.70, 1.53) for those who had stopped smoking for 3-5 years, 1.04 (0.74, 1.45) for 6-10 years, 1.19 (0.84, 1.69) for 11-15 years, and 0.92 (0.73, 1.15) for > 15 years. Our study suggests that the risk of incident dementia among ex-smokers becomes the same level as that of never smokers if they maintain abstinence from smoking for at least 3 years. more...

Objective: This cross-sectional study aims to examine if cognitive impairment, depressive symptoms, and their combination are associated with biases between self-evaluated and measured masticatory performance in community-dwelling older Japanese adults., Methods: The sample constituted of 804 community-dwelling elderly Japanese individuals aged ≥70 years. Cognitive impairment and depressive symptoms were assessed using the Mini-Mental State Examination and Geriatric Depression Scale, respectively. Self-evaluated masticatory performance (SMP) was assessed for 10 food items. Measured masticatory performance (MMP) was assessed as the maximum occlusal force, which is a surrogate indicator. Multivariate logistic regression was applied to examine the associations of cognitive impairment, depressive symptoms, and their combination with the deviation between SMP and MMP, SMP overestimation, and SMP underestimation, with adjustment for age, sex, body mass index, smoking, alcohol consumption, duration of education, medical history, physical function, regular dental visits, and number of teeth., Results: Cognitive impairment was significantly associated with SMP overestimation (odds ratio [OR]: 2.37, 95% confidence interval [CI]: 1.25-4.50); in parallel, SMP underestimation was significantly associated with depressive symptoms (OR: 1.86, 95% CI: 1.14-3.04) and the presence of both cognitive impairment and depressive symptoms (OR: 2.77, 95% CI: 1.01-7.61)., Conclusions: This cross-sectional study clarifies the gap between self-evaluated and measured masticatory performance in geriatric participants who have cognitive impairment or depressive symptoms. These biases must be taken into consideration when appraising self-evaluated masticatory performance or oral health status in geriatric patients with cognitive impairment or depressive symptoms., Clinical Significance: This study explores the biases in geriatric patients with cognitive impairment or symptoms of depression. It clarifies that participants with cognitive impairment tend to overestimate their self-evaluated masticatory performance. Conversely, the participants with depression symptoms tend to underestimate their self-evaluated masticatory performance., (Copyright © 2020 Elsevier Ltd. All rights reserved.) more...

In 2016, the Japanese Society of Gerodontology (JSG) proposed the concept of "oral hypofunction (OHF)," and recommended two initial criteria for reduced occlusal force (ROF): <200 N of maximum occlusal force (MOF) and < 20 remaining teeth. However, the JSG stated that these criteria need to be reviewed by accumulating further evidence. To examine the validity and equivalence of the two criteria for ROF in the diagnostic criteria for OHF by using the incidence of functional disability as the outcome. This study enrolled 815 community-dwelling Japanese individuals ≥ 70 years. They underwent examinations for physical, mental and social functions; MOF; and number of teeth at baseline. The incidence of functional disability (a condition that requires at least partial assistance with daily activities) based on the first certification of long-term care insurance was followed up. The Cox proportional hazard model revealed that MOF < 200 N (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.04-1.72) and < 20 teeth (HR, 1.40; 95% CI, 1.07-1.84) were significantly associated with increased risk of functional disability. Receiver operating characteristic curve analyses revealed that the optimal cut-off values of MOF and number of teeth that best predicted incident functional disability were 264.6 N and 19 teeth, respectively. Twelve teeth were the optimal threshold that best predicted < 200 N of MOF. The two criteria for ROF in the diagnostic criteria for OHF had some degree of validity. However, further studies are needed to develop appropriate and reliable criteria for a decision of ROF., (© 2020 John Wiley & Sons Ltd.) more...

Background: The physical and psychological health impacts on victims of the Great East Japan Earthquake (GEJE) have lasted for a long time. Some cross-sectional studies have reported a relationship between social networks and/or social support and mental health among victims. Previous studies were cross-sectional observations at one time point after a disaster, it remains unclear whether the lack of social trust soon after the GEJE predicts long-term mental health outcomes among the victims. The objective of the present study was to examine prospectively the association between social trust soon after the GEJE and trends in sleep disorders up to 6 years after the GEJE., Methods: We conducted a health survey on residents living in two areas affected by the GEJE. We analyzed data from 1293 adults (aged ≥18 years) who had participated in an initial health survey. The participants responded to a self-administrated questionnaire composed of items on health condition, mental health, including sleep disorders (based on the Athens Insomnia Scale [AIS]), and social trust. We classified the participants into two categories (high or low) based on the level of social trust at the first health survey. A linear mixed model was used to estimate trends in AIS scores in relation to social trust at the first health survey., Results: The AIS scores of participants in the low social trust group were significantly higher than those in the high social trust group throughout the 6 years after the GEJE (P < 0.01). After adjusting for some covariates, the AIS score estimate for the participants who had low social trust was 1.30 point higher than those for the participants who had high social trust., Conclusion: Social trust at 3 to 5 months after the GEJE predicted AIS scores at 6 years after the GEJE among victims. This finding suggests that it may be possible to identify people who have a lower potential for mental resilience from disaster damage over the long term. Further, health interventions for this high-risk group could help promote resilience after a disaster. more...

Purpose: This study aimed to investigate the relationship between the bilateral maximum occlusal force (MOF) of full dental arches and all-cause mortality in a group of community-dwelling older males and females in Japan., Methods: This 13-year prospective cohort study was conducted among 815 older adults (395 male and 420 female) aged 70 years or over (mean age ± standard deviation: 75.1 ± 4.5 years). Bilateral MOF in the intercuspal position was recorded with horseshoe-shaped pressure-sensitive film. Participants were grouped by gender into tertiles according to MOF. Demographic variables, chronicity, comorbidity, physical status, cognitive and psychological status, social functioning, and blood chemistry data were also assessed. Information regarding all-cause mortality and migration was obtained from the Sendai Municipal Authority. Cox proportional hazard modeling was performed to assess all-cause mortality during the follow-up period., Results: In total, 159 male and 109 female participants died over a median 12.9-year follow-up period, and the cumulative mortality significantly increased with lower MOF in both males and females. The multivariate Cox proportional hazard model demonstrated a significant increase in the risk of all-cause mortality associated with lower tertiles of MOF, relative to the upper tertile in males (hazard ratio: 1.62; 95% confidence interval: 1.05-2.51) and females (hazard ratio: 1.94; 95% confidence interval: 1.10-3.56)., Conclusions: There was a significant and independent association of bilateral MOF with all-cause mortality in community-dwelling elderly males and females in Japan. These findings suggested that maintenance of oral functioning contributes to general health., (Copyright © 2019 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.) more...

