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BACKGROUND Sleeping pills are widely used for sleep disorders and insomnia. This population-based study aimed to evaluate the association between the use of sleeping pills and metabolic syndrome (MetS) and metabolic components in an apparently healthy Japanese cohort. METHODS We examined baseline cross-sectional data from the JMS-II Cohort Study. The criteria for MetS and its components were based on The National Cholesterol Education Program Adult Treatment Panel III. Sleep habits including the sleep duration of the subjects and the frequency of sleeping pill use were obtained using The Pittsburgh Sleep Quality Index questionnaire. For different sleep durations, the association between sleeping pill use and MetS was assessed. Odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated using multiple logistic regression models to quantify this association. RESULTS Our study included 6,153 individuals (mean age, 63.8 [standard deviation 11.2] years), and 3,348 (54.4%) among them were women. The association between sleep duration and MetS was an inverted J-shaped curve among sleeping pill users and a J-shaped curve among non-users. After adjustment for various confounders, less than 6 h of sleep among sleeping pill users was associated with increased rates of MetS (< 6 h, OR [95% CI]: 3.08 [1.29-7.34]). The frequency of sleeping pill use in individuals with short sleep duration showed a positive association with the prevalence of MetS and its components. CONCLUSIONS Sleeping pill users with a short sleep duration had a 3-fold higher chance of having MetS than non-users with a short sleep duration.

Background The extremes of maternal pre-pregnancy body mass index (BMI) are known to be risk factors associated with obstetric and adverse perinatal outcomes. Among Japanese women aged 20 years or older, the prevalence of underweight (BMI 2) was 11.5% in 2019. Maternal thinness is a health problem caused by the desire to become slim. This study aimed to investigate the association between the severity of maternal low pre-pregnancy BMI and adverse perinatal outcomes, including preterm birth (PTB), low birth weight (LBW), and small-for-gestational age (SGA). Methods We conducted a prospective cohort study using data from the Japan Environment and Children’s Study, which recruited pregnant individuals between 2011 and 2014. Pre-pregnancy BMI was categorized as severe-moderate underweight (BMI < 16.9 kg/m2), mild underweight (BMI, 17.0–18.4 kg/m2), low-normal weight (BMI, 18.5–19.9 kg/m2), high-normal weight (BMI, 20.0–22.9 kg/m2), overweight (BMI, 23.0–24.9 kg/m2), and obese (BMI ≥ 25.0 kg/m2). The high-normal weight group was used as the reference for statistical analyses. Adjusted logistic regression was performed to evaluate the association between pre-pregnancy BMI and PTB, LBW, and SGA. Results Of 92,260 singleton pregnant individuals, the prevalence was 2.7% for severe-moderate underweight, 12.9% for mild underweight, and 24.5% for low-normal weight. The prevalence of adverse outcomes was 4.6% for PTB, 8.1% for LBW, and 7.6% for SGA. The adjusted odds ratios (aORs) for PTB were 1.72 (95% confidence interval [CI], 1.46–2.03) for severe-moderate underweight and 1.26 (95% CI, 1.14–1.39) for mild underweight. The aORs of LBW were 2.55 (95% CI, 2.27–2.86) for severe-moderate underweight, 1.64 (95% CI, 1.53–1.76) for mild underweight, and 1.23 (95% CI, 1.16–1.31) for low-normal weight. The aORs of SGA were 2.53 (95% CI, 2.25–2.84) for severe-moderate underweight, 1.66 (95% CI, 1.55–1.79) for mild underweight, and 1.29 (95% CI, 1.21–1.38) for low-normal weight. Conclusions A dose-response relationship was found between the severity of low pre-pregnancy BMI and PTB, LBW, and SGA. Even low-normal BMI (18.5–19.9 kg/m2) increased the risk of LBW and SGA. This study provides useful information for pre-conception counseling in lean individuals.

Background: Population impact of modifiable risk factors on orofacial clefts is still unknown. This study aimed to estimate population attributable fractions (PAFs) of modifiable risk factors for nonsyndromic cleft lip with or without cleft palate (CL±P) and cleft palate only (CP) in Japan. Methods: We conducted a prospective cohort study using data from the Japan Environment and Children’s Study, which recruited pregnant women from 2011 to 2014. We estimated the PAFs of maternal alcohol consumption, psychological distress, maternal active and passive smoking, abnormal body mass index (BMI) (

Purpose There are notable geographic variations in incidence rates of suicide both in Japan and globally. Previous studies have found that rurality/urbanity shapes intra-regional differences in suicide mortality, and suicide risk associated with rurality can vary significantly by gender and age. This study aimed to examine spatial patterning of and rural–urban differences in suicide mortality by gender and age group across 1887 municipalities in Japan between 2009 and 2017. Methods Suicide data were obtained from suicide statistics of the Ministry of Health, Labour and Welfare in Japan. We estimated smoothed standardized mortality ratios for suicide for each of the municipalities and investigated associations with level of rurality/urbanity using Bayesian hierarchical models before and after adjusting for socioeconomic characteristics. Results The results of the multivariate analyses showed that, for males aged 0–39 and 40–59 years, rural residents tended to have a higher suicide risk compared to urban ones. For males aged 60+ years, a distinct rural–urban gradient in suicide risk was not observed. For females aged 0–39 years, a significant association between suicide risk and rurality was not observed, while for females aged 40–59 years and females aged 60 years or above, the association was a U-shaped curve. Conclusion Our results showed that geographical distribution of and rural–urban differences in suicide mortality in Japan differed substantially by gender and age. These findings suggest that it is important to take demographic factors into consideration when municipalities allocate resources for suicide prevention.

Background: Levels of student loan debt have been increasing, but very little research has assessed if this is associated with poor health. The aim was to examine the association between student loans and psychological distress in Japan. Methods: We conducted a cross-sectional web-based self-administered questionnaire survey in 2017. The sample comprised of 4,149 respondents aged 20-34, with 3,170 graduates and 979 current university students. The independent variables were whether or not current students had student loans, and for graduates, the total amount of their student loan debt. The dependent variable was severe psychological distress assessed by the Kessler Psychological Distress Scale (K6: the cut-off point was 13/14). Covariates were demographic and parents' socioeconomic variables. A Poisson regression analysis with a robust error variance was conducted to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Because there was a significant interaction between current student status and the status of borrowing student loans, stratified analyses were conducted. Results: The percentage of those with student loans was 33.8% among graduates, and 35.2% among current university students, respectively. Among graduates, student loan debt was significantly associated with a high possibility of having severe psychological distress after adjusting for covariates (PR of ≥4 million yen = 1.44 [95% CI = 1.02, 2.03]). Among current university students, there was no significant association (PR of borrowing student loans = 0.91 [95% CI = 0.60, 1.37]). Conclusions: There was a significant association between student loan debt and psychological distress among graduates, but not current university students.

Objective: This study examined psychological status trajectories of mothers of infants with nonsyndromic orofacial clefts in Japan. Design: Prospective cohort study. Setting: Data from the Japan Environment and Children’s Study. Participants: Infants with a nonsyndromic cleft (N = 148) including cleft lip and palate (CLP; n = 72), cleft lip (CL; n = 46), and cleft palate (CP; n = 30). The control group included unaffected infants (N = 84 454). Main Outcome Measures: At 15 weeks and 27 weeks of pregnancy and 12 months after birth, the Kessler Psychological Distress Scale (clinical cutoff ≥5) was used. At 1 month and 6 months after birth, the Edinburgh Postnatal Depression Scale (clinical cutoff ≥9) was used. Results: Prenatal diagnosis rates were unavailable. Mothers of infants with CLP had higher psychological distress than controls at 27 weeks of pregnancy (prevalence ratio [PR] = 1.36, 95% CI: 1.06-1.74) and postnatal depression at 1 month after birth (PR = 2.21, 95% CI: 1.53-3.19). Mothers of infants with CP showed heightened psychological distress at 27 weeks of pregnancy (PR = 1.62, 95% CI: 1.21-2.17) and postnatal depression 6 months after birth (PR = 1.86, 95% CI: 1.01-3.43). There was no significant association between CL and maternal psychological status. At 12 months after birth, no differences in distress were found between mothers of infants with a cleft and controls. Conclusions: Mothers of infants with orofacial clefts may need psychosocial support, particularly during pregnancy and the first year after birth.

