Background: Publicly available aggregate health data can support regional surveillance of cardiometabolic risk, but analyses must address aggregation, ecological inference, and cell suppression or unavailability. Waist circumference and body mass index (BMI) capture related but distinct aspects of adiposity. We evaluated the usefulness and limitations of selected 10th National Database (NDB) Open Data indicators for prefecture-level cardiometabolic surveillance among Specific Health Checkup examinees in Japan.

Methods: We conducted an ecological descriptive analysis of the 10th NDB Open Data. Data were analyzed by prefecture, sex, and 5-year age band among examinees aged 40–74 years. Primary indicators were the percentage meeting the waist circumference criterion (≥85 cm in men, ≥90 cm in women) and the percentage with hemoglobin A1c (HbA1c) ≥6.5%; BMI categories were examined as exploratory indicators. Prefecture-level percentages were internally age-standardized within sex using the age distribution of publicly displayed examinee counts pooled across prefectures for each indicator as the internal standard. Cells displayed as “-” were treated as suppressed/unavailable and not as zero values.

Results: Waist circumference criterion data were complete across prefectures, sexes, and age bands. HbA1c ≥6.5% data were complete among men but included suppressed/unavailable cells among women, and BMI indicators had substantial cell suppression/unavailability. The age-standardized percentage meeting the waist circumference criterion ranged from 45.5% in Niigata to 60.6% in Okinawa among men and from 13.7% in Kyoto to 24.0% in Okinawa among women. HbA1c ≥6.5% ranged from 8.3% in Nagano to 11.3% in Miyagi among men and from 3.9% in Kanagawa to 7.8% in Saga among women. Okinawa had the highest percentage meeting the waist circumference criterion in both sexes. Waist-HbA1c correlations were positive in available-cell analyses, but estimates among women and estimates involving BMI were sensitive to cell availability and the prefectures included in the analysis.

Conclusions: The percentage meeting the waist circumference criterion was the most complete and robust descriptive indicator for prefecture-level cardiometabolic surveillance using the 10th NDB Open Data. HbA1c analyses among women and BMI-based analyses require suppression-aware interpretation. Ecological correlations should be interpreted as descriptive co-patterning of aggregate surveillance indicators, not as individual-level associations or evidence of regional determinants.

Trial registration: Not applicable.

Background: Hypertension is prevalent and is influenced by modifiable factors. Increasing attention has focused on community-based health promotion. However, studies on the relationship between neighborhood characteristics and hypertension prevalence are limited. This study combined medical claims and geographic information system data to identify neighborhood characteristics associated with hypertension.

Methods: The study population included participants enrolled in the National Health Insurance or Medical Care System for the Elderly in both 2017 and 2021, and their 2021 data were aggregated at the elementary school district level. Hypertension was defined using the International Statistical Classification of Diseases and Related Health Problems-10 codes I10–I15. Neighborhoods were defined by elementary school districts. For each school district, hypertension prevalence, the proportions of participants aged <65 years, 65–74 years, and ≥75 years, and the proportion of men were calculated. Neighborhood characteristics included college graduation rate, area deprivation index, annual average temperature, annual total precipitation, average slope angle, number of destination types, and densities of public places. Quasi-Poisson regression analyses were conducted with the number of hypertension cases as the dependent variable, neighborhood characteristics as explanatory variables, the proportions of participants aged 65–74 years and ≥75 years, and the proportion of men (in the overall analysis) as covariates, and the number of participants as an offset term. For the quasi-Poisson regression analyses, a Bonferroni-adjusted p-value < 0.05 was considered statistically significant.

Results: The study covered 424 elementary school districts across 14 municipalities in five prefectures in western Japan. The mean number of participants per district was 2,248 (men: 946, women: 1,302), with an average age of 67 years (men: 66; women: 68). The mean hypertension prevalence was 51% (men: 53%; women: 50%). In the combined and female-only analyses, the neighborhood proportion of university graduates and green space coverage were significantly negatively associated with hypertension prevalence. In the male-only analysis, the proportion of university graduates, green space coverage, and park density showed significant negative associations.

Conclusions: Neighborhood socioeconomic and physical environmental characteristics were associated with hypertension prevalence in Japan, particularly educational attainment and green space coverage, suggesting that social and physical environmental attributes may contribute to community-level cardiovascular health.

Background: Reproductive history can be conceptualized as a life-course exposure integrating biological and social factors. Although reproductive factors have been associated with stroke risk and cognitive function, their relationships with structural brain changes remain unclear. Evidence from general population–based studies linking reproductive factors to brain volume, an intermediate marker of cognitive decline, is limited. This study examined whether age at menarche, age at menopause, estrogen exposure duration, and parity are associated with brain volume in postmenopausal women.

Methods: This cross-sectional study included 361 postmenopausal women aged ≥55 years from the Ohasama Study in Japan. Reproductive factors were obtained from a 1998 questionnaire were categorized into quartiles, and MRI data from 2009 to 2019 were analyzed with voxel-based morphometry. Associations were assessed using analysis of covariance adjusted for intracranial volume, age, birth cohort, and BMI. Effect sizes were reported as percent change and standardized effect sizes, with the smallest effect size of interest (SESOI) based on one-year age-related brain volume change.

Results: After covariate adjustment, most associations between reproductive factors and brain volume were attenuated. Earlier age at menarche showed a weak trend toward larger temporal lobe volume (β = 0.59 cm³, 95% CI −0.03 to 1.21; p = 0.06), corresponding to a 0.63% change and 0.06 SD, which was comparable to the SESOI (±0.54% or 0.06 SD). Earlier age at menopause was associated with smaller occipital lobe volume (β = −0.52 cm³, 95% CI −1.01 to −0.03; p = 0.04), corresponding to a −1.08% change and 0.10 SD, exceeding the primary SESOI threshold (±0.64% or 0.06 SD), although confidence intervals included effects smaller than the SESOI. No significant associations were found for estrogen exposure or parity.

