Background: This study aimed to investigate diurnal variations in copper-induced hepatic toxicity and the molecular mechanisms underlying this chronotoxicity.

Methods: Male C57BL/6J mice were intraperitoneally injected with copper chloride (CuCl₂) at zeitgeber time 2 (ZT2) or 14 (ZT14), twice per week for 5 or 8 weeks. Seventy-two hours after the final CuCl₂ injection, the mice were euthanized, and plasma samples were collected. The livers and kidneys were collected and weighed. In vitro experiments were performed to assess cell viability and fluctuations in clock gene expression levels in Hepa1-6 cells after CuCl₂ treatment. We examined copper homeostasis- and apoptosis-related genes under clock genes overexpression.

Results: Repeated CuCl₂ administration for 8 weeks resulted in more severe toxicity at ZT14 compared to ZT2. CuCl₂ administration at ZT14 elevated plasma aspartate aminotransferase, hepatic tumor necrosis factor-α, and interleukin-6 for 5 weeks, whereas the toxic effects of CuCl₂ administration at ZT2 were weaker. Moreover, CuCl₂ treatment inhibited Hepa1-6 cell viability in a dose-dependent manner. We observed increased expression of three clock genes (Ciart, Cry2, and Per1) after CuCl₂ treatment. Among them, overexpression of Cry2 and Per1 accelerated CuCl₂-induced inhibition of Hepa1-6 cell viability. Moreover, we found that the overexpression of Cry2 and Per1 regulates cleaved caspase-3 by modulating the copper transporter genes ATP7B and CTR1.

Conclusion: These results suggest that CuCl₂-induced diurnal toxicity is associated with Cry2 and Per1 expression through the regulation of copper transporter genes in mice.

Background: This study examined the association between dermatological, neurological, and bone manifestations of neurofibromatosis type 1 (NF1) and quality of life (QoL) in patients with NF1 using a nationwide database of all patients who newly claimed for medical expense subsidies in Japan from 2015 to 2019.

Methods: The Japanese Ministry of Health, Labour and Welfare provided the “National Database of Designated Intractable Diseases of Japan” containing clinical and personal records (“Medical Certificates of Designated Intractable Diseases”) of all patients with NF1 following approval of the study protocol. To examine the association between the severity of symptoms and QoL, multinominal logistic regression analyses were performed, adjusted for potential confounders.

Results: The final study population consisted of 1,487 patients (775 females and 712 males; mean (standard deviation) age, 45.4 (17.9) years). More than 50% and nearly 45% of participants were recorded as having moderate or severe “pain/discomfort” and “anxiety/depression,” respectively. The severity of neurological symptoms was significantly associated with all components of QoL, whereas the severity of dermatological symptoms was significantly associated with only moderate or severe subjective and mental health-related components of QoL, and the severity of bone lesions was associated with only moderate or severe physical health-related components of QoL. Subjective and mental health-related components of QoL tended to be deteriorated more than physical health-related components of QoL in younger and female patients.

Conclusions: Severities of neurological and dermatological symptoms were significantly associated with subjective and mental health-related components of QoL, while the severity of bone symptoms was associated with only moderate and severe deterioration of physical health-related components of QoL.

Background: Reproductive risk factors and air pollution for developing chronic obstructive pulmonary disease (COPD) have been documented separately. However, the combined effects of overall reproductive risk status on COPD and the extent to which this can be impacted by air pollution are unknown. The aim of this study was to construct a reproductive risk score (RRS) and an air pollution score (APS) and assess independent and joint associations between the two with incident COPD risk.

Methods: 78,027 female participants aged 40–69 years without baseline COPD from UK Biobank recruited between 2006 to 2010 were included in this study. RRS was constructed by 17 women’s reproductive health-related items, and APS incorporating PM_2.5, PM_2.5–10, PM₁₀, NO₂, and NO_x was calculated to assess the joint exposure level. The outcome of the incident COPD was identified through the in-patient hospital register. The associations of RRS and APS with COPD were examined by Cox proportional hazards regression.

Results: The risk of COPD reached its highest in the fourth quartile of the RRS (adjusted HR: 2.23, 95% CI: 1.76–2.82, P for trend < 0.001). A dose-response manner can also be observed between higher tertile APS with increased COPD risk and the highest risk was found in the third tertile of the APS (adjusted HR: 1.37, 95% CI: 1.19–1.58, P for trend < 0.001). The relative excess risk due to interaction (RERI) of 0.030 (95% CI: 0.012–0.048) showed additive interaction between RRS and APS on COPD was significant. In the joint analysis, the combinations of both higher RRS and APS signified higher incident COPD risk.

Conclusion: High RRS and high APS were jointly associated with increased COPD risks in a dose-response pattern. Using comprehensive indicators to identify women’s reproductive risk factors, together with the control of air pollution, is effective for COPD prevention.

Background: Non-adherence to anti-hypertensive medications can lead to hypertension-related complications. One of the most effective preventive measures to mitigate these complications is to understand the underlying determinants of medication non-adherence using various scales. Unfortunately, existing scales for measuring non-adherence to anti-hypertensive medications have certain limitations, such as insufficient consideration of validity, dimensionality, and cultural adaptation. In response, the current study aimed to develop and validate a measure of non-adherence to anti-hypertensive medications—known as the Malaysian Anti-hypertensive Agent Non-Adherence Scale (MAANS)—for use in local hypertensive patients.

Methods: A two-phase mixed-methods approach was used. Phase 1 involved qualitative interviews with hypertensive patients from two health clinics in Kuala Lumpur, Malaysia. The themes extracted from these interviews were used to generate items for the MAANS. In Phase 2, data from 213 participants were analysed using exploratory factor analysis (EFA) to establish the scale’s factor structure, thereby created the modified version of the MAANS. Confirmatory factor analysis (CFA) was then conducted on a separate dataset of 205 participants to confirm the factor structure, resulted in the final version of the MAANS. The reliability of the final MAANS version was assessed using Cronbach’s alpha coefficient. The MAANS scores were used to predict subscales of the Malay version of the WHO Quality-of-Life (QOL) BREF, demonstrating the scale’s predictive validity.

Results: Ten qualitative interviews yielded 73 items. The EFA produced a modified MAANS with 21 items grouped into five factors. However, the CFA retained three factors in the final scale: Perceived Non-Susceptibility, Poor Doctor-Patient Relationship, and Unhealthy Lifestyle. The final 14-item, 3-factor MAANS demonstrated moderate reliability (Cronbach’s alpha coefficient = 0.64) and exhibited partial predictive validity, with the Poor Doctor-Patient Relationship and Unhealthy Lifestyle subscales significantly predicting Social QOL and Environmental QOL.

Conclusion: The MAANS is a reliable, valid, and multidimensional scale specifically developed to evaluate non-adherence to anti-hypertensive medications in local clinical settings with the potential to further the advancement of research and practice in sociomedical and preventive medicine.

Background: As at June 14, 2023, the coronavirus disease 2019 (COVID-19) pandemic had affected more than 767 million people and caused more than 6.9 million deaths worldwide. This study aimed to clarify the lifestyle factors that influence the exacerbation of COVID-19 severity.

Methods: This was a cross-sectional study of patients with COVID-19 whose severity classification of “moderate or severe” (COVID-19 exacerbation) was defined as an objective variable. The 1,353 participants were selected from 4,899 patients with COVID-19 between August 10, 2020 and December 10, 2022. Participants who underwent a specific health checkup before the date for a COVID-19 consultation were included. Using binominal logistic regression analysis, we evaluated the odds ratios (ORs) for COVID-19 exacerbation according to lifestyle-related factors. Limitations were discussed using a target trial emulation framework which clarifies problems in observational studies.

Results: The explanatory variables extracted as factors that exacerbated COVID-19 severity were gender (OR [man vs. woman]: 2.533, 95% confidence interval [CI] 1.484–4.322); age (OR [50s vs. 10s, 20s, or 30s]: 4.858, 95% CI 2.319–10.177; OR [60s]: 9.738, 95% CI 4.355–21.777; OR [70s + 80s + 90s]: 8.327, 95% CI 3.224–21.507); and comorbid chronic lung disease (OR [‘yes’ vs. ‘no’]: 2.892, 95% CI 1.227–6.818). The explanatory variables extracted as factors that reduce the severity of COVID-19 were hospital consultation year (OR [2022, predominantly Omicron variant prevalent vs. 2020, predominantly Alpha variant prevalent]: 0.180, 95% CI 0.058–0.559); number of vaccinations (OR [2 doses vs. 0 or one doses]: 0.223, 95% CI 0.114–0.436; OR [≥3 doses vs. 0 or one doses]: 0.090, 95% CI 0.035–0.229); regular exercise (exercising ≥2 days/week ≥30 minutes each at an intensity that causes a slight sweat for ≥1 year) (OR [‘yes’ vs. ‘no’]: 0.458, 95% CI 0.242–0.866).

Conclusions: These results suggest the importance of vaccination, regular exercise, and prevention of chronic lung disease as measures against exacerbation of COVID-19 severity.

Background: Both napping and nighttime sleep duration have been reported to be associated with cognitive function in older adults, whereas little is known about the association between daytime napping and cognitive impairment in different nighttime sleep duration subgroups. This study aimed to explore the correlation between daytime napping and cognitive impairment across nighttime sleep duration subgroups.

Methods: A cross-sectional study was conducted by using the fourth survey of China Health and Retirement Longitudinal Study (CHARLS). We utilized the Mini-Mental State Examination (MMSE) scale to define cognitive impairment, and the daytime napping and nighttime sleep duration was self-reported by individuals. We applied the Restricted Cubic Spline (RCS) to analysis the dose-response relationships between daytime napping and cognitive impairment. And the multivariate Logistic Regression Model (LRM) was performed to evaluate the association of daytime napping and cognitive impairment.

Results: A total of 3,052 individuals were included, of which 769 were cognitive impairment. The RCS showed there were non-linear association between daytime napping and cognitive impairment in all participants group and longer nighttime sleep duration subgroup (P_Non-linear < 0.05, P_{Daytime napping} < 0.05). The LRM revealed no napping (OR = 1.62, 95%CI 1.14–2.30) and excessive napping (1.64 95%CI 1.09–2.48) were related to cognitive impairment in longer nighttime sleep duration subgroup.