Poor accessibility to physicians might be linked to the inadequate control of cardiovascular risk factors. The aim of this study was to investigate whether the accessibility of primary care physicians was related to a lower incidence of ischemic heart disease and stroke mortality via ecological data analyses of both primary care facility density and internal physician density. The unit of observation was the Japanese secondary medical service area, the basic unit for healthcare planning and administration. A primary care facility was defined as a clinic or medical institution with less than 200 inpatient beds, whose specialty included internal medicine. The number of primary care facilities per 10,000 population and the number of internal physicians per 10,000 population were used as explanatory variables. Bayesian hierarchical models were used to analyze the relative risks (RR) of primary care facility density and internal physician density using the socioeconomic confounders of designated emergency hospitals, natural log-transformed population density, birth rate, secondary and tertiary industrial workers, and taxable income. In multivariate models for ischemic heart disease mortality, primary care facility density was significantly related to the total population (RR = 0.986, 95% credible interval [CrI]: 0.979-0.993), men (RR = 0.988, 95% CrI: 0.981-0.996), and women (RR = 0.986, 95% CrI: 0.979-0.993). No significant results were obtained for internal physician density. In the multivariate models for stroke mortality, neither primary care facility density nor internal physician density showed any significant effects. Increasing primary care facility density may reduce ischemic heart disease mortality.

Oral diseases produce enormous productivity loss. However, epidemiological evidence of work stress and tooth loss is scarce. The aim of this study was to examine the association of work stress, according to effort–reward imbalance (ERI), with tooth loss. We conducted a cross-sectional study using data obtained between 2010 and 2011 in Japan. This study included 1,195 employees aged 25–50 years old (response rate=32%). The dependent variable was self-reported tooth loss (having or not). The independent variable was a dichotomized ERI ratio (>1.4 and ≤1.4). Age, sex, sociodemographic variables, work-related factors, and health-related variables were adjusted. Psychological distress was used as a potential mediator. We also examined an additive interaction between support from supervisors and ERI. The median age was 37, and 48% were women. After adjusting for the covariates, ERI was still associated with tooth loss (prevalence ratio=1.20 [95% confidence interval=1.01, 1.42] from Poisson regression models with a robust error variance). Psychological distress partially explained the association, and support from supervisors significantly attenuated the association. In conclusion, high ERI ratio was still associated with an increased risk of tooth loss among working adults.

Urinary cotinine concentration (UCC) reflects smoking status. However, in pregnant women, its association with adverse birth outcomes related to fetal growth is not widely known. Thus, we aimed to explore this relationship by focusing on dose-response relationships. We investigated 86,638 pregnant women enrolled between 2011 and 2014 in a prospective cohort study in Japan and observed three birth outcomes (preterm birth, low birth weight, and small-for-gestational age). We measured UCC in the second or third trimester, and categorized the participants using cut-off values (negative cotinine concentration, passive cotinine concentration, and active cotinine concentration corresponding to non-smokers, passive smokers, and active smokers, respectively). Logistic regression analyses were conducted to evaluate the risks, and dose-response relationships were visualized using restricted cubic spline curves. Analyses based on self-reported smoking status were also performed. We found that in low active and highly active cotinine concentrations, the adjusted odds ratios (aORs) of birth outcomes were significantly increased (preterm birth, 1.24 [95% CI 1.06-1.46], 1.39 [95% CI 1.19-1.62]; low birth weight, 1.40 [95% CI 1.24-1.58], 2.27 [95% CI 2.05-2.53]; small-for-gestational age, 1.35 [95% CI 1.19-1.52], 2.39 [95% CI 2.16-2.65]). Restricted cubic spline curves demonstrated risk elevations in the active cotinine concentration range. Our research revealed dose-response relationships between UCC during pregnancy and the risks of preterm birth, low birth weight, and small-for-gestational age. Measurement of UCC to ascertain smoking status during pregnancy may be a useful approach for predicting the risks of these birth outcomes.

Resistant hypertension is an important cardiovascular risk factor. This analysis of the JAMP study (Japan Ambulatory Blood Pressure Monitoring Prospective) data investigated the effects of uncontrolled resistant hypertension diagnosed using ambulatory blood pressure (BP) monitoring on the risk of heart failure (HF) and overall cardiovascular events. The JAMP study patients with hypertension and no HF history were included. They had true resistant hypertension (24-hour BP ≥130/80 mm Hg), pseudoresistant hypertension (24-hour BP P =0.012 and 2.24 [95% CI, 1.17–4.30]; P =0.015, respectively) and versus uncontrolled nonresistant hypertension (1.51 [1.03–2.20]; P =0.034 and 3.03 [1.58–5.83]; P Registration: URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000020377.

Background The influence of maternal psychological distress on infant congenital heart defects (CHDs) has not been thoroughly investigated. Furthermore, there have been no reports on the combined effect of maternal psychological distress and socioeconomic status on infant CHDs. This study aimed to examine whether maternal psychological distress, socioeconomic status, and their combinations were associated with CHD. Methods We conducted a prospective cohort study using data from the Japan Environment and Children’s Study, which recruited pregnant women between 2011 and 2014. Maternal psychological distress was evaluated using the Kessler Psychological Distress Scale in the first trimester, while maternal education and household income were evaluated in the second and third trimesters. The outcome of infant CHD was determined using the medical records at 1 month of age and/or at birth. Crude- and confounder-adjusted logistic regression analyses were performed to evaluate the association between maternal psychological distress and education and household income on infant CHD. Results A total of 93,643 pairs of mothers and infants were analyzed, with 1.1% of infants having CHDs. Maternal psychological distress had a significantly higher odds ratio in the crude analysis but not in the adjusted analysis, while maternal education and household income were statistically insignificant. In the analysis of the combination variable of lowest education and psychological distress, the P for trend was statistically significant in the crude and multivariate model excluding anti-depressant medication, but the significance disappeared in the full model (P = 0.050). Conclusions The combination of maternal psychological distress and lower education may be a possible indicator of infant CHD.

Pets may play a role in the social-emotional development of children. In particular, some studies have suggested that family dog ownership is associated with better health outcomes. To date, no study has assessed child development in association with dog ownership of different time points. The purpose of the current study was primary to investigate whether “ever” family dog ownership was associated with early child development, and secondary to further examine whether associations between family dog ownership and early child development differ among family dog ownership of status, including “past only”, “current only”, and “always” groups, using the data of family dog ownership obtained at multiple time points. Associations between family dog ownership and infant development at 3 years of age were examined using data from a nationwide prospective birth cohort study, the Japan Environment and Children’s Study (n = 78,941). “Ever” family dog ownership was categorized to “past only”, “current only”, and “always”. We observed that children with “ever” family dog ownership showed a significantly decreased risk of developmental delay in the communication (odds ratio [OR] = 0.87, 95% confidence interval [CI]: 0.78, 0.96), gross motor (OR = 0.83, 95% CI: 0.76, 0.92), problem-solving (OR = 0.89, 95% CI: 0.83, 0.96) and personal-social (OR = 0.86, 95% CI: 0.72, 0.92) domains compared to children with “never” family dog ownership. Furthermore, a significantly decreased risk of developmental delay in gross motor function was observed in association with living with dogs in the “past only” (OR = 0.83, 95% CI: 0.73, 0.95) and “always” (OR = 0.86, 95% CI: 0.75, 0.98). In addition, a decreased risk of developmental delay in the problem-solving domain was associated with “past” family dog ownership (OR = 0.87, 95% CI: 0.79, 0.97) and in the personal-social domain was associated with “always” family dog ownership (OR = 0.81, 95% CI = 0.68, 0.95). Given the possible positive association between early life child development and family dog ownership, living with dogs may be an important factor to be considered when assessing child development.

