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Aim: The aim of this study is to analyse the risk factors for unplanned readmissions within 1 month after hospital discharge to develop a seamless support system from discharge to home care. Background: With shorter hospital stay lengths, understanding the characteristics of patients with multiple risk factors is important to prevent rehospitalization. Design: This is a single‐centre retrospective descriptive study. Methods: Logistic regression and decision tree analyses were performed using eight items from the records of 3117 patients discharged from a university hospital between April–September 2017 as risk factors. Results: Unplanned readmission risk was significantly associated with emergency hospitalization (odds ratio [OR]: 3.12, 95% confidence interval [CI]: 2.04–4.77), malignancy (OR: 2.16, 95% CI: 1.44–3.24), non‐surgical admission (OR: 1.76, 95% CI: 1.07–2.88), hospital stay of ≥ 15 days (OR: 1.66, 95% CI: 1.14–2.43) and decline in activities of daily living owing to hospitalization (OR: 1.68, 95% CI: 1.06–2.64). The highest risk combinations for rehospitalization were as follows: emergency hospitalization and malignancy; emergency admission, non‐malignancy and a hospital stay of ≥15 days; and scheduled hospitalization, no surgery and a hospital stay of ≥15 days. Conclusions: Patients with multiple risks for unplanned readmission should be accurately screened and provided with optimal home care. Summary statement: What is already known about this topic? Although the characteristics of patients at high risk of rehospitalization include malignancy, heart failure, conditions such as chronic obstructive pulmonary disease and other diseases prone to recurrence, old age, reduced activities of daily living and emergency hospitalization, few studies have reported on cases with multiple risks. What this paper adds? The most frequent risk types for unplanned readmissions within a month were emergency admissions for malignant tumours, emergency admissions for non‐malignant tumours with a hospital stay of 2 weeks or more and scheduled admissions for non‐surgical purposes with a length of stay of 2 weeks or more. The implications of this paper: The risk of unplanned readmission within 1 month of discharge increased due to a combination of multiple risks.This study helps us identify patients who are at high risk for readmission early in the hospitalization process and in providing nursing support for transition to their homes. [ABSTRACT FROM AUTHOR]

Background: No study has investigated sleep‐related environmental factors in patients according to their functional independence measure (FIM) cognitive scores. Aims: The aim of this study is to examine the associations between environmental factors such as noise and sleep latency according to the FIM cognitive scores among inpatients in rehabilitation wards. Design This is a prospective longitudinal study. Methods: This study measured the sleep state using a bed‐based actigraphy, environmental data from Environmental Sensor®, and medical record information of 33 inpatients in the rehabilitation wards during 2018. A linear mixed‐effect model was used to analyse the associations between sleep latency and environmental factors. Participants were grouped according to high or low FIM cognitive scores. Results: The average patient age was 77.2 ± 10.9 years, and 48.5% were male. In the high FIM cognitive score group, the loudness and frequency of noise exceeding 40 dB during sleep latency were significantly associated with sleep latency. In the low FIM cognitive score group, only the noise frequency was associated with sleep latency, and intra‐individual variance was larger than that of the high group. Conclusion: These findings suggest that providing night care with attention to subdued noise is important, particularly for patients with low cognitive functional independence levels measured by the FIM cognitive score. Summary statement: What is already known about this topic? Many elderly individuals have sleep disorders, such as difficulties falling and staying asleep.Environmental factors, like light and noise, influence inpatients' sleep. What this paper adds? Patients with high functional independence measure (FIM) cognitive scores had longer sleep latency when both the loudness and frequency of noise exceeded 40 dB.Patients with low FIM cognitive scores had longer sleep latency with frequent noise, regardless of loudness.Nurses should provide care with more caution, taking into consideration the frequency of noise produced, regardless of loudness, particularly for patients with a low cognitive functional independence level measured by the FIM cognitive score. The implications of this paper For elderly inpatients with a lower cognitive functional independence level measured by the FIM cognitive score, the number of nurses' visits at night should be minimized to avoid disturbing the patients' sleep by using devices such as nonwearable sleep monitoring sensors, which can also contribute to reducing nurses' burden. [ABSTRACT FROM AUTHOR]

Subjective cognitive complaints (SCCs) are a crucial modifiable risk factor for dementia. There is increasing interest in the association between SCC and sleep disturbance; however, the effects of sleep disturbance on SCC development among community-dwelling elderly individuals in Japan remain unclear. We aimed to cross-sectionally investigate the association between SCC and sleep disturbance, with adjustment for multiple factors related to cognitive decline, among 241 community-dwelling elderly persons without cognitive impairment. The measures were SCCs (Kihon Checklist-Cognitive Function, KCL-CF), sleep disturbance (Japanese version of the Athens Insomnia Scale, AIS-J), general cognitive function (Mini-Mental State Examination), and depressive symptoms (five-item version of the Geriatric Depression Scale [GDS-5]). The following data were collected: sex, age, educational history, whether the participants had visited a medical institution for diseases (hypertension, diabetes, hyperlipidemia, heart disease), and the presence/absence of established risk factors (hearing loss, history of head injury, drinking habits, smoking habits, social isolation, and physical inactivity and activity). Based on the KCL-CF, 96 and 145 participants were considered to have and lack SCCs, respectively. On logistic regression analysis, the AIS-J score and smoking history were significantly associated with SCCs. Our findings suggest that sleep disturbance is associated with SCC development among community-dwelling elderly people in Japan. Evaluating and managing sleep disturbances can be important in preventing SCCs and dementia. [ABSTRACT FROM AUTHOR]

Objectives: In this paper and prospective study, we examine the number of healthy behaviors and the incidence of disability in community-dwelling older adults aged 65 years and older. Methods: Participants (N = 4483) were residents of Obu, Japan who were asked about regular exercise, smoking status, and sleep duration. Demographic variables, history of disease, physical function, and cognitive function were measured as confounders. Information about disability was obtained from the Obu City Office. Results: At 24 months after baseline assessment, 165 participants (3.7%) were certified as having disability. Participants with 2 healthy behaviors had a 1.61-fold increased risk of disability (95% CI: 1.08 -2.42) compared with those with 3 healthy behaviors; those with one or no healthy behaviors had a 2.01-fold risk (95% CI: 1.26-3.19) even though adjusting for confounders. Conclusions: The number of healthy behaviors was associated with the incidence of disability, with the hazard ratios increasing progressively as the number of healthy behaviors decreased. [ABSTRACT FROM AUTHOR]

Severe heavy rains caused by linear precipitation systems are occurring more frequently in Japan owing to climate change, and residents are being asked to evacuate more often. The purpose of this study was to identify factors associated with the willingness of people with mental health illness (PMHI) in group homes to disclose their illness when being evacuated. Participants were PMHI living in group homes in Japan. We conducted an original anonymous self-administered questionnaire based on previous research. Valid data from 119 people were analyzed. Factors associated with the willingness to disclose illness to supporters upon evacuation were "I can imagine living in a public shelter" (Odds Ratio [OR] 4.50, 95% Confidence Interval [CI]: 1.78–11.43), and "I socialize with neighbors" (OR 5.63, 95% CI: 1.74–18.22). Managers of group homes should encourage PMHI to imagine life in an evacuation zone by increasing opportunities for disaster training and for interaction with local residents. People who are less likely to socialize with neighbors should be especially careful, as they may not be able to disclose their illness, and those who support evacuees should pay special attention to these people. [ABSTRACT FROM AUTHOR]

Background: Living in rural areas is a major contributor of health inequity. Tackling health inequity is important for primary care physicians. Therefore, it is important to compare the quality of primary care between rural and urban areas. To the best of our knowledge, this is the first study to examine the association between rurality and patient experience (PX) in Japan using validated measures. Methods: This cross-sectional study was conducted using online surveys. Participants were selected using a stratified random sample based on sex and age. The Japanese version of the Person-Centered Primary Care Measure (PCPCM) was used as an indicator of PX. We used the Rurality Index for Japan (RIJ) to measure rurality. Furthermore, we used multivariate linear regression analysis to examine the relationship between the RIJ and PCPCM after adjusting for confounders. Results: Of the 1112 eligible participants, 800 responded to the survey (response rate:71.9%). The mean PCPCM scores were 2.46 (standard deviation: 0.73) and median RIJ was 15 (interquartile range: 6–33). The crude and adjusted coefficients of rurality were − 0.02 (− 0.006–0.001, p = 0.114) and − 0.02 (− 0.005–0.001), respectively, demonstrating that rurality was not significantly associated with the total PCPCM score. Subgroup analyses were similar to the main analyses. Conclusion: We found that PX in primary care did not differ by rurality in the general Japanese population. [ABSTRACT FROM AUTHOR]

