Publications by authors named "Naho Tsuchiya"

43 Publications

Familial Clusters of Coronavirus Disease in 10 Prefectures, Japan, February-May 2020.

Emerg Infect Dis 2021 03;27(3):915-918

The overall coronavirus disease secondary attack rate (SAR) in family members was 19.0% in 10 prefectures of Japan during February 22-May 31, 2020. The SAR was lower for primary cases diagnosed early, within 2 days after symptom onset. The SAR of asymptomatic primary cases was 11.8%.
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http://dx.doi.org/10.3201/eid2703.203882DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920650PMC
March 2021

Impacts of the urinary sodium-to-potassium ratio, sleep efficiency, and conventional risk factors on home hypertension in a general Japanese population.

Hypertens Res 2021 Feb 15. Epub 2021 Feb 15.

Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.

Recently, a high urinary sodium-to-potassium (Na/K) ratio and reduced sleep efficiency, in addition to conventional risk factors (obesity and excess alcohol intake), have been identified as risk factors for hypertension. We estimated the population attributable fraction (PAF) for home hypertension due to these risk factors in a general Japanese population. We conducted a cross-sectional study including 1384 participants (393 men and 991 women) to estimate the odds ratio (OR) and 95% confidence interval (CI) for the presence of any of the conventional risk factors using multivariable logistic regression analyses. The models were adjusted for sex, age, smoking status, and log-transformed average daily steps. We also estimated the OR and 95% CI for the presence of any of the overall risk factors. Furthermore, we calculated the PAF due to these risk factors. The results showed that the prevalence of home hypertension was 39.0% (540/1384). The presence of any of the conventional risk factors, as well as any of the overall risk factors, was significantly associated with an increased prevalence of hypertension (OR 2.80, 95% CI 2.15-3.65; OR 2.50, 95% CI 1.93-3.22, respectively). The PAF for hypertension due to the presence of any of the conventional risk factors and the PAF due to the presence of any of the overall risk factors were 30.2% and 39.0%, respectively. In conclusion, the impact of the overall risk factors, including the urinary Na/K ratio and sleep efficiency, on home hypertension was higher than that of conventional risk factors alone. The management of the urinary Na/K ratio and sleep efficiency as well as conventional risk factors might be important in the management of blood pressure.
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http://dx.doi.org/10.1038/s41440-021-00628-yDOI Listing
February 2021

Combined associations of liver enzymes and obesity with diabetes mellitus prevalence: The Tohoku Medical Megabank Community-based Cohort Study.

J Epidemiol 2020 Dec 26. Epub 2020 Dec 26.

Tohoku Medical Megabank Organization, Tohoku University.

Background: Alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) are enzymes associated with diabetes mellitus (DM) prevalence. However, limited information is available regarding the association of liver enzymes and DM consistently present in obese and non-obese individuals. We examined whether the combination of ALT and GGT enzymes is associated with the prevalence of DM regardless of obesity in a general Japanese population.

Methods: We conducted a cross-sectional study of 62,786 participants aged ≥20 years who lived in Miyagi and Iwate, Japan. We divided all the participants into eight groups according to the ALT level (low: <30 IU/L and high: ≥30 IU/L), GGT level (low: <50 IU/L and high: ≥50 IU/L), and the presence of obesity. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable logistic regression analysis, adjusting for potential confounders, to determine associations of the combination of ALT and GGT levels and obesity with DM prevalence.

Results: Overall, 6,008 participants (9.6%) had DM. Compared to non-obese individuals with low ALT and GGT levels, the participants with high ALT and GGT levels had high ORs for DM in both obese (OR 4.06; 95% CI, 3.61-4.56) and non-obese groups (OR 2.19; 95% CI, 1.89-2.52). The obese group had high ORs for DM, even at low ALT and GGT levels.

Conclusion: High ALT and GGT levels are associated with DM prevalence in obese and non-obese participants. This finding suggests that correcting ALT and GGT levels and controlling obesity are important for the prevention of DM.
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http://dx.doi.org/10.2188/jea.JE20200384DOI Listing
December 2020

Deficiency of mannose-binding lectin is a risk of Pneumocystis jirovecii pneumonia in a natural history cohort of people living with HIV/AIDS in Northern Thailand.

PLoS One 2020 23;15(12):e0242438. Epub 2020 Dec 23.

Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand.

Background: Mannose-binding lectin (MBL) plays a pivotal role in innate immunity; however, its impact on susceptibility to opportunistic infections (OIs) has not yet been examined in a natural history cohort of people living with HIV/AIDS.

Methods: We used archived samples to analyze the association between MBL expression types and risk of major OIs including Pneumocystis jirovecii pneumonia (PCP), cryptococcosis, talaromycosis, toxoplasmosis, and tuberculosis in a prospective cohort in Northern Thailand conducted from 1 July 2000 to 15 October 2002 before the national antiretroviral treatment programme was launched.

Results: Of 632 patients, PCP was diagnosed in 96 (15.2%) patients, including 45 patients with new episodes during the follow-up period (1006.5 person-years). The total history of PCP was significantly associated with low MBL expression type: high/intermediate (81/587, 13.8%), low (10/33, 30.3%) and deficient (5/12, 41.7%) (p = 0.001), whereas the history of other OIs showed no relation with any MBL expression type. Kaplan-Meier analysis (n = 569; log-rank p = 0.011) and Cox's proportional hazards model revealed that deficient genotype dramatically increased the risk of PCP, which is independent upon sex, age, CD4 count, HIV-1 viral load and hepatitis B and C status (adjusted hazard ratio 7.93, 95% confidence interval 2.19-28.67, p = 0.002).

Conclusions: Deficiency of MBL expression is a strong risk factor determining the incidence of PCP but not other major OIs.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242438PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757797PMC
January 2021

Impact of the Great East Japan Earthquake on the Employment Status and Mental Health Conditions of Affected Coastal Communities.

