Publications by authors named "Miwako Takeda"

29 Publications

  • Page 1 of 1

Effect of Multimorbidity on Fragility Fractures in Community-Dwelling Older Adults: Shimane CoHRE Study.

J Clin Med 2021 Jul 22;10(15). Epub 2021 Jul 22.

Department of Neurology, Shimane University Faculty of Medicine, Izumo 693-8501, Japan.

Fragility fractures (FFxs), which are a common musculoskeletal injury in older adults, is associated with an increased frequency of falls. Both FFxs and falls may result from drugs, habits, and co-occurring diseases. We aimed to evaluate the effects of various diseases on the risk of FFx. This retrospective study included 1420 individuals aged ≥60 years. We evaluated the history of clinical FFx and diseases using a detailed questionnaire and a health examination. The risk of comorbidities was assessed using the Age-Adjusted Charlson Comorbidity (AAC) Index. We performed binary logistic regression analysis to determine the risk of FFx and falls after adjusting for covariates. In elderly men, the incidence of FFx positively correlated with rheumatoid arthritis and parent's hip fracture. For elderly women, the incidence of FFx positively correlated with rheumatoid arthritis and antihypertensive drugs but was inversely associated with dyslipidemia and antilipidemic drugs. The FFX risk of older adults with an AAC Index ≥6 was higher than those with an AAC Index of 1-3. In addition, the AAC Index and falls were independently and strongly associated with a higher risk of FFx. Taken together, multimorbidity increases the risk of clinical FFx independent of falls in the community-dwelling elderly population.
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http://dx.doi.org/10.3390/jcm10153225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8348412PMC
July 2021

Relationship between Masticatory Function and Bone Mineral Density in Community-Dwelling Elderly: A Cross-Sectional Study.

Healthcare (Basel) 2021 Jul 5;9(7). Epub 2021 Jul 5.

Department of Oral and Maxillofacial Surgery/Oral Care Center, Shimane University Faculty of Medicine, 89-1 Enya Cho, Izumo 693-8501, Shimane, Japan.

The relationship between masticatory function and bone mineral density (BMD) is unclear. This cross-sectional study examined this relationship after adjusting for confounding factors. The subjects were 702 community-dwelling elderly adults (306 men, 396 women) who had been recruited for the Community-Based Healthcare Research and Education study in 2019. Objective masticatory function was assessed using the gummy jelly method. The median for each descriptive statistic was 69.0 years for age, 86.2% for the young adult mean, and 18.0 for masticatory function. Comparisons of the groups with good and poor masticatory function by sex revealed a significant difference in muscle mass and the tooth number for both sexes ( < 0.05). Men showed significant differences in age ( < 0.05) and salivary occult blood findings ( < 0.05). Multivariate analysis using propensity scores showed a significant association between masticatory function and BMD in both sexes (men: odds ratio 163.0, 95% confidence interval 1.36-19,610.55, = 0.04; women: odds ratio 48.65, 95% confidence interval 1.52-1561.15, = 0.03 in women). Masticatory function and BMD in the community-dwelling elderly may be related. However, other factors, including frailty and sarcopenia, may also be involved. Regular oral health care by dentists and dental hygienists may benefit this population.
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http://dx.doi.org/10.3390/healthcare9070845DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305999PMC
July 2021

An association analysis between hypertension, dementia, and depression and the phases of pre-sarcopenia to sarcopenia: A cross-sectional analysis.

PLoS One 2021 22;16(7):e0252784. Epub 2021 Jul 22.

Center for Community-Based Healthcare Research and Education (CoHRE), Shimane University, Shimane, Japan.

Sarcopenia is intricately related to aging associated diseases, such as neuropsychiatric disorders, oral status, and chronic diseases. Dementia and depression are interconnected and also related to sarcopenia. The preliminary shift from robust to sarcopenia (i.e., pre-sarcopenia) is an important albeit underdiscussed stage and is the focus of this study. Identifying factors associated with pre-sarcopenia may lead to sarcopenia prevention. To separately examine the effects of dementia and depression on pre-sarcopenia/sarcopenia, we conducted multiple analyses. This cross-sectional study used health checkup data from a rural Japanese island. The participants were aged 60 years and above, and the data included muscle mass, gait speed, handgrip strength, oral status (teeth and denture), chronic diseases (e.g., hypertension), dementia (cognitive assessment for dementia, iPad Version), and depression (self-rating depression scale). A total of 753 older adult participants were divided into the sarcopenia (n = 30), pre-sarcopenia (n = 125), and robust (n = 598) groups. An ordered logit regression analysis indicated that age and depression were positively correlated with sarcopenia, while hypertension was negatively associated with it. A multiple logistic regression analysis between the robust and pre-sarcopenia groups showed significant associations between the same three variables. Depression was associated with pre-sarcopenia, but not dementia. There was also a significant association between hypertension and pre-sarcopenia. Further research is needed to reveal whether the management of these factors can prevent sarcopenia.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252784PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297796PMC
July 2021

Number of teeth and masticatory function are associated with sarcopenia and diabetes mellitus status among community-dwelling older adults: A Shimane CoHRE study.

PLoS One 2021 2;16(6):e0252625. Epub 2021 Jun 2.

Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Izumo City, Shimane, Japan.

Objectives: We aimed to examine the number of teeth and masticatory function as oral health indices and clarify their roles in the pathogenesis of sarcopenia and diabetes mellitus in community-dwelling older adults.

Subjects And Methods: This cross-sectional study was conducted with 635 older adults in Ohnan, Shimane Prefecture, in rural Japan. The number of teeth and masticatory function (measured by the number of gummy jelly pieces collected after chewing) were evaluated by dental hygienists. Sarcopenia status was assessed using handgrip strength, skeletal muscle index, calf circumference, and a possible sarcopenia diagnosis based on the Asian Working Group for Sarcopenia 2019. Diabetes mellitus status was defined as a hemoglobin A1c level ≥6.5% or self-reported diabetes. A multivariable logistic regression model was used to analyze the association between oral health, sarcopenia, and diabetes mellitus after adjusting for confounders.