Conclusion: Reproductive factors were not associated with moderate or large differences in brain volume in postmenopausal women. The slight, region-specific differences observed were comparable in magnitude to short-term age-related changes. These findings suggest that the clinical significance at the individual level is likely limited. However, subtle associations at the population level cannot be entirely excluded.

Background: Heatstroke is a major public health problem during summer, and meteorological conditions, particularly wet bulb globe temperature (WBGT), strongly influence its occurrence. However, even under similar heat conditions, heatstroke risk may vary according to behavioural patterns on weekdays, weekends/holidays, and post-holiday days. This study aimed to examine whether heatstroke-related ambulance transports in Tokyo vary according to day type after adjusting for WBGT.

Methods: We conducted a time-series analysis using daily heatstroke-related ambulance transports in Tokyo, Japan, during the warm season (May–September) from 2015 to 2025. The days were classified as weekday, weekend/holiday, or post-holiday. The WBGT data for seven locations in Tokyo were used, and the highest daily maximum WBGT served as the heat exposure indicator. Modified Poisson regression models were used to estimate risk ratios (RRs) and 95% confidence intervals (CIs) according to day type, adjusting for the WBGT category at lags 0 and 1 and the calendar year. The same models were applied by age group, severity, and place of occurrence. Four sensitivity analyses, including the use of alternative heat exposure indicators and exclusion of the coronavirus disease 2019 period, were conducted.

Results: After adjusting for WBGT and calendar year, the occurrence of heatstroke-related ambulance transports differed according to day type. Overall, ambulance transports tended to be more frequent on post-holiday days than on weekdays (RR, 1.08; 95% CI, 0.97–1.22). Among adults aged ≥65 years, transports were more frequent on post-holiday days (RR, 1.13; 95% CI, 1.00–1.28) and less frequent on weekends/holidays (RR, 0.87; 95% CI, 0.79–0.96). Among individuals aged <18 years, transports were markedly more frequent on weekends/holidays (RR, 1.80; 95% CI, 1.61–2.03). Weekend/holiday increases were also observed in mild cases and in public indoor and outdoor spaces and educational institutions, whereas cases in residences and workplaces were less frequent. Sensitivity analyses yielded similar results.

Conclusions: Heatstroke-related ambulance transports in Tokyo varied according to day type even after adjusting for WBGT, with distinct patterns across age groups, severity categories, and places of occurrence. Weekly behavioural patterns may contribute to heatstroke risk and warrant consideration in preventive strategies.

Background: Long-term birth cohort studies depend on sustained participant engagement. In such studies, children are not only observed over time but also increasingly become participants who experience, interpret, and evaluate their own involvement in research. However, research on continued participation has focused mainly on parental perspectives, with limited attention to children’s own views or to similarities and differences between parents and children. Against the growing recognition that people in medical research should be understood as participants rather than passive subjects, this study examined research participation experiences and retention intentions in both parents and children within a Japanese birth cohort.

Methods: We conducted a questionnaire survey from September to October 2024 within the Japan Environment and Children’s Study (JECS). The primary outcome was retention intention. Factors associated with retention intention were analyzed separately for parents and children using ordinal logistic regression. Parent-child concordance in retention intention was assessed descriptively using weighted Cohen’s kappa.

Results: Among 1,008 eligible parents of fifth-grade children, 485 responded (response rate, 44%). A large majority of parents (92%) and children (79%) reported willingness to continue participation. Parent–child responses showed moderate agreement (κ = 0.46). In separate adjusted ordinal logistic regression models, stronger parental retention intention was associated with lower perceived questionnaire burden (adjusted odds ratio [aOR]: 5.58, 95% confidence interval [CI]: 3.40–9.17), fewer concerns about possible disagreement with their child (aOR: 5.75, 95% CI: 3.51–9.42), and less difficulty scheduling study activities (aOR: 5.80, 95% CI: 3.50–9.63). In children, stronger retention intention was associated with anticipated gifts (aOR: 7.38, 95% CI: 2.93–18.56), talking with friends about the study (aOR: 6.02, 95% CI: 2.25–16.09), and a desire for peer interaction (aOR: 6.72, 95% CI: 3.39–13.29).

Conclusions: Parents and children both showed generally positive retention intentions, but disagreement was not negligible. Their retention intentions were associated with different participation-related experiences, suggesting that long-term birth cohort studies should attend to participants’ perspectives in age-specific ways. Understanding research participation through both parental and child experiences may help inform more participant-centered engagement strategies and support the quality of long-term cohort research.

Background: In Japan, community-driven dining spaces known as children’s cafeterias (kodomo shokudo) have increased rapidly. Despite their rapid expansion, the role of social environmental factors in the development of children’s cafeterias, particularly social capital, has received limited empirical attention. We examined the association between social capital and changes in the number of children’s cafeterias in Japan.

Methods: We conducted a longitudinal ecological study. The outcome was the change in the number of children’s cafeterias per municipality between 2020 and 2022. Social capital indicators (trust in neighbors, norm of reciprocity, trust in the national government, neighborhood ties, and social participation) were derived from a nationwide internet survey.

Results: A total of 512 local municipalities were analyzed. Multiple regression analyses showed that higher neighborhood trust was positively associated with increases in the number of children’s cafeterias, whereas denser neighborhood ties were inversely associated with such increases.

Conclusions: The findings suggest that cognitive and structural dimensions of social capital may operate differently in the diffusion of children’s cafeterias. These results indicate that community social contexts are associated with the spread of child-focused initiatives.

Background: Accessible and trustworthy health information sources support informed decisions. Longitudinal evidence on how health information sources influence behavioural changes in community-dwelling populations remains limited. Thus, we examined associations between health information sources and behaviour changes in walking time, balanced meal consumption, and smoking cessation.