Background: The workload of public health nurses (PHNs) working for local governments has been increasing as health issues become more diverse and complicated. Even amidst the ongoing administrative and fiscal reforms, there is an urgent need to ensure how effectively and efficiently public health nurses can practice in health service development. The objective of this research was to clarify the actual conditions of best practice transfer (BPT) and its related factors. Methods: An anonymous postal and self-administered questionnaire survey was conducted among PHNs working at 334 sites, including the local government offices and health centers across Japan, and analysed mainly through logistic regression analysis. Results: One hundred eighty-five of the 334 institutions (55.4%) agreed to participate, and of the 966 questionnaire forms distributed, 709 forms (73.4%) were collected, of which 702 responses (72.7%) were valid. Although less than half (43.2%) have experience in BPT in health service development, more than 80% are willing to perform going forward. Significant factors for both the group with experience in BPT and the group with willingness to perform include an organizational culture that promotes BPT, as well as multiple elements of the workplace environment and facilitating factors related to knowledge and learning. The experienced group recognised the needs for criteria to evaluate the adaptability of best practice, while the willing group, to evaluate the quality of practice. Conclusions: Through a nationwide survey, this research elucidated for the first time the actual conditions of BPT by PHNs in Japan and related factors. The results indicated the importance of developing a system to promote BPT at the workplace level, also highlighted the importance for practitioners and experts, including researchers, to work together to develop practical guidelines to ensure evidence-based practices. Urgent actions are needed for the national and local governments to develop a system to promote BPT from diverse perspectives, building on the findings of this research. [ABSTRACT FROM AUTHOR]

Lung cancer (LC) is currently the leading cause of cancer deaths in Japan. Early detection through lung cancer screening (LCS) is important for reducing mortality. Therefore, exploring the factors affecting willingness to undergo LCS, particularly among young people, is important. This study aimed to elucidate the inclination toward LCS and its determining factors among Japanese university students. This cross-sectional study, involving 10,969 Japanese university students, was conducted in April 2023. A Pearson's chi-square test and a binomial logistic regression analysis were used to analyze factors related to the dependent variable, willingness to undergo LCS in the future. Out of the 6779 participants (61.8%) involved in this study, 6504 (95.9%) provided valid responses, and 4609 (70.9%) expressed a willingness to undergo LCS in the future. Analysis revealed current smoking as a barrier to future willingness to undergo LCS. Other barriers included postponing the age of screening, anxiety about the screening content, and concerns about the possibility of having cancer after screening. Addressing barriers, such as current smoking and anxiety about screening, that prevent young people from undergoing LCS in the future is crucial. Therefore, universities should provide opportunities to educate students about LCS and explore various educational methods. [ABSTRACT FROM AUTHOR]

Background: Culturally appropriate communication training programs for a wide range of professions that can be used during infection epidemics are crucial for advance care planning implementation. Starting in 2018, the Japanese Ministry of Health, Labour and Welfare made a major policy change, and doctors, nurses, and social workers, and care managers were identified in the guidelines as the professions that promote advance care planning. Motivated by the lack of online programs for Japanese care managers, we proposed a new one-day program. Objectives: This study aimed to determine the changes in the positive attitude of care managers toward dying patients compared to that of nurses, which has been used in past literature as an outcome of advance care planning educational interventions, after administering the program in Japan. Design: Before-after comparison study. Methods: Care managers were recruited through our website, ACP-Piece, http://plaza.umin.ac.jp/~acp-piece/piece.html. A questionnaire survey concerning positive attitudes toward dying patients was administered before and after the program on 28 August 2021. Sixty-six subjects participated in the training and 60 participants, including 14 care managers, consented to the study and completed the questionnaire surveys before and after the program. Results: The Frommelt attitude toward care of the dying scores for care managers increased after the program (p -values, confidence intervals, and effect sizes: p < 0.001, −11.90 to −4.388, −1.252). After training, care managers had a significantly higher maximum score occurrence than nurses. Older care managers with advance care planning experience may have had a higher maximum score occurrence compared to younger, inexperienced participants. Conclusion: To our knowledge, this is the first to demonstrate the increased positive attitude scores toward dying patients after online communication training for Japanese care managers. The limitations of this study include the lack of evidence regarding reasons for score changes, long-term score changes, and effectiveness for patients and their families. [ABSTRACT FROM AUTHOR]

Background: An innovative measurement system using a computerized adaptive testing technique based on the item response theory (CAT) has been expanding to measure mental health status. However, little is known about details in its measurement properties based on the empirical data. Moreover, the response time (RT) data, which are not available by a paper-and-pencil measurement but available by a computerized measurement, would be worth investigating for exploring the response behavior. Purpose: We aimed at constructing the CAT to measure depressive symptomatology in a community population and exploring its measurement properties. Also, we examined the relationships between RTs, individual item responses, and depressive levels. Method: For constructing the CAT system, responses of 2061 workers and university students to 24 depression scale plus four negatively revised positive affect items were subjected to a polytomous IRT analysis. The stopping rule was set for standard error of estimation < 0.30 or the maximum 15 items displayed. The CAT and non-adaptive computer-based test (CBT) were administered to 209 undergraduates, and 168 of them administered again after 1 week. Results: On average, the CAT was converged by 10.4 items. The θ values estimated by CAT and CBT were highly correlated ( r = 0.94 and 0.95 for the 1st and 2nd measurements) and with the traditional scoring procedures ( r's > 0.90). The test-retest reliability was at a satisfactory level ( r = 0.86). RTs to some items significantly correlated with the θ estimates. The mean RT varied by the item contents and wording, i.e., the RT to positive affect items required additional 2 s or longer than the other subscale items. Conclusion: The CAT would be a reliable and practical measurement tool for various purposes including stress check at workplace. [ABSTRACT FROM AUTHOR]

Natural disasters cause numerous short- and long-term psychosocial effects on young children because of their increased vulnerability. This study aimed to examine the mental health of young children at 15 months after the Kumamoto earthquake. We conducted a self-administered questionnaire survey on the parents of 363 children aged 4–6 years across Kumamoto Prefecture. The questionnaire items included current residence, housing damage and evacuation experience during the disaster, as well as the Strengths and Difficulties Questionnaire (SDQ). The results showed that children who could stay in their home during the disaster had lower percentages of scores in the clinical range for conduct problems (odds ratio [OR] = 0.33, 95% confidence interval [CI]: 0.13–0.85) and hyperactivity/inattention (OR = 0.42, 95%CI: 0.19–0.93) on the SDQ. Furthermore, children who experienced living apart from their parents during the disaster had a higher percentage of scores in the clinical range for conduct problems (OR = 2.39, 95%CI: 1.05–5.42). At 15 months post-disaster, the mental health of the sample was worse than the normative data of Japan, indicating that the mental health of young children who experienced living at home and apart from their parents during the disaster was still affected. [ABSTRACT FROM AUTHOR]

Acquired brain injury (ABI) is a public health issue that affects family caregivers, because individuals with ABI often require semi-permanent care and community support in daily living. Identifying the characteristics of family caregivers and individuals with ABI and examining life-change adaptation may provide valuable insights. The current study sought to explore the factors contributing to life-change adaptation in family caregivers of community-dwelling individuals with ABI. As a secondary analysis, a cross-sectional study was conducted using data obtained in a previous study of 1622 family caregivers in Japan. We hypothesized that life-change adaptation in family caregivers of individuals with ABI would also be related to family caregivers' characteristics and the characteristics of individuals with ABI. In total, 312 valid responses were analyzed using Poisson regression analysis. The results revealed that life-change adaptation in family caregivers of individuals with ABI was related to sex (prevalence ratio [PR]: 0.65, confidence interval [CI]: −0.819;−0.041) and mental health (PR: 2.04, CI: 0.354; 1.070) as family caregivers' characteristics, and topographical disorientation (PR: 1.51, CI: 0.017; 0.805) and loss of control over behavior (PR: 1.61, CI: 0.116; 0.830) as the characteristics of individuals with ABI, after adjusting for the effects of the caregiver's age, sex, and the duration of the caregiver's role. The current study expands existing knowledge and provides a deeper understanding to enhance the development of specific policies for improving caregiving services and supporting families. [ABSTRACT FROM AUTHOR]

