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Objective　Paternal involvement in child-rearing is an action goal of Healthy Parents and Children 21 (Tier 2), and should be actively promoted. Clarifying the related factors may contribute to countermeasures for promoting paternal involvement in child-rearing. This study aimed to examine the association between fathers' gender role attitudes and social support from their spouses (i.e., the mothers of the children) and their involvement in child-rearing.Methods　We obtained the data of fathers involved in childcare (aged 25-50 years; all full-time workers) through an internet research company. The paternal involvement in childcare scale (11 items, 4-point scale, e.g., "taking care of children," "cooking") was used as the dependent variable. The independent variables were gender role attitude ("Husbands should work outside the home and wives should take care of the home," 4-point scale) and social support from the mothers of the children (including appraisal, emotional, and instrumental support). The control variables were father's age, mother's employment status, number of children, the age of the youngest child, children going to nursery school or kindergarten, use of childcare services, self-evaluation of low economic status, work hours on weekdays, and marital relationship satisfaction.Results　The data of 360 men were analyzed (mean age 36.8 years, standard deviation 5.6). The results of the multivariable regression analyses with interaction terms are as follows: gender role attitude was significantly associated with childcare (β=-0.103) and housework (β=-0.125); appraisal support was significantly associated with childcare (β=0.142) and housework (β=0.199); and the interaction between gender role attitude and instrumental support was significant (β=0.176), indicating that, in individuals with a high gender role attitude score, a higher level of instrumental support was related to a higher childcare score (β=0.242).Conclusions　Fathers with egalitarian gender role attitudes and those who receive appraisal support from the other parent are more likely to participate in childcare. In addition, fathers with traditional gender role attitudes who receive instrumental support from the other parent may tend to participate in childcare.

Objective　Due to the rapid development of the internet, its overuse and addiction among the younger population have increased. Several studies have reported a relationship between the prolonged usage hours of the internet and other media among junior and senior high school students and certain lifestyle habits, such as no breakfast, no exercise routine, lack of sleep, and mental health decline. There is a growing concern that the students' health could be affected due to over usage of the internet and other networking media. Therefore, we have examined the relationship between media usage time and self-rated health (SRH) of the junior and senior high school students.Methods　We analyzed the data of the "Fukushima Citizens' Health and Lifestyle Survey" conducted on May 2016. The participants included in the survey were junior and senior high school students from Fukushima City. We randomly selected 1,633 students and conducted a self-administered questionnaire survey. Of the 1,589 respondents, survey data from 1,480 students (583 junior and 897 senior high school students) were used in the analysis. The analysis was performed in each junior and senior high school student, with SRH as the dependent variable, media usage time as the independent variable, and various lifestyle factors as the adjustment variables. Furthermore, the odds ratio (OR) and 95% confidence interval (CI) were estimated.Results　Fifty-two junior high school students (8.9%) and 123 senior high school students (13.7%) had poor SRH. Among the junior and senior high school students, those who used media for >3 h were more likely to have poor SRH, and the significant association was noted among high school students (OR; 2.30, 95% CI; 1.36-3.90). For both junior and senior high school students, the SRH was significantly associated with obesity, no exercise routine, and stress. Additionally, for the high school students, the SRH was significantly associated with late bedtime routine.Conclusion　Our findings suggest that junior and high school students who overuse media are more likely to have a poor SRH.

Objectives　Posttraumatic growth (PTG) refers to a positive psychological transformation experienced as a result of struggling with a major life crisis or traumatic event. In recent times, PTG has been used as a form of psychological support for those who have experienced trauma. In this study, we classified the free descriptions of PTG in Fukushima residents who experienced the Great East Japan Earthquake (GEJE). We examined the relationship between basic characteristics and PTG clusters, and between "recovery from radiation anxiety" and PTG clusters.Methods　A mail survey was conducted in August 2016 among 2,000 Fukushima residents, aged 20-79 years. We asked the participants for a free description of the specific content of their PTG. We also asked about their age, gender, and education, as well as about radiation anxiety immediately after the GEJE and at the time of the survey. Participants were divided into the following groups: "no anxiety," "recovered from anxiety," and "unrecovered from anxiety". The PTG free descriptions were classified into eight categories, including five dimensions based on the Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996) ("relating to others," "new possibilities," "personal strength," "spiritual change," and "appreciation of life") and three categories created according to Nishino et al. (2013) ("increased awareness of disaster prevention," "renewed recognition of nuclear-related issues," and "critical examination of information from authorities").Results　Of the 916 collected responses, data from 786 responses with no missing values were analyzed. Among women and young people, the proportion of those who answered "relating to others" and "appreciation of life" was high. For those with higher education, the proportion of those who answered "relating to others," "renewed recognition of nuclear issues," "critical examination of information from authorities," "personal strength," "spiritual change," and "appreciation of life" was high. In the "recovered from anxiety" group, the proportion of those who answered "renewed recognition of nuclear issues" was high.Conclusion　In assessing PTG, women and young people were more likely to report that they felt closely connected to family or friends, as well as to the community, and that they were grateful for their daily lives. Those with higher education tended to recognize that they have come to critically examine information provided by the national government, electric power companies, and national newspapers; they felt mental strength and growth after the earthquake. Those who recovered from radiation anxiety were more likely to report forming a heightened awareness of issues relating to nuclear power plants and energy.