Int J Environ Res Public Health 2020 11 3;17(21). Epub 2020 Nov 3.

Department of Disaster Psychiatry, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-Machi, Aoba-ku, Sendai 980-8573, Japan.

The Great East Japan Earthquake devasted the old community in coastal areas characterized by primary industry. The number of unemployed people increased from 150,000 to 190,000 after the earthquake. All of the adult residents of Shichigahama (18 years old or older), located in the coastal area of the Miyagi prefecture, whose houses were totally or majorly damaged, were recruited for a survey conducted in October 2011. All of the residents who responded with written informed consent were included in this study. Among 904 individuals who had a job before the Great East Japan Earthquake, 19% became unemployed. Concerning gender and age, 9% of young men, 34% of elderly men, 21% of young women, and 49% of elderly women became unemployed. Concerning the type of industry, 38%, 15%, and 16% of people who had belonged to the primary, secondary, and tertiary industries, respectively, before the disaster became unemployed. Those who became unemployed exhibited a significantly higher risk of insomnia compared to those who maintained jobs. The study pointed out the severe impact of the Great East Japan Earthquake on populations who had belonged to the primary industry, especially among elderly women, and its effect on sleep conditions.
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http://dx.doi.org/10.3390/ijerph17218130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7662503PMC
November 2020

Residents in a Remote Island Having Family Members in Distant Areas Showed Higher Preference for Place of End-of-Life Care: The Ajishima Study.

JMA J 2020 Apr 10;3(2):138-145. Epub 2020 Apr 10.

Department of Internal Medicine, Amishou Clinic, Ishinomaki, Japan.

Introduction: To investigate the proportion of those having preferred place for end-of-life care among residents in a remote island and its association with family composition.

Methods: Cross-sectional questionnaire survey was conducted in Ajishima, an island 23 km away from the coast of Ishinomaki City, northeast of Japan. Between October 2017 and February 2018, the questionnaire was distributed to 288 eligible residents and 113 valid responses were analyzed. Primary outcome was whether the subjects had preferred place for end-of-life care. The explanatory variable was family composition defined as whether having family members inside or outside the island [none (In-/Out-), only inside the island (In+/Out-), only outside the island (In-/Out+), and both inside and outside (In+/Out+)]. Poisson regression analysis was used to calculate the prevalence ratios (PRs) and 95% confidence intervals (CIs) of showing preferred place in each group.

Results: The proportion of those having preferred place for end-of-life care was 72.6% in total. This rate significantly differed across family composition groups: 67.6%, 40.0%, and 82.9% for In+/Out+, In+/Out-, and In-/Out+ groups, respectively. The PR (95%CI) of having preferred place was 0.66 (0.33, 1.36) and 1.26 (1.01, 1.56) for In+/Out- and In-/Out+ groups, respectively, compared with In+/Out+ group.

Conclusions: This study showed that significantly higher preference for place of end-of-life care was seen among residents who had family members only outside the island compared with those who had families both inside and outside. Health care professionals should consider family compositions when initiating end-of-life discussion to residents in remote areas.
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http://dx.doi.org/10.31662/jmaj.2019-0026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590377PMC
April 2020

Maternal Baseline Characteristics and Perinatal Outcomes: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study.

J Epidemiol 2020 Oct 10. Epub 2020 Oct 10.

Tohoku Medical Megabank Organization, Tohoku University.

Background: The Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study was launched in 2013 to evaluate the complex interactions of genetic and environmental factors in multifactorial diseases. The present study describes the maternal baseline profile and perinatal data of participating mothers and infants.

Methods: Expectant mothers living in Miyagi prefecture were recruited from obstetric facilities or affiliated centers between 2013 and 2017. Three sets of self-administered questionnaires were collected, and the medical records were reviewed to obtain precise information about each antenatal visit and each delivery. Biospecimens, including blood, urine, umbilical cord blood, and breast milk, were collected for the study biobank. The baseline maternal sociodemographic characteristics, results of screening tests, and obstetric outcomes were analyzed according to the maternal age group.

Results: A total of 23 406 pregnancies involving 23 730 fetuses resulted in 23 143 live births. Younger maternal participants had a tendency toward a higher incidence of threatened abortion and threatened premature labor, while older age groups exhibited a significantly higher rate of low lying placenta, placenta previa, gestational diabetes and hypertensive disorders of pregnancy.

Conclusions: The present study clearly shows the distribution of maternal baseline characteristics and the range of perinatal outcomes according to maternal age group. This cohort study can provide strategic information for creating breakthroughs in the pathophysiology of perinatal, developmental, and noncommunicable diseases by collaborative data visiting or sharing.
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http://dx.doi.org/10.2188/jea.JE20200338DOI Listing
October 2020

Sodium/potassium ratio change was associated with blood pressure change: possibility of population approach for sodium/potassium ratio reduction in health checkup.

Hypertens Res 2021 Feb 17;44(2):225-231. Epub 2020 Aug 17.

Division of Personalized Prevention and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.

