Search

Aim: In order to understand the digital divide among older adults during the coronavirus disease 2019 (COVID‐19) pandemic, we investigated the association between internet use and compliance with COVID‐19 preventive behaviors during the first state of emergency in Japan. Methods: A total of 8952 community‐dwelling citizens aged 75 years and above were asked about their preventive behaviors during the first state of emergency using a paper‐based questionnaire. Among them, 51% responded and were divided into internet users and non‐users. We used multivariable logistic regression models to estimate the adjusted odds ratios and 95% confidence intervals of internet use for compliance with preventive behaviors. Results: Approximately 40% of the respondents used the internet, and 9.29% used social media to collect COVID‐19‐related information. Internet usage was independently associated with compliance with using hand sanitizers, avoiding going out, avoiding eating out, avoiding traveling, getting vaccinated, and getting tested for COVID‐19; the adjusted odds ratios (95% confidence intervals) were 1.21 (1.05–1.38), 1.19 (1.04–1.37), 1.20 (1.05–1.38), 1.32 (1.15–1.52), 1.30 (1.11–1.53), and 1.23 (1.07–1.41), respectively. Exploratory subgroup analyses demonstrated that social media users might have shown early adaptation to newly recommended preventive behaviors during the first state of emergency. Conclusions: Results suggest that a digital divide exists, as evidenced by the varied compliance with preventive behaviors depending on internet use. Additionally, social media use may be associated with early adaptation to newly recommended preventive behaviors. Therefore, future studies regarding the digital divide among older adults should investigate differences depending on the types and content of internet resources. Geriatr Gerontol Int 2023; 23: 289–296. [ABSTRACT FROM AUTHOR]

Objective: Two percent of the Japanese population is comprised of foreign residents with further increase expected due to immigration policy revisions. The purpose of this paper is to examine the healthcare needs and difficulties experienced by foreign residents in Japan by level of their Japanese language fluency. Design: A quantitative, descriptive design was used. Sample: We surveyed foreign residents in the greater Tokyo area (N = 209). Measurements: The research team created the survey questions and the contents of the survey include foreign residents' experiences during their visits or stays at medical and public health facilities in Japan. Results: More than 90% of the participants or their families visited medical facilities in Japan regardless of Japanese language fluency; however, those with less Japanese language fluency experienced statistically significant uneasiness or inconvenience concerning communication compared to those with native Japanese language fluency (p =.000). Conclusions: Nurses in Japan may benefit from additional training related to use of interpreters as well as education about diversity and cultural humility. Through better understanding of the specific communication barriers of foreign residents, nurses will be able to better anticipate difficulties and address them. [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]

Aim: The paper examines recent time trends, explores potentially influential background factors and discusses prevention strategies of pregnancy among girls under 15 years of age in Japan. Methods: Using Japanese government data, we first analyzed time trends of early adolescence (<15 years of age) abortion, live birth and child sexual abuse from 2003 to 2010. Second, we analyzed ecological correlations of early adolescent pregnancy (abortion, live birth and stillbirth) with pregnancy in other age groups, child sexual abuse, and indicators of juvenile victimization and juvenile delinquency, using prefectural data. Results: We found that rates of both abortion and live birth in early adolescents have increased since 2005 (annual percent change 5.3% and 2.3%, respectively), despite declining rates in older age groups. The abortion ratio in early adolescence remained the highest among all age groups in Japan. The early adolescent pregnancy rate showed significant correlation with the rates of juvenile victimization of welfare crimes (obscenity, alcohol drinking, smoking and drug use) ( Spearman's rank correlation coefficient [rs] = 0.42, P = 0.00) and juvenile delinquency among junior high school students (12-14 years of age) (rs = 0.69, P = 0.00). Conclusion: The observed rise in rates of abortion, live birth and child sexual abuse among early adolescents along with strong ecological correlations of their pregnancy rate with juvenile victimization and delinquency indicators suggests that epidemiological investigation and public health programs at the individual and community levels are needed to address the complex social roots of these trends and to produce effective improvements in early adolescent reproductive health. [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]

Aim: This study aimed to investigate the relationship between the distance and travel time from each municipality to the nearest delivery facilities in the other municipalities and the frequency of out‐of‐facility deliveries in Hokkaido. Methods: Vital statistics from 2016 to 2020 were used. For municipalities without delivery facilities, the distance and travel time from the town office of each municipality to the nearest delivery facility was measured using Google maps. Negative binomial regression with an offset term was used to calculate the relative risks (RRs) and 95% confidence intervals (CIs) of out‐of‐facility delivery for distance (<30, 30–59, ≥60 km), and travel time by car (<30, 30–59, and ≥60 min) from the town office to the nearest delivery facility compared with the presence of delivery facilities. Results: The overall rate of out‐of‐facility deliveries in Hokkaido was 2.1‰; in municipalities with delivery facilities, 1.8‰, and in municipalities without delivery facilities, 3.1‰. The adjusted RRs (95% CIs) for out‐of‐facility deliveries were significantly higher in municipalities with less than 30 km and travel time of less than 30 min to delivery facilities, 2.63 (1.34–5.17) and 2.76 (1.36–5.58), respectively, compared to municipalities with delivery facilities. However, the adjusted RR of out‐of‐facility delivery for municipalities ≥30 km was higher, although the difference was not significant. Conclusions: Even in municipalities with a distance to delivery facilities of less than 30 km or travel time of less than 30 min, we should keep in mind the occurrence of out‐of‐facility deliveries. [ABSTRACT FROM AUTHOR]

Aim Subjective memory complaints scales are expected to be useful for the prediction of future cognitive decline. In Japan, the 'Kihon Checklist-Cognitive Function' (KCL-CF), which consists of three items, is used for primary screening of high-risk older adults. However, the predictive validity of the KCL-CF remains unknown. The aim of the present cohort study was to examine whether the KCL-CF can predict the incidence of dementia. Methods Information on the KCL-CF score (0-3 points) was collected from community-dwelling older adults (≥65 years) through a questionnaire. Data on incident dementia were retrieved from the Long-term Care Insurance database. The Cox model and receiver operating characteristic curve analysis were used. Results Among 13 974 participants, the 5.7-year rate of incident dementia was 8.8%. All KCL-CF items significantly predicted the risk of incident dementia even after adjustment for age and sex ( P-trend < 0.0001). A higher KCL-CF score was associated with a higher risk of dementia; the age- and sex-adjusted hazard ratios (95% confidence interval) were 1.00 (reference) for a KCL-CF score of 0 points, 1.89 (1.65-2.15) for 1 point, 3.01 (2.59-3.50) for 2 points, and 6.20 (4.87-7.90) for 3 points ( P-trend < 0.0001). A cut-off score of ≥1 points had a specificity of 65.1% and a sensitivity of 60.2%, and the area under the receiver operating characteristic curve was 0.65 (95% confidence interval 0.63-0.66). Conclusions The KCL-CF was able to predict incident dementia. However, because a false-negativity rate of approximately 40% would be expected, the KCL-CF score alone might not be sufficient for screening of dementia incidence. Geriatr Gerontol Int 2017; 17: 1300-1305. [ABSTRACT FROM AUTHOR]

Background Both in vivo and in vitro studies have indicated that edible mushrooms may have preventive effects against cognitive impairment. However, few cohort studies have yet examined the relationship between mushroom consumption and incident dementia. Objective We examined the relationship between mushroom consumption and incident dementia in a population of elderly Japanese subjects. Design Prospective cohort study. Setting Ohsaki Cohort 2006 Study. Participants 13,230 individuals aged ≥65 years living in Ohsaki City, northeastern Japan. Measurements Daily mushroom consumption, other lifestyle factors, and dementia incidence. Results The 5.7 years incidence of dementia was 8.7%. In comparison with participants who consumed mushrooms <1 time/wk, the multi-adjusted HRs (95% CI) for incident dementia among those did so 1-2 times/week and ≥3 times/week were 0.95 (0.81, 1.10) and 0.81 (0.69, 0.95), respectively ( P-trend <.01). The inverse association persisted after excluding participants whose dementia event occurred in the first 2 years of follow-up and whose baseline cognitive function was lower. The inverse association did not differ statistically in terms of vegetable consumption ( P-interaction = .10). Conclusions This cohort study suggests that frequent mushroom consumption is significantly associated with a lower risk of incident dementia, even after adjustment for possible confounding factors. [ABSTRACT FROM AUTHOR]