Methods: Baseline (2021) and follow-up (2023) survey questionnaires were distributed to residents randomly selected from the 18 residential areas. Health information sources were classified into five categories: print media, television (TV) and radio, the Internet, family and friends, and professionals. Desirable health behaviours were defined as walking for ≥60 min/day; consuming ≥2 meals per day comprising staple grains, main dishes, and side items (SMS); and smoking cessation. Meeting these criteria was classified as good; not meeting them as poor. Improvement was defined as poor at baseline and good at follow-up. Maintenance was defined as good at both surveys. Improvement analyses included participants with poor baseline conditions. Maintenance analyses included those with good baseline conditions. Associations were analysed using multilevel modified Poisson regression models, accounting for clustering within residential areas and adjusting for covariates. Risk ratios (RRs) and 95% confidence intervals (95% CIs) were calculated.

Results: Of the 12 119 baseline participants, 6620 (54.6%) completed the follow-up. The most common health information sources were TV and radio (68.5%), the Internet (56.8%), and print media (48.9%). Use of family and friends as information sources was associated with improvement in walking time (RR: 1.19; 95% CI: 1.02–1.39), as was use of professionals (RR: 1.15; 95% CI: 1.03–1.28). Professionals showed a marginal association with sustained walking time (RR: 1.07; 95% CI: 0.99–1.15). TV and radio was associated with improvement in SMS meal consumption (RR: 1.13; 95% CI: 1.02–1.26), while print media was associated with maintenance of SMS meal consumption (RR: 1.05; 95% CI: 1.01–1.08). No sources were related to smoking cessation.

Conclusions: Health information sources showed distinct associations with improved and maintained health behaviours. Interpersonal sources were relevant for improving walking time, while mass media were linked to dietary improvement and maintenance. These findings suggest tailoring health communication strategies to specific health behaviours.

Depression affects more than 280 million people worldwide and remains a major public health challenge, with limited universally effective preventive strategies. Non-pharmacological interventions have gained increasing attention as complements or alternatives to pharmacotherapy. Shinrin-yoku (forest bathing), a Japanese health practice involving immersion in forest environments, has been reported to relieve stress, enhance immune function, and improve mood. This review synthesizes current evidence on the potential preventive effects of forest bathing on depressive symptoms and examines the mechanistic pathways underlying these effects. A structured search of major scientific databases identified studies investigating psychological responses, neuroendocrine and autonomic regulation, immune-inflammatory markers, and related physiological parameters. Across diverse populations, forest bathing consistently reduced negative mood states, improved vigor, and showed beneficial effects on anxiety, depressive symptoms, sleep quality, and stress biomarkers. Mechanistic evidence suggests that forest bathing may modulate the psycho-neuro-endocrino-immune network through improved sleep, reduced stress hormone levels, enhanced parasympathetic activation, and increases in circulating serotonin, oxytocin, and insulin-like growth factor-1, alongside reduced inflammatory markers. While existing findings are promising, most studies involve small samples, short-term interventions, and limited clinical populations. Future large-scale, controlled studies are needed to confirm long-term effects and to clarify whether forest bathing can contribute to prevention or adjunctive management of depressive symptoms.

Background: Tuberculosis (TB) remains a major global health challenge, with delayed diagnosis perpetuating transmission in resource-limited settings. Although the sensitivity of molecular diagnostic methods is high, their dependence on the laboratory infrastructure limits accessibility in many regions. Serological approaches that detect host antibody responses represent a technically simple diagnostic strategy; however, the performance of currently available TB serodiagnostic tests is inconsistent, largely due to suboptimal antigen selection and heterogeneity in host immune responses. Therefore, the identification of conserved antigens naturally recognized during human infection is essential for improving serological diagnostics.

Methods: A cDNA expression library derived from Mycobacterium bovis BCG Tokyo was constructed and screened by colony immunoblotting using pooled sera from patients with active TB. Immunoreactive clones were sequenced and analyzed bioinformatically. The full-length coding sequence of the identified antigen was expressed recombinantly using a cold-shock expression system in Escherichia coli. The recombinant protein was purified and evaluated for immunoreactivity using a Western blot analysis. Serological reactivity was further assessed using a dot-blot assay with individual serum samples from microbiologically confirmed TB patients (n = 40) and healthy controls (n = 40) from the Lao People’s Democratic Republic. Diagnostic performance was evaluated by a receiver operating characteristic (ROC) curve analysis.

Results: Immunoscreening identified a conserved hypothetical protein corresponding to Rv1073 of M. tuberculosis, designated MtbAg1073, for which no antigenicity had been previously reported. The protein was highly conserved among members of the M. tuberculosis complex. Recombinant expression using a cold-shock system produced soluble His-tagged MtbAg1073, which was specifically recognized by sera from TB patients in the Western blot analysis. Dot-blot assays showed significantly higher antibody responses in TB patients than in controls (median intensity: 761.2 vs. 471.9; the Mann–Whitney U test, P = 0.0002). The ROC analysis demonstrated moderate discriminatory performance (AUC = 0.734; 95% CI: 0.624–0.844), with a sensitivity of 70.0% and specificity of 67.5% at the optimal cut-off value.

Conclusions: MtbAg1073 is a conserved and immunoreactive antigen that elicits detectable antibody responses in active TB. These findings provide preliminary evidence of its immunoreactivity and warrant further investigation into its potential utility in serological approaches.

Background: Evidence on the association between blood metal exposure and mortality among adults with cardiovascular–kidney–metabolic (CKM) syndrome stages 0–3 remains limited. We examined the associations of blood lead (Pb), cadmium (Cd), mercury (Hg), selenium (Se), and manganese (Mn) with all-cause and cardiovascular mortality in this population.

Methods: We analyzed data from 4,394 adults with CKM stages 0–3 from the National Health and Nutrition Examination Survey (NHANES) 2011–2018 linked to mortality records. Blood metal concentrations were measured using inductively coupled plasma mass spectrometry. Weighted Cox proportional hazards models, restricted cubic spline (RCS) analyses, and weighted quantile sum (WQS) regression were used to assess associations of individual and mixed metal exposures with mortality outcomes.