Recently, the sodium (Na)/potassium (K) ratio was reported to be associated with blood pressure (BP). A Na/K ratio self-monitoring device using spot urine was established recently. Here, we assessed whether the urinary Na/K ratio change measured using the Na/K device was associated with BP change in a health checkup setting. We targeted 12,890 participants who attended the health checkup in Tome City, Miyagi between 2017 and 2018. Tome City introduced urinary Na/K ratio measurements during health checkups since 2017. For each year, we compared the baseline characteristics according to the urinary Na/K ratio and BP level. We assessed the relationship between change in urinary Na/K ratio and BP change using multiple regression analyses adjusted for age, sex, and change in body mass index (BMI) and alcohol intake. The average urinary Na/K ratio was significantly lower in 2018 than in 2017 (5.4 ± 3.0 to 4.9 ± 2.2, P < 0.01). The systolic BP of the participants in 2018 (130.9 ± 17.4 mmHg) was lower than that in 2017 (132.1 ± 17.9 mmHg). Moreover, the change in systolic BP and diastolic BP was positively associated with the change in urinary Na/K ratio. In conclusion, the association of the change in urinary Na/K ratio with hypertension and changes in systolic and diastolic BP can be explained by a change in alcohol intake, BMI, and urinary Na/K ratio. Therefore, measuring the urinary Na/K ratio in community settings is a potential population approach for counteracting hypertension.
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http://dx.doi.org/10.1038/s41440-020-00536-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815510PMC
February 2021

Low birth weight and abnormal pre-pregnancy body mass index were at higher risk for hypertensive disorders of pregnancy.

Pregnancy Hypertens 2020 Oct 5;22:119-125. Epub 2020 Aug 5.

Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address:

Low birth weight is known to be associated with hypertension, cardiovascular disease and hypertensive disorders of pregnancy (HDP); however, this association might vary by race/ethnicity. This study aimed to clarify the association between women's own birth weight and their subsequent risk for HDP in a Japanese population, in combination with pre-pregnancy body mass index (BMI). We conducted a cohort study as part of the Tohoku Medical Megabank Birth and Three-Generation Cohort Study in Miyagi, Japan. Our study's population included 4810 women. A multivariate logistic regression analysis was performed to calculate the adjusted odds ratio (aOR) and the 95% confidence interval (CI) of the women's own birth weight for HDP, in the combination categories of birth weight and pre-pregnancy BMI. As a result, the group with a low birth weight of <2500 g had a significant association with HDP (the aOR, 1.50; 95% CI, 1.02-2.21). In the subtype analysis, the odds ratio for only preeclampsia was significantly increased in the low birth weight group (aOR, 3.37; 95% CI, 1.84-6.16). In the group with a low birth weight, the prevalence of HDP was higher in both the underweight and overweight groups. In conclusion, there was a significant association between low birth weight and subsequent HDP in Japanese women. Furthermore, a significant association with HDP was found for women born with a low birth weight who were underweight or overweight as adults. Maintaining a normal weight may be effective for preventing HDP even if a woman was born small.
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http://dx.doi.org/10.1016/j.preghy.2020.08.001DOI Listing
October 2020

The Impact of Health Consciousness on the Association Between Walking Durations and Mental Health Conditions After a Disaster: a Cross-Sectional Study.

Sports Med Open 2020 Jul 16;6(1):30. Epub 2020 Jul 16.

Department of Disaster Psychiatry, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-Machi, Aoba-ku, Sendai, 980-8573, Japan.

Background: In communities affected by a disaster, walking can be a feasible form of physical exercise to improve physical and mental health conditions. However, there is limited evidence to support relationships between walking habits and mental health conditions in post-disaster settings. Cross-sectional epidemiological data obtained from a questionnaire survey (conducted in October 2017) of a community affected by the 2011 Great East Japan Earthquake (GEJE) was analyzed to evaluate the relationships.

Methods: Participants included individuals over 20 years of age (N = 718) from Shichigahama town in Miyagi prefecture, whose houses were significantly damaged by the GEJE. Their mental health conditions were assessed by the Kessler Psychological Distress Scale (K6), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Impact of Event Scale-Revised (IES-R). Additionally, the questionnaire asked the participants spent duration walking on average and their walking purpose by the following items: (1) longer than 60 min per day, (2) between 30 and 60 min per day, or (3) less than 30 min per day, and whether they walked to maintain healthy living habits (health-conscious walkers) or merely for transportation without considering health consequences (non-health-conscious walkers). These information and mental health indicators were analyzed using analysis of covariance (ANCOVA).

Results: Among the three walking duration groups of health-conscious walkers, there were significant differences in CES-D and K6 scores (p = 0.01 and p = 0.04), but not in IES-R scores, considering age, gender, and alcohol drinking habits as covariates. CES-D score was significantly higher among short walkers (p = 0.004). Among the three walking duration groups of non-health-conscious walkers, there were significant differences in avoidance symptoms, the subdomain of IES-R (p = 0.01), but not in CES-D, K6, and total IES-R scores, considering the variants.

Conclusion: Our study suggests that walking durations may positively affect mood, but not PTSR, only when walking is performed with the purpose of maintaining healthy living habits. Walking durations were negatively associated with avoidance symptoms among non-health-conscious walkers in the community affected by the GEJE, indicating that the disaster may have had a long-lasting impact on walking habits.
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http://dx.doi.org/10.1186/s40798-020-00259-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366311PMC
July 2020

Clusters of Coronavirus Disease in Communities, Japan, January-April 2020.

Emerg Infect Dis 2020 09 10;26(9). Epub 2020 Jun 10.

We analyzed 3,184 cases of coronavirus disease in Japan and identified 61 case-clusters in healthcare and other care facilities, restaurants and bars, workplaces, and music events. We also identified 22 probable primary case-patients for the clusters; most were 20-39 years of age and presymptomatic or asymptomatic at virus transmission.
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http://dx.doi.org/10.3201/eid2609.202272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454082PMC
September 2020

Hypertensive disorders of pregnancy, obesity, and hypertension in later life by age group: a cross-sectional analysis.

Hypertens Res 2020 11 13;43(11):1277-1283. Epub 2020 May 13.

Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.