Background & Aims: Although it has been reported that the Japanese dietary pattern is associated with a lower risk of incident functional disability among older people, the potential benefits of improving adherence to the Japanese diet remain unclear. The aim of the present study was to evaluate the association between 12-year change in adherence to the Japanese diet and the subsequent risk of incident functional disability in older people in Japan., Methods: We analyzed 10-year follow-up data from a cohort study of 2923 Japanese older adults (age ≥65 years) in 2006. We collected dietary information using a validated 39-item food frequency questionnaire at two time points (1994 and 2006). Adherence to the Japanese diet (high intake of rice, miso soup, seaweeds, pickles, green and yellow vegetables, fish, green tea; low intake of beef and pork, and coffee) was assessed using the Japanese Diet Index (JDI), which ranges from 0 to 9. Participants were categorized into five groups according to changes in the JDI score at these two time points. Data on incident functional disability from December 2006 to November 2016 were retrieved from the public long-term care insurance database. The Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident functional disability., Results: During 22,466 person-years of follow-up, 1093 cases of incident functional disability were documented. Compared with participants in the group with the largest decrease in the JDI score (≤-2), the multivariate-adjusted HR (95% CI) of incident functional disability was 0.77 (0.61-0.98) for those in the largest increase group (≥+2)., Conclusions: Improved adherence to the Japanese diet was associated with a significantly lower risk of incident functional disability in older people in Japan., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.) more...

Objectives: To assess whether systemic inflammation and nutritional status contribute to a relationship between tooth loss and mortality in community-dwelling older Japanese individuals using mediation analyses., Materials and Methods: This longitudinal study targeted community-dwelling older Japanese individuals (N = 891). The exposure variable was the number of teeth (edentulous, 1-9, 10-19, ≥ 20), while the outcome was all-cause mortality from 2003 to 2016. Nutritional status and systemic inflammation were evaluated as mediators and based on serum albumin and high-sensitivity C-reactive protein levels, respectively. Covariates included age, sex, smoking, alcohol consumption, medical history, educational level, depressive symptoms, cognitive impairment, and physical function. The Cox proportional hazards model was applied to calculate hazard ratios (HRs) for the association between tooth loss and mortality and the contributions of systemic inflammation and nutritional status to this association., Results: Edentulous participants (HR, 1.84; 95 % confidence interval [CI], 1.30-2.59) and those with 1-9 teeth (HR, 1.75; 95% CI, 1.28-2.40) groups exhibited a significantly higher risk of mortality than did those with ≥ 20 teeth. Mediation analyses showed that nutritional status contributed to the association between tooth loss and mortality in participants with 1-9 teeth, whereas systemic inflammation played no role in this association., Conclusions: Nutritional status may contribute to the association between tooth loss and mortality in community-dwelling older Japanese individuals with fewer remaining teeth., Clinical Relevance: The data from this prospective cohort study help in elucidating parts of the biological mechanism underlying tooth loss and all-cause mortality in older individuals. more...

In vivo and in vitro evidence has shown that mushrooms have the potential to prevent prostate cancer. However, the relationship between mushroom consumption and incident prostate cancer in humans has never been investigated. In the present study, a total of 36,499 men, aged 40-79 years, who participated in the Miyagi Cohort Study in 1990 and in the Ohsaki Cohort Study in 1994 were followed for a median of 13.2 years. Data on mushroom consumption (categorized as <1, 1-2 and ≥3 times/week) was collected using a validated food frequency questionnaire. Cox proportional hazards regression analysis was used to estimate multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for prostate cancer incidence. During 574,397 person-years of follow-up, 1,204 (3.3%) cases of prostate cancer were identified. Compared to participants with mushroom consumption <1 time/week, frequent mushroom intake was associated with a decreased risk of prostate cancer (1-2 times/week: HRs [95% CIs] = 0.92 [0.81, 1.05]; ≥3 times/week: HRs [95% CIs] = 0.83 [0.70, 0.98]; p-trend = 0.023). This inverse relationship was especially obvious among participants aged ≥50 years and did not differ by clinical stage of cancer and intake of vegetables, fruit, meat and dairy products. The present study showed an inverse relationship between mushroom consumption and incident prostate cancer among middle-aged and elderly Japanese men, suggesting that habitual mushroom intake might help to prevent prostate cancer., (© 2019 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.) more...

It is already known that adult height is a factor associated with an increased risk of colon cancer and postmenopausal breast cancer, pancreatic cancer, premenopausal breast cancer, and ovarian cancer. However, the association between adult height and lung cancer incidence remains unclear. The purpose of the present study was to examine the association between adult height and the risk of lung cancer incidence in the Japanese population. We analyzed data for 43,743 men and women who were 40-64 years old at the baseline in 1990. We divided the participants into quintiles based on height at the baseline. Cox proportional hazards analysis was used to estimate the multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of lung cancer according to adult height, after adjustment for potential confounders. We identified 1,101 incident case of lung cancer during 24.5 years of follow-up. The multivariate HRs and 95% CIs for the highest category relative to the lowest were 1.48 (1.15-1.91) in men and 1.35 (0.91-1.99) in women. Furthermore, the association between adult height and the incidence of lung cancer was found the significant increased risk among ever smokers in men, but not never smokers. We also observed that adult height tend to be associated with an increased risk of small cell lung cancer and squamous cell carcinoma. This prospective cohort study has demonstrated a positive association between adult height and the risk of lung cancer incidence among men, especially those who have ever smoked. more...

