Publications by authors named "Tetsuya Ohira"

282 Publications

Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia and Cardiovascular Diseases in Japan - What Is the Next Step?

Authors:
Tetsuya Ohira

Circ J 2021 Sep 17. Epub 2021 Sep 17.

Department of Epidemiology, Fukushima Medical University School of Medicine.

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http://dx.doi.org/10.1253/circj.CJ-21-0688DOI Listing
September 2021

Accurate endoscopic identification of the afferent limb at the Y anastomosis using the fold disruption sign after gastric resection with Roux-en-Y reconstruction.

Dig Endosc 2021 Sep 13. Epub 2021 Sep 13.

Department of Gastroenterology, Sendai City Medical Center, Miyagi.

In patients with Roux-en-Y (RY) reconstruction for gastric resection, the newly defined "fold disruption" (FD) sign can be useful to distinguish the afferent limb from the efferent limb at the Y anastomosis when balloon endoscopy-assisted ERCP (BE-ERCP) is performed. The FD sign was defined as endoscopic findings of the internal folds disrupted toward the afferent limb and continued toward the efferent limb at the Y anastomosis. In this prospective observational study, the accuracy of the FD sign was evaluated for those who underwent BE-ERCP after gastric resection with RY reconstruction. Of 28 patients for whom the accuracy could be evaluated among 30 enrolled patients, the afferent limb was identified using the FD sign with 100% accuracy. For the other 2 patients, the scope could not reach the target lumen due to severe intestinal adhesion in one and reached the target lumen without recognition of the Y anastomosis in the other. There was no patient for whom the FD sign could not be judged for any reason, such as a blurred anastomosis line, unclear folds, sticky discharge and blood coating the surface, when the Y anastomosis was recognized. The fold disruption sign was a highly accurate tool for distinguishing the afferent limb from the efferent limb in patients after gastric resection with RY reconstruction.
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http://dx.doi.org/10.1111/den.14128DOI Listing
September 2021

Endoscopic Ultrasonography-guided Fine-needle Aspiration Cytology Combined with a Cell-block Method for Gastrointestinal Subepithelial Lesions.

Intern Med 2021 Sep 11. Epub 2021 Sep 11.

Department of Gastroenterology, Sendai City Medical Center, Japan.

Introduction The diagnostic accuracy of an endoscopic ultrasound-guided fine-needle aspiration cytology/biopsy combined with a cell-block method (FNA-CB) for gastrointestinal subepithelial lesions (GI-SELs) has not been fully studied. Methods A total of 109 patients (with 110 GI-SELs) were evaluated to clarify the rate of obtaining evaluable histology specimens using FNA-CB. In addition, we investigated the following: 1) the accuracy for determining the histology, 2) effects of the number of cell clusters obtained via FNA-CB, 3) correlation of the Ki67 labelling index (Ki67LI) of the gastrointestinal stromal tumor (GIST) lesions between FNA-CB and resected specimens, and 4) clinical courses for patients followed up after FNA-CB. Results Of the 110 GI-SELs for which FNA-CB was performed, 95 (86%) were able to be histologically evaluated using the first FNA-CB. For the 70 resected GI-SELs, the accuracy of FNA-CB to determine histology was 96%, remaining at 90% even when only a few cell clusters were obtained. The concordance rate of the risk-grouping of GIST (high-risk, Ki67LI ≥8; low-risk, <8) between FNA-CB and resected specimens was 84%. Of the 29 patients followed up after the first FNA-CB, 12 with benign GI-SELs determined using the first FNA-CB showed no obvious increases in their GI-SEL sizes. Conclusions Since FNA-CB can be used to determine the histology and reproductive activity of GI-SELs accurately, not only preoperative histological confirmation but also reliable information to determine clinical plans, such as follow-up without surgery or neoadjuvant chemotherapy, can be obtained.
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http://dx.doi.org/10.2169/internalmedicine.7889-21DOI Listing
September 2021

Suboptimal diabetic control and psychological burden after the triple disaster in Japan: the Fukushima Health Management Survey.

BMJ Open Diabetes Res Care 2021 Sep;9(1)

Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan

Introduction: A triple disaster struck eastern Japan in March 2011. We investigated the psychological distress and post-traumatic stress disorder (PTSD) symptoms caused by the disaster in people without or with diabetes mellitus.

Research Design And Methods: This cross-sectional analysis examined the 16 097 evacuees (1820 (11.3%) with and 14 277 (88.7%) without diabetes mellitus) included in the Fukushima Health Management Survey. Non-specific mental health distress was assessed using the Kessler-6 Scale, and traumatic symptoms were evaluated using the PTSD Checklist. Logistic regression analyses were used to estimate the OR and 95% CI associated with symptoms, adjusted for diabetes-related and disaster-related factors.

Results: In the age-adjusted and sex-adjusted logistic models, suboptimal diabetic control (hemoglobin A1c (HbA1c) ≥7%) was associated with both psychological distress and possible PTSD. In the same models, current smoking, evacuation, and sleep dissatisfaction were associated with psychological distress and possible PTSD. In the multivariate-adjusted logistic models, HbA1c ≥7% was associated with psychological distress, independent of job change, evacuation, or sleep dissatisfaction.

Conclusion: After the triple disaster, non-specific mental health distress was associated with suboptimal diabetic control. Thus, patients with diabetes, especially those with suboptimal diabetic control, may be vulnerable to postdisaster psychological burden.
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http://dx.doi.org/10.1136/bmjdrc-2020-002007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8438729PMC
September 2021

Associations Between Occupational Status, Support at Work, and Salivary Cortisol Levels.

