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Objectives　Food environment improvement involving salt reduction requires improving access to and labeling low-sodium foods. Assessing the implementation status of these measures is also necessary. However, to date, no established methods exist for assessing the availability of low-sodium foods in communities. In this study, we aimed to devise a survey on the availability of low-sodium foods as a community food environment assessment method in order to establish common assessment methods, criteria, and practical measures, as well as standardization nationwide.Methods　A preliminary survey on the availability of low-sodium foods was conducted in Kitakyushu City in four stores with nationwide representation. Consent for providing information on handled product lists was obtained. The on-site lists collected through direct investigation by surveyors were compared with the handled product lists provided by the stores and analyzed to identify survey challenges and examine feasibility and the potential for accuracy. The definition of low-sodium foods, which emerged as a challenge in the preliminary survey, was confirmed. Preliminary survey data were carefully reviewed to establish classification criteria for low-sodium foods and create a low-sodium food list to serve as a reference for on-site surveys. Forms for recording the results of on-site surveys and a survey manual were developed. Registered dietitians conducted on-site surveys using the manual to confirm its applicability.Results　The preliminary survey results revealed that the on-site lists had fewer omissions and greater feasibility than store-provided lists. After clearly defining low-sodium foods, we established classification criteria (three major categories, seven subcategories, and 37 minor categories) considering the ease of on-site investigations and purchases. Three forms for recording survey results were developed, including a standard input form allowing detailed documentation of the availability of individual low-sodium foods, an aggregation form for a quantitative assessment of low-sodium foods availability, and a display form visualizing the availability of low-sodium foods by store. Furthermore, a survey manual was developed explaining the purpose and approach of the low-sodium foods availability survey, definition and classification criteria for low-sodium foods, and the three forms for recording survey results. Findings indicated that all registered dietitians could conduct on-site surveys using the manual and successfully collect and organize data.Conclusion　On-site surveys using the manual and documentation forms enabled easy and accurate assessments of low-sodium foods availability. Thus, this standardized method to assess the availability of low-sodium foods could be a food environment assessment method for regional salt reduction initiatives.

Objectives: The current status of home blood pressure (HBP) measurement is unknown at a Japanese worksite. We aimed to calculate the proportion of individuals who periodically measured HBP and to explore the demographic and lifestyle characteristics of these workers., Methods: The study included 4,664 employees aged 40-65 years who worked at a retail company and underwent health check-ups in 2018. Multivariable logistic regression models were used to estimate odds ratios (ORs) of participant's demographics and lifestyle characteristics and habits for HBP measurement by sex and medical treatment for hypertension. Periodic HBP measurement was defined as HBP measurements performed two times or more per month (opportunistic HBP measurement) among participants not being treated for hypertension, and daily measurement of HBP (everyday HBP measurement) among participants treated for hypertension., Results: The percentages of opportunistic HBP measurement were 8.7% in males and 12.4% in females not being treated for hypertension. In both sexes, age (ORs per 1-year increment: 1.11 in males and 1.06 in females) and blood pressure (ORs of ≥ 140/90 mmHg: 7.42 in males and 4.71 in females compared with < 130/80 mmHg) were positively associated with opportunistic HBP measurement. Females treated for dyslipidemia (OR: 1.77), who had a self-described fast walking speed (OR: 1.49), and who exercised habitually (OR: 1.79) had significantly high ORs for opportunistic HBP measurement. Females who frequently consumed snacks after dinner had significantly lower ORs (0.65) than those who did not. The percentages of workers who did everyday HBP measurement were 21.6% in males and 25.5% in females treated for hypertension. Males treated for diabetes (OR: 0.23) had significantly lower OR than those who did not. Females treated for dyslipidemia (OR was 0.53), who had uncontrolled hypertension (OR: 0.58), consumed alcohol (OR: 0.60), and frequently ate within two hours before bed (OR: 0.54) had significantly lower ORs. Females who lived alone had significantly higher ORs (2.43) than those who did not., Conclusion: Approximately 10% of individuals not treated for hypertension periodically measured HBP. Age and blood pressure in males and females, and healthy lifestyles in females, were associated with having opportunistic HBP measurement. Approximately 25% of individuals treated for hypertension measured HBP every day. Individuals treated for dyslipidemia or diabetes and females with unhealthy lifestyle and uncontrolled hypertension were less likely to measure HBP every day.