Objective: Here, the authors aimed to determine whether the presence of cerebral hemodynamic failure predicts subsequent bleeding attacks and how it correlates with the effect of direct bypass surgery in hemorrhagic moyamoya disease., Methods: Data from the Japanese Adult Moyamoya (JAM) Trial were used in this study: 158 hemispheres in 79 patients. A newly formed expert panel evaluated the SPECT results submitted at trial enrollment and classified the cortical hemodynamic state of the middle cerebral artery territory of each hemisphere into one of the following three groups: SPECT stage (SS) 0 as normal, SS1 as decreased cerebrovascular reserve (CVR), and SS2 as decreased CVR with decreased baseline blood flow. In the nonsurgical cohort of the JAM Trial, the subsequent hemorrhage rate during the 5-year follow-up was compared between the SS0 (hemodynamic failure negative) and SS1+2 (hemodynamic failure positive) groups. The effect of direct or combined direct/indirect bypass surgery on hemorrhage prevention was examined in each subgroup., Results: The hemodynamic grade was SS0 in 59 (37.3%) hemispheres, SS1 in 87 (55.1%), and SS2 in 12 (7.6%). In the nonsurgical cohort, subsequent hemorrhage rates in the SS0 and SS1+2 groups were 12 cases per 1000 person-years and 67 cases per 1000 person-years, respectively. Kaplan-Meier analysis revealed that hemorrhagic events were significantly more common in the SS1+2 group (p = 0.019, log-rank test). Cox regression analysis showed that hemodynamic failure was an independent risk factor for subsequent hemorrhage (HR 5.37, 95% CI 1.07-27.02). In the SS1+2 subgroup, bypass surgery significantly suppressed hemorrhagic events during 5 years (p = 0.001, HR 0.16, 95% CI 0.04-0.57), with no significant effect in the SS0 group (p = 0.655, HR 1.56, 95% CI 0.22-11.10). Examination of effect modification revealed that the effect of surgery tended to differ nonsignificantly between these two subgroups (p = 0.056)., Conclusions: Hemodynamic failure is an independent risk factor for subsequent hemorrhage in hemorrhagic moyamoya disease. Direct bypass surgery showed a significant preventive effect in the hemodynamically impaired hemispheres. Thus, hemodynamic failure, as well as previously proposed factors such as choroidal anastomosis, should be considered for the surgical indication in hemorrhagic moyamoya disease.Clinical trial registration no.: C000000166 (umin.ac.jp). more...

Background: A growing number of epidemiology studies have shown that poor oral health is associated with an increased incidence of functional disability. However, there are few studies in which the confounding bias is adjusted appropriately. In this study, we examined whether dental status is associated with functional disability in elderly Japanese using a 13-year prospective cohort study after elimination of confounding factors with propensity score matching., Methods: Participants were community-dwelling Japanese aged 70 years or older who lived in the Tsurugaya district of Sendai (n = 838). The number of remaining teeth (over 20 teeth vs 0-19 teeth) was defined as the exposure variable. The outcome was the incidence of functional disability, defined as the first certification of long-term care insurance (LTCI) in Japan. The variables that were used to determine propensity score matching were age, sex, body mass index (BMI), medical history (stroke, hypertension, myocardial infarction, cancer, and diabetes), smoking, alcohol consumption, educational attainment, depression symptoms, cognitive impairment, physical function, social support, and marital status., Results: As a result of the propensity score matching, 574 participants were selected. Participants with 0-19 teeth were more likely to develop functional disability than those with 20 or more teeth (hazard ratio 1.33; 95% confidence interval, 1.01-1.75)., Conclusions: In this prospective cohort study targeting community-dwelling older adults in Japan, having less than 20 teeth was confirmed to be an independent risk factor for functional disability even after conducting propensity score matching. This study supports previous publications showing that oral health is associated with functional disability. more...

Previous studies have suggested that emotional support may promote cognition; however, the effects of giving or receiving emotional support on incident dementia remain unclear. Therefore, we sought to investigate the relationship between emotional support (giving or receiving) and incident dementia. In December 2006, we conducted a prospective cohort study of 31,694 Japanese individuals aged ≥65 years who lived in Ohsaki City, Miyagi Prefecture, Japan. A self-reported questionnaire including items on emotional support and lifestyle factors was distributed. After excluding those who did not provide consent or responses to all items, 13,636 eligible responses were analyzed for this study. According to responses of "yes" or "no" for emotional support, we made two categories for both giving (gave or did not give) and receiving (received or did not receive) emotional support. Furthermore, we combined giving and receiving emotional support into four categories ("giving = no & receiving = no", "giving = no & receiving = yes", "giving = yes & receiving = no", "giving = yes & receiving = yes"). Data on incident dementia were retrieved from the Long-term Care Insurance Database in which participants were followed up for 5.7 years. Using multivariate Cox proportional hazards models, we found that compared with participants who did not give emotional support to others, those who did give had a lower risk of dementia (multivariate-adjusted hazard ratio [HR]: 0.61 (95% confidence interval [CI]: 0.52, 0.71)). However, a nonsignificant relationship was observed for receiving emotional support. Additionally, compared to "giving = no & receiving = no" for emotional support, "giving = no & receiving = yes" showed a higher risk of dementia (multivariate-adjusted HR: 1.51 [95% CI: 1.07, 2.14])., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.) more...

Objectives We aimed to investigate the progress of health promotion program implementation. This included an examination of the current status of and issues around planning, implementation, and evaluation of health and welfare services at the municipal level; further progress through focus on the population approach emphasized in Health Japan 21 (2nd) was also discussed.Methods A questionnaire survey on health promotion and welfare services was conducted among municipal offices in charge of health promotion. The status of health promotion program implementation was classified by types and fields. For focused health and welfare services, respondents were asked to answer a self-administered questionnaire about the process of planning, implementation, and evaluation. The details of services were confirmed by browsing reference materials or website information. We distributed the questionnaires to all 260 municipalities of 6 prefectures (Miyagi, Saitama, Shizuoka, Aichi, Osaka, and Wakayama); of which, 238 municipalities responded (response rate: 91.5%).Results Health promotion programs on nutrition and diet, physical activity, dental and oral health, prevention of lifestyle-related diseases, and promotion of regular health checkups were implemented with a high rate. Among the 238 municipalities, 85.2% responded that they focused on educational activities targeting the general population; of which 27.4% were considering using incentives to promote greater health awareness. Our survey indicated that 14.8% of municipalities focused on health education and classroom-style programs. While planning programs, 52.1% of municipalities used "materials from other municipalities where such programs were already implemented" and 89.1% of municipalities used them in incentive-related programs. Although 70% of municipalities were aware of health discrepancies among the local population, approximately 90% did not consider discrepancies between different economic, living environment, and occupation groups when planning programs. Although 87.3% of municipalities used number of participants as the main indicator in evaluating the programs, approximately 30% of municipalities used coverage rate and before-and-after assessments of health conditions as the main indicators.Conclusion Findings from this study suggest that improvements in the process of health promotion program planning and implementation, reference materials, and the perspective of health discrepancies are needed, along with an evaluation in programs focusing both on educational activities targeting the general population and incentive-related programs. It is also recommended that the central government and prefectures should not only introduce precedents, but also provide information. Using this, municipalities can demonstrate applied skills, such as the rationale and preparation status of the program, and propose evaluations based on the plan-do-check-act cycle. more...