Aim: To enable easy assessment of oral frailty; that is, an overlapping slight decline in multifaceted oral function, in any setting, we developed the oral frailty five‐item checklist (OF‐5), and examined its predictive validity for increased risks of physical frailty, physical disability and mortality among community‐dwelling older adults. Methods: This population‐based cohort study randomly selected 2044 residents in Kashiwa, Japan, with no long‐term care needs. Baseline data were collected in 2012, and follow‐up data were collected in 2013, 2014, 2016, 2018 and 2021. The OF‐5 includes five measures: fewer teeth, difficulty in chewing, difficulty in swallowing, dry mouth and low articulatory oral motor skills. Physical frailty was defined according to the Cardiovascular Health Study criteria. Physical disability and mortality determined from the long‐term care insurance receipt database were followed for 9 years. Results: Of 2031 eligible participants (mean age 73.1 ± 5.6 years; 51.1% women), 39.3% individuals with ≥2 OF‐5 points had significantly increased prevalence and new‐onset rate of physical frailty. After adjusting for potential confounders, oral frailty, defined as ≥2 OF‐5 points, was associated with increased risks of physical disability (adjusted hazard ratio 1.40; 95% confidence interval 1.14–1.72) and mortality (adjusted hazard ratio 1.44; 95% confidence interval 1.11–1.87). The highest adjusted hazard ratios were observed in older adults with coexisting physical and oral frailty. Conclusions: The OF‐5 showed strong predictive validity for physical frailty, physical disability and mortality in Japanese older adults. This assessment tool can be implemented in various settings and foster comprehensive prevention through interprofessional collaboration. Geriatr Gerontol Int 2023; 23: 651–659. [ABSTRACT FROM AUTHOR]

(1) Background: Subjective well-being (SWB) is internationally recognized as an important health-related factor for most age groups and is particularly influential for life quality and expectancy in independent, healthy, community-dwelling older adults. However, the physical function and community participation correlates of SWB in independent living older adults in super-aging societies and other influencing factors remain underexplored. (2) Methods: A total of 926 independent, healthy, community-dwelling older adults aged 65 years and above registered in Yokohama, Japan, were included. Respondents' mean age was 78.1 years (standard deviation = 6.7), and 74.0% were women. The dependent variable was SWB. The independent variables were respondents' demographic characteristics, physical factors (visual, hearing, and cognitive functions, and mobility), and community and social factors (participation in community groups, social networks, and community commitment. (3) Results: The mean (standard deviation) WHO-5 score was 16.3 (5.1). Significant factors associated with WHO-5 score were visual function (odds ratio [OR]: 0.708; 95% confidence interval [CI]: 0.352–0.690), hearing function (OR: 0.615; CI: 0.431–0.878), community groups (OR: 1.310; CI: 1.003–1.059), community commitments (OR: 1.180; CI: 1.132–1.231), and social networks (OR: 1.525; CI: 1.142–2.037) adjusted for the effects of demographic factors. (4) Conclusions: These findings are important because factors associated with SWB are likely to contribute to individual well-being and longevity and to developing a healthy super-aged society. [ABSTRACT FROM AUTHOR]

Objective: This meta‐analysis aimed to determine the effect of mindfulness interventions on nurses' levels of depression and anxiety. Design: Meta‐analysis of randomised controlled trials. Methods: The following Chinese and English databases were searched: PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Internet (CNKI). The retrieval period was from database construction to 30 March 2022. Two researchers screened the relevant literature and extracted the data. After a cross‐check, data were input into Stata version 16.0 for meta‐analysis. Results: Twelve randomised controlled trials from 2017 to 2021 were included, which involved 807 subjects (405 and 402 in the intervention and control groups, respectively). Meta‐analysis results showed that nurses' anxiety reduced by mindfulness‐based interventions was significantly higher compared to that of the control group (SMD = 0.91, 95% CI: 0.27–1.55, p < 0.05). Furthermore, an 8‐week mindfulness‐based intervention (SMD = 1.43, 95% CI: 0.61–2.24) reduced the level of anxiety significantly more compared to a 4‐week intervention (SMD = 1.03, 95% CI: 0.36–1.71). Mindfulness‐based interventions were better compared to conventional intervention to reduce the level of depression (SMD = 1.02, 95% CI: 0.42–1.61, p < 0.05), and an 8‐week mindfulness intervention (SMD = 1.81, 95% CI: 0.78–2.84) reduced the level of depression significantly more compared to a 4‐week intervention (SMD = 0.82, 95% CI: 0.29–1.35). Since limited studies had interventions longer than 8 weeks, results on longer mindfulness interventions in reducing nurses' anxiety and depression are inconclusive. In conclusion, mindfulness intervention for 8 weeks or less can significantly reduce nurses' anxiety and depression levels. Patient or Public Contribution: None. [ABSTRACT FROM AUTHOR]

Introduction: Although many studies have investigated the relationship between patient outcomes and the level of nurse staffing, little is known about the association between increased night‐shift nurse staffing and patient outcomes. In the Japanese universal health insurance system, a new scheme of additional financial incentives for acute care hospitals was launched in 2012 to increase the number of nurses during the night shift in general wards. The objective of this study was to investigate whether an additional financial incentive to increase night‐shift nurse staffing in general wards was associated with better patient outcomes. Design: Adoption of the above‐mentioned scheme of additional financial incentives was used as a natural experiment, and the difference‐in‐differences method was conducted to evaluate the effect of the scheme. The study was performed using a nationwide inpatient database and hospital information in Japan. Methods: To conduct a difference‐in‐differences analysis, first, hospitals with and without increased night‐shift nurse staffing were matched using propensity score matching. A patient‐level difference‐in‐differences analysis was then conducted. The intervention group comprised the hospitals that adopted the new scheme of additional financial incentives. The outcome measures were in‐hospital mortality, failure to rescue, and length of hospital stay. Results: Subjects were 403,971 adult patients who underwent planned major surgeries in Japanese acute care hospitals from April 2012 to March 2018. The adjusted difference‐in‐differences estimates were not significant for in‐hospital mortality (odds ratio: 0.83; 95% confidence interval: 0.68 to 1.01; p = 0.07) or failure to rescue (odds ratio: 0.92; 95% confidence interval: 0.73 to 1.14; p = 0.44). The adjusted difference‐in‐differences estimate for length of hospital stay was significant (percent change: −3.2%; 95% confidence interval: −6.1 to −0.3%; p = 0.029), indicating that the adoption of the scheme was associated with a decreased length of hospital stay. Conclusions: Increased night‐shift nurse staffing was not associated with a decrease in in‐hospital mortality or failure to rescue, but it was associated with a reduction in the length of hospital stay. It may be necessary to consider changes in policy content to make the policy more effective. The findings of this study are potentially useful for medical policymakers considering nurse staffing to decrease the length of stay, which may decrease costs. Clinical relevance: This study showed that increased night‐shift nurse staffing was not associated with a decrease in in‐hospital mortality or failure to rescue, but it was associated with a reduction in the length of hospital stay. The examination of the effectiveness of increasing nurse staffing during a specific shift in acute care hospitals is potentially useful for health policymakers worldwide in their considerations of future nurse staffing policies. [ABSTRACT FROM AUTHOR]

Objectives: Effective daily oral hygiene behaviour will prevent periodontal disease. This study aimed to examine the oral symptoms, oral hygiene behaviours and factors contributing to oral hygiene behaviours among patients with type 2 diabetes in a hospital in Japan. Methods: A cross‐sectional survey was conducted with 198 patients with type 2 diabetes. Oral symptoms were assessed using a dichotomous scale based on clinical guidelines. Oral hygiene behaviours were assessed based on the frequency of daily tooth brushing and the use of interdental cleaning aids. Chi‐square tests and logistic regression analyses were also performed. Results: Overall, 71.2% of the participants had oral symptoms. Of the participants, 80.3% performed twice daily tooth brushing and 61.1% did not perform interdental cleaning on a daily basis. Logistic regression analysis revealed that tooth brushing behaviour was negatively associated with male patients (odds ratio [OR] = 0.45, 95% confidence interval [CI]: 0.25–0.80), difficulty with mastication (OR = 0.63, CI: 0.43–0.92) and tooth loss (OR = 0.68, CI: 0.46–1.00) and positively associated with periodontal disease (OR = 1.73, CI: 1.10–2.72). There were no significant variables related to the use of interdental cleaning aids. Conclusions: Patients need to learn about the necessity for regular oral hygiene behaviours and the appropriate way. In particular, support for male patients, those who have difficulty with mastication, those who have experienced natural tooth loss, and those who have not been diagnosed with periodontal disease are needed. [ABSTRACT FROM AUTHOR]