Objectives: In academia, harassment may often occur and remain unrevealed in Japan, which discourages young researchers from pursuing their career. It is necessary to estimate and improve the perception of "academic harassment" among university faculties. Therefore, in this study, we aim to develop a scale of perception of academic harassment., Methods: Prior to a quantitative survey, a task team consisting of medical doctors, researchers, nurses, hospital workers, and managers in general affairs division identified 36 items related to academic harassment. In February 2016, we sent a self-administered questionnaire to 1,126 academic faculty members who worked in a medical university located in Tokyo, Japan. We instructed them to score the extent to which they consider each item as related to academic harassment based on a Likert scale. We carried out maximum likelihood factor analyses with promax rotation and computed Cronbach's alpha to develop a scale and investigate the reliability of the scale., Results: In total, 377 returned the questionnaires (response rate, 33.5%; male, 73.8%). In factor analyses, we removed 17 items owing to low factor loadings, and four factors were eventually extracted. The first factor was termed "Harassment in organization (7 items)" because it included conditions of forcing a particular person to work on chores or lectures for students that may prevent one's academic research outputs. The second factor was termed "Violence and denying personal character (4 items)". The third factor was termed "Research misconduct (5 items)" including conditions of excluding a particular person from the coauthor list of research outputs or pressuring a person to fabricate, falsify, or plagiarize research outputs. The fourth factor was termed "Research interference (3 items)" including a condition of interference with conference attendance. Cronbach's alpha values of these four factors ranged from 0.83 to 0.91, suggesting that the scale had high reliability. The means of these factors did not differ according to gender but were higher in participants aged 50 or older than in younger participants., Conclusions: The results suggest that the scale of perception on academic harassment consisting of four factors with 19 items is valid and reliable to some extent.

Objectives: To clarify the association between job stress and the number of physical symptoms among newly certified female nurses., Methods: In this cross-sectional self-administered survey, we investigated 313 female nurses working at three medical-university-affiliated hospitals in February 2016. We investigated working conditions including numbers of working and on-call hours, work-life balance, Job Content Questionnaire (JCQ) scores, and 16 physical symptoms perceived more often than once a week., Results: Among the 313 participants (mean age, 31.9), 57% were aged 21-29 years and 70% were single. Of the 16 physical symptoms investigated, fatigability was the most frequent complaint (66.1%), followed by lower back pain (44.7%). Univariate analysis showed that significant factors related to physical symptoms are job demands (p<0.001) and social support (p<0.001) in JCQ, binary index of supports (p<0.001), and total working hours per day (p =0.025). Multivariable-adjusted logistic regression analyses demonstrated that the likelihood of reporting a greater number (n≥3) of physical symptoms increased by 7% [95% confidence interval (CI), 2-13%] with a one-unit increase in job demand degree, and decreased by 16% (95% CI, 10-22%) in social support degree. When binary JCQ indexes were assessed, the high-support group [odds ratio (OR) 0.36; 95% CI, 0.23-0.59] was protectively associated with a greater number of physical symptoms while long working hours was significantly associated with a higher risk (OR 18%, 95% CI, 1-38%)., Conclusions: Reporting a greater number of physical symptoms may be a good indicator of job stress perceived by a nurse in a university hospital setting.

Self-measured blood pressure at home is a more accurate prognosticator than the conventionally measured blood pressure, because of the greater number of readings and the avoidance of the white-coat effect and measurement error. Ambulatory blood pressure recordings also have higher reproducibility and provide a better estimate of usual blood pressure and cardiovascular prognosis in individual. Participant-level meta-analysis showed that these out-of-office blood pressure substantially refines risk stratification at conventional blood pressure levels assumed to carry no or only mildly increased risk, in particular in the presence of masked hypertension. Properly designed randomized clinical trials are required to demonstrate whether identification and treatment of high out-of-office blood pressure versus the current standard of care, i.e., not to perform home blood pressure measurement and not to treat people with normotension on conventional measurement, leads to a reduction of cardiovascular complications and is cost-effective.