Objective: Personality traits have been associated with an increased risk of cardiovascular disease (CVD) mortality as well as life-style-related cardiovascular risk factors. However, the mediating effects of life-style behaviors in the association between personality factors and CVD mortality remain insufficiently understood. The aim of the present study was to examine the mediating effect of life-style behaviors on the association between personality traits and CVD mortality., Methods: We conducted a prospective cohort study of 29,766 Japanese adults aged 40 to 64 years at the baseline and followed them up for 20.8 years from 1990 to 2011. Personality was measured using the Japanese version of the Eysenck Personality Questionnaire - Revised Short Form in 1990. We estimated the multivariable hazard ratio and 95% confidence interval for CVD mortality using Cox proportional hazards models, and explored the mediating effects of life-style behaviors (smoking, drinking, body mass index, and time spent walking) on the association between personality traits and CVD mortality., Results: We documented 1033 deaths due to CVD during 562,446 person-years of follow-up. Psychoticism represents tough-mindedness, aggressiveness, coldness, a lack of deliberateness, and egocentricity. After adjusting for confounding variables, higher psychoticism was associated with CVD mortality (base model hazard ratio = 1.36, 95% confidence interval = 1.14-1.61, p trend < .001). All the life-style behaviors together mediated this association by 19.2%, with smoking having the greatest effect at 15.7%. For the other personality traits, no significant associations with CVD mortality were found., Conclusion: The present study demonstrated that life-style behaviors, especially smoking, partially mediate the association between psychoticism and CVD mortality. more...

Background & Aims: Although it has been suggested that the Japanese diet contributes to the longevity of the Japanese population, no study has examined the association between the Japanese diet and survival time. The present study investigated the association between the Japanese diet and survival time., Methods: We analyzed 20-year follow-up data from a cohort study of 14,764 Japanese men and women aged 40-79 years. At the baseline survey in 1994, we collected dietary information using a validated 40-item food frequency questionnaire. Adherence to a Japanese diet consisting of nine components (rice, miso soup, seaweeds, pickles, green and yellow vegetables, fish, green tea, beef and pork, and coffee) was assessed in terms of a Japanese dietary index (JDI) score, the total score ranging from 0 to 9. Cox proportional hazards model and Laplace regression analysis were used to estimate the hazard ratios (HRs) and differences in median age at death (50th percentile differences - PDs in age at death) with 95% confidence intervals (CIs) according to the quartiles of the JDI score., Results: During the follow-up period, we documented 4,619 deaths. We observed that a higher JDI score was associated with a lower risk of mortality and longer survival time: In comparison to participants in the lowest JDI score quartile (0-4), the multivariate-adjusted HR (95% CI) of all-cause mortality was 0.91 (0.83-0.99) and the multivariate-adjusted 50th PD in age at death (95% CI) was 10.2 (3.2-17.2) months longer for those in the highest quartile (7-9)., Conclusions: Adherence to a Japanese diet is associated with a longer survival time., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.) more...

Fish harbour many types of nutrients that are beneficial for preventing cognitive decline. Therefore, habitual fish intake might contribute to a lower risk of incident dementia. However, few prospective cohort studies have investigated fish consumption in relation to incident dementia, and their findings have been inconsistent. To investigate the association between fish consumption and the risk of incident dementia, we collected data on the consumption of fish and other foods using an FFQ in a baseline survey of individuals aged ≥65 years living in Ohsaki City, Japan. After 5·7 years of follow-up, the incidence of dementia was 1118 (8·5 %) among 13 102 participants. We then used a multivariate-adjusted Cox model to estimate hazard ratios (HR) and 95 % CI. Compared with subjects with the lowest fish intake (Q1), the multivariate HR were 0·90 (95 % CI 0·74, 1·11) for Q2, 0·85 (95 % CI 0·73, 0·99) for Q3 and 0·84 (95 % CI 0·71, 0·997) for Q4 (Ptrend = 0·029). Such associations were also observed even after excluding participants who were diagnosed with dementia in the first 2 years of follow-up and those who had poorer cognitive function at baseline. In conclusion, an association was observed between higher fish consumption and a lower risk of incident dementia among healthy elderly people without disability. These findings suggest that habitual fish intake may be beneficial for the prevention of dementia. more...

Background: The relationship between body mass index (BMI) and disability-free survival (DFS) remains unclear., Methods: We conducted a 10-year prospective cohort study of 12,666 Japanese individuals aged ≥ 65 y. Information on BMI and lifestyle factors was collected via a questionnaire in 2006. Functional disability data were retrieved from the public Long-term Care Insurance database. Subjects were divided into seven groups according to BMI (<19, 19-21, 21-23, 23-25, 25-27, 27-29 and ≥29). Fiftieth percentile differences (PDs) and 95% confidence intervals (CIs) in the DFS period (differences of period until the first 50% of the composite outcome (disability or death) occurred in each of the BMI groups) were calculated using the Laplace regression model., Results: There was a U-shaped relationship between BMI and the risk of incident composite outcome, with a BMI nadir of 25-27. Based on BMI 25-27 as a reference, the 50th PDs (95% CIs) (in months) in age at disability or death (median DFS) were -20.8 (-26.4, -15.2) (P < 0.001) months for BMI <19, -13.5 (-18.2, -8.7) (P < 0.001) months for BMI 19-21, -9.8 (-14.2, -5.4) (P < 0.001) months for BMI 21-23, -2.9 (-7.5, 1.7) (P = 0.21) months for BMI 23-25, -2.7 (-8.4, 2.9) (P = 0.34) months for BMI 27-29, and -11.5 (-19.6, -3.5) (P = 0.005) months for BMI ≥ 29. These relationships did not differ by sex., Conclusion: Older individuals with a BMI of <23 or ≥29 have a significantly shorter DFS period than those with a BMI of 25-27. It is suggested that the optimal BMI range for maximization of disability-free life expectancy in the elderly population is 23-29. more...