Int J Behav Med 2021 Aug 30. Epub 2021 Aug 30.

Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan.

Objective: The present study investigated associations between occupation, job stress, and salivary cortisol levels after psychological tasks.

Methods: We examined 766 (273 men and 493 women) healthy employed Japanese participants aged 21 to 68 years (mean age = 46.4 years, standard deviation = 8.5) with three types of occupation: manager, teacher, and general worker. The Brief Job Stress Questionnaire was used to evaluate participants' job stress levels, including job demand, job control, support from supervisors, and support from coworkers. Salivary cortisol levels were measured at pre-session, post-stressful tasks, and post-relaxation. All samples were assayed using an enzyme-linked immunosorbent assay test. Natural log transformation was applied before statistical analyses. A multiple regression analysis and a repeated measures analysis of covariance were conducted to test associations between occupation and salivary cortisol levels, adjusting for confounding factors. Statistical analyses were conducted separately for men and women.

Results: Among both men and women, general workers had higher cortisol levels than managers throughout the experimental session (men 0.6 μg/dL and 0.4 μg/dL, respectively; women 0.5 μg/dL and 0.4 μg/dL, respectively). Job control was positively associated with cortisol levels measured in all sessions, after adjusting for confounding factors (standardized beta 0.15, 0.21, and 0.18 for pre-session, post-stressful-tasks, and post-relaxation, respectively, all p < 0.05). Men with low support from coworkers had higher cortisol levels than those with high support through the sessions (0.6 μg/dL and 0.4 μg/dL, respectively).

Conclusion: Socioeconomic disparity according to occupational status was related to cortisol levels in Japanese workers. Support from coworkers may be effective for reducing cortisol secretion in men.
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http://dx.doi.org/10.1007/s12529-021-10020-2DOI Listing
August 2021

Socioeconomic status, damage-related conditions, and PTSD following the Fukushima-daiichi nuclear power plant accident:The Fukushima Health Management Survey.

Fukushima J Med Sci 2021 ;67(2):71-82

Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.

The Great East Japan Earthquake severely damaged the Tohoku and Kanto districts, and Fukushima Prefecture faced a subsequent nuclear disaster. Few studies have reported the effects of socioeconomic stressors on individuals' mental status following disasters. We analyzed the responses of 60,704 adult residents of a designated restricted area to the PTSD Checklist-Stressor-Specific Version (PCL-S). The relationships between the PCL-S scores and demographic, socioeconomic, and damage-related variables were analyzed using regression analysis to predict participants' severity of PTSD symptoms. Approximately 14.1% of evacuees had severe PTSD symptoms (PCL-S ≥50) eighteen months post-earthquake. The PCL-S scores were higher among women, older adults, less educated people, those with a history of mental illness, and those living outside Fukushima Prefecture. The PCL-S scores increased with participants' scores on the Kessler Psychological Distress Scale. The number of trauma-exposure stressors and socioeconomic stressors were associated with 1.52 and 3.77 increases in the PCL-S score, respectively. Furthermore, psychological distress, unemployment, decreased income, house damage, tsunami experience, nuclear power plant accident experience, and loss of someone close due to the disaster were associated with the prevalence of severe PTSD symptoms. The complex triple disaster of a major earthquake, tsunami, and nuclear accident created significant socioeconomic changes that may be important determinants of PTSD among residents of restricted access areas in Fukushima.
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http://dx.doi.org/10.5387/fms.2020-24DOI Listing
January 2021

Psychosocial support for the examinees and their families during the secondary confirmatory examination:Analyses of support records at first visit.

Fukushima J Med Sci 2021 Aug 7;67(2):53-63. Epub 2021 Aug 7.

Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.

Background and Purpose The Thyroid Ultrasound Examination (TUE) program is conducted as part of the Fukushima Health Management Survey. Following the established criteria, examinees are called in for a secondary confirmation examination, which may induce high anxiety related to a thyroid cancer for both the examinees and their families. Therefore, Fukushima Medical University created the Thyroid Support Team to reduce anxiety. The purpose of this study is to analyze the psychosocial support for examinees and their families through two types of records, and to clarify the current issues and determine future directions of support.Materials and methods We analyzed 223 records of support for the first visit of examinees who attended the secondary confirmatory examination, conducted at Fukushima Medical University from September 2018 to March 2019.Results During the first visit, frequent topics and questions brought up by the examinees and their families were about the "Thyroid Ultrasound Examination (TUE) program" and "Examination findings". The Thyroid Support Team members assisted them by "Responding to questions", "Confirming the doctor's explanation" and "Providing information". The percentage of people with high anxiety decreased in both examinees and their family members after the examination. The level of anxiety was lower among those who had already taken the secondary confirmatory examination. Family members' anxiety was significantly higher than that of the examinees, and anxiety levels were highly correlated between examinees and their families.Conclusion The psychosocial support for examinees and their families was important in reducing their anxiety. Currently there are changes in social conditions and various opinions concerning the TUE. Thus, careful explanation and the need for decision-making supports for the examinees and their families increased. Also, we should take into account the aging of the examinees and expanding the available psychosocial support.
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http://dx.doi.org/10.5387/fms.2021-01DOI Listing
August 2021

Association between Psychosocial Factors and Oral Symptoms among Residents in Fukushima after the Great East Japan Earthquake: A Cross-Sectional Study from the Fukushima Health Management Survey.

Int J Environ Res Public Health 2021 06 4;18(11). Epub 2021 Jun 4.

Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.