Objectives　Nine years after the accident at the TEPCO Fukushima Daiichi Nuclear Power Plant in March 2011, anxiety about the effects of radiation on future generations persists. We considered the possibility that information from mass media sources and the Internet might influence this anxiety. Thus, this study examined the relationship between information sources and anxiety; based on the results, we consider the necessary measures to reduce this anxiety.Methods　We conducted a mail-based survey by distributing an anonymous self-administered questionnaire to 2,000 Fukushima Prefecture residents aged 20 to 79. We randomly selected 500 residents from Aizu, Nakadori, Hamadori, and the evacuation areas, and compared the data obtained from Hamadori and the evacuation areas. The objective variable was anxiety about the effects (of radiation) on future generations, while the explanatory variables were trusted sources and media the respondents used to get information on radiation. Other variables assessed included health status and knowledge of radiation. We conducted univariate analysis of combined data to assess the relationship between anxiety and the questionnaire items. This was followed by multiple regression analysis with anxiety as the objective variable and those showing significant differences in the univariate analysis as the explanatory ones. We then conducted multiple regression analysis, that included the interaction means between explanatory variables and evacuation areas.Results　Of the 500, 201 respondents were from Hamadori (40.2%) and 192 from the evacuation areas (38.4%). Multiple regression analysis revealed that anxiety was significantly lower among those who trusted government ministries and those who were healthy. Anxiety was also significantly lower among those who correctly answered the question on the genetic influence of radiation, while it was significantly higher among those who correctly answered the question on the dose-response model of radiation-induced cancer. In Hamadori, anxiety was significantly higher among those who watched private national television. In the evacuation areas, the result was the same as that of the combined data.Conclusion　Different information sources and media were significantly associated with anxiety about the effects of radiation on future generations. Therefore, media sensationalism should be reduced to prevent anxiety among citizens. Our findings highlight the importance of selecting information sources and media that disseminate accurate information, as well as the need to improve media literacy among citizens. Furthermore, a dose-response model of radiation-induced cancer must be communicated in a way that is not misleading. Receiving accurate information on the genetic effects of radiation can reduce anxiety among citizens.

Objectives Child care involves mentally and physically intensive work. Women involved in child care are prone to various cognitive failures (e.g., forgetting to carry something or missing an appointment) because of being overburdened with child care activities and chores, constantly limited attention for coping with the frequent demands of children, and cognitive deterioration in the perinatal period. We conducted a survey of women caring for children aged 3 months to 6 years old, aiming to 1) develop a Japanese version of the cognitive failure scale (named the Short Inventory of Minor Lapses [SIML]), and 2) examine the psychometric properties of the scale (including factor structure, validity, reliability, and score distribution), and comparing the scale score according to job status, the youngest child's age, and the number of children.Methods We used data obtained through an internet research company from 310 women (aged 25-45 years; 155 full-time workers and 155 housewives), caring for children aged 3 months to 6 years old. We used the 15-item SIML with a five-point Likert-type scale. We also collected information about employment status, maternal age, the youngest child's age, the number of children, income, the status of using child-care services, sleep duration, fatigue, and neuroticism.Results The scale consisted of one factor. Cognitive failure was found to have the following correlations with memory complaints (polyserial correlation=0.66), sleep duration (r=-0.17), fatigue (r=0.32), and neuroticism (r=0.22). Cronbach's alpha for the scale was 0.94. A three-way analysis of variance (including main effects of working status, the youngest child's age, and the number of children) in cognitive failure revealed significant main effects of the youngest child's age (aged 0-3 years: mean (standard deviation [SD])=34.9 (11.5) point, > aged 4-6 years: mean (SD)=32.6 (10.5) point, partial η 2 =0.013), and the number of children (only one: mean (SD)=32.4 (11.3) points < two or more: mean (SD)=34.9 (10.9) points, and partial η 2 =0.014). A three-way analysis of covariance in cognitive failure adjusted for mother's age demonstrated a significant main effect of the youngest child's age (partial η 2 =0.014).Conclusion Our findings confirmed the psychometric properties of the Japanese version of SIML among women involved in child care (including factor structure, validity, reliability, and score distribution).

Objective　In recent years, the long-term use of media (including the Internet, video games, and social networking services) at a young age has been regarded as a problem. It has been pointed out that prolonged media usage may have an undesirable effect on the growth of adolescents from the physical, mental, and social perspectives. Junior and senior high school students are in a particularly important period of self-management of the basic lifestyle habits acquired thus far. Additionally, they must cultivate the ability to interact appropriately with media used daily. In this study, we investigated the relationship between the time expended on media usage and lifestyle habits among junior and senior high school students.Methods　A sample of 1,633 students was extracted from all junior and senior high schools in Fukushima City. Principals of the schools distributed a self-administered questionnaire to their students. In total, 1,589 responses were obtained; as surveys of 30 students were missing values for gender and grade, they were excluded from the analysis, and data from 1,559 respondents were ultimately analyzed. A binomial logistic regression analysis was performed to examine the relationship between an independent variable (media usage time) and dependent variables (subjective health, lifestyle habits, and drinking and smoking experience) while controlling for gender and grade.Results　Among junior high students, media usage for more than three hours was significantly related to "no breakfast," "no exercise habits," "irregular sleep," "lack of rest," and "feeling stressed." Among high school students, media usage for three hours or more was significantly related to "poor subjective health status," "eating only one or two meals a day," "no breakfast," "low food diversity," "obesity," "no exercise habits," "irregular sleep," "late bedtime," "waking up late," "drinking," and "smoking."Conclusion　Our findings indicate that three or more hours of daily media usage is related to unhealthy lifestyles in terms of sleeping, eating, physical activity, drinking, and smoking. Junior and senior high school students who responded to the survey indicated that prolonged usage was also adversely related to their subjective health. Because the overuse of media is associated with students' lifestyles and health, it is important to develop an educational system that helps junior and senior high school students use media properly.

Objectives　Leisure activities are important for older adults, not only to maintain their subjective well-being but also to prevent bedridden states. This study aimed to develop a leisure activity scale for contemporary older adults and examine its psychometric properties, based on a previous study from Iwasa et al. (2018). As people who actively engage in leisure activities are reportedly less likely to experience cognitive decline, the relationship between the scale score and cognitive function should be assessed while developing the scale. Specifically, the study was conducted to examine the reliability of the scale and its factor structure, confirm basic statistical characteristics, examine the scale's gender- and age-based differences, and the relationship between the scale score and cognitive function.Methods　We surveyed Japanese older adults living in a community (aged 70-84 years; N=594) and used data from 306 participants (151 men and 155 women). We developed and administered a scale comprising 11 items that were measured using a 4-point Likert-type scale. Additionally, we used cognitive function scales including the Mini-Mental State Examination (MMSE), the Memory Impairment Screen (MIS), and the Word Fluency Test. Covariates in tests for independent associations between the leisure activity scale score and cognitive function were socioeconomic status, chronic disease, functional capacity, and living alone. We conducted two web surveys with two-week intervals for test-retest reliability purposes and used data from 192 of those participants (aged 70-79 years; 101 men and 91 women).Results　A confirmatory factor analysis upheld the fact that the scale was comprised of one factor. The scale obtained high indicators of reliability: Cronbach's alpha coefficient (0.81) and test-retest reliability (0.81). The mean, standard deviation, median, skewness, and kurtosis of the scale score were 14.44, 7.13, 15, -0.12, and -0.73, respectively. The analysis of variance for the scale score indicated significant age-based differences (i.e., the score for those who were 70-74 years old was higher than for those who were 80-84 years old) and no significant gender differences. Multiple regression analyses demonstrated that the scale score was significantly and independently correlated with MMSE (β=0.31), MIS (β=0.24), and word fluency (β=0.25).Conclusion　This study confirmed the psychometric properties of the leisure activity scale, including factor structure, reliability, basic statistical characteristics, no gender differences, significant age-based differences, and relationship to cognitive function. Future studies should examine the longitudinal relationship between the leisure activity scale score and cognition among older adults in community settings.