We investigated whether the association between a history of hypertensive disorders of pregnancy (HDP) and hypertension in later life varies by age group and the effect of obesity on the association between a history of HDP and hypertension in later life. This cross-sectional population-based study was conducted at the Tohoku Medical Megabank Project in Miyagi and Iwate, Japan. The study subjects were 33,412 parous women of 20 years of age and older. We used multivariate logistic regression analysis to assess the association between a history of HDP and hypertension. We constructed a composite variable that combined a history of HDP (±) and overweight/obesity (BMI ≥ 25 kg/m) (±), resulting in four categories, and analyzed the risks of each category by multivariate logistic regression analysis. In total, 1585 (4.7%) women had a history of HDP. The prevalence of hypertension was higher in women with HDP (51.4%) than in those without HDP (36.8%; p < 0.01). The adjusted odds ratios (ORs) for hypertension in women with HDP in their 30s, 40s, 50s, 60s, and 70s or older were 3.63, 1.84, 2.15, 1.48, and 1.86, respectively. In the interaction analysis, the association between a history of HDP and hypertension was stronger in women in their 30s-50s than in women who were 60 or older (p = 0.057). The adjusted ORs for hypertension were higher in overweight/obese women with HDP than in their nonoverweight/obese counterparts in all age groups (30s: 27.17 vs. 2.22; 70s: 4.75 vs. 1.90). In conclusion, the association between HDP and later hypertension was stronger in younger women and in obese women in the 30-70 age group.
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http://dx.doi.org/10.1038/s41440-020-0463-8DOI Listing
November 2020

Relationship Between Calcium Intake and Impaired Activities of Daily Living in a Japanese Population: NIPPON DATA90.

J Epidemiol 2021 Feb 8;31(2):119-124. Epub 2020 Feb 8.

Department of Public Health, Shiga University of Medical Science.

Background: Major reasons for long-term care insurance certification in Japan are stroke, dementia, and fracture. These diseases are reported to be associated with calcium intake. This study examined the association between calcium intake and impaired activities of daily living (ADL) using the data from NIPPON DATA90, consisting of representative sample of the Japanese population.

Methods: A population-based nested case-control study was performed. A baseline survey was conducted in 1990, followed by ADL surveys of individuals ≥65 years old in 2000. Individuals with impaired ADL and selected age- and sex-matched controls were then identified. We obtained 132 pairs. Calcium intake was energy-adjusted using the residual method. The association between calcium intake and impaired ADL was examined using conditional logistic regression models. To assess the accuracy of the estimates, we conducted bootstrap analyses.

Results: The adjusted odds ratios (ORs) for impaired ADL compared with the group with a calcium intake of <476 mg/day were 0.72 (95% confidence interval [CI], 0.37-1.40) for the 476-606 mg/day group and 0.44 (95% CI, 0.21-0.94) for the ≥607 mg/day group in 2000 (P for linear trend = 0.03). After the bootstrap analyses, the inverse relationship unchanged (median OR per 100-mg rise in calcium intake, 0.87 [1,000 resamplings]; 95% CI, 0.76-0.97).

Conclusions: After bootstrap analyses, calcium intake was inversely associated with impaired ADL 10 years after the baseline survey.
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http://dx.doi.org/10.2188/jea.JE20190234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813771PMC
February 2021

Study Profile of the Tohoku Medical Megabank Community-Based Cohort Study.

J Epidemiol 2021 Jan 11;31(1):65-76. Epub 2020 Jan 11.

Tohoku Medical Megabank Organization, Tohoku University.

Background: We established a community-based cohort study to assess the long-term impact of the Great East Japan Earthquake on disaster victims and gene-environment interactions on the incidence of major diseases, such as cancer and cardiovascular diseases.

Methods: We asked participants to join our cohort in the health check-up settings and assessment center based settings. Inclusion criteria were aged 20 years or over and living in Miyagi or Iwate Prefecture. We obtained information on lifestyle, effect of disaster, blood, and urine information (Type 1 survey), and some detailed measurements (Type 2 survey), such as carotid echography and calcaneal ultrasound bone mineral density. All participants agreed to measure genome information and to distribute their information widely.

Results: As a result, 87,865 gave their informed consent to join our study. Participation rate at health check-up site was about 70%. The participants in the Type 1 survey were more likely to have psychological distress than those in the Type 2 survey, and women were more likely to have psychological distress than men. Additionally, coastal residents were more likely to have higher degrees of psychological distress than inland residents, regardless of sex.

Conclusion: This cohort comprised a large sample size and it contains information on the natural disaster, genome information, and metabolome information. This cohort also had several detailed measurements. Using this cohort enabled us to clarify the long-term effect of the disaster and also to establish personalized prevention based on genome, metabolome, and other omics information.
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http://dx.doi.org/10.2188/jea.JE20190271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738642PMC
January 2021

Multiple measurements of the urinary sodium-to-potassium ratio strongly related home hypertension: TMM Cohort Study.

Hypertens Res 2020 01 27;43(1):62-71. Epub 2019 Sep 27.

Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.

Previous studies have reported a positive association between the urinary sodium-to-potassium (Na/K) ratio and hypertension, and multiple measurements of the casual urinary Na/K ratio are more strongly correlated with the 24-h urinary Na/K ratio than a single measurement. Multiple measurements of the urinary Na/K ratio might be more strongly associated with hypertension. We aimed to determine the association between multiple measurements of the casual urinary Na/K ratio and home hypertension compared with a single measurement. A population-based cross-sectional study was performed in Miyagi Prefecture, Japan. Subjects were over 20 years old and participated in the Tohoku Medical Megabank Project Cohort Study. We targeted 3273 subjects who borrowed home blood pressure (HBP) monitors and urinary Na/K ratio monitors for 10 consecutive days. The association between the urinary Na/K ratio and home hypertension (HBP ≥ 135/85 mmHg or under treatment for hypertension) was examined using multiple logistic regression models. To compare the prediction of home hypertension using multiple measurements with that using a single measurement, we calculated the area under the receiver operating characteristic curve (AUROC). Multiple measurements of the urinary Na/K ratio strongly related to home hypertension were better than 1 or 2 days of measurement (adjusted odds ratio of home hypertension per unit increase in urinary Na/K ratio over 6 days: 1.13-1.15). The AUROC of the urinary Na/K ratio measurement for home hypertension was stable after 5 days (AUROC = 0.779). In conclusion, multiple measurements of the urinary Na/K ratio are strongly related to home hypertension. This finding suggests that multiple measurements of the urinary Na/K ratio are useful for evaluating home hypertension.
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http://dx.doi.org/10.1038/s41440-019-0335-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076007PMC
January 2020

Reduced sleep efficiency, measured using an objective device, was related to an increased prevalence of home hypertension in Japanese adults.