Oral health is closely related to subjective general health and systemic diseases. This cross-sectional study aimed to identify the factors related to oral symptoms and their worsening in relation to psychosocial factors after the Great East Japan Earthquake. In this study, 64,186 residents aged 15-101 years old, who experienced the earthquake on 11 March 2011, were surveyed regarding their oral symptoms; psychological factors, such as post-traumatic reactions and psychological distress; and social factors such as evacuation, work change, and loss of a close person; history of systemic diseases; and lifestyle. Binomial logistic regression analysis was used to calculate odds ratios, and 95% confidence intervals were established for each factor associated with prevalent and exacerbated oral symptoms. The proportions of participants with prevalent and exacerbated oral symptoms were 10.3% and 1.6%, respectively. The multivariate odds ratios and 95% CI of psychosocial factors associated with exacerbated oral symptoms were as follows: post-traumatic stress disorder symptoms, 2.24 (1.64-3.06); work changes, 1.88 (1.34-2.65); history of dyslipidemia, 1.74 (1.27-2.39); and subjective current poor health condition, 2.73 (2.00-3.75). Psychological factors, social factors, and physical factors were associated with both prevalent and exacerbated oral symptoms.
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http://dx.doi.org/10.3390/ijerph18116054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200098PMC
June 2021

Impact of Perceived Social Support on the Association Between Anger Expression and the Risk of Stroke: The Circulatory Risk in Communities Study (CIRCS).

J Epidemiol 2021 Jun 26. Epub 2021 Jun 26.

Department of Cardiovascular Disease Prevention, Osaka Center for Cancer and Cardiovascular Disease Prevention.

Background: Anger has been suggested as a risk factor for stroke. Perceived social support (PSS) may relieve anger, thus reducing the risk of stroke; however, evidence supporting this is limited. We aimed to examine whether PSS modifies the risk of stroke associated with anger expression.

Methods: A cohort study was conducted among 1,806 community residents aged 40-74 years who received a cardiovascular risk survey including anger expression in 1997. A Cox proportional hazards model was applied to the participants with low and high PSS to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of the risks of total stroke and its subtypes based on total anger expression after adjusting for known stroke risk factors.

Results: The median follow-up duration was 18.8 years, with 51 incident strokes. Among the participants with low PSS, anger expression had a positive association with the total stroke risk: The multivariable HR per SD increment of total anger expression was 1.43 (95% CI, 1.13-1.82). In contrast, no association was identified among those with high PSS. The corresponding HR was 0.83 (95% CI, 0.49-1.40), with a significant interaction between low and high PSS (p = 0.037). Similar associations regarding the risk of ischemic stroke were found.

Conclusions: We found an increased risk of stroke associated with anger expression among the participants with low PSS, but not among those with high PSS. Our results suggest that PSS might mitigate the risk of stroke associated with anger.
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http://dx.doi.org/10.2188/jea.JE20200607DOI Listing
June 2021

Needs Survey for Health Support Application Development Project for Residents Returning from Evacuation After the Fukushima Nuclear Accident.

Stud Health Technol Inform 2021 May;281:1091-1092

Futaba Medical Center.

The purpose of this study was to identify the needs of stakeholders in developing a mobile application (MP) to be used by returning residents and providers of healthcare and medical/social services. The needs assessment of the residents revealed that among the elderly, ownership of smartphones and tablets was low and they were less likely to use the applications themselves.
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http://dx.doi.org/10.3233/SHTI210359DOI Listing
May 2021

Associations of the COVID-19 pandemic with the economic status and mental health of people affected by the Fukushima disaster using the difference-in-differences method: The Fukushima Health Management Survey.

SSM Popul Health 2021 Jun 15;14:100801. Epub 2021 Apr 15.

Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.

Although the coronavirus disease 2019 (COVID-19) pandemic and relevant preventive measures can affect the economic status and mental health of the public, their effect remains unraveled owing to a limited number of surveys conducted before and during the COVID-19 pandemic. We investigated the association of COVID-19 and relevant measures with multivariate outcomes among people affected by the Fukushima disaster in 2011 using the difference-in-differences (DID) method. We then analyzed the associations between sociodemographic factors and outcomes. We assessed psychological distress, problem drinking, insomnia state, unemployment, household economic decline, and interpersonal problems using three questionnaire surveys administered in 2018, 2019, and 2020. Participants were grouped according to three time periods by dates of voluntary stay-at-home requests (February 26) and the declaration of emergency (April 16) in Japan. The years 2020 and 2019 were regarded as the treatment group and control group, respectively, after confirming that no DIDs were found between 2018 and 2019. We performed regression analyses to identify the risk factors for outcomes. The DIDs were significant for household economic decline after the declaration of emergency, whereas problem drinking significantly improved. No significant DIDs were observed for other mental health outcomes including psychological distress and insomnia state. Absence of counselors was positively and significantly associated with all outcomes in 2020. Overall, people affected by the Fukushima disaster experienced more economic damage after the declaration of emergency during the COVID-19 pandemic but their mental health status did not reduce. Identifying people who have no counselors and providing them with support are emergent requirements to prevent a subsequent mental health decline.
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http://dx.doi.org/10.1016/j.ssmph.2021.100801DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8095183PMC
June 2021

Relationship between physical activity/exercise habits and the frequency of new onset of lifestyle-related diseases after the Great East Japan Earthquake among residents in Fukushima: the Fukushima Health Management Survey.

J Radiat Res 2021 May;62(Supplement_1):i129-i139

Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima-city, Fukushima, Japan.