Conclusions: Daytime napping had nonlinear association with cognitive impairment in Chinese elderly population. No napping and excessive daytime napping (>90 minutes) were related to cognitive impairment in participants with 7 and more hours nighttime sleep duration.

Background: No study has examined the association between constipation and atopic dermatitis (AD) in infants and toddlers. We aimed to explore that association in toddlers using the data from a nationwide birth cohort study.

Methods: From the Japan Environment and Children’s Study, a nationwide prospective birth cohort study that began in 2011, children born in a singleton live birth were analyzed. Participants completed questionnaires containing questions related to bowel movements and AD, during 1.5 to 3 years after birth. Constipation at 1 year of age was defined as having ≤2 bowel movements per week. AD was defined based on participant’s responses to the modified ISAAC questionnaire and/or self-reported physician’s diagnosis. Outcome was defined as the cumulative number of AD cases that occurred until 3 years of age. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for development of AD were calculated by a multivariable logistic regression.

Results: From a total of 62,777 participants who met the study inclusion criteria, 14,188 children (22.6%) were affected by AD between the ages of 1.5 and 3 years. The adjusted OR of developing AD for the presence versus absence of constipation at 1 year of age was 1.18 (95% CI, 1.01–1.38).

Conclusion: Constipation at 1 year of age was associated with a slightly higher risk of AD until 3 years of age.

Background: To analyze the prevalence and spatial-temporal characteristics of severe fever with thrombocytopenia syndrome (SFTS), clustering mode of transmission, and the serological dynamic detection results in multiple areas in Hefei from 2015 to 2021, and to provide the basis for SFTS prevention and control.

Method: Case data were obtained from the Chinese Disease Control and Prevention Information System. Information on the clustering outbreak was obtained from the outbreak investigation and disposal report. Population latent infection rate information was obtained from field sampling in multiple-incidence counties in 2016 and 2021 by multi-stage random sampling. Epi data3.2 and SPSS 16.0 softwares were used to perform a statistical analysis of the data on SFTS cases, and QGIS 3.26 software was used to draw the incidence map with township (street) as unit.

Results: The an average annual reported incidence rate of SFTS in Hefei from 2015 to 2021 was 0.65/100,000, and the case fatality rate was 9.73%. The overall prevalence of SFTS epidemics in Hefei City showed a fluctuating upward trend from 2015 to 2021 (χ²trends = 103.353, P < 0.001). Chaohu City, Feixi County, Feidong County and Lujiang County ranked the top 4 in the city in terms of average annual incidence rate. The number of epidemic-involved towns (streets) kept increasing ((χ²_trend = 47.640, P = 0.000)). Co-exposure to ticks accounted for the majority of clustered outbreaks and also human-to-human outbreaks. Population-based latent infection rate surveys were conducted in four SFTS multi-incidence counties, with 385 people surveyed in 2016 and 403 people surveyed in 2021, increasing the population-based latent infection rate from 6.75% to 10.91%, just as the incidence rate increased.

Conclusions: The incidence rate of SFTS in Hefei is obviously regional, with an expanding trend in the extent of the epidemic involved. Co-exposure to ticks accounted for the majority of clustered outbreaks and the latent infection rate cannot be ignored.

Background: In this study, we aimed to investigate the effects of acute and chronic resistance training of varying intensities on molecular responses and their association with muscular fitness in a cohort of young males who participated in this intervention study.

Methods: Young males (19–28 years) with no prior training experience underwent a six-week program consisting of two distinct modalities of resistance training. The participants were randomly divided into a functional resistance training group (FRT; n = 9; participants performed 4–5 sets of 20 repetitions maximum (RM) at 40% 1RM) or a traditional resistance training group (TRT; n = 9; participants performed 4–5 sets of 12 RM at 70% 1RM). Both protocols entailed training three days per week for six weeks. Blood samples were obtained before, immediately after an acute bout of training, and after the six-week training program to determine alterations in molecular responses. Muscular fitness analysis and anthropometric measurements were conducted before and after the six-week training program.

Results: After the six-week training program, the lean body mass of participants in both TRT and FRT groups was significantly increased (p < 0.05), whereas body fat percentage and fat mass were significantly decreased solely in the FRT group (p < 0.05). All muscular fitness variables were significantly increased in both groups (p < 0.01), with no difference between the two groups. Additionally, in the TRT group, serum levels of AMP-activated protein kinase (AMPK) were significantly increased following acute training and six weeks of resistance training, whereas in the FRT group, no significant increase in serum levels of AMPK was observed. In both groups, serum levels of peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α), irisin, and insulin-like growth factor-1 were significantly increased. Moreover, myostatin was significantly decreased following acute training and six weeks of resistance training (p < 0.05), with no difference between the two groups. Furthermore, a significant correlation was observed between barbell back squat and certain molecular variables.

Conclusions: Overall, our study indicates that acute and chronic resistance training of varying intensities are effective changing molecular responses, the chronic FRT and TRT improve muscular fitness in young males through the AMPK/PGC-1α/irisin signaling pathway.

Trial registration: Chinese Clinical Trial Registry: ChiCTR2200059775 (11/05/2022).

Background: Existing researches have established a correlation between internet search data and the epidemics of numerous infectious diseases. This study aims to develop a prediction model to explore the relationship between the Pulmonary Tuberculosis (PTB) epidemic trend in China and the Baidu search index.

Methods: Collect the number of new cases of PTB in China from January 2011 to August 2022. Use Spearman rank correlation and interaction analysis to identify Baidu keywords related to PTB and construct a PTB comprehensive search index. Evaluate the predictive performance of autoregressive integrated moving average (ARIMA) and ARIMA with explanatory variable (ARIMAX) models for the number of PTB cases.

Results: Incidence of PTB had shown a fluctuating downward trend. The Spearman rank correlation coefficient between the PTB comprehensive search index and its incidence was 0.834 (P < 0.001). The ARIMA model had an AIC value of 2804.41, and the MAPE value was 13.19%. The ARIMAX model incorporating the Baidu index demonstrated an AIC value of 2761.58 and a MAPE value of 5.33%.

Conclusions: The ARIMAX model is superior to ARIMA in terms of fitting and predicting accuracy. Additionally, the use of Baidu Index has proven to be effective in predicting cases of PTB.

Background: The negative association of quality of life (QoL) and negative life evens (NLEs) among adolescents has been proved by cross-sectional studies, without exploring sex differences. This study aimed to explore the longitudinal associations between QoL and NLEs among adolescents during novel coronavirus disease 2019 (COVID-19) pandemic and whether there are sex or age differences.

Methods: A stratified cluster sampling was used to select 1421 students in primary school and middle school in Chongqing, China. From November 2020 (T0) to December 2021 (T2), the Adolescent Self-Rating Life Events Checklist and the Adolescent Quality of Life Scale were used to collect 3 waves of data. The correlations between study variables were conducted by the Pearson correlation analyses. The direction and strength of the longitudinal associations were analyzed using cross-lagged panel analyses.

Results: Results showed significant changes in both variables during COVID-19 pandemic (P < 0.001). Cross-sectional analyses showed stable negative correlations between NLEs and QoL stratified by sex or by age (P < 0.001). Sex and age differences in longitudinal relationships were shown by cross-lagged panel analyses. For males, NLEs had a short-term bi-directional association with QoL [β_A–D = −(0.091–0.340), P < 0.05]; for females, QoL had a short-term correlation with NLEs [β_A = −0.119), β_C = −0.109), P < 0.001]. In the youngest age group, NLEs had a short-term bi-directional correlation with QoL [β_A–D = −(0.098–0.428), P < 0.05]. There was a short-term association between total QoL and NLEs among students except the 14∼15 year group [β_A = −(0.071–0.149), β_C = −(0.086–0.119), P < 0.05], the long-term association between total QoL and NLEs was only significant in adolescents aged 14∼15 years (β_E = −0.132, P < 0.05). The strength of NLEs was slightly higher than that of total QoL, but lower than that of QoL in each dimension.

Conclusion: There were negative longitudinal relationships between NLEs and QoL during COVID-19 pandemic, and the strength of the associations varied across sex or age. Strengthening QoL in different dimensions may be a promising way to reduce NLEs during the pandemic among adolescents, and interventions should be tailored according different sex and ages.

Background: Resistant hypertension (RHTN), a clinically complex condition with profound health implications, necessitates considerable time and allocation of medical resources for effective management. Unraveling the environmental risk factors associated with RHTN may shed light on future interventional targets aimed at reducing its incidence. Exposure to heavy metal has been linked to an increased risk of hypertension, while the relationship with RHTN remains poorly understood.

Methods: Using the 1999–2018 National Health and Nutrition Examination Survey (NHANES) data, we examined the association of blood lead (Pb), cadmium (Cd), and mercury (Hg) with RHTN using a multinomial logistic regression model. The combined effects of the metals and the contribution of each metal were assessed using a weighted quantile sum (WQS) analysis.

Results: A total of 38281 participants were included in the analysis. Compared with no resistant hypertension (NRHTN), per 1 µg/dL increase in blood Pb concentration, the proportion of RHTN increased by 16% [adjusted odds ratio (aOR), 1.16; 95% confidence interval (CI) 1.01–1.32]. When analyzed by quartiles (Q), the aOR [95% CI] for Pd was 1.30[1.01,1.67] (Q4 vs. Q1); there was a significant dose-response relationship (p < 0.05). Likewise, as a continuous variable, each 1 µg/dL increase in blood Cd level was associated with a 13% increase in the proportion of RHTN (aOR: 1.13; 95%CI: [1.00,1.27]); when analyzed as quartile, aOR [95% CI] for Cd were 1.30[1.01,1.69] (Q3 vs. Q1), and 1.35[1.03,1.75] (Q4 vs. Q1); the dose-response relationship was significant (p < 0.05). WQS analysis showed a significant combined effects of Pb, Cd, and Hg on RHTN, with Pb as the highest weight (0.64), followed by Cd (0.25) and Hg (0.11). Stratified analysis indicated that the associations for the two heavy metals were significant for participants who were male, ≼ 60 years old, and with kidney dysfunction.