Enhancing the voluntary supportive actions of older adults towards other community‐dwelling citizens is an important measure for a healthy community. Volunteering action in adulthood is related to the volunteering actions of older adults' parents, which they remember from their youth. In this study, the association between parents' former voluntary supportive actions and the current voluntary supportive actions of older adults is explored. Questionnaires were distributed to community‐dwelling citizens aged 65 years and above, in Tokamachi city, Niigata Prefecture, Japan (response rate: 81.7%). Participants self‐reported their current voluntary supportive actions and reported on their parents' former voluntary actions during their youth. The results indicated that the current voluntary supportive actions of the study participants were related to the former voluntary actions of their parents (OR: 2.28, 95% CI: 1.62–3.20). Moreover, the participants were more likely to extend support in contexts which are more closely related to one's private life, only when their parents provided support in those private contexts. The study provides implications for the importance of considering life experiences when facilitating voluntary supportive actions and renders information on how unique strategies should to be implemented to involve individuals who are unfamiliar with volunteering actions. [ABSTRACT FROM AUTHOR]

Life satisfaction is increasingly important for older cancer survivors as the global population ages and the life expectancy 29 of cancer survivors increases. This study sought to identify factors associated with physical symptoms, quality of life under treatment, and current life satisfaction in cancer survivors aged 75 years and older receiving outpatient chemotherapy. Information about treatment for cancer survivors was collected from electronic medical records, and interviews were conducted to assess life satisfaction under treatment. Participants were older cancer survivors in Ishikawa, Japan. Of the participants, 80% lived on the Noto Peninsula. The average linear distance traveled for treatment was 40.7 km. The factors associated with patients' dissatisfaction with their current lives included general malaise (odds ratio: 9.61; 95% confidence interval: 1.28–72.22) and being less happy now than when they were younger (odds ratio: 10.559; 95% confidence interval: 1.50–74.24). In outpatient cancer treatment for survivors aged 75 years and older, support should consider the distance to the hospital. As in past studies, general malaise was shown to have a negative impact on the lives of cancer survivors aged 75 years or older. Support providers should pay attention to patients' general malaise when providing support. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Demographic changes in Japan have resulted in an increased number of elderly living alone. AIM: The aim of this study was to identify if there is an association between frailty and living alone. METHODS: We conducted a cross-sectional study of 1602 Japanese men and women living in isolated islands. Information obtained included height, body weight, handgrip strength, and family structure; antihypertensive, hypoglycaemic, and lipid-lowering medication use; history of stroke or ischaemic heart disease, smoking history, alcohol intake, joint pain or swelling. Relevant laboratory test results were obtained from recent health check-ups. The Frailty Index for Japanese elderly, a 15-item self-report questionnaire was completed by participants and the Kessler Psychological Distress Scale (K6) was administered. RESULTS: After individuals aged below 60 years old or those with missing data were excluded, data from 1224 participants were analysed. Living alone (single household family structure) was significantly associated with frailty in men (odds ratio [OR] 3.85; 95% confidence interval [CI] 1.94-7.65), but not in women (OR 1.08; 95% CI 0.72-1.63). This association in men remained statistically significant after adjustment for known risk factors for frailty. DISCUSSION: In the elderly population in rural Nagasaki, men living alone have a high risk of frailty. Screening and intervention to prevent frailty in this population is urgently needed. [ABSTRACT FROM AUTHOR]

Family caregivers provide long‐term, home‐based, informal medical care to patients with special healthcare needs. We examined whether informal care involving medical device use is associated with caregiver burden, considering potential risk variables as moderators. Data were collected from March to May 2019 through a Japanese public visiting care system. This system is offered to patients with severe chronic or intractable disease or impairment. After contacting government‐certified offices that provide visiting care systems, the offices that agreed to participate invited dyads of patients and caregivers to complete our questionnaire. To focus on new parameters other than the caregiver factor that had been clarified previously, we aimed to analyse the data from patient–caregiver dyads. Using a questionnaire‐based cross‐sectional design, we asked participants about caregiver and patient characteristics, care types, and caregiver burden using the Zarit Caregiver Burden Interview. Logistic regression analyses were conducted to test the association between caregiver burden and informal medical care. Data from 371 complete patient–caregiver dyads were analysed; 49.3% showed high caregiver burden, and 40.4% were administering at least one informal medical care procedure. Univariate analyses indicated a relationship between high caregiver burden among caregivers who slept less, provided care for longer periods daily, performed medical care procedures and cohabited with patients. Importantly, logistic regression analyses indicated a significant relationship between high caregiver burden and care involving multiple medical procedures (i.e. 4–6 procedures with medical devices; adjusted odds ratio (AOR) = 2.03, 95% confidence intervals (95% CI) = [1.01, 4.09]). In propensity‐matched participants (n = 314), results continued to show that multiple medical care procedures were significantly related to high caregiver burden (AOR = 2.19, 95% CI [1.14–4.22]). The effects of non‐medical informal care on caregiver burden were moderate. This result suggests that more intensive interventions are required for patients with multiple medical care needs to reduce caregiver burden. [ABSTRACT FROM AUTHOR]

We examined mothers' health information sources and their relationships with continued participation in health checkups among urban Japanese mothers. Participants were 152 mothers below 40 years old with one or more children under 12 years old. We collected data at a children's festival in Tokyo in 2019. A self-administered questionnaire was used to collect information regarding health checkups, trusted sources of information regarding mother's health, and anthropological variables. Continued participation in health checkups was defined as participating in health checkups almost every year during the past five years. Logistic regression analysis was used to adjust for health insurance, mothers' age, number of children, and current medical history. the sources of mothers' health information trusted by over 20% of mothers in the two groups were "family", "friends", "Web/SNS", and "healthcare professionals." However, continued participation in health checkups was significantly associated with only the source of health information from "healthcare professionals" (odds ratio: 2.8 [95% confidence interval: 1.26–6.31], p = 0.01). These findings suggest that reliable information from health professionals encourages urban Japanese mothers' continued participation in health checkups among Japanese mothers under 40 years old who have children under 12 years of age. [ABSTRACT FROM AUTHOR]

Purpose: To find suggestions for a future definitive randomized control trial and examine the effects of physical exercise on neurocognition in schizophrenia. Design and Methods: Patients hospitalized with schizophrenia were randomly assigned to exercise (n = 5) or control (n = 17) groups. The experimental group performed an exercise regimen for 8 weeks. Following intervention, demographics, psychiatric symptoms, and neurocognitive functions were examined. Findings: The patients in the control and exercise groups, 14 and 4, respectively, showed significant differences in hospitalization duration and negative symptoms. After controlling both, neurocognition improved in the exercise group compared with the control group. Practice Implications: Mild‐intensity physical exercise improves global neurocognition in schizophrenic inpatients and could lead to earlier release. [ABSTRACT FROM AUTHOR]

Objectives Having a lighter skin tone is highly valued among many Asian women. If skin colour is affected by smoking, women may be motivated to avoid tobacco or quit smoking. The present study examined the association of tobacco smoking with skin colour in Japanese women. Method Information on smoking habits was obtained through a self-administered questionnaire completed by 939 Japanese women aged 20–74 in Gifu, Japan, during 2003–2006. Skin colour was examined on the inner side of the upper and lower arm and on the forehead using a Mexameter device (a narrow-band reflective spectrophotometer), which expressed results as a melanin index and erythema index. Results Current smokers had higher melanin indices than never-smokers and former smokers for all measured sites. The number of cigarettes smoked per day, the years of smoking and pack-years were significantly positively associated with melanin indices for all measured sites after adjustments for age, body mass index, lifetime sun exposure, and room temperature and humidity. Smoking was also significantly associated with erythema indices on the inner upper and lower arms. Conclusions These data suggest that smoking is associated with a darker skin colour. If our findings are confirmed by further studies, they could be used in antismoking campaigns or by smoking cessation services. [ABSTRACT FROM AUTHOR]