Results: After adjusting for all confounders, logistic regression analysis showed that the number of remaining teeth was negatively associated with a low level of handgrip strength (odds ratio [OR], 0.961; 95% confidence interval [CI], 0.932-0.992) and possible sarcopenia (OR, 0.949; 95% CI, 0.907-0.992). Higher levels of masticatory function were also negatively associated with a low level of handgrip strength (OR, 0.965; 95% CI, 0.941-0.990) and possible sarcopenia (OR, 0.941; 95% CI, 0.904-0.979). Logistic regression analysis showed that the number of remaining teeth and a higher level of masticatory function were negatively associated with diabetes mellitus (OR, 0.978; 95% CI, 0.957-0.999; OR, 0.976; 95% CI, 0.960-0.992, respectively).

Conclusion: Our findings suggest that improvement in oral health, including the maintenance of masticatory function and remaining teeth, may contribute to the prevention of sarcopenia and diabetes mellitus in older adults.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252625PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172058PMC
June 2021

Assessing the Impact of a Hilly Environment on Depressive Symptoms among Community-Dwelling Older Adults in Japan: A Cross-Sectional Study.

Int J Environ Res Public Health 2021 04 24;18(9). Epub 2021 Apr 24.

Department of Functional Pathology, Faculty of Medicine, Shimane University, Shimane 693-8501, Japan.

Although some neighborhood environmental factors have been found to affect depressive symptoms, few studies have focused on the impact of living in a hilly environment, i.e., land slope, on depressive symptoms among rural older adults. This cross-sectional study aimed to investigate whether a land slope is associated with depressive symptoms among older adults living in rural areas. Data were collected from 935 participants, aged 65 years and older, who lived in Shimane prefecture, Japan. Depressive symptoms were assessed using the Zung Self-Rating Depression Scale (SDS) and defined on the basis of an SDS score ≥ 40. Land slopes within a 400 m network buffer were assessed using geographic information systems. Odds ratios (ORs) with 95% confidence intervals (CIs) of depressive symptoms were estimated using logistic regression. A total of 215 (23.0%) participants reported depressive symptoms. The land slope was positively associated with depressive symptoms (OR = 1.04; 95% CI = 1.01-1.08) after adjusting for all confounders. In a rural setting, living in a hillier environment was associated with depressive symptoms among community-dwelling older adults in Japan.
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http://dx.doi.org/10.3390/ijerph18094520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8123156PMC
April 2021

Relationship between Oral Health Status and Bone Mineral Density in Community-Dwelling Elderly Individuals: A Cross-Sectional Study.

Healthcare (Basel) 2021 Apr 7;9(4). Epub 2021 Apr 7.

Oral Care Center, Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan.

The relationship between oral health status and bone mineral density has been poorly elucidated. We conducted a cross-sectional study to examine the relationship between oral health status and bone mineral density with data from healthy community-dwelling elderly individuals in Ohnan-cho, Shimane Japan who were recruited in 2019 for the Shimane Center for Community-Based Health Research and Education (CoHRE) study. The study included 702 participants (306 men and 396 women). The median age, bone mineral density, and number of remaining teeth were 69.0 years, 86.2%, and 26.0, respectively. The two groups (Low teeth group and High teeth group) showed significant differences in age, hemoglobin A1c (HbA1c) level, and masticatory function in men ( < 0.05). In women, age, number of untreated teeth, and masticatory function were significantly different ( < 0.05). The odds ratio of propensity score analysis for the association between the number of remaining teeth and bone mineral density was 27.7 (95% confidence interval: 1.86-414.9, < 0.05). The number of remaining teeth could be associated with bone mineral density in the healthy elderly women, and no significant association was observed in men. Number of remaining teeth and bone mineral density may be interrelated, and oral care by dentists/dental hygienists may play an important role in maintaining bone mineral density in elderly women.
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http://dx.doi.org/10.3390/healthcare9040432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067960PMC
April 2021

Inconvenience of Living Place Affects Individual HbA1c Level in a Rural Area in Japan: Shimane CoHRE Study.

Int J Environ Res Public Health 2021 01 28;18(3). Epub 2021 Jan 28.

Department of Functional Pathology, Faculty of Medicine, Shimane University, Izumo, Shimane 693-8501, Japan.

Background: It has been shown that the socio-geographical environment of residential areas, such as altitude, affects the health status and health-maintenance behavior of residents. Here, we examined a hypothesis that altitude of residence would influence glycemic control in a general elderly population living in a rural area.

Methods: A thousand and sixteen participants living in a mountainous region in Japan were recruited at health examinations. Hemoglobin A1c (HbA1c) was measured in serum as a parameter of glycemic control. The altitude of residence, distance to grocery stores and to medical facilities were estimated using a geographic information system.

Results: Linear regression analysis confirmed a significant effect of the altitude on log HbA1c even after adjustment of other demographic and biochemical factors. When the distance to grocery stores or medical facilities were used instead of the altitude in a linear regression analysis, distance to secondary medical facilities alone showed a significant effect on HbA1c.

Conclusions: We found a positive correlation between HbA1c level and residential altitude in a rural area of Japan. The altitude seemed to be a parameter substituting the inconvenicence of residential areas. Socio-geographical factors of living place, such as inconvenience, may influence glycemic control of the residents.
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http://dx.doi.org/10.3390/ijerph18031147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908499PMC
January 2021

Serological screening for celiac disease in adults in Japan: Shimane CoHRE study.

JGH Open 2020 Aug 7;4(4):558-560. Epub 2020 Apr 7.

Second Department of Internal Medicine Shimane University Faculty of Medicine Izumo Japan.