Background: Father's closeness and playful behavior influence a child's emotional and cognitive development. In this study, we aimed to assess the long‐term association of paternal involvement in childcare at 1–3 years of life on subsequent behavioral outcomes at 8 years of age. Methods: Data were obtained from the 2010 cohort of the Longitudinal Survey of Newborns in the 21st century in Japan. We used group‐based trajectory modeling to predict the trajectory of total childcare scores in surveys 1, 2 and 3 to determine the overall involvement of fathers in childcare during early childhood. The level of fathers' involvement in childcare was categorized as "low", "medium" and "high". Responses from the eighth survey were used to assess child behavioral outcomes using five indicators when the child was 8 years old. Crude and adjusted logistic regression analysis was conducted to estimate the odds ratio (OR) separately for each of the behavioral outcomes of the child. Results: Among the 17,027 father‐child dyads included in this study, two‐thirds of the fathers were of the age group 30–39 years. Compared to low involvement, children of fathers with high involvement in childcare during the early childhood years were less likely to not want to go to school even after adjusting for covariates (adjusted OR, 0.46; 95% CI: 0.32–0.66). Conclusions: Children benefit from their fathers' involvement in early childcare activities. To improve a child's well‐being, fathers should be encouraged by providing them with a suitable working environment with flexible arrangements and the opportunity to involve in childcare. [ABSTRACT FROM AUTHOR]

Background: The RASopathies (Noonan syndrome [NS] and Costello syndrome [CS]) are rare disorders. Although these have been characterized, precise delineation of the differences in the spinal deformities associated with RASopathy has not been described. This study characterized the spinal deformities found in NS and CS and describes a strategy for the screening of scoliosis. Methods: The clinical records and spinal X‐rays of 35 consecutive NS and CS patients were reviewed. Spinal X‐rays were assessed to define the presence and progression of scoliosis. Clinical records were examined to identify the risk factors associated with scoliosis. In addition, we investigated the association between clinical records and scoliosis using logistic regression analysis. Results: Twenty‐four patients with NS and 11 with CS were included. Nine patients with NS and five with CS showed scoliosis. The mean ± SD age at diagnosis was 12.6 ± 2.4 years in NS and 11.4 ± 2.5 years in CS (p = 0.55), and mean follow‐up period was 4.8 ± 2.6 years and 6.3 ± 2.4 years (p = 0.42), respectively. The coronal angular deformity at final follow‐up was 27.3 ± 8.5° in NS and 19.4 ± 6.9° in CS (p = 0.030) with a mean annual progression of 2.8 ± 1.1° in NS 1.0 ± 1.0° in CS (p = 0.030). Cardiac disease was present in eight out of nine patients with NS with concomitant scoliosis in NS, and significantly more than in CS (p = 0.007). PTPN11 significantly correlated with scoliosis (odds ratio 12.4 0.035, 95% confidence interval: 1.20–128.00). Conclusions: Spinal deformity in NS is more severe than in CS. This study identified a relationship between PTPN11 and scoliosis. Therefore, PTPN11 can be used for the screening of scoliosis. [ABSTRACT FROM AUTHOR]

Objective This systematic review aimed to evaluate the scientific evidence on the efficacy of desensitizing mouthwashes for the treatment of dentin hypersensitivity ( DH) and root sensitivity ( RS). Material and methods A thorough search in MEDLINE, PubMed and Cochrane Plus Library was conducted up to February 2015. Randomized clinical trials, parallel, double-blinded and placebo-controlled, with a follow-up of at least 6 weeks, reporting changes on response to tactile stimuli, thermal/evaporative stimuli or patients' subjective assessment of the pain experienced during their daily life after the home use of desensitizing mouthwashes were considered for inclusion. Results The screening of titles and abstracts resulted in seven publications meeting the eligibility criteria. The desensitizing agents evaluated were potassium nitrate ( n = 5), aluminium lactate ( n = 1) and sodium fluoride ( n = 1). A meta-analysis for each of the hypersensitivity stimuli was performed. Results demonstrated statistically significant reduction in sensitivity scores favouring test group when DH was assessed by means of patients' self-reported pain experience ( SMD at 8 weeks = 0.77; 95% CI [0.23; 1.31]; P = 0.005). No significant effects were detected in response to tactile or thermal/evaporative stimuli. Meta-regression analysis demonstrated a tendency towards an increased effect favouring test group for the patients' subjective perception, whereas tactile and thermal/evaporative stimuli showed a slight tendency towards a reduction in the efficacy of the test mouthwash. Conclusions There exists a tendency towards a decrease in DH or RS scores with time in both treatment groups, with significant differences in favour of test group when sensitivity is evaluated in terms of patients' self-reported sensitivity symptoms. [ABSTRACT FROM AUTHOR]

Background: Patients in intensive care units (ICU) are frequently prescribed sedatives, which might increase the risk for pressure injury (PI). Although the association between sedation and incidence of PI has been noted, the adequate sedation level to prevent the incidence of PI in patients admitted to ICU is still unclear. Aim: This study aimed to investigate the association between fluctuating sedation levels and the incidence of PI in patients admitted to ICU. Study Design: We retrospectively reviewed the medical records of 104 patients admitted to ICU. Data regarding the length of ICU stay (LOS) and comorbid infection were abstracted from medical records. The Richmond Agitation‐Sedation Scale (RASS) was scored twice per day, and the standardized RASS (S‐RASS, summation of RASS values divided by the number of samples) was used to evaluate changes in sedation levels. Results: Among the 104 included patients, 65 patients (62.5%) were male (median age: 68.0 years), and 13 patients (12.5%) had PI during ICU admission. S‐RASS scores were lower in patients with PI than in those without PI (P =.0001) even after adjustment for confounders (OR [95%CI]: 0.14 [0.03–0.58], P =.006). The LOS and infections were higher in patients with PI than in those without PI (P <.0001 and P =.005, respectively). The cut‐off value of S‐RASS for PI incidence was −3.2 (sensitivity: 88%; specificity: 85%), and a significant predictor of PI incidence (HR [95%CI]: 20.07 [2.53–159.11], P =.005). Conclusions: Deeper sedation levels based on S‐RASS scores, which account for the effects of fluctuating sedation levels, were a strong, highly accurate predictor of PI incidence in patients admitted to ICU. Relevance to Clinical Practice: Assessing fluctuations in the level of sedation using the S‐RASS might help to identify sedative‐induced PI in patients admitted to ICU. [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]

Aim: Hiesho is a condition characterized by having a cold sensation in the hands or feet (i.e., sensitivity of the hands or feet to cold). This condition is common among Japanese women and is an important health problem. In this study, we aimed to evaluate a hiesho intervention program for nurses called "Preventing Hiesho: Intervention Program for Educating Nurses" in terms of its effectiveness in improving the knowledge and perceptions of nurses about the importance of hiesho care. Methods: A total of 130 nurses from Japanese hospitals and clinics providing prenatal care participated in our randomized controlled trial. Sixty‐eight nurses participated in the "Preventing Hiesho: Intervention Program for Educating Nurses" for 2 weeks (intervention group). Sixty‐two nurses received a pamphlet on hiesho care (control group). The responses of the participants to the questionnaire survey were collected by postal mail. An intention‐to‐treat analysis of the results was conducted. Results: One week after the implementation of the web‐based learning program, the scores of knowledge and perceptions of the importance of administering hiesho care were significantly higher in the intervention group than in the control group. Conclusions: A 2‐week web‐based learning program for educating nurses on preventing hiesho significantly improved their knowledge and perceptions of the importance of hiesho care. [ABSTRACT FROM AUTHOR]