Objectives　The purpose of this study was to examine the psychometric properties of the diet-related quality of life (DRQOL) scale among older adults. Specifically, the study was conducted to confirm the scale's factor structure and construct a short version of the scale. Further, the scale's internal consistency and gender- and age-based differences as well as the validity of the DRQOL scale and its short version were examined.Methods　We surveyed a random sample of community-dwelling older Japanese adults (aged 60-84 years; N=1,200; response rate: 70.8%) and used the data of 780 participants (367 men and 413 women). We used the DRQOL scale, comprising 18 items that were measured using a five-point Likert-type scale. Additionally, we assessed subjective well-being, diet satisfaction, appetite, meal restriction, mastication, number of meals with others, frequency of using ready-made and instant food, information gathering regarding food, and dietary variety scores as external criterion variables; socioeconomic status and health habits were used to describe basic participant characteristics.Results　Confirmatory factor analysis revealed a replication of the four-factor structure of the measure ("pleasure from a meal," "eating satisfaction," "circumstances of meal," and "diet diversity"). A short version of the measure comprising 8 items was developed. The DRQOL scale, its subscales, and its short version had high Cronbach's alpha coefficients as indicators of reliability (0.94; 0.86, 0.89, 0.77, and 0.72; and 0.90, respectively). There were significant sex differences in the scores of all constructs, and no significant age-based differences. The DRQOL scale scores had weak-to-moderate correlations with the external criterion variables mentioned above.Conclusion　Overall, this study confirmed the psychometric properties of the DRQOL scale, including factor structure, reliability, gender and age differences, and its validity among older adults using data from the general population in Japan. In addition, a short version of the DRQOL scale was developed. Future studies should examine the factors associated with the DRQOL. The predictive validity of the scale, with health outcomes as external criteria, should be examined to test its usefulness for epidemiological surveys among older adults in community settings.

Psychiatric comorbidities, including mood, anxiety, psychotic disorders, and autism spectrum disorder are common in patients with epilepsy (PWE), often occurring at rates 2-3-fold or higher than in the general population without epilepsy. Furthermore, an attention should be paid to psychiatric symptoms together with those caused by antiepileptic drug therapy, epilepsy surgery, and vagus nerve stimulation because these therapies sometimes induce psychiatric comorbidities. It is important to differentiate psychogenic non epileptic seizures (PNES) from epilepsy, and to provide patients with psychiatric treatment. We focused on the process and certainty of diagnosis and the managements of PNES. An accurate, undistorted understanding of the relationship between mental status and epilepsy is essential to ensure appropriate therapy and avoid misconceptions and unnecessary treatment. Psychiatric and psychological states should be evaluated at the time of the first visit in every PWE and patients should be provided adequate psychiatric therapy if necessary within the overall therapeutic plan.

Objectives　The purpose of this study was to provide normative data of middle-aged and older adults for the Japanese version of the Ten-Item Personality Inventory (TIPI-J), based on the Big Five model of personality (Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness).Methods　We surveyed a random sample of community-dwelling middle-aged and older Japanese adults (aged 60-84 years, N=1,200, response rate: 70.8%) and used data from 776 participants (368 men and 408 women). We used the TIPI-J as a measure of the Big Five model of personality comprising ten items, which were measured on a seven-point Likert-type scale. We also assessed the socio-economic and health variables to describe the basic characteristics of participants.Results　Standard psychometric methods showed a near-normal score distribution across all subscales; there were significant sex differences in Neuroticism and Openness, and there was no significant difference with respect to age.Conclusion　This study provided a grand total table and normative data for the TIPI-J, and examined gender- and age-based differences in the TIPI-J among middle-aged and older adults using data from the general population of Japan. In the future, factors associated with the TIPI-J scores and predictive validity of the scale for health outcomes as external criteria should be examined to test the scale's usefulness for epidemiological surveys among middle-aged and older adults in community settings.

Purpose: The present study was conducted to identify the characteristics of non-participants in secondary comprehensive health examinations among community-dwelling elderly., Methods: The subjects were 728 men and 984 women aged 70 years and over who had participated in comprehensive health examinations in 2002. Multiple logistic regression analysis was performed to assess the characteristics associated with non-participation in comprehensive health examinations after 2 years (in 2004)., Results: The rates of participation in follow-up health examinations were 66.3% for men and 67.3% for women. Logistic regression analysis showed that male non-participants had low cognitive function (odds ratio (OR) = 2.19, 95% confidence interval (CI) = 1.07-4.49), low education (OR = 1.58, 95% CI = 1.22-2.22), and suffered from health problems (OR = 1.82, 95% CI = 1.27-2.59), and that female non-participants had low cognitive function (OR = 2.01, 95% CI 1.13-3.59), tended to be smokers (OR = 2.05, 95%, CI = 1.13-3.72), and had no hobby (OR = 0.68, 95% CI = 0.50-0.92)., Conclusion: Poor cognitive function, health problems, and unfavorable lifestyle factors are related to non-participation in comprehensive health examinations., Proposal: It is necessary to devise various approaches to encourage participation of such individuals.