The effect of exercise habits on the increased incidence of lifestyle-related diseases among residents of the evacuation area in Fukushima Prefecture after the Great East Japan Earthquake is not well characterized. This study examined the influence of exercise habits on the frequency of new onset of lifestyle-related diseases in the aftermath of the earthquake using data from the Fukushima Health Management Survey (FHMS). Of the 32 289 individuals (14 004 men and 18 285 women) aged 40-90 years who underwent one or more health examinations in both 2011-12 and 2014-15, those who knew whether they had any lifestyle diseases and who responded to a questionnaire about their exercise and physical activity habits were included (dyslipidemia, 8017; hypertension, 7173; and diabetes mellitus, 13140 individuals). The association between the frequency of new onset of lifestyle-related diseases in 2014-15 and the presence or absence of persistent exercise and physical activity habits (active lifestyle) was examined using the FHMS data. The frequency of new onset of dyslipidemia was significantly lower in the active lifestyle group than in the sedentary lifestyle group (P = 0.008). On univariate and multivariate logistic regression analyses, the presence of active lifestyle, obesity and the experience of evacuation showed a significant association with new onset of dyslipidemia, independent of age, sex or follow-up period. Thus maintaining physical activity and exercise habits may help prevent the new onset of dyslipidemia among residents of the evacuation area in the Fukushima Prefecture after the earthquake.
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http://dx.doi.org/10.1093/jrr/rraa134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114221PMC
May 2021

Trajectories of peer relationship problems and emotional symptoms in children 5 years after a nuclear disaster: Fukushima Health Management Survey.

J Radiat Res 2021 May;62(Supplement_1):i114-i121

Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.

The Fukushima Daiichi Nuclear Power Station (NPS) accident, which occurred in March 2011, is having long-term effects on children. About 3 years after the accident, we identified three patterns of peer relationship problems and four patterns of emotional symptoms using group-based trajectory modeling. As a result, we reported that different factors might be related to very severe trajectories of peer relationship problems and emotional symptoms. In this study, we used five waves of data from fiscal year (FY) 2011 to FY2015 from the Mental Health and Lifestyle Survey, a detailed survey of the Fukushima Health Management Survey started in FY2011. We analyzed 7013 residents within the government-designated evacuation zone (aged 6-12 years old as of 11 March 2011) with responses to all items of psychological distress in at least one wave from FY2011 and FY2015. We planned this study to describe the trajectories of peer relationship problems and emotional symptoms in children and to examine potential risks and protective factors over the 5 years following the NPS accident. We identified four patterns of peer relationship problems and five patterns of emotional symptoms using latent class growth analysis. For peer relationship problems, male sex, experiencing the NPS explosion and lack of exercise habits were associated with the severe trajectory group. For emotional symptoms, experiencing the NPS explosion, experiencing the tsunami disaster and lack of exercise habits were associated with the severe trajectory group. Exercise habits are very important for the mental health of evacuees after a nuclear disaster.
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http://dx.doi.org/10.1093/jrr/rraa126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114218PMC
May 2021

Factors Hindering Social Participation among Older Residents from Evacuation Zones after the Nuclear Power Plant Accident in Fukushima: The Fukushima Health Management Survey.

Int J Environ Res Public Health 2021 04 21;18(9). Epub 2021 Apr 21.

Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.

Considering the health effects of radiation accompanying the nuclear power plant accident that occurred in the wake of the Great East Japan Earthquake, this study aimed to examine social participation after the disaster and factors hindering participation among citizens aged ≥ 65 years from designated evacuation zones inside the Fukushima prefecture. The target population comprised 180,604 residents in 13 municipalities containing designated evacuation zones. There were 73,433 valid responses (response rate, 40.7%); of which, data from 19,573 respondents aged ≥ 65 years were analyzed. Multinomial logistic regression analyses were conducted to investigate the factors associated with social participation. In total, 53.0% of older evacuees did not participate in recreational activities or communal services. Stratified analysis showed that living outside the Fukushima prefecture and requiring assistance with activities of daily living were associated with low social participation. This study clarified that the majority of older evacuees did not participate in social activities at the time of the survey within one year of the disaster. Furthermore, where these older individuals were evacuated to and whether they were able to live independently might have affected their social participation. Better subjective health, better sleep quality, and more frequent exercise may be associated with improved social participation.
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http://dx.doi.org/10.3390/ijerph18094426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122270PMC
April 2021

Risk of metastatic recurrence after endoscopic resection for esophageal squamous cell carcinoma invading into the muscularis mucosa or submucosa: a multicenter retrospective study.

J Gastroenterol 2021 Jul 21;56(7):620-632. Epub 2021 Apr 21.

National University Corporation Hirosaki University, Hirosaki, Japan.

Background: We aimed to elucidate the risk of metastatic recurrence after endoscopic resection (ER) without additional treatment for esophageal squamous cell carcinomas (ESCCs) with tumor invasion into the muscularis mucosa (pT1a-MM) or submucosa (T1b-SM).

Methods: We retrospectively enrolled patients with pT1a-MM/pT1b-SM ESCC after ER at 21 institutions in Japan between 2006 and 2017. We compared metastatic recurrence between patients with and without additional treatment, stratified into category A (pT1a-MM with negative lymphovascular invasion [LVI] and vertical margin [VM]), B (tumor invasion into the submucosa ≤ 200 µm [pT1b-SM1] with negative LVI and VM), and C (others). Subsequently, using multivariate Cox analysis, we evaluated risk factors for metastatic recurrence after ER without additional treatment.