Aim: Despite a growing interest in decision‐making by care recipients, few empirical studies have examined the everyday care decisions of community‐dwelling older adults. This study aimed to examine the association of recipient‐ and caregiver‐related factors with decision‐making involvement of community‐dwelling older care recipients. Methods: We conducted secondary data analysis using publicly available cross‐sectional data from a dyadic survey with care recipients aged ≥65 years and their primary caregivers in two regions of Japan, one urban and another rural, in 2003. In total, 643 pairs with no missing data on any variable were included in the analysis. The level of care recipients' perceived decision‐making involvement was assessed using one dichotomized item (not involved or involved). We examined care recipient‐ and caregiver‐related factors described by previous studies as having the potential to inhibit or facilitate care recipient's subjective decision‐making involvement. Results: Of the care recipients, 60.2% were women, 72.2% were >75 years, and 83.7% were involved in decision‐making. Of the primary caregivers, 72.0% were women, 49.0% were <65 years, and 47.9% were spouses. Multivariable logistic regression analysis showed that care recipients were more likely to be involved in decision‐making when their caregivers respected their decisions (odds ratio = 3.03 [95% confidence interval: 1.90–4.86], P < 0.001). Care recipients with more care needs were less likely to be involved in decision‐making than those with less care needs (odds ratio = 0.53 [95% confidence interval: 0.32–0.89], P = 0.015). Conclusions: Our results suggest that family caregivers play a crucial role in increasing care recipients' decision‐making involvement regarding daily care. Geriatr Gerontol Int 2022; 22: 876–882. [ABSTRACT FROM AUTHOR]

Aim: In sarcopenic dysphagia, confirmation of recovery of the swallowing function and activity of daily living is insufficient. The aim of this study was to examine differences in the recovery of the swallowing function and activities of daily living between sarcopenic dysphagia patients and non‐sarcopenic dysphagia patients. Methods: The registry data of the Japanese Sarcopenic Dysphagia Database were used for the analysis; 440 patients met the eligibility criteria of the study. Dysphagia was evaluated according to the Food Intake Level Scale and a five‐step diagnostic algorithm for the disorder. Patients were divided into two groups according to the presence or absence of sarcopenic dysphagia. Results: Sarcopenic dysphagia was found in 268 cases (60.9%). The rate of improvement in the Food Intake Level Scale was 47.4% in sarcopenic dysphagia patients and 62.2% in non‐sarcopenic dysphagia patients. The rate of improvement in the Food Intake Level Scale was lower in the sarcopenic dysphagia patients (P = 0.008). A multiple regression analysis showed that the presence of sarcopenic dysphagia had a significant influence on changes in the Food Intake Level Scale and Barthel Index (β = −0.191, 95% confidence interval, −1.484 to −0.530, P < 0.001, β = 0.112, 95% confidence interval, 0.587 to 10.450, P = 0.028). Conclusion: Improvement in the swallowing function was poor in patients with sarcopenic dysphagia. Sarcopenic dysphagia should be examined to improve swallowing function. Geriatr Gerontol Int 2022; 22: 839–845. [ABSTRACT FROM AUTHOR]

Background: Direct oral anticoagulants (DOACs) have been used for both primary and secondary prevention of cerebral infarction in older patients with atrial fibrillation (AF). However, whether DOACs are more effective and safer than warfarin for secondary prevention of cerebral infarction in older patients with AF remains unclear. Methods: Using the Japanese Diagnosis Procedure Combination database, we identified patients with AF who were hospitalized for cerebral infarction from January 1, 2015 to March 31, 2019 and were aged ≥75 years at admission. We performed propensity score‐stabilized inverse probability of treatment weighting analyses to balance measured confounders between patients with AF receiving DOACs and those receiving warfarin after discharge. The primary outcomes were 365‐day readmission for (a) benefit: cerebral infarction or (b) harm: bleeding events after discharge. The secondary outcomes were 365‐day readmission for intracranial bleeding or gastrointestinal bleeding after discharge as well as all‐cause death during readmission. Using a Fine–Gray model, we compared the subdistribution hazard ratios (SHRs) of readmission between the DOAC group and warfarin group. Results: We identified 101,389 eligible patients, including 80,726 patients receiving DOACs and 20,663 patients receiving warfarin. After the propensity score‐stabilized inverse probability of treatment weighting, the adjusted SHRs of readmission (95% confidence interval [CI]) for cerebral infarction, bleeding events, and intracranial bleeding in the DOAC group as compared with the warfarin group were 0.76 (0.71–0.81), 0.78 (0.68–0.90), and 0.69 (0.57–0.82), respectively. There was no significant difference in readmission for gastrointestinal bleeding (SHR, 1.01; 95% CI, 0.72–1.41) between the DOAC and warfarin groups. Conclusion: In this retrospective nationwide study, DOACs were more effective and safer than warfarin for preventing reinfarction and bleeding events in patients with AF aged ≥75 years who have a history of cerebral infarction. [ABSTRACT FROM AUTHOR]

Aim: To estimate the risk of disability associated with high‐risk prescribing, such as polypharmacy and drugs with sedative or anticholinergic properties, using long‐term care needs certification as a proxy of incident disability. Methods: A case–control study nested within a cohort of older adults (89% aged ≥65 years) was carried out between 2014 and 2019 using the combined medical claims and long‐term care needs certification database of Tsukuba City, Japan. We identified 2123 cases who received their first long‐term care certification, and matched them to 40 295 controls based on age, sex, residential area and observation period (≥36 months). The risk of long‐term care needs certification associated with high‐risk prescribing exposure 7–30 months before the index month was estimated using conditional logistic regression adjusting for baseline comorbidities and health service use. Results: Polypharmacy (5–9 drugs; adjusted odds ratio [aOR] 1.32, 95% confidence interval [95% CI] 1.18–1.47), hyperpolypharmacy (≥10 drugs; aOR 1.87, 95% CI 1.57–2.23) and cumulative dose of drugs with sedative or anticholinergic properties (1–364 defined daily dose [DDD]; aOR 1.07, 95% CI 0.97–1.19; 365–729 DDD; aOR 1.25, 95% CI 1.07–1.45; ≥730 DDD; aOR 1.33, 95% CI 1.19–1.62) had dose–response relationships with long‐term care certification risks. Conclusions: High‐risk prescribing was associated with the risk of long‐term care needs certification in the general older population. Further studies are warranted to examine whether a decrease in prescribing drugs with sedative or anticholinergic properties could reduce the long‐term care burden on society. Geriatr Gerontol Int 2022; 22: 497–504. [ABSTRACT FROM AUTHOR]

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

Aim: There is a chronic shortage of obstetrician‐gynecologists in Japan. To increase the number of obstetrician‐gynecologists, it is crucial to increase the number of residents being recruited. The purpose of this study was to identify the factors that led students and interns to specialize in obstetrics and gynecology through a questionnaire survey. Methods: We sent a questionnaire to the obstetrics and gynecology departments of all the medical schools in Japan (N = 81) and collected data about the institutional background, including the location, total number of obstetrician‐gynecologists employed, and number of newly joined obstetrics‐gynecology residents and resigned obstetrician‐gynecologists and the educational and recruitment activities for medical students and interns. The net balance (increased or decreased) over the fiscal years 2013–2015 was considered a surrogate marker for the number of newly joined obstetrics‐gynecology residents. We used binomial logistic regression analysis to determine the factors related to a positive net balance of obstetrician‐gynecologists. Results: We obtained responses from 59 (72.8%) medical schools. Medical students who observed deliveries were more likely to become obstetrician‐gynecologists than those who did not (95% confidence interval: 1.000–1.045, p = 0.052). Medical school location (rural or urban), providing medical students with preparatory lectures for national board examinations, and providing interns with experience as the first assistant during surgery were not associated with an increase in the number of newly joined obstetrician‐gynecologists. Conclusions: The experience of observing deliveries may encourage medical students to become obstetrician‐gynecologists. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether the type and frequency of social interaction during the state of emergency due to coronavirus disease were associated with self‐rated health (SRH) after the state of emergency. Methods: Data from a cross‐sectional study were collected for 889 oldest‐old adults in Bibai City, Hokkaido, Japan. In total, 612 participants (mean age: 83.0 ± 4.3 years; women: 51.8%) were included in the analysis, taking biological sex into account. The self‐reported questionnaire included questions about demographic variables, SRH (July 2020, after the emergency), and the type and frequency of social interaction (March 2020, during the state of emergency). Results: There was no significant association between social interaction and SRH in men (P > 0.05). Women who had social interactions (both face‐to‐face and non‐face‐to‐face) more than once a week during the state of emergency reported higher SRH after the emergency than those who did not (odds ratio 2.17, 95% confidence interval 1.07–4.41). Conclusions: Having both types of interaction more than once a week during the state of emergency was related to higher SRH after the emergency among oldest‐old women. It is suggested that having opportunities for both types of interaction at least once a week would potentially be beneficial for high SRH in women, even in situations where the declaration of a state of emergency restricts face‐to‐face interaction. Geriatr Gerontol Int 2022; 22: 405–411. [ABSTRACT FROM AUTHOR]