Home adaptations are integral for inpatients with fall-related fractures, especially during discharge. However, it is unclear as to how patient-implemented home evaluations can be prioritized with limited professional rehabilitation resources. This study examines the associations between predisposing, enabling, and needs factors with the implementation of home evaluations in the eastern district of Tokyo. Being a female and lower comprehension in cognitive function was significantly associated with the implementation of home evaluations. It may be necessary to consider patients' cognitive function when deciding who to target for housing evaluations and to seek strategies to best estimate their needs. [ABSTRACT FROM AUTHOR]

Background: Although the smoking rate among Japanese men has been the highest in developed countries, the epidemiological evidence about whether smoking cessation can extend their lifespan is not well established. Methods: A total of 1083 Japanese men aged $40 years were classified by their smoking status and followed up prospectively for 18 years (1988-2006). Results: Current smoking was a significant risk factor for all-cause death: the multivariate-adjusted HRs of all-cause death for current smokers of 1-19, 20-39 and $40 cigarettes per day were 1.61 (95% CI 1.16 to 2.22), 1.56 (95% CI 1.08 to 2.23) and 3.15 (95% CI 1.59 to 6.24), respectively. Former smokers did not have an increased risk of all-cause death compared with never smokers. The excess risk of all-cause death for current smokers tended to decrease within 5 years after smoking cessation, eventually reaching a level almost equivalent to that of never smokers. The risk of cancer death decreased by 53% in subjects who had quit smoking for $10 years, while the risk of cardiovascular death decreased by 56% in subjects with the cessation period of <10 years. Conclusions: Our findings suggest that even a modest smoking habit significantly increases the risk of death among Japanese men, and the risk of death diminishes soon after cessation of smoking. These results imply the importance of smoking cessation to extend life in Japanese men. [ABSTRACT FROM AUTHOR]

Aim: We investigated adverse events (AEs) in a Japanese intensive care unit (ICU) and evaluated the impact of cause‐specific AEs on mortality and length of stay. Design: A retrospective observational study in the ICU of an academic hospital. Methods: We reviewed medical records with the Global Trigger Tool. Results: Of the 246 patients, 126 (51%) experienced one or more AEs with an incidence of 201 per 1000 patient‐days and 115 per 100 admissions. A total of 294 AEs were detected with 119 (42%) adverse drug events, 67 (24%) procedural complications, 63 (22%) surgical complications, 26 (9%) nosocomial infections, 5 (2%) therapeutic errors and 4 (1%) diagnostic errors. Adverse event (AE) presence was associated with length of ICU stay (β = 2.85, 95% confidence interval [CI]: 1.09–4.61). Adverse drug events, procedural complications and nosocomial infections were strongly associated with length of ICU stay (β = 2.38, 95% CI: 0.77–3.98; β = 3.75, 95% CI: 2.03–5.48; β = 6.52, 95% CI: 4.07–8.97 respectively). [ABSTRACT FROM AUTHOR]

Older adults' preference regarding where they want to spend their end‐of‐life (EOL) has been reported to be a significant predictor of the actual EOL location. Home‐care nurses have often been reported to try involving single older adults' neighbours in the support network of the older adults (community involvement activities) to allow them to stay at home. Hence, nurses' community involvement activities may be among the significant factors of older adults' preference to stay at home during EOL. Therefore, this study explored home‐care nurses' community involvement activities and its association with single older adults' EOL preference. A cross‐sectional questionnaire survey was conducted with older adults (aged 65 years or older) who lived alone and used home‐care nursing services for more than 6 months, their home‐care nurses, and managers of their home‐care nursing agencies. Questions included participants' characteristics, nurses' community involvement activities and older adults' preference to remain at home during EOL. We conducted multiple logistic regression analyses to explore the relationship between nurses' community involvement activities and older adults' preference to remain at home during EOL while controlling for their demographic variables. In total, 103 pairs of home‐care nurses and single older adults from 27 home‐care nursing agencies participated. Approximately 70% of older adults preferred to remain at home during EOL, and 50% of nurses implemented community involvement activities. Older adults' preference to remain at home during EOL was associated with implementation of community involvement activities (Odds Ratio [OR]: 3.4; 95% Confidence Interval [95%CI]:1.1–9.8), home‐care nurses' higher practical clinical ability (OR: 1.4, 95%CI:1.0–1.8), and older adult's longer use of home‐care nursing service (OR: 2.2, 95%CI:1.2–4.1). Community involvement activities may be essential in helping single older adults to stay at home as per their preference for EOL. [ABSTRACT FROM AUTHOR]

Few studies of depression have examined older inpatients with fracture and preexisting cognitive impairment. The current study sought to confirm whether depression affects the condition of older inpatients with fracture who also have cognitive impairment, and to investigate the extent to which depression affects activities of daily living. This was a retrospective cross-sectional study. The subjects were older inpatients with fracture and preexisting cognitive impairment. We examined data within 1 week of hospitalization, obtained from medical records. The data included demographic information, the motor Functional Independence Measure, Charlson Comorbidity Index, Mini-Mental State Examination, Geriatric Depression Scale 15, Geriatric Nutritional Risk Index, Skeletal Muscle Index and maximum grip strength test. These variables were compared between the two groups (with and without depression), and multiple regression analysis was performed with the motor Functional Independence Measure as the dependent variable. The subjects were 68 patients. Only the motor Functional Independence Measure was significantly lower in the depression group than the non-depression group. Multiple regression analysis confirmed that depression strongly affected activities of daily living. In considering the recovery of older inpatients with fracture and preexisting cognitive impairment, it is important to take the effects of depression into account. The number of older fracture inpatients with cognitive impairment is predicted to increase, and such patients have a high prevalence of depression. Depression strongly affected Activities of Daily Living in older inpatients with fracture and pre-existing cognitive impairment. Focusing on depression assessment and intervention is important for rehabilitation of older fracture inpatients with cognitive impairment. [ABSTRACT FROM AUTHOR]

This study evaluated the impact of a public medical interpreter on the follow-up clinic attendance rate of foreign-born people with HIV who live in Japan. Participants were patients who visited Nagoya Medical Center from 2009 to 2016. Lost to follow-up was defined as an absence from follow-up visits for more than six months without any notification. A log-rank test was conducted to compare the lost-to-follow-up rates by patients' nation of origin and medical interpreter use. Of the 931 participants, 114 were foreign patients, whose overall attendance rate at 5 years was 75.5%, which was significantly lower than that of Japanese patients (94.1%, p < 0.001). There was no significant difference in regular attendance with respect to medical interpreter use (p = 0.09). Social support in addition to a medical interpreter may be needed to improve attendance rates in the study population. [ABSTRACT FROM AUTHOR]

This study examined the degree to which goals perceived by occupational therapists (OTs) matched those perceived by their clients. A total of 100 clients and 79 OTs were recruited from seven subacute rehabilitation wards in Japan. Matched pairs of OTs and their clients were independently asked for their perception about the clients' occupational therapy goals through semi-structured interviews. Collectively, the OTs reported 239 goals, while the clients reported 161 goals. While both the OTs and the clients reported a high level of client engagement in the goal setting process, 79% of the goal statements were mismatched between pairs of OTs and their clients. Goal matching was slightly better for goals about activities of daily living or participation than for goals about body structure or body function. Although most OTs and their clients perceived that they engaged in goal-setting together, only 21% of reported goals actually matched between OTs and clients. It would also be worth investigating whether there is any correlation between the content of goals, patient engagement in goal setting, degree of goal matching, and health outcomes achieved by clients following discharge from rehabilitation services. Although most occupational therapists (OTs) and their clients perceived that they engaged in goal-setting together, 79% of the goals independently reported by OTs and their clients did not match in seven post-acute rehabilitation wards across Japan. Goals were slightly more likely to match if the topic of the goals related to instrumental activities of daily living or participation (30.3%) or basic activities of daily living (24.7%) than if the topic of the goals were about body structure or body function (11.2%); however, the overall rate of goal matching was low. Japanese OTs need to develop more effective methods for recording or communicating goals in ways that clients can understand; this may be the same for other countries. [ABSTRACT FROM AUTHOR]