Conclusion: Findings of this study with national data provide new evidence regarding the role of environmental heavy metal exposure in RHTN. The prevention strategies aimed at reducing heavy metal exposure should particularly focus on Americans who are middle-aged, male, and afflicted with kidney dysfunction.

Background: This study aimed to examine population-based characteristics of non-fatal self-harm in an urban area during pre- and peri-pandemic periods of COVID-19 by sex, age, and severity of self-harm, using pre-hospital medical emergency records.

Methods: We used a registry of all pre-hospital medical records of self-harm cases that occurred in Kawasaki City, Japan, between January 2018 and December 2021. Adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated using Poisson regression models with the log-transformed population by year, sex, age group, and ward as an offset term.

Results: During the 4-year study period, 1,534 patients were transported by ambulance due to non-fatal self-harm and were alive on arrival at the hospital. Among women, the number of non-fatal self-harm cases increased by 1.2-fold in 2021 compared with that in 2018. The incidence rate of “severe” non-fatal self-harm among men aged 19 years or younger in 2021 (IRR 4.82, 95% CI 1.25–18.65) and that among women aged 50–59 years in 2020 (IRR 2.51, 95% CI 1.06–5.95) significantly increased compared with that 2018 and 2019. The incidence rate of “mild” self-harm among women aged 20–29 years tended to be higher in 2021 than in 2018 and 2019 (IRR 1.42, 95% CI 0.95–2.12, P = 0.085).

Conclusions: During the peri-pandemic period of COVID-19, the incidence rate of “severe” non-fatal self-harm among men aged 19 years or younger and women aged 50–59 years, as well as that of “mild” self-harm among women aged 20–29 years, sharply increased compared with that during the pre-pandemic period. Our findings suggest that in urban areas during public health crises such as a pandemic, it is important to take measures to reduce the risk of non-fatal self-harm in young women, in addition to strengthening counseling and support for young women at risk for completed suicide.

Background: The risk of low back pain (LBP) increases steeply during adolescence, and adolescents with LBP are more likely to have low back pain in their adult years. This study aimed to investigate the dose-response relationship between daily screen time and the risk of low back pain among children and adolescents.

Methods: PubMed, the Cochrane Library, Embase, and Web of Science were searched to collect relevant studies on daily screen time and the risk of low back pain from the establishment of the database up to December 2022. Two investigators independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. Stata16.0 was used to perform a dose-response meta-analysis and the methodological quality evaluation of the included studies.

Results: The results of the meta-analysis showed that there is a positive correlation between daily computer time (OR = 1.32, 1.05–1.60), daily mobile phone time (OR = 1.32, 1.00–1.64), daily TV watching (OR = 1.07, 1.04–1.09) and the risk of low back pain, separately. The dose–response meta-analysis showed that there is a linear relationship between daily computer use and low back pain. The risk of low back pain increased by 8.2% for each 1-hour of daily computer use.

Conclusions: Screen time is related to the risk of low back pain, and there is a linear relationship between daily computer use and the risk of low back pain. A number of strategic measures should be taken to prevent adolescents from developing severe low back pain.

Background: Zinc absorption and competition among gut bacteria have been reported in animal studies. Thus, gut bacteria may modify zinc availability in humans. Metabolism of intestinal bacteria is known to be necessary for the activation of several phytoconstituents in the body. For example, equol, a typical substance of soybean isoflavone, is produced by intestinal bacteria metabolizing daidzein and the enterotype is one of distinct ones among Japanese population. The difference in the intestinal microflora can modify the bioavailability of zinc. In this study, we examined urinary zinc concentrations in adult female equol producers (EQPs).

Methods: Urine samples from women participating in health examinations in Miyagi, Okinawa, Kyoto, Kochi, and Hokkaido prefectures were used; from total 17,484 samples, approximately 25 samples were randomly selected for each age group from 30 to 60 years per region (subsample: n = 520), and 520 samples with available urinary zinc concentration (determined by flame atomic absorption analysis) and enterobacterial type were analyzed. EQP was defined as log(equol/daidzein) ≥ −1.42, and urinary concentrations were corrected for creatinine concentration. Urinary zinc concentrations were compared by Student’s t-test and multiple regression analyses.

Results: The geometric mean urinary zinc concentration (µg/g-Cr) was lower in EQP than in non-EQP (p = 0.0136 by t-test after logarithm transformation). On the other hand, there was no correlation between urinary zinc concentration with daidzein (r = −0.0495, P = 0.436) and equol concentrations (r = −0.0721, P = 0.256). There was a significant negative association between urinary zinc concentration and EQP (β = −0.392, P = 0.0311) after adjusting with other potential confounding variables, such as daidzein intake.

Conclusions: The results suggest that gut bacteria that produce equol are involved in the metabolism of zinc. Based on previous studies, the bacteria that affect the metabolism of both substances are thought to be Enterococcus. Future studies are expected to identify specific intestinal bacteria for zinc availability and understand individual differences in the effects of micronutrients.

Background: Atherosclerotic cardiovascular disease (ASCVD) is a major cause of morbidity and mortality. Life satisfaction is a measure of mental health with a potential cardioprotective role. This study aimed to investigate the association between life satisfaction and ASCVD risk in the general Japanese population.

Method: We used data from 6,877 people (30–84 years) registered in the Suita Study, a Japanese population-based prospective cohort study. All participants were free from stroke and coronary heart disease (CHD) at baseline. Then, participants were followed up for incident ASCVD, including cerebral infarction and CHD. Cox proportional hazards models were used to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) of incident ASCVD according to life satisfaction.

Results: Within 102,545 person-years (median follow-up = 16.6 years), 482 incident ASCVD events were identified. In the age- and sex-adjusted model, being very satisfied, rather satisfied, or not sure, compared to being dissatisfied with life, showed a lower risk of ASCVD: HR (95% CI) = 0.55 (0.41, 0.74), 0.67 (0.50, 0.89), and 0.57 (0.36, 0.88), respectively (p-trend < 0.001). The associations remained consistent after adjusting for stress and unfortunate events: HR (95% CI) = 0.57 (0.42, 0.77), 0.68 (0.50, 0.91), and 0.54 (0.35, 0.84), respectively (p-trend < 0.001). The results did not vary between cerebral infarction and CHD: HR (95% CI) for being very satisfied with life = 0.58 (0.37, 0.91) and 0.55 (0.36, 0.84), respectively.

Conclusion: Life satisfaction was inversely associated with the risk of ASCVD in the investigated general Japanese population.

Background: We previously developed risk models predicting stroke, coronary heart disease (CHD), and cardiovascular disease (CVD) among Japanese people from the Suita Study. Yet, applying these models at the national level was challenging because some of the included risk factors differed from those collected in the Japanese governmental health check-ups, such as Tokutei-Kenshin. We, therefore, conducted this study to develop new risk models for stroke, CHD, and atherosclerotic CVD (ASCVD), based on data from the Suita Study. The new models used traditional cardiovascular risk factors similar to those in the Japanese governmental health check-ups.

Methods: We included 7,413 participants, aged 30–84 years, initially free from stroke and CHD. All participants received baseline health examinations, including a questionnaire assessing their lifestyle and medical history, medical examination, and blood and urine analysis. The risk factors of stroke, CHD, and ASCVD (cerebral infarction or CHD) were determined using the multivariable-adjusted Cox regression. The models’ performance was assessed using the C-statistics for discrimination and the Hosmer-Lemeshow for calibration. We also developed three simple scores (zero to 100) that could predict the 10-year incidence of stroke, CHD, and ASCVD.

Results: Within 110,428 person-years (median follow-up = 16.6 years), 410 stroke events, 288 CHD events, and 527 ASCVD events were diagnosed. Age, smoking, hypertension, and diabetes were associated with stroke, CHD, and ASCVD risk. Men and those with decreased high-density lipoproteins or increased low-density lipoproteins showed a higher risk of CHD and ASCVD. Urinary proteins were associated with an increased risk of stroke and ASCVD. The C-statistic values of the risk models were >0.750 and the p-values of goodness-of-fit were >0.30. The 10-year incidence of stroke, CVD, and ASCVD events was 3.8%, 3.5%, and 5.7% for scores 45–54, 10.3%, 11.8%, and 19.6% for scores 65–74, and 27.7%, 23.5%, and 60.5% for scores ≥85, respectively.

Conclusions: We developed new Suita risk models for stroke, CHD, and ASCVD using variables similar to those in the Japanese governmental health check-ups. We also developed new risk scores to predict incident stroke, CHD, and ASCVD within 10 years.

Background: Stair climbing is a readily available form of physical activity with potential cardioprotective merits. Herein, we investigated the association between stair climbing and atherosclerotic cardiovascular disease (ASCVD) incidence among Japanese people.

Methods: This prospective cohort study used data from 7,282 participants, aged 30–84 years, registered in the Suita Study and free from stroke and ischemic heart disease (IHD). Standard approaches were used to detect incident ASCVD events, including cerebral infarction and IHD, during follow-up. Stair climbing was assessed using a baseline questionnaire. We applied the Cox regression to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of incident ASCVD for climbing stairs in 20–39%, 40–59%, and ≥60% compared to <20% of the time. We adjusted the regression models for age, sex, body mass index, smoking, alcohol consumption, physical activity, hypertension, diabetes, atrial fibrillation, lipid profile, chronic kidney disease, and history of cardiac murmur or valvular diseases.

Results: A total of 536 new ASCVD events were detected within a median follow-up period of 16.6 years. In the age- and sex-adjusted model, stair climbing 20–39%, 40–59%, and ≥60% of the time was associated with lower ASCVD incidence: HRs (95% CIs) = 0.72 (0.56, 0.92), 0.86 (0.68, 1.08), and 0.78 (0.61, 0.99), respectively (p-trend = 0.020). The corresponding associations were attenuated after adjusting for lifestyle and clinical factors: HRs (95% CIs) = 0.74 (0.58, 0.95), 0.90 (0.71, 1.13), and 0.89 (0.69, 1.13), respectively (p-trend = 0.152).

Conclusion: Frequent stair climbing was associated with lower ASCVD incidence; however, this association was partly explained by lifestyle and clinical factors of participants.

Background: Resveratrol is a polyphenolic phytoalexin which has the properties of anti-oxidant, anti-inflammatory and anti-fibrotic effects. The aim of this study was to investigate the anti-fibrotic effects of resveratrol in primary human pterygium fibroblasts (HPFs) and elucidate the underlying mechanisms.