Aim: This study examined the maternal experience of threatened abortion, threatened premature labor, or preterm birth before, during, and after the first state of emergency for COVID‐19 in 2020 in Japan. Methods: This was a cross‐sectional, internet‐based questionnaire survey. We recruited 600 postpartum women and divided them into three groups by date of delivery: before (October 2019–March 2020), during (April–May 2020), and after (June–October 2020) the first state of emergency. The outcome was the presence of at least one of the following complications: threatened abortion, threatened premature labor, and/or preterm birth. The prevalence ratios (PRs) of the outcome were calculated and compared among the three groups using a multivariable Poisson regression model with adjustment for potential confounders. Results: Of the 553 women eligible for analysis, those who delivered during (PR 0.69, 95% confidence interval [CI] 0.47–0.99) and after (PR 0.62, 95% CI 0.42–0.90) the state of emergency were less likely to have experienced either threatened abortion, threatened premature labor, or preterm birth than those who delivered before the state of emergency. Among the adjustment variables, smoking at the time of survey (PR 1.68, 95% CI 1.01–2.80) and living in the prefectures with a population of >5 million (PR 0.71, 95% CI 0.51–0.97) were associated with the study outcome. Conclusion: Threatened abortion, threatened premature labor, or preterm birth appeared to decrease during and after the first state of emergency in 2020. The longitudinal effects of coronavirus disease on maternal and newborn health should be monitored continuously. [ABSTRACT FROM AUTHOR]

Aim: Identification of modifiable intrinsic factors for occupational falls is required for initiating effective fall prevention strategies for older workers. This study aimed to identify modifiable intrinsic factors related to falls during occupational activities among older workers. Methods: This retrospective study involved 1164 older workers (aged ≥60 years, workdays ≥4/month) sampled from 18 public employment agencies for seniors in Saitama, Japan. Participants were assessed regarding the following 10 modifiable intrinsic factors: multimorbidity, polypharmacy, fall‐risk‐increasing medication use, self‐rated vision and hearing, functional strength, bilateral stepping, standing balance, executive function and visuospatial ability. The number of falls during occupational activities in the past year was also recorded. Results: In total, 111 falls occurred in 73 of the 1164 participants during occupational activities in the past year. A negative binomial regression model showed that use of fall‐risk‐increasing medications (incidence rate ratio [IRR]: 2.23, 95% confidence interval [CI]: 1.08, 4.60, P = 0.031), reduced functional strength (IRR: 1.81, 95% CI: 1.02, 3.21, P = 0.042), poor standing balance (IRR: 1.83, 95% CI: 1.09, 3.09, P = 0.023) and poor visuospatial ability (IRR: 1.56, 95% CI: 1.03, 2.36, P = 0.034) were independently associated with occupational falls. Conclusions: Our findings suggest that the assessment of medication use, functional strength, standing balance and visuospatial ability in regular health checks in the workplace may be useful for screening older workers at risk of occupational falls. Geriatr Gerontol Int 2022; 22: 338–343. [ABSTRACT FROM AUTHOR]

This study examined the association between adding nurse aides and patient mortality in acute care settings. We conducted a retrospective cohort study using a national healthcare administrative claims database. We identified patients who underwent planned surgery for six types of cancer from 2010 to 2017. Multivariable logistic analyses were used to examine the association between the nurse aide staffing level and patient outcomes. The primary outcomes were failure to rescue and 30‐day hospital mortality. We examined 330 666 in‐hospital patients. The median number of nurse aides per 100 occupied beds was 6.60 (interquartile range, 4.61–8.43). In the multivariable analysis, nurse aide staffing level was not significantly associated with failure to rescue or 30‐day hospital mortality. The Japanese government provides economic incentives to hospitals that hire more nurse aides, expecting that a higher nurse aide staffing level will help licensed nurses concentrate on the tasks that need their specialties. However, our findings suggest that adding nurse aides may not be associated with lower rates of failure to rescue or 30‐day hospital mortality in acute care settings. [ABSTRACT FROM AUTHOR]

Background: Daily toothbrushing prevents early childhood caries, but reinforcement depends on facilitative parenting behaviours. Mother‐to‐infant bonding, the maternal affection towards the infant, is an environmental factor that strongly influences parenting. Aim: This study examined the association between maternal bonding and children's daily toothbrushing frequency. Design: The sample consisted of 83 954 mother‐infant pairs at two years postpartum, derived from the initial sample of JECS (cohort study), which included 104 062 foetuses. Maternal bonding disorders were assessed using the Mother‐to‐Infant Bonding Scale (MIBS). After multiple imputation for missing data, a multinomial logistic regression analysis was conducted with adjustments for several maternal (eg, age at delivery) and child‐related (eg, self‐performed toothbrushing) variables. Results: The odds ratio (95% confidence interval) for the association of maternal bonding disorders with the low (once per day) and the very low child toothbrushing frequency (<1 per day) was 1.12 (1.07‐1.17) and 1.23 (0.91‐1.66), respectively, after covariate adjustments. Furthermore, the univariate general linear model showed that the mean MIBS scores significantly decreased as the daily child toothbrushing frequency increased. Conclusions: The prevalence of maternal bonding disorders at one year postpartum was prospectively associated with a lower frequency of child toothbrushing at two years of age. [ABSTRACT FROM AUTHOR]

Background and Aim: This study aimed to determine the efficacy and safety of vedolizumab treatment with or without concomitant immunomodulator use in Japanese patients with moderate‐to‐severe ulcerative colitis. Methods: Among enrolled patients in a phase 3 study conducted in Japan (clinicaltrials.gov, NCT02039505), data from patients allocated to 300‐mg intravenous vedolizumab for induction and maintenance phases were used for this exploratory analysis. Efficacy endpoints were clinical response, clinical remission, and mucosal healing at week 10 and clinical remission and mucosal healing at week 60, and disease worsening and treatment failure during the maintenance phase. Results: At week 10, the differences in clinical response, clinical remission, and mucosal healing rates between the subgroups (those with concomitant immunomodulator use minus those without) were 0.7 (95% confidence interval: −14.3, 15.7), 3.3 (95% confidence interval: −8.5, 15.2), and 1.8 (95% confidence interval: −13.0, 16.5), respectively. At week 60, the differences in clinical remission and mucosal healing between the subgroups with and without concomitant immunomodulator use were 26.1 (95% confidence interval: −3.5, 55.6) and 29.9 (95% confidence interval: 1.4, 58.4), respectively. The proportions of patients without treatment failure at day 330 of the maintenance phase were 90.7% with concomitant immunomodulator use and 73.7% without. No marked differences in incidence of infections were observed between subgroups. Conclusions: This study suggested the possibility that concomitant immunomodulator use may be beneficial to maintain the clinical efficacy of vedolizumab. [ABSTRACT FROM AUTHOR]

