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Background and Objective: Salivary lactate dehydrogenase (LDH) was reported to be a useful parameter for the screening of periodontal disease. We performed a cross‐sectional study to verify the usefulness of salivary LDH as a biomarker of periodontitis and to investigate the association of severity of periodontitis with systemic inflammation by measuring salivary LDH and serum high sensitive C‐reactive protein (hs‐CRP) levels in a community‐based middle‐aged and elderly population in Japan. Material and Methods: We recruited 644 men and 1171 women, aged 30‐79 years, who participated in the Toon Health Study during 2011–15. Periodontal condition was assessed by full‐mouth examination including mean value of probing depth, percentage of probing depth of ≥4 mm and ≥6 mm, and bleeding on probing. Saliva and blood serum samples were collected for measurement of salivary LDH level and hs‐CRP, respectively. A linear trend across quartiles of salivary LDH was calculated using linear regression. Interaction of salivary LDH and overweight status (body mass index of ≥25 kg/m2) was tested using the cross‐product term of log‐transformed continuous salivary LDH and overweight status. Results: Analysis of covariance adjusted for potential confounders revealed strong associations between salivary LDH level and the indicators of periodontal condition (P < .01) in both men and women. Sex‐ and age‐adjusted mean values of hs‐CRP according to salivary LDH quartiles were 0.40, 0.45, 0.45 and 0.50 mg/L (P for trend <.01). Although the association was attenuated after further adjustment for body mass index, hypertension, diabetes mellitus, dyslipidemia, alcohol intake, smoking status and physical activity. When stratified by overweight status, the association remained significant in overweight individuals (P = .03). The multivariable adjusted odds ratio of hs‐CRP level of ≥1 mg/L for the highest vs lowest quartile of salivary LDH was 1.93 (95% CI, 1.01‐3.69) in overweight individuals, but not significant in non‐overweight individuals. Conclusion: Salivary LDH appears to be a promising biomarker for the mass screening of periodontitis in local community health settings. High salivary LDH levels, particularly in overweight individuals might contribute to prevention of cardiovascular disease, through measuring systemic inflammatory burdens as well as traditional cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Background. The Fukushima Nuclear Energy Worker's Support (NEWS) Project Study previously showed that experiences related to the Fukushima nuclear disaster on 11 March 2011 had a great impact on psychological states, including post-traumatic stress response (PTSR) and general psychological distress (GPD), among the Fukushima nuclear plant workers. To determine the causal relationship between disaster-related experiences and levels of psychological states, we conducted a 3-year longitudinal study from 2011 to 2014. Method. PTSR and GPD of the nuclear plant workers were assessed by annual questionnaires conducted from 2011 to 2014. The present study included a total of 1417 workers who provided an assessment at baseline (2011). A total of 4160 observations were used in the present analysis. The relationship between disaster-related experiences and psychological states over time was analysed using mixed-effects logistic regression models. Results. A declining influence of disaster-related experiences on PTSR over time was found. However, the impact on PTSR remained significantly elevated even 3 years after the disaster in several categories of exposure including the experience of life-threatening danger, experiences of discrimination, the witnessing of plant explosion, the death of a colleague and home evacuation. The associations between GPD and disaster-related experiences showed similar effects. Conclusions. The effects of disaster-related experiences on psychological states among the nuclear plant workers reduced over time, but remained significantly high even 3 years after the event. [ABSTRACT FROM AUTHOR]

BackgroundThe Fukushima Daiichi and Daini Nuclear Power Plant workers experienced multiple stressors as both victims and onsite workers after the 2011 Great East Japan Earthquake and subsequent nuclear accidents. Previous studies found that disaster-related exposures, including discrimination/slurs, were associated with their mental health. Their long-term impact has yet to be investigated.MethodA total of 968 plant workers (Daiichi, n = 571; Daini, n = 397) completed self-written questionnaires 2–3 months (time 1) and 14–15 months (time 2) after the disaster (response rate 55.0%). Sociodemographics, disaster-related experiences, and peritraumatic distress were assessed at time 1. At time 1 and time 2, general psychological distress (GPD) and post-traumatic stress response (PTSR) were measured, respectively, using the K6 scale and Impact of Event Scale Revised. We examined multivariate covariates of time 2 GPD and PTSR, adjusting for autocorrelations in the hierarchical multiple regression analyses.ResultsHigher GPD at time 2 was predicted by higher GPD at time 1 (β = 0.491, p < 0.001) and discrimination/slurs experiences at time 1 (β = 0.065, p = 0.025, adjusted R2 = 0.24). Higher PTSR at time 2 was predicted with higher PTSR at time 1 (β = 0.548, p < 0.001), higher age (β = 0.085, p = 0.005), and discrimination/slurs experiences at time 1 (β = 0.079, p = 0.003, adjusted R2 = 0.36).ConclusionsHigher GPD at time 2 was predicted by higher GPD and discrimination/slurs experience at time 1. Higher PTSR at time 2 was predicted by higher PTSR, higher age, and discrimination/slurs experience at time 1. [ABSTRACT FROM PUBLISHER]

Objective:Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging has been used to detect alterations in the composition of inner-ear fluid. This study investigated the association between hearing level and the signal intensity of pre- and post-contrast three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging in patients with sudden-onset sensorineural hearing loss.Method:Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging was performed in 18 patients with sudden-onset sensorineural hearing loss: 12 patients with mild-to-moderate sensorineural hearing loss (baseline hearing levels of 60 dB or less) and 6 patients with severe-to-profound sensorineural hearing loss (baseline hearing levels of more than 60 dB).Results:High-intensity signals in the inner ear were observed in two of the six patients (33 per cent) with severe-to-profound sensorineural hearing loss, but not in those with mild-to-moderate sensorineural hearing loss (mid-p test, p = 0.049). These signals were observed on magnetic resonance imaging scans 6 or 18 days after sensorineural hearing loss onset.Conclusion:The results indicate that three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging is not a useful tool for detecting inner-ear abnormalities in patients with mild sensorineural hearing loss. [ABSTRACT FROM PUBLISHER]

Irritable bowel syndrome (IBS) is a common gastrointestinal disease. Detailed clinical characteristics of patients with different IBS subtypes have not been well established. Our aim was to examine the prevalence and risk factors of IBS and its subtypes in Japanese adults. We performed a cross-sectional study of Japanese workers who visited a clinic for a routine health check-up and asked them to fill out a self-report questionnaire. Irritable bowel syndrome and its subtypes were defined by ROME III criteria. A logistic regression model was used to identify risk factors. Irritable bowel syndrome was present in 367 (13.5%) of 2717 eligible subjects; 79 had IBS with constipation (IBS-C); 102 had IBS with diarrhea (IBS-D); 89 had mixed IBS (IBS-M); and 97 had unsubtyped IBS (IBS-U). Irritable bowel syndrome was significantly associated with young age [odds ratio (OR) = 0.87, 95% confidence interval (CI) 0.80-0.95], female gender (OR = 1.78, 95% CI 1.38-2.29), low body mass index (BMI) (OR = 0.95, 95% CI 0.92-0.99), and the presence of allergic disease (OR = 2.19, 95% CI 1.40-3.54). Analysis of IBS subtypes revealed that IBS-C was associated with young age and female gender; IBS-D with young age, low BMI, and drinking habit; IBS-M with female gender, smoking habits, and allergic diseases; and IBS-U with age, female gender, and allergic diseases. Irritable bowel syndrome was common and associated with young age, female gender, low BMI, and presence of allergic diseases in Japanese adults. Several differences were noted between the risk factors among different IBS subtypes. [ABSTRACT FROM AUTHOR]

Most of the gastroprotective drugs which had been marketed in Japan were considered to have insufficient rationale for use as ulcer treatments. Such drugs may have a crucial role in maintaining mucosal integrity by the mechanisms other than inhibition of acid secretion. We re-evaluated the effect of gastroprotective drugs on gastric ulcer healing using current ICH E9 guidelines. We collected reports of pivotal trials on healing rate of gastric ulcer with 9 kinds of gastroprotective drugs submitted in New Drug Applications. In the comparative trial of cetraxate vs. placebo, the healing rate of gastric ulcer at 8-week endoscopy in the cetraxate was significantly higher than that in the placebo groups (88.6 % and 62.2 %, p = 0.0062). Non-inferiority to cetraxate was confirmed for 8 kinds of gastroprotective drugs. In conclusion, the superiority of cetraxate over placebo and non-inferiority to cetraxate for 7 drugs was established in the respect of effect on ulcer healing. [ABSTRACT FROM AUTHOR]

Examines the effect of job strain on helper-inducer and suppressor-inducer T cells among blue collar workers in Japan. Assessment of perceived job stressors; Administration of Job Content Questionnaire; Correlation between job control and T cells inducer.