Background And Aim: Celiac disease (CD) is a chronic autoimmune enteropathy triggered by ingested gluten in genetically predisposed individuals. Although common in Europe and the United States, cases of CD are rarely encountered in East Asia, including Japan, and its prevalence remains to be fully evaluated in a large-scale study. We previously investigated the presence of CD in adults in Japan, which revealed a low prevalence of 1 (0.05%) of 2008 nonclinical subjects, while 1 (2.1%) of 47 symptomatic patients was diagnosed based on serology and duodenal histopathology results. To confirm those results, we conducted an additional retrospective serological screening study of adults in Japan.

Methods: Serum samples were collected from 2055 adults who underwent a health examination in four local areas of Shimane prefecture in Japan from July 2008 to August 2013. As a screening test for CD, the antitissue transglutaminase IgA antibody (TTG) titer was determined in all subjects, and a value greater than 10 U/mL was considered to be evidence of CD.

Results: Of the 2055 subjects, 4 (0.19%) showed a high concentration of TTG. Although two of the four who were seropositive had died at the time of this retrospective study, none reported prominent digestive symptoms such as diarrhea or weight loss in a follow-up survey.

Conclusions: Among a general population in Japan, a positive rate of serological tests for CD was noted in 0.19%, indicating quite a low presence, consistent with our previous results.
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http://dx.doi.org/10.1002/jgh3.12334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7411563PMC
August 2020

Hilly environment and physical activity among community-dwelling older adults in Japan: a cross-sectional study.

BMJ Open 2020 03 26;10(3):e033338. Epub 2020 Mar 26.

Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Izumo, Shimane, Japan.

Objectives: We investigated whether a moderate-to-vigorous physical activity (MVPA) level and walking time were associated with a hilly environment in rural Japanese older adults.

Design: Cross-sectional study.

Setting: Unnan city, Ohnan and Okinoshima towns in Shimane, Japan.

Participants: Data were collected from 1115 adults from the Shimane CoHRE study, who were aged 60 years and older and living in rural Japan in 2012.

Measures: We measured the total time spent on MVPA and walking using a Japanese short version of the International Physical Activity Questionnaire. The land slope in 400 or 800 m network buffers was assessed using the geographic information system. A multivariable Poisson regression model examined the prevalence ratios (PR) and 95% CIs of walking time or MVPA levels meeting the WHO guideline (150 min/week) in the land slope categories (low, middle and high), adjusted for confounders.

Results: Engaging in the recommended level of MVPA was significantly associated with middle land slope (PR=1.07; p=0.03) and high land slope (PR=1.06; p=0.07) compared with low land slope in the 400 m network buffer, as well as with middle land slope (PR=1.02; p=0.48) and high land slope (PR=1.04; p=0.25) compared with the low land slope in the 800 m network buffer. Walking time was significantly associated with middle land slope (PR=1.13; p=0.04) and high land slope (PR=1.17; p=0.01) compared with low land slope in the 400 m network buffer, and with middle land slope (PR=1.09; p=0.16) and high land slope (PR=1.17; p<0.01) compared with low land slope in the 800 m network buffer. The sensitivity analysis found only a positive association between walking time and land slope in the 400 and 800 m network buffers.

Conclusions: This study showed that a hilly environment was positively associated with walking time among older adults living in rural Japan.
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http://dx.doi.org/10.1136/bmjopen-2019-033338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170569PMC
March 2020

Prevalence of lifestyle-related chronic diseases among agricultural and non-agricultural workers in ruralareas of Japan: the Shimane CoHRE study.

J Rural Med 2020 Jan 23;15(1):1-7. Epub 2020 Jan 23.

The Center for Community-based Healthcare Research and Education (CoHRE), Shimane University, Japan.

Engaging in agriculture greatly affects workers' lifestyles, particularly related to physical activity. This study aimed to clarify the prevalence of lifestyle-related chronic diseases among workers engaging and not engaging in agriculture in rural areas of Japan. A total of 4,666 consecutive participants aged ≥40 years (1,929 men and 2,737 women) were recruited during health examinations conducted from 2006 to 2014. For analysis, the participants were divided by sex and age into those engaging in agriculture and those not engaging in agriculture. Engaging in agriculture may be contributing with a low prevalence of dyslipidemia, a constitutive factor of metabolic syndrome, in both sexes between the ages of 40 and 64 years. In the elderly aged ≥65 years, engaging in agriculture may influence the low prevalence of hypertension in men. Hypertension, a strong risk factor for stroke and cardiovascular disease, is very frequent among the Japanese elderly and, therefore, engaging in agriculture may have a significant impact on its prevention and control. In rural areas of Japan, engaging in agriculture may contribute to the control of lipid metabolism in middle-aged individuals and blood pressure in the elderly.
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http://dx.doi.org/10.2185/jrm.2019-008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6983452PMC
January 2020

J-curve association between alcohol intake and varicose veins in Japan: The Shimane CoHRE Study.

J Dermatol 2019 Oct 29;46(10):902-906. Epub 2019 Jul 29.

Department of Dermatology, Shimane University Faculty of Medicine, Izumo, Japan.

The effect of alcohol intake on varicose veins (VV) has not been determined by its consumption level. The aim of this study was to investigate the association between alcohol intake and VV in an elderly general population. Using a cross-sectional approach, the Shimane CoHRE Study data, comprising a total of 1060 participants, were analyzed. By multivariate regression analysis adjusted with basic characteristics, past work history, lifestyle-related factors and medical history, compared with non-drinkers, mild drinkers (<20.0 g/day) showed a significantly lower adjusted odds ratio (aOR) of VV (aOR = 0.64, P = 0.036). In a similar way, regular drinkers (1-5 days/week) showed a significantly lower aOR of VV when compared with occasional drinkers (aOR = 0.57, P = 0.032). VV and alcohol intake showed J-curve relationships. In a stratified analysis by alcohol consumption levels, the association of smoking and VV were also observed in moderate to heavy drinkers and habitual drinkers. These findings can provide better understanding of pathophysiological mechanism and be used for evidence-based patient education.
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http://dx.doi.org/10.1111/1346-8138.15022DOI Listing
October 2019

Relationship between Individual Social Capital and Cognitive Function among Older Adults by Gender: A Cross-Sectional Study.