Aim: To investigate how nursing faculties' perceived time devoted to research changed during the first wave of the pandemic in Japan (April–June 2020) compared to pre‐pandemic. Methods: This cross‐sectional study was conducted online from July 1 to August 10, 2020 and involved 1,023 nursing faculties in Japan. Participants were asked to respond to a questionnaire based on their experiences from April to June 2020. We calculated descriptive statistics for several measures and examined associations between professional/personal demographic factors and declines in overall research time. Results: Of the 1,023 participants, 71.1% were spending less time on overall research activity; 79.6% spent less time attending academic events/conferences, and 77.4% spent less time conducting experiments/surveys. In contrast, 81.2% spent more time teaching, a much greater proportion than the global scientific community in a previous survey. As for work time allocation during the pandemic, teaching was by far the one activity that participants spent the most time on. Logistic regression analysis revealed that declines in overall research time were associated with several professional demographic factors, such as type of university, current academic position, and acquisition status of Japan's major research grant (KAKENHI) (all p <.05). Conclusions: Nursing faculties in Japan clearly spent less time on research, and more time on teaching during the first wave of the pandemic compared to pre‐pandemic. The initial impact of the pandemic on nursing faculties revealed through this study is an eye‐opener and a start for addressing the long‐term impact on the nursing scientific community. [ABSTRACT FROM AUTHOR]

Aim: Maintaining ≥20 teeth is a public health goal worldwide. Healthy aging, which includes psychological and social well‐being, as well as physical indicators, has attracted a great deal of attention with the progression of aging societies. However, no studies have examined the association between the number of remaining teeth and healthy aging. This study aimed to investigate the association between the number of remaining teeth and healthy aging. Methods: This community‐based longitudinal cohort study included 8300 Japanese people aged ≥65 years who were free of disability and depression in the baseline survey in 2006. The participants were categorized into four groups according to the number of remaining teeth at baseline: 0–9, 10–19, 20–24 and ≥25. The primary outcome was healthy aging (defined as meeting all four of the following criteria: free of disability, free of depression, high health‐related quality of life and high life satisfaction), as assessed by a questionnaire survey carried out in 2017. Multiple logistic regression was used to calculate the corresponding odds ratios and 95% confidence intervals. Results: During about 11 years of follow‐up, 621 (7.5%) participants attained healthy aging. Participants with ≥20 remaining teeth showed a higher healthy aging rate. Compared with participants with 0–9 teeth, the multivariate‐adjusted odds ratios (95% confidence intervals) for 10–19, 20–24 and ≥25 teeth were 0.98 (0.77–1.26), 1.28 (1.01–1.63) and 1.59 (1.24–2.03), respectively. Conclusions: These findings suggest that maintaining ≥20 teeth was associated with healthy aging. Geriatr Gerontol Int 2022; 22: 68–74. [ABSTRACT FROM AUTHOR]

Objectives Coffee, green tea, and caffeine are potential preventive factors for dementia, but the underlying evidence is insufficient. This study aimed to examine associations between the consumption of coffee, green tea, and caffeine and dementia risk in middle‐aged and older people. Methods: This was a cohort study with an 8.0‐year follow‐up. Participants were community‐dwelling individuals (n = 13,757) aged 40–74 years. A self‐administered questionnaire survey was conducted in 2011–2013. Predictors were the consumption of coffee/green tea, from which caffeine consumption was estimated. The outcome was incident dementia obtained from the long‐term care insurance database. Covariates were demographic factors, body mass index, physical activity, energy, smoking, drinking, and disease history. Adjusted hazard ratios (HRs) were calculated using Cox proportional hazards models. HRs were also calculated using a Cox model with delayed entry. Results: The number of dementia cases during the study period was 309. Participants with higher coffee consumption had lower HRs (adjusted p for trend = 0.0014), with the fifth quintile (≥326 ml/day) having a significantly lower HR (0.49, 95% confidence interval [CI]: 0.30–0.79) than the first quintile (<26 ml/day, reference). Similarly, participants with higher caffeine consumption had a significantly lower HR (adjusted p for trend = 0.0004) than the reference. The Cox model with delayed entry yielded similar results. These associations were significant in men, but not in women. Moreover, participants who consumed 2–2.9 cups/day and ≥3 cups/day of coffee had lower HRs (0.69, 95% CI: 0.48–0.98 and 0.53, 95% CI: 0.31–0.89, respectively) than those who consumed 0 cup/day. The association between green tea consumption and reduced dementia risk was significant (adjusted p for trend = 0.0146) only in the 60–69 years age subgroup. Conclusions: High levels of coffee and caffeine consumption were significantly associated with a reduced dementia risk in a dose‐dependent manner, especially in men. Moreover, coffee consumption of ≥3 cups/day was associated with a 50% reduction in dementia risk. [ABSTRACT FROM AUTHOR]

Introduction: A criterion for disseminated intravascular coagulation (DIC) that reflects the status of controlled coagulopathy would be useful for determining when to stop treatment. Use of the DIC criteria of the Japanese Society on Thrombosis and Hemostasis (JSTH) for predicting the outcome during recombinant soluble thrombomodulin (thrombomodulin alfa, TM‐α) treatment was evaluated. Methods: A retrospective, multicenter survey was conducted in 798 medical facilities in Japan. Of the 4342 patients who underwent TM‐α treatment, 193 with infection‐associated DIC were investigated. Results: The 28‐day mortality rate increased with the increase in JSTH DIC scores at the end of TM‐α treatment, with a Cramer's coefficient of association of 0.431. A reduced platelet count (odds ratio [OR]: 0.847, P <.001), prolonged prothrombin time ratio (OR: 5.681, P <.001), decreased fibrinogen level (OR: 0.995, P <.001), higher level of fibrinogen and fibrin degradation products (OR: 1.009, P =.026), and lower antithrombin activity (OR: 0.973, P <.001) were correlated with 28‐day mortality. On multivariate analysis, the JSTH DIC score at the completion of TM‐α therapy was a predictor of mortality (OR: 1.591, 95% CI: 1.219‐2.077). Conclusion: The JSTH DIC score at the end of anticoagulation therapy may be a reliable tool for predicting the outcome in patients with infection‐associated DIC. [ABSTRACT FROM AUTHOR]

Aim: A feeling of isolation childcare mothers' face is a serious social problem in Japan because the relationships with mothers and local communities have grown sparser. The purpose of this study was to clarify the feelings of isolation of mothers during childcare and the factors related to it. Methods: We conducted a questionnaire survey in Yao City, Osaka. We mailed out a questionnaire survey of 1293 mothers with infants who had either a 4‐month or 42‐month routine health checkup during the period from September to December of 2018. Results: There was no association between "feeling lonely while raising my child" and the absence of "people who helped raise my children." On the other hand, it was found that the mothers' inner feelings, such as "I wasn't satisfied with my childcare environment" (OR: 2.55, 95% CI: 1.32–4.91, p = 0.0052) or "I lacked confidence in my own childcare abilities" (OR: 6.21, 95% CI: 4.31–8.95, p < 0.0001), were associated with their sense of loneliness. Conclusions: Mothers' "sense of loneliness" was shown to be best correlated with their dissatisfaction with the environment of their childcare and with their lack of confidence in raising their own children. [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]

Aim: This study aimed to identify the factors related to complex care needs of older adults in community‐based integrated care centers. Methods: We sent 936 self‐reported questionnaires to community‐based integrated care center directors in the Kinki region of Japan. These questionnaires included questions not only about the directors' demographic data, but also regarding the sociodemographic, psychosocial, and family‐related dimensions of the older adults in the community centers. The directors divided their cases into two categories: "Complex cases" and "Straightforward cases." We compared the intergroup differences and examined the factors related to complex care needs in older adults. Results: A total of 232 directors responded. Complex cases were significantly associated with younger age, poor health conditions, and having a family member who needs care, as compared to straightforward cases where these associations were not present. Logistic regression showed that in older adults, factors of refusing support or social services, social isolation, and trouble with neighbors were associated with their complexities. Additionally, family members with a high likelihood of refusing social services, older adults without a key family member, and difficulties in forming their consensus regarding care were associated with older adults' complexities. Conclusion: Older adults with complex care needs could have the risk of self‐neglect, and their families faced difficulties in supporting them as family members. Healthcare professions should carefully assess these factors and develop needs‐oriented services for them without their family support as an upstream intervention. [ABSTRACT FROM AUTHOR]