Objectives: This study was conducted in order to examine the prevalence of geriatric syndrome (falls, incontinence, depression, and under-nutrition) in community-dwelling elderly people, and to analyze the health status of the elderly with geriatric syndrome risk compared to those of a group not at risk., Methods: The subjects comprised 1,784 residents (769 men and 1,015 women) aged 70 years or more living in Itabashi-ku, Tokyo, who took part in the study. For this study, we divided the subjects into two groups: those with geriatric syndrome (n=688) and those without (n=1,096)., Results: It was found that 33.6% of men and 42.4% of women had geriatric syndrome. Elderly with geriatric syndrome in both men and women had a significantly lower the proportion of subjects who perceived as 'healthy' in terms of the self-rated health, the higher-level functional capacity, higher prevalence of fear of falling, and decreased physical performance including handgrip strength and usual.maximal walking speed than those in the group who did not have geriatric syndrome. Logistic regression analysis showed that geriatric syndrome was associated with poor perceived self-rated health, a lower hemoglobin level and a slower usual walking speed in men, whereas in women it was associated with poor perceived self-rated health and fear of falling., Conclusion: Elderly individuals with geriatric syndrome have significantly decreased health status and physical performance compared to those without geriatric syndrome.

Background: The present study was conducted to identify the characteristics of non-participants in intervention for geriatric syndrome among community-dwelling elderly., Methods: The subjects were 208 men and 399 women aged 70 years and over who were eligible for participation in intervention programs for geriatric syndrome (falls, urinary incontinence, depression, and malnutrition) after recruitment based on a baseline health examination survey in 2002. Multiple logistic regression analysis was performed to assess non-participation in the intervention program as a dependent variable, and the relevant characteristics for participation in the baseline survey as the independent variables., Results: The rates of participation in the intervention were 16.8% for men and 32.6% for women. Logistic regression analysis showed that male non-participants had not participated in group social activity (odds ratio (OR)=2.46, 95% confidence interval (CI) 1.08-5.59), and had no medical history of heart disease (OR=0.38, 95%CI 0.17-0.89), whereas female non-participants had not lived alone (OR=0.53, 95%CI 0.34-0.83), and had no medical history of hyperlipemia (OR=0.54, 95% CI 0.34-0.84)., Conclusion: Social activity, living arrangement, and medical history are related to non-participation in intervention for geriatric syndrome. It is necessary to devise various intervention programs and approaches to encourage participation.

Objective: The present study was performed to comprehensively investigate the prevalence of multiple symptoms of the geriatric syndrome, characteristics and related factors in urban community-dwelling elderly women., Methods: Among 669 women aged 70 years and above living in 5 areas of Itabashi-ku, who attended the Otassha Kenshin (comprehensive health check for the elderly) in November 2004 and gave consent to participate in this study, 668 had no missing data and their interview and physical fitness data were analyzed. The criteria for the geriatric syndrome were: (1) functional decline: a score of 10 points or below for the 13 items of the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence; (2) falls: "have fallen" once or more in the last year; and (3) urinary incontinence: frequency of urine leakage of "1 to 3 times in a month" in daily life. The interview and physical fitness data were compared between healthy persons, persons with one symptom and persons with multiple symptoms. Multiple logistic regression models were used to analyse related factors., Results: The prevalence of multiple geriatric syndromes was 15.3%; comprising 2.2% with "functional decline+falls", 6.0% with "functional decline+urinary incontinence", 5.1% with "falls+urinary incontinence", and 2.0% with "functional decline+falls+urinary incontinence". The group reporting multiple symptoms had poor self-rated health, had a high percentage currently taking three or more medications, had a fear of falling and had a significantly (P < 0.05) higher likelihood of a history of stroke and urinary disease. In addition, the group with multiple symptoms were older, and had significantly (P < 0.05) poorer results for grip strength, usual walking speed, maximum walking speed, functional reach, knee extension strength, and one leg standing time with eyes open. Within this group, the "functional decline+falls" subgroup had the lowest level of physical fitness. Analysis of factors related to the presence (1) or absence (0) of multiple symptoms identified fear of falling and usual walking speed as two significant variables., Conclusion: This study showed that: (1) physical fitness is significantly lower in the group with multiple symptoms of the geriatric syndrome compared with healthy persons, and was the lowest in the subgroup with "functional decline+falls"; and (2) fear of falling and usual walking speed were two factors related to multiple geriatric syndromes. These results suggest directions for future intervention strategies.

Aim: We examined the prevalence and characteristics of urinary incontinence in community-dwelling elderly individuals., Methods: The participants were 1,783 individuals (768 men and 1,015 women) aged over 70 years who participated in a comprehensive health examination involving a medical examination and interview, plus physical performance tests. Differences in characteristics between individuals with and without urinary incontinence were examined, and multivariate logistic regression models were used to describe the characteristics associated with urinary incontinence., Results: The prevalence of urinary incontinence was 13.4% in men and 23.3% in women. Urinary incontinence was significantly associated with a lower level of physical fitness. Multivariate logistic regression showed that urinary incontinence was significantly associated with a slower walking speed (Odds Ratio (OR) = 0.19, 95% Confidence Intervals (CI) 0.08-0.48) and lower serum albumin level (OR = 0.40, 95% CI 0.16-0.99) in men, and with a slower walking speed (OR = 0.29, 95% CI 0.15-0.56), a higher BMI (OR = 1.09, 95% CI 1.04-1.14), depression (OR = 3.06, 95% CI 1.40-6.69), and lack of physical activity (OR = 0.70, 95% CI 0.50-0.98) in women., Conclusion: The characteristics of urinary incontinence in this cohort of community-dwelling elderly individuals were a low level of physical fitness and poor nutritional state in men, and a low level of physical fitness, a tendency to be obese, a poor mental health state, and lack of physical activity in women.