Int J Environ Res Public Health 2019 06 17;16(12). Epub 2019 Jun 17.

Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, 223-8 Enya-cho, Izumo-shi, Shimane 693-8501, Japan.

As it is not easy to modify lifestyle, it is important to examine the effect of social capital (SC), which does not require behavior modifications, on dementia prevention. This study aimed to clarify gender differences in the relationship between cognitive function and individual SC among people living in a rural area in Japan. We used the Shimane Center for Community-based Healthcare Research and Education (CoHRE) study data from 2011 to conduct a cross-sectional analysis. The analysis included 491 participants, aged 40 years or older, who had undergone medical examinations in two rural towns in Japan. Both cognitive SC and structural SC were measured. Multivariate logistic regression analysis was conducted to estimate the odds ratios (OR) and 95% confidence interval (CI) for cognitive function levels as binary outcomes. We found a significant association between cognitive function and individual cognitive SC in men (OR: 3.11, 95% CI: 1.43-6.78), and found that cognitive function was associated with structural SC in women (OR: 1.89, 95% CI: 1.08-3.31). This study showed that the relationship between cognitive function and individual SC differed by gender. These results suggest that it is important to approach dementia prevention differently in men and women.
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http://dx.doi.org/10.3390/ijerph16122142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6616497PMC
June 2019

Hilly neighborhoods are associated with increased risk of weight gain among older adults in rural Japan: a 3-years follow-up study.

Int J Health Geogr 2019 05 10;18(1):10. Epub 2019 May 10.

Department of Functional Pathology, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo-shi, Shimane, 693-8501, Japan.

Background: Neighborhood environments have been regularly associated with the weight status. Although the evidence is mostly limited to adults residing in western urban settings, the weight status of older adults living in rural areas is also assumed to be significantly affected by their neighborhood environments. This study aimed to identify environmental attributes specific to rural areas that could affect the risk of longitudinal weight gain among older adults (≥ 65 years) in Japan.

Methods: We examined five environmental attributes, i.e., land slope, public transportation accessibility, residential density, intersection density, and the availability of parks and recreational centers, measured by the geographic information system. Our analysis was based on 714 subjects participated in Shimane Community-based Healthcare Research and Education study in 2012 and 2015. Multinomial logistic regression model was conducted to examine the association between each neighborhood environmental attribute and weight change status (gain, loss and unchanged).

Results: We observed a significant increase in the risk of weight gain as the steepness of the neighborhood land slope increased. There was no significant association between other environmental attributes and risk of weight gain as well as weight loss among older adults.

Conclusion: Living in hilly neighborhoods was associated with increased risk of weight gain among rural Japanese older adults. Future research should consider region-specific environmental attributes when investigating their effect on older adults' weight status.
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http://dx.doi.org/10.1186/s12942-019-0174-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509780PMC
May 2019

Height loss but not body composition is related to low back pain in community-dwelling elderlies: Shimane CoHRE study.

BMC Musculoskelet Disord 2019 May 10;20(1):207. Epub 2019 May 10.

Center for Community-Based Healthcare Research and Education (CoHRE), Shimane University, Matsue-city, Shimane, Japan.

Background: Low back pain (LBP) is a common complaint in the elderly Japanese population. Although previous studies showed that height loss was associated with LBP, it remains unclear whether LBP is associated with body composition. The objective of the present study was to investigate whether body composition and physical characteristics, including height loss, were associated with LBP.

Methods: The present study is retrospectively registered, and the participants were 2212 community-dwelling Japanese people aged over 60 years who participated in the Shimane CoHRE study in 2016. We investigated the presence of LBP, body composition parameters (muscle, fat, body weight, and bone mass), physical characteristics (body height and height loss), chronic diseases, history of fall, smoking, and drinking habits. We examined the relationships of body composition parameters and physical characteristics with point prevalence of LBP using multivariate logistic regression.

Results: The point prevalence of LBP was 43.2% in women and 39.5% in men. Logistic regression models showed that body height and body composition were not significantly associated with LBP; however, height loss was associated significantly with LBP in women and men (OR: 1.14, 95% CI: 1.08-1.20 and OR: 1.13, 95% CI: 1.06-1.21, respectively). Hypertension (OR: 1.32, 9 5% CI: 1.04-1.69) and chronic heart disease (OR: 1.57, 95% CI: 1.01-2.43) in women and history of fall (OR: 1.70, 95% CI: 1.13-2.56) and cerebrovascular disease (OR: 1.88, 95% CI: 1.05-3.34) in men were significantly associated with LBP. However, body composition was not associated with LBP in either gender.

Conclusions: The present study demonstrated that height loss, but not body composition, was related to LBP in community-dwelling elderly people. To elucidate the cause of LBP, it is important to consider the relationship with height loss.
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http://dx.doi.org/10.1186/s12891-019-2580-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511157PMC
May 2019

Additive Effect of Physical Activity and Sedentary Time on Depressive Symptoms in Rural Japanese Adults: A Cross-Sectional Study.

J Epidemiol 2019 Jun 25;29(6):227-232. Epub 2018 Aug 25.

Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University.

Background: Previous studies have reported an additive effect of moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) on depressive symptoms. However, no studies have been conducted in rural community settings. This cross-sectional study investigated whether the additive effect of MVPA and ST was associated with depressive symptoms in rural Japanese adults.

Methods: We identified 2,814 participants from health examinations conducted in Shimane, rural Japan, in 2012 and analyzed data from 1,958 participants. We assessed depressive symptoms using the Zung Self-Rating Depression Scale and measured the total time spent on MVPA and ST using a Japanese short version of the International Physical Activity Questionnaire. Poisson regression analysis examined the prevalence ratios (PR) of depressive symptoms in nine category combinations of MVPA level (no, insufficient, or sufficient MVPA) and ST level (high, moderate, or low ST).