Results: In the fully adjusted model, elevated blood Cd levels were associated with a higher risk of all-cause mortality (HR = 1.71, 95% CI: 1.26–2.33). In contrast, blood Se showed an inverse association with all-cause mortality, with lower risks observed in Q2 (HR = 0.61, 95% CI: 0.41–0.90) and Q4 (HR = 0.59, 95% CI: 0.38–0.93). RCS analyses showed nonlinear associations of Cd and Se with all-cause mortality. Cd exhibited an inverted U-shaped pattern, whereas Se showed an L-shaped inverse association. WQS regression suggested a positive association between mixed metal exposure and all-cause mortality (HR = 1.16, 95% CI: 0.99–1.34; P = 0.046). Associations with cardiovascular mortality were weaker and less consistent.

Conclusions: Among U.S. adults with stage 0–3 cardiovascular–kidney–metabolic syndrome, elevated blood cadmium levels and reduced blood selenium levels were potentially associated with a higher risk of all-cause mortality.

Background: Global epidemic diseases such as COVID-19 have driven both the excessive use of pharmaceuticals and shifts in their usage spectrum. Consequently, the profile of pharmaceuticals in the environment (PiE) may undergo dynamic temporal changes, posing a significant challenge to eco-pharmacovigilance (EPV), a specialized branch of pharmacovigilance focused on detecting, evaluating, understanding, and preventing the adverse environmental effects of pharmaceuticals.

Methods: Based on data extracted from 89 studies published between 2014 and 2025, this review conducts a focused comparison of the occurrence patterns of 43 selected typical anti-COVID-19 drugs (20 antibacterials, 11 antivirals, and 12 anti-inflammatory pharmaceuticals) as contaminants in distinct regions across China’s seven major river basins before, during, and after the pandemic. The need of dynamic EPV was then analyzed.

Results: Before the COVID-19 outbreak, erythromycin, ampicillin, roxithromycin, and acetaminophen dominated the PiE profile in terms of reported maximum residual concentrations; during the pandemic lockdown, ciprofloxacin, ofloxacin, azithromycin, and ketoprofen were identified as the top-priority anti-COVID-19 PiE; after the pandemic, azithromycin, norfloxacin, ofloxacin, ciprofloxacin, and roxithromycin remained the dominant PiE. Residual levels of individual PiE at the same location varied noticeably across the three periods.

Conclusions: Results revealed highly distinct regional and temporal variations in surface freshwater pollution by these COVID-19-associated PiE across the three periods, with no consistent regularity observed, thereby further highlighting the necessity of implementing EPV in a “dynamic” manner. Drawing on the framework of dynamic pharmacovigilance, the implementation of dynamic EPV can be promoted by establishing a dynamic watch-list mechanism, clarifying stakeholder roles, and advancing supportive policies and technological platforms, so as to enable adaptive interventions for the timely management of event-driven pharmaceutical pollution.

Background: Gestational exposure to environmental toxicants has been reported to be associated with epigenetic alterations in the male germ line. We have previously demonstrated that gestational arsenic exposure induces characteristic DNA methylation alterations in F1 sperm, namely the global DNA hypomethylation and the retrotransposon-associated alterations, including an increased frequency of differentially methylated cytosines (DMCs) and a predominance of hypomethylated DMCs (hypoDMCs) within long terminal repeats (LTRs) and long interspersed nuclear elements (LINEs). Hypomethylation of retrotransposon promoters is associated with increased detrimental retrotransposition and may contribute to disease development. Determining when and how these methylation alterations occur during spermatogenesis is important for elucidating the underlying molecular mechanisms.

Methods: To determine the developmental stage at which these alterations are established, prospermatogonia and type A spermatogonia were isolated from late-gestation and early postnatal testes of F1 male mice exposed to arsenic during gestation. Genome-wide DNA methylation profiles were analyzed in each cell population using reduced representation bisulfite sequencing (RRBS). Global methylation levels and the genomic distribution of DMCs, with particular focus on retrotransposon-associated regions, were examined. In addition, the expression of genes encoding DNA methylation-related enzymes was measured.

Results: Global DNA hypomethylation was observed in prospermatogonia derived from arsenic-exposed mice and was also detected in type A spermatogonia. In contrast, an increased frequency of DMCs and a predominance of hypoDMCs within retrotransposon-associated regions were not observed in prospermatogonia or type A spermatogonia, suggesting that these locus-specific alterations may be established during later stages of spermatogenic differentiation subsequent to the type A spermatogonial stage. Furthermore, decreased expression of Dnmt and Tet family genes was observed in prospermatogonia from the arsenic-exposed group.

Conclusions: These findings demonstrate that sperm DNA methylation alterations induced by gestational arsenic exposure are established in a stepwise manner during spermatogenesis. Global DNA hypomethylation associated with alterations in epigenetic remodeling processes is established at the prospermatogonial stage. Subsequently, more locus-specific alterations, characterized by an increased frequency of DMCs and a predominance of hypoDMCs primarily within LTR and LINE retrotransposon regions, emerge during later stages of spermatogenic differentiation subsequent to the type A spermatogonial stage.

Background: The d-ROMs and BAP serum tests are promising markers of oxidative balance in research settings. Conventional assay systems require 30 µL of serum and approximately 10 minutes to analyze a single sample. Although these systems have the advantages of calibration-free operation and the flexibility to perform individual tests at any time, their limited throughput and relatively high cost restrict their use in large-scale studies.

Methods: To address this issue, we developed a small-scale, semi-automated measurement system incorporating a pipetting robot and a 384-well plate. The system requires only 5.0 µL of serum sample and can process up to 144 samples simultaneously for both d-ROMs and BAP assays (a total of 288 measurements).