Introduction: The purpose of this study is to investigate the association of subjective sleepiness and severity of sleep-disordered breathing among truck drivers in Japan. Materials and methods: Age adjusted subjective daytime sleepiness was not significantly related to the severity of sleep-disordered breathing in this population (p =0.36). Among the subjects who had severe sleep-disordered breathing (RDI⩾20), ESS score of non-sleepiness and moderate sleepiness was 56.3% and 34.4% respectively. For the BMI stratified analysis, prevalence of non-sleepiness and moderate sleepiness for severe sleep-disordered breathing was 60.0% and 30.0% for <25kg/m2, and 54.6% and 36.4% for ⩾25kg/m2. Results: Age adjusted subjective daytime sleepiness was not significantly related to the severity of sleep-disordered breathing in this population (p =0.36). Among the subjects who had severe sleep-disordered breathing (RDI⩾20), ESS score of non-sleepiness and moderate sleepiness was 56.3% and 34.4% respectively. For the BMI stratified analysis, prevalence of non-sleepiness and moderate sleepiness for severe sleep-disordered breathing was 60.0% and 30.0% for <25kg/m2, and 54.6% and 36.4% for ⩾25kg/m2. Conclusion: The results of our study showed that more than 90% of the participants who had severe sleep-disordered breathing did not have severe daytime sleepiness. Objective screening for sleep-disordered breathing is_ important even if the drivers have no subjective sleepiness. Acknowledgements: We are indebted to Mr. Shuzo Fujioka, the president of Nara Trucking Association for great effort. This study was supported in part by grants from the International Association of Traffic and Safety Sciences Grant No. H2422, from the Japanese Ministry of Education, Culture, Sports, Science and Technology (Grant-in-Aid for research B: 22390134 in 2010–2012, Grant-in-Aid for research C: 23590796 in 2011–2013), and from the Japanese Society for the Promotion of Science, and by Health and Labour Sciences Research Grants from the Ministry of Health, Welfare and Labour, Japan. (Comprehensive Research on Life- Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus 201021038A in 2010–2012). [Copyright &y& Elsevier]

This cross-sectional study investigates the association between long working hours, short sleep duration, and mental health among Japanese physicians. We enrolled 232 Japanese physicians. We used the Brief Job Stress Questionnaire to assess high-stress status, and the Japanese version of the Center for Epidemiologic Studies Depression scale to assess depressive status. Daily sleep duration (DSD) and weekly working hours (WWHs) were collected using a self-administered questionnaire. Multivariable-adjusted logistic regression analysis was performed to examine the association of the combined categories of DSD and WWHs with high-stress and depressive status. Compared to physicians with WWHs <80 h and DSD ≥6 h, the multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of high-stress status for those with WWHs ≥80 and DSD ≥6, WWHs <80 and DSD <6, and WWHs ≥80 and DSD <6 were 2.76 (0.97-7.87), 3.36 (1.53-7.40), and 3.92 (1.52-10.14), respectively. The respective ORs (CIs) of depressive status were 1.82 (0.42-7.81), 4.03 (1.41-11.53), and 4.69 (1.33-16.62). The results showed that regardless of working long hours or not, physicians with DSD <6 h had significantly higher stress and depressive status, suggesting that not only regulating long working hours but also ensuring adequate sleep duration is important for preventing physicians' mental health.

Background: This cohort study aimed to examine the relationship between objectively measured daily ambulatory activity (AA) variables and the onset of metabolic syndrome (MetS) in middle-aged and older Japanese individuals., Methods: A total of 1,034 participants (women, 76.8%; mean age, 56.9 years) who were initially free from MetS, underwent objective assessment of daily AA using a uniaxial accelerometer at baseline. The number of steps, time accumulated in light-intensity AA (LIAA), moderate-to-vigorous intensity AA (MVAA), and total AA (LIAA + MVAA) were calculated. The diagnostic criteria outlined by the Japanese standards were employed to define the presence of MetS. To explore the association between AA variables and MetS onset, both multivariate logistic regression and a restricted cubic spline model were used while controlling for variables such as age, sex, education, alcohol habit, smoking habit, energy intake, and the number of MetS components present at baseline., Results: Over the course of the 5-year follow-up period, 116 participants (11.2%) developed MetS. In terms of the number of steps, LIAA, and total AA, the third quartile had significantly lower multivariate adjusted odds ratios for MetS onset than the first quartile. The odds ratios (95% confidence intervals) were 0.386 (0.197-0.755), 0.527 (0.285-0.975), and 0.392 (0.206-0.745), respectively. In the spline model, an L-shaped association with MetS was observed for the number of steps (p for nonlinearity = 0.066), LIAA (p for nonlinearity = 0.034), and total AA (p for nonlinearity = 0.040)., Conclusions: Among the variables related to AA, the index of daily amount AA, in particular, may be linked to the onset of MetS., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Purpose: Both obstructive sleep apnea (OSA) and the common cold are disorders of the upper respiratory tract, and may be associated. However, studies on the association between OSA and upper respiratory tract infections (URTI) in children are scarce. The aim of this study was to investigate possible associations between snoring, the severity of OSA, and URTI in elementary school children., Methods: This was a cross-sectional study in a community cohort of elementary school children (first and second graders) in Japan. Information on sleep habits, history of URTI, and OSA risk was obtained from a parental questionnaire. Children underwent overnight tracheal sound recordings from which apnea-hypopnea index was estimated. Multivariable logistic analysis was employed to define the association between snoring, OSA, and URTI ≥ 3 episodes over six months., Results: Of the 922 potential enrollees, 653 children and their parents (71%) agreed to participate in the study. Multivariable-adjusted ORs for URTI were 1.73 (95%CI: 1.16 to 2.59) in children who snored 1 to 4 nights per week and 2.82 (95%CI: 1.26 to 6.28) in snoring ≥ 5 nights per week compared with never snoring (reference). Likewise, subjectively reported louder snoring, as well as objectively defined louder sound levels, were significantly associated with URTI. In addition, OR for URTI in children with an estimated apnea-hypopnea index ≥ 2.0 events/hour was 2.65 (95%CI: 1.32 to 5.31) compared to children with apnea-hypopnea index less than 1.0 events/hour (reference)., Conclusions: Snoring and severity of OSA as measured by nocturnal tracheal sound recordings were associated with increased susceptibility to URTI in elementary school children., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: The culture of excessively long overtime work in Japan has not been recently addressed. New legislation on working hours, including a limitation on maximum overtime work for physicians, will be enforced in 2024. This study was performed to elucidate the working conditions of full-time hospital physicians and discuss various policy implications., Methods: A facility survey and a physician survey regarding physicians' working conditions were conducted in July 2022. The facility survey was sent to all hospitals in Japan, and the physician survey was sent to all physicians working at half of the hospitals. The physicians were asked to report their working hours from 11 to 17 July 2022. In addition to descriptive statistics, a multivariate logistic regression analysis on the factors that lead to long working hours was conducted., Results: In total, 11,466 full-time hospital physicians were included in the analysis. Full-time hospital physicians worked 50.1 h per week. They spent 45.6 h (90.9%) at the main hospital and 4.6 h (9.1%) performing side work. They spent 43.8 h (87.5%) on clinical work and 6.3 h (12.5%) on activities outside clinical work, such as research, teaching, and other activities. Neurosurgeons worked the longest hours, followed by surgeons and emergency medicine physicians. In total, 20.4% of physicians were estimated to exceed the annual overtime limit of 960 h, and 3.9% were estimated to exceed the limit of 1860 h. A total of 13.3% and 2.0% exceeded this level only at their primary hospital, after excluding hours performing side work. Logistic regression analysis showed that male, younger age, working at a university hospital, working in clinical areas of practice with long working hours, and undergoing specialty training were associated with long working hours after controlling for other factors., Conclusions: With the approaching application of overtime regulations to physicians, a certain reduction in working hours has been observed. However, many physicians still work longer hours than the designated upper limit of overtime. Work reform must be further promoted by streamlining work and task-shifting while securing the functions of university hospitals such as research, education, and supporting healthcare in communities., (© 2024. The Author(s).)

Aims: To determine the association between drinking habits and social factors among women undergoing assisted reproductive technology (ART) treatment in Japan., Methods: The study participants who provided answers for the questionnaire concerning alcohol consumption were 1017 female patients undergoing ART treatment were enrolled in the Japan-Female Employment and Mental Health in assisted reproductive technology (J-FEMA) study between August and December 2018. Patient characteristics, including demographic, clinical, and socioeconomic status, were assessed using a self-administered questionnaire which was distributed only once during the period, regardless of their first or follow-up examination. We defined current drinkers who drank ≥46 g of ethanol per week as the habitual drinking group. The risk factors for habitual drinking were analyzed using multivariable-adjusted logistic regression., Results: The proportion of habitual drinkers was 15.5% in this study population. The multivariable-adjusted odds ratios (95% confidence interval) for habitual drinking were 2.27 (0.99-5.21) for women aged ≥35 years versus those <35 years, 4.26 (1.98-9.16) for women having partners who currently drink compared to those with partners without current drinking, 1.84 (1.08-3.12) for women without a history of childbirth versus those with, and 1.77 (1.00-3.14) for working women compared with those not working., Conclusions: In our study, habitual drinking among women undergoing ART treatment was significantly associated with older age, no history of childbirth, partner's current drinking status, and working.