Method: Profibrotic activation was induced by transforming growth factor-beta1 (TGF-β1). The expression of profibrotic markers, including type 1 collagen (COL1), α-smooth muscle actin (α-SMA), and fibronectin, were detected by western blot and quantitative real-time-PCR after treatment with various concentrations of resveratrol in HPFs to investigate the anti-fibrotic effects. Relative signaling pathways downstream of TGF-β1 were detected by Western blot to assess the underlying mechanism. Cell viability and apoptosis were assessed using CCK-8 assay and flow cytometry to evaluate proliferation and drug-induced cytotoxicity. Cell migration and contractile phenotype were detected through wound healing assay and collagen gel contraction assay.

Results: The expression of α-SMA, FN and COL1 induced by TGF-β1 were suppressed by treatment with resveratrol in dose-dependent manner. The Smad3, mitogen-activated protein kinase (p38 MAPK) and phosphatidylinositol-3-kinase (PI3K) / protein kinase B (AKT) pathways were activated by TGF-β1, while resveratrol attenuated those pathways. Resveratrol also inhibited cellular proliferation, migration and contractile phenotype, and induced apoptosis in HPFs.

Conclusions: Resveratrol inhibit TGF-β1-induced myofibroblast activation and extra cellular matrix synthesis in HPFs, at least partly, by regulating the TGF-β/Smad3, p38 MAPK and PI3K/AKT pathways.

Background: Underage drinking is a public health concern. However, few studies have examined the association between alcoholic beverage advertising and underage drinking, particularly in countries with low underage drinking rates, such as Japan. Therefore, we aimed to investigate the relationship between exposure to advertising in various media and alcohol drinking among Japanese adolescents.

Methods: We conducted a cross-sectional study involving 15,683 adolescents (51% girls) using data from a nationwide lifestyle survey in 2021 among junior and senior high schools across Japan. Media types were websites, stores, and public transportation. We defined current drinking as alcohol consumption of ≥1 day in the 30 days preceding the survey. Multivariable logistic regression was used to examine the association between exposure to alcohol advertisements and current drinking, adjusting for sex, grades, school area, lifestyle (bedtime and having fun at school), and addictive behaviors (smoking status and parents’ alcohol consumption).

Results: The prevalence of current drinking was 2.2% (2.3% of boys and 2.0% of girls). Students who were exposed to any alcohol advertising media had higher odds of current drinking compared with those who were not (odds ratio, 1.48; 95% confidence interval [CI], 1.18–1.87). Students who were exposed to web, in-store, and public transportation advertisements had odds ratios of 1.44 (95% CI, 1.14–1.81), 1.62 (1.28–2.05), and 1.45 (1.06–1.98) of current drinking, respectively, compared with those who were not. The association of exposure to alcohol advertising media with the prevalence of current drinking was similar among boys and girls (all p for sex interaction >0.1), except for that of exposure to web advertisements; its association with current drinking was more pronounced in girls (p for sex interaction = 0.046). Exposure to a larger cumulative number of different alcohol advertising media was independently associated with a higher prevalence of current drinking among all students, boys, and girls (p-values for trend <0.001, 0.031, and <0.001, respectively; p for sex interaction = 0.085).

Conclusions: We found an association with a dose-response relationship between exposure to alcohol advertisements and current drinking among adolescents in junior and senior high schools across Japan. Our findings highlight the need for further advertising regulations to prevent underage drinking.

Background: This cross-sectional study aimed to identify the accumulation patterns of objectively measured ambulatory activity (AA) variables in the Japanese middle-aged and elderly individuals and examine the relationship of these derivative patterns with metabolic syndrome (MetS).

Methods: A total of 1850 participants (66.1% women, mean age: 57.7 years) provided objectively assessed AA data using a uniaxial accelerometer. The number of steps, time accumulated in light-intensity AA (LIAA) and moderate-to-vigorous intensity AA (MVAA), and the ratio of MVAA to total AA (LIAA + MVAA) were calculated. Latent profile analysis was used to identify groups of participants based on their distinct AA patterns. Logistic regression models were used to assess the association of groups with MetS after adjusting for age, sex, alcohol intake, and cigarette smoking.

Results: Four distinct groups were identified: Group A had few steps and low levels of LIAA and MVAA; group B had a certain number of steps and recommended level of MVAA but low level of LIAA; group C had a certain number or more of steps, high level of LIAA, and recommended level of MVAA; group D had an extremely high number of steps and high levels of both LIAA and MVAA. The multivariate-adjusted odds ratio (95% CI) for MetS in groups B, C, and D relative to group A were 0.857 (0.611–1.201), 0.679 (0.500–0.922), and 0.434 (0.259–0.730), respectively. Groups C and D had significantly lower odds ratio of MetS compared to group A.

Conclusion: AA pattern involving a certain number or greater of steps accumulated through not only MVAA but also LIAA may help reduce the risk of MetS compared to inactive AA pattern.

Background: Postpartum smoking relapse is a serious public health concern. Previous studies have identified several risk factors for postpartum smoking relapse; however, very little is known about the predictors of early postpartum smoking relapse. This study aimed to determine postpartum smoking relapse status and its associated risk factors at 1 month postpartum among Japanese women.

Methods: Data were obtained from 93,851 mothers with live births in an ongoing birth cohort study, the Japan Environment and Children’s Study. Data on smoking status and confounding variables were collected using self-administered questionnaires and medical record transcripts. Self-administered questionnaires were administered during the first trimester, second/third trimester, and 1 month after delivery. A multiple logistic regression analysis was performed.

Results: Among the 14,326 mothers who smoked during pregnancy, 10,917 (76.2%) quit smoking during pregnancy. Subsequently, 617 (5.7%) of the mothers who had quit relapsed smoking at 1 month postpartum. Maternal age (≤24, ≥35), maternal education (≤12 years), parity (≥Second), feeding method (Formula milk), partner smoking status during pregnancy (Smoker), number of cigarettes per day before the cessation of smoking (≥11), maternal alcohol consumption at 1-month postpartum (Drinker), postpartum depression (EPDS score ≥9), and spending time at the parents’ home after delivery (≥14 days) were associated with smoking relapse.

Conclusions: A certain number of mothers relapsed even 1 month postpartum. Besides mother's alcohol and smoking habit before pregnancy, breastfeeding and partner smoking are important factors in early postpartum smoking relapse in Japan.

Background: Adolescent idiopathic scoliosis (AIS) is the most common type of idiopathic scoliosis, affecting approximately 0.61%–6.15% adolescents worldwide. To date, the results on the relationship between moderate-to-vigorous physical activity (MVPA) and AIS were inconsistent, and the association between screen time (ST) and AIS remained unclear. This study aimed to describe MVPA and ST among adolescents, and to explore the independent and joint associations between PA, ST, and AIS.

Methods: A frequency-matched case-control study based on the 2021 Chinese School-based Scoliosis Screening Program in Shenzhen city, south China, was conducted. The research involved 494 AIS patients (aged 9–17 years) and 994 sex- and age-matched healthy controls. MVPA and ST were measured using a self-administered questionnaire. Logistic regression models estimated associations between PA, ST, and AIS.

Results: Compared to subjects meeting the recommended 60-min daily of MVPA, adolescents reporting daily MVPA time less than 60 min had 1.76 times higher odds of experiencing AIS (95% CI: 1.32–2.35) and adolescents reporting daily MVPA in inactive status had 2.14 times higher odds of experiencing AIS (95% CI: 1.51–3.03). Moreover, participants reporting ST for 2 hours or more had 3.40 times higher odds of AIS compared with those reporting ST less than 2 hours (95% CI: 2.35–4.93). When compared with the adolescents reporting both ST and MVPA meeting the guidelines recommended times (ST < 2 h and MVPA ≥ 60 min/day), those reporting both ST ≥ 2 h and MVPA in inactive status are 8.84 times more likely to develop AIS (95% CI: 3.99–19.61).

Conclusions: This study reported that the insufficient MVPA, especially MVPA in inactive status, and excessive ST were risk factors for AIS. Additionally, the joint effects of insufficient MVPA and excessive ST probably increase the risk of AIS.

Background: Recent advances have been achieved in the genetic diagnosis and therapies against malignancies due to a better understanding of the molecular mechanisms underlying carcinogenesis. Since active preventive methods are currently insufficient, the further development of appropriate preventive strategies is desired.

Methods: We searched for drinks that reactivate the functions of tumor-suppressor retinoblastoma gene (RB) products and exert anti-inflammatory and antioxidant effects. We also examined whether lactic acid bacteria increased the production of the cancer-specific anti-tumor cytokine, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), in human, and examined whether the RB-reactivating drinks with lactic acid bacteria decreased azoxymethane-induced rat colon aberrant crypt foci (ACF) and aberrant crypts (ACs) in vivo.

Results: Kakadu plum juice and pomegranate juice reactivated RB functions, which inhibited the growth of human colon cancer LIM1215 cells by G1 phase arrest. These juices also exerted anti-inflammatory and antioxidant effects. Lactiplantibacillus (L.) pentosus S-PT84 was administered to human volunteers and increased the production of TRAIL. In an in vivo study, Kakadu plum juice with or without pomegranate juice and S-PT84 significantly decreased azoxymethane-induced rat colon ACF and ACs.

Conclusions: RB is one of the most important molecules suppressing carcinogenesis, and to the best of our knowledge, this is the first study to demonstrate that natural drinks reactivated the functions of RB. As expected, Kakadu plum juice and pomegranate juice suppressed the growth of LIM1215 cells by reactivating the functions of RB, and Kakadu plum juice with or without pomegranate juice and S-PT84 inhibited rat colon ACF and ACs. Therefore, this mixed juice has potential as a novel candidate for cancer prevention.

Background: Students and workers have been subjected to increased levels of psychological distress due to the quarantine policy and containment measures during the COVID-19 pandemic. This scoping review aimed to present an overview of published evidence regarding formal and informal help-seeking intentions/behaviors for non-mental health-related issues as well as mental health-related issues among students and workers during the pandemic.

Methods: In June 2022, we searched MEDLINE, APA PsycNet, and CINAHL for articles reporting the state of help-seeking intentions/behaviors among students and workers during the pandemic. Peer-reviewed original articles published in English were selected.