Purpose: We explored correlates of change in cognitive function during a two-year follow-up period among the community-dwelling elderly in Japan, using a population-based prospective approach., Method: The participants analyzed in the present study were 260 men and 222 women aged 70 to 84 years at baseline, living in an urban Japanese community. Data such as change in cognitive function during two years (calculated by subtracting baseline Mini-Mental State Examination [MMSE] score from follow-up MMSE score: a negative value means a decrease in MMSE scores during the two-year period) as an outcome variable, age, education, hearing and vision problems, IADL deficit (measured by the Tokyo Metropolitan Institute of Gerontology of Index of Competence), problems related to memory complaint, living alone, hemoglobin level, as explanatory variables, and the baseline MMSE score, depressive status (measured by the Mini-International Neuropsychiatric Interview), chronic conditions (hypertension, stroke, and diabetes mellitus) as covariates, were collected during a comprehensive health examination survey for the elderly., Results and Conclusion: We conducted multivariate regression analysis by genders to explore correlates of change in cognitive function. The results showed that higher age (beta = -0.18), presence of hearing problem (beta = -0.21), presence of IADL deficit (beta = -0.15), and memory complaint (beta = -0.20) in men, and higher age (beta = -0.27), low education level (beta = -0.25) and lower hemoglobin level (beta = 0.16) in women, were significantly associated with change in cognitive function when adjusting for the potential confounders. These factors may be reliable predictors for cognitive decline.

Aim: We examined the relationship between subjective well-being and all-cause mortality among middle-aged and elderly people, using a population-based prospective approach (Tokyo Metropolitan Institute of Gerontology-Longitudinal Interdisciplinary Study on Aging)., Methods: The participants were 1,034 men and 1,413 women aged 52 to 77 years, living in an urban Japanese community. The baseline data on age, gender, number of years of education, hospitalization, lifestyle-related illness, subjective health status, living alone and subjective well-being (measured by Philadelphia Geriatric Center Morale Scale) were collected in 1993., Results: Mean subjective well-being scores for men and women were 12.3 +/- 3.2 and 11.9 +/- 3.5, respectively. Analysis of covariance controlling for age, the number of years of education, hospitalization, lifestyle-related illness and living alone, revealed no inter-gender difference in subjective well-being. Multiple regression analysis to explore factors related to subjective well-being showed that age in men, and the number of years of education in both genders were significantly, independently and positively associated with subjective well-being, and that hospitalization, lifestyle-related illness and living alone in both genders were significantly, independently and negatively related to subjective well-being. From 1993 to 2000, there were 183 deaths and 258 dropouts. In Cox's multivariate hazard model adjusted for age, the number of years of education, hospitalization, lifestyle-related illness and living alone, there was a significant and independent association between a low level of subjective well-being and the risk for all-cause mortality in both genders., Conclusion: Satisfaction with life is an important factor affecting longevity among middle-aged and elderly people.

It is predicted that the future increase in the oldest-old (85 years and older) population will have a marked influence on society. However, little is known about the features of various functions in the oldest-old. The purpose of this study was to clarify the functional status of the oldest-old. We surveyed all oldest-old residents in a small area of Itabashi ward in metropolitan Tokyo to clarify their living conditions. The oldest-old themselves and their family members were invited to participate, and 235 out of 311 residents (75.6%) agreed to do so. Forty-two percent of the participants were dependent and needed care from others. The ADL status measured by the Barthel Index showed that 30% of independent participants also had some deterioration of physical function. These results are indicative of increased frailty in the oldest-old. Comparison between independent and dependent (need care from others in daily living) showed that the functional status was lower in dependent group. However, the psychological well-being was the same in this two groups. These results indicate progressive functional deterioation and psychological adaptation to it, in the oldest-old. Further research to elucidate the process of psychological adaptation to frailty is necessary in order to promote the well-being among the oldest-old, in whom functional limitation is evident.

This study was conducted to clarify the characteristics of cognitive function among physically independent very old people dwelling in an urban community in Japan. Five hundred and thirteen Old-Old (aged 75-84 years) and 168 Oldest-Old (aged 85-100 years) adults participated. We carried out the Mini-Mental State Examination (MMSE) for measuring cognitive functions in the elderly. Age-related differences in the total score and sub-scale scores of the MMSE were analyzed by sex using ANCOVA, controlling for education, vision and hearing problems. Mean MMSE scores for Old-Old and Oldest-Old males were 27.53 and 25.88, respectively, and those for Old-Old and Oldest-Old females were 27.77 and 24.98, respectively. Age-related differences in the MMSE total score between the Old-Old and Oldest-Old were observed in both sexes, suggesting that overall cognitive functions continue to decline over time in very old age. Age-related differences between the Old-Old and Oldest-Old in items measuring, registration, calculation and delayed recall were observed in both sexes, and in addition, time orientation, place orientation, delayed recognition, writing sentences, and copying figures were observed in females. These findings suggest that the faculties are those most sensitive to normal aging among very old individuals. There were no age group differences in five items: reverse spelling, naming objects, repeating a sentence, listening and obeying, and reading and obeying.

Purpose: Previous studies have indicated that memory complaints may predict cognitive decline and dementia among the elderly. The present study was therefore conducted to clarify memory complaint characteristics among elderly dwelling in an urban community in Japan., Method: The participants analyzed in the present study were 453 men and 385 women aged 70 to 84 years living in an urban Japanese community. Data on problems related to memory complaints, cognitive decline (below 24 points on Mini-Mental State Examination), depression (measured by Mini-International Neuropsychiatric Interview), hearing and vision problems, I-ADL (measured by TMIG Index of Competence), self-rated health, age, sex, and years of education were collected at a comprehensive mass health examination for the elderly ("Otasha-kenshin")., Results and Discussion: Twenty-seven percent of male respondents and 32% of female respondents reported having current trouble remembering things (reported as "frequently" or "sometimes"). We collected specific descriptions of the memory complaint difficulties the subjects were experiencing. A quarter of the responses indicated problems with forgetting persons' names, a fifth with forgetting where things had been left, 15% with leaving things behind, and a quarter with prospective memory failure. The results of multivariate logistic regression analysis to explore correlates showed that in men self-rated health and cognitive decline, and in women hearing problems and self-rated health were significantly and independently related to the memory complaint. These findings suggest that in addition to cognitive decline, self-rated health and hearing problems may influence memory complaints, and that memory complaints in men may be a reliable, simple indicator of cognitive decline. We now need to carry out a longitudinal study to clarify predictive validity.