Objectives: Life enjoyment, linked to the ability to engage pleasurably with one's environment, may be related to the risk of developing dementia. This prospective cohort study examined the association between level of life enjoyment and disabling dementia incidence among Japanese community residents., Methods: The participants were Japanese, aged 45-74 years old at 5-years follow-up, in the Japan Public Health Center-based Study (N = 38,660). Psychological conditions and other confounding variables were identified through self-administered questionnaires. Incident disabling dementia registered based on the Japan's Long-Term Care Insurance system from 2006 to 2016. Hazard ratios [95% confidence intervals] were assessed using Cox proportional hazards models., Results: Over a median follow-up period of 9.4 years, a total of 4,642 cases of disabling dementia developed. Level of life enjoyment was inversely associated with the risk of disabling dementia: the multivariable hazard ratios were 0.75 [0.67-0.84] (p < .001) and 0.68 [0.59-0.78] (p < .001) with medium and high life enjoyment, respectively, compared to low life enjoyment. Furthermore, the association between greater life enjoyment and low risk for disabling dementia was strongest in the subgroup with low-medium mental stress. In the high mental stress group, this association was evident for poststroke disabling dementia, but not for disabling dementia without a history of stroke., Discussion: A higher level of life enjoyment was associated with a lower risk of disabling dementia, particularly in the low-medium mental stress group. This finding suggests the importance of having life enjoyment by managing mental stress for reducing risk of disabling dementia., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

To determine the impact of the coverage of risk-reducing salpingo-oophorectomy (RRSO) and mastectomy (RRM) as well as genetic testing for BRCA pathogenic variants by the national insurance system in Japan. We compared the clinical background of women who underwent RRSO at our institution before and after its coverage by the national insurance system. Those who underwent RRSO between January 2017 and December 2019 and between April 2020 and March 2022 were classified as Period. A and B, respectively. Overall, 134 women underwent RRSO during the study period. In Period A and B, 45 and 89 women underwent RRSO for the study period was 36 and 24 months, respectively. Compared with Period A, the number of women who underwent RRSO per month increased by threefold in Period B (p < 0.01). In addition, the number of women who underwent surgery for breast cancer along with RRSO increased in Period B (p < 0.01). Although the number of women who underwent concurrent RRM with RRSO in Period B increased, the difference was not statistically significant. Compared with Period A, the number of women diagnosed with BRCA pathogenic variant increased by 3.9-fold, and the proportion of women who underwent concurrent hysterectomy at the time of RRSO decreased from 66 to 7.9% in Period B (p < 0.01). Owing to the introduction of the national insurance system, the number of women who underwent RRSO and concurrent surgery for breast cancer at the time of RRSO increased in Japan., (© 2023. The Author(s).)

The Great East Japan Earthquake occurred on 11 March 2011, forcing Fukushima Prefecture residents to change their living environment. Such sudden changes possibly have long-term effects on cardiovascular-related diseases. We therefore sought to identify temporal relationships between living environment changes and blood pressure levels over three years following the earthquake. Participants included 14,941 men and 21,533 women aged 16 years or older who answered self-administered questionnaires, including questions on living environment changes at baseline (2012). Blood pressure levels were measured each year from 2012 to 2015. Linear mixed-effects models were used to analyze associations between living environment changes and blood pressure levels. Men with changes in living environment (i.e., those living in shelters or in temporary housing, rental apartments, relatives' houses, or others) showed significantly higher diastolic blood pressure levels than those who lived in their home at baseline (77.3 mmHg vs. 77.8 mmHg; p < 0.001). The time-dependent effect of diastolic blood pressure levels associated with living environment was not statistically significant, indicating a sustained difference in diastolic blood pressure associated with living environment changes at baseline after three years. The effect of living environment changes on diastolic blood pressure increment was also evident in men without antihypertensive medication use during the study period and in men who were current drinkers at baseline. There were no associations between living environment changes and diastolic blood pressure levels among women. Sudden changes in living environment due to the disaster had an impact on the long-term effects of higher diastolic blood pressure among middle-aged men.

Fish and omega-3 fatty acid consumption is known to be beneficial for cardiometabolic health. However, the related evidence for individuals with a relatively higher intake of fish or omega-3 unsaturated fatty acids, e.g., Japanese individuals, is scarce. Therefore, this study aimed to examine the association of fish and omega-3 fatty acid intakes with the carotid intima-media thickness (C-IMT) in the Japanese population. In total, 1803 Japanese men and women aged 30-84 years without a history of myocardial infarction or angina pectoris were included in the study. The fish and omega-3 fatty acid intakes were estimated using food frequency questionnaires. The C-IMT was measured using ultrasound imaging, and the participants were classified into three groups: normal, moderate (1.1 to 1.4 mm of maximum C-IMT), and severely increased C-IMT (≥1.5 mm). Multinomial logistic regression models were used to calculate the odds ratio (OR) and 95% confidence intervals (95% CI) of the presence of moderately and severely increased C-IMT. The omega-3 fatty acid intake was shown to be associated with lower odds of severely increased C-IMT. The multivariable-adjusted OR (95%CI) was 0.55 (0.31-0.97; p for trend = 0.04). We also found a borderline significant negative association between fish intake and the presence of severely increased C-IMT. In conclusion, omega-3 fatty acid intake might protect against the development of atherosclerosis in the Japanese population.

Purpose: This study aims to elucidate the risk factors of infertility treatment-associated harassment (I-harassment) among Japanese working women., Methods: The study participants were 1103 female patients who enrolled in the Japan-Female Employment and Mental Health in artificial reproductive technology (J-FEMA) study. Of the 1727 female patients, 1103 female patients were working during the initiation of infertility treatment and were still working during the survey. Risk factors for I-harassment were analyzed using a multivariable logistic regression model., Results: In this study, 82 female patients (7.4%) experienced I-harassment. The risk was significantly higher in those who had more in vitro fertilization (IVF) cycles than those who had fewer IVF cycles (OR, 1.06; 95% CI, 1.01-1.10). Similarly, those who disclosed their infertility treatment to their workplace were at significantly higher risk for I-harassment than those who did not (OR, 1.80; 95% CI, 1.03-3.15)., Conclusion: This study found that 7.4% of female patients experienced I-harassment after infertility treatment initiation. Those female patients who "experienced more IVF cycles," and "disclosed their infertility treatment in their workplace" should be carefully followed up by healthcare professionals to prevent I-harassment., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Psychological stress is considered to be a potential contributor in the development of arterial stiffness. However, an independent association between arterial stiffness and biological markers of stress has not yet been established. We examined the independent association between salivary alpha-amylase (sAA) activity and arterial stiffness, not mediated by cardiometabolic disease associated with arterial stiffness, in a sample of healthy Japanese men and women. Participants (992 in total, 296 men and 696 women aged 30-79 years) had neither previous cardiovascular events or stroke, nor coexisting hypertension, diabetes, or dyslipidemia. Arterial stiffness was measured by the cardio-ankle vascular index (CAVI), and increased CAVI was defined as a CAVI value of 9 or higher. A saliva sample was collected in the morning and sAA was measured with a commercial assay kit. Higher sAA activity was positively associated with greater arterial stiffness particularly among women (β = 0.070; 95% CI = 0.014-0.126; p = 0.01), and not across all participants (β = 0.042; 95% CI = -0.005-0.089; p = 0.08) and in men (β = -0.005; 95% CI = -0.097-0.087; p = 0.91). The association was strongest in the group of women aged 60 years and older (β = 0.121; 95% CI = 0.018-0.224; p = 0.02). Although the association between sAA and increased CAVI (CAVI ≥ 9) was not significant in all and sex subgroups, odds ratios (OR) for CAVI ≥ 7 were significantly high in all participants (OR = 1.25; 95% CI = 1.03-1.53) and women (OR = 1.43; 95% CI = 1.12-1.82). Elevation of sAA was associated with an increase in arterial stiffness, particularly for women aged 60 years or older., (© 2022. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