Background: Previous studies have suggested that a healthy lifestyle (HL) may prolong the years of life spent in good health. However, the impact of HL on disability-free survival (DFS) among the elderly is still uncertain., Objective: To investigate the relationship between HL and DFS in the general elderly population., Design: Prospective cohort study with a 10-year follow-up (2006-2016)., Participants: 9910 community-dwelling elderly people (≥ 65 years)., Main Measures: A HL index derived by summing the number of HL behaviors. Data on incident disability were retrieved from the public Long-term Care Insurance database. Multivariate-adjusted 50th percentile differences (PDs) in age at disability or death (months) and their 95% CIs were estimated with the Laplace regression model., Key Results: During the 10 years, 4562 disability or death events occurred. Participants who adhered to all three HL behaviors lived 17.1 (95% CI 12.7, 21.5) months longer without disability than those who adhered to zero or one. Each 1-point increase of the index score conferred 8.8 months additional life without disability. The tendency for the 50th PDs to increase with a higher HL index score did not differ according to age (< 75 or ≥ 75 years), sex, or the presence of chronic conditions (none, or ≥ 1 chronic condition)., Conclusions: A combination of HL behaviors may substantially increase DFS, even for late-elderly (≥ 75 years), or elderly people with chronic conditions. more...

Aim: Caregiver burden is known to negatively affect a partner's health. Given the important role of physical and mental stress in mortality, a higher caregiver burden might be associated with an increased incidence of fatal events. However, previous studies of the effects of the partner's caregiving on mortality have shown inconsistent results. Thus, the purpose of the present longitudinal study was to determine if there is an association between a spouse's functional disability and mortality in the older Japanese population., Methods: A baseline survey was carried out with 7598 participants in 2006. Information on the date of functional disability, death or emigration was retrieved from the Ohsaki City government. Functional disability was defined as receiving a certification for long-term care insurance in Japan. After a follow-up period of a maximum of 87 months, 1316 of the participants died and Cox regression analysis with adjustment for confounding factors was used to assess mortality after the incidence of functional disability in a spouse., Results: The multivariate adjusted hazard ratio for mortality was 1.78 (95% confidence interval 1.52-2.08, P < 0.01) in those whose spouses had functional disabilities compared with those with spouses who did not have functional disabilities. The mortality was consistently higher, irrespective of age group or sex., Conclusions: These results imply that caregiver burden might increase stress responses and lead to increased mortality; therefore, enhancement of support systems, including long-term care, housing and livelihood support services, for those with disability and their spouses might be important for preventing deaths. Geriatr Gerontol Int 2019; 19: 774-779., (© 2019 The Authors Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.) more...

Background: Although our previous study using a food frequency questionnaire simulated nutritional characteristics of the traditional Japanese diet, this issue has not been sufficiently evaluated. This study was conducted to examine the relationship between the traditional Japanese diet and nutrient density (ND)., Methods: A cross-sectional study employing the dietary record method was conducted among 2221 community-dwelling Japanese adults (40-88 years) living in Aichi Prefecture, Japan, in 2006-2008. Based on previous studies, a 9-component Japanese Diet Index (JDI) and a 12-component modified JDI (mJDI 12 ) were defined. To develop a new weighted index, a multiple linear regression model was used to select food components which were significantly associated with an ND score (integrated by 11 nutrient components) from the mJDI 12 and weight them. Correlation analyses were performed between JDI, mJDI 12 , the new weighted JDI score and the ND score and its 11 nutrient components. The findings were validated with data from 2008 to 2010 by assessing the associations between the JDIs scores and the ND score., Results: Scores of the JDI and mJDI 12 were positively correlated with the ND score (corresponding Spearman's ρ [95% confidence interval; CI], 0.34 [0.31, 0.38] and 0.44 [0.41, 0.48], respectively; P < 0.05 for both). Among the mJDI 12 , 9 food components (rice, fish and shellfish, green and yellow vegetables, seaweed, green tea, beef and pork, soybeans and soybean foods, fruit, and mushrooms) significantly associated with the ND score. All of these 9 components were weighted and a new weighted JDI (wJDI 9 ) was developed. The wJDI 9 score was also positively correlated with the ND score (Spearman's ρ [95% CI] = 0.61 [0.58, 0.64]; P < 0.05). However, scores for all 3 indices were positively correlated with sodium intake. The wJDI 9 score obtained using dietary record data from 2008 to 2010 was also positively correlated with the ND score (Spearman's ρ [95% CI] = 0.61 [0.58, 0.64]; P < 0.05)., Conclusions: Adhering to a traditional Japanese diet as defined by the JDI was associated with good ND. Furthermore, the modified indices (mJDI 12 and wJDI 9 ) had a higher performance for ND. However, all of the indices were correlated with high sodium intake. more...

Suicide is an important public health issue and previous studies have suggested that social support can one preventive factor. However, the association between emotional and instrumental social support and suicide death has not been investigated in detail. The purpose of this study was to investigate the association between each type of social support and suicide death based on a population-based cohort study. We analyzed follow-up data for 47,223 subjects (aged ≥40 y) participating in a community-based, prospective cohort study. At the baseline, the subjects were asked five questions about social support. The end point of the study was suicide mortality, based on data from the National Vital Statistics. The Cox model was used to estimate the multivariate-adjusted hazard ratios of suicide death. In addition, stratified analysis was conducted to test the interaction of each type of social support with gender (male/female) and age (<65/≥65 y) separately. Among 320,880 person-years of follow-up, 90 cases of suicide death were documented. There were significant association between instrumental social support and lower risk of suicide death, and the hazard ratio was 0.60 (95% CI: 0.38-0.94). Emotional social support was also associated with a lower risk of suicide death, but not to a significant degree, and the hazard ratio was 0.70 (95% CI: 0.42-1.17). It is suggested that instrumental social support was significantly associated with a lower risk of suicide death, and emotional social support tended to be associated with a lower risk of suicide death., (Copyright © 2019 Elsevier Ltd. All rights reserved.) more...