Results: We enrolled 593 patients, and metastatic recurrence occurred in 38 patients. Metastatic recurrence after additional treatment was significantly lower than that after no additional treatment in category C (9.1% vs. 23.6% in 5 years, p = 0.001), whereas no significant difference was noted in categories A (0.0% vs. 2.6%) and B (0.0% vs. 4.3%). In patients without additional treatment after ER, risk factors for metastatic recurrence were lymphatic invasion (hazard ratio [HR], 5.61), positive VM (HR, 4.55), and tumor invasion into the submucosa > 200 μm (HR, 3.25), and, but near half of the patients with metastatic recurrence had no further recurrence after salvage treatment, resulting in excellent 5-year disease-specific survival in categories A (99.6%) and B (100.0%).

Conclusions: Closed follow-up with no additional treatment may be an acceptable option after ER in pT1a-MM/pT1b-SM1 ESCC with negative LVI and VM.
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http://dx.doi.org/10.1007/s00535-021-01787-yDOI Listing
July 2021

Association between lifestyle habits and the prevalence of abdominal obesity after the Great East Japan Earthquake: The Fukushima Health Management Survey.

J Epidemiol 2021 Apr 3. Epub 2021 Apr 3.

Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.

Background: The proportion of overweight individuals living in the evacuation zone of Fukushima increased after the Great East Japan Earthquake. However, the change in the prevalence of abdominal obesity has not been reported. Lifestyle habits and changes in these habits after the disaster might have affected the onset of abdominal obesity; however, the association between the two is unclear.

Methods: This study evaluated 19,673 Japanese participants of the Fukushima Health Management Survey. We used data from general health check-ups conducted in 13 municipalities between 2008 and 2010. Follow-up examinations were performed from June 2011 to March 2013. Changes in the proportion of individuals with abdominal obesity before and after the disaster were compared. Then, lifestyle habits affecting these changes were assessed.

Results: We found that 34.2% and 36.6% of participants (P < 0.001), both evacuees (37.0% and 42.1% (P < 0.001)) and non-evacuees (32.8% and 34.0% (P < 0.001)), had abdominal obesity before and after the disaster, respectively. Abdominal obesity was positively associated with smoking cessation, snacking after dinner and non-breakfast skipping after the disaster and alcohol drinking before and after the disaster (all P < 0.05). Smoking cessation was positively associated with abdominal obesity in both evacuees and non-evacuees and in both men and women (all P < 0.01).

Conclusions: The prevalence of abdominal obesity increased among residents in the area affected by nuclear disaster. It might be associated with not only lifestyle habits before the disaster but also changes in these habits after the disaster, especially smoking cessation.
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http://dx.doi.org/10.2188/jea.JE20200597DOI Listing
April 2021

Leukocyte Count and Risks of Stroke and Coronary Heart Disease: The Circulatory Risk in Communities Study (CIRCS).

J Atheroscler Thromb 2021 Mar 21. Epub 2021 Mar 21.

Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University.

Aim: This study aimed to investigate the associations of leukocyte count with the risks of stroke and coronary heart disease among the general Japanese population.

Methods: A total of 5,242 residents aged 40-69 years living in two Japanese communities underwent leukocyte count measurements between 1991 and 2000, and the data were updated using 5- or 10-year follow-ups or both. Participants who had histories of stroke, coronary heart disease, or high values of leukocyte count (>130×10 cells/mm) were excluded. Hazard ratios with 95% confidence intervals (CIs) were calculated according to quartiles of cumulative average leukocyte count.

Results: During follow-up of 21 years, 327 stroke and 130 coronary heart disease cases were determined. After adjustments for age, sex, community, and updated cardiovascular risk factors, the multivariable hazard ratio (95% CI) for the highest versus lowest quartile of leukocyte count was 1.50 (1.08-2.08) for ischemic stroke, 1.59 (1.00-2.51) for lacunar infarction, 1.42 (0.90-2.26) for non-lacunar infarction, 2.17 (1.33-3.55) for coronary heart disease, and 1.40 (1.11-1.76) for total cardiovascular disease. In smoking status-stratified analyses, the corresponding multivariable hazard ratio (95% CI) was 2.45 (1.11-5.38) for ischemic stroke, 2.73 (1.37-5.44) for coronary heart disease in current smokers, 2.42 (1.07-5.46), 1.55 (0.58-4.15) in former smokers, and 1.17 (0.75-1.82), 1.78 (0.83-3.82) in never smokers.

Conclusion: Leukocyte count was positively associated with the risks of ischemic stroke and coronary heart disease among the general Japanese population, especially in current smokers.
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http://dx.doi.org/10.5551/jat.60889DOI Listing
March 2021

Impact of Major Cardiovascular Risk Factors on the Incidence of Cardiovascular Disease among Overweight and Non-Overweight Individuals: The Circulatory Risk in Communities Study (CIRCS).

J Atheroscler Thromb 2021 Mar 16. Epub 2021 Mar 16.

Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.

Aim: We aimed to examine the impact of high-risk levels of cardiovascular risk factors on the incidence of cardiovascular disease (CVD) in overweight and non-overweight individuals without treatment for the risk factors.

Methods: A total of 8,051 individuals aged 40-74 years without a history of CVD and/or without treatment for hypertension, diabetes, hyperlipidemia, and kidney disease at baseline in 1995-2000 were followed up for a median of 14.1 years. We classified the participants into three risk categories (low-, intermediate-, and high-risk groups) on the basis of individual risk factors (blood pressure, serum glucose, low-density lipoprotein cholesterol [LDL-C], and urinary protein) according to the guidelines of Japanese clinical societies. The high-risk group (systolic blood pressure ≥ 160 mmHg or diastolic blood pressure ≥ 100 mmHg, fasting serum glucose ≥ 130 mg/dL or non-fasting serum glucose ≥ 180 mg/dL, LDL-C ≥ 180 mg/dL, proteinuria ≥ 2+) needed to refer to physicians or start treatment immediately. Overweight was defined as a body mass index of ≥ 25 kg/m.