The COVID-19 pandemic has shaped the dynamics of many diseases. This study aims to assess how the pandemic affected community-acquired pneumonia admission of all age groups among Japanese hospitals with various size and availability of COVID-19 wards. Our findings revealed a 44%-53% reduction in community-acquired pneumonia admission among 82 hospitals in Japan, from April through September of 2020, compared to the same period of 2019. Decreases were consistently found among hospitals with and without COVID-19 wards. The most significant decrease was found in the age group <20 years old. COVID-19 preventive measures and personal hygiene are considered to be effective measures to prevent the spreading of this disease. As vaccination progresses and the public gradually become less attentive to infection countermeasures, incidence of community-acquired pneumonia may increase in the coming season. Continued monitoring is required., (Copyright © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Aim: This study aimed to investigate the associations of leukocyte count with the risks of stroke and coronary heart disease among the general Japanese population., Methods: A total of 5,242 residents aged 40-69 years living in two Japanese communities underwent leukocyte count measurements between 1991 and 2000, and the data were updated using 5- or 10-year follow-ups or both. Participants who had histories of stroke, coronary heart disease, or high values of leukocyte count (＞130×10 2 cells/mm 3 ) were excluded. Hazard ratios with 95% confidence intervals (CIs) were calculated according to quartiles of cumulative average leukocyte count., Results: During follow-up of 21 years, 327 stroke and 130 coronary heart disease cases were determined. After adjustments for age, sex, community, and updated cardiovascular risk factors, the multivariable hazard ratio (95% CI) for the highest versus lowest quartile of leukocyte count was 1.50 (1.08-2.08) for ischemic stroke, 1.59 (1.00-2.51) for lacunar infarction, 1.42 (0.90-2.26) for non-lacunar infarction, 2.17 (1.33-3.55) for coronary heart disease, and 1.40 (1.11-1.76) for total cardiovascular disease. In smoking status-stratified analyses, the corresponding multivariable hazard ratio (95% CI) was 2.45 (1.11-5.38) for ischemic stroke, 2.73 (1.37-5.44) for coronary heart disease in current smokers, 2.42 (1.07-5.46), 1.55 (0.58-4.15) in former smokers, and 1.17 (0.75-1.82), 1.78 (0.83-3.82) in never smokers., Conclusion: Leukocyte count was positively associated with the risks of ischemic stroke and coronary heart disease among the general Japanese population, especially in current smokers.

Purpose: With a rapidly aging society, there is increasing interest in the health of female workers in the field of care services for older adults due to increasing demands to maintain 24-h care and to support older adults without errors or accidents. Therefore, the purpose of this cross-sectional study was to examine the association between sleep-disordered breathing (SDB) and sustained attention in women caring for older adults in Japan., Methods: The study was conducted in women aged 18-67 years old working in care service facilities for older adults in Japan. The sustained attention of participants was measured by the 10-min psychomotor vigilance task (PVT). SDB was assessed based on the respiratory disturbance index (RDI), which was measured using an ambulatory airflow monitor with a polyvinylidene fluoride (PVDF) film sensor to monitor the respiratory airflow of nasal and oral breathing. The participants wore the monitor to record the breathing status while asleep at home. The severity of SDB was categorized as follows: normal, RDI < 5 events/h; mild SDB, RDI 5-10 events/h; and moderate-to-severe SDB, RDI ≥ 10 events/h., Results: Of 688 women enrolled, medians of age, body mass index (BMI), sleep duration, and prevalence of hypertension tended to be higher with increasing RDI. No significant association was found between RDI and PVT parameters. However, when we limited the analysis to women with BMI ≥ 22 kg/m 2 , those with moderate-to-severe SDB had significantly higher odds of having the slowest 10% reaction times compared to those without SDB (OR = 2.03; 95% CI = 1.17-3.53). The association did not decrease after adjusting to account for sleep duration, alcohol drinking habits, and history of hypertension (OR = 1.97; 95% CI = 1.10-3.52). A significant increasing trend was also found between RDI and the slowest 10% of reaction times (p for trend = 0.03)., Conclusions: Our findings suggest that SDB is associated with reduced sustained attention in participants with BMI ≥ 22 kg/m 2 , although the number of assessments of SDB and PVT was only once per participant due to the nature of the cross-sectional study., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: This study aimed to clarify predictors of depressive symptoms and anxiety symptoms after cancer diagnosis among Japanese cancer survivors (CSs)., Methods: As part of a Japanese cancer survivorship research project commissioned by the Ministry of Health, Labour and Welfare (MHLW) of Japan, we conducted a web-based nationwide survey of CSs in 2018. We analyzed the risk factors for depressive and anxiety symptoms, as measured by the Hospital Anxiety and Depression Scale Japanese version (HADS)., Results: Of 1,234 Japanese CSs, mean score of HADS-depression and HADS-anxiety were 4.08 and 4.78, respectively. At the time of the study, the number of CSs with symptoms of depression and anxiety were 111 (9.0%) and 269 (21.8%), respectively. After multivariable analysis, CSs ≥ 60 years old (reference: ≤ 39 years old, odds ratios (OR): 0.39, 95%CI: 0.17-0.90) and those ≥ 10 years from cancer diagnosis (reference: 0-4 years, OR: 0.55, 95%CI: 0.32-0.96) had lower odds for depressive symptoms. And CSs ≥ 60 years old (reference: ≤ 39 years old, OR: 0.27, 95%CI: 0.15-0.49) and those ≥ 10 years from cancer diagnosis (reference: 0-4 years, OR: 0.62, 95%CI: 0.42-0.90) also had lower odds for anxiety symptoms. CSs who received chemotherapy (OR: 1.56, 95%CI: 1.10-2.20) had higher odds for anxiety symptoms., Conclusions: Based on manifestation of symptoms, CSs who were younger, closer to the time of cancer diagnosis, had advanced-staged cancer, or received chemotherapy may be at higher risk for depressive or anxiety symptoms. Those CSs who have higher risk for depression and anxiety symptoms, should be followed-up more carefully for better cancer survivorship, by medical professionals, companies, and society., (© 2022. The Author(s).)

We predicted the energy balance (EB) of Holstein cows in Japan from milk traits obtained by herd testing. Records covered 156 lactations of 102 cows. The number of artificial inseminations was highest, and the first conception rate was lowest in the low-EB group. Four prediction models were developed-for the whole lactation and for the early, middle, and late stages of lactation-with 20 variables, covering days in milk (DIM), milk yield, and milk composition traits. The actual and predicted EB means agreed well within DIM classes; the means of the residuals were smaller in the lactation stage models than in the all-lactation model, but the standard deviations (SDs) of the residuals were similar among models. After data reduction, the SDs of the residuals for 100 iterations were <1 throughout lactation in both types of models when n = 100. After model reduction, including the daily change of milk yield as a variable minimized the SDs of the residuals. Our equations for herd-level EB prediction have potential for use in genetic evaluation., (© 2022 Japanese Society of Animal Science.)

Background: There is growing interest in examining objective markers for early identification and behavioral intervention to prevent dementia and mild cognitive impairment in clinical and community settings., Objective: To investigate the association between salivary alpha-amylase as an objective measure of psychological stress response and mild cognitive impairment for the implication of psychological stress in the development of mild cognitive impairment., Design, Setting, and Participants: This cross-sectional study involved 865 participants aged ≥ 65 years. A saliva sample was collected in the morning, and the levels of salivary alpha-amylase were assayed. Mild cognitive impairment was evaluated using the Japanese version of the Montreal Cognitive Assessment; a score < 26 was indicative of mild cognitive impairment. A multivariable logistic regression model was used to examine the association of salivary alpha-amylase and mild cognitive impairment after adjusting for age, sex, current drinking status, current smoking status, body mass index, hypertension, diabetes mellitus, physical activity, education, social support, social network, and heart rate variability., Results: Salivary alpha-amylase was associated with mild cognitive impairment (the multivariable-adjusted odds ratio [95% confidence interval] for the 1-standard deviation increment of log-transformed salivary alpha-amylase was 1.24 [1.07-1.44]). This significant association persisted after adjusting for various confounding factors., Conclusion: Elevation of salivary alpha-amylase was associated with mild cognitive impairment among Japanese community-dwelling older adults. This suggests that salivary alpha-amylase is a useful objective marker of psychological stress responses associated with mild cognitive impairment., Competing Interests: Dr. Ikeda reports grants from JSPS KAKENHI, during the conduct of the study. Dr. Saito reports grants from 8020 Promotion Foundation, during the conduct of the study. Dr. Tanigawa reports grants from JSPS KAKENHI, during the conduct of the study. The other authors have nothing to disclose.