Background Although the majority of survivors of the huge Great East Japan Earthquake and Tsunami evacuated to two types of temporary housings, prefabricated housing and rented housing, health effects of these different environments were unclear. We examined whether prevalent social participation in prefabricated housing brought larger health benefits than in rented housing using the largest health survey data of the disaster survivors. Methods This cross-sectional study used a 2012 survey by the Miyagi Prefectural Government, in which almost all of evacuees were targeted (response rate: 61.6%). Self-rated health (SRH) and psychological distress measured via K6 score were the dependent variables, and social participation was the independent variable. Odds ratios of the social participation on health variables were estimated using logistic regression models. To assess the contribution of social participation, the population attributable fraction (PAF) was estimated. Results The participants lived in prefabricated and rented housing numbered 19,726 and 28,270, respectively. Participants in prefabricated housing had poorer SRH and K6 than those in rented housing. The proportions of participants engaging in social participation of prefabricated and rented housing were 38.2% and 15.4%, respectively. The absence of social participation was significantly associated with poor SRH and K6 among participants in both housing types. The PAFs of social participation with good SRH were 39.5% in prefabricated housing and 14.4% in rented housing. For K6, the PAFs were 47.1% and 19.5% in prefabricated and rented housing, respectively. Conclusion Compared to the residents in rented housing, residents in prefabricated housing had more frequent opportunities for social participation, which was associated with larger health benefits.

ObjectivePrevious studies have indicated that spatial variation in suicide mortality is associated with area-specific socioeconomic characteristics, such as socioeconomic deprivation and social fragmentation. However, most of these studies have been conducted in the West and findings from Asian countries are limited. This study aims to investigate associations between socioeconomic characteristics and suicide mortality rates across 1887 municipalities in Japan between 2009 and 2017. We also assessed these associations by gender and age group.MethodsSuicide data were obtained from the suicide statistics of the Ministry of Health, Labour and Welfare in Japan and included information on the number of suicides by gender, age and municipality location. Social fragmentation, socioeconomic deprivation and urbanicity were used as socioeconomic characteristics in this study and were created from survey data obtained from the 2010 census. Bayesian hierarchical models were used to examine associations between socioeconomic characteristics and suicide risk.ResultsSuicide rates were significantly higher in municipalities with higher levels of deprivation, with a rate ratio of 1.13 (95% credible interval: 1.10 to 1.17) in the highest quartile compared with the lowest. Higher levels of urbanicity had significantly lower suicide rates, with a rate ratio of 0.79 (95% credible interval: 0.77 to 0.82) in the highest quartile compared with the lowest. However, associations between exposures and suicide varied considerably by gender and age. Among both men and women aged 0–39 years, fragmentation was significantly associated with suicide, with rate ratios of 1.07 and 1.15 for men and women, respectively, in the highest quartile compared with the lowest.ConclusionSuicide prevention in Japan should particularly focus on areas with high levels of deprivation or low levels of urbanicity. Furthermore, young Japanese people residing in the most fragmented municipalities were also at high risk of suicide, and appropriate measures need to be taken.

ObjectivesSmall dense low-density lipoprotein cholesterol (sdLDL-C) might be a better cardiovascular disease (CVD) indicator than low-density lipoprotein cholesterol (LDL-C); however, details regarding its epidemiology remain elusive. The present study aimed at evaluating the association between the demographic factors, such as age, gender and menopausal status, and sdLDL-C levels and sdLDL-C/LDL-C ratio in the Japanese population.DesignThis was a cross-sectional study.Setting13 rural districts in Japan, 2010–2017.ParticipantsThis study included 5208 participants (2397 men and 2811 women), who underwent the health mass screening that was conducted in accordance with the medical care system for the elderly and obtained informed consent for this study.ResultsIn total, 517 premenopausal women (mean age ±SD, 45.1±4.2 years), 2294 postmenopausal women (66.5±8.8 years) and 2397 men (64.1±11.2 years) were analysed. In men, the sdLDL-C levels and sdLDL-C/LDL-C ratio increased during younger adulthood, peaked (36.4 mg/dL, 0.35) at 50–54 years, and then decreased. In women, relatively regular increasing trends of sdLDL-C level and sdLDL-C/LDL-C ratio until approximately 65 years (32.7 mg/dL, 0.28), followed by a downward or pleated trend. Given the beta value of age, body mass index, fasting glucose and smoking and drinking status by multiple linear regression analysis, standardised sdLDL-C levels and sdLDL-C/LDL-C ratio in 50-year-old men, premenopausal women and postmenopausal women were 26.6, 22.7 and 27.4 mg/dL and 0.24, 0.15 and 0.23, respectively. The differences between premenopausal and postmenopausal women were significant (pConclusionsSdLDL-C and sdLDL-C/LDL-C ratios showed different distributions by age, gender and menopausal status. A subgroup-specific approach would be necessary to implement sdLDL-C for CVD prevention strategies, fully considering age-related trends, gender differences and menopausal status.

Background Lower respiratory tract infections (LRTIs) are a cause of inpatient and outpatient care among children. Although orofacial clefts seem to be associated with LRTIs, epidemiological studies are scarce on this topic. This study aimed to examine whether infants with orofacial clefts were associated with LRTIs. Methods This prospective cohort study used data from the Japan Environment and Children's Study, whose baseline recruitment was conducted during 2011-2014. This study included 81,535 participants. The number of infants with cleft lip and palate (CLP), cleft lip (CL), and cleft palate only (CP) was 67, 49, and 36, respectively. We defined history of LRTIs until 12 months' age reported by their mothers as the dependent variable. Accumulated breastfeeding duration was used as potential mediators. Results The incidence proportion of LRTIs among the control group was 6.0%. The incidence proportion among infants with CLP, CL, and CP were 11.9%, 14.3%, and 5.6%, respectively. After adjusting for covariates, compared with the control group, infants with CLP and CL were associated with risk of LRTIs (incidence risk ratio [IRR] of CLP = 2.38 [95% confidence interval = 1.30, 4.36] and of CL = 2.73 [1.40, 5.33]) , but not ones with CP (1.08 [0.28, 4.15]). Accumulated breastfeeding duration decreased the IRR of CLP only (IRR of CLP = 2.16 [1.19, 3.93]). Conclusions Infants with orofacial clefts aged 1 year have a potentially high incidence proportion of LRTIs. Accumulated breastfeeding duration might mediate the associations of CLP.

Background The influence of mothers’ and fathers’ educational levels in separate evaluations of asthma has not been fully investigated. This study aims to examine the associations of the mother’s and fathers’ educational levels with childhood wheeze and asthma adjusting for crude and pre-and post-natal modifiable risk factors. Methods We conducted a prospective cohort study using data from the Japan Environment and Children’s Study, which recruited pregnant women from 2011 to 2014. The mother’s and father’s educational levels were surveyed by a questionnaire during the pregnancy, and childhood wheezing and doctor-diagnosed asthma were estimated using a 3-year questionnaire. Multilevel logistic regression analysis was performed to evaluate the association between the mother’s and father’s educational levels and childhood wheezing and asthma, adjusted for pre-and post-natal factors. Results A total of 69,607 pairs of parents and their single infants were analyzed. We found 17.3% of children had wheezing and 7.7% had asthma. In crude analyses, lower educational level of parents was associated with an increased risk of childhood wheezing and asthma. After full adjustment, a lower educational level of mothers was associated with an increased risk of childhood asthma (junior high school (reference: high school); odds ratio (OR): 1.17, 95% CI, 1.01–1.36), and higher educational level, especially the mother’s, was associated with an increased risk of childhood wheezing (technical junior college, technical/vocational college, or associate degree (ECD3); OR: 1.12, 95% CI, 1.06–1.18, bachelor’s degree, or postgraduate degree; OR: 1.10, 95% CI, 1.03–1.18), and asthma (ECD3; OR: 1.13, 95% CI, 1.04–1.21). Conclusions Parents’ lower educational level was a crude risk factor for childhood wheezing and asthma. However, an increased risk of wheezing due to mothers’ higher educational level was found after adjusting for pre-and post-natal factors.