Hypertens Res 2020 01 18;43(1):23-29. Epub 2019 Sep 18.

Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.

Few studies have reported the relationship between reduced sleep efficiency and the prevalence of hypertension independent of sleep duration in Japan. This study aimed to evaluate whether reduced sleep efficiency, measured using an objective device for >1 week, was related to an increased prevalence of hypertension independent of sleep duration in the general Japanese population. We conducted a cross-sectional study of 904 participants aged ≥20 years who lived in Miyagi Prefecture, Japan. Sleep efficiency was measured using a contactless biomotion sleep sensor for 10 continuous days. The participants were classified into two groups according to their sleep efficiency: reduced (<90%) or not reduced (≥90%). Hypertension was defined as morning home blood pressure ≥135/85 mmHg or self-reported treatment for hypertension. Multivariable logistic regression models were used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) to assess the relationship between sleep efficiency and hypertension adjusted for potential confounders. The results showed that two hundred and ninety-four individuals (32.5%) had reduced sleep efficiency, and 331 (36.6%) had hypertension. Individuals with reduced sleep efficiency had a higher body mass index and shorter sleep duration. In the multivariable analysis, reduced sleep efficiency was significantly related to an increased prevalence of hypertension (OR, 1.62; 95% CI, 1.15-2.28). In conclusion, reduced sleep efficiency was significantly related to an increased prevalence of hypertension in Japanese adults. Improvements in sleep efficiency may be important to reduce blood pressure in Japanese adults.
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http://dx.doi.org/10.1038/s41440-019-0329-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076010PMC
January 2020

Predicting the risk of pulmonary tuberculosis based on the neutrophil-to-lymphocyte ratio at TB screening in HIV-infected individuals.

BMC Infect Dis 2019 Jul 29;19(1):667. Epub 2019 Jul 29.

Research Institute of Tuberculosis (RIT), Anti-Tuberculosis Association (JATA), Tokyo, Japan.

Background: The neutrophil to lymphocyte ratio (NL ratio) has been reported to be a predictive biomarker of tuberculosis (TB). We assessed the association between the NL ratio and the incidence of active TB cases within 1 year after TB screening among HIV-infected individuals in Thailand.

Methods: A day care center that supports HIV-infected individuals in northernmost Thailand performed TB screening and follow-up visits. We compared the baseline characteristics between the TB screening positive group and the TB screening negative group. The threshold value of NL ratio was determined by cubic-spline curves and NL ratios were categorized as high or low NL ratio. We assessed the association between NL ratio and progression to active TB within 1-year using the Cox-proportional hazard model.

Results: Of the 1064 HIV-infected individuals who screened negative for TB at baseline, 5.6% (N = 60) eventually developed TB and 26 died after TB diagnosis. A high NL ratio was associated with a higher risk of TB (adjusted hazard ratio (aHR) 2.19, 95% CI: 1.23-3.90), after adjusting for age, sex, ethnicity, CD4 counts, and other risk factors. A high NL ratio in HIV-infected individuals with normal chest X-ray predicted TB development risk. In particular, a high NL ratio with TB symptoms could predict the highest risk of TB development (aHR 2.58, 95%CI: 1.07-6.23).

Conclusions: Our results showed that high NL ratio increased the risk of TB. NL ratio combined with TB symptoms could increase the accuracy of TB screening among HIV-infected individuals.
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http://dx.doi.org/10.1186/s12879-019-4292-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664723PMC
July 2019

Respiratory resistance among adults in a population-based cohort study in Northern Japan.

Respir Investig 2019 May 13;57(3):274-281. Epub 2019 Feb 13.

Department of Occupational Health, Tohoku University Graduate School of Medicine, Japan; Tohoku University Tohoku Medical Megabank Organization, Japan; Center for Environmental Conservation and Research Safety, Tohoku University, Japan. Electronic address:

Background: Forced oscillation technique (FOT) is a noninvasive method used to measure respiratory system resistance (Rrs) and reactance (Xrs) during quiet breathing, which has been extensively studied in clinical settings. The distribution of measured FOT values was previously assessed in a community-based cohort study. In this study, we aimed to confirm the distribution of measured FOT values in a different cohort in order to investigate the relationship between these values and patient clinical and biological data.

Methods: We reviewed FOT data and relevant patient clinical and biological information collected from the Community-Based Cohort Study (CommCohort Study), carried out between 2013 to 2016 as a part of the Tohoku Medical Megabank project (TMM). In total, 16,231 adults were enrolled in the study (Male/Female: 4886/11,345).

Results: Significant gender differences were observed in distributions of Rrs and Xrs values at 5 Hz (termed R5 and X5, respectively). R5 values in males were lower than those in females, while X5 values in males were slightly less negative. High R5 values were strongly associated with high BMI, short height, smoking status in males, high serum IgE level, and high peripheral blood eosinophil count.

Conclusion: The present distribution values and their relation to clinical and biological data should provide useful insights for clinical settings and serve as a helpful guide in implementing FOT. Forced oscillation technique, respiratory system resistance, respiratory system reactance, gender difference, obesity.
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http://dx.doi.org/10.1016/j.resinv.2018.12.008DOI Listing
May 2019

Dietary Inflammatory Index Positively Associated With High-Sensitivity C-Reactive Protein Level in Japanese From NIPPON DATA2010.