Background: To clarify the clinical as well as pathological outcomes in Japanese women with germline pathogenic BRCA1/2 variants who underwent risk-reducing salpingo-oophorectomy (RRSO)., Methods: This prospective study examined the rate of occult cancer and primary peritoneal cancer after RRSO at our institution in the period from 2011 to 2020. Clinical records of genetically confirmed patients with germline pathogenic BRCA1/2 variants who desired to undergo RRSO were reviewed. Specimens obtained during RRSO were pathologically diagnosed as per SEE-FIM protocol. All the participants underwent magnetic resonance imaging (MRI) about 1 month preoperatively., Results: One hundred and seventeen women underwent RRSO during this period. Of these, the numbers of women with germline pathogenic BRCA1 and BRCA2 variants were 72 and 45, respectively. The mean observational time after RRSO was 35.8 months. Despite negative preoperative screening results, three (2.6%) serous tubal intraepithelial carcinoma and three (2.6%) invasive carcinomas were identified. Of the three invasive carcinomas cases, two were International Federation of Gynecology and Obstetrics (FIGO) stage I primary fallopian tube cancer, and the third case was double cancer (ovarian cancer and fallopian tube cancer) with FIGO stage IC3., Conclusions: The rate of occult neoplasms was similar to those reported by studies performed in other countries. Although women with occult cancer were diagnosed with FIGO stage I, the MRI performed 1 month preoperatively did not show any such malignant findings. Thus, RRSO is the only promising method that can improve the prognosis in women with germline pathogenic BRCA1/2 variants., (© 2021. Japan Society of Clinical Oncology.)

Aim: Seaweed contains soluble dietary fibers, potassium, and flavonoids and was recently reported to be inversely associated with the risk of coronary heart disease and mortality from stroke. However, epidemiological evidence on this issue has remained scarce., Methods: At the baseline survey of four Japanese communities between 1984 and 2000, we enrolled 6,169 men and women aged 40-79 years who had no history of cardiovascular disease. We assessed their seaweed intake using the data from a 24 h dietary recall survey and categorized the intake into four groups (0, 1-5.5, 5.5-15, and ≥ 15 g/day). We used sex-specific Cox proportional hazards models to examine the association between seaweed intake and risk of cardiovascular disease (stroke, stroke subtypes, and coronary heart disease)., Results: During the 130,248 person-year follow-up, 523 cases of cardiovascular disease occurred: 369 cases of stroke and 154 cases of coronary heart disease. Seaweed intake levels were inversely associated with the risk of total stroke and cerebral infarction among men but not among women. Adjustment for cardiovascular risk factors did not change the associations: the hazard ratios (95% confidence intervals; P for trend) for the highest versus lowest categories of seaweed intake were 0.63 (0.42-0.94; 0.01) for total stroke and 0.59 (0.36-0.97; 0.03) for cerebral infarction. No associations were observed between seaweed intake and risks of intraparenchymal hemorrhage, subarachnoid hemorrhage, or coronary heart disease among men or women., Conclusions: We found an inverse association between seaweed intake and risk of total stroke, especially that from cerebral infarction, among Japanese men.

There is limited evidence regarding the combined effects of sleep-disordered breathing (SDB) and alcohol consumption on hypertension. The aim of this study was to examine the combined effects of SDB and alcohol consumption on hypertension in Japanese male bus drivers. This cross-sectional study included 2525 Japanese male bus drivers aged 20-65 years. SDB was assessed using a single-channel airflow monitor, which measured the respiratory disturbance index (RDI) during overnight sleep at home. Alcohol consumption (g/day) was assessed by a self-administered questionnaire and calculated per unit of body weight. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg and/or use of antihypertensive medications. Multiple logistic regression analyses were performed to examine the association of the combined categories of RDI and alcohol consumption with hypertension. The multivariable-adjusted odds ratio (OR) and 95% confidence interval (95% CI) of hypertension for the alcohol consumption ≥1.0 g/day/kg and RDI ≥ 20 events/h group were 2.41 (1.45-4.00) compared with the alcohol consumption <1.0 g/day/kg and RDI < 10 events/h group. Our results suggest that Japanese male bus drivers with both SDB and excessive alcohol consumption are at higher risk of hypertension than those without SDB and excessive alcohol consumption, highlighting the importance of simultaneous management of SDB and excessive alcohol consumption to prevent the development of hypertension among bus drivers., (© 2021. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

Purpose: To identify risk factors for severe psychological stress in women undergoing fertility treatment., Methods: This cross-sectional, multi-center study was conducted from August to December 2018. We recruited 1672 subjects who completed an anonymous, self-reported questionnaire regarding fertility treatment, conditions at work and home, and psychological stress using K6 score, which estimates psychological distress during the previous 30 days. We further focused our analysis on 1335 subjects who were working when starting fertility treatment., Results: Of 1672 women, mean K6 score (range 0-24) was 4.8 ± 4.4, including 103 women (6.2%) with K6 score ≥ 13 (high K6), and classified as probable severe psychological distress. Multivariate logistic regression analysis showed that high K6 was strongly associated with low annual family income of ≤ USD55,700 (JPY6 million) (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.04-3.42), infertility duration of ≥ 2 years (OR 1.87, 95% CI 1.08-3.25), and no experience of childbirth (OR 2.04, 95% CI 1.05-3.97). Focusing on 1335 working women, 266 (19.9%) experienced resignation from work. High K6 was strongly associated with low family income (OR 2.83, 95% CI 1.52-5.28), cessation of professional duties (OR 2.08, 95% CI 1.05-4.14), infertility-related harassment in the workplace (OR 2.07, 95% CI 1.08-3.98), and perceived difficulties to continue working during fertility treatment (OR 2.94, 95% CI 1.15-7.50)., Conclusion: Severe psychological stressors in women during fertility treatment included low family income, long infertility duration, childlessness, infertility-related harassment, and perceived difficulty in working conditions or cessation from work. Establishment of mental health care support systems is urgently required in this population.

Objective: The association between work-family conflict and insomnia has not been thoroughly studied. Therefore, we sought to examine the relationship between work-family conflict and insomnia symptoms among Japanese working women., Methods: In a cross-sectional study, 608 women aged 18-60 years old who worked in aged care services between 2015 and 2016 were selected, and 445 of these women were ultimately included. Insomnia symptoms were measured using the Athens Insomnia Scale. Work-to-family conflict (WFC) and family-to-work conflict (FWC) were assessed through a self-administered questionnaire and were divided into four categories: low work-family conflict (low WFC and FWC), high FWC, high WFC, and high work-family conflict (high WFC and FWC). The prevalence ratio (PR) and 95% confidence interval (CI) of insomnia symptoms were calculated using a Poisson regression model after multivariable adjustment., Results: The multivariable-adjusted PR (95% CI) of insomnia symptoms was 1.99 (1.34-2.93) in the high work-family conflict group compared to the low work-family conflict group., Conclusions: The results from the present study suggest that insomnia symptoms are highly prevalent among working women in aged care services with high work-family conflict., (Copyright © 2021. Published by Elsevier B.V.)

Introduction. An on-going coronavirus disease 2019 (COVID-19) has become a challenge all over the world. Since an endoscopy unit and its staff are at potentially high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we conducted a survey for the management of the gastrointestinal endoscopic practice, personal protective equipment (PPE), and risk assessment for COVID-19 during the pandemic at multiple facilities. Methods. The 11-item survey questionnaire was sent to representative respondent of Department of Gastroenterology, Osaka City University Hospital, and its 19 related facilities. Results. A total of 18 facilities submitted valid responses and a total of 373 health care professionals (HCPs) participated. All facilities (18/18: 100%) were screening patients at risk for SARS-CoV-2 infection before endoscopy. During the pandemic, we found that the total volume of endoscopic procedures decreased by 44%. Eleven facilities (11/18: 61%) followed recommendations of the Japan Gastroenterological Endoscopy Society (JGES); consequently, about 35%-50% of esophagogastroduodenoscopy and colonoscopy were canceled. Mask (surgical mask or N95 mask), face shield/goggle, gloves (one or two sets), and gown (with long or short sleeves) were being used by endoscopists, nurses, endoscopy technicians, and endoscope cleaning staff in all the facilities (18/18: 100%). SARS-CoV-2 infection risk assessment of HCPs was conducted daily in all the facilities (18/18: 100%), resulting in no subsequent SARS-CoV-2 infection in HCPs. Conclusion. COVID-19 has had a dramatic impact on the gastrointestinal endoscopic practice. The recommendations of the JGES were appropriate as preventive measures for the SARSCoV-2 infection in the endoscopy unit and its staff., (© 2021 Hirotsugu Maruyama et al., published by Sciendo.)