Previous studies on trust and health have not fully considered the nature of trust in relation to types of trust and socio-cultural background. The present study aimed to examine whether generalized trust (trust in general people; GT) and particularized trust (trust in particular people; PT) in urban and rural areas had different associations with health. This prospective cohort study on older adults used panel data obtained in 2010 and 2013. Surveys were conducted in 24 municipalities in Japan. Of 20,209 respondents, 13,657 participants were followed up. The independent variables were GT and PT in neighbors; the dependent variable was self-rated health (SRH) at follow-up. We examined the interaction term between population density and each trust variable. Age, sex, SRH at the baseline, and other potential confounders were adjusted. The median age was 72 years (females: 53.4%). Percentages of high GT and high PT were 21.0% and 72.4%, respectively. Prevalence of poor SRH at the follow-up was 15.5% and 28.5% in high and low GT, respectively, and 16.9% and 32.8% in high and low PT, respectively. After adjusting for covariates in logistic regression models, low GT and PT were significantly associated with higher odds ratios (ORs) for poor SRH compared to high trust (GT: OR = 1.43 [95% confidence interval (95%CI) = 1.17, 1.75] and PT: OR = 1.44 [95%CI = 1.15, 1.81]). Associations of low PT with poor SRH significantly strengthened when population density increased (interaction term of low PT: OR = 1.16 [95%CI = 1.04, 1.27]). On the other hand, associations of GT with SRH were not significantly interacted by population density. The mediation analysis showed that the direct effects of PT influenced SRH in urban areas only. In urban areas with high social uncertainty, trust in particular neighbors was more beneficial to health.

Background: Secondhand smoke (SHS) causes many deaths. Inequalities in SHS have been reported in several countries; however, the evidence in Asian countries is scarce. We aimed to investigate the association between socioeconomic status (SES) and SHS at home and the workplace/school among non-smoking Japanese adults. Methods: Cross-sectional data from the Miyagi Prefectural Health Survey 2014 were analyzed. Self-reported questionnaires were randomly distributed to residents ≥20 years of age and 2,443 (92.8%) responded. The data of the 1,738 and 1,003 respondents were included to the analyses for SHS in the past month at home and at the workplace/school, respectively. Ordered logistic regression models considering possible confounders, including knowledge of the adverse health effects of tobacco, were applied. Results: The prevalence of SHS at home and the workplace/school was 19.0% and 39.0%, respectively. Compared with ≥13 years of education, odds ratios (ORs) and 95% confidence intervals (CIs) for SHS at home were 1.94 (95% CI, 1.42–2.64) for 10–12 years and 3.00 (95% CI, 1.95–4.60) for ≤9 years; those for SHS at the workplace/school were 1.80 (95% CI, 1.36–2.39) and 3.82 (95% CI, 2.29–6.36), respectively. Knowledge of the adverse health effects of tobacco was significantly associated with lower SHS at home (OR 0.95; 95% CI, 0.91–0.98) but it was not associated with SHS at the workplace/school (OR 1.02; 95% CI, 0.98–1.06). Conclusions: Social inequalities in SHS existed among Japanese non-smoking adults. Knowledge about tobacco was negatively associated with SHS at home but not at workplace/school.

The Japan Gerontological Evaluation Study is a nationwide cohort study of individuals aged 65 years and older established in July 2010. Seven months later, one of the study field sites was directly in the line of the 2011 Great East Japan Earthquake and Tsunami. Despite the 1-hour warning interval between the earthquake and tsunami, many coastal residents lost their lives. We analyzed the risk of all-cause mortality on the day of the disaster as well as in the 38-month interval after the disaster. Among 860 participants, 33 (3.8%) died directly because of the tsunami and an additional 95 people died during the 38-month follow-up period. Individuals with depressive symptoms had elevated risk of mortality on the day of the disaster (odds ratio = 3.90 [95% CI: 1.13, 13.47]). More socially connected people also suffered increased risk of mortality, although these estimates were not statistically significant. In contrast, after the disaster, frequent social interactions reverted back to predicting improved survival (hazard ratio = 0.46 (95% CI: 0.26, 0.82)). Depressive symptoms and stronger social connectedness were associated with increased risk of mortality on the day of the disaster. After the disaster, social interactions were linked to improved survival.

This study examined whether the number of teeth contributes to the compression of morbidity, measured as a shortening of life expectancy with disability, an extension of healthy life expectancy, and overall life expectancy. A prospective cohort study was conducted. A self-reported baseline survey was given to 126,438 community-dwelling older people aged ≥65 y in Japan in 2010, and 85,161 (67.4%) responded. The onset of functional disability and all-cause mortality were followed up for 1,374 d (follow-up rate = 96.1%). A sex-stratified illness-death model was applied to estimate the adjusted hazard ratios (HRs) for 3 health transitions (healthy to dead, healthy to disabled, and disabled to dead). Absolute differences in life expectancy, healthy life expectancy, and life expectancy with disability according to the number of teeth were also estimated. Age, denture use, socioeconomic status, health status, and health behavior were adjusted. Compared with the edentulous participants, participants with ≥20 teeth had lower risks of transitioning from healthy to dead (adjusted HR, 0.58 [95% confidence interval (CI), 0.50–0.68] for men and 0.70 [95% CI, 0.57–0.85] for women) and from healthy to disabled (adjusted HR, 0.52 [95% CI, 0.44–0.61] for men and 0.58 [95% CI, 0.49–0.68] for women). They also transitioned from disabled to dead earlier (adjusted HR, 1.26 [95% CI, 0.99–1.60] for men and 2.42 [95% CI, 1.72–3.38] for women). Among the participants aged ≥85 y, those with ≥20 teeth had a longer life expectancy (men: +57 d; women: +15 d) and healthy life expectancy (men: +92 d; women: +70 d) and a shorter life expectancy with disability (men: –35 d; women: –55 d) compared with the edentulous participants. Similar associations were observed among the younger participants and those with 1 to 9 or 10 to 19 teeth. The presence of remaining teeth was associated with a significant compression of morbidity: older Japanese adults’ life expectancy with disability was compressed by 35 to 55 d within the follow-up of 1,374 d.

Background: Annually, more than 1.2 million deaths due to road traffic accidents occur worldwide. Although previous studies have examined the association between cigarette smoking and injury death, the mortality outcome often included non-traffic accident-related deaths. This study aimed to examine the association between cigarette smoking and traffic accident death. Methods: We conducted a prospective cohort study using data from the Ibaraki Prefectural Health Study conducted from 1993 through 2013. The cohort included 97,078 adults (33,138 men and 63,940 women) living in Ibaraki Prefecture who were aged 40–79 years at an annual health checkup in 1993. We divided participants into four smoking status groups: non-smokers, ex-smokers, and current smokers who smoked

OBJECTIVES: To describe associations between tooth loss and changes in higher-level functional capacity. DESIGN: Prospective cohort study. SETTING: Twenty-four Japanese municipalities between 2010 and 2013. PARTICIPANTS: Functionally independent community-dwelling persons aged 65 and older (N = 62,333). MEASUREMENTS: Self-reported number of teeth was used as an exposure variable. The outcome was changes in higher-level functional capacity measured using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), which consists of three domains: instrumental activities of daily living, intellectual activity, and social roles. The TMIG-IC score ranges from 0 (lowest function) to 13 (highest function). All covariates were chosen from baseline demographic, socioeconomic, health behavior, and health variables based upon evidence from previous studies. Inverse-probability weighting (IPW) with propensity score and multiple linear regression, estimating nonstandardized coefficients (β) and 95% confidence intervals (CIs), were used. RESULTS: The baseline response rate was 65.2%, and the follow-up rate was 70.1%. During the follow-up period, participants' TMIG-IC score declined by an average of 0.247 points (standard deviation: 1.446). The results showed a significant dose-response association between tooth loss and decline in higher-level functional capacity in multiple linear regression models. IPW models estimated the increment in TMIG-IC score (β = 0.170, 95% CI = 0.114-0.227) if edentulous participants gained 20 or more natural teeth. CONCLUSION: Tooth loss is associated with future decline in higher-level functional capacity. IPW models suggest that treatment for tooth loss attenuates decline in higher-level functional capacity.