Aim: To verify the reliability and validity of Multidimensional Measure of Leader–Member Exchange Japanese version (LMX‐MDM‐J) for staff nurses. Background: Staff nurses who have a high‐quality relationship with nurse managers tend to have low turnover intention. However, the validity and reliability of LMX‐MDM Japanese version have not been confirmed. Methods: Staff nurses (n = 870) working in wards of four Japanese hospitals were surveyed using self‐administered questionnaires. Reliability was tested by internal consistency. Validity was tested by the confirmatory factor analysis for construct validity and relationships with external criteria for criterion‐related validity. Results: There were 450 valid responses. Cronbach's α coefficients of the overall scale and each dimension were 0.97 and 0.86–0.95, respectively. The goodness‐of‐fit indices of the confirmatory factor analysis showed CFI = 0.981 and RMSEA = 0.076. Correlation coefficients with external criteria were 0.57 for job satisfaction, 0.80 for relationship satisfaction with the nurse manager and −0.36 for turnover intention (all p <.001). Conclusion: The reliability and validity of LMX‐MDM‐J were determined to be adequate for staff nurses. Implications for Nursing Management: LMX‐MDM‐J can accurately measure the quality of the dyadic relationship between nurse managers and staff nurses. This measurement indicates whether nurse managers are providing leadership. [ABSTRACT FROM AUTHOR]

This research investigated patterns of the use of dietary supplement and doping awareness among high-ranked judoists from 2 countries. Korean (70 men and 31 women) and Japanese (37 men and 34 women) national judo team members were divided into 2 groups (high and low competitive performance levels) according to their international and national rankings. Fifty-nine percent of Korean and 61% of Japanese judoists consumed dietary supplements. Eighty-eight percent of high- and 51% of low-competitive-performance-level Korean judoists consumed dietary supplements. Sixty-eight percent of high- and 57% of low-competitiveperformance- level Japanese judoists consumed dietary supplements. Oriental supplements (34%), vitamins (23%), and protein powder (12%) were the most commonly consumed dietary supplements in Korean judoists. Vitamins (45%), protein powder (33%), and minerals (15%) were the most commonly consumed dietary supplements in Japanese judoists. Thirty-eight percent of judoists from both countries had not received any proper education about antidoping, and 44% of judoists from both countries had not received knowledge of antidoping legislation. There was a significant difference in education about antidoping between high and low competitive-performance levels of Korean judoists (p < .001). Korean judoists received significantly less antidoping education than Japanese judoists (p < .001). The associations for antidoping education and knowledge of antidoping legislation with the use of dietary supplements were 3.46 (95% CI = 1.31-9.12) and 1.63 (95% CI = 0.71-3.76), respectively. Our findings showed that use of dietary supplements in judoists from both countries was increased after experiencing antidoping education. [ABSTRACT FROM AUTHOR]

Background: The dietary variety score (DVS), a simple dietary survey method for older adults, investigates the weekly frequency of consumption of the 10 food groups in Japan. The DVS is also associated with nutritional status. The original scoring method applied only to community‐dwelling older adults, not to older patients receiving home care, who have little dietary variety. Aim: Using three different scoring methods for the DVS, we examined which method was most likely to reflect the nutritional status of older patients receiving home care. Methods: This cross‐sectional study was carried out on older patients receiving home care. Participant characteristics, the DVS (evaluated using three different scoring methods), and the Mini Nutritional Assessment‐Short Form (MNA®‐SF) survey were researched. A receiver operating characteristic (ROC) analysis was performed to find the cut‐off value for the DVS. Multivariate analysis was performed, with malnutrition as the outcome, to investigate the extent to which the DVS is associated with malnutrition. Results: We studied 317 participants. The DVS could produce significant ROC curves using modified scoring methods A and B (p =.028 and.042) with nutritional status as the outcome. Cut‐off value, sensitivity and specificity were 30 points, 60.9% and 55.9% in modified scoring method A and 5 points, 79.1%, and 35.6% in modified scoring method B. Results of the multivariate logistic regression analysis, in Model 1 dysphagia (odds ratio [95% confidence interval]: 3.85 [1.70–8.71]) and the DVS of modified scoring method A (2.00 [1.11–3.62]) were significant independent factors. In Model 2, dysphagia (3.57 [1.58–8.07]) and the DVS based on modified scoring method B (2.36 [1.24–4.47]) were significant independent factors. Conclusions: Modified scoring method B was found to be most suitable for the dietary assessment of older patients receiving home care. Implications for practice: Even in the absence of registered dietitians, any care staff member who is involved in providing nursing services during home‐visits is capable of administering a dietary survey, when using the easy DVS scoring method. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the differences in clinical practice activities and work‐related burden between nurses with past work experience other than nursing (second career nurses: SCNs) and nurses without any past work experience (nonsecond career nurses: NSCNs). Background: The number of SCNs is increasing. Some studies note that SCNs must perform additional clinical practice activities and experience more work‐related burden than NSCNs. However, there are no quantitative studies exploring SCNs' clinical practice and work‐related burden. Design: A cross‐sectional survey. Methods: Research was conducted according to the STROBE statement. Participants were 2,013 nurses working at 56 hospitals in Japan. A 30‐item questionnaire was developed to capture clinical practice activities using clinical ladders, asking about the types of clinical practice activities participants had practiced. Every practiced activity received a score of 1. The total count of each clinical practice activity was then summed. The quantitative workload (QW) scale score was used to investigate levels of QW. Higher QW scores indicated higher levels of work‐related burden. These variables were then compared between SCNs and NSCNs, and the factors that were associated with high QW among SCNs were examined. Results: Altogether, 961 participants (328 SCNs and 633 NSCNs) were included in the analyses. No significant differences were shown in clinical practice activities between the groups; however, SCNs' QW was significantly higher than was NSCNs' after controlling for demographic variables. SCNs' high QW was associated with the following variables: unmarried marital status, not having role model nurses and previous employment as a care worker. Conclusions: Quantitative workload was significantly higher among SCNs than among NSCNs. Tailored support for SCNs' high QW based on their specific needs should be considered. Relevance to clinical practice: These results can help nurse managers reduce SCNs' work‐related burden and illustrate future research directions for this minority group. [ABSTRACT FROM AUTHOR]

Objective: We evaluated the association between prehospital epinephrine administration by emergency medical services (EMS) and the long-term outcomes of out-of-hospital cardiac arrest (OHCA) with initial pulseless electrical activity (PEA) or asystole.Methods: We conducted a controlled, propensity-matched, retrospective cohort study by using Japan's nationwide OHCA registry database. We studied 110,239 bystander-witnessed OHCA patients aged 15–94 years with initial non-shockable rhythms registered between January 2008 and December 2012. We created 1–1 matched pairs of patients with or without epinephrine by using sequential risk set matching based on time-dependent propensity scores to balance the patients' severity and characteristics. We compared overall and neurologically intact survival 1 month after OHCA between cases and controls using conditional logistic regression models by category of the initial rhythm.Results: Propensity matching created 7,431 pairs in patients with PEA and 8,906 pairs in those with asystole. Epinephrine administration was associated with higher overall survival (4.49% vs. 2.96%; odds ratio [OR], 1.55; 95% confidence interval [CI], 1.30–1.85) but not with neurologically intact survival (0.98% vs. 0.78%; OR, 1.26; 95% CI, 0.89–1.78) in patients with PEA, and with higher overall survival (2.38% vs. 1.04%; OR, 2.34; 95% CI, 1.82–3.00) and neurologically intact survival (0.48% vs. 0.22%; OR, 2.28; 95% CI, 1.31–3.96) in those with asystole.Conclusions: Prehospital epinephrine administration by EMS is favorably associated with long-term neurological outcomes in patients with initial asystole and with long-term survival outcomes in those with PEA. [ABSTRACT FROM PUBLISHER]

Objectives: Using a large-scale nationwide survey database, we investigated the epidemiological characteristics for idiopathic SSNHL in Japan. Methods: The subjects for this analysis were patients registered in a Japanese multicentre database between April 2014 and March 2016. A total of 3419 idiopathic SSNHL patients were registered in the database, and the clinical characteristics of the idiopathic SSNHL patients were obtained. Several factors associated with the severity of hearing impairment and prognosis were then investigated. Statistical analysis was performed to clarify the factors associated with the severity of hearing impairment and prognosis. Results: There were significant correlations between the severity of hearing loss and diabetes mellitus, kidney disease, past history of brain infarction, heart disease, age (under 16 years/elderly), and symptoms of vertigo/dizziness. We also analyzed the prognostic factors for idiopathic SSNHL, and found that the severity of hearing loss (Grade 3 or 4), heart disease, aged 65 years or over, time from onset to treatment (over 7 days), and symptoms of vertigo/dizziness were all significantly related to poor prognosis. Conclusion: The present large-scale clinical survey revealed current epidemiological trends for idiopathic sudden sensorineural hearing loss (SSNHL) and various factors associated with the severity of hearing impairment and prognosis. [ABSTRACT FROM AUTHOR]