Results: In total, 150 articles were identified, and 12 articles were selected for final analysis after removing articles that met the exclusion criteria. Three studies targeted university students, and nine targeted healthcare workers. Study settings were restricted to Western countries and China. Of the 12 studies, 11 were observational and predominantly cross-sectional studies. Two longitudinal studies using student samples suggested that university students became more reluctant to seek help from both formal and informal sources during the COVID-19 pandemic compared to before, despite the increased need for support during the pandemic. Among healthcare workers, the proportions of those who sought help from formal sources in person were low (7–26%), even among those with mental health issues, despite the increase in the need for mental health services. One randomized controlled study reported that a brief video-based intervention increased treatment-seeking intentions among healthcare workers in the intervention group compared with the non-intervention group.

Conclusions: The present review revealed that, although most studies included in the final analysis were cross-sectional, intentions/behaviors to seek help from both formal and informal sources decreased among university students, even those with mental health issues. Among healthcare workers, while the frequency of help-seeking from formal sources in person was low, a brief online intervention was suggested to be useful for promoting help-seeking from formal sources. During public health crises such as the COVID-19 pandemic, system and infrastructure development of online help-seeking services could potentially promote formal and informal help-seeking intentions/behaviors for diverse issues, including non-mental health-related issues, among university students and healthcare workers/providers.

Background: To examine workplace factors associated with willingness to undergo human immunodeficiency virus (HIV) testing during workplace health checkups.

Methods: This cross-sectional study used an Internet-based self-administered questionnaire to obtain data from a pool of 24,287 Japanese workers. Binary and multiple logistic regression analyses evaluated the association between workplace factors and HIV testing. Data were adjusted for sex, age, marital status, education, and history of HIV testing.

Results: We gathered information from 4,143 (17.1%) respondents, of whom 1,129 (27.3%) were willing to be tested for HIV as part of a workplace health checkup. The participants were 20–59 years old. Approximately half of the participants were male (49.9%), half were married (48.9%), and half had completed higher education (47.6%). Workplace hepatitis testing was offered to 15.6% of the respondents, and most participants underwent health checkups without their colleagues (52.1%) at a medical facility (60.2%). Willingness to undergo HIV testing was positively correlated with having an increased risk of occupational blood exposure (vs. not at risk, adjusted odds ratio [OR]: 1.74, 95% confidence interval [CI]: 1.41–2.15) or working in medical and welfare roles (vs. manufacturing, OR: 1.40, 95% CI: 1.07–1.84). The presence of occupational health staff at the workplace (vs. their absence, adjusted OR: 1.35, 95% CI: 1.16–1.59) and hepatitis testing (vs. not testing, adjusted OR: 2.02, 95% CI: 1.66–2.44) increased willingness to undergo HIV testing.

Conclusions: A pilot HIV-testing program involving individuals at an increased risk of occupational blood exposure and undergoing hepatitis tests in workplaces providing occupational health staff support is recommended.

Background: Long-term exposure to PM_2.5 from burning domestic substances has been linked to an increased risk of lung disease, but the underlying mechanisms are unclear. This study is to explore the hub genes and pathways involved in PM_2.5 toxicity in human bronchial epithelial BEAS-2B cells.

Methods: The GSE158954 dataset is downloaded from the GEO database. Differentially expressed genes (DEGs) were screened using the limma package in RStudio (version 4.2.1). In addition, DEGs analysis was performed by Gene Ontology (GO) functional analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. A protein-protein interaction (PPI) network was constructed, MCODE plug-in and the cytoHubba plug-in in Cytoscape software was used to identify the hub genes. Finally, CytoHubba and DEGs were used to integrate the hub genes, and preliminary validation was performed by comparing the toxicology genomics database (CTD). Differential immune cell infiltration was investigated using the CIBERSORT algorithm.

Results: A total of 135 DEGs were identified, of which 57 were up-regulated and 78 were down-regulated. Functional enrichment analyses in the GO and KEGG indicated the potential involvement of DEGs was mainly enriched in the regulation of endopeptidase activity and influenza A. Gene Set Enrichment Analysis revealed that Chemical Carcinogenesis - DNA adducts were remarkably enriched in PM_2.5 groups. 53 nodes and 198 edges composed the PPI network. Besides, 5 direct-acting genes were filtered at the intersection of cytohubba plug-in, MCODE plug-in and CTD database. There is a decreasing trend of dendritic cells resting after BEAS-2B cells long-term exposure to PM_2.5.

Conclusions: The identified DEGs, modules, pathways, and hub genes provide clues and shed light on the potential molecular mechanisms of BEAS-2B cells upon long-term exposure to PM_2.5.

Background: Dengue fever is a viral infection transmitted to humans through the bite of a mosquito infected with the dengue virus. Dengue is one of the most common infectious diseases in the world, and its incidence is rapidly increasing. We estimated the risk of dengue importation from endemic countries to Japan and the transmission risk within Japan using data collected between 2016 and 2018.

Methods: We conducted simulations that included the number of reported dengue infections and travelers per month in ten countries in Southeast and South Asia.

Results: The estimated importation risks for Japanese returnees and international travelers from each of the ten endemic countries was approximately 1.0 every month from 2016 to 2018. The autochthonous transmission risk in Japan from any target country was 1.0 from June to September yearly. The estimated number of Japanese dengue cases returning to Japan is approximately 25 times higher than that of imported cases reported in Japan.

Conclusions: The risk of dengue importation into Japan can be sufficiently high. Attention should be paid to autochthonous transmission spread between June and September when mosquitoes are active in Japan. Estimates of seasonal risk variation from each dengue virus-endemic country can be used to inform preventive and control measures for dengue in Japan.

Background: Itai-itai disease is caused by environmental cadmium (Cd) pollution in the Jinzu River basin in Japan. To reduce the Cd contamination of rice, soil restoration of paddy fields was carried out. We evaluated the effect of soil restoration on the health status of residents of the former Cd-polluted area.

Methods: Participants were 1,030 men and 944 women who lived in the area of restoration of Cd-polluted rice paddies. First morning urine was collected and urinary Cd, β2-microglobulin (β2MG), and N-acetyl-β-D-glucosaminidase (NAG) levels were measured. Associations among age, years of residence before and after soil restoration, and urinary Cd, β2MG, and NAG levels were evaluated by multiple regression analysis.

Results: The geometric mean (interquartile range) of urinary Cd (µg/g Cr) was 1.00 (0.58–1.68) in men and 1.67 (1.02–2.91) in women. The geometric means of urinary β2MG (µg/g Cr) and NAG (U/g Cr) were 174.6 (92.6–234.2) and 1.47 (0.72–3.14) in men, and 217.6 (115.3–28.7) and 1.48 (0.73–2.96) in women, respectively. Urinary Cd, β2MG, and NAG were significantly positively correlated (p < 0.01 all). Age and duration of residence in the Cd-polluted area before soil restoration were independently associated with urinary Cd, β2MG, and NAG. Among the 916 participants who had resided in the area before the soil restoration, urinary Cd concentrations were significantly higher, thus by 1.03-fold (95% CI, 1.01–1.04) in men and 1.03-fold (95% CI, 1.01–1.05) in women, when the years of residence before soil restoration by each 5-years increment. By contrast, urinary Cd concentrations were significantly lower, thus 0.97-fold (95% CI, 0.96–0.99) lower in men and 0.97-fold (95% CI, 0.95–0.99) lower in women, by each 5-year increment of residence after soil restoration. A similar association was observed for urinary β2MG concentration, and no significant association was observed for urinary NAG levels in men or women.

Conclusions: Cd exposure and associated renal tubular dysfunction in residents of a former Cd-polluted area were influenced by Cd exposure from the environment prior to soil restoration. Soil restoration in Cd-polluted areas reduced the Cd exposure of local residents.

Background: The effect of ambient PM_2.5 on the incidence of tuberculosis (TB) has been investigated in epidemiological studies. However, they did not separately study new and relapsed TB infection and focused on relatively short-term effects of PM_2.5. In this regard, we examined the associations of long-term PM_2.5 exposures with both new and relapsed TB incidences in South Korea, where the disease burden of TB is greatest among high-income countries.

Methods: An area-level ecological study of 250 districts was conducted from 2015 to 2019. Age- and sex-standardized TB incidence ratios for each district and year were used as outcome variables, and their associations with PM_2.5 concentrations for one to five-year average were examined. Negative binomial regression models incorporating spatiotemporal autocorrelation were employed using integrated nested Laplace approximations. Stratified analyses were conducted by type of TB (total, new, and relapsed cases).

Results: Districts with higher PM_2.5 concentrations tended to have significantly higher TB recurrence rate. The relative risks per 10 µg/m³ PM_2.5 increase were 1.218 (95% credible interval 1.051–1.411), 1.260 (1.039–1.527) and 1.473 (1.015–2.137) using the two, three and five-year average PM_2.5 exposures, respectively.

Conclusions: The results imply that interventions for reducing air pollution might help prevent TB recurrence.

Background: Fish are a rich source of essential nutrients that protect against preterm birth. However, as fish can absorb environmental pollutants, their consumption can also increase the risk of preterm birth. This study aimed to assess whether maternal fish consumption during pregnancy is associated with preterm birth in a nationwide large Japanese cohort that consumed relatively high amounts and many types of fish.

Methods: This study included 81,428 mother-child pairs enrolled in a nationwide prospective Japanese birth cohort study. Fish consumption was assessed using a validated food frequency questionnaire. Multivariate logistic regression was used to investigate the association of total consumption of fish, fatty fish and lean fish, fish paste, and seafood and clams with preterm birth, adjusted for potential confounders.

Results: There was no association between overall fish consumption and preterm births. However, the highest quintile of fish paste consumption was significantly associated with an increased risk of preterm birth (odds ratio [OR]: 1.11; 95% confidence interval [CI: 1.04, 1.17]). The consumption of baked fish paste at least three times per week was significantly associated with preterm birth (OR: 1.20; 95% CI: 1.03, 1.40). Consumption of other types of fish, except fish paste, was not significantly associated with preterm birth risk.

Conclusions: Fish paste consumption may increase the risk of preterm birth. Further studies are required to confirm this association.