To further investigate the prevalence of hepatitis E virus (HEV) infection and characterize HEV genomes among Japanese wild boars (Sus scrofa leucomystax), 1880 boars captured in 17 prefectures in Japan from 2013 to 2019 were studied. Overall, anti-HEV IgG was detected in 8.9 % and HEV RNA was detected in 3.9 % of boars, which was comparable with our previous studies during 2003-2013 (10.3 % and 3.5 %, respectively). Among 74 boar HEV strains obtained from infected boars in the present study, 50 (68 %) were classified into genotype 3 (3a and 3b), 23 (31 %) were classified into genotype 4 (4i), and the remaining strain (wbJGF_19-1) was classified into genotype 5. The wbGF_19-1 strain shared 92.7 % identity over the entire genome with the prototype genotype 5 strain (JBOAR135-Shiz09). The identification of the second genotype 5 HEV strain in a place that is located only 100 km from the site at which JBOAR135-Shiz09 was identified, suggests that genotype 5 HEV circulates within a relatively close range in Japan. Genetically similar HEV strains forming a clade were identified from wild boars living in each area during the observation period of 11-13 years, although the nucleotide sequence changed gradually, accounting for up to 3.4-3.6 % within the 412-nucleotide ORF2 sequence. Eight groups of boars with a cluster of HEV infections were observed, consisting of two, three or four infected offspring, presumably born to the same mother or offspring with their mother. These results suggest that wild boars continue to be important reservoirs for HEV infection in humans in Japan.

Background Temporary employment leads to psychological distress and higher mortality, but data on its associations with oral health is limited. We examined whether having the experience of temporary employment was associated with tooth loss among working adults in Japan. Methods We conducted a cross-sectional study from the 2010–2011 Japanese Study on Stratification, Health, Income, and Neighborhood study that analyzed 2652 participants aged 25–50 years (men = 1394; women = 1258). Independent variable was changes in employment status (continuous regular employment and the experience of temporary employment). Dependent variable was self-reported tooth loss (none, 1 tooth, 2 teeth, 3 teeth, 4 teeth, and more than 4 teeth). Covariates were sex, age, years of education, self-rated household economic status in early life at 5 years old, marital status, number of family members in the household, history of diabetes, and body mass index. We conducted a negative binomial regression analysis to estimate prevalence rate ratios (PRRs) and 95% confidence intervals (95%CIs) for tooth loss. We also confirmed the interaction term between changes in employment status and sex. Results The median age of the participants was 37 years. The percentages of men and women who experienced temporary employment were 14.5% and 61.3%, respectively. Compared with continuous regular employment, the experience of temporary employment was significantly associated with tooth loss in both sexes after adjusting for the covariates (men: PRR = 1.50 [95%CI = 1.13, 2.00]; women: PRR = 1.42 [95%CI = 1.14, 1.76]). The interaction term between employment status and sex was not significant (p = 0.71). Conclusions Temporary employment is adversely associated with oral health.

Background No studies have examined the associations between the numbers of teeth and sleep disturbance. Therefore, we examined the associations between the number of teeth and sleep duration in older people, considering the evidence linking fewer teeth and sleep apnoea through changes in jaw position. Methods For this study we used information from a sample of 23,444 cohort participants, randomly selected from the Japan Gerontological Evaluation Study 2010 (N = 169,215). The outcome variable was self-reported sleep duration (h/day), and the explanatory variable was self-reported number of teeth (0, 1–9, 10–19, ≥20). We treated age, sex, body mass index, educational attainment, annual equalized household income, depressive symptoms, physical activity, activities of daily living, presence of diabetes, and smoking status as covariates. Multinomial logistic regression was used among the 20,548 eligible participants with all necessary information. Results The mean age was 73.7 (standard deviation = 6.13) years. Most participants (28.1%) reported sleep duration of 7 h, while a small proportion of the participants reported short (≤4 h, 2.7%) or long (≥10 h, 4.7%) sleep duration. The proportion of edentulous participants was 14.7%. Taking the 7-h sleep duration as the reference category, edentulous participants (relative risk ratio (RRR) = 1.43, 95% confidence interval (CI) = 1.07–1.90) or one to nine teeth (RRR = 1.29, 95% CI = 1.02–1.63) had a significantly higher relative risk ratio for short sleep, independent of covariates. Furthermore, they had a higher relative risk ratio for long sleep duration (RRR = 1.75, 95% CI = 1.40–2.19; RRR = 1.48, 95% CI = 1.21–1.81, respectively). Conclusions Compared to people with 20 or more teeth, older adults with fewer than 10 teeth have higher risks for short and long sleep durations.

The 2011 Great East Japan Earthquake and Tsunami resulted in widespread property destruction and over 250,000 displaced residents. We sought to examine whether the type of housing arrangement available to the affected victims was associated with a differential incidence of depressive symptoms. In this prospective cohort study, which comprised participants aged ≥65 years from Iwanuma as a part of the Japan Gerontological Evaluation Study, we had information about the residents’ mental health both before the disaster in 2010 and 2.5 years afterward. The Geriatric Depression Scale was used. Type of accommodation after the disaster was divided into 5 categories: no move, prefabricated housing (temporary housing), existing private accommodations (temporary apartment), newly established housing, and other. Poisson regression analysis was adopted, with and without multiple imputation. Among the 2,242 participants, 16.2% reported depressive symptoms at follow-up. The adjusted rate ratio for depressive symptoms among persons moving into prefabricated housing, compared with those who did not, was 2.07 (95% confidence interval: 1.45, 2.94). Moving into existing private accommodations or other types of accommodations was not associated with depression. The relationship between living environment and long-term mental health should be considered for disaster recovery planning.

PURPOSE To evaluate the effectiveness of selective photocoagulation (S-PC) for nonperfusion areas (NPA) in preproliferative diabetic retinopathy (PPDR). SUBJECTS AND METHODS A multicenter randomized controlled clinical trial of 69 patients with PPDR showing NPA comparable to or larger than those on reference photographs. The patients were assigned to 2 groups; one was treated with S-PC (PC group: 32 patients), while the other did not receive S-PS (non-PC group: 37 patients). In the non-PC group, panretinal photocoagulation (PRP) was performed whenever proliferative diabetic retinopathy (PDR) developed. In the PC group, S-PC of the NPA was performed followed by additional coagulation whenever the NPA extended, and PRP was performed whenever PDR developed. The primary outcome was the development of PDR. RESULTS During the entire course, PDR developed in 18 (26%) of the 69 patients. The incidence was significantly higher in the non-PC group than in the PC group. Comparison of the visual acuity at the time of registration and after 36 months showed no significant differences between the two groups. CONCLUSIONS S-PC for NPA in PPDR is effective at preventing PDR development.

To clarify the relationship between sleep-disordered breathing (SDB) and background factors in patients with proliferative diabetic retinopathy (PDR).One hundred fifty-one consecutive PDR patients were included in this study. These patients' SDB parameters, including the mean and lowest SpO(2), sleeping 4% oxygen desaturation index (ODI), and cumulative percentage of time spent at SpO(2)90% (CT90%), were measured. Simple linear regression analyses were conducted to investigate whether the SDB parameters correlated with systemic factors for PDR, including age, duration of diabetes, HbA1c value, incidence of hypertension, estimated glomerular filtration rate (eGFR), body mass index (BMI), and insulin therapy. Logistic regression analysis was also conducted to investigate whether the SDB evaluation items were factors independently associated with the incidence of hypertension.Hypertension and BMI were statistically correlated with all of the parameters. The eGFR was statistically correlated with 4% ODI and insulin therapy with the lowest SpO(2). Logistic regression analysis revealed 4% ODI and eGFR as factors independently contributing to the incidence of hypertension.The results of our study confirmed the relationship between SDB and background factors reported to be risk factors for diabetic retinopathy progression in patients with PDR.

To investigate whether sleep-disordered breathing is a risk factor for iris and/or angle neovascularization in patients with proliferative diabetic retinopathy (PDR).Cross-sectional comparative case series.One hundred fifty-one consecutive patients with PDR who underwent surgery in our hospital were divided based on the presence of iris and/or angle neovascularization (NV group, 37 patients) or absence of NV (non-NV group, 114 patients). Pulse oximetry was conducted during the night and the mean SpO(2), 4% oxygen desaturation index (4% ODI times/hour), the lowest SpO(2)% during sleep (lowest SpO(2)), and the cumulative percentage of time at SpO(2)90% in analysis times (CT90%) were calculated. When the 4% ODI exceeded 5 times/hour, sleep-disordered breathing was diagnosed. The results were compared between the 2 groups. Preoperative systemic parameters also were analyzed by logistic regression to clarify risk factors for the NV group.A mean total of 50% (62% of the NV group and 46% of the non-NV group) was diagnosed with sleep-disordered breathing. The mean SpO(2) and lowest SpO(2) did not differ significantly between the 2 groups; the 4% ODI (12.3 vs 6.6) and CT90% (3.8 vs 1.7) were significantly higher in the NV group (P=.02, for both comparisons). Logistic regression analysis identified insulin therapy (odds ratio [OR], 3.01; 95% confidence interval [CI], 1.26∼7.20; P=.01); and 4% ODI (OR, 1.09; CI, 1.01∼1.16; P=.02) as risk factors for the NV group.In patients with PDR, nocturnal intermittent hypoxia/reoxygenation resulting from sleep-disordered breathing may be a risk factor for iris and/or angle neovascularization.