Results: Based on nonlinearity testing, 450 nm was selected as the optimal wavelength. To maintain linearity across various sample types, including turbid serum, d-ROMs required incubation at 4 °C for one week, and BAP required centrifugation to remove precipitates. Intra- and inter-assay, as well as inter-day, coefficients of variation ranged from 1% to 9% for d-ROMs and 2% to 17% for BAP. Inter-operator variations were <9%. Lipemic serum showed abnormally low BAP values using the conventional method but normal values using our method. In non-turbid samples, the current and conventional methods showed high agreement. Deming regression analysis of log₁₀-transformed d-ROMs values yielded a slope of 1.06 (95% confidence interval between 0.99–1.13), and an intercept of −0.12 (−0.28 to 0.04). The same analysis for BAP yielded a slope of 0.97 (0.821–1.13) and an intercept of −0.12 (−0.391 to 0.625). Stability testing indicated that serum should be stored at −80 °C in volumes ≥100 µL for standard 1.5 mL tubes or ≥21 µL for 96-well format tubes. Our method reduced serum requirements by 83%, reagent use by 93% for d-ROMs and 86% for BAP. Although colorimetric measurement is required after one week of incubation, actual labor time was reduced by approximately 80%.

Conclusions: We have developed a high-throughput, cost-effective in-house assay system for large-scale studies. This system provides accurate measurements of oxidative stress markers even in turbid samples, facilitating robust evidence-based research on oxidative stress and health.

Background: Previously, several studies have focused on the correlation between SNPs of the excision repair cross-complementation group 5 (ERCC5) gene and breast cancer susceptibility, and the rs17655 (Asp1104His) has been mostly studied among many SNPs of ERCC5 gene. However, contradictory results also existed among these published articles. So, we performed this meta-analysis to evaluate the relationship between the rs17655 of ERCC5 gene and the susceptibility to breast cancer.

Methods: All analyses in this meta-analysis were performed using Stata 15.0 version software. The heterogeneity test was performed using the chi-square-based Q-test and the I-square test. Sensitivity analysis was performed to estimate the influence of the combined ORs caused by individual data. Begg’s funnel plot method was used for the publication bias testing.

Results: We found a significant relationship between the rs17655 of ERCC5 gene and the breast cancer risk for the dominant model, OR (95% CI) = 1.24 (1.01–1.52), p = 0.036. But we found no significant association between the rs17655 and breast cancer risk for the recessive model (OR = 1.03, 95% CI = 0.80–1.32, p = 0.825) and the allele model (OR = 1.16, 95% CI = 0.98–1.38, p = 0.083). No statistically significant association were found between the ERCC5 gene rs17655 and the risk of breast cancer for the dominant model observed in Caucasian populations (pooled OR = 1.03, 95%CI = 0.91–1.18), in African populations (pooled OR = 1.55, 95%CI = 0.77–3.12) and in Asian population (pooled OR = 1.76, 95%CI = 0.755–4.12). No publication bias was observed for three genetic models (P = 0.061 for the dominant model, P = 0.825 for the recessive model, P = 0.118 for the allele model).

Conclusions: Carriers with rs17655 minor allele have higher susceptibility to breast cancer for the dominant model. But no significant relationship was observed between rs17655 and breast cancer susceptibility in Caucasian, African, and Asia populations.

Background: The coronavirus disease 2019 (COVID-19) pandemic highlighted poor health literacy (HL) as an underestimated public health problem. This study aimed to examine whether COVID-19–related HL and general HL were differentially associated with mental health problems.

Methods: A questionnaire survey was conducted among residents of Japanese metropolitan areas during the resurgence phase of the pandemic. Data from 1,482 participants were analyzed. COVID-19–related HL was assessed by participants’ perceived difficulty in understanding COVID-19–related information and recommendations. General HL was measured using the Communicative and Critical Health Literacy scale. Mental health outcomes included psychological distress, mood and anxiety disorders, and COVID-19–related anxiety. Multiple logistic regression analyses were conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs) per one–standard deviation increase in each HL measure, adjusting for age, sex, education, income, work status, self-rated health, and the other HL measure.

Results: The correlation coefficient between the two HL measures was 0.195. Higher COVID-19–related HL was associated with decreased risks of mental health problems; the ORs were 0.70 (95% CI, 0.62–0.78) for psychological distress, 0.76 (95% CI, 0.66–0.88) for mood and anxiety disorders, and 0.66 (95% CI, 0.53–0.81) for COVID-19–related anxiety. General HL was not associated with mental health problems; the corresponding ORs were 0.95 (95% CI, 0.85–1.06), 0.90 (95% CI, 0.79–1.03), and 1.11 (95% CI, 0.90–1.36), respectively.

Conclusions: Higher COVID-19–related HL, but not general HL, was associated with decreased risks of mental health problems.

Background: Environmental endocrine disruptors (EEDs), endocrine-interfering pollutants, attract attention for potentially affecting heart diseases via epigenetics. Nonylphenol (NP), a classical representative of endocrine-disrupting chemicals, has previously been demonstrated by our research group to induce myocardial fibrosis in rats. LncRNA, a gene regulator, mediates EED-induced heart cell damage and fibrosis.

Objective: This study aimed to investigate the role of long noncoding RNA OIP5 antisense RNA 1 (lncRNA OIP5-AS1) knockdown in NP-induced myocardial fibrosis.

Methods: Small interfering RNA (siRNA) transfection was used to interfere with the expression of lncRNA OIP5-AS1 in H9C2 cells. Lactate dehydrogenase (LDH), cell Counting Kit-8 (CCK-8), transwell, quantitative real time polymerase chain reaction (qRT-PCR), and Western blot assays were employed to detect cell membrane integrity, proliferation, migration ability, and the expression of fibrosis-related genes/proteins in H9C2 cells. This process was also validated in Sprague Dawley (SD) rats.