Background: For patients with neurofibromatosis type 2 (NF2), maintaining an independent state of living is important. The present study aimed to examine the loss of social independence (i.e., a status that patients can work and go to school) and its contributing factors in patients with NF2 using data from a national registry in Japan.

Methods: This longitudinal study used a registry database containing information on patients with NF2 who had submitted initial claims to receive medical expense subsidies between 2004 and 2010. Patients with “employed,” “studying,” and “housekeeping” categories were classified as “socially independent.” Patients who were socially independent at baseline were followed-up for up to nine years. The primary outcome of the present study was the loss of social independence during the follow-up period, which was defined as the change in status from being socially independent to socially dependent. First, we examined longitudinal associations between demographic variables and neurological symptoms at baseline and the loss of social independence. Second, we examined whether the occurrence of neurological symptoms is associated with a loss of social independence in patients.

Results: A total of 156 patients were included in the present study. During the follow-up period, 37 (23.7%) patients experienced a loss of social independence. In the first analysis, the multivariate logistic regression model showed that the loss of social independence was significantly more frequent among patients with spinal dysfunction than among patients without. In the second analysis, logistic regression analyses showed that neurological symptoms, including bilateral hearing loss, facial nerve palsy, cerebellar dysfunction, decreased facial sensation, speech dysfunction (dysphagia/dysarthria and aphasia), double vision, blindness, hemiparesis, and seizures, were significantly associated with loss of social independence.

Conclusions: The occurrence of various neurological symptoms of NF2 can hinder social independence in the long term. Medical service providers need to observe patients while considering the risks, and provide appropriate support to address neurological symptoms that can restrict social independence, as this will lead to maintaining social engagement.

Background: The second term Health Japan 21 aims at eliminating unwanted exposure to secondhand smoke (SHS) in society; however, the ambiguity of the term “unwanted exposure” complicates the evaluation of the program. In this study, we examined SHS exposure that occurred despite the efforts to avoid it (i.e. unavoidable SHS exposure) as a proxy for “unwanted SHS exposure”.

Methods: Individuals aged 16–74 responded to a nationwide, Internet-based, self-reported survey. Frequency (daily/≥monthly) of SHS exposure in the past month was assessed for specific places (home/car/restaurant/cafe/bar/workplace/school/pachinko parlor) and any place. Unavoidable SHS was identified when respondents always tried to avoid but were exposed to SHS. The observed prevalence was compared to the target of Health Japan 21 (“Eliminate unwanted SHS exposure”, =0%). Analyses were weighted to account for the selectivity of the Internet-based sample.

Results: Among overall (N = 25,672), those who always tried to avoid SHS (N = 14,971), and never smokers of combustible tobacco who always tried to avoid SHS (N = 10,416), the prevalence of daily SHS exposure was 12.4%, 5.7%, and 4.2%; ≥monthly SHS exposure was 34.0%, 21.4%, and 17.5%, respectively. Among never smokers, the adjusted prevalence ratio (APR) of daily unavoidable SHS exposure was significantly high in adolescents (age 16–19) (APR = 4.97, vs. age 60–74), less-educated individuals (APR = 2.37, vs. ≥some college education), and heated tobacco product (HTP) users (APR = 8.27, vs. nonusers). Among never smokers, daily unavoidable SHS exposure was highest in the home (3.4%), workplaces (2.3%), and pachinko parlors (1.3%); ≥monthly unavoidable SHS exposure was highest in workplaces (11.4%), restaurants/cafes/bars (10.0%), and the home (7.6%).

Conclusions: Daily unavoidable SHS exposure was disproportionately high among adolescents, less-educated individuals, and HTP users. The prevalence of unavoidable SHS exposure did not reach the national target in any of the assessed indoor places; home and workplace were the dominant sources of unavoidable SHS exposure. The lack of comprehensive smoke-free laws provides inadequate protection against SHS that cannot be complemented by individual efforts. The authorities must ensure smoke-free environments for all.

Background: We investigated the relationship between characteristic geriatric symptoms and healthy life expectancy in older adults in Japan. Additionally, we determined relationship predictors that would help formulate effective approaches toward promoting healthy life expectancy.

Methods: The Kihon Checklist was used to identify older people at high risk of requiring nursing care in the near future. We evaluated the association of geriatric symptoms with healthy life expectancy while considering risk factors (frailty, poor motor function, poor nutrition, poor oral function, confinement, poor cognitive function, and depression). Data from the 2013 and 2019 Japan Gerontological Evaluation Studies were used. Healthy life expectancy was assessed using the multistate life table method.

Results: Overall, 8,956 individuals were included. For both men and women, healthy life expectancy was shorter in the symptomatic group than in the asymptomatic group for several domains of the Kihon Checklist. For men, the difference between individuals with risk factors and those with no risk factors was the maximum for confinement (3.83 years) and the minimum for cognitive function (1.51 years). For women, the difference between individuals with risk factors and those with no risk factors was the maximum for frailty (4.21 years) and the minimum for cognitive function (1.67 years). Healthy life expectancy tended to be shorter when the number of risk factors was higher. Specifically, the difference between individuals with ≥3 risk factors and those with no risk factors was 4.46 years for men and 5.68 years for women.

Conclusions: Healthy life expectancy was negatively associated with characteristic geriatric symptoms, with strong associations with frailty, physical functional decline, and depression. Therefore, comprehensive assessment and prevention of geriatric symptoms may increase healthy life expectancy.

Background: Arsenic is a harmful heavy metal and a well-known developmental neurotoxicant. Previously, we have reported that gestational arsenic exposure resulted in impaired social behaviors in F1 and F2 male mice. However, little is known about the developmental arsenic exposure on anxiety-like behavior. This study aimed to detect the effect of gestational arsenic exposure on anxiety-like behavior and related gene expressions in 74-week-old F1 female mice.

Method: Pregnant C3H/HeN mice (F0) were given drinking water containing 85 ppm sodium arsenite (NaAsO₂) from gestational day 8 to 18. The control mice were given tap water only. At 74-week-old, open field test was performed, then anxiety and apoptosis-related factors were determined by real_time RT_PCR and immunohistochemical analyses.

Results: The arsenite-exposed F1 female mice showed decreased center entry and center time in open field test. In addition, the number of grooming and fecal pallet was significantly increased in the arsenite-exposed F1 female mice compared to the control. Downregulation of brain-derived neurotrophic factor (BDNF), serotonin receptor (5HT1A) and upregulation of nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB), interleukin 1 β (IL-1β), cyclooxygenase 2 (COX2), caspase-3, Bcl2-associated X protein (Bax) were detected in the prefrontal cortex in the arsenite-exposed F1 female mice. Microglial marker ionized calcium-binding adapter molecule 1 (Iba1)-positive cells were increased in the arsenite-exposed F1 female mice. Moreover, a significantly increased plasma corticosterone level was observed in the arsenic-exposed F1 female mice.

Conclusions: This study suggested that gestational arsenic exposure induced anxiety-like behavior accompanied with dysregulation of neurological and immunological markers, neuroinflammatory responses, neuronal apoptosis, and decreased neurogenesis in the prefrontal cortex of F1 female mice.

Background: Although life satisfaction (LS) has been shown to predict mortality, research studying the relationship between LS and functional decline is scarce. This study examined the association between LS and functional decline across four time points in young-old Japanese adults.

Methods: We analysed 1,899 community-dwelling 65-year-olds in this age-specific cohort study conducted between 2000 and 2005. The Life Satisfaction Index K was used to evaluate LS and was classified into quartiles. Functional decline was determined using the Japanese Long-Term Care Insurance (LTCI) system: 1) mild disability; 2) severe disability; 3) all-cause mortality; 4) mild or severe disability; 5) severe disability or death; 6) mild or severe disability, or death. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were calculated using the Cox proportional hazard model. The analyses were conducted in the 8^th, 10^th, 12^th, and 14^th years to assess the effect of LS on functional decline across time points.

Results: The impact of LS gradually weakened over time. In the 8^th year (aged 72–73), a higher LS was associated with a lower risk of mild or severe disability among the women participants (adjusted HR [95% CI] = 0.30 [0.11–0.81]). However, the effect disappeared gradually (adjusted HR [95% CI] = 0.55 [0.27–1.14]) in the 10^th year (aged 74–75), 0.72 (0.41–1.26) in the 12^th year (aged 76–77), and 0.68 (0.41–1.14) in the 14^th year (aged 78–79). This trend continued in severe disability or death (adjusted HR [95% CI] = 0.24 [0.06–0.70], 0.31 [0.11–0.76], 0.57 [0.28–1.14], and 0.60 [0.32–1.12]) and mild or severe disability, or death (adjusted HR [95% CI] = 0.30 [0.14–0.68], 0.46 [0.24–0.87], 0.67 [0.41–1.10], and 0.65 [0.42–1.02]) in the 8^th, 10^th, 12^th, and 14^th years, respectively. No statistically significant association was found among men at any time points or in any classification of outcomes.

Conclusions: Higher LS scores in 65-year-old women were associated with a lower risk for functional decline in any combination of mild disability, severe disability, or death. Additionally, the effect of LS was observed to weaken over time.

Trial registration: This is not an intervention survey and does not require registration.

Background and aims: Unhealthy eating behaviors, including eating fast, eating after satiety, skipping breakfast, and eating out are common among men aged 20–39 years. In this cross-sectional study, we aimed to examine the association between self-reported eating habits and the prevalence of dyslipidemia.

Methods: The participants of this study were 38,233 men aged 20–39 years, whose food consumption frequency related information was collected through a questionnaire. Dyslipidemia was defined as total cholesterol (TC) ≥190 mg/dL, fasting triglyceride (TG) ≥150 mg/dL and non-fasting TG ≥175 mg/dL, high-density lipoprotein cholesterol (HDL-C) <40 mg/dL, low-density lipoprotein cholesterol (LDL-C) ≥140 mg/dL. Odds ratios (ORs) and 95% confidence intervals were calculated relative to healthy eating habits using logistic regression, after adjustment for age, study unit, and other potential confounding factors.