BACKGROUND: There are well-known associations of ionizing radiation with female breast cancer, and emerging evidence also for male breast cancer. In the United Kingdom, female breast cancer following occupational radiation exposure is among that set of cancers eligible for state compensation and consideration is currently being given to an extension to include male breast cancer. OBJECTIVES: We compare radiation-associated excess relative and absolute risks of male and female breast cancers. METHODS: Breast cancer incidence and mortality data in the Japanese atomic-bomb survivors were analyzed using relative and absolute risk models via Poisson regression. RESULTS: We observed significant (p ≤ 0.01) dose-related excess risk for male breast cancer incidence and mortality. For incidence and mortality data, there are elevations by factors of approximately 15 and 5, respectively, of relative risk for male compared with female breast cancer incidence, the former borderline significant (p = 0.050). In contrast, for incidence and mortality data, there are elevations by factors of approximately 20 and 10, respectively, of female absolute risk compared with male, both statistically significant (p < 0.001). There are no indications of differences between the sexes in age/time-since-exposure/age-at-exposure modifications to the relative or absolute excess risk. The probability of causation of male breast cancer following radiation exposure exceeds by at least a factor of 5 that of many other malignancies. CONCLUSIONS: There is evidence of much higher radiation-associated relative risk for male than for female breast cancer, although absolute excess risks for males are much less than for females. However, the small number of male cases and deaths suggests a degree of caution in interpretation of this finding. CITATION: Little MP, McElvenny DM. 2017. Male breast cancer incidence and mortality risk in the Japanese atomic bomb survivors -- differences in excess relative and absolute risk from female breast cancer. Environ Health Perspect 125:223-229; http://dx.doi.org/10.1289/EHP151 [ABSTRACT FROM AUTHOR]

BACKGROUND: Perfluorinated chemicals (PFCs) disrupt cholesterol homeostasis. All steroid hormones are derived from cholesterol, and steroid hormones such as glucocorticoids and androgenic hormones mediate several vital physiologic functions. However, the in utero effects of PFCs exposure on the homeostasis of these steroid hormones are not well understood in humans. OBJECTIVES: We examined the relationship between prenatal exposure to perfluorooctane sulfonate (PFOS)/perfluorooctanoate (PFOA) and cord blood levels of glucocorticoid and androgenic hormones. METHODS: We conducted a hospital-based birth cohort study between July 2002 and October 2005 in Sapporo, Japan (n = 514). In total, 185 mother -- infant pairs were included in the present study. Prenatal PFOS and PFOA levels in maternal serum samples were measured using liquid chromatography -- tandem mass spectrometry (LC-MS-MS). Cord blood levels of glucocorticoid (cortisol and cortisone) and androgenic hormones [dehydroepiandrosterone (DHEA) and androstenedione] were also measured in the same way. RESULTS: We found a dose -- response relationship of prenatal PFOS, but not PFOA, exposure with glucocorticoid levels after adjusting for potential confounders. Cortisol and cortisone concentrations were -23.98-ng/mL (95% CI: -0.47.12, -11.99; p for trend = 0.006) and -63.21-ng/mL (95% CI: -132.56, -26.72; p for trend < 0.001) lower, respectively, in infants with prenatal PFOS exposure in the fourth quartile compared with those in the first quartile. The highest quartile of prenatal PFOS exposure was positively associated with a 1.33-ng/mL higher DHEA level compared with the lowest quartile (95% CI: 0.17, 1.82; p for trend = 0.017), whereas PFOA showed a negative association with DHEA levels (quartile 4 vs. quartile 1: - 1.23 ng/mL, 95% CI: - 1.72, - 0.25; p for trend = 0.004). We observed no significant association between PFCs and androstenedione levels. CONCLUSIONS: Our results indicate that prenatal exposure to PFCs is significantly associated with glucocorticoid and DHEA levels in cord blood. CITATION: Goudarzi H, Araki A, Itoh S, Sasaki S, Miyashita C, Mitsui T, Nakazawa H, Nonomura K, Kishi R. 2017. The association of prenatal exposure to perfluorinated chemicals with glucocorticoid and androgenic hormones in cord blood samples: the Hokkaido Study. Environ Health Perspect 125:111-118; http://dx.doi.org/10.1289/EHPl42 [ABSTRACT FROM AUTHOR]

BACKGROUND: The robotic Hybrid Assistive Limb (HAL) provides motion according to the wearer's voluntary activity. HAL training effects on walking speed and capacity have not been clarified in subacute stroke. OBJECTIVES: To determine improvement in walking ability by HAL and the most effective improvement measure for use in future large-scale trials. METHODS: Sixteen first-ever hemiplegic stroke patients completed at least 20 sessions over 5 weeks. Per session, the experimental group received no more than 20 min of gait training with HAL (HT) and 40 min of conventional physiotherapy, whereas the control group received at least 60 min of conventional physiotherapy. Primary outcome was maximum walking speed (MWS). RESULTS: The change in MWS from baseline at week 5 was 11.6±10.6 m/min (HAL group) and 2.2±4.1 m/min (control group) (adjusted mean difference = 9.24 m/min, 95% confidence interval 0.48-18.01, P = 0.040). In HAL subjects there were significant increases in Self-selected walking speed (SWS; a secondary outcome) and in step length (a secondary outcome) at MWS and SWS compared with controls. CONCLUSIONS: HT improved walking speed in hemiplegic sub-acute stroke patients. In future, randomized controlled trials are needed to confirm the utility of HT. [ABSTRACT FROM AUTHOR]

Objective: To assess differences in improvement of hiesho (sensitivity to cold) through a randomized controlled trial (RCT) of one group that used a self-care program (the Home Care Package Program for Relieving Hiesho) and another that did not. Methods: Participants were pregnant women experiencing hiesho in the 28th to 33rd weeks of pregnancy. The group carried out the intervention program for 4 weeks by wearing leg warmers, performing exercises, and pressing acupuncture points. The control group did not take any specific actions. Hiesho condition was assessed by using thermography to measure temperature in the four limbs; the changes were analyzed. Results: Findings for 140 pregnant women (73 in the experimental group and 67 in the control group) were analyzed. Participants' body temperatures were measured after completion of the program for 4 weeks and compared to their temperatures before start of the program. Compared with the control group, the experimental group had arm skin temperature 3.0°C ( p < 0.001) higher and leg skin temperature 1.93°C ( p = 0.02) higher; both differences were significant. Conclusion: The Home Care Package Program for Relieving Hiesho self-care program significantly relieved hiesho. [ABSTRACT FROM AUTHOR]

Objectives To determine the standard values of and age-related changes in objective oral function of healthy older people; compare oral function of robust, prefrail, and frail older people; and determine the association between oral function and frailty. Design Cross-sectional analysis. Setting General community. Participants Elderly adults (≥65) from the Obu Study of Health Promotion for the Elderly were included and assigned to the robust, prefrail, and frail groups (N = 4,720). Measurements Each participant underwent detailed physical testing to assess frailty. The frailty phenotype was defined according to the presence of limitations in three or more of the following five domains: mobility, strength, endurance, physical activity, and nutrition. The numbers of present teeth and functional teeth were counted, and occlusal force, masseter muscle thickness, and oral diadochokinesis ( ODK) rate were measured, along with sociodemographic and functional status, comorbidities, and blood chemistry. Results The number of present teeth, occlusal force, masseter muscle thickness, and ODK rate decreased with age. The frail group had significantly fewer present teeth (women aged ≥70), lower occlusal force (women aged ≥70; men aged ≥80), lower masseter muscle thickness, and lower ODK rate than the robust group. Multivariate analysis indicated that age, Geriatric Depression Scale score, skeletal muscle mass index, Mini-Mental State Examination score, hypertension, diabetes mellitus, albumin and triglyceride levels, and oral function were significantly associated with frailty. Conclusion Age-related differences in oral function were found in older adults. Moreover, frail older individuals had significantly poorer oral function than prefrail and robust individuals. The risk of frailty was associated with lower occlusal force, masseter muscle thickness, and ODK rate. [ABSTRACT FROM AUTHOR]