To evaluate the efficacy of vitrectomy with internal limiting membrane (ILM) peeling and SF(6) gas tamponade for macular holes without face-down positioning.Twenty-one eyes of 21 consecutive patients undergoing pars plana vitrectomy with indocyanine green-assisted ILM peeling and 20% SF(6) gas tamponade without face-down positioning were included in this study. Biomicroscopy and optical coherence tomography were used to assess macular hole closure. Pre- and postoperative visual acuities (VAs) were compared.Among the 21 eyes, five (23.8%) had stage 2, 11 (52.4%) stage 3, and five (23.8%) stage 4 macular holes. Mean macular hole size was 0.35 disc diameters. The macular holes had been present for an average of 2.3 months. Twenty eyes (95.2%) were phakic, and one (4.8%) was pseudophakic. Nineteen of the 21 holes (90.5%) initially closed. The final closure rate was 100%, and no eyes showed reopening. Preoperative mean VA (logMAR) was 0.65, and mean VA had significantly improved to 0.46 at 1 month and to 0.42 at 3 months after surgery (P0.0001, repeated measures analysis of variance).Vitrectomy with ILM peeling and SF(6) gas tamponade for macular holes without face-down positioning achieved favorable anatomical and functional results.

Results of vitreous surgery alone in patients with diabetic macular edema (Vit group) were compared with results of surgery combined with peeling of the internal limiting membrane (ILM group), and surgery combined with removal of the residual vitreous cortex after its visualization using triamcinolone acetonide (TA) and a postoperative intravitreal TA injection (TA group). Visual acuities after the operation, degree of improvement in visual acuity (VA), and intra- and postoperative complications were evaluated.The study included 141 consecutive patients (168 eyes) who could be followed up for at least 12 months after the operation. The Vit group consisted of 66 eyes, the ILM group of 62 eyes, and the TA group of 40 eyes. Patient background factors, and visual acuities 6 and 12 months after operation were evaluated first, and at the final examination, the degree of improvement in VA, the incidences of intra- and postoperative complications, and the incidence of intraocular pressureor =25 mmHg were studied.Preoperative VA was compared with the 6- and 12-month postoperative VA and the VA at the final examination. The preoperative to 6 months postoperative improvements and those between the 12-month postoperative and final examination did not differ among the three groups. However, the degree of improvement in VA between 6 and 12 months after the operation was significantly smaller in the TA group than in the other two groups. The incidences of intra- and postoperative complications did not differ among the three groups, but the incidence of intraocular pressure/=25 mmHg was slightly higher in the TA group.Surgical results did not differ among the three operative techniques examined in this study.

Disasters greatly threaten the health and lives of people all over the world. Japan experienced severe damage following the Great East Japan Earthquake on March 11, 2011, and some survivors continue to live in prefabricated temporary housing, built collectively in damaged areas. Previous studies have shown that social relationships in such communities have the potential to protect the mental health of disaster survivors. We examined the association between survivors' social support and social participation in 2012 and their psychological distress in 2013 using the K6 scale. Self-reported questionnaires were distributed to all 15,979 households in prefabricated temporary housing in eight municipalities in Miyagi prefecture in 2012, and 19,284 adults from 9366 (58.6%) households responded. One year later, 10,880 adults responded to a follow-up survey. Multivariate multilevel linear regression analyses with multiply imputed datasets showed that survivors' psychological distress at follow-up significantly differed between communities (community-level variance [standard error] = 0.38 [0.13]). The variance was reduced to 0.25 [0.09] after considering individual demographic characteristics and psychological distress at baseline. Individual- and community-level social relationships of 7.1% and 15.8%, respectively, explained the difference. After adjusting for covariates including K6 scale at baseline, individual-level social support, community-level social support, and individual-level social participation were significantly associated with low psychological distress at follow-up (coefficients [95% confidence intervals] were: -0.54 [-0.79, -0.30]; -0.43 [-0.72, -0.14]; and -0.22 [-0.40, -0.04], respectively). Community-level social participation was not significantly associated with psychological distress. The present study showed that: 1) survivors' psychological distress varied between temporary housing communities in 2013; 2) individual- and community-level social relationships contributed to the difference; and 3) individual- and community-level social relationships in 2012 were protectively associated with survivors' psychological distress in 2013. Promoting social relationships in communities after disasters might decrease disaster survivors' psychological distress.

We evaluated the effects of the peeling of the internal limiting membrane (ILM) during vitrectomy in diabetic cystoid macular edema (CME) patients.Visual outcome and intraoperative and postoperative complications were evaluated retrospectively in 84 CME patients (100 eyes), all of whom had been followed for at least 1 year postoperatively. Before January 2001, we did not perform ILM peeling at our hospitals; 57 patients (66 eyes) treated before 2001 were included in this retrospective study as the non-peeling group. After January 2001, ILM peeling was performed in 27 (34 eyes) CME patients, who were included in this study as the peeling group. In the peeling group, indocyanine green (ICG) staining was performed at the time of ILM peeling.Visual acuity improved significantly after vitrectomy regardless of ILM peeling. Visual acuity improved gradually from 6 months to 1 year after the operation, and improved further at the final observation point in both groups. Visual acuity did not differ significantly between the two groups at any time point. There was no difference in the incidence of intraoperative and postoperative complications between the two groups. There were no adverse events associated with ICG-assisted ILM peeling.Visual acuity improved with vitrectomy for diabetic cystoid macular edema in both groups. ILM peeling was not found to improve visual acuity postoperatively.

Purpose: To compare the efficacy of surgically removing or not removing the internal limiting membrane (ILM) during pars plana vitrectomy on the visual acuity and retinal thickness in eyes with diabetic macular edema. Methods: A prospective, case-control study was carried out on 30 eyes of 29 patients undergoing pars plana vitrectomy for diabetic macular edema. Fifteen eyes underwent pars plana vitrectomy with ILM removal and 15 eyes without ILM removal. Results: In 7 of 15 eyes (47%) in the ILM-removed group, the visual acuity improved by 0.2 or more log of the minimum angle of resolution (log MAR) units and remained unchanged in 8 eyes (53%). In the ILM-preserved group, the final visual acuity improved in 9 of 15 eyes (60%) and remained unchanged in 6 eyes (40%). The difference in visual acuity between the two groups after 11 months the surgery was not significant (Fisher’s exact test, p = 0.4938). In the ILM-removed group, the final retinal thickness decreased by more than 20% of the preoperative retinal thickness in 12 of 15 eyes (80%), remained unchanged in 2 of 15 eyes (13%), and increased in 1 of 15 eyes (7%). In the ILM-preserved group, the final retinal thickness decreased in 13 of 15 eyes (87%) and remained unchanged in 2 of 15 eyes (23%). The differences in the changes in the retinal thickness between the two groups were not statistically significant (Fisher’s exact test, p = 0.5945). Conclusion: Vitrectomy in eyes with diabetic macular edema without ILM removal was as effective in reducing the retinal thickness and improving the visual acuity as eyes with ILM removal. We conclude that ILM need not be removed to treat eyes with diabetic macular edema.