Background: Epidemiologic observations have raised expectations that the Japanese dietary pattern could promote longer disability-free survival (DFS) times among the Japanese population; however, no previous study has examined this issue., Objective: The aim of this study was to investigate the association between the Japanese dietary pattern and DFS time in the elderly Japanese population., Methods: We analyzed follow-up data covering a 10-y period for 9456 elderly Japanese individuals (aged ≥65 y) participating in a community-based prospective cohort study. Dietary habits were assessed using a food-frequency questionnaire. Based on previous studies, we used 9 food items to calculate the Japanese Diet Index (JDI) score: rice, miso soup, fish and shellfish, green and yellow vegetables, seaweed, pickled vegetables, green tea (1 point for each item if the consumption value was more than or equal to the median, and 0 points otherwise), beef and pork, and coffee (0 points for each item if the consumption value was more than or equal to the median, and 1 point otherwise). Differences in median age at incident disability or death [50th percentile differences (PDs)] according to quartiles (Q1-Q4) of the JDI score were estimated using Laplace regression., Results: During the follow-up period, 4233 (44.8%) incident disability or death events occurred. In addition, a higher JDI score was significantly associated with longer DFS time: compared with the lowest quartile of JDI scores (Q1), the multivariate-adjusted 50th PD (95% CI) was 7.1 (1.8, 12.4) mo longer for Q4. Each 1-SD increase of the JDI score was associated with 3.7 (1.7, 5.7) additional months of life without disability (P-trend < 0.01). No differences were seen in sex or chronic condition (no or ≥1 chronic condition) at baseline. A post hoc analysis showed a larger effect on DFS time when using a modified JDI score without coffee., Conclusion: These results suggest that the Japanese dietary pattern is associated with improved DFS time in the general elderly population., (Copyright © American Society for Nutrition 2019.) more...

Introduction: Physical activity is one of the major modifiable factors for promotion of public health. Although it has been reported that financial incentives would be effective for promoting health behaviours such as smoking cessation or attendance for cancer screening, few randomised controlled trials (RCTs) have examined the effect of financial incentives for increasing the number of daily steps among individuals in a community setting. The aim of this study is to investigate the effects of financial incentives for increasing the number of daily steps among community-dwelling adults in Japan., Methods and Analysis: This study will be a two-arm, parallel-group RCT. We will recruit community-dwelling adults who are physically inactive in a suburban area (Nakayama) of Sendai city, Japan, using leaflets and posters. Participants that meet the inclusion criteria will be randomly allocated to an intervention group or a waitlist control group. The intervention group will be offered a financial incentive (a chance to get shopping points) if participants increase their daily steps from their baseline. The primary outcome will be the average increase in the number of daily steps (at 4-6 weeks and 7-9 weeks) relative to the average number of daily steps at the baseline (1-3 weeks). For the sample size calculation, we assumed that the difference of primary outcome would be 1302 steps., Ethics and Dissemination: This study has been ethically approved by the research ethics committee of Tohoku University Graduate School of Medicine, Japan (No. 2018-1-171). The results will be submitted and published in a peer-reviewed scientific journal., Trial Registration Number: UMIN000033276; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.) more...

Objective: This study aimed to investigate whether the intake of the 1975 Japanese diet (JD) could reduce the amount of abdominal fat in people with overweight., Methods: Using a single-blind randomized controlled trial, the modern diet (MD) was compared with the 1975-type JD, which is based on the MD but includes five characteristics of the 1975 JD in an enhanced form. Overweight people were randomly assigned to an MD group (n = 30) and a JD group (n = 30). The participants consumed test diets that were provided three times a day for 28 days. Body composition measurements and blood biochemical examinations were performed before and after the test diet intake, and the proportions of change were compared., Results: Those in the JD group had significantly decreased BMI, fat mass, and levels of low-density lipoprotein cholesterol, glycated hemoglobin, and C-reactive protein (P = 0.002, 0.015, 0.014, 0.012, and 0.039, respectively) and significantly increased high-density lipoprotein cholesterol levels compared with those in the MD group (P = 0.020)., Conclusions: The intake of a diet with the characteristics of the 1975 JD may have beneficial effects on lipid metabolism in people with overweight and reduce the onset risk of metabolism-related disorders, such as obesity and diabetes., (© 2019 The Obesity Society.) more...

Background: This cohort study estimated the population attributable fraction (PAF) of seven combined major risk factors for incident dementia., Methods: We conducted a cohort study of 8563 community-dwelling individuals aged ≥ 65 years. In a baseline survey (2006), we collected data on major seven risk factors: diabetes mellitus, hypertension, obesity, physical inactivity, severe psychological distress, smoking, and low educational attainment. The total number of risk factors was applied as an exposure variable. Subjects were categorized into four groups according to the total number of risk factors they possessed (0, 1, 2, ≥ 3 risk factors). Data on incident dementia were retrieved from the public Long-term Care Insurance database. Hazard ratios (HRs) and 95% confidence interval (95% CI) were estimated using the Cox proportional regression model. We also calculated the PAF using HRs and the prevalences in our cohort data., Results: The number of cases of incident dementia was 577 (6.7%). A dose-response relationship between the total number of risk factors and incident dementia was observed; in comparison with no risk factors (reference), the age- and sex-adjusted HRs (95% CIs) were 1.25 (0.92-1.70) for one risk factor, 1.59 (1.18-2.15) for two, and 2.21 (1.62-3.01) for three or more (P trend < 0.001). If subjects had adhered to none of the risk factors, the PAF would have been 32.2%. If subjects had improved toward one better category, the PAF would have been 23.0%., Conclusion: Our findings suggest that reducing the combined number of risk factors would contribute significantly to reducing the incidence of dementia. more...

Background: It has been noted that not only adverse psychosocial health effects but also mortality might increase for a person living with a spouse with cancer. This study examined the association between a partner's cancer diagnosis and mortality among a Japanese population., Methods: In December 2006, a survey was conducted on participants aged 40 years or older who were residing in northeastern Japan. We identified couples using municipality-specific household ID numbers by searching public records and confirmed partner's cancer diagnosis after the baseline measurement using regional cancer registration information. After following up for a maximum of 4.0 years with the participants regarding mortality and emigration by reviewing the Residential Registry Record, we used Cox's proportional hazards regression to estimate the hazard ratio (HR) of all-cause mortality., Results: We identified 25,938 participants (12,969 pairs) and included them in the analyses. A total of 1,308 (5.0%) participants had partners with a cancer diagnosis after baseline. The study found no association between a partner's cancer diagnosis and all-cause mortality; multivariable HRs of all-cause mortality for individuals in exposed subjects compared with those in unexposed subjects were 1.35 (95% confidence interval [CI] = 0.99-1.83; p = .055). Contrarily, sensitivity analyses of mortality attributed to having partners diagnosed with cancer based on the time since entry showed that all-cause mortality significantly increased only within one year from spouse cancer diagnosis; HR = 2.18 (95% CI = 1.44-3.30; p < .01)., Conclusions: Our findings reveal that the mortality rate from partner's cancer diagnosis was significantly high during the early period of diagnosis and multidisciplinary teams for cancer treatment might be important for preventing death among the partner. more...