Results: Moderate and fast speeds were associated with a higher prevalence of reduced HDL-C (by 27% and 26%, respectively) compared to slow speeds. Eating after satiety was associated with a higher prevalence of elevated TC (by 16%) and elevated TG (by 11%), elevated LDL-C (by 21%). Breakfast eating of 1–4 times/week and <1 time/week were associated with a higher prevalence of elevated TC (by 11% and 16%, respectively) and elevated LDL-C (by 21% and 38%, respectively) compared to that of ≥5 times/week. Eating out of ≥5 times/week was associated with a 13% higher prevalence of elevated TG.

Conclusions: All of four unhealthy eating habits were associated with a higher prevalence of dyslipidemia in men aged 20–39 years.

Background: Overweight and obesity lead to a range of noncommunicable diseases (NCDs), such as type 2 diabetes, cardiovascular disease, and stroke. Physical activity (PA) is an important lifestyle behavior for controlling body weight. Dietary inflammatory index (DII), which is associated with systemic inflammatory markers, is used to evaluate the potential of dietary inflammation. This is the first study to investigate the independent and joint associations of PA and DII with the risk of overweight/obesity among US adults.

Methods: Participants and data were obtained from the National Health and Nutrition Examination Survey (NHANES) from 2007–2018, which is designed to examine the health and nutritional status of the non-institutionalized US population by a complex, multi-stage, probability sampling design.

Results: A total of 10723 US adults were selected. Physically active participants had lower overweight/obesity risk (total-time PA: OR = 0.756, 95% CI: 0.669–0.855; leisure-time PA: OR = 0.723, 95% CI: 0.643–0.813; and walk/bicycle-time PA: OR = 0.748, 95% CI: 0.639–0.875); however, those with work-time PA showed no significant association between PA and overweight/obesity. Compared with participants in the lowest DII group (Q1), those in the other three groups had high risks of overweight/obesity (Q2: OR = 1.218, 95% CI: 1.054–1.409; Q3: OR = 1.452, 95% CI: 1.245–1.693; Q4: OR = 1.763, 95% CI: 1.495–2.079). In joint analyses, PA was not eligible for reducing risks of weight/obesity if far more pro-inflammatory diet (Q4 of DII = 2.949–5.502) was taken in (total-time PA: OR = 1.725, 95% CI: 1.420–2.097; leisure-time PA: OR = 1.627, 95% CI: 1.258–2.105; walk/bicycle-time PA: OR = 1.583, 95% CI: 1.074–2.332; and work-time PA: OR = 1.919, 95% CI: 1.493–2.467).

Conclusions: More leisure-time PA and walk/bicycle-time PA are associated with lower risk of overweight/obesity, and higher DII is associated with higher risk of overweight/obesity. In addition, higher DII impacts overweight/obesity substantially: once the DII score reached Q4, there is still risks of overweight/obesity even if PA is performed.

Background: Pacific islanders face drastic increase of obesity-related noncommunicable disease (NCD) due to lifestyle shifts of unhealthy diets and physical inactivity. To date, however, obesity related factors have not been well elucidated in Republic of Palau. This study aimed to investigate sociodemographic and behavioral factors related to obesity using the national level data in Palau.

Methods: This is a cross-sectional, population-based study analyzing random sampling data of 2133 adults aged 25–64 years (of 20 thousand national population) from the WHO STEPwise approach to NCD risk factor surveillance (STEPS) implemented between 2011 and 2013. Sociodemographic and behavioral factors were obtained by the STEPS standardized questionnaire for NCD risk factors plus the question on betel nut chewing because of its common behavior in Micronesian countries. Logistic regression analysis was performed to estimate multivariable odds ratio (OR) of general obesity (body mass index ≥30.0 kg/m²) and central obesity (waist circumference ≥90 cm in men and ≥80 cm in women).

Results: Means of body mass index, prevalence of general obesity and central obesity were higher in women (29.9 kg/m², 45.5% and 85.4%) than in men (29.3 kg/m², 40.4% and 67.6%). After adjusted by other potential factors, native Palauan (OR 4.4, 95% CI, 2.7–7.0 for men and 3.6, 2.3–5.6 for women), betel nut chewing (1.5, 1.1–2.1 for men and 1.6, 1.2–2.3 for women), men who work at government office (1.6, 1.2–2.1), women with higher household income (1.4, 1.0–1.8) were positively associated with general obesity, while frequent vegetable intake were inversely associated with it among women (0.71, 0.54–0.93). Similar associations were observed between the aforementioned factors and central obesity.

Conclusions: Native Palauan, people with betel nut chewing behavior, government employment and higher income appeared to be associated with obesity, while frequent vegetable consumption were inversely associated with obesity. Further interventions for prevention and control of obesity are necessary through the enhancing public relation activities to understand harmful health effects on betel nuts chewing and recommending domestic production of vegetables.

Background: Per- and polyfluoroalkyl substances (PFASs) are highly fluorinated organic compounds that have been widely used in industry during the past few decades. The main exposure routes for PFASs are thought to be the diet, drinking water, and dust. In this study, we aimed to evaluate the relationship between perfluoroalkyl carboxylic acids (PFCAs, members of the PFAS family) and the plasma eicosapentaenoic acid-to-arachidonic acid ratio (EPA/AA), a biological indicator of seafood intake, to determine whether seafood intake may represent a means of exposure to PFASs in the Japanese population.

Methods: We performed a cross-sectional study using 131 plasma samples collected from residents of Kyoto, Japan in 2013 and held in the Kyoto University biological sample bank. The concentrations of perfluoroheptanoic acid (PFHpA), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluoroundecanoic acid (PFDA), perfluoroundecanoic acid (PFUnDA), perfluorododecanoic acid (PFDoDA), perfluorotridecanoic acid (PFTrDA), EPA, and AA were quantified by gas chromatography-mass spectrometry, and multiple linear regression was used to analyze the results.

Results: In multiple linear regression analyses with age and eGFR, PFOA showed a significant positive linear association with age (p = 0.0005); PFHpA showed a significant negative linear association with estimated glomerular filtration rate (eGFR; p = 0.0338); and PFHpA, PFOA, PFNA, PFUnDA, and PFDoDA exhibited significant positive linear associations with EPA/AA (p = 0.0358, 0.0056, 0.0242, <0.0001, and <0.0001, respectively). Because only PFHpA and PFOA were associated with smoking, their concentrations were examined again with smoking variable included and neither showed an association with smoking habit. PFOA showed a significant linear association with EPA/AA ratio (p = 0.0072), but PFHpA did not (p = 0.051).

Conclusions: The plasma concentrations of PFOA, PFNA, PFUnDA and PFDoDA significantly associated with the EPA/AA ratio in residents of Kyoto.

Background: The current study aimed to investigate the determinants of high double product (DP) by evaluating the association between resting DP, which is calculated as systolic blood pressure (SBP) multiplied by heart rate (HR), and blood test results and lifestyle factors.

Methods: This research included 973 participants in the baseline survey of the KOBE study, which included a cohort of urban residents. The possible DP determinants were identified by examining the association between lifestyle factors and laboratory findings and DP by analyzing covariance adjusted for sex and age. Logistic regression analysis was performed with high DP (SBP × HR ≥ 9145 mmHg beats/min or quintile according to sex) as outcome and DP determinants as independent variables.

Results: Age, hematocrit, and gamma-glutamyl transferase (log) level were positively associated with a high DP in both men and women. In addition, a high DP was positively associated with Homeostatic Model Assessment for Insulin Resistance score in women alone. Meanwhile, the amount of exercise was negatively associated with a high DP in men alone.

Conclusions: High DP values at rest were associated with insulin resistance, gamma-glutamyl transferase, and the amount of exercise in participants without underlying disease.

Background: We designed a quick simple exercise program that can be performed in a short period of time in real-world occupational health settings and investigated the effects of three months of program implementation on non-specific low back pain (NSLBP).

Methods: Participants were 136 individuals working in the manufacturing industry. The quick simple exercise program was designed to be doable in three minutes and consisted of two exercises: a hamstring stretch and a lumbar spine rotation with forward, backward, and lateral flexion. This was a randomized controlled trial incorporating an intervention group to whom the exercises were recommended within a leaflet, and a control group to whom the exercises were not recommended. NSLBP was evaluated at baseline and after three months using numerical rating scale (NRS) scores, ranging from 0 points (no pain at all) to 10 points (worst pain imaginable). The percentages of cases that improved by a minimal clinically important difference (two points or above) were compared.

Results: Overall, 76.1% of the intervention group participants performed the quick simple exercises at least once every one or two days. Three months after baseline, a significantly higher percentage of participants in the intervention group (17 participants: 25%) had NSLBP improvement of two or more points on the NRS compared to that in the control group (8 participants, 12%) (P = 0.047). The average NRS score decreased significantly from 1.87 ± 1.86 to 1.33 ± 1.60 in the intervention group but showed no significant change in the control group, transitioning from 1.46 ± 1.73 to 1.52 ± 1.83. A significant interaction was also observed between the intervention and control groups (F = 6.550, P = 0.012).

Conclusions: Three months of a quick simple exercise program among workers in the manufacturing industry increased the percentage of workers with improvement in the NRS scores. This suggests that the program is effective in managing NSLBP in workers in the manufacturing industry.

Trial registration: UMIN-CTR UMIN000024117.

Background: Many previous studies have reported that COVID-19 vaccine effectiveness decreased over time and declined with newly emerging variants. However, there are few such studies in Japan. Using data from a community-based retrospective study, we aimed to assess the association between vaccination status and severe COVID-19 outcomes caused by the Omicron variant, considering the length of time since the last vaccination dose.

Methods: We included all persons aged ≥12 diagnosed with COVID-19 by a doctor and notified to the Chuwa Public Health Center of Nara Prefectural Government during the Omicron BA.1/BA.2 and BA.5-predominant periods in Japan (January 1 to September 25, 2022). The outcome variable was severe health consequences (SHC) (i.e., COVID-19-related hospitalization or death). The explanatory variable was vaccination status of the individuals (i.e., the number of vaccinations and length of time since last dose). Covariates included gender, age, risk factors for aggravation, and the number of hospital beds per population. Using the generalized estimating equations of the multivariable Poisson regression models, we estimated the cumulative incidence ratio (CIR) and 95% confidence interval (CI) for SHC, with stratified analyses by period (BA.1/BA.2 or BA.5) and age (65 and older or 12–64 years).