Background: Few studies have investigated the association between serum albumin levels and the risk of stroke subtypes among the general Japanese population., Methods and results: In this study, 5,071 men and 7,969 women aged 40-74 years, initially free from stroke, coronary artery disease, and kidney and hepatic failure, and residing in 4 Japanese communities completed a baseline risk factor survey between 1985 and 1994. During the 24-year follow-up, 528 men and 553 women experienced stroke. In the entire study cohort, multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) of total stroke, ischemic stroke, and intracerebral hemorrhage for the lowest vs. highest quartiles of serum albumin were 1.45 (1.18-1.77), 1.52 (1.17-1.97), and 1.57 (1.04-2.37), respectively. In men, multivariable HRs (95% CIs) for total stroke, ischemic stroke, and intracerebral hemorrhage in the lowest vs. highest serum albumin quartile were 1.44 (1.07-1.92), 1.48 (1.03-2.11) and 1.71 (0.92-3.18), respectively, whereas in women they were 1.50 (1.13-1.99), 1.63 (1.11-2.39), and 1.56 (0.89-2.74), respectively. Similar inverse associations were observed for each of the ischemic stroke subtypes, but not for subarachnoid hemorrhage., Conclusions: Low serum albumin levels were associated with an increased risk of total stroke, ischemic stroke, ischemic stroke subtypes, and intracerebral hemorrhage.

Background: The frequency of laughter has been associated with cardiovascular disease and related biomarkers, but no previous studies have examined association between laughter and changes in blood pressure levels. We sought to identify temporal relationships between frequency of laughter in daily life and systolic and diastolic blood pressure changes in participants from 2010 through 2014., Methods: Participants were 554 men and 887 women aged 40-74 years who answered self-administered questionnaire quantifying frequency of laughter at baseline. We measured participant blood pressure levels twice using automated sphygmomanometers for each year from 2010 to 2014. The associations between laughter and changes in blood pressure over time were analyzed using linear mixed-effect models., Results: There was no significant difference in blood pressure according to frequency of laughter at baseline in either sex. Men with frequency of laughter 1 to 3 per month or almost never had significantly increased systolic and diastolic blood pressure levels over the 4-year period (time-dependent difference: 0.96 mm Hg (95% confidence interval [CI], -0.2 to 1.8; P = 0.05). Changes in blood pressure associated with infrequent laughter (ie, 1 to 3 per month or almost never) were evident in men without antihypertensive medication use over 4 years (0.94 mm Hg; 95% CI, -0.2 to 2.0; P = 0.09) and men who were current drinkers at baseline (1.29 mm Hg; 95% CI, -0.1 to 2.3; P = 0.04). No significant difference was found between frequency of laughter and systolic (0.23 mm Hg; 95% CI, -1.0 to 1.5; P = 0.72) and diastolic (-0.07 mm Hg; 95% CI, -0.8 to 0.7; P = 0.86) blood pressure changes in women., Conclusions: Infrequent laughter was associated with long-term blood pressure increment among middle-aged men.

Aim: This study aimed to investigate the association between the serum high-sensitivity C-reactive protein (hs-CRP) levels and incident atrial fibrillation risk in the general Japanese population, who have lower hs-CRP levels than the Western population, and assess whether the association is modified by sex, overweight, hypertension, and smoking status., Methods: We conducted a prospective study in 6517 Japanese men and women aged 40-79 years without atrial fibrillation at baseline and enrolled in the Circulatory Risk in Communities Study (2002-2008). The hs-CRP levels were measured using the latex particle-enhanced immunonephelometric assay. Atrial fibrillation was identified using standard 12-lead electrocardiograms and information on physician-diagnosed atrial fibrillation history from the follow-up surveys. We used a Cox proportional hazard regression stratified by community., Results: During a median follow-up of 11 years, 127 new cases of atrial fibrillation (74 and 53 cases among men and women, respectively) were found. Compared to the lowest quintile of hs-CRP levels, the multivariable hazard ratios (95% confidence intervals) were 2.54 (1.17-5.50), 2.28 (1.06-4.93), 2.92 (1.37-6.23), and 2.77 (1.30-5.91) for the second, third, fourth, and fifth (highest) quintiles, respectively. There was no significant effect modification by sex, overweight, hypertension, and smoking status (P for interaction ＞0.05)., Conclusions: Elevated hs-CRP levels were significantly associated with increased risk of atrial fibrillation in the Japanese population. The association of hs-CRP levels with incident atrial fibrillation did not vary according to sex, overweight, hypertension status, or smoking status.

To clarify how low BMI and weight loss were associated with risk of chronic obstructive pulmonary disease (COPD) mortality, in a large prospective cohort of the general population across Japan, the Japan Collaborative Cohort Study, conducted between 1988 and 2009. A total of 45,837 male residents were observed for a median period of 19.1 years. Self-administered questionnaires, collecting information on BMI, weight loss since the age of 20, lifestyles, history of diseases, as well as records of COPD mortality, were analysed at 2019. During follow-up, 268 participants died from COPD. The multivariate-adjusted hazard ratio (95% confidence interval) of COPD mortality associated with a 1-SD increment of body mass index (BMI) was 0.48 (0.41-0.57), while for weight change from age of 20 (+ 2.0 kg) it was 0.63 (0.59-0.68). These associations were persistently observed after stratifications with smoking status, excluding those having airway symptoms in the baseline survey, and excluding early COPD deaths within 5, 10 and 15 years. Our study suggests that BMI and weight change since the age of 20 could be markers for COPD prognosis, indicated by risk of COPD mortality.

Background: In Japan, 55.5% of breast cancer survivors (BCSs) are of working age, so various perspectives regarding return to work (RTW) after cancer diagnosis need to be considered. Therefore, this study aimed to clarify the risk factors for resignation and taking sick leave (SL) among BCSs in continued employment at the time of diagnosis., Methods: A web-based retrospective cross-sectional survey was conducted on BCSs using data from a 2018 Japanese national research project (Endo-Han) commissioned by the Ministry of Health, Labour and Welfare of Japan. The subjects were women aged 18-69 years who had been diagnosed with breast cancer for the first time at least 1 year previously. The risk factors for resignation and taking SL after breast cancer diagnosis, including age at diagnosis, education level, cancer stage, surgery, chemotherapy, radiotherapy, employment status, and occupational type, were then analyzed using a logistic regression model., Results: In total, 40 (14.9%) of 269 BCSs quit their jobs at least 1 year after being diagnosed with breast cancer. The results of the multivariable analysis indicated that lower education level (odds ratio [OR]: 3.802; 95% confidence interval [CI]: 1.233-11.729), taking SL (OR: 2.514; 95%CI: 1.202-5.261), and younger age at diagnosis (OR: 0.470; 95%CI: 0.221-0.998) were predictors of resignation. Of 229 patients who continued working, SL was taken by 72 (31.4%). In addition, undergoing surgery was found to be a predictor of taking SL (OR: 8.311; 95%CI: 1.007-68.621)., Conclusions: In total, 40 (14.9%) of 269 BCSs quit their jobs at least 1 year after being diagnosed with breast cancer. The results of this study indicated that younger age, lower education level, and taking SL were predictors of resignation after breast cancer diagnosis.

Ciguatera poisoning (CP) is one of the most abundant seafood poisonings in the world. CP frequently occurred in the tropical and subtropical Indo-Pacific Ocean and the Caribbean Sea. In Japan, CP cases have been reported annually, from the subtropical regions, including Okinawa Prefecture and Amami Islands, Kagoshima Prefecture. The principal toxins, named ciguatoxins (CTXs), are bio-synthesized by benthic dinoflagellate of genera Gambierdiscus and Fukuyoa. They are bio-transferred herbivorous animals to carnivorous fishes via the food chain.The Ogasawara Islands comprise more than 30 islands, Mukojima Islands, Chichijima (Bonin) Islands, Hahajima Islands, Iwo Islands, Nishinoshima, Minamitorishima, and Okinotorishima, which locate in the tropical to subtropical regions. The Mukojima Islands, Chichijima Islands, and Hahajima Islands locate approximately the same latitude as Okinawa. The distance from Tokyo is approximately 1,000 km for Chichijima, 1,700 km for Okinotorishima (the southernmost tip of Japan), and 1,900 km for Minamitorishima (the easternmost tip of Japan). These islands exist in a wide range of waters, latitudes from 20°25' to 27°44' North and longitudes from 136°04' to 153° 59' East. We collected 65 specimens of a grouper, Variola louti, the most frequent species implicated in CP in Japan, from the waters around the Chichijima, Mukojima, and Hahajima islands. The fish flesh specimens were analyzed CTXs using the liquid chromatography-tandem mass spectrometer (LC-MS/MS). While the peak whose retention time is almost identical to that of CTX1B was detected in all specimens on our routine protocol, no 52-epi-54-deoxyCTX1B nor 54-deoxyCTX1B was detected. The peak retention time was quite different from that of CTX1B when re-analyzing by changing the analytical column. Thus, the CTXs in the specimens in the waters of these islands seemed to be undetectable levels.