Encouraging self-medication is expected to reduce healthcare costs. To assess the current situation of self-medication practices in the general population, we conducted a questionnaire survey regarding the use of over-the-counter (OTC) medications or dietary supplements in 1008 participants (37% men; mean age, 64±13 years) from Ohasama, a rural Japanese community. A total of 519 (52%) participants used OTC medications or dietary supplements, with common cold medication (36%) and supplements (28%) such as shark cartilage products representing the most common choices. Stepwise logistic regression showed female gender, a higher frequency of visits from a household medicine kit distributor, dyslipidemia, and lower home systolic blood pressure levels as predictors for the use of such materials (chi-square values: 25.3, 12.6, 7.0, and 4.6, respectively; all p<0.03). Stratifying the participants according to the use of antihypertensive treatment showed a negative association between systolic blood pressure and the use of OTC medications or supplements only in participants being treated for hypertension. These results suggest that although the adoption rate of self-medication in Japan can be increased in rural areas, it may remain lower in urban areas. The present study clarifies the factors associated with the use of OTC medications or dietary supplements and indicates that appropriate self-medication practices might improve the control of hypertension, particularly in patients undergoing antihypertensive treatment.

Aim: To investigate the reliability and validity of the Japanese version of the abbreviated Lubben Social Network Scale (LSNS-6), which is used worldwide as a screening tool for social isolation in elderly individuals., Methods: An interview-format questionnaire survey was given to 232 elderly community residents undergoing general health checkups. In addition to the Japanese version of the LSNS-6, other questionnaire items regarding social support, the Japanese version of the Zung Self-Rating Depression Scale (SDS), base attributes, and self-ratings of health, physical function and suicidal ideation were obtained. The internal consistency, test-retest, and interrater reliability of the Japanese version of the LSNS-6 were determined using the Cronbach α correlation, Spearman correlation, and intraclass correlation coefficients, respectively. Construct validity was investigated by comparison with the results of a previous study, while concurrent validity was determined in relation to SDS scores as well as questionnaire items on social support., Results: The Cronbach α coefficient was 0.82, the correlation coefficient for the test-retest was 0.92 (P<0.001), and the intraclass correlation coefficient for interrater reliability was 0.96 (95% confidence interval [CI] 0.90-0.99). Mean scores on the Japanese version of the LSNS-6 increased as the number of household members increased (P=0.033), but decreased among elderly individuals at risk of suicide (P=0.026), and tended to decrease among those with a poor self-rated health score (P=0.081). Scores on the Japanese version of the LSNS-6 had a significant negative correlation with SDS scores (P<0.001) On 4 of the 5 questionnaire items on social support, and those without social support had significantly lower mean scores on the Japanese version of the LSNS-6 (P<0.05) than those with social support., Conclusions: We confirmed the reliability and validity of the Japanese version of the abbreviated LSNS-6.

In recent years soaring medical costs have become a major social problem in developed countries. Ambulatory blood pressure (ABP) measurements have a stronger predictive power for cardiovascular events than clinic blood pressure (CBP) measurements. Therefore the introduction of ABP measurement for the diagnosis and treatment of hypertension should lead to a decrease in medical expenditure. This study presents calculations of the cost saving and life years associated with changing from CBP to ABP measurement as diagnostic tool. We constructed a Markov model using data from the Ohasama study and a Japanese national database. Study population was 7.042 million individuals aged 40 years and above living in Japan. The introduction of ABP for hypertension would result in a reduction of about 9.48 trillion yen per 10 years. We conducted a sensitivity analysis and found that the introduction of ABP was associated with at least a cost reduction of 47500 billion yen. But it did not provide significant extension of average life years. However the introduction of ABP for hypertension treatment would be a very effective method in perspective of public health because it reduced about 59600 individuals of stroke and about 18900 individuals of death. Given its cost-effectiveness, extensive application of ABP measurement in clinical practice is expected.