Results: Compared with those in the non-overweight low-risk group, the hazard ratios (HRs) (95% confidence intervals, population-attributable fractions [PAFs]) of CVD in the high-risk categories of blood pressure were 2.0 (1.4-2.9, 7.0%) in the non-overweight high-risk group and 2.9 (1.9-4.3, 6.8%) in the overweight high-risk group. The corresponding HRs (95% confidence intervals, PAFs) of serum glucose were 2.0 (1.2-3.4, 2.5%) and 2.2 (1.1-4.3, 1.5%) in the non-overweight and overweight high-risk groups, respectively. Such associations were not observed for the high-risk group of LDL-C and proteinuria.

Conclusions: The present long-term observational study implies that targeting persons with non-treated severe hypertension and diabetes is prioritized to prevent CVD regardless of overweight status.
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http://dx.doi.org/10.5551/jat.60103DOI Listing
March 2021

The association between body mass index and recovery from post-traumatic stress disorder after the nuclear accident in Fukushima.

Sci Rep 2021 Mar 5;11(1):5330. Epub 2021 Mar 5.

Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.

Post-traumatic stress disorder (PTSD) and obesity share common risk factors; however, the effect of obesity on recovery from PTSD has not been assessed. We examined the association between body mass index (BMI) and recovery from PTSD after the Great East Japan Earthquake. We analyzed 4356 men and women with probable PTSD aged ≥ 16 years who were living in evacuation zones owing to the radiation accident in Fukushima, Japan. Recovery from probable PTSD was defined as Post-traumatic Stress Disorder Checklist-specific scores < 44. Using Poisson regression with robust error variance adjusted for confounders, we compared the prevalence ratios (PRs) and 95% confidence intervals (CIs) for this outcome in 2013 and 2014. Compared with point estimates for normal weight (BMI: 18.5-24.9 kg/m), especially in 2013, those for underweight (BMI: < 18.5 kg/m) and obesity (BMI: ≥ 30.0 kg/m) tended to slightly increase and decrease, respectively, for recovery from probable PTSD. The multivariate-adjusted PRs (95% CIs) for underweight and obesity were 1.08 (0.88-1.33) and 0.85 (0.68-1.06), respectively, in 2013 and 1.02 (0.82-1.26) and 0.87 (0.69-1.09), respectively, in 2014. The results of the present study showed that obesity may be a useful predictor for probable PTSD recovery. Obese victims with PTSD would require more intensive support and careful follow-up for recovery.
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http://dx.doi.org/10.1038/s41598-021-84644-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935866PMC
March 2021

Social Factors for Leading to Life Satisfaction among Residents with Developmental Disorders in Fukushima Prefecture.

Tohoku J Exp Med 2021 02;253(2):113-123

Department of Epidemiology, Fukushima Medical University School of Medicine.

A developmental disorder is condition in which a person has deficiency in either physical, learning, language, or behavior, and people with developmental disorders often experience difficulties in their social lives. In Japan, no systematic surveys of developmental disorders targeting local residents have been reported, including working-age. Hence, we aimed to estimate the prevalence and determine the psychosocial factors associated with life satisfaction and psychological distress in the Fukushima prefecture. We conducted an Internet questionnaire survey among 4,030 residents (2,136 men and 1,894 women) aged 16-65 years who either had a job or were willing to work. Developmental disorders were defined based on participants' self-reported history diagnosed by a psychiatrist or their responses to screening questionnaires. The prevalence of developmental disorders was 9.6% (n = 386). Subsequently, a secondary survey (on a first-come, first-served basis) was conducted to assess psychosocial factors among those with developmental disorders, and responses were received from 121 men and 79 women aged 16-65. Being a regular employee and disclosing diagnosis at the workplace was associated with higher job satisfaction. The participants living with a spouse and/or their children tended to feel satisfied with their life (multivariable-adjusted odds ratio (OR): 3.55), job (OR: 3.20), and income (OR: 4.68), whereas those living with parents tended to not feel satisfied with their life, job, or income. Working as a regular employee, having co-workers who understand developmental disorders, and living with a spouse or children are important social factors that increase life satisfaction among people with developmental disorders.
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http://dx.doi.org/10.1620/tjem.253.113DOI Listing
February 2021

Seaweed Intake and Risk of Cardiovascular Disease: The Circulatory Risk in Communities Study (CIRCS).

J Atheroscler Thromb 2021 Feb 18. Epub 2021 Feb 18.

Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba.

Aim: Seaweed contains soluble dietary fibers, potassium, and flavonoids and was recently reported to be inversely associated with the risk of coronary heart disease and mortality from stroke. However, epidemiological evidence on this issue has remained scarce.

Methods: At the baseline survey of four Japanese communities between 1984 and 2000, we enrolled 6,169 men and women aged 40-79 years who had no history of cardiovascular disease. We assessed their seaweed intake using the data from a 24 h dietary recall survey and categorized the intake into four groups (0, 1-5.5, 5.5-15, and ≥ 15 g/day). We used sex-specific Cox proportional hazards models to examine the association between seaweed intake and risk of cardiovascular disease (stroke, stroke subtypes, and coronary heart disease).