Results: Of the 69,827 participants, 2,224 (3.2%) had SHC, 12,154 (17.4%) were unvaccinated, and 29,032 (41.6%) received ≥3 vaccine doses. Regardless of period or age, there was a significant dose-response relationship in which adjusted CIR for SHC decreased with an increased number of vaccinations and a longer time since the last vaccination. On the one hand, in the BA.5 period, those with ≥175 days after the third dose had no significant difference in people aged 65 and older (CIR 0.77; 95% CI, 0.53–1.12), but significantly lower CIR for SHC in people aged 12–64 (CIR 0.47; 95% CI, 0.26–0.84), compared with those with ≥14 days after the second dose.

Conclusion: A higher number of vaccinations were associated with lower risk of SHC against both BA.1/BA.2 and BA.5 sublineages. Our findings suggest that increasing the number of doses of COVID-19 vaccine can prevent severe COVID-19 outcomes, and that a biannual vaccination is recommended for older people.

Background: Due to the continuous spread of the epidemic, some colleges and universities have implemented a campus lockdown management policy in China. In the context of the campus lockdown, this study aimed to explore whether anxiety mediated the association between interpersonal sensitivity and depression, and investigate whether psychological capital moderated the indirect or direct effect of mediation model.

Methods: A total of 12945 undergrad students were recruited in China from April 10 to 19, 2022. These participants were asked to complete the online questionnaires measuring interpersonal sensitivity, anxiety, psychological capital, and depression. A moderated mediation model was examined by using PROCESS macro for SPSS 25.0, in which anxiety was a mediating variable, and psychological capital was a moderating variable.

Results: Interpersonal sensitivity was positively associated with depression among Chinese college students (r = 0.47, P < 0.001). Anxiety partially mediated the association between interpersonal sensitivity and depression (indirect effect = 2.31, 95%CI [2.18, 2.44], accounting for 70% of the total effect). Moreover, the interaction effect of interpersonal sensitivity and psychological capital on anxiety (β = −0.04, t = −17.36, P < 0.001) and the interaction effect of anxiety and psychological capital on depression (β = 0.002, t = 1.99, P < 0.05) were statistically significant.

Conclusions: The current study explained the mediation role of anxiety and the moderation role of psychological capital in the relation between interpersonal sensitivity and depression. The findings suggested that strict monitoring anxiety and promoting psychological capital may decrease the risk of depression among Chinese college students during the campus lockdown.

Background: Townsville is in the dry tropics in Northern Australia and an endemic region for melioidosis. Melioidosis is an infectious disease caused by Burkholderia pseudomallei, a soil dwelling organism. The incidence of melioidosis is associated with high levels of rainfall and has been linked to multiple weather variables in other melioidosis endemic regions such as in Darwin. In contrast to Townsville, Darwin is in the wet-dry tropics in Northern Australia and receives 40% more rainfall. We assessed the relationship between melioidosis incidence and weather conditions in Townsville and compared the patterns to the findings in Darwin and other melioidosis endemic regions.

Method: Performing a time series analysis from 1996 to 2020, we applied a negative binomial regression model to evaluate the link between the incidence of melioidosis in Townsville and various weather variables. Akaike’s information criterion was used to assess the most parsimonious model with best predictive performance. Fourier terms and lagged deviance residuals were included to control long term seasonal trends and temporal autocorrelation.

Results: Humidity is the strongest predictor for melioidosis incidence in Townsville. Furthermore, the incidence of melioidosis showed a three-times rise in the Townsville region when >200 mm of rain fell within the fortnight. Prolonged rainfall had more impact than a heavy downpour on the overall melioidosis incident rate. There was no statistically significant increase in incidence with cloud cover in the multivariable model.

Conclusion: Consistent with other reports, melioidosis incidence can be attributed to humidity and rainfall in Townsville. In contrast to Darwin, there was no strong link between melioidosis cases and cloud cover and nor single large rainfall events.

Background: Whether dietary protein intake worsens renal function in the general population has been discussed but not yet determined. We aimed to examine the longitudinal association between dietary protein intake and risk of incident chronic kidney disease (CKD).

Methods: We conducted a 12-year follow-up study with 3,277 Japanese adults (1,150 men and 2,127 women) aged 40–74 years, initially free from CKD, who participated in cardiovascular risk surveys from two Japanese communities under the Circulatory Risk in Communities Study. The development of CKD was defined by the estimated glomerular filtration rate (eGFR) during the follow-up period. Protein intake was measured at baseline by using the brief-type self-administered diet history questionnaire. We estimated sex-, age-, community- and multivariate-adjusted hazard ratios (HR) for incident CKD were calculated using the Cox proportional hazards regression models according to quartiles of percentage of energy (%energy) from protein intake.

Results: During 26,422 person-years of follow-up, 300 participants developed CKD (137 men and 163 women). The sex-, age-, and community-adjusted HR (95% confidence interval, CI) for the highest (≥16.9%energy) versus lowest (≤13.4%energy) quartiles of total protein intake was 0.66 (0.48–0.90), p for trend = 0.007. The multivariable HR (95%CI) was 0.72 (0.52–0.99), p for trend = 0.016 after further adjustment for body mass index, smoking status, alcohol drinking status, diastolic blood pressure, antihypertensive medication use, diabetes mellitus, serum total cholesterol levels, cholesterol-lowering medication use, total energy intake, and baseline eGFR. The association did not vary by sex, age, and baseline eGFR. When examining animal and vegetable protein intake separately, the respective multivariable HRs (95%CIs) were 0.77 (0.56–1.08), p for trend = 0.036, and 1.24 (0.89–1.75), p for trend = 0.270.

Conclusions: Higher protein intake, more specifically animal protein intake was associated with a lower risk of CKD.

Background: Level of care-need (LOC) is an indicator of elderly person’s disability level and is officially used to determine the care services provided in Japan’s long-term care insurance (LTCI) system. The 2018 Japan Floods, which struck western Japan in July 2018, were the country’s second largest water disaster. This study determined the extent to which the disaster affected the LOC of victims and compared it with that of non-victims.

Methods: This is a retrospective cohort study, based on the Japanese long-term care insurance claims from two months before (May 2018) to five months after the disaster (December 2018) in Hiroshima, Okayama, and Ehime prefectures, which were the most severely damaged areas in the country. A code indicating victim status, certified by a residential municipality, was used to distinguish between victims and non-victims. Those aged 64 years or younger, those who had the most severe LOC before the disaster, and those whose LOC increased even before the disaster were excluded. The primary endpoint was the augmentation of pre-disaster LOC after the disaster, which was evaluated using the survival time analysis. Age, gender, and type of care service were used as covariates.

Results: Of the total 193,723 participants, 1,407 (0.7%) were certified disaster victims. Five months after the disaster, 135 (9.6%) of victims and 14,817 (7.7%) of non-victims experienced the rise of LOC. The victim group was significantly more likely to experience an augmentation of LOC than the non-victim group (adjusted hazard ratio 1.24; 95% confidence interval 1.06–1.45).

Conclusions: Older people who were affected by the disaster needed more care than before and the degree of care-need increase was substantially more than non-victims. The result suggests that natural disasters generate more demand for care services among the older people, and incur more resources and cost for society than before.

Background: Central obesity as measured by waist-to-hip circumference ratio (WHR) has been reported to be associated with renal hemodynamics and function. However, the adipose component of WHR, which is a composite measure of fat mass and fat-free mass, is small, particularly in nonobese subjects. Trunk-to-peripheral fat ratio as measured using dual-energy absorptiometry (DXA) is a more precise method for evaluating central fat distribution than WHR. The present study investigated the cross-sectional association between DXA-measured trunk-to-peripheral fat ratio and estimated glomerular filtration rate (eGFR) in community-dwelling elderly Japanese men.

Methods: Participants were 575 men aged ≥65 years at the time of the baseline survey of the second Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) cohort study. Trunk-to-appendicular fat ratio (TAR) was calculated as trunk fat divided by appendicular fat (sum of arm and leg fat), and trunk-to-leg fat ratio (TLR) as trunk fat divided by leg fat.

Results: eGFR values significantly decreased from the lowest to the highest quintile of TAR/TLR. After adjusting for potential confounding factors including whole-body fat, the highest quintile of both TAR and TLR showed statistically significant odds ratios for the risk of eGFR <60 ml/min/1.73 m², relative to the lowest quintile. In addition, a significant decreasing trend was observed for eGFR values from the lowest to the highest quintile of TAR/TLR after adjusting for confounding factors including whole-body fat.

Conclusion: Elderly men with a large trunk-to-peripheral fat ratio tended to have a lower eGFR. This association occurred independently of that between whole-body fat and eGFR.

Background: According to recent reports, individuals with reduced aldehyde dehydrogenase activity may require more energy for the detoxification of aldehydes. Aldehyde dehydrogenase 2 (ALDH2), an ALDH isozyme, is responsible for detoxifying acetaldehyde, an intermediate metabolite of ethanol. Because the variant allele of the rs671 polymorphism of ALDH2 results in a substantial reduction in enzymatic activity, carriers of this variant allele may have a higher energy demand when consuming alcohol than non-carriers. However, no studies have evaluated this phenomenon to date.

Method: To test the hypothesis, we statistically examined the interactive effects between the rs671 and ethanol consumption on energy intake using cross-sectional data from a population-based cohort study, the Japan Multi-Institutional Collaborative Cohort Study, which was conducted in Saga city between 2005–2007 (N = 12,068).

Results: General linear regression models adjusted for age, sex, ethanol consumption, current smoking status, years of education, dietary restriction, medical history, and physical activity level revealed that energy intake was higher in variant allele carriers than in non-carriers among individuals with alcohol drinking habits, whereas no such correlation was observed among those without drinking habits (≤2 g ethanol/day) (p = 0.03 for interaction between rs671 and ethanol consumption). Energy intake excluding energy from alcoholic beverages, carbohydrate intake, protein intake, and fat intake, showed similar tendencies (p for interaction = 0.01, 0.01, 0.04, and 0.07, respectively).

Conclusions: These findings support the hypothesis that increased energy intake is required for the detoxification of aldehydes in individuals with low ALDH activity. This epidemiological evidence provides a possible scientific basis for understanding aldehyde detoxification mechanisms and suggests a novel phenotype of the ALDH2 rs671 polymorphism.