Objectives: The Great East Japan Earthquake and subsequent tsunami cause large-scale destruction in the north-eastern coastal areas in Japan, and forced many survivors to relocate to prefabricated temporary housing, a typical emergency accommodation. Based on the hypothesis that higher toothache prevalence among the disaster survivors is associated with postdisaster distress, we determined the impact of temporary residential environment as potential stressor on the subjective toothache prevalence., Methods: A repeated cross-sectional health survey based on self-reported questionnaire was conducted in 2776 disaster survivors, of whom 1446 participants underwent dental examination by dentists. Housing type was categorized into three groups including the same housing as before the earthquake, temporary housing and rented/new housing. The association of housing type with subjective toothache prevalence was examined using multivariate logistic regression analysis in all subjects and subgroup analysis in dental examination applicants. Stratified analysis by survey wave was applied with inclusion of covariates such as the socio-demographic factors, and presence of insomnia and psychological distress. In subgroup analysis, presence of dental caries and gum problems in dental examination were included as factors of direct exposure to subjective toothache., Results: In the first survey wave, the participants living in the temporary housing had significantly higher odds ratio (OR) for toothache prevalence compared to the participants living in the same housing (OR: 3.76, 95% confidence interval [CI]: 1.85-7.65, P < 0.001); whereas in all other survey waves, there was no significant difference. Subgroup analysis of dental examination applicants confirmed the presence of significant association of subjective toothache prevalence in the temporary housing group alone (OR: 3.27, 95% CI: 1.38-7.76, P = 0.004), but not in the rented/new housing group (OR: 1.50, 95% CI: 0.57-3.91, P = 0.411), even after adjusting for covariates related to oral findings., Conclusion: Temporary housing may be a factor to increase the risk of subjective toothache among disaster survivors only at postdisaster acute phase., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.) more...

As the factors that link education level with incident functional disability in elderly Japanese have never been investigated, the present study investigated this issue in an elderly Japanese population. A 9-year prospective cohort study (2006-2015) was conducted among 8,680 Japanese individuals (≥65 years), Ohsaki city, Japan. In a baseline survey, we collected data on education level and potential mediators. Data on incident functional disability were retrieved from the Long-term Care Insurance database. The Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident functional disability by education level (below upper-secondary education (reference), and upper secondary education and above). Mediating effects were estimated using accelerated failure time model and a logistic regression model. During 9-year follow-up period, 2,742 cases (31.6%) of incident functional disability were observed, and education level showed an inverse association with functional disability (P for trend <0.01). Participation in community activities had the largest mediating effect (34.7%) on the relationship between education level and incident functional disability. This effect remained among those aged 65-74 years (19.9%) but became negligible among those aged ≥75 years. Other potential mediators (such as smoking and drinking status) were also tested, but these showed only small mediating effects. The inverse association between education level and the incident risk of functional disability appears to be largely mediated by participation in community activities among elderly Japanese, especially those aged 65-74 years., Competing Interests: The authors have declared that no competing interests exist. more...

Objectives: After the Great East Japan Earthquake (GEJE) of 2011, many survivors have been forced to live in prefabricated temporary housing, which is uncomfortable and insufficiently durable for permanent living. Public reconstruction housing has been built to improve their living conditions; however, those moving have to rebuild personal relationships and adapt to a new environment. This study examined whether survivors moving to public reconstruction housing became more socially isolated than those remaining in prefabricated temporary housing., Design, Setting and Participants: Self-report questionnaire data collected in 2015 (4 years after the GEJE) were used as the baseline for follow-up surveys in 2016 and 2017, as many survivors moved from prefabricated temporary housing to public reconstruction housing from 2015. We analysed longitudinal data from 393 survivors, distinguishing those who moved to public reconstruction housing during the 5th year after the disaster from those who remained in prefabricated temporary housing. Participants were assessed using the Lubben Social Network Scale-6 (LSNS-6) in all three surveys, with social isolation defined by a score of <12/30. To reduce the effect of selection bias, propensity score analysis was performed (178 of 393 participants were retained). We used a generalised estimated equation to evaluate the association between moving from prefabricated temporary housing to public reconstruction housing and changes in social isolation over 2 years., Results: LSNS-6 scores of the reconstruction housing group were worse than those of the prefabricated housing group between 4 and 6 years after the GEJE (P=0.006). Over the same period, social isolation worsened in the reconstruction housing group but improved in the prefabricated housing group (P=0.002)., Conclusions: Social isolation should be monitored while supporting survivors who moved to public reconstruction housing, and further longitudinal research is needed to clarify the risk of social isolation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.) more...

It is unclear whether weight change during adulthood affects the risk of obesity-related cancers such as those of the esophagus, colorectum, pancreas, breast, endometrium, and kidney among Japanese, where obesity is less frequent and less severe. We examined the association between weight change during adulthood and the risk of obesity-related cancer among Japanese by conducting a pooled analysis of two prospective studies of residents in Miyagi Prefecture, Japan. A total of 78,743 persons (40,422 women and 38,321 men) aged 40-79 years participated in the Miyagi Cohort Study in 1990 and in the Ohsaki Cohort Study in 1994. Weight change since age 20 was divided into four categories (weight loss; stable weight; moderate weight gain; high weight gain). Cox proportional hazards regression analysis was used to estimate the multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for obesity-related cancer incidence. During 1,057,899 person-years of follow up, 4,467 cases of obesity-related cancer (women; 1,916 cases, men; 2,551cases) were identified. In women, compared to the stable weight, weight gain was associated with an increased risk of obesity-related cancer (moderate weight gain; HRs = 1.10, 95%CIs: 0.97-1.26, high weight gain; HRs = 1.29, 95%CIs: 1.14-1.47). The results indicate that weight gain since age 20 was associated with a significantly increased risk of obesity-related cancer among Japanese women. By contrast, in men, our study found that weight change is not associated with the incidence of obesity-related cancer., (© 2018 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.) more...