Results: The expression of fibrosis-related factor mRNA and proteins in H9C2 cells increased, and the expression of lncRNA OIP5-AS1 was significantly upregulated after 24 h of exposure to 70 µmol/L NP. The knockdown of lncRNA OIP5-AS1 did not show differential changes in LDH activity across treatment groups. However, the knockdown of lncRNA OIP5-AS1 significantly attenuated NP-induced proliferation and migration abilities of H9C2 cells and inhibited the increase in the expression of fibrosis-related factor mRNA/proteins caused by NP. This suggested that the interference with lncRNA OIP5-AS1 expression inhibited the NP-induced myocardial fibrosis in H9C2 cells. In vivo results suggested that NP exposure and isoproterenol hydrochloride groups in rats showed accumulation of myocardial collagen fibers in the interstitial space, increased distribution and content of collagen fibers, and elevated expression of fibrosis-related proteins. The distribution range, content of collagen fibers, and expression of fibrosis-related proteins significantly reduced in rats with lncRNA OIP5-AS1 knockdown exposed to NP compared with those in the NP group.

Conclusions: The expression of lncRNA OIP5-AS1 was upregulated in NP-treated H9C2 cells, rat hearts, and myocardial fibrosis model rats. Knockdown of lncRNA OIP5-AS1 was associated with attenuated NP-induced myocardial fibrosis and reduced collagen deposition.

Background: Nitrogen dioxide (NO₂) and ozone (O₃) exposure is associated with alterations in liver function, but epidemiological evidence in pregnant women remains limited, especially regarding the combined effects. This study aimed to investigate the associations of exposure to NO₂ and O₃ with maternal liver function and their roles in the combined effect of air pollutant mixture.

Methods: A birth cohort study with 11,909 pregnant women was conducted in Shenzhen, China. Exposure concentration of air pollutants during the first trimester were assessed based on the residential addresses of the pregnant women. Generalized additive model was used to analyze the association of NO₂ and O₃ exposure with maternal liver function. Furthermore, quantile G-computation model was used to investigate the combined effects of air pollutant mixture and the contribution of each pollutant.

Results: Each 10 µg/m³ increase in first-trimester NO₂ exposure was associated with elevated alanine aminotransferase (ALT) and total bilirubin (TBIL) in both the second trimester (ALT: 15.45%, 95% CI: 10.12%, 21.04%; TBIL: 6.69%, 95% CI: 3.75%, 9.72%) and third trimester (ALT: 3.89%, 95% CI: 0.32%, 7.59%; TBIL: 9.27%, 95% CI: 6.52%, 12.10%). For O₃, first-trimester exposure showed a positive association with second-trimester TBIL (2.03%, 95% CI: 1.25%, 2.81%), but was inversely associated with third-trimester ALT (−2.73%, 95% CI: −3.86%, −1.58%) and TBIL (−0.81%, 95% CI: −1.45%, −0.17%). These associations remained significant in the two-pollutant model. The Qgcomp analysis revealed that a one-quartile increase in the air pollutant mixture was associated with a 2.05% (95% CI: 0.56%, 3.56%) increase in third-trimester TBIL, with NO₂ accounting for 55.6% of the positive weight in the model.

Conclusions: First-trimester NO₂ exposure was associated with elevated maternal liver function biomarkers in both the second and third trimesters, while O₃ showed trimester-dependent associations. Exposure to air pollutant mixture was associated with increased third-trimester TBIL, and NO₂ may be the predominant relative contributor. These findings highlight the need for further studies and public health attention to air pollution exposure during pregnancy to protect maternal and fetal health.

Background: Bisphenol A (BPA) and its structural substitutes, bisphenol S (BPS) and bisphenol F (BPF), are widely used endocrine-disrupting chemicals. While BPA exposure has been linked to metabolic disorders, evidence regarding BPA substitutes in children remains limited, particularly in Southeast Asia.

Methods: We conducted a cross-sectional study among Thai children and adolescents aged 7–18 years classified as normal weight (NW) or overweight/obese (OW/OB). Urinary BPA, BPS, and BPF concentrations were measured using liquid chromatography–tandem mass spectrometry. Anthropometric measurements, body composition, fasting glucose, insulin, lipid profiles, and liver enzymes were assessed. Associations between urinary bisphenol concentrations and metabolic parameters were analyzed using multivariable regression models.

Results: A total of 114 participants were included (26 normal weight and 88 overweight/obese). BPA was detected in all (100%) urine samples, whereas BPS and BPF were detected in 50.0% and 53.6% of participants, respectively. Creatinine-adjusted urinary concentrations of BPA, BPS, and BPF did not differ significantly between NW vs. OW/OB. Higher urinary BPS and BPF concentrations were associated with higher fasting insulin levels (aGMR 1.13; 95%CI 1.05–1.20; p = 0.001) and higher LDL cholesterol levels (aGMR 5.82; 95%CI 0.52–11.11; p = 0.032), respectively. In contrast, higher urinary BPA concentrations were associated with lower fasting insulin levels (aGMR 0.77; 95%CI 0.66–0.90; p = 0.001).

Conclusions: Exposure to BPA and its substitutes, BPS and BPF, were associated with distinct metabolic alterations independent of weight status. BPS was associated with hyperinsulinemia, while BPF was associated with elevated LDL cholesterol.

Background: As population aging progresses in Japan, an increasing number of older wheelchair users regularly travel in the rear space of motor vehicles. Poor seatbelt fit is the main cause of severe or fatal injuries in collisions. The current study sought to examine the potential risks regarding seatbelts for wheelchair users in Japan using national statistics, and to elucidate the mechanisms of injuries among wheelchair users involved in frontal collisions using sled tests. We propose a restraint system for wheelchair users traveling in vehicles.

Methods: To identify cases of collisions involving vehicles with wheelchair user passengers, national police database was examined. A sled test representing a 48 km/h frontal collision with a Hybrid III AF05 dummy was used to examine kinematics at collision and biomechanical parameters of wheelchair users. We examined three test conditions (1. generally used seatbelt path for standard wheelchairs; 2. close seatbelt path for standard wheelchair; 3. close seatbelt path for sturdy wheelchair).

Results: According to a national database in Japan, a seatbelt was worn in most cases of fatalities and casualties among wheelchair user passengers. In sled test condition 1, the dummy moved forward and the lap belt compressed the abdomen. High values were observed for head injury criterion and neck injury criterion. In condition 2, the dummy moved forward and fell because the wheelchair seat collapsed. In all conditions, high values for chest deflections (51.3 to 53.8 mm) were caused by high shoulder-belt load (8,217 to 8,660 N).