Aim: We compared Japan nurse practitioner‐led care and physician trainee‐led care in terms of patients' length of stay in a secondary emergency department in Japan. Methods: This was a retrospective observational study, utilizing medical records. Participants (n = 1419; mean age = 63.9 ± 23.4 years; 52.3% men) were patients transferred to the emergency department by ambulance between April 2016 and March 2018 in western Tokyo. Multiple linear regression analyses were performed, with length of stay as the dependent variable and factors related to the length of stay, including medical care leaders, as the independent variable. Results: Approximately half of the patients (n = 763; 53.8%) received Japan nurse practitioner‐led care. Patients' length of stay was significantly shorter, by 6 min, in the Japan nurse practitioner‐led care group, compared with the physician trainee‐led care group (unstandardized coefficient: −6.81; 95% confidence interval: −13.35 to −0.26; p < 0.05). Conclusion: Patients' shorter length of stay in the Japan nurse practitioner group, compared with the physician trainee group, suggests that Japan nurse practitioners are not inferior to physician trainees in terms of the time spent to manage patients. [ABSTRACT FROM AUTHOR]

Aim: We aimed to evaluate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of noninvasive prenatal testing (NIPT) in high‐risk pregnant women. Methods: Pregnant women who underwent GeneTech NIPT, the most commonly used NIPT in Japan, between January 2015 and March 2019, at Japan NIPT Consortium medical sites were recruited for this study. The exclusion criteria were as follows: pregnant women with missing survey items, multiple pregnancy/vanishing twins, chromosomal abnormalities in the fetus other than the NIPT target disease, and nonreportable NIPT results. Sensitivity and specificity were calculated from the obtained data, and maternal age‐specific PPV and NPV were estimated. Results: Of the 45 504 cases, 44 263 cases fulfilling the study criteria were included. The mean maternal age and gestational weeks at the time of procedure were 38.5 years and 13.1 weeks, respectively. Sensitivities were 99.78% (95% confidence interval [95% CI]: 98.78–99.96), 99.12% (95% CI: 96.83–99.76), and 100% (95% CI: 88.30–100) for trisomies 21, 18, and 13, respectively. Specificities were more than 99.9% for trisomies 21, 18, and 13, respectively. Maternal age‐specific PPVs were more than 93%, 77%, and 43% at the age of 35 years for trisomies 21, 18, and 13, respectively. Conclusion: The GeneTech NIPT data showed high sensitivity and specificity in the detection of fetal trisomies 21, 18, and 13 in high‐risk pregnant women, and maternal age‐specific PPVs were obtained. These results could provide more accurate and improved information regarding NIPT for genetic counseling in Japan. [ABSTRACT FROM AUTHOR]

Objectives Weight loss is a critical health issue in older adults. Oral function is essential for nutrient intake and can be restored using dental prosthetic treatments in patients with tooth loss. This study aimed to investigate the relationship between tooth loss and weight loss among the older adults and to evaluate the magnitude of its risk reduction by dental prosthetic treatment. Design Three‐year follow‐up longitudinal study based on a self‐reported questionnaire. Setting Community‐dwelling older adults in Japan. Participants Adults aged 65 and older (n = 53,690). Measurements We used >10% weight loss during follow‐up, the number of remaining teeth, and the use of dental prostheses as the outcome variable, exposure variable, and mediator, respectively. We fitted the logistic regression model including possible confounders and calculated the odds ratios (ORs) and 95% confidence intervals (95% CIs) of the controlled direct effect (CDE) at the level of use or nonuse of the dental prosthesis based on a causal mediation analysis framework. Additionally, we calculated the proportion eliminated by the dental prosthesis. Results: The mean age of participants was 72.6 years (1 SD = 5.5), and 47.4% were males. About 5.8% (n = 3132) of them experienced >10% weight loss during the follow‐up. Weight loss was observed in 6.8% of the participants with 0–19 remaining teeth and in 4.3% of them with ≥20 remaining teeth. The CDE of 0–19 remaining teeth was greater when no one used dental prosthesis (OR = 1.41; 95% CI = 1.26–1.59) compared with that when all participants used dental prosthesis (OR = 1.26; 95% CI = 1.08–1.46). This indicated that dental prosthesis decreased the risk of weight loss by 37.3%. Conclusion: Our study revealed that tooth loss increased the risk of clinically critical levels of weight loss among community‐dwelling older adults. However, this risk was reduced by dental prosthetic treatment. [ABSTRACT FROM AUTHOR]

Aim: Family caregivers can experience psychological distress, resulting in physical and mental health problems, and discontinuation of caregiving. This study's objective was to examine factors associated with caregiver psychological distress. Methods: We analyzed data from the Comprehensive Survey of Living Conditions in 2007, 2010, 2013 and 2016, which included 12 504 pairs of caregivers and care recipients sharing a household in Japan. Kessler's Psychological Distress Scale (K6) was used to measure caregiver psychological distress. Multivariable logistic regression analyses identified factors associated with caregiver psychological distress (K6 score ≥5). Results: Caregivers' median K6 score was 3 (interquartile range 0–7), and 38.6% had a K6 score ≥5. K6 scores ≥5 were positively associated with female sex (adjusted odds ratio 1.35, 95% CI 1.21–1.51), poor caregiver health status (compared with "very good," 9.48, 95% CI 7.91–11.37 for "not very good/poor"), longer care time (compared with "help only when needed," 1.40, 95% CI 1.25–1.58 for "almost all day") and dementia (1.16, 95% CI 1.05–1.28), lower respiratory tract disease (1.25, 95% CI 1.06–1.49) and diabetes (1.16, 95% CI 1.00–1.33) in care recipients. K6 scores ≥5 were negatively associated with older caregiver age (compared with 20–54 years, 0.65, 95%CI 0.58–0.74 for 55–64 years, 0.54, 95%CI 0.46–0.63 for 65–74 years and 0.50, 95% CI 0.40–0.62 for ≥75 years), employment (0.88, 95% CI 0.80–0.97) and being a care recipient's child‐in‐law (compared with spouse 0.75, 95% CI 0.61–0.92). Conclusions: The findings identified several factors associated with caregiver psychological distress, showing that particular attention might need to be paid to caregivers with these risk factors. Geriatr Gerontol Int 2021; 21: 855–864. [ABSTRACT FROM AUTHOR]

Aim: Although poor childhood rearing environment is known to negatively impact late‐life cognitive function, there is a scarcity of evidence on the contribution of positive parenting behaviors. The present study investigates the association between parental involvement in childhood and late‐life cognitive function. Methods: A total of 266 older adults aged between 65 and 88 years living in Wakuya City, Miyagi Prefecture, Japan, without indication of mild cognitive impairment or dementia, participated in a survey. Parental involvement in childhood was assessed by a questionnaire, and late‐life cognitive function was measured by the Japanese version of the Quick Mild Cognitive Impairment (QMCI) screening test (range: 0–100). Multiple regression analysis was performed to investigate the association, adjusting for potential confounders and mediators. Results: After adjusting for age, sex, other child‐rearing environment, and academic performance in grade 6, older adults with a high level of positive parental involvement in childhood scored 6.00 (95% CI: 2.39, 9.61) points higher for the QMCI total score than those without. Parental involvement in childhood showed significant dose–response positive associations with the QMCI total score (P < 0.001), clock‐drawing test score (P < 0.05), and verbal fluency score (P < 0.001). Among the six types of positive parental involvement, book reading showed a significant independent positive association with QMCI total score (P < 0.01) and logical memory score (P < 0.01). Conclusions: Greater parental involvement in childhood, particularly book reading, was associated with better late‐life cognitive function. Geriatr Gerontol Int 2021; 21: 794–801. [ABSTRACT FROM AUTHOR]

Previous papers have reported that clusterin (CLU, also called apolipoprotein J) maintains amyloid β-peptide (Aβ) solubility and protects against Aβ neurotoxicity. Recently, two large genome-wide association studies (GWAS) identified that a specific single nucleotide polymorphism (SNP) on the gene has been reported to modify the risk for Alzheimer's disease (AD). The present study aimed to investigate whether common single nucleotide polymorphisms (SNP) of the CLU gene are associated with AD. Six SNP, genotyped using TaqMan technology, were analyzed using a case-control study design. Furthermore, an analysis of the cases divided according to apolipoprotein E (APO E) status was also carried out. Our case-control dataset consisted of 180 AD patients and 130 age-matched controls. The present study failed to detect any association between the SNP of the CLU gene and AD. Although rs7982 and rs1532277 showed marginal association in the APO E4 negative group, the linkage disequilibrium analysis results suggest this to be a false positive. The negative associations were mainly the result of our small sample size. Larger genetic studies in different ethnics and future meta-analysis are needed to clarify the relationship between the CLU gene and AD. [ABSTRACT FROM AUTHOR]