Results: A total of 117 (6.0%) participants had depressive symptoms. Compared with the reference category (no MVPA/high ST), multivariate analysis showed that the likelihood of depressive symptoms was significantly lower in the sufficient MVPA/low ST category (PR 0.23; 95% confidence intervals [CI], 0.08-0.66), insufficient MVPA/low ST category (PR 0.37; 95% CI, 0.16-0.86), and insufficient MVPA/moderate ST category (PR 0.39; 95% CI, 0.17-0.90).

Conclusion: Analysis of the additive effect of MVPA and ST showed that the combinational category of sufficient MVPA and low ST had the lowest prevalence of depressive symptoms in rural Japanese adults. Moderate ST and low ST showed significantly lower likelihoods of depressive symptoms, regardless of insufficient MVPA.
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http://dx.doi.org/10.2188/jea.JE20180017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522389PMC
June 2019

Is the Effect of Body Mass Index on Hypertension Modified by the Elevation? A Cross-Sectional Study of Rural Areas in Japan.

Int J Environ Res Public Health 2017 09 7;14(9). Epub 2017 Sep 7.

Department of Functional Pathology, Shimane University School of Medicine, 89-1 Enya-chou, Izumo, Shimane 693-8501, Japan.

Obesity is an established independent risk factor for developing hypertension. A recent study showed that the effect of obesity on hypertension varies by the elevation of the residence area. Thus, we hypothesized that the interaction effect of body mass index (BMI) and elevation has a significant association with hypertension. The first aim of this cross-sectional study was to examine whether BMI was associated with hypertension, after adjustment for covariates. The second aim was to examine whether the interaction term between BMI and elevation was associated with hypertension, after adjustment for covariates. Data were collected from a cross-sectional study conducted in a rural area of Japan in 2016. After excluding participants with missing data ( = 2), data from 729 participants were analyzed. We found that BMI was significantly associated with hypertension. In addition, the interaction term between BMI and elevation had a significant association with hypertension. The findings of the present study support the recent evidence that high BMI is an independent risk factor for hypertension, but its effect varies by elevation. Thus, context-specific interventions could be an effective approach to prevent hypertension in this area.
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http://dx.doi.org/10.3390/ijerph14091022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5615559PMC
September 2017

Association of High-Density Lipoprotein Subclasses with Carotid Intima-Media Thickness: Shimane CoHRE Study.

J Atheroscler Thromb 2018 Jan 27;25(1):42-54. Epub 2017 Apr 27.

Department of Laboratory Medicine, Shimane University.

Aims: Recent studies suggested that subclasses of high-density lipoprotein (HDL) may be a better biomarker to predict the risk of atherosclerotic disorders. We aimed to examine the association of HDL2- and HDL3-cholesterol (HDL2-C and HDL3-C) with carotid intima-media thickness (IMT) using a new method to quantify the HDL-C subclasses.

Methods: Participants were 657 Japanese subjects (434 women) who received a health examination (mean age: 73 years). Serum samples were analyzed by the homogenous assay for HDL-C and HDL3-C. HDL2-C was calculated indirectly by subtracting HDL3-C from HDL-C. HDL3-C measured by this assay was well correlated with that measured by ultracentrifugation (r=0.898, p<0.001). The maximum IMT (max-IMT) and plaque score (PS) were evaluated by ultrasonography following the standard protocol.

Results: HDL3-C was associated with age both in men (r=-0.322, p<0.0001) and women (r=-0.315, p<0.0001). In a simple regression analysis, max-IMT showed an inverse association with HDL3-C, whereas no significant association was observed with HDL2-C. A multiple linear regression analysis indicated, however, that the association between HDL3-C and max-IMT was not significant in both aged and younger populations when age was included in the analysis. Further, not only HDL2-C but also HDL3-C was not a significant predictor of 'atherosclerotic arteries' defined as the max-IMT ≥1.5 mm. Similar results were observed in the analysis on PS.

Conclusions: Neither HDL3-C nor HDL2-C was significantly associated with carotid atherosclerosis in the Japanese population in this study.
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http://dx.doi.org/10.5551/jat.38844DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770223PMC
January 2018

Is Accessibility to Dental Care Facilities in Rural Areas Associated with Number of Teeth in Elderly Residents?

Int J Environ Res Public Health 2017 03 21;14(3). Epub 2017 Mar 21.

Department of Functional Pathology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan.

Given that public transportation networks are less developed in rural than in urban areas, a lack of accessibility to dental care facilities could be a barrier to routine dental checkups. Thus, we hypothesized that the distance to the dental care facilities is a risk factor for tooth loss. The aim of this study was to test whether there is an association between the distance to dental care facilities, estimated by geographic information systems, and number of teeth, assessed by an oral examination, among elderly residents of a rural area in Japan. Data were collected in 2016 from a cross-sectional study conducted in Shimane prefecture, Japan. After excluding participants with missing data (n = 21), we analyzed data from 710 participants. Of them, 40.6% were male and the mean (standard deviation) age was 67.4 (7.4) years. Further, 68.0% (n = 483) had at least 20 teeth. We found that the distance to dental care facilities was significantly associated with the number of teeth (less than 20) (odds ratio = 1.07, 95% confidence interval = 1.01-1.12) after adjustment for potential confounders. This result suggested that individuals without easy access to dental care facilities may be important targets for dental care.
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http://dx.doi.org/10.3390/ijerph14030327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369162PMC
March 2017

Geographic Elevation, Car Driving, and Depression among Elderly Residents in Rural Areas: The Shimane CoHRE Study.

Int J Environ Res Public Health 2016 07 21;13(5). Epub 2016 Jul 21.

Department of Functional Pathology, School of Medicine, Shimane University, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan.