Conclusions: Indications for future design of safety restraint system were provided as follows: both the shoulder and lap belts would be correctly positioned across the bony parts of the shoulder and pelvis, respectively; a force limiter would be installed in the restraint system to reduce shoulder belt loads; a sturdy wheelchair and adequate tie-down system that can resist applied forces would be used.

Background: The long-term impact of dynapenic abdominal obesity (D/AO)—the coexistence of muscle weakness and central adiposity—on physical, psychological, and cognitive multidimensional multimorbidity (mMM) remains unclear.

Methods: We analyzed longitudinal data from 8,311 adults aged ≥45 [China Health and Retirement Longitudinal Study (CHARLS), n = 4,887; Health and Retirement Study (HRS), n = 3,424] without baseline mMM (i.e., having at most a single-domain impairment), followed biennially for up to 4 years. To account for cross-cultural heterogeneity, analyses were conducted independently per cohort. Three mMM patterns—physical-psychological (PP-MM), physical-cognitive (PC-MM), and physical-psychological-cognitive (PPC-MM)—were constructed using chronic diseases, depressive symptoms, and cognitive tests. Multivariate regression assessed the risk and trajectory of mMM associated with D/AO, and continuous-time Markov multi-state models were utilized to estimate transition probabilities.

Results: In both the CHARLS and HRS cohorts, D/AO was significantly associated with an increased risk of all three specific mMM patterns compared to the non-dynapenic/non-abdominal obesity group, with the strongest association observed for PPC-MM [OR = 2.475 (1.100–5.002) in CHARLS; OR = 5.712 (2.009–14.882) in HRS]. Longitudinal analysis revealed that D/AO was associated with a higher likelihood of entering “incident/worsening” trajectories (RRR = 2.001, P = 0.014 in CHARLS; RRR = 2.507, P = 0.013 in HRS) and an elevated probability of progressing from PC-MM to complex PPC-MM. Notably, age significantly modified these associations, with risk magnitudes markedly higher among individuals aged <65 years (e.g., PP-MM in HRS: OR = 6.98, 95% CI: 1.85–26.31; PC-MM in CHARLS: OR = 4.39, 95% CI: 1.95–9.89). Pooled analyses and multiple sensitivity tests confirmed the robustness of the D/AO “risk gradient effect” across diverse populations, without significant cohort interactions.

Conclusion: D/AO is longitudinally associated with a higher incidence of mMM and less favorable health trajectories, particularly among individuals aged <65 years. These findings suggest that integrating muscle strength and abdominal adiposity assessments into primary care may offer potential value for early risk stratification. While the efficacy of targeted interventions warrants further verification in interventional studies, focusing on the D/AO phenotype provides a proactive perspective for mitigating the multidimensional multimorbidity burden in aging populations.

Background: Research over the past decade has indicated that exposure to per- and polyfluoroalkyl substances (PFAS) disrupts the intestinal barrier, potentially contributing to the development of gastrointestinal disorders. More recently, constipation has been hypothesized as one such outcome. However, epidemiological studies examining this association remain limited.

Methods: We analyzed data from 17,686 mothers and their children from the Japan Environment and Children’s Study, a Japanese birth cohort study. We used maternal plasma samples collected during pregnancy to determine PFAS concentrations. Of the 28 PFAS compounds analyzed, we included seven compounds that were quantified in more than 80% of the samples. We assessed functional constipation in children at ages 3 and 4 using caregiver-completed questionnaires based on the Rome III criteria. Logistic regression models were used to examine associations between maternal PFAS concentrations and childhood functional constipation, applying a Bonferroni-corrected significance threshold of P < 0.0035 to account for multiple comparisons.

Results: Functional constipation was observed in 11.3% of children at age 3 and 9.8% at age 4. After adjusting for potential confounders, we observed no significant associations between any of the seven maternal PFAS concentrations and functional constipation in children at 3 years of age. However, at 4 years, perfluorooctanoic acid (PFOA) concentrations were significantly associated with functional constipation, with an adjusted odds ratio of 1.13 (95% confidence interval: 1.05–1.21, P = 0.00057) per doubling of concentration. The remaining six PFAS compounds showed no significant associations at 4 years.

Conclusions: The single positive association between maternal PFOA concentration and functional constipation at 4 years of age is unlikely to reflect a true causal relationship, given limited biological plausibility. Our results do not provide evidence of an association between prenatal PFAS exposure and functional constipation in children, although further investigation is warranted.

Background: Stroke is a leading cause of death in China. While chronic kidney disease is a known stroke risk factor, quantitative evidence on the graded relationship between estimated glomerular filtration rate (eGFR) and stroke risk in the Chinese population remains limited.

Methods: This study integrated individual-level data from the China Health and Retirement Longitudinal Study (CHARLS), including a prospective cohort (n = 7,786, follow-up from 2015 to 2020) and a cross-sectional cohort (n = 8,467, 2011 wave), alongside a hospital-based cross-sectional dataset (n = 1,649, including 839 patients with stroke). The association between eGFR (modeled as continuous and categorical variables) and stroke was assessed using multivariable Cox proportional hazards models. Additionally, Kaplan-Meier survival curves and log-rank tests were also performed. The dose-response relationship was examined using restricted cubic spline (RCS) analysis. Sensitivity analyses using multiple imputation were conducted.

Results: Reduced eGFR was consistently associated with higher stroke risk across all datasets. In the fully adjusted prospective model, each 1 mL/min/1.73 m² decrease in eGFR was associated with a 1.3% increase in stroke hazard (HR = 1.013, 95% CI: 1.006–1.020). Consistent associations were observed in the cross-sectional CHARLS cohort (OR = 1.020, 95% CI: 1.008–1.032) and the hospital cohort (OR = 1.026, 95% CI: 1.019–1.033). Kaplan-Meier curves showed significantly lower stroke-free survival in lower eGFR quartiles (log-rank P < 0.001). RCS analyses confirmed a linear inverse relationship in all datasets (P for overall < 0.001; P for nonlinear > 0.05). Subgroup analyses showed no significant effect modification by key demographics or comorbidities. Sensitivity analyses confirmed the robustness of the findings.