Background: Familial hypercholesterolemia (FH) is an autosomal dominant disorder characterized by elevated low-density lipoprotein cholesterol concentration and premature acute coronary syndrome (ACS). However, hereditary diseases may have regional characteristics, and few data are available regarding the prevalence of FH throughout particular regions in Japan. This study investigated the prevalence and prognosis of FH in patients with ACS in Mie Prefecture, Japan., Methods and results: This study investigated 738 ACS patients from the Mie ACS Registry in Mie Prefecture, and 706 (95.7%) with sufficient data to diagnose FH were enrolled for analysis. Eighteen patients (2.5%) were diagnosed with FH, which was similar to findings of another multidistrict registry conducted in Japan. Patients with FH were significantly younger and had a higher prevalence of premature onset of ACS than patients with non-FH (P<0.01). Incidence of major adverse cardiac and cerebrovascular events (MACCE) was not statistically different between patients with FH and non-FH in this study population, even in the propensity score-matched analysis., Conclusions: Prevalence of FH in ACS patients from the Mie Prefecture was similar to that found in another Japanese multidistrict registry. Among ACS patients, short-term incidence of MACCE was not statistically different between patients with FH and non-FH in this study population.

Background: MicroRNAs (miRNAs) in exosomes represent disease-specific profiles and are applied as biomarkers in oncology. However, in functional dyspepsia (FD), the role of exosomal miRNAs has not been fully elucidated., Aims: To investigate exosomal miRNAs as potential biomarkers of FD using liquid biopsy., Methods: This retrospective cohort study included 11 subjects with FD and 11 age- and sex-matched healthy controls (HCs). We collected gastric juice and isolated exosomal miRNAs. In a discovery cohort, expression levels of 2565 miRNAs were evaluated by 3D-Gene ® microarray. miRNA expression profiles from exosomes of subjects with FD and HCs were compared by two normalization methods: (1) global normalization and (2) normalization by internal control. Subsequently, in a validation cohort, the expression levels of miRNAs were validated by quantitative reverse transcription PCR (RT-qPCR)., Results: Through microarray analysis using the two methods, we identified 39 miRNAs that were consistently and significantly downregulated in FD cases compared with those in HCs. Of these, 12 miRNAs (hsa-miR-933, hsa-miR-345-5p, hsa-miR-708-5p, hsa-miR-203a-3p, hsa-miR-619-5p, hsa-miR-4294, hsa-miR-4481, hsa-miR-196a-5p, hsa-miR-3918, hsa-miR-372-3p, hsa-miR-658, and hsa-miR-3654) were further validated by RT-qPCR. Our results indicated that hsa-miR-933 was significantly downregulated in FD compared with HCs (0.317 ± 0.205-fold, P = 0.0317). Furthermore, the expression level of hsa-miR-933 was negatively associated with dyspepsia score and the frequency of epigastric pain and/or burning (P < 0.01, r = - 0.835; P = 0.0280, r = - 0.688, respectively)., Conclusions: Exosomal hsa-miR-933 in gastric juice could be a candidate biomarker for FD.

Aims/introduction: Low birthweight is reportedly associated with type 2 diabetes mellitus; however, this association has not been confirmed in the Japanese population, and whether high birthweight is associated with type 2 diabetes mellitus is controversial. We aimed to investigate the association between birthweight and type 2 diabetes mellitus among a general Japanese population., Materials and Methods: Overall 1,135 middle- to old-aged Japanese men and women were enrolled in the Toon Health Study. A 75-g oral glucose tolerance test was used to diagnose type 2 diabetes mellitus, and a questionnaire survey about birthweight was administered. The association between birthweight and the prevalence of type 2 diabetes mellitus in later life of the participants was examined using multivariable logistic regression analysis. Stratified analysis by current body mass index was also carried out., Results: The mean age was 56.5 ± 12.2 years. Type 2 diabetes mellitus was observed in 9.3% of the participants in this study. Compared with the reference group (2,500-3,999 g), the adjusted odds ratio of the low-birthweight group (<2,500 g) for type 2 diabetes mellitus was 2.46 (95% confidence interval 1.48-4.10). The association between the high-birthweight group (≥4000 g) and type 2 diabetes mellitus was not significant after including family history of diabetes in the multivariable model. The odds ratio of the low-birthweight group for type 2 diabetes mellitus was higher in the overweight/obese group than in the non-overweight group., Conclusions: Low birthweight was associated with an increased risk of type 2 diabetes mellitus in a Japanese population, especially in overweight/obese individuals., (© 2020 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.)

Background: Studies on the association between asthma and anxiety in Asian children are limited. Therefore, we aimed to evaluate the association between asthma and anxiety among Japanese elementary school students., Methods: A cross-sectional study of the association between asthma and anxiety in primary school children in Matsuyama City was conducted in 2014. The questionnaires included inquiries on asthma, anxiety, and other demographic variables. After excluding missing values, 17 752 (51.5% male) children were included in the analysis. The presence of asthma (yes/no) was answered by guardians. A score of four or more on the emotional symptom subscale of the strengths and difficulties questionnaire was considered as having anxiety. A Rohrer index score of 145 or more was considered as overweight. We estimated the prevalence ratio (PR) of having anxiety in relation to the presence of asthma based on the Poisson regression model., Results: The multivariate PR (95% confidence interval) of having anxiety in asthmatic boys compared with non-asthmatic boys was 1.56 (1.21-1.99). The association was more evident in older than younger boys, where PR = 1.32 (0.93-1.88) for younger versus 1.87(1.32-2.64) for older boys (P for interaction = .08); and in non-overweight boys than overweight, where PR = 1.64 (1.27-2.13) and 0.94 (0.41-2.19) (P for interaction = .22), respectively. Similar associations were not found for girls., Conclusion: Asthma was significantly associated with anxiety in boys, particularly in older boys., (© 2020 Wiley Periodicals LLC.)

Background: Smoking cessation helps extend a healthy life span and reduces medical expenses. However, the standard 12-week smoking cessation program in Japan has several notable problems. First, only 30% of participants complete this program. Second, participants may choose not to participate unless they have a strong motivation to quit smoking, such as health problems. Third, the program does not provide enough support during the period between clinical visits and after 12 weeks., Objective: This study examined the efficacy of the 24-week ascure program to address the problems of accessibility and continuous support. The program combines online mentoring, over-the-counter pharmacotherapy, and a smartphone app., Methods: Using a retrospective study design, we investigated data for 177 adult smokers who were enrolled in the ascure smoking cessation program between August 2017 and August 2018. The primary outcomes were continuous abstinence rates (CARs) during weeks 9-12 and weeks 21-24. To confirm smoking status, we performed salivary cotinine testing at weeks 12 and 24. We also evaluated the program adherence rate. Finally, we performed exploratory analysis to determine the factors associated with continuous abstinence at weeks 21-24 to provide insights for assisting with long-term continuous abstinence., Results: The CARs of all participants for weeks 9-12 and weeks 21-24 were 48.6% (95% CI 41.2-56.0) and 47.5% (95% CI 40.0-54.8), respectively. Program adherence rates were relatively high throughout (72% at week 12 and 60% at week 24). In the analysis of the factors related to the CAR at weeks 21-24, the number of entries in the app's digital diary and number of educational videos watched during the first 12 weeks were significant factors., Conclusions: The ascure program achieved favorable CARs, and participants showed high adherence. Proactive usage of the smartphone app may help contribute to smoking cessation success in the long-term., (©Ayaka Kato, Tomoyuki Tanigawa, Kohta Satake, Akihiro Nomura. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 14.05.2020.)

Background: The proportion of non-regularly employed persons has increased in Japan, but few studies have examined the relationship between employment status and lung cancer screening (LCS) participation., Methods: Authors analyzed data from the 2010 Comprehensive Survey of Living Conditions in Japan. The anonymous responses of 28,951 people aged 40-69 years old were analyzed. Authors defined nine employment status categories: unemployed, regularly employed in a large-, middle-, and small-scale company, non-regularly employed in a large-, middle-, and small-scale company, self-employed, and other. LCS participation in the past year was surveyed through a self-reported questionnaire. Sex-specific prevalence ratios (PRs) and 95% confidence intervals (CIs) for LCS participation for all employment status categories, using the regularly employed in a middle-scale company category as the reference, were calculated using multivariable Poisson regression analysis, after adjusting for potentially confounding factors., Results: Multivariable-adjusted PRs (95% CI) for LCS participation for the regularly employed in a large-scale company were 1.33 (1.25-1.41) in men and 1.53 (1.38-1.71) in women. Multivariable-adjusted PRs (95% CI) for LCS participation for the non-regularly employed in a middle- and small-scale company compared with the regularly employed in a middle-scale company were 0.81 (0.72-0.92) and 0.62 (0.50-0.76) in men, and 0.89 (0.80-0.99) and 0.80 (0.71-0.91) in women, respectively., Conclusion: Regularly employed in a large-scale company had significantly higher LCS participation, and non-regularly employed in a middle- or small-scale company showed significantly lower LCS participation than those who were regularly employed in a middle-scale company.