Results: During the 130,248 person-year follow-up, 523 cases of cardiovascular disease occurred: 369 cases of stroke and 154 cases of coronary heart disease. Seaweed intake levels were inversely associated with the risk of total stroke and cerebral infarction among men but not among women. Adjustment for cardiovascular risk factors did not change the associations: the hazard ratios (95% confidence intervals; P for trend) for the highest versus lowest categories of seaweed intake were 0.63 (0.42-0.94; 0.01) for total stroke and 0.59 (0.36-0.97; 0.03) for cerebral infarction. No associations were observed between seaweed intake and risks of intraparenchymal hemorrhage, subarachnoid hemorrhage, or coronary heart disease among men or women.

Conclusions: We found an inverse association between seaweed intake and risk of total stroke, especially that from cerebral infarction, among Japanese men.
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http://dx.doi.org/10.5551/jat.61390DOI Listing
February 2021

Association between atrial fibrillation and white blood cell count after the Great East Japan Earthquake: An observational study from the Fukushima Health Management Survey.

Medicine (Baltimore) 2021 Feb;100(6):e24177

Radiation Medical Science Center for the Fukushima Health Management Survey.

Abstract: We had earlier reported about the increase in the prevalence of atrial fibrillation (AF) among residents in the evacuation zone of Fukushima Prefecture after the Great East Japan Earthquake. In the present investigation, we explored the association between the prevalence of AF and white blood cell (WBC) count after the earthquake through an observational cross-sectional study.A total of 14,800 participants (6427 men and 8373 women) were included in the Fukushima Health Management Survey. For the present study, 12-lead electrocardiogram tracings and the WBC count and its subtypes were obtained and analyzed. The odds ratios (ORs) of AF after the earthquake and the 95% confidence intervals (CIs) for one standard deviation of differential WBC count were calculated after adjustments for age and other potential confounding factors using the logistic regression model.Our results revealed a prevalence of AF of 1.8% (269 participants) after the earthquake. Monocyte count and neutrophil/lymphocyte ratio exhibited a significant association with the prevalence of AF in the multivariable-adjusted model. The adjusted ORs of monocyte count and neutrophil/lymphocyte ratio for AF were 1.21 (95% CI, 1.05-1.40, P = .01) and 1.22 (95% CI, 1.01-1.44, P < .05), respectively.The prevalence of AF was associated with increased monocyte count and neutrophil/lymphocyte ratio among residents in the evacuation zone in Fukushima Prefecture, suggesting that inflammation and psychological stress could be important factors mediating the development of AF after the earthquake.
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http://dx.doi.org/10.1097/MD.0000000000024177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886431PMC
February 2021

Evacuation after the Great East Japan Earthquake is an independent factor associated with hyperuricemia: The Fukushima Health Management Survey.

Nutr Metab Cardiovasc Dis 2021 04 3;31(4):1177-1188. Epub 2021 Feb 3.

Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan.

Background And Aims: On March 11, 2011, the Great East Japan Earthquake occurred in Japan, with a nuclear accident subsequently occurring at the Fukushima Daiichi Nuclear Power Plant. The disaster forced many evacuees to change particular aspects of their lifestyles. This study assessed the association between evacuation and hyperuricemia based on the Fukushima Health Management Survey from a lifestyle and socio-psychological perspective.

Methods And Results: This cross-sectional study included 22,812 residents (9391 men and 13,297 women) who underwent both the Comprehensive Health Check and the Mental Health and Lifestyle Survey in fiscal year 2011. Associations between hyperuricemia and lifestyle- and disaster-related factors including evacuation were estimated using a logistic and liner regression analysis. With hyperuricemia defined as uric acid levels >7.0 mg/dL for men and >6.0 mg/dL for women, significant associations were observed between evacuation and hyperuricemia in men (the multivariate-adjusted odds ratio 1.20, 95% confidence interval, 1.05-1.36, p = 0.005), but not in women. In the multivariate-adjusted multiple liner regression analysis, evacuation had significant and positive associations with uric acid levels both in men (β = 0.084, p = 0.002) and women (β = 0.060, p < 0.001).

Conclusion: Evacuation after a natural disaster is an independent factor associated with hyperuricemia.
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http://dx.doi.org/10.1016/j.numecd.2020.12.016DOI Listing
April 2021

Relationship between risk of hyper- low-density lipoprotein cholesterolemia and evacuation after the Great East Japan Earthquake.

J Epidemiol 2021 Jan 13. Epub 2021 Jan 13.

Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University.

BackgroundThe Great East Japan Earthquake and the Fukushima Daiichi nuclear disaster forced the evacuation of residents and led to many changes in lifestyle for the evacuees. The Comprehensive Health Check was implemented to support the prevention of lifestyle-related disease and we analyzed the effect of prolonged evacuation (average of 3.0 years) on the new onset of hyper-LDL cholesterolemia.MethodsThe study participants were Japanese adults living near the Fukushima Daiichi nuclear power plant in Fukushima Prefecture. Annual health checkups focusing on metabolic syndromes were conducted for persons ≥ 40 years by the Specific Health Checkup. Based on data from annual checkups from 2011 or 2012, we followed 18,670 non-hyper-LDL cholesterolemia who underwent at least one other annual checkup during 2013-2015.ResultsWe found that the new onset of hyper-LDL cholesterolemia was significantly by 31% higher in evacuees than in non-evacuees. Evacuees had a significantly higher prevalence of obesity, hypertension, and diabetes, and higher frequency of weight change. Furthermore, logistic regression model analysis showed that the evacuation was significantly associated with the new onset of hyper-LDL cholesterolemia after adjusting age, gender, body mass index (BMI), smoking habit, alcohol consumption, diabetes, weight change, sleep deprivation, and exercise.ConclusionsThe findings of the present study suggest that prolonged evacuation after a disaster is a risk factor for the new onset of hyper-LDL cholesterolemia, and lead to an increase in cardiovascular disease. It is therefore important to follow-up evacuees and recommend lifestyle changes where necessary.
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http://dx.doi.org/10.2188/jea.JE20200267DOI Listing
January 2021

Association between frequency of laughter and oral health among community-dwelling older adults: a population-based cross-sectional study in Japan.