Purpose: This study was conducted to examine age-related differences in cognitive function, and their relation to higher-level competence of elderly living in an urban community., Method: Participants were 438 individuals (males 168, females 270) aged 70 to 84 years living in an urban community in Tokyo. Three cognitive performance tests, the Wechsler Adult Intelligence Scale-Revised (WAIS-R) Digit Symbol, Word Fluency Test, and the WAIS-R Digit Span, were employed for estimating cognitive function, and the TMIG Index of Competence for measuring higher-level competence. In the Index, three constructions: "Instrumental Self-Maintenance", "Intellectual Activity", and "Social Role" were involved., Results and Conclusions: Age-related differences in the cognitive tests were analyzed using ANCOVA controlling for educational year. Age-related differences between younger elderly (70-79 years old) and older elderly (80-84 years old) were observed with the WAIS-R Digit Symbol, Word Fluency Test and the WAIS-R Digit Span. The results indicate that information processing speed, executive function and primary memory in community-dwelling elderly continue to decline in old age, and this trend is salient in the old-old. We carried out partial correlation analysis and multiple regression analysis for exploring the relationships between cognitive function and the sub-scales in the TMIG Index of Competence, controlling for age and educational year. Cognitive function was significantly and positively related with the sub-scales in the Index, this being especially robust for "Intellectual Activity". The results suggest that higher-level competence can be modestly determined with reference to cognitive function, and "Intellectual Activity" may have a stronger relation with cognitive function than the other two sub-scales in the Index.

Purpose: We conducted a comprehensive mass health examination for elderly subjects aged 70 or above, living in the community, to assess early deterioration to long-term care conditions and promote healthy and successful aging ("Otasha-Kenshin"). In this study, we clarified characteristic differences between participants and non-participants., Subjects & Methods: A mass health examination was offered in October 2001 to 863 community elderly, including individuals suffering from falls (and fractures), incontinence, malnutrition, depression, mild cognitive impairment and less of functional capacity. Among the total, 438 (50.8%) opted for the "Otasha-Kenshin" examination. Differences in characteristics between the participants and non-participants were examined, parameters including sex and age distribution, self-rated health, functional capacity by the TMIG Index of Competence, depressed status by the General Health Questionnaire (GHQ), subjective well-being by the Philadelphia Geriatric Center Morale Scale: A revision (PGC-MS), frequency of falls, and prevalence of chronic diseases. The comparison was based on the results of measurements from the final survey conducted in 2000., Results: 1) The participation rate in the "Otasha-Kenshin" was 49.0% in males and 51.0% in females. The average age was 75.3 year olds in participants and 76.4 in non-participants, the difference being significant (t = 3.97, P < 0.0001). 2) Non-participants had a significantly lower level of self-rated health than participants. 3) There was no significant difference in hand grip strength between participants and non-participants. 4) Non-participants showed significantly lower level of functional capacity and subjective well-being, and they were more likely to be in a depressed state than participants. 5) There was no significant difference in fall rate between participants and non-participants. 6) The prevalence of hypertension and diabetes (found in more than 5% among the subjects surveyed in 2000) was not significantly different between participants and non-participants., Conclusion: With aging of society, new and specialized health maintenance systems for the elderly are essential, both for the prevention of deterioration to a long-term care condition (a bed-ridden status) and for the promotion of successful aging with autonomy. Participants in "Otasha-Kenshin" appear to be healthier and more independent than non-participants who were more frail and at higher risk group of a long-term care condition and a bed-ridden status. The major reason for non-participation in the health examination found in this study was subjective or mental deterioration rather than the presence of chronic illness or any geriatric syndrome per se. Frail elderly people like the non-participants in this study should be encouraged and mentally supported to avoid aggravation of their health status through intensive or specialized health surveillance system such as home-visit nursing.

In the past decade, molecular genetics has revealed that some life-threatening arrhythmogenic disorders, such as long QT syndrome, are due to mutated genes encoding ion channels that generate the cardiac action potential. Great efforts made in various fields have partly solved problems caused by unforeseen genetic diversity of these congenital arrhythmogenic disorders, while the genetics of these disorders has recently proved to be applicable to very wide-ranging conditions associated with sudden cardiac death, and increased knowledge about the human genome will revolutionize researches into arrhythmic diseases in future. The purpose of this review is to outline the recent advances and problems in the molecular genetics in long QT syndrome.

To clarify the mechanisms of interaction between adenosine receptor subtypes (A1R and A2R) on 5-HT release, the present study determined the effects of adenosine receptor subtypes on voltage-sensitive Ca(2+)-channels (VSCCs), protein-kinases (PKs) and synaptic-proteins (SNAREs) related 5-HT release using microdialysis in freely moving rat. A1R-antagonists increased basal 5-HT release, which was reduced by inhibitors of N-VSCC, PKC and syntaxin predominantly, and by inhibitors of PKA and synaptobrevin weakly, but was not affected by P-VSCC inhibitor. In the presence of A1R-antagonist, A2R-agonists increased basal 5-HT release, whose action was inhibited by P-VSCC, PKA and synaptobrevin inhibitors predominantly and reduced by N-VSCC, PKC and syntaxin inhibitors weakly. Under the condition of adenylate-cyclase activation in the absence of A1R-antagonists, A2R-agonists increased basal 5-HT release. K(+)-evoked 5-HT release was enhanced by A1R-antagonist and A2R-agonist, whose actions were inhibited by P-VSCC, PKA and synaptobrevin inhibitors predominantly. These results suggest that an activation of A1R suppresses 5-HT release via an inhibition of N-VSCC/PKC/syntaxin and P-VSCC/PKA/synaptobrevin, and an activation of A2-R stimulates 5-HT release via an enhancement of P-VSCC/PKA/synaptobrevin. Therefore PKA activity plays an important role in the interaction between A1R and A2R on hippocampal 5-HT release.