Purpose: The internal limiting membrane (ILM) removal has been combined with macular hole surgery in recent years, which facilitates shortening of the prone-positioning period after surgery. In this study, surgical outcome of macular hole surgery with ILM removal, air tamponade, and 1-day prone positioning was evaluated. Methods: In a prospective study, 23 patients (23 eyes) underwent vitrectomy for idiopathic macular holes. Macular holes

Purpose: We evaluated visual outcomes following vitrectomy for diabetic cystoid macular edema. Methods: Visual outcomes and factors possibly influencing final visual acuity were assessed and documented retrospectively in 45 eyes of 40 patients, all of whom were followed up for at least 6 months postoperatively. Results: Compared with the preoperative logarithm of the minimum angle of resolution (logMAR) visual acuity, final logMAR visual acuity improved 0.2 or more in 51% of the eyes, was unchanged in 47%, and decreased 0.2 or more in 2%. A final postoperative visual acuity of 0.5 or better was achieved in 38%. Preoperative visual acuity and the extent of the cystoid space on fluorescein angiography were significantly related to final visual acuity. A final postoperative visual acuity of 0.5 or better was noted in 8% of eyes with a preoperative visual acuity below 0.1, in 50% of eyes with a preoperative visual acuity of 0.1 or better, in 71% of eyes with a cystoid space smaller than 5 disc areas, and in 20% of eyes with a cystoid space of 5 disc areas or more. The state of the posterior vitreous membrane did not influence final visual acuity. There were no complications that decreased visual acuity. Conclusions: We conclude that diabetic cystoid macular edema is a good indication for vitrectomy, regardless of the state of the posterior vitreous membrane. A preoperative visual acuity of 0.1 or better and/or a cystoid space smaller than 5 disc areas may be indications for surgery aimed at achieving a final postoperative visual acuity of 0.5 or better.

Objectives Survivors of the 2011 Great East Japan Earthquake have an increased risk of depressive symptoms. We sought to examine whether participation in group exercise and regular walking could mitigate the worsening of depressive symptoms among older survivors. Design Prospective observational study. Setting Our baseline survey was conducted in August 2010, ∼7 months prior to the Great East Japan Earthquake and tsunami, among people aged 65 or older residing in Iwanuma City, Japan, which suffered significant damage in the disaster. A 3-year follow-up survey was conducted in 2013. Participants 3567 older survivors responded to the questionnaires predisaster and postdisaster. Primary outcome measures Change in depressive symptoms was assessed using the 15-item Geriatric Depression Scale (GDS). Results From predisaster to postdisaster, the mean change in GDS score increased by 0.1 point (95% CI −0.003 to 0.207). During the same interval, the frequency of group exercise participation and daily walking time also increased by 1.9 days/year and 1.3 min/day, respectively. After adjusting for all covariates, including personal experiences of disaster, we found that increases in the frequency of group exercise participation ( B =−0.139, β =−0.049, p=0.003) and daily walking time ( B =−0.087, β =−0.034, p=0.054) were associated with lower GDS scores. Interactions between housing damage and changes in group exercise participation ( B =0.103, β =0.034, p=0.063) and changes in walking habit ( B =0.095, β =0.033, p=0.070) were marginally significant, meaning that the protective effects tended to be attenuated among survivors reporting more extensive housing damage. Conclusions Participation in group exercises or regular walking may mitigate the worsening of depressive symptoms among older survivors who have experienced natural disaster.

Cryofiltration (CF) is a technique in which separated plasma is chilled before being subjected to a plasma fractionator (PF), leading to cryoglobulin precipitation or cryogel formation. In CF using the Evaflux-5A as the PF, there is no consensus on the necessity of albumin supplementation, and when or how often the PF column should be washed. We analyzed the sieving effects of various solutes (albumin, IgG, IgM, LDL, HCV-RNA, and cryoglobulin) depending on transmembrane pressure (TMPPF ) during CF using the Evaflux-5A in a patient with hepatitis C virus-associated cryoglobulinemic glomerulonephritis. Five CF treatments were initially performed and a sixth one later, at disease recurrence. Quantitative detection of cryoglobulin and a marked rise in TMPPF to 400 mm Hg were observed only at the first and sixth treatment, and albumin losses during these treatments were very high, at 16.8 g, and 14.6 g, respectively, while those of others (from the second to fifth) were 6.7 g, 6.4 g, 5.9 g, and 7.0 g, respectively. The sieving coefficients (SCs) of both albumin and IgG were stable (0.8-1.0) at TMPPF 200 mm Hg, but significantly decreased at TMPPF ≥ 200 mm Hg (P 0.01). The SC of IgM tended to decrease at TMPPF ≥ 200 mm Hg, but not significantly, while that of LDL was zero regardless of the TMPPF . Albumin loss per treatment likely depends on degree of TMPPF rise, which is mainly affected by the patient's cryoglobulinemic status. In CF using Evaflux-5A, washing the PF column to keep TMPPF 200 mm Hg during treatment may be a recommended for selective removal and albumin salvage.

The Great East Japan Earthquake in March 2011 destroyed many communities, and as a result many older victims lost their removable dentures. No previous studies have documented the prevalence of denture loss after a natural disaster or examined its negative impact. Therefore, investigation of the consequences of such a disaster on oral health is of major importance from a public health viewpoint.Three to five months after the disaster, questionnaire surveys were conducted in two coastal towns, Ogatu and Oshika, located in the area of Ishinomaki city, Miyagi prefecture. Among the survey participants, 715 individuals had used one or more removable dentures before the disaster, and these comprised the population analyzed. The effect of denture loss on oral health-related quality life (OHRQoL) was examined by a modified Poisson regression approach with adjustment for sex, age, subjective household economic status, dental caries, tooth mobility, psychological distress (K6), access to a dental clinic, physical activity, and town of residence.There were 123 (17.2%) participants who had lost their dentures. In comparison with participants who had not lost their dentures, those lacking dentures showed a significantly higher relative risk for eating difficulties (RR = 2.65, 95%CI = 1.90-3.69), speech problems (RR = 4.37, 95%CI = 2.46-7.76), embarrassment upon smiling, laughing, or showing their teeth (RR = 5.32, 95%CI = 2.34-12.1), emotional distress (RR = 2.38, 95%CI = 1.41-4.03), and problems related to social interaction (RR = 6.97, 95%CI = 1.75-27.7).Denture loss appeared to impair eating and speaking ability, thus discouraging communication with others. Public health intervention after major natural disasters should include dental care.

To evaluate the relationship between nocturnal dipping in heart rates and iris and/or angle neovascularization (NV) in patients with proliferative diabetic retinopathy(PDR).One hundred fifty-one patients with PDR who underwent surgery were divided into groups based on either the presence or absence of iris and/or angle NV (NV group, 37; non-NV group, 114 patients). Pulse oximetry was conducted overnight and the heart rates were measured both before and during sleep; the resting and nocturnal heart rates and the resting-nocturnal heart rate dip ratio were calculated.The resting and nocturnal heart rates did not differ significantly between the two groups. The resting-nocturnal heart rate dip ratio was significantly lower in the NV group than in the non-NV group (p = 0.006). In the NV group, the frequency of insulin therapy (p = 0.003) and a history of coronary artery disease were significantly (p = 0.033) higher than in the non-NV group. Pearson's correlation analysis showed that only the NV group was significantly negatively correlated with the resting-nocturnal heart rate dip ratio (r = -0.18, t value = -2.2, p = 0.028).In patients with PDR, the non-occurrent of nocturnal dip in heart rate may be a related factor for iris and/or angle neovascularization.

To evaluate the vitreous fluid levels of soluble LR11 (sLR11), a novel circulating marker for proliferative diabetic retinopathy (PDR), in patients with PDR and non-PDR (NPDR) in comparison to those in patients with non-diabetic ocular diseases. Twenty NPDR and 60 PDR cases were included. Twenty-four subjects with a macular hole were served as a control group. The sLR11 levels of vitreous fluid and serum were determined by sandwich enzyme-linked immunosorbent assay. The serum sLR11 levels in the PDR and NPDR groups were 12.3 ± 5.0 ng/ml and 10.0 ± 2.7 ng/ml, respectively. The sLR11 levels in the vitreous fluid in the PDR (17.8 ± 6.2 ng/ml) and NPDR (17.4 ± 7.1 ng/ml) groups were significantly higher than those in the control subjects (12.3 ± 4.5 ng /ml) (P = 0.0003 and P = 0.006, respectively). The vitreous fluid levels of sLR11 were not significantly different between the PDR and NPDR groups, and the levels were not significantly correlated with the serum levels of sLR11 in the patients with PDR or NPDR. Vitreous fluid sLR11 level may be a novel risk factor for the early development of PDR prior to the increase in circulating levels in diabetic patients.