J Epidemiol 2020 Feb 9;30(2):98-107. Epub 2019 Feb 9.

Department of Public Health, Shiga University of Medical Science.

Background: It has been reported that chronic inflammation may play an important role in the pathogenesis of several serious diseases and could be modulated by diet. Recently, the Dietary Inflammatory Index (DII) was developed to assess the inflammatory potential of the overall diet. The DII has been reported as relevant to various diseases but has not been validated in Japanese. Thus, in the present study, we analyzed the relationship between DII scores and high-sensitivity C-reactive protein (hs-CRP) levels in a Japanese population.

Methods: Data of the National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged 2010 (NIPPON DATA2010), which contained 2,898 participants aged 20 years or older from the National Health and Nutrition Survey of Japan (NHNS2010), were analyzed. Nutrient intakes derived from 1-day semi-weighing dietary records were used to calculate DII scores. Energy was adjusted using the residual method. Levels of hs-CRP were evaluated using nephelometric immunoassay. Multiple linear regression analyses were performed.

Results: After adjusting for age, sex, smoking status, BMI, and physical activity, a significant association was observed between DII scores and log(CRP+1) (standard regression coefficient = 0.05, P < 0.01). Although it was not statistically significant, the positive association was consistently observed in almost all age-sex subgroups and the non-smoker subgroup.

Conclusions: The current study confirmed that DII score was positively associated with hs-CRP in Japanese.
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http://dx.doi.org/10.2188/jea.JE20180156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6949183PMC
February 2020

[Association between mild physical injury and psychological distress: Shichigahama Health Promotion Project].

Nihon Koshu Eisei Zasshi 2018 ;65(4):157-163

Tohoku Medical Megabank Organization, Tohoku University.

Objective Although a number of previous studies have investigated the association between natural disaster-related physical injury and mental health, very few have focused on mild physical injury. The aim of this study was to evaluate the association between natural disaster-related mild physical injury and psychological distress in a cross-sectional study.Method This study is a part of the Shichigahama Health Promotion Project, which was conducted in cooperation with the Tohoku University and Shichigahama Town, Miyagi Prefecture, after the Great East Japan Earthquake (GEJE). We conducted the research about one year after the GEJE, and performed logistic regression analyses using 3,844 participants (1,821 males/2,023 females) aged 20 years or older, who answered all the questions on physical injuries and the Kessler 6 scale (K6), after adjusting for gender, age, social factors, and lifestyles. Psychological distress was defined as a K6 score ≥ 13 out of 24 points. We also investigated the effect of other disaster situations on the association between mild physical injury and psychological distress by stratifying the dataset by bereavement, witnessing someone's death, and house damage.Results The participants with physical injury were at a significantly higher risk of psychological distress, with an adjusted odds ratio (aOR) of 2.05 and 95% confidence interval (CI) of 1.26-3.34, than those uninjured. Additionally, the participants with mild physical injury were at a significantly higher risk of psychological distress (aOR=2.18, 95% CI=1.32-3.59). In the subgroup of participants with small-scale house damage, mild physical injury was significantly associated with psychological distress with an aOR of 4.01 and 95% CI of 2.03-7.93, whereas not in the subgroup of those with large-scale house damage, and a significant interaction was detected between mild physical injury and house damage.Conclusion We investigated the association between natural disaster-related physical injury and psychological distress in a cohort of approximately 4,000 residents in an area devastated by the GEJE. In this study, natural disaster-related physical injury was positively associated with psychological distress. The finding indicates that even mild physical injury can be an indicator of high risk for psychological distress.
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http://dx.doi.org/10.11236/jph.65.4_157DOI Listing
February 2019

Test-and-treat approach to HIV/AIDS: a primer for mathematical modeling.

Theor Biol Med Model 2017 09 5;14(1):16. Epub 2017 Sep 5.

Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.

The public benefit of test-and-treat has induced a need to justify goodness for the public, and mathematical modeling studies have played a key role in designing and evaluating the test-and-treat strategy for controlling HIV/AIDS. Here we briefly and comprehensively review the essence of contemporary understanding of the test-and-treat policy through mathematical modeling approaches and identify key pitfalls that have been identified to date. While the decrease in HIV incidence is achieved with certain coverages of diagnosis, care and continued treatment, HIV prevalence is not necessarily decreased and sometimes the test-and-treat is accompanied by increased long-term cost of antiretroviral therapy (ART). To confront with the complexity of assessment on this policy, the elimination threshold or the effective reproduction number has been proposed for its use in determining the overall success to anticipate the eventual elimination. Since the publication of original model in 2009, key issues of test-and-treat modeling studies have been identified, including theoretical problems surrounding the sexual partnership network, heterogeneities in the transmission dynamics, and realistic issues of achieving and maintaining high treatment coverage in the most hard-to-reach populations. To explicitly design country-specific control policy, quantitative modeling approaches to each single setting with differing epidemiological context would require multi-disciplinary collaborations among clinicians, public health practitioners, laboratory technologists, epidemiologists and mathematical modelers.
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http://dx.doi.org/10.1186/s12976-017-0062-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583977PMC
September 2017

Regional Differences in the Prevalence of Major Opportunistic Infections among Antiretroviral-Naïve Human Immunodeficiency Virus Patients in Japan, Northern Thailand, Northern Vietnam, and the Philippines.

Am J Trop Med Hyg 2017 Jul;97(1):49-56

Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan.