Ambulatory and home blood pressure (BP) measurements more accurately and reliably reflect the true BP levels of individuals than conventional BP measurement. Moreover, they can be measured over an extended period, thus generating information about BP variability. We conducted a population-based prospective study in Japan (the Ohasama study), demonstrating their superior predictive power for cardiovascular mortality/morbidity over conventional BP measurements as well as unique prognostic significance of variability in their values. Masked hypertension defined as normal conventional BP and high ambulatory or home BP was associated with worse prognosis. A disturbed nocturnal decline in BP was associated with cerebral infarction and heart diseases, whereas a large morning surge in BP was associated with cerebral hemorrhage. Morning hypertension at home, a reflection of a disturbed nocturnal decline or a large morning surge in BP, was a good predictor of stroke, particularly among individuals using anti-hypertensive medication. The J-HOME (Japan Home versus Office Measurement Evaluation) study among hypertensive patients receiving antihypertensive treatment revealed that morning home BP levels were not adequately controlled among approximately 60% of the patients. Interim analysis of the HOMED-BP (Hypertension Objective treatment based on Measurement by Electrical Devices of Blood Pressure) study, a randomized controlled trial to determine optimal target of morning home BP, demonstrated effectiveness of systematic antihypertensive drug regimen to lower morning home BP levels. The diagnosis and treatment of hypertension can be managed effectively by considering information from home and ambulatory BP monitoring.

Mild hypertension(stage 1 hypertension at ESC-ESH guideline 2007) defined as systolic blood pressure 140-159 mmHg and/or diastolic blood pressure 90-99 mmHg has been described as an established risk factor for cardiovascular events in guidelines on hypertension. Many trials have established the usefulness of treatment to moderate and severe hypertension with blood pressure levels of 160/100 or more. Some recent trials including patients with mild hypertension have also shown that antihypertensive treatment significantly reduced the risk of cardiovascular events, especially in patients with history of cardiovascular disease or diabetes. However, more studies are required to clarify the most appropriate antihypertensive drugs for the treatment of mild hypertension.

Calcium channel blockers are most commonly used in hypertensive patients in Japan. However, information on the efficacy and safety of generic calcium channel blockers is insufficient. The objective of the present study was to retrospectively evaluate the efficacy and safety of manidipine hydrochloride in 21 essential hypertensive patients (mean age; 70.6+/-10.6 years, male/female; 14/7) in Sendai Postal Services Agency Hospital who were switched (substituted) from a brand product (Calslot) to a generic product (Manidip). For this retrospective study, we used data from patient medical records and drug prescription information. Data from patients who were taking both types of manidipine hydrochloride, whose regimen were not changed for > 6 months before and after switching, and who provided informed consent were included in the analysis. Control values of blood pressure were not significantly different between before and after substitution (systolic/diastolic; from 137.9+/-9.1/78.7+/-5.4 mmHg to 137.3+/-9.1/77.8+/-6.3 mmHg, p=0.73/p=0.36). The level of patient compliance for the antihypertensive drugs was also not different between before and after substitution (from 94.0+/-8.8% to 93.1+/-9.6%, p=0.72). There were 8 cases of adverse effects before substitution and 4 after substitution. No patient stopped taking the generic drug due to an adverse effect. In conclusion, significant differences in the efficacy, safety, and patient compliance were not observed between the brand product and generic product among patients who were switched from the brand product to the generic product.

Systolic blood pressure elevates with increase in age. The frequency of white-coat hypertension and masked hypertension also increase with increase in age. Elderly persons tend to have abnormal circadian rhythm of blood pressure. Home blood pressure measurements are very useful to determine such pathophysiological conditions. Home blood pressure is useful not only for diagnosis of hypertension but also for treatment and management of hypertension; i.e. choice and titration of antihypertensive drugs. A minimal antihypertensive effect and duration of action of antihypertensive drugs are determined by home blood pressure measurements: the latter is established by the comparison of the antihypertensive effect of the drug in the morning with that in the evening, i.e. morning-evening ratio (ME ratio).