Qual Life Res 2021 Jun 11;30(6):1561-1569. Epub 2021 Jan 11.

Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.

Purpose: Oral health has been reported to have an impact on the activities of daily life such as chewing, eating, and laughing, while psychological factors such as depression and loneliness have been reported to affect oral health. Little is known, however, about the association between laughter and oral health in older adults. This study examined the bidirectional association between the frequency of daily laughter and oral health in community-dwelling older Japanese adults.

Methods: Our cross-sectional study employed data from the 2013 Japan Gerontological Evaluation Study's self-reported survey, which included 11,239 male and 12,799 female community-dwelling independent individuals aged 65 years or older. We defined the oral health status by the number of remaining teeth. The association between the self-reported frequency of laughter (almost every day, 1-5 days per week, 1-3 days per month, or almost never) and oral health was examined using logistic regression analysis.

Results: The participants with 10 or more teeth were significantly more likely to laugh compared with the edentulous participants, after adjusting for all covariates. Compared with those who almost never laughed, those who laughed 1-5 days per week were significantly less likely to be edentulous. After stratifying by sex, similar results were found only in the men for both analyses.

Conclusion: There was a significant bidirectional association between frequency of laughter and oral health that was independent of socioeconomic and lifestyle factors among older adults.
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http://dx.doi.org/10.1007/s11136-020-02752-7DOI Listing
June 2021

Dietary Patterns and Progression of Impaired Kidney Function in Japanese Adults: A Longitudinal Analysis for the Fukushima Health Management Survey, 2011-2015.

Nutrients 2021 Jan 7;13(1). Epub 2021 Jan 7.

Radiation Medical Science Centre for Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan.

To investigate associations between dietary patterns and the risk of impaired kidney function, we analyzed data from 14,732 participants (40-89 years) who completed the baseline diet questionnaire of The Fukushima Health Management Survey in 2011. The incidence of chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m or proteinuria (≥1+ by dipstick test)) and annual changes in eGFR were assessed from 2012 to 2015. Three major dietary patterns were identified. The adjusted cumulative incidence ratio of the highest vs. lowest tertile of a vegetable diet scores was 0.90 (95% confidence interval (CI): 0.82, 1.00) for eGFR < 60 mL/min/1.73 m, 0.68 (95% CI: 0.52, 0.90) for proteinuria, and 0.88 (95% CI: 0.80, 0.97) for CKD ( for trend = 0.031, 0.007, and 0.005, respectively). The incident risk of CKD in the highest tertile of juice diet scores was 18% higher than the lowest tertile. The odds ratio of the highest vs. lowest tertile of vegetable diet scores was 0.85 (95% CI: 0.75, 0.98) in the rapidly decreasing eGFR group ( for trend = 0.009). We did not observe significant associations for the meat dietary pattern. A Japanese vegetable diet could reduce the risk of developing impaired kidney function and CKD.
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http://dx.doi.org/10.3390/nu13010168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827845PMC
January 2021

Does variety of social interactions associate with frequency of laughter among older people? The JAGES cross-sectional study.

BMJ Open 2021 01 7;11(1):e039363. Epub 2021 Jan 7.

Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Chiba, Japan.

Objective: Several studies have reported that laughter is associated with health benefits. In addition, social interactions, such as social relationships, social participation and so forth, have shown the association with not only health but also individual emotion. In this study, we conducted a cross-sectional study to examine the association between variety of social interactions and the frequency of laughter.

Design: Cross-sectional study.

Setting: Sampled from 30 municipalities in Japan.

Participants: Non-disabled Japanese men (n=11 439) and women (n=13 159) aged ≥65 years using data from the Japan Gerontological Evaluation Study, which was conducted during October to December in 2013.

Primary Outcome Measures: Laughing almost every day by self-reported questionnaire.

Results: Poisson regression analysis with robust error variance was used to calculate prevalence ratios (PRs) for laughing almost every day according to each social relationship and its potential community-level environmental determinants. The prevalence of laughing almost every day tended to increase with increased variety in each social interaction after adjusting, instrumental activities of daily living, number of living together, working status, depression, self-reported economic status and residence year. Among men and women, multivariate-adjusted PRs (95% CIs) by comparing participants with the highest and lowest categories were 1.18 (1.04 to 1.35) and 1.16 (1.04 to 1.29) in positive life events; 1.26 (1.10 to 1.45) and 1.09 (0.96 to 1.24) in perceived positive changes in the area; 1.15 (1.04 to 1.28) and 1.17 (1.07 to 1.28) in social participations; 2.23 (1.57 to 3.16) and 1.47 (1.02 to 2.12) in social relationships and 1.25 (1.08 to 1.45) and 1.29 (1.15 to 1.45) in positive built environments. These associations were also preserved after the restriction of participants who were not in depression.

Conclusions: This study shows that a greater variety of each social relationships and the potential community-level environmental determinants are associated with higher frequencies of laughter in Japan.
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http://dx.doi.org/10.1136/bmjopen-2020-039363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797251PMC
January 2021
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