Objectives To investigate whether social participation ( SP) in older adults is associated with ability to perform instrumental activities of daily living ( IADLs). Design Prospective cohort study. Setting Two local municipalities of Nara, Japan. Participants Individuals aged 65 to 96 (n = 2,774 male, n = 3,586 female) free of IADL disability at baseline. Measurements SP and IADLs were assessed using self-administered questionnaires. SP was categorized into five types and assessed using the number and type of social activities. IADLs were evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Logistic regression analysis stratified according to sex was used to examine change in IADLs according to SP, with nonparticipation as a reference. Results During the 3-year follow-up, 13.6% of men and 9.0% of women reported IADL decline. After adjusting for age, family structure, body mass index, pension, occupation, medical treatment, self-rated health, drinking, smoking, depression, cognitive function, and activities of daily living, participation in various social activities was inversely associated with change in IADLs in women but not men. Participation in the following types of social activities had significant inverse associations with IADL disability: hobby clubs (odds ratio ( OR) = 0.68, 95% confidence interval ( CI) = 0.49-0.94) for men and local events ( OR = 0.68, 95% CI = 0.48-0.95), hobby clubs ( OR = 0.53, 95% CI = 0.36-0.79), senior citizen clubs ( OR = 0.74, 95% CI = 0.56-0.97), and volunteer groups ( OR = 0.56, 95% CI = 0.32-0.99) for women. Conclusion Participation in a variety of different types of social activities was associated with change in IADLs over the 3 years of this study in women, and participation in hobby clubs was associated with change in IADLs in men and women. Recommending that community-dwelling elderly adults participate in social activities appropriate for their sex may promote successful aging. [ABSTRACT FROM AUTHOR]

Objectives From a life-course perspective, adverse childhood experiences ( ACEs) such as childhood abuse are known risk factors for adult diseases and death throughout life. ACEs could also cause poor dental health in later life because they could induce poor dental health in childhood, initiate unhealthy behaviors, and lower immune and physiological functions. However, it is not known whether ACEs have a longitudinal adverse effect on dental health in older age. This study aimed to investigate the association between experience of childhood abuse until the age of 18 and current number of remaining teeth among a sample of older Japanese adults. Methods A retrospective cohort study was conducted using the data from the Japan Gerontological Evaluation Study ( JAGES), a large-scale, self-reported survey in 2013 including 27 525 community-dwelling Japanese aged ≥65 years (response rate=71.1%). The outcome, current number of remaining teeth was used categorically: ≥20, 10-19, 5-9, 1-4, and no teeth. Childhood abuse was defined as having any experience of physical abuse, psychological abuse, and psychological neglect up until the age of 18 years. Ordered logistic regression models were applied. Results Of the 25 189 respondents who indicated their number of remaining teeth (mean age: 73.9; male: 46.5%), 14.8% had experience of childhood abuse. Distributions of ≥20, 10-19, 5-9, 1-4, and no teeth were as follows: 46.6%, 22.0%, 11.4%, 8.2%, and 11.8% among respondents with childhood abuse, while 52.3%, 21.3%, 10.3%, 6.6%, and 9.5% among respondents without childhood abuse. Childhood abuse was significantly associated with fewer remaining teeth after adjusting for covariates including socioeconomic status (odds ratio=1.14; 95% confidence interval: 1.06, 1.22). Conclusions Childhood abuse could have a longitudinal adverse effect on later dental health in older age. This study emphasizes the importance of early life experiences on dental health throughout later life. [ABSTRACT FROM AUTHOR]

Purpose: Being appropriately aware of the extent of stress experienced in daily life is essential in motivating stress management behaviours. Excessive stress underestimation obstructs this process, which is expected to exert adverse effects on health. We prospectively examined associations between stress underestimation and mental health outcomes in Japanese workers. Methods: Web-based surveys were conducted twice with an interval of 1 year on 2359 Japanese male workers. Participants were asked to complete survey items concerning stress underestimation, depressive symptoms, sickness absence, and antidepressant use. Results: Multiple logistic regression analysis revealed that high baseline levels of 'overgeneralization of stress' and 'insensitivity to stress' were significantly associated with new-onset depressive symptoms (OR = 2.66 [95 % CI, 1.54-4.59], p < .01) and antidepressant use (OR = 4.91 [95 % CI, 1.22-19.74], p < .05), respectively, during the 1-year follow-up period. Conclusions: This study clearly demonstrated that stress underestimation, including stress insensitivity and the overgeneralization of stress, could exert adverse effects on mental health. [ABSTRACT FROM AUTHOR]

Objectives To examine whether number of remaining teeth and regular dental care affect incident functional disability in elderly Japanese adults. Design Prospective cohort study. Setting Tsurugaya district, Sendai, Japan. Participants Community-dwelling individuals aged 70 and older (N = 834). Measurements The outcome measurement was incident functional disability, defined as first certification of long-term care insurance in Japan, which is determined on the basis of a strictly established uniform nationwide standard. During a median follow-up of 7.9 years (interquartile range 4.8-7.9 years), information on long-term care insurance was obtained from the Sendai Municipal Authority. Oral health was assessed according to number of remaining teeth and presence or absence of regular dental care. Data were also collected on age, sex, body mass index, medical history, smoking, alcohol consumption, duration of education, depressive symptoms, cognitive impairment, physical functioning, and social support. Results Participants with 10 to 19 teeth (adjusted hazard ratio ( aHR) = 1.42, 95% confidence interval ( CI) = 1.03-1.94), one to nine teeth ( aHR = 1.46, 95% CI = 1.04-2.03), and no teeth ( aHR = 1.49, 95% CI = 1.03-2.14) were more likely to develop functional disability than those with 20 or more teeth. There was no significant difference in risk of functional disability between participants with 20 or more teeth and those with zero to 19 teeth who were receiving regular dental care, whereas those with zero to 19 teeth without regular dental care had a significantly greater risk of functional disability than those with 20 or more teeth ( HR = 1.46, 95% CI = 1.11-1.92). Conclusion Tooth loss was associated with greater risk of functional disability in community-dwelling elderly Japanese. Regular dental care might moderate the risk of functional disability in elderly individuals with missing teeth. [ABSTRACT FROM AUTHOR]

BACKGROUND: The elucidation of the relationship between the morphology of the peripheral nerves and the diseases would be valuable in developing new medical treatments on the assumption that characteristics of the peripheral nerves in females are different from those in males. METHODS: We used 13 kinds of the peripheral nerve. The materials were obtained from 10 Japanese female and male cadavers. We performed a morphometric analysis of nerve fibers. We estimated the total number of myelinated axons, and calculated the average transverse area and average circularity ratio of myelinated axons in the peripheral nerves. RESULTS: There was no statistically significant difference in the total number, average transverse area, or average circularity ratio of myelinated axons between the female and male specimens except for the total number of myelinated axons in the vestibular nerve and the average circularity ratio of myelinated axons in the vagus nerve. CONCLUSIONS: The lower number of myelinated axons in the female vestibular nerve may be one of the reasons why vestibular disorders have a female preponderance. Moreover, the higher average circularity ratio of myelinated axons in the male vagus nerve may be one reason why vagus nerve activity to modulate pain has a male preponderance. [ABSTRACT FROM AUTHOR]

Paternal postpartum depression may affect not only the mental health and wellbeing of fathers but their partners and children. We investigated the point and period prevalence of paternal postpartum depression and its association with factors measured during pregnancy in a regional longitudinal study in Nishio City, Aichi Prefecture, Japan, between December 1, 2012, and April 30, 2013. Data were collected once in pregnancy and five times in the first three months postpartum. The Edinburgh Postnatal Depression Scale was used to assess paternal depression, and data were collected in pregnancy on demographic and psychosocial factors. Of 215 fathers who returned at least one of the five postpartum assessments, 36 (17%) reported symptoms of depression in the first three months after birth. In logistic regression analyses, among a number of demographic and psychosocial characteristics that previously had been linked to paternal postpartum depression, only fathers' history of psychiatric treatment and depressive symptoms during pregnancy were associated with paternal depressive symptoms in the postnatal period. The results add to the growing body of evidence on prevalence of paternal postnatal depression and indicate that assessment and support for fathers are important starting in pregnancy. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]