Combination therapy using HCFU and TNP 470, which inhibits angiogenesis, was examined for effectiveness against the footpad injection model of LMFS tumor. This LMFS, a retroperitoneal sarcoma of BALB/c mice, proliferated at the inoculation site (100% take) and all mice operated on after day 15 had spontaneous metastatic nodules in the liver. Mice with the LMFS tumor were given HCFU and 5-FU (5 days/week), and/or TNP 470 (3 days/week) from day 3 for 3 weeks and sacrified at day 28 under anesthesia. Seven of 10 mice receiving 5-FU and TNP 470 died from the side effects of the drugs. Mean tumor weight and liver metastatic nodules were determined and compared with a control group. The results were as follows: HCFU group: 94.6%, 11.8%, 5 FU group: 73.9%, 28.8%, TNP 470 group: 67.6%, 44%, HCFU and TNP 470 group: 33.3%, 6.4%. Mice with LMFS were given HCFU and/or TNP 470 from day 3 for 4 weeks. The foot on the injected side was amputated on day 15, and the animals were sacrified on day 35. Liver metastatic nodules compared with those of the operation (OP) group as follows: OP + HCFU group: 14.4%, OP + TNP group: 39.1%, and OP + HCFU + TNP 470 group: 5.4%. Histologically, 5 of 5 mice of the OP group, 3 of 5 of the OP + HCFU group, 4 of 5 of the OP + TNP 470 group and 1 of 5 of the OP + HCFU + TNP 470 group had liver metastases. These results show that while either HCFU or TNP 470 is effective by itself, a combination of these drugs is more effective against liver metastasis.

We studied the location of the electric generator of photoparoxysmal discharges using a scalp-skull-brain dipole tracing (DT) method. By this method, the location of epileptic discharges on each scalp EEG was calculated as an equivalent current dipole (ECD) in 8 cases of epilepsy who had photoparoxysmal discharges. We divided these cases into groups A and B (4 cases each), comprising of patients with and without visually-induced seizures, respectively. The ECDs of the 3 cases in group A corresponded to the small area adjacent to the lateral geniculate nucleus on MRI superimposed. On the other hand, the ECDs of all cases in group B located at the corpus callosum. This study suggests the pathways of epileptic discharges from the epileptic focus are different between two groups. It is supposed that neural activity of the lateral geniculate nucleus might be responsible for the generator mechanism of photoparoxysmal discharges which evokes photosensitive epilepsy.

Venous angioma is a relatively rare vascular malformation of the brain. It is usually asymptomatic and may be an incidental finding at autopsy or on cerebral angiography. We report a very rare case in which TIA-like attack occurred as the initial manifestation. A 59-year-old woman was hospitalized because of a TIA-like attack about 5 months after left putaminal bleeding. Detailed examination allowed us to make a diagnosis of subcortical venous angioma of the left parietal lobe and multiple cerebral aneurysms. The cerebral aneurysms were treated surgically. Since the angioma was localized in an eloquent area, radiotherapy was chosen first. Angioma giving rise to TIAs is very rare. The ischemia may have been caused by transient venous thrombosis or a steal phenomenon due to a decrease in blood circulation in the left cerebrum caused by the putaminal bleeding.

A 13-year-old girl was struck by a car while riding her bicycle. She was comatose on her arrival at the hospital. Neurological examination revealed no focal sign except for right oculo-motor palsy. She became alert 15 days after the head injury when she first experienced a coarse tremor-like movement on the right arm. Neurological examination showed persistent oculo-motor palsy on the right side, decreased sensation of pain and touch on the left. There was no pyramidal deficit. Her gait and speech were normal and joint sensation was intact. A coarse tremor of the right arm was induced by volitional movements especially such as maintaining the arm in certain posture. It was not present at rest. Trajectory of finger-to-nose test was fairly well. However, the tremor became worse when the patient kept her finger near the target. Occasionally myoclonic-jerk and movement oppositionniste were mixed. Superficial EMG recordings of the tremor revealed 4 c/s rhythmic reciprocal grouping discharges, alternating flexor and extensor muscles. From these features, the abnormal movement should better be called tremor type of hyperkinésie volitionnelle (HV). The HV subsided spontaneously 4 months later. MRI of T2-weighted image showed high-intensity areas corresponding anatomically to the caudal part of right red nucleus and the right superior cerebellar peduncle just before its decussation. It is widely believed that lesions in cerebellar outflow pathway (i.e. dentate, red nucleus and thalamus) can cause HV.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of dietary vitamin E on the fetal ischemic distress induced by clamping the uterotubal vessels of pregnant rats was studied. The fetal heart rate was measured by the pulsed doppler technique as an index of fetal distress induced by ischemia. On reperfusion after clamping the vessels for 9 min., the decreased fetal heart rate was restored to normal rapidly and completely in the E-supplemented group, but slowly and incompletely in the E-deficient and control groups. On reperfusion after ischemia, the amounts of lipid peroxides, measured as thiobarbituric acid (TBA)-reactive substances, were greatly increased in the fetal brain and liver and in the placenta in the E-deficient and control groups, but not in the E-supplemented group. The vitamin E concentrations in fetal tissues were less than 10% of those in the maternal tissues. But a diet containing a large amount of vitamin E induced significantly increased concentrations of vitamin E in fetal brain and liver. These results suggest that vitamin E may have a protective effect on fetal distress by decreasing lipid peroxides.

Unlabelled: The secretion of melatonin (MLT) was examined in 6 ICT patients, 2 men and 4 women, who showed marked midline shift of CT scan findings with intracranial hypertension signs (headache, nausea, vomiting). Their ages ranged from 22 to 40 years. The controls, 6 healthy men and 4 healthy women (follicular stage) were aged from 18 to 35. With the subject recumbent, blood was drawn at 14, 20, 02 and 08 hour (Lights out, 9 pm; sunrise, 6 am). After separation of plasma by centrifugation, MLT was extracted by SEP-PAK C18 cartridge and determined by radioimmunoassay (RIA). (, Method: The extracted MLT, the antiserum and the 3H-MLT were incubated overnight at 4 degrees C, the antibody-combined and free 3H-MLT were separated using ammonium sulfate, and the radioactivity of the precipitate containing combined 3H-MLT was measured by liquid scintillation.) Plasma MLT concentrations of controls were 42.5 +/- 7.0 (Mean +/- SEM) pg/ml at 14 hr, 50.9 +/- 8.2 pg/ml at 20 hr, 165.1 +/- 22.7 pg/ml at 02 hr, and 49.1 +/- 5.4 pg/ml at 08 hr. The value of 14 hr. significantly differed from 02 hr, (P less than 0.01) showing a diurnal rhythm. The patients' MLT levels (pg/ml) were 19.8 +/- 6.2 at 14 hr, 15.9 +/- 5.2 at 20 hr, 52.0 +/- 17.2 at 02 hr, and 20.3 +/- 3.5 at 08 hr. These values were significantly lower than in controls (P less than 0.01) except at 14 hr. (P less than 0.05), showing no diurnal rhythm except 2 cases. In conclusion, in ICT with midline shift of CT scan melatonin secretion was inhibited and diurnal rhythm disappeared in four cases (67%).