Objective: Following hemorrhagic stroke in moyamoya disease, de novo intracranial hemorrhage can occur in the previously unaffected nonhemorrhagic hemisphere. In the present analysis the authors intended to determine whether the presence in the nonhemorrhagic hemisphere of choroidal collateral vessels, which have been the focus of attention as a source of bleeding, affects the risk of de novo hemorrhage., Methods: The subject of focus of the present cohort study was the nonhemorrhagic hemispheres of adult patients with hemorrhagic moyamoya disease enrolled in the Japan Adult Moyamoya Trial and allocated to the nonsurgical arm. The variable of interest was the presence of choroidal collaterals (also termed choroidal anastomoses), identified with baseline angiography and represented by a connection (anastomosis) between the anterior or posterior choroidal arteries and the medullary arteries. The outcome measure was de novo hemorrhage during the 5-year follow-up period, assessed in all nonhemorrhagic hemispheres. The incidence of de novo hemorrhage in the collateral-positive and -negative groups was compared., Results: Choroidal collaterals were present in 15 of 36 (41.7%) nonhemorrhagic hemispheres analyzed. The overall annual risk of de novo hemorrhage was 2.0%. Three de novo hemorrhages occurred in the collateral-positive group, whereas no hemorrhage occurred in the collateral-negative group. The annual risk of de novo hemorrhage was significantly higher in the collateral-positive group than in the collateral-negative group (5.8% per year vs 0% per year; p = 0.017). All hemorrhage sites corresponded to the distribution of choroidal collaterals., Conclusions: The present preliminary results suggest that the presence of choroidal collaterals affects the risk of de novo hemorrhage in the nonhemorrhagic hemisphere, subject to verification in larger studies. Further studies are needed to determine the optimal treatment strategy for nonhemorrhagic hemispheres and asymptomatic patients. more...

Background: Although lower household economic status is known to be a risk factor for obesity among school-age children, such an association among toddlers remains unclear. The present study investigated the association between household economic status and obesity in toddlers., Design: We conducted a cross-sectional study of children aged 4 years attending daycare centers in Japan. Information on subjective household economic status ["affluent", "neither", "less affluent", or "non-affluent"] was collected via questionnaire from the children's guardians in 2015. Based on measured values of height and weight, obesity was defined using the International Obesity Task Force cut-offs of overweight (BMI ≥17.47 for boys and ≥17.19 for girls). We used the logistic regression model to investigate the association between household economic status and obesity., Results: Among 1,848 respondents, the prevalence of obesity was 6.8%. Non-affluent household economic status was associated with a significantly higher probability of obesity in toddlers; the multivariate adjusted odds ratio for "non-affluent" households was 2.31 (95% confidence interval, 1.23-4.33) compared with "affluent" households., Conclusion: Perception of non-affluent economic status by the guardian was associated with a higher probability of toddler obesity. This result suggests that non-affluent household economic status is associated with obesity in toddlers. more...

We have previously demonstrated that cardiac shock wave therapy (CSWT) effectively improves myocardial ischemia through coronary neovascularization both in a porcine model of chronic myocardial ischemia and in patients with refractory angina pectoris (AP). In this study, we further addressed the efficacy and safety of CSWT in a single-arm multicenter study approved as a highly advanced medical treatment by the Japanese Ministry of Health, Labour and Welfare. Fifty patients with refractory AP [mean age 70.9 ± 12.6 (SD) years, M/F 38/12] without the indications of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) were enrolled in 4 institutes in Japan. Ischemic myocardial regions in the left ventricle (LV) were identified by drug-induced stress myocardial perfusion imaging (MPI). Shock waves (200 shots/spot at 0.09 mJ/mm 2 ) were applied to 40-60 spots in the ischemic myocardium 3 times in the first week. The patients were followed up for 3 months thereafter. Forty-one patients underwent CSWT and completed the follow-up at 3 months. CSWT markedly improved weekly nitroglycerin use [from 3.5 (IQR 2 to 6) to 0 (IQR 0 to 1)] and the symptoms [Canadian Cardiovascular Society functional class score, from 2 (IQR 2 to 3) to 1 (IQR 1 to 2)] (both P < 0.001). CSWT also significantly improved 6-min walking distance (from 384 ± 91 to 435 ± 122 m, P < 0.05). There were no significant changes in LV ejection fraction evaluated by echocardiography and LV stroke volume evaluated by cardiac magnetic resonance imaging (from 56.3 ± 14.7 to 58.8 ± 12.8%, P = 0.10, and from 52.3 ± 17.4 to 55.6 ± 15.7 mL, P = 0.15, respectively). Percent myocardium ischemia assessed by drug-induced stress MPI tended to be improved only in the treated segments (from 16.0 ± 11.1 to 12.1 ± 16.2%, P = 0.06), although no change was noted in the whole LV. No procedural complications or adverse effects related to the CSWT were noted. These results of the multicenter trial further indicate that CSWT is a useful and safe non-invasive strategy for patients with refractory AP with no options of PCI or CABG. more...

Objectives: This study examined the hypothesis that time spent walking daily has a marked impact on incident dementia., Methods/design: First, we analyzed data from a Japanese cohort (n = 13 990 aged ≥65 y) to obtain hazard ratios. Time spent walking per day (<0.5, 0.5-1, or ≥1 h) was assessed using a self-reported questionnaire. Data on 5.7-year incident dementia were retrieved from the public long-term care insurance database. After estimating the multivariate-adjusted hazard ratios (HRs) of incident dementia using the Cox model, the population attributable fraction (PAF) was calculated using the prevalence in a representative Japanese survey, the "National Health and Nutrition Survey"., Results: The time spent walking per day showed an inverse association with incident dementia: the multiple-adjusted HRs (95% confidence intervals) were 1.00 (reference) for less than 0.5 hour, 0.81 [0.71, 0.92] for 0.5 to 1 hour, and 0.72 [0.62, 0.84] for more than or equal to 1 hour. Our estimates indicate that 18.1% of dementia cases would be attributable to walking if all subjects walked more than or equal to 1 h/d and 14.0% if subjects increased their daily time spent walking to one level above the present one (<0.5 to 0.5-1 or 0.5-1 to ≥1 h)., Conclusions: Our results suggest that the daily time spent walking has a considerable preventive impact on incident dementia in Japan., (© 2018 John Wiley & Sons, Ltd.) more...