Aim: The study assessed the association between boosting the workforce supply by types of long‐term care services and in‐home deaths among older people at the municipality level. Methods: A fixed‐effect panel data analysis was conducted using administrative data for every 3 years from 2008 to 2014. The outcome was the proportion of home deaths, excluding those due to external factors, such as suicide or accident. The explanatory variables were the full‐time equivalent numbers of care workers engaged in in‐home services, day services, short‐stay services, and long‐term care facilities per 1000 population aged 65 years and older. Ordinary least squares estimation was conducted, with standard errors corrected for clustering at the prefecture level, adjusting the covariates. Results: Analysis included 1706 municipalities. One care worker increase providing day services per 1000 population aged 65 years and older was associated with a 0.09% increase in the proportion of deaths at home (95% CI: 0.008–0.17). Although statistically non‐significant, the number of care workers providing in‐home services was positively associated with the proportion of home deaths, whereas the number of those providing short‐stay services and providing long‐term care facilities and nursing home services were inversely associated with home deaths. Conclusions: Given the increased number of care‐dependent older people who opt to stay at home until death, and their informal caregivers who have the burden and stress of care, the findings suggest that policymakers should ensure that the number of care workers for day services is sufficient for supporting care recipients and informal caregivers. Geriatr Gerontol Int 2021; 21: 712–717. [ABSTRACT FROM AUTHOR]

Background: This study aims to clarify the association between marital status and dementia in Japan, adjusting for socioeconomic, lifestyle, and lifestyle‐related disease factors. Methods: Data from the Japanese Toyama Dementia Survey were used. Individuals aged ≥65 years living in Toyama Prefecture were randomly selected, and 1171 participants were analysed, with a sampling rate of 0.5%. The participants' marital status, socioeconomic status, lifestyle factors, and lifestyle‐related diseases were assessed. The odds ratio (OR) of marital status for each lifestyle factor and medical histories were calculated by logistic regression analysis. The OR of marital status for dementia was also calculated by logistic regression analysis. Results: The prevalence of dementia was 7.4% for married, and 20.6% for non‐married participants. Non‐married participants showed a higher prevalence of a history of stroke than married participants. The age‐ and sex‐adjusted OR of marital status for dementia was 1.99 (95% confidence interval (CI) 1.24–3.18) for non‐married compared with married participants. Following variable adjustments, the OR for dementia was higher for non‐married participants (adjusted OR 1.71; 95% CI 1.03–2.85). Conclusions: Non‐marital status was an independent risk factor for dementia in Japan even after adjusting for socioeconomic, lifestyle, and lifestyle‐related disease factors. Non‐married people were more likely to have dementia because of their history of stroke. [ABSTRACT FROM AUTHOR]

Objectives: Root surface caries experience tends to increase with age. The purpose of this longitudinal study was to evaluate the relationship between aspects of dietary intake, including milk and sucrose in coffee or tea (SCT), and root surface caries in older Japanese individuals. Methods: 303 community‐dwelling older individuals (age 75 years) were enrolled for analysis. All participants underwent a dental examination at baseline and then annually from 2003 to 2008 (ie six times over a 5‐year period). A disease event was considered to have occurred when root surface caries was detected on a previously sound or nonexposed root surface. Over the observation period, disease events in each year were counted. Dietary habits during the preceding month were evaluated using a brief self‐administered diet history questionnaire (BDHQ) in 2003 and 2008. Poisson regression analysis performed crude and adjusted increment‐rate ratios (IRRs) for root surface caries and the intake of milk and SCT. Results: The adjusted increment‐rate ratio (IRR) of the increment of root surface caries for participants in the highest SCT tertile was 1.72 (95%CI: 1.40‐2.14) compared with the referent group. In addition, for the amount of milk intake, the adjusted IRR in the highest tertile was 0.63 (95% CI: 0.51‐0.78) compared with the referent group. Conclusions: Much SCT and low milk intake were associated with the increment of root surface caries in community‐dwelling older people in Japan. These findings suggest that to help prevent root surface caries, community‐dwelling older people in Japan should consume adequate amounts of milk daily and limit their intake of SCT. [ABSTRACT FROM AUTHOR]

Employee voice is an important organizational behavior that affects work group performance, and many studies have explored its mechanism; nonetheless, the existing literature narrowly defines the construct and overlooks a variety of strategic approaches employees take as they engage in voice. Based on this problematization, the current research has developed and validated a scale of employee voice strategy through four studies in Japan (total N = 1,156). Employee voice strategy is defined as a set of direct and indirect communicative approaches that organizational members utilize to share ideas with intentions to exert constructive influence to their work group. Studies 1 and 2 analyzed interview narratives to develop an initial typology, which was refined in Study 3 into a six-factor scale. Study 4 replicated it through confirmatory factor analyses. Construct validity of the scale was also examined by testing the strategy factors' nomological network-as expected, proactive personality was positively associated with assertive strategies, while relationship maintenance goal orientation was linked to conciliatory, nonconfrontational strategies; negative emotion display showed negative associations with voice strategy use in general. These findings were discussed vis-à-vis culturally inclusive human resource management practices, as well as theoretical exploration of the employee voice phenomena from process-centered perspectives. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of lasmiditan in Japanese adults with migraine. Background: Global clinical studies have demonstrated the efficacy and safety of lasmiditan in the acute treatment of migraine. Methods: This was a multicenter, randomized, double‐blind, placebo‐controlled, phase 2 study in Japan (NCT03962738), which enrolled adults with migraine with or without aura. Participants were randomized 7:3:7:6 to placebo, lasmiditan 50 mg, 100 mg, or 200 mg to be self‐administered orally within 4 h of onset of a single moderate‐to‐severe migraine attack. Participants recorded their response to treatment prior to dosing and for 48 h postdose. The primary endpoint was headache pain freedom at 2 h postdose. Results: Participants (N = 846) were randomized and treated (N = 691, safety; N = 682, modified intent‐to‐treat). At 2 h postdose, a significantly higher proportion of participants were headache pain‐free in the lasmiditan 200 mg (40.8%, 73/179; odds ratio 3.46 [95% confidence interval 2.17 to 5.54]; p < 0.001; primary objective) and 100 mg groups (32.4%, 67/207; odds ratio 2.41 [1.51 to 3.83]; p < 0.001) compared with the placebo group (16.6%, 35/211), whereas the lasmiditan 50 mg group had a numerically higher proportion of participants headache pain‐free (23.5%, 20/85; odds ratio 1.55 [0.83 to 2.87]; p = 0.167) compared with placebo. A statistically significant linear dose–response relationship for pain freedom was achieved at 2 h by a Cochran–Armitage trend test (p < 0.001). Lasmiditan treatment was also associated with headache pain relief, most bothersome symptom freedom, and improvement on disability and Patient Global Impression of Change outcomes. The majority of treatment‐emergent adverse events were mild and of short duration, the most common of which were dizziness (39.4%; 188/477), somnolence (19.3%; 92/477), and malaise (10.5%; 50/477) in all lasmiditan groups, with no serious adverse events reported. Conclusions: Lasmiditan was well tolerated and effective for the acute treatment of Japanese patients with migraine, consistent with global phase 3 studies. [ABSTRACT FROM AUTHOR]