Background: Owing to the rarity of this tumor, there is limited information about second-line chemotherapy for patients with previously treated advanced thymic carcinoma., Material and Methods: We performed a multi-institutional, retrospective study named NEJ023 for patients with advanced thymic carcinoma. Patients without indications for curative treatment were treated with chemotherapy from 1995 to 2014 at 40 institutions in the North East Japan Study Group. Demographic and clinicopathologic characteristics, data on treatment methods, and outcomes of second-line chemotherapy were obtained from medical records., Results: In total, 191 patients were enrolled in this study. Second-line chemotherapy included platinum-based doublets in 57.6% of patients, other multidrug chemotherapy (e.g., cisplatin, doxorubicin, vincristine, and cyclophosphamide) in 13.6%, and monotherapy in 28.8%. The median follow-up time was 50.5 months, and the median overall survival (OS) from the start of second-line chemotherapy was 22.4 (95% confidence interval, 17.5-26.7) months. The average response rate (RR) was 20.0% overall; it was 21.6% for patients treated with platinum-based doublet chemotherapy, 13.6% for those treated with other multidrug chemotherapy, and 19.6% for those treated with single agent chemotherapy. There was no significant difference in OS between platinum-based doublet chemotherapy, other multidrug chemotherapy, and monotherapy (the median OS was 22.4, 25.7, and 21.4 months, respectively)., Conclusion: The median OS was 22.4 months in patients with advanced thymic carcinoma treated with second-line chemotherapy. There were no significant differences in RR and OS between monotherapy and multidrug chemotherapy in this study., Implications for Practice: Owing to the rarity of this tumor, there is limited information about second-line chemotherapy for patients with previously treated advanced thymic carcinoma. This is the largest data for those patients treated with second-line chemotherapy. This study suggests there is no significant difference in efficacy between monotherapy and multidrug chemotherapy for previously treated advanced thymic carcinoma. This result can support the adequacy to select monotherapy as treatment of those patients., (© AlphaMed Press 2019.)

To date, there are few studies in Asian populations on the association between snoring (a major clinical symptom of sleep apnea) and hypertension. This study aims to examine whether snoring frequency is associated with blood pressure and hypertension in the general Japanese population, after adjustment for major confounding factors. A cross-sectional study of 2021 middle-aged Japanese men and women enrolled in the Toon Health Study between 2009-2012 was conducted. Snoring frequency was assessed using a self-reported questionnaire, and was classified into four categories: never, ≤2 times/week, ≥3 times/week, and unknown. Multivariable regression coefficients for each snoring category were calculated for systolic and diastolic blood pressure, and their odds ratios (ORs) and 95% confidence intervals (95% CIs) for hypertension were calculated after adjusting for major confounding factors. The same analyses were also conducted after stratification by several major confounding factors. Multivariable-adjusted means of systolic and diastolic blood pressure among individuals who snored ≥3 times/week were 4.57 mmHg and 2.58 mmHg higher, respectively, than in individuals who never snored (p < 0.05). The multivariable-adjusted OR (95% CI) for hypertension in the group that snored ≥3 times/week was 1.79 (1.29-2.48), compared with the group that never snored. We also found a significant positive association between snoring frequency and hypertension not only in normal and overweight individuals, but also in lean individuals (body mass index ≤22.8 kg/m 2 ). Higher snoring frequency was associated with higher blood pressure and hypertension among both lean and non-lean Japanese.

Background: Marital status is one of the socio-economic factors associated with health. Several studies have indicated a significant association between marital status and insomnia. The increases in the percentages of unmarried people in Japan are expected to produce a significant impact on insomnia. The purpose of this study was to examine the association between marital status and insomnia., Methods: The participants were 35 288 people aged 30-59 years selected from the 2010 comprehensive survey of living conditions. We categorized marital status into five groups: single, married couples living with other family members, married couples living without other family members, widowed and divorced. Insomnia-related symptoms (IRS) were based on the participants who chose the answer, 'I couldn't sleep'. Sex-specific multivariable odds ratios (ORs) and 95% confidence intervals (CI) of IRS according to marital status were calculated using the logistic regression model, which was adjusted for potential confounding factors., Results: The proportions of people with IRS were 2.5% in men and 2.8% in women. The multivariable ORs (95% CI) were 1.15 (0.89-1.49) for single, 1.69 (1.11-2.58) for divorced and 1.01 (0.73-1.39) for married couples living without other family members in men, and 1.56 (1.20-2.03) for single, 2.43 (1.83-3.22) for divorced and 1.31 (1.01-1.71) for married couples living without other family members in women., Conclusions: We found divorced men and single, divorced and married women living without other family members had higher IRS than those who were married couples living with other family members in Japanese. This association was more evident in unemployed men., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Short sleep duration (SSD) is reported to be highly associated with socio-economic status. There are few studies on the relationship between employment status and SSD in Japan., Method: The authors used the 2006 Survey on Time Use and Leisure Activities conducted by the Ministry of Internal Affairs and Communications Japan, which provides representative samples of Japanese people. The anonymous data of 120,783 people aged 30-59 years were analyzed. Authors defined five categories of employment status: "unemployed," "regularly employed," "non-regularly employed," "self-employed," and "other." Authors also defined a sleep duration shorter than 5 h per night as SSD. Multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of SSD using regular employment as the reference group were calculated using the logistic regression model, adjusting for potential confounding factors, i.e., age, marital status, education level, communication device use, and the amount of time spent on various daily activities., Results: The prevalence of SSD was 2.8% (1639/58,308) in men and 3.2% (1976/62,475) in women. The multivariable-adjusted OR (95% CI) of SSD for the self-employed was 0.78 (0.65-0.92) in men and 1.78 (1.43-2.21) in women after adjustment for potential confounding factors, i.e., age, marital status, education level, and communication device use. Further adjustment for the time spent on daily activities revealed that the OR (95% CI) of SSD for the self-employed was 0.78 (0.65-0.92) in men and 1.89 (1.52-2.36) in women., Conclusion: Self-employed women had a higher prevalence of SSD. By contrast, self-employed men had a lower prevalence of SSD.

Background: We aimed to evaluate the association between hyperactivity/anxiety and obesity among elementary school students in Matsuyama City, Japan., Methods: We conducted a cross-sectional study of all 46 elementary school students (24, 296 students) in Matsuyama City. The questionnaire included question items from the Strengths and Difficulties Questionnaire (SDQ), as well as questions about height and weight. The students were classified into two groups according to Rohrer index. After separating the data by gender, we examined the association between (1) obesity and hyperactivity, (2) obesity and anxiety, and (3) obesity and combination of hyperactivity and anxiety, by estimating relative risk using Poisson regression model. We also conducted stratified analyses to examine the effect modification by age groups and unbalance of diet on those associations. Moreover, we calculated relative excess risk due to the interaction (RERI) to examine whether there was an additive interaction between hyperactivity and anxiety., Results: Sixteen thousand forty-eight students were included in the present analysis. The prevalence ratio (PR) of being obese in girls who had both hyperactivity and anxiety was higher compared to girls without those symptoms (PR = 1.80; 95% CI 1.04-3.13). There was no significant difference in the prevalence ratio for obesity in boys, whether they were hyperactive, anxious, or neither. RERI was 0.00 for boys and 0.18 for girls., Conclusion: We found a significant association between obesity and co-existence of hyperactivity and anxiety among elementary school girls. Our findings strengthen the need to further explore the association between childhood obesity, hyperactivity, and anxiety.

Objective: In contrast to the association between excess weight and sickness absence (SA), the association in relation to underweight has been under-researched. This study aimed to examine the effects of BMI at both extremes of its distribution on SA., Methods: Data came from the Japan Epidemiology Collaboration on Occupational Health study of 77,760 workers aged 20 to 59 years (66,166 males, 11,594 females). Information was collected on medically certified long-term SA (LTSA) (i.e., SA lasting ≥ 30 consecutive days) from April 2012 to March 2017. A sex-specific Cox proportional hazards model was used to investigate the associations., Results: Among males, both obesity (hazard ratio [HR] = 1.81, 95% CI: 1.50-2.17) and underweight (HR = 1.56, 95% CI: 1.23-1.96) were significantly associated with LTSA compared with normal weight. This U-shaped association between BMI categories and LTSA was observed both for mental and physical disorders. Among females, an elevated risk was observed among those with overweight (HR = 1.54, 95% CI: 1.16-2.05)., Conclusions: In a cohort of the Japanese working-age population, both obesity and underweight were associated with a greater risk of LTSA in males. Future research should not overlook the excess risk of LTSA associated with underweight., (© 2020 The Authors. Obesity published by Wiley Periodicals, Inc. on behalf of The Obesity Society (TOS).)