The authors performed 15 vitrectomies for diabetic macular heterotopia, and then compared visual prognoses and postoperative complications with those of 88 macular detachments to determine the role of, and indications for, vitrectomy for diabetic macular heterotopia.Fifteen patients with diabetic macular heterotopia and 88 with traction macular detachment, in which the vitreous cavities were sufficiently clear for posterior poles to be observed, underwent vitrectomies. Preoperative and postoperative visual acuity and postoperative complications were assessed and documented retrospectively.There was no statistically significant difference between the two groups in terms of eyes showing improvement in visual acuity postoperatively. However, a final postoperative visual acuity better than 20/20 was documented in 93% of patients with macular heterotopia and 48% of patients with macular detachment (P0.002), whereas 47% of the former and 10% of the latter had visual acuities better than 20/40 (P0.001). Postoperative neovascular glaucoma and retinal detachment developed in 10% and 13%, respectively, of patients with macular detachments. None of the patients with macular heterotopia experienced these complications.Based on the above results, the authors conclude that diabetic macular heterotopia is a very good indication for early vitrectomy.

To investigate the prevalence of sleep-disordered breathing (SDB) in proliferative diabetic retinopathy (PDR) patients and clarify the relationship between SDB and PDR.Sixty-four PDR patients who had undergone vitrectomy in our hospital were included in this study. Forty-two patients were male, and 22 were female. Pulseoximetry was conducted during the nighttime; the sleeping 3% oxygen desaturation index (ODI/h) was calculated. If ODI wasor = 10/h, SDB was diagnosed. Blood glucose control and the presence of hypertension and albuminuria were evaluated and compared between the SDB and non-SDB groups.Fifty percent of male patients, 27% of female patients and 42% of all PDR patients were diagnosed as having SDB. The presence of hypertension and albuminuria was 96% and 74%, respectively, in the SDB group, both significantly higher than in the non-SDB group. There were no significant differences between the two groups in preoperative HbAlc levels. However, compared with the non-SDB group, the prevalence of insulin therapy was significantly higher in the SDB group.PDR cases had a high frequency of SDB. It appears that SDB might hamper blood glucose control, raise the occurrence of hypertension and albuminuria, and is thus related to the progression of diabetic retinopathy.

Purpose To clarify the relationships of sleep-disordered breathing (SDB) to nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). Design Cross sectional case-control study. Methods Forty-eight consecutive NPDR and 118 PDR cases that had undergone surgery in our hospital were included in this study. Pulse oximetry was conducted during the night and the sleeping 4% oxygen desaturation index (ODI) (number of oxygen desaturation events/hour exceeding 4%) and mean SpO 2 % were calculated. If 4% ODI > 5 times/hour, SDB was diagnosed. The results were evaluated and compared between the 2 groups. In addition, these results and preoperative patient background factors were analyzed using multiple regression analysis to identify correlations with the diagnosis of PDR. Results Twenty-nine percent of the NPDR and 48% of the PDR patients were diagnosed as having SDB. The incidence of SDB and the 4% ODI/hour value were significantly higher in the PDR than in the NPDR group ( P = .003 and .03, respectively). Multiple regression analysis showed younger age and a higher 4% ODI value to be factors independently contributing to a diagnosis of PDR (age, standard regression coefficient=−0.34; t value=−4.44; P t value=2.15; P = .03, correlation coefficient (R) = 0.43). Conclusion Our results suggest that, in diabetic retinopathy patients with nocturnal desaturation, reoxygenation caused by SDB may relate to the development of PDR.

To clarify the relationship between systemic factors and the development of retinopathy in patients with type 2 childhood diabetes.We evaluated the relationship between retinopathy incidence and systemic factors (i.e., sex, age at diagnosis, and mean HbA(1c)) in 36 patients (11 boys and 25 girls).Ten of the 36 cases (28%) developed retinopathy during a mean observation period of 7 years and 11 months. Retinopathy was found only in female patients. The mean HbA(1c) value correlated significantly with the onset of retinopathy. The incidence of retinopathy in the patients with mean HbA(1c) values less than 8.0% was 0% at 5 and 10 years, and 5% at 15 years. On the other hand, the incidence of retinopathy in the patients with mean HbA(1c) values of 8.0% or more was 44% at 5 years, and 56% at 10 and 15 years after the diagnosis of diabetes.As female patients with mean HbA(1c) values of 8.0% or more have a high risk of developing retinopathy, strict blood glucose control and frequent ophthalmologic examinations are necessary.

To investigate the long-term results of grid pattern photocoagulation for diffuse diabetic macular edema.In 45 cases, 56 eyes foveal thickness and visual outcome were observed 12 months or more after grid pattern photocoagulation.Compared with preoperative values, average foveal thickness decreased significantly during the initial 3 postoperative months and this reduction was maintained through 30 postoperative months. Foveal thickness was reduced by more than 20% in 66% of eyes. The final logarithm of the minimum angle of resolution (logMAR) visual acuity improved 0.2 or more in 41% of eyes. There was a significant correlation between preoperative and postoperative visual acuity. A final visual acuity of 0.5 or better was obtained in 80% of eyes with a preoperative visual acuity of 0.4 or better. There were no eyes with visual loss due to atrophic creep in this study.Grid pattern photocoagulation for diffuse diabetic macular edema showed long-term effectiveness in reducing foveal thickness postoperatively. It will be possible to achieve a final visual acuity of 0.5 or better in a high percentage of cases, if grid pattern photocoagulation is performed for those with relatively good visual acuity. The foveal thickness measurement was useful for quantitative evaluation of photocoagulation for diabetic macular edema.

To analyze the long-term effects of pars plana vitrectomy for diabetic macular edema.Sixty-nine patients (73 eyes) with diabetic macular edema were examined retrospectively after pars plana vitrectomy. The mean follow-up time was 24.6 +/- 7.3 months.The postoperative best-corrected visual acuity (BCVA) at 12 months was significantly better than the preoperative BCVA, and the improvement was maintained for at least 24 months. The mean central retinal thickness (RT) at 3 months after surgery was significantly thinner than the preoperative central RT, and was maintained for at least 24 months in the cases followed for this period. The postoperative BCVA was significantly worse than the preoperative BCVA at 2 years after surgery in eyes with a preoperative BCVA ofor =0.05. In addition, there was lower probability that the postoperative BCVA would beor =0.5 in eyes with a preoperative BCVA of0.3.The results indicate that the improvement in the BCVA is attained by 12 months postvitrectomy, and is maintained for at least 24 months. The reduction in RT can be maintained for up to 24 months. The results also indicate that vitrectomy should be performed when the preoperative BCVA is0.05 at worst.

To investigate the role of chemokines in the pathogenesis of proliferative diabetic retinopathy (PDR).In total, 41 eyes of 38 patients undergoing vitrectomy were divided into two groups; PDR and non-PDR. The PDR group was comprised of 30 eyes, and the non-PDR group of 11 eyes. Vitreous specimens obtained at vitrectomy were centrifuged and separated into supernatants and cellular components. Concentrations of vascular endothelial growth factor(VEGF), interleukin-8 (IL-8), monocyte chemotactic protein-1 (MCP-1), and regulated upon activation, normal T cell expressed and secreted(RANTES) in the supernatants were determined by enzyme-linked immunosorbent assay(ELISA) or chemiluminescence enzyme immunoassay(CLEIA). Expression of VEGF in the cellular components was determined by immunohistochemistry.Vitreous levels of VEGF(p0.05), IL8 (p0.0001) and MCP-1 (p0.05) in the PDR group were significantly higher than in the non-PDR group. However, there was no significant difference in RANTES between the two groups. There was a significant correlation (p0.0001, r = 0.84) between vitreous IL-8 and MCP-1 levels in the PDR group. After immunohistochemical staining with antiVEGF monoclonal antibody, VEGF positivity was localized in polymorphonuclear leukocytes and monocytes of the cellular components of PDR vitreous specimens.These results indicate that chemokines are possibly involved in the recruitment of neutrophils and monocytes into the vitreous and that they play a role in the intraocular neovascularization characteristic of PDR.