To identify regional differences in the distribution of opportunistic infections (OIs) among human immunodeficiency virus (HIV)-infected patients in Asia, the medical records of antiretroviral therapy (ART)-naïve patients who attended the following tertiary hospitals from 2003 to 2011 were reviewed: Nagoya Medical Center (NMC, Nagoya, Japan), Lampang Hospital (LPH, Lampang, northern Thailand), Bach Mai Hospital (BMH, Hanoi, northern Vietnam), and Philippine General Hospital (PGH, Manila, Philippines). Logistic regression analyses were performed to identify associations between country of origin and risk of major OIs. In total, 1,505 patients were included: NMC, = 365; LPH, = 442; BMH, = 384; and PGH, = 314. The median age was 32 years, and 73.3% of all patients were male. The median CD4 count was 200 cells/μL. Most patients at NMC and PGH were men who have sex with men. Injection drug users were most common at BMH (35.7%). (TB) was most common at PGH ( = 75) but was rare at NMC ( = 4). pneumonia (PCP) prevalence was highest at NMC ( = 74) and lowest at BMH ( = 13). Multivariable logistic regression showed increased odds of TB at PGH (adjusted odds ratio [aOR] = 42.2, 95% confidence interval [CI] = 14.6-122.1), BMH (aOR = 12.6, CI = 3.9-40.3), and LPH (aOR = 6.6, CI = 2.1-21.1) but decreased odds of PCP at BMH (aOR = 0.1, CI = 0.04-0.2) and LPH (aOR = 0.2, CI = 0.1-0.4) compared with those at NMC. The cryptococcosis risk was increased at LPH (aOR = 6.2, CI = 0.9-41.0) compared with that at NMC. Cytomegalovirus (CMV) retinitis prevalences were similar in all countries. OI prevalence remained high among ART-naïve patients in our cohort. The risks of TB, PCP, and cryptococcosis, but not CMV retinitis, differed between countries. Improved early HIV detection is warranted.
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http://dx.doi.org/10.4269/ajtmh.16-0783DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508895PMC
July 2017

Psychological Distress and the Risk of Withdrawing From Hypertension Treatment After an Earthquake Disaster.

Disaster Med Public Health Prep 2017 04;11(2):179-182

1Department of Preventive Medicine and Epidemiology,Tohoku Medical Megabank Organization,Tohoku University,Sendai,Japan.

Objective: This study examined the association between psychological distress and the risk of withdrawing from hypertension treatment (HTTx) 1 year after the earthquake disaster in the coastal area affected by the Great East Japan Earthquake (GEJE).

Methods: Using cross-sectional data from 2012, we studied people over 20 years of age living in Shichigahama Town, Miyagi, on the northeastern coast of Japan, which had been severely inundated by the tsunami that followed the GEJE in 2011. A total of 1014 subjects were categorized as in need of HTTx. Withdrawing from HTTx was assessed by using a self-reported questionnaire.

Results: Subjects with a higher degree of psychological distress (Kessler-6 [K6] score ≥ 13) exhibited a significantly higher risk of withdrawing from HTTx, compared with subjects with a lower degree of psychological distress (K6 score ≤ 12; odds ratio=4.0; 95% confidence interval: 1.3-10.6, P<0.01).

Conclusions: This study indicated that psychological distress is a risk factor for withdrawing from HTTx in post-disaster settings. Our data suggested that the increased risk of withdrawing from HTTx associated with post-disaster psychological distress may underlie the increased prevalence of vascular diseases after the earthquake disaster in coastal areas affected by the tsunami. (Disaster Med Public Health Preparedness. 2017;11:179-182).
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http://dx.doi.org/10.1017/dmp.2016.102DOI Listing
April 2017

Impact of social capital on psychological distress and interaction with house destruction and displacement after the Great East Japan Earthquake of 2011.

Psychiatry Clin Neurosci 2017 Jan 21;71(1):52-60. Epub 2016 Dec 21.

Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.

Aim: Social capital has been considered an important factor affecting mental-health outcomes, such as psychological distress in post-disaster settings. Although disaster-related house condition and displacement could affect both social capital and psychological distress, limited studies have investigated interactions. This study aimed to examine the association between social capital and psychological distress, taking into consideration the interaction of disaster-related house condition after the Great East Japan Earthquake of 2011.

Methods: Using data from 3793 adults living in Shichigahama, Miyagi Prefecture, Japan, we examined the association between social capital measured by generalized trust and psychological distress measured by the Kessler 6 scale. We conducted stratified analysis to investigate an interaction of house destruction and displacement. Multivariate analyses taking into consideration the interaction were performed.

Results: In the crude analysis, low social capital (odds ratio [OR] 4.46; 95% confidence interval [CI], 3.27-6.07) and large-scale house destruction (OR 1.96; 95%CI, 1.47-2.62) were significantly associated with psychological distress. Stratified analyses detected an interaction with house destruction and displacement (P for interaction = 0.04). Multivariate analysis with interaction term revealed that individuals with low social capital, large-scale house damage, and displacement were at greater risk of psychological distress, corresponding to adjusted OR of 5.78 (95%CI, 3.48-9.60).

Conclusion: In the post-disaster setting, low social capital increased the risk of psychological distress, especially among individuals who had large-scale house destruction. Among the participants with severe disaster damage, high social capital would play an important role in protecting mental health.
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http://dx.doi.org/10.1111/pcn.12467DOI Listing
January 2017

Partners' Ongoing Treatment for Chronic Disease and the Risk of Psychological Distress after the Great East Japan Earthquake.

Tohoku J Exp Med 2016 08;239(4):307-14

Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University.