Older age is a risk factor for intracranial injury after head trauma, and computed tomography (CT) is generally recommended. We aimed to develop a clinical prediction rule for risk stratification to avoid CT head imaging in older adult patients with minor head injury, named Computed Tomography of the Head for the patients at Advanced age (CTHEAD). This was a single‐center observational study in Japan that used retrospective chart review data to service a prediction rule that was prospectively validated. Patients aged ≥ 65 years who presented to our emergency department with a chief complaint of head trauma and a Glasgow Coma Scale (GCS) of ≥13 were eligible. Patients were excluded if they had GCS score < 13, anticoagulant therapy, focal neurologic symptoms, posttraumatic seizures, penetrating injury, evident depressed fracture, unknown mechanism, or CT not undertaken. The primary outcome was acute traumatic lesion on head CT. We screened 1,494 patients; 538 were included in the derivation cohort, and 580, in the validation cohort. Multivariable analysis of the derivation group found that high‐risk mechanisms of injury, vomiting, witnessed loss of consciousness, and anterograde amnesia were significantly associated with traumatic head findings on CT. A clinical prediction rule was developed from these four risk factors. The negative predictive value (NPV) of the absence of the four components was 95.1% (95% confidence interval [CI] = 92.9% to 96.7%), and the positive predictive value (PPV) of one or more risk factors was 20.6% (95% CI = 17.3% to 24.4%). The rule was validated prospectively with an NPV of zero risk factors of 94.5% (95% CI = 92.4% to 96.1%) and a PPV of one or more risk factors of 15.9% (95% CI = 13.0% to 19.3%). Fifty‐three (9.1%) patients in the validation cohort experienced the primary outcome. The results suggest that older adult patients with minor head injury may forgo head CT if they do not have high‐risk mechanisms of injury, vomiting, witnessed loss of consciousness, or anterograde amnesia. External validation of this rule is needed. [ABSTRACT FROM AUTHOR]

Aim: There is a large discrepancy between people's preferred and actual place of death in Japan. To manage this discrepancy, this study aimed to identify the variability in preferred places of death and their associated factors among Japanese older people. Methods: Cross‐sectional survey data were collected in 2016 as part of the Japan Gerontological Evaluation Study, in which 20 204 participants were asked about their preferred place of death. Logistic regression analyses were conducted to examine the final determinants for home as the preferred place of death. Results: Based on survey data, 35.8% of respondents preferred home as the place of death, 42.7% preferred some sort of facility and 21.5% were unsure. Those who preferred to be at home when receiving end‐of‐life care were more likely to be older in age, live with others, be employed, be homeowners, have lived in their current residence for a longer period, not be vaccinated for influenza in the past year, engage in physical work or intense sports, not have participated in end‐of‐life discussions regarding preferred place of death, have experienced relatives dying at home, practice norms of reciprocity, have a sense of attachment to their neighborhood, receive instrumental social support, interact with neighbors and live in a rural area. Conclusions: Factors related to community attachment were associated with choosing home as the preferred place of death. To fulfill the preferences of Japanese older people, a broad range of demographic, health, behavioral, social, cultural and environmental factors should be considered. Geriatr Gerontol Int 2021; 21: 345–352. [ABSTRACT FROM AUTHOR]

High graduation of nurses and limited job opportunities in Indonesia may lead to the emigration of nurses particularly through facilitated migration. This study aimed at identifying the prevalence of Indonesian nursing students with intention to work in Japan and predictors of their intention to migrate as well as having a definite plan to work in Japan. The study adopted cross‐sectional design with a sample of 1,407 Indonesian nursing students. Factors associated with having migration intention, as well as a definite plan to work in Japan, were age, residence, and overseas experience. Other factors related to a definite plan to work abroad were family income, mastering a foreign language, knowledge about the nurse migration related to Indonesia‐Japan cooperation, and their motivations to migrate to Japan. Sustainability of this international recruitment of nurses is possible by understanding the context of both source and destination countries. Maximizing benefits of migration of nurses for Indonesia and Japan requires structured policies targeting the educational sector and addressing the sustainability issues. [ABSTRACT FROM AUTHOR]

Aim: To determine the relationship between multiple medications and falls. Methods: This case–control and case–crossover study was carried out at Kudanzaka Hospital in Chiyoda, Tokyo, Japan. A total of 325 patients who experienced their first falls when hospitalized between January 2016 and November 2018, and 1285 controls matched by sex, age and clinical departments were included in this study. Hospitalization duration and fall risk score were adjusted for in the analyses. Results: In the case–control study, multivariable logistic regression showed that increasing the intake of oral medications was not significantly associated with the incidence of falls (odds ratio 1.02, 95% confidence interval 0.998–1.049). In contrast, drugs prescribed with special caution in accordance with the Elderly Oral Medication Guidelines were significantly associated with falls (odds ratio 1.17, 95% confidence interval 1.09–1.26). A similar pattern was observed in the case–crossover analysis. Among the drugs to be prescribed with special caution according to the guidelines, atypical antipsychotics, non‐benzodiazepine hypnotics and magnesium oxide were significantly associated with the risk of falls. Conclusion: The drugs to be prescribed with special caution according to the guidelines were associated with an increased fall risk. The risk of falls in hospitalized older people due to multiple medications varies among medications. Geriatr Gerontol Int ••; ••: ••–••Geriatr Gerontol Int 2021; ••: ••–••. [ABSTRACT FROM AUTHOR]

Aim: Existing evidence links social isolation with poor health. To examine differences in the mortality risk by social isolation, and in socio‐economic correlates of social isolation, we analyzed large‐scale cohort studies in Japan and England. Methods: Participants were drawn from the Japan Gerontological Evaluation Study (JAGES) and the English Longitudinal Study of Ageing (ELSA). We analyzed the 10‐year mortality among 15 313 JAGES participants and 5124 ELSA respondents. Social isolation was measured by two scales, i.e., scoring the frequency of contact with close ties, and a composite measurement of social isolation risk. We calculated the population attributable fraction, and Cox regression models with multiple imputations were used to estimate hazard ratios (HRs) for mortality due to social isolation. Results: The proportion of those with contact frequency of less than once a month was 8.5% in JAGES and 1.3% in ELSA. Males, older people, those with poor self‐rated health, and unmarried people were significantly associated with social isolation in both countries. Both scales showed that social isolation among older adults had a remarkably higher risk for premature death (less frequent contact with others in JAGES: hazard ratio [HR] = 1.18, 95% confidence interval [CI]: 1.05–1.33, in ELSA: HR = 1.27, 95% CI: 0.85–1.89; and high isolation risk score in JAGES: HR = 1.30, 95% CI: 1.12–1.50, in ELSA: HR = 2.05, 95% CI: 1.52–2.73). The population attributable fraction showed less frequent contact with close ties was attributed to about 18 000 premature deaths annually in Japan, in contrast with about 1800 in England. Conclusions: Negative health impacts of social isolation were higher among older Japanese compared with those in England. Geriatr Gerontol Int 2021; 21: 209–214. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to examine the association of knowledge and self‐efficacy as variables for behavior related to dental consultations among patients with type 2 diabetes, depending on the diagnosis of periodontal disease at a general hospital in Japan. Methods: A cross‐sectional survey was conducted with 198 patients with type 2 diabetes (mean age: 66.1 ± 10.1 years, men: 56.6%, mean glycated hemoglobin: 7.3 ± 1.0%). The self‐efficacy of patients with periodontal disease was assessed using the Self‐Efficacy Scale for Self‐Care. Knowledge was measured using five dichotomous items based on reference to clinical guidelines. Dental consultation behavior was assessed from regular dental checkup behavior. Results: In total, 31.8% of participants attended their regular dental checkup in the last year. Logistic regression analysis revealed that dental consultation behavior was positively associated with self‐efficacy among patients diagnosed with periodontal disease (odds ratio [OR] = 1.26, 95% confidence interval [CI]: 1.10–1.45), and positively associated with the knowledge among patients not diagnosed with periodontal disease (OR = 1.54, 95%, CI: 1.09 − 2.16). Conclusion: Patients without periodontal disease need to learn about accurate knowledge regarding periodontal disease as a complication of diabetes and its prevention via dental checkups. Supportive consultation to improve self‐efficacy with respect to dental consultations should be offered to patients with periodontal disease. Medical professionals will be able to support each patient with type 2 diabetes by changing the educational approach for promoting regular dental checkups at the time of diabetes consultations. [ABSTRACT FROM AUTHOR]