Conclusion: Reduced eGFR is significantly and independently associated with increased stroke risk among Chinese adults aged ≥45 years, exhibiting a clear dose-response relationship. These findings support the potential utility of integrating renal function monitoring into stroke risk assessment and prevention strategies.

Background: The coronavirus disease 2019 (COVID-19) pandemic has imposed significant psychological stress worldwide. Although many studies have examined the mental health impacts during the pandemic’s early phase, evidence from the late phase remains limited. This study investigated the associations between COVID-19-related anxiety and sense of coherence (SOC) with psychological distress among rural residents during the pandemic late phase in Japan.

Methods: This community-based cross-sectional study was conducted from July 2022 to March 2023, the late phase of the COVID-19 pandemic. The participants were residents of rural communities in the Shimane Prefecture, Japan. They were recruited through a health check-up program arranged by a cooperative organization for farmers. Psychological distress was assessed using the Kessler 6-item Psychological Distress Scale (K6); COVID-19-related anxiety and SOC were assessed using self-administered questionnaires. Multivariable logistic regression analyses were performed to examine the associations between pandemic-related anxiety, SOC, and psychological distress after adjusting for age, sex, subjective health status, and communicative health literacy.

Results: Of the 1,310 individuals who underwent health checkups, 743 agreed to participate in the study, and 664 who completed all questionnaires were included in the final analyses. Psychological distress (K6 ≥ 5) was observed in 29.2% of participants and was more prevalent among younger adults. Fear of infection (OR = 1.32, 95% confidence interval [CI]: 1.05–1.68), stress related to mask wearing (OR = 1.35, 95% CI: 1.10–1.68), and concern about reduced income (OR = 1.32, 95% CI: 1.08–1.61) were associated with higher odds of psychological distress. Higher SOC was inversely associated with psychological distress.

Conclusions: During the late phase of the COVID-19 pandemic, several COVID-19-related anxiety factors, particularly fear of infection, stress related to mask wearing, and concern about reduced income, were associated with psychological distress among rural residents. Higher SOC was associated with lower psychological distress, suggesting that strengthening individual and community resilience may be important for mitigating the mental health impact of prolonged pandemic conditions in rural settings.

Background: Little is known about smoking and alcohol consumption after high school in Japan. This study examined factors associated with smoking and risky drinking among Japanese university students, focusing on sex-related differences.

Methods: A cross-sectional web-based survey was conducted among students from five Japanese universities. A total of 253 men and 510 women anonymously completed questionnaires assessing smoking, alcohol use, substance-related behaviors, and depressive symptoms. Logistic regression using penalized regression methods were performed to determine factors associated with smoking and risky drinking.

Results: Overall, 7.7% students reported smoking and 25.6% were classified as risky drinkers. Peer smoking was strongly associated with current smoking in men (odds ratio [OR]: 4.58) and women (OR: 2.45). Family smoking and depressive symptoms were associated with smoking only among women, indicating a sex-specific pattern. Regarding risky drinking, common associated factors in both sexes included alcohol-related negative outcomes (OR: 5.83 for men, 5.49 for women) and current smoking (OR: 3.83 for men, 4.86 for women). Among men, additional factors associated with risky drinking were living alone (OR: 2.96) and mixing alcohol with energy drinks (OR: 4.53).

Conclusions: After the age of 20, the rates of smoking and risky drinking might increase sharply among Japanese young adults. Sex-specific patterns indicate that male behaviors are shaped by external invitations and living situations, whereas female behaviors are linked to familial and psychological factors.

Background: Gender disparities in the intention to leave research careers after marriage have not been investigated. This study aimed to clarify the gender-specific associations of marital status and nurturing children with the intention to leave research careers among medical researchers.

Methods: A cross-sectional study was conducted from December 2022 to January 2023. The study was based on a web-based survey targeting medical researchers affiliated with 141 Japanese academic societies. Participants who disagreed with continuing their research careers were classified as intending to leave. Multivariable-adjusted logistic regression analysis was used to evaluate the gender-specific association of marital status and having children with the intention to leave research careers.

Results: Among 3,009 participants, 812 (27.0%) were women, and 342 (11.4%) expressed an intention to leave. A total of 2,481 participants (82.5%) were married, and 2,267 (75.3%) had children. Marital status was associated with intention to leave research careers in opposite directions for men and women, with significant interactions on both multiplicative (P = 0.015) and additive (P = 0.001) scales. Specifically, married men had a significantly lower intention to leave compared with unmarried men (adjusted odds ratio [aOR] 0.63, 95% confidence interval [CI]: 0.40–0.97). In contrast, among women, marriage was associated with a higher intention to leave compared with being unmarried (aOR 1.41, 95% CI: 0.86–2.32), although this increase was not significant. In post hoc subgroup analyses by medical license status, the gender-specific association between marital status and intention to leave research careers was more evident among medical doctors (MDs) than non-MDs, among whom the proportion reporting intention to leave was lower (4% to 6% across groups). However, estimates among non-MD researchers were imprecise due to the small number of events. Similar gender disparities were observed for having children, although the interaction did not reach statistical significance (P for additive interaction = 0.083).

Conclusions: The present results suggest that marital status showed opposite associations with intention to leave research careers between men and women, a pattern primarily observed among MD researchers. Our finding highlights the need to consider gender difference when developing strategies to support retention of medical researchers.

Background: Climate change poses significant threats to human health, necessitating the integration of environmental protection into public health efforts. Planetary health education (PHE) represents an emerging paradigm connecting human well-being with natural systems; however, its global implementation remains inadequately documented, particularly in environmentally vulnerable regions. This scoping review aimed to