Several studies have reported that not only patients with chronic diseases but also their partners are likely to face major psychosocial problems. This study examined the association between a partner's ongoing treatment for chronic disease and the risk of psychological distress after the Great East Japan Earthquake (GEJE). In 2012, a questionnaire was distributed as part of a cross-sectional study of participants aged 20 years or older living in a municipality that had been severely inundated by the tsunami following the GEJE. We identified couples using the household numbers of the municipality and collected self-reported information on ongoing chronic disease treatment for stroke, cancer, myocardial infarction, and angina. Psychological distress was evaluated using the Kessler 6 scale (K6) and was defined as a score ≥ 5/24 points. Among 1,246 couples (2,492 participants) thus identified, 2,369 completed the K6. The number of participants whose partners were under treatment for chronic diseases was 209 (9%). Overall, participants with partners who were receiving treatment for chronic diseases (odds ratio [OR] = 1.3, 95% confidence interval [CI] = 0.95-1.8, P = 0.09) did not show a significantly higher risk of psychological distress using logistic regression analysis. Women, but not men, whose partners were receiving treatment for chronic diseases, had a higher risk of psychological distress (women: OR = 1.6, P = 0.02; men: OR = 1.0, P = 0.92). After the GEJE, only in women the presence of partners under treatment for chronic diseases appears to be a risk factor for psychological distress.
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http://dx.doi.org/10.1620/tjem.239.307DOI Listing
August 2016

Does the flushing response modify the relationship between alcohol intake and hypertension in the Japanese population? NIPPON DATA2010.

Hypertens Res 2016 Sep 12;39(9):670-9. Epub 2016 May 12.

Department of Public Health, Shiga University of Medical Science, Shiga, Japan.

The influence of alcohol intake on hypertension may vary depending on the flushing response, but this relationship has not been confirmed. The relationship between alcohol intake and hypertension was examined according to the flushing response in a representative sample of the Japanese population. Participants in the National Health and Nutrition Survey in 2010 were asked to participate in the baseline survey of NIPPON DATA2010. Here, we investigated the relationship between alcohol intake and hypertension according to the flushing response. Statistical analyses were performed in a cross-sectional manner using multiple logistic regression models after adjusting for age, body mass index, smoking status, present illness of diabetes mellitus and present illness of dyslipidemia. Of the 1139 men and 1263 women, 659 and 463, respectively, had hypertension. Among the men, alcohol intake was positively associated with hypertension, regardless of the flushing response (P for linear trend both <0.05). This positive relationship was observed for both users and non-users of antihypertensive drugs. No interaction with the flushing response was observed (P for interaction=0.360). In women, although the direction differed between flushers and non-flushers, the association between alcohol intake and hypertension was not significant, regardless of flushing response. In conclusion, In Japanese men, alcohol intake was positively associated with hypertension in a manner that was not influenced by the flushing response.
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http://dx.doi.org/10.1038/hr.2016.46DOI Listing
September 2016

Public Attitudes toward an Epidemiological Study with Genomic Analysis in the Great East Japan Earthquake Disaster Area.

Prehosp Disaster Med 2016 Jun 28;31(3):330-4. Epub 2016 Mar 28.

Tohoku Medical Megabank Organization (ToMMo),Tohoku University,Sendai,Japan.

Unlabelled: Introduction The Great East Japan Earthquake of March 11, 2011 may have influenced the long-term health of those in the disaster area. It is important to collect current and future health information of the people living in the post-disaster area to provide appropriate health support and quality-oriented care. However, public perceptions of health and genomic studies in the Great East Japan Earthquake disaster area are still unknown.

Methods: A questionnaire survey was conducted in one town affected by the Great East Japan Earthquake and subsequent tsunami. The results of the questionnaire were tailed and the differences in responses to each question were assessed by sex and age.

Results: In 284 eligible people (137 men, 147 women), almost all participants agreed to join a health survey investigating the adverse effects of the disaster, and over 80% of the total participants agreed to genomic analysis. Over 70% of the participants wanted to receive pharmacogenetic testing and to receive feedback on which medications were suitable or unsuitable for them.

Conclusions: Most people living in the disaster area are interested in health surveys. Most of the participants also showed interest in genomic analysis. Ishikuro M , Nakaya N , Obara T , Sato Y , Metoki H , Kikuya M , Tsuchiya N , Nakamura T , Nagami F , Kuriyama S , Hozawa A , the ToMMo Study Group. Public attitudes toward an epidemiological study with genomic analysis in the Great East Japan Earthquake disaster area. Prehosp Disaster Med. 2016;31(3):330-334.
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http://dx.doi.org/10.1017/S1049023X16000182DOI Listing
June 2016

Prospect of future housing and risk of psychological distress at 1 year after an earthquake disaster.

Psychiatry Clin Neurosci 2016 Apr 14;70(4):182-9. Epub 2016 Jan 14.

Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.

Aim: Since the Great East Japan Earthquake in 2011, many of the affected have been forced to live in temporary housing or at a relative's house. Special attention needs to be paid to the negative health impacts resulting from such changes in living conditions. This study examined the association between future housing prospects and the risk of psychological distress 1 year after the earthquake.

Methods: In 2012, a questionnaire was completed by a cross-sectional study of people aged 20 years or older living in Shichigahama Town, Miyagi, northeastern Japan, an area that had been severely inundated by the tsunami. Future housing prospects post-earthquake were classified into four categories: already settled in permanent housing, moving to new housing, under consideration, or unable to make any plans. Psychological distress was evaluated using the Kessler 6 scale, defined as ≥5 points out of 24. We performed multiple logistic regression analyses adjusted for potential confounding factors.

Results: Of the 3614 individuals studied, subjects whose future housing was under consideration (odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.6-2.7, P < 0.01) and those who were unable to make any future housing plans (OR = 1.9, 95%CI = 1.4-2.5, P < 0.01) exhibited a significantly higher risk of psychological distress compared with subjects who had already settled in permanent housing.

Conclusion: In this study, subjects whose future housing prospects were under consideration and those who were unable to make any future housing plans were at a higher risk of psychological distress 1 year after the earthquake disaster.
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http://dx.doi.org/10.1111/pcn.12377DOI Listing
April 2016