Given that public transportation networks are often worse in rural areas than in urban areas, it is difficult for elderly non-drivers to access health-promoting goods, services, and resources related to mental health. Moreover, geographical location, assessed by elevation, could modify this association in a rural area. The aim of this study was to test whether the association between car driving (being a driver or not) and depression, as measured by the Zung Self-Rating Depression Scale (SDS), varied by elevation. Data were collected from a cross-sectional study conducted in the town of Ohnan located in a rural area of Japan. After excluding participants with missing data (n = 26), 876 participants were analysed in this study. After adjustment for potential confounders, being a non-driver had a significantly higher odds ratio of SDS (40+) among elderly people living at a low elevation (odds ratio = 2.17, 95% confidence interval = 1.28-3.71). However, similar findings were not observed among elderly people living at a high elevation. These results suggest that car driving importantly predicts depression in elderly people living at relatively low elevations in rural areas.
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http://dx.doi.org/10.3390/ijerph13070738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962279PMC
July 2016

Effect of salt intake on blood pressure in patients receiving antihypertensive therapy: Shimane CoHRE Study.

Eur J Intern Med 2016 Mar 2;28:70-3. Epub 2015 Nov 2.

Department of Functional Pathology, Shimane University School of Medicine, Izumo, Japan; The Center for Community-based Health Research and Education (CoHRE), Shimane University, Izumo, Japan. Electronic address:

Background: Salt intake is recognized as an important risk factor for hypertension in the general population. On the other hand, the availability of various classes of antihypertensive drugs means that it is generally not considered crucial to control the salt intake of hypertensive patients. In this study, we evaluated whether blood pressure (BP) was correlated with 24-hour salt intake in patients receiving antihypertensive therapy.

Methods: A total of 1496 consecutive participants undergoing health screening examinations were recruited. Subjects were divided into two groups according to their antihypertensive medications checked on prescriptions: 1005 subjects without antihypertensive therapy (untreated subjects) and 491 subjects with antihypertensive therapy (treated subjects). The 24-hour urinary sodium excretion (24h-uNa), a surrogate marker for daily salt intake, was estimated with the formula proposed by Tanaka et al. in 2002.

Results: Univariate analysis indicated that 24h-uNa was positively correlated with the systolic BP of both untreated and treated subjects. This was confirmed by multiple linear regression analysis after adjustment for confounding factors (untreated subjects: partial regression coefficient β=1.45 ± 0.26, p<0.001; treated subjects: β=0.75 ± 0.27, p=0.01). Salt intake was also correlated with the pulse pressure in both treated subjects (β=0.55 ± 0.24, p=0.02) and untreated subjects (β=0.93 ± 0.19, p<0.001).

Conclusion: These results suggest the importance of reducing salt intake in hypertensive patients on pharmacotherapy, as well as in the general population. Further studies of hypertensive patients employing 24-h urine collection are warranted to confirm the present findings.
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http://dx.doi.org/10.1016/j.ejim.2015.10.013DOI Listing
March 2016

Geographic Elevation and Cognitive Function among Elderly Residents in Rural Mountainous Areas: Shimane CoHRE Study.

Int J Environ Res Public Health 2015 Oct 23;12(10):13365-71. Epub 2015 Oct 23.

Center for Community-Based Health Research and Education (CoHRE), Organization for the Promotion of Project Research, Shimane University, 223-8 Enya-cho, Izumo, Shimane 693-8501, Japan.

The aim of this study was to test whether there is an association between elevation and cognitive function among elderly residents in rural mountainous areas. Data were collected in 2012 from a cross-sectional study conducted in Ohnan Town, which is located in a rural mountainous area in the southern part of Shimane Prefecture, Japan. Cognitive function was evaluated using CADi (Cognitive Assessment for Dementia, iPad version) and elevation was estimated by using Geographic Information Systems according to the participant's address. After excluding subjects with missing data, 866 participants were analyzed. After adjustment for potential confounding factors, higher elevation was significantly associated with decreased cognitive function. This finding suggests that it is important to consider the physical environment, i.e., elevation, that would affect accessibility to health-promoting goods, services, and resources when seeking to maintain cognitive function in elderly people living in rural mountainous areas.
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http://dx.doi.org/10.3390/ijerph121013365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4627035PMC
October 2015

Relationship between Blood Myostatin Levels and Kidney Function:Shimane CoHRE Study.

PLoS One 2015 26;10(10):e0141035. Epub 2015 Oct 26.

Department of Laboratory Medicine, Shimane University Faculty of Medicine, Shimane, Japan; The Center for Community-based Health Research and Education (CoHRE), Shimane University, Shimane, Japan.

Objectives: Myostatin (MSTN), a member of TGF-β superfamily, is produced in the skeletal muscle to inhibit myocyte differentiation. MSTN expression is increased in the skeletal muscle in patients with chronic kidney disease (CKD), which may play a role in the pathogenesis of sarcopenia or in the protein energy wasting (PEW). This observation implies that the plasma MSTN level may be correlated with kidney function. Thus, we conducted a cross-sectional study to evaluate the association between the plasma MSTN concentration and the estimated glomerular filtration rate (eGFR).

Subjects And Methods: Subjects were 781 participants of a health examination performed in a rural area in Japan. Among them, 124 subjects were selected by stratified random sampling according to eGFR. Creatinine clearance (ClCr) by the Cockcroft-Gault equation was used as a measure of kidney function. Plasma concentration of MSTN was determined by ELISA.

Results: The plasma MSTN level was not different between men (3.42±1.61 ng/mL) and women (3.27±1.43 ng/mL). In a simple regression analysis, the MSTN level was significantly correlated with eGFR (r = -0.25, p<0.01) and ClCr (r = -0.20, p<0.05) but not with age and BMI. In a multiple linear regression analysis, the MSTN level showed a negative correlation with eGFR (standardized β = -0.31, p<0.01) and ClCr (standardized β = -0.35, p<0.01) under the adjustment with age, sex, BMI and LDL-C. Weak correlation was observed between the MSTN level and BMI / the serum LDL-C level. When the subjects were stratified into 4 groups according to eGFR, MSTN was significantly greater in the groups with the lowest and the 2nd lowest eGFR (3.55±1.79 and 3.76±1.75 ng/mL, respectively) than the level in the group with the highest eGFR (2.77±0.85 ng/mL).

Conclusion: Plasma MSTN level was elevated in an early stage of CKD, which could be involved in the progression of sarcopenia.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0141035PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4621051PMC
June 2016

Altitudes of residential areas affect salt intake in a rural area in Japan: a Shimane CoHRE Study.

Hypertens Res 2015 Dec 27;38(12):895-8. Epub 2015 Aug 27.

Department of Functional Pathology, School of Medicine, Shimane University, Izumo, Japan.

There is increasing evidence of an association between residential environments and hypertension. As shown in our previous study, the inconvenience of the locations of residential areas may be one of the factors influencing the blood pressures of inhabitants. Salt intake is one of the likely mediators between inconvenience and hypertension. Therefore, in this study, we evaluated the association between the altitudes of residential areas and salt intake in a rural Japanese region because altitude may be one of the proxies for inconvenience. In this cross-sectional study, 1016 participants living in a mountainous region in Japan were recruited during health examinations. The altitude of each participant's residence was estimated using a geographic information system. Subjects were divided into quartile groups according to the altitudes of their residences. To evaluate salt intake, we employed the 24-h salt intake estimation of Kawano et al. (e24-h salt intake) and the urinary sodium-to-potassium ratio (uNa/K). Linear regression analyses indicated that altitude was an independent factor influencing both e24-h salt intake and uNa/K after adjustments for age, sex, body mass index, physical activity, alcohol consumption, triglycerides and county of residence. The same result was observed when the subjects who did not take antihypertensive medications were analyzed (N=633). The present study indicated that altitude of residence had a significant positive influence on salt intake in a rural area of Japan.
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http://dx.doi.org/10.1038/hr.2015.91DOI Listing
December 2015

Association Between Geographic Elevation, Bone Status, and Exercise Habits: The Shimane CoHRE Study.

Int J Environ Res Public Health 2015 Jun 30;12(7):7392-9. Epub 2015 Jun 30.

Center for Community-Based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, 223-8 Enya-cho, Izumo, Shimane 693-8501, Japan.

In recent years, there has been growing interest in the association between the residential environment and health. The association between residential environment (i.e., geographic elevation) and bone status is unknown. Furthermore, these associations could differ by exercise habits due to the chronically greater daily activity caused by steep slopes in mountainous areas. The aim of this study was to test whether the association between bone status of elderly people measured using quantitative ultrasound (QUS) and elevation varied according to the exercise habits in a mountainous area population. Data were collected from a cross-sectional study conducted during 2012-2013. QUS value was expressed as a proportion of the young adult mean (%YAM), with higher scores donating better bone status. After excluding subjects with missing data, we analyzed the data for 321 men and 500 women. Our results indicate that %YAM was not associated with elevation among men, or among women with exercise habits. However, elevation was associated with %YAM among women without exercise habits. Our results highlight the importance of considering residential environment and exercise habits when establishing promotion strategies to maintain bone status of the elderly people who live in rural mountainous areas.
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http://dx.doi.org/10.3390/ijerph120707392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515663PMC
June 2015

Accessible Transportation, Geographic Elevation, and Masticatory Ability Among Elderly Residents of a Rural Area.

Int J Environ Res Public Health 2015 Jun 26;12(7):7199-207. Epub 2015 Jun 26.

Center for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, 223-8 Enya-cho, Izumo, Shimane 693-8501, Japan.

Given that public transportation networks are often worse in rural areas than in urban areas, rural residents who do not drive can find it difficult to access health-promoting goods, services, and resources related to masticatory ability. Moreover, geographical location, assessed by elevation, could modify this association. The aim of this study was to test whether the association between access to transportation and masticatory ability varied by elevation. Data were collected from a cross-sectional study conducted in Mizuho and Iwami counties, Japan. Objective masticatory ability was evaluated using a test gummy jelly and elevation was estimated by the geographic information systems according to the participant's address. After excluding subjects with missing data, 672 subjects (Mizuho = 401 and Iwami = 271) were analyzed. After adjustment for potential confounders, being a driver was not significantly associated with masticatory ability among elderly people living at low elevation (≤313 m) in Mizuho county. However, after the same adjustment, being a driver remained significantly associated with increased masticatory ability among elderly at high elevations. Similar findings were observed in Iwami county. Accessible transportation was significantly associated with increased mastication ability in elderly people living at high elevations, but not in those living at low elevations.
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http://dx.doi.org/10.3390/ijerph120707199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515650PMC
June 2015

Standing posture at work and overweight exacerbate varicose veins: Shimane CoHRE Study.

J Dermatol 2014 Nov 9;41(11):964-8. Epub 2014 Oct 9.

Center for Community-Based Health Research and Education (CoHRE), Organization for the Promotion of Project Research, Izumo, Japan; Department of Dermatology, Shimane University Hospital, Izumo, Japan.

Varicose veins (VV) in legs are commonly observed in the general global population. However, the prevalence of and risk factors for VV in Japan are not clear. This study aimed at clarifying the risk factors for VV in traditional rural areas of Shimane prefecture. Subjects (113 men and 205 women aged ≥45 years) were recruited from health examinations in those areas in 2012. VV were defined as a reflux of blood in the great and/or small saphenous vein and incompetent perforating veins detected by ultrasonography. Risk factors for VV were analyzed using logistic regression models that included various parameters. We also investigated the possible interaction between standing at work and overweight and calculated the synergistic index. VV were found in 20.1% of the subjects (12.4% of men and 24.4% of women). The previously known risk factors of prolonged upright standing posture during work, higher body mass index (BMI), female sex, and age were also significant factors for VV. There was a significant combined effect of overweight (BMI ≥25) and prolonged upright standing posture at work [adjusted odds ratio = 3.42; 95% confidence interval (CI), 1.07-10.89], although the synergistic effect was not significant [synergistic index = 1.3; 95% CI, 0.2-8.7]. The prevalence of VV in the traditional rural area of Shimane prefecture was comparable to that reported previously in European countries. Our results confirm that exposure to both prolonged standing at work and overweight exacerbate VV development. This finding is useful to develop strategies for VV prevention.
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http://dx.doi.org/10.1111/1346-8138.12643DOI Listing
November 2014

Evaluation of salvage surgery for type 4 gastric cancer.

World J Gastrointest Surg 2012 Dec;4(12):301-5

Toshio Hashimoto, Department of Surgery, Yonezawa City Hospital, 6-36, Aioicho, Yonezawa, Yamagata 992-8502, Japan.

Patients with type 4 gastric cancer and peritoneal metastasis respond better to chemotherapy than surgery. In particular, patients without gastric stenosis who can consume a meal usually experience better quality of life (QOL). However, some patients with unsuccessful chemotherapy are unable to consume a meal because of gastric stenosis and obstruction. These patients ultimately require salvage surgery to enable them to consume food normally. We evaluated the outcomes of salvage total gastrectomy after chemotherapy in four patients with gastric stenosis. We determined clinical outcomes of four patients who underwent total gastrectomy as salvage surgery. Outcomes were time from chemotherapy to death and QOL, which was assessed using the Support Team Assessment Schedule-Japanese version (STAS-J). Three of the patients received combination chemotherapy [tegafur, gimestat and otastat potassium (TS-1); cisplatin]. Two of these patients underwent salvage chemotherapy after 12 and 4 mo of chemotherapy. Following surgery, they could consume food adequately and their STAS-J scores improved, so their treatments were continued. The third patient underwent salvage surgery after 7 mo of chemotherapy. This patient was unable to consume food adequately after surgery and developed surgical complications. His clinical outcomes at 3 mo were very poor. The fourth patient received combination chemotherapy (TS-1 and irinotecan hydrochloride) for 6 mo and then underwent received salvage surgery. After surgery, he could consume food adequately and his STAS-J score improved, so his treatment was continued. After the surgery, he enjoyed his life for 16 mo. Of four patients who received salvage total gastrectomy after unsuccessful chemotherapy, the QOL improved in three patients, but not in the other patient. Salvage surgery improves QOL in most patients, but some patients develop surgical complications that prevent improvements in QOL. If salvage surgery is indicated, the surgeon and/or oncologist must provide the patient with a clear explanation of the purpose of surgery, as well as the possible risks and benefits to allow the patient to reach an informed decision on whether to consent to the procedure.
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http://dx.doi.org/10.4240/wjgs.v4.i12.301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596528PMC
December 2012

Effect of environmental and lifestyle factors on hypertension: Shimane COHRE study.

PLoS One 2012 9;7(11):e49122. Epub 2012 Nov 9.

Center for Community-Based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, Izumo, Japan.

Background: In recent years there has been increasing evidence of an association between residential remoteness and hypertension (HTN); however, no study has examined the effects of residential remoteness-lifestyle associations on HTN. The objective of this study was to evaluate the effects of residential remoteness, as measured by road network distance and elevation, and lifestyle associations, including access to daily products as a measure of car use, on HTN in a rural region in Japan.

Method: This is a cross-sectional population based study. We analyzed data from the Shimane COHRE study conducted from 2006 to 2009 in the rural mountainous regions of Japan. After excluding missing data, we conducted a logistic regression analysis of the data for 1,348 individuals and examined the effects of residential remoteness and lifestyle associations, including road network distance, elevation and access to daily products as a measure of car use, on the prevalence of HTN.

Principal Findings: In participants without access to car use, the odds ratios for self-reported HTN (i.e. taking antihypertensive medication) were significantly increased in those living in moderate (odds ratio (OR): 2.21, 95% confidence interval (CI): 1.19-4.08) and far (OR: 2.55, 95% CI: 1.00-6.51) road distances, whereas there were no significant associations in participants with access to car use. There were no significant associations between elevation and HTN for participants either with or without access to car transportation.

Conclusions: Our findings show that specific residential remoteness-hypertension associations vary according to access to daily products as a measure of car use in a rural mountainous area of Japan. These results advance the understanding and importance of considering residential environment, "where people live," in establishing health policy.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0049122PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494668PMC
May 2013

Is location associated with high risk of hypertension? Shimane COHRE Study.

Am J Hypertens 2012 Jul 12;25(7):784-8. Epub 2012 Apr 12.

Center for Community based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, Izumo, Japan.

Background: There is growing evidence that residential environment is associated with hypertension. Recently, interest has also turned toward examining the possible influence of remoteness on hypertension. The aim of this study is to explore the effect of remoteness, the shortest path between the subject location and the population center, on hypertension prevalence in a rural region in Japan.

Methods: We analyzed data from the Shimane COHRE Study conducted from 2006 to 2009 in rural mountainous regions of Japan. After excluding the missing data, we conducted a logistic regression analysis of the data for 1,348 individuals. Geographic information systems (GIS) were used in the network analysis. Network analysis determined the distance between subject's location and population center on road networks, and the distance was divided into tertiles: 0-26,685.8 m = close distance, 26,685.9 m-38,350.6 m = moderate distance, 38,350.7 m-68,070.1 m = far distance.

Results: According to self-reported hypertension, the odds ratios for hypertension (taking antihypertensive medication or under treatment for hypertension without medication) were 1.44 (95% confidence interval (CI): 1.04-1.99) and 1.78 (95% CI: 1.29-2.46) in moderate and far distances, respectively, after adjustment for potential confounders. The odds ratios no longer remained significant after considering the measurement of blood pressure (BP) to define hypertension (taking antihypertensive medication or under treatment for hypertension without medication or BP ≥ 140/90 mm Hg for systolic BP (SBP)/diastolic BP (DBP)).

Conclusions: Our findings show that residential remoteness might be associated with a higher risk of hypertension in a rural region in Japan.
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http://dx.doi.org/10.1038/ajh.2012.36DOI Listing
July 2012
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