A case of SIADH after head injury was encountered and treated successfully with furosemide and hypertonic saline. 250 mg of furosemide was given twice at two hours' interval. The dose of 2.5% saline for the infusion was calculated according to the excretion of sodium in the urine collected during this period. The level of serum sodium quickly rose from 113 mEq/l to 137 mEq/l in 33 hours. The consciousness of the patient returned to normal. The problems of quick correction of hyponatremia including the central pontine neurolysis were discussed.

In order to examine the transfer of antitumor drug in breast cancer after administration of FT-207 suppository, FT and 5-FU concentrations in blood, tumor tissues, normal tissues and axillary lymph nodes were determined respectively. FT and 5-FU concentrations in tumor tissues were higher than those in normal tissues or lymph nodes in every cases, and there was a significant difference between FT and 5-FU concentration in blood and tumor tissues. Blood levels of FT and 5-FU remained quite constant at 16 and 20 hours after administration, respectively. Accordingly, it was suggested that the administration of FT-207 suppository to breast cancer was very effective as an adjuvant chemotherapy.

The effects of a combined chemotherapy of solcoseryl and FT-207 on tumor growth, delayed hypersensitivity and cell population of the spleen were studied using inbred BALB/c mice. Meth-A tumor cells (2 X 10(6] were inoculated into the back of 5 to 6 week old BALB/c male mouse. Animals were divided into three groups: Solcoseryl group, in which 0.04 mg of solcoseryl was injected intravenously three times before inoculation and four times after inoculation; Combined group, in which 1.2 mg of FT-207 and 0.04 mg of solcoseryl were injected intravenously four times after inoculation; FT-207 group, in which 1.2 mg of FT-207 was injected four times after inoculation, with out solcoseryl administration. Following results were obtained: Solcoseryl group showed enhanced immunity and tumor suppression; Decreased immunity due to FT-207 was recovered by administration of solcoseryl but no tumor suppression was observed and, Decreased T-cell population of spleen due to FT-207 was recovered by administration of solcoseryl. These facts suggested that solcoseryl was useful because of making recovery possible from decreased immunity due to chemotherapy.

Perforation of the small intestine occurs rarely in the course of Crohn's disease. A case of perforation of the ileum affected by Crohn's disease was presented. A 92-year-old woman was admitted to the hospital complaining of sudden onset of abdominal pain. Laparotomy revealed peritonitis and two perforations in the diseased ileum. She underwent resection of 60 cm of terminal ileum, ileocecum and adjacent 5 cm of ascending colon with an end-to-end ileocolic anastomosis. The intestinal wall of 40 cm of terminal ileum was thickened and edematous. The bowel lumen was narrow. Several longitudinal ulcers were seen. Histological examination of the resected specimen revealed the perforation in Crohn's disease. The intestinal wall was thickened. The mucosal surface was ulcerated and focally perforated. Ulcerated base was covered by abundant necrotizing mass. The submucosa was replaced by non-caseous inflammatory granuloma comprising with fibroblasts, lymphocytes and plasma cells. Perforated area showed abscess formation with plentiful granulocytes. She died of pneumonia 10 days after operation.

Second-look operations for glioblastomas, one of the most malignant types of brain tumor, were performed after the administration of chemotherapeutic treatments of general-VM 26 plus ACNU, local-MTX, or interferon-beta in each of ten, two, and three cases, respectively. Patients who had received the treatments were divided into two groups, living and deceased, as of August 1982. Therapeutic evaluation was performed with clinical parameters. Among the cases of CR, one (a 14-year-old female) had undergone surgery four times in the four years following onset, and no trace of tumor shadow appeared on the CT grams that were taken one month after the last surgery. Her performance was evaluated as almost 100% (ECOG). In cases of local administration, one case, which had been treated with IFN-beta, demonstrated an apparent decrease in the growth fraction and a pronounced decrease in tumor progression potency. Cell kinetic analyses were also performed, and cell cycle time and growth fraction were estimated by computer with the aid of flow cytometry. Efficacious chemotherapy yielded a decreased value of the growth fraction and an increase in cell cycle time. The decreased value of the growth fraction demonstrates especially well the effectiveness of a chemotherapeutic regimen. The cell kinetic analyses aided in the rational establishment of a chemotherapeutic regimen. Second-look operations for malignant brain tumors will enable more effective refinements in chemotherapeutic regimens and more successful results.

The peritoneal surface of the lesion was observed after treatment by scanning electron microscopy to evaluate the anticancer effect of FT-207. FT-207 (1.0 mg/day) was injected intraperitoneally to the DDN mice in which 3 X 10(7) MM2 tumor cells were inoculated the day before treatment. The anticancer effect was examined from 2nd to 7th consecutive day after tumor cell implantation, and the following results were obtained. 1) In the early phase after injection of FT-207, many macrophage-like cells were observed on the peritoneal surface. 2) Each MM2 tumor cell was covered by many macrophage-like cells, and these tumor cells were destroyed. 3) In the late phase after injection of FT-207, tumor cells were hyperplastic on the peritoneal surface, but less prominent than in the control group. 4) Effusion and adhesion in peritonitis carcinomatosa of FT-207 group were less than in the control group.

Headache and visual impairment resulting from downward migration of the optic system in an acromegalic patient, occurred after one year postoperatively. A 25-year-old woman with eosinophilic adenoma was operated on via transsphenoidal approach and irradiated (5,000 rads) following the operation. After the operation, bitemporal hemianopia was thoroughly improved and serum HGH level was also markedly decreased after radiation therapy. One year later, headache and visual impairment recurred. Pneumoencephalogram revealed that the infundibular and optic recessus of the third ventricle were elongated and descended into the sella turcica. The second operation was performed by subfrontal approach and the optic system was found to be migrated into the sella, which we assumed to be the cause for the recurrence of the headache and visual field defect. In order to prevent this type of complication, it would be recommended to fill up the dead space in the sella with bone or cartilage fragments in addition to muscle pieces, as was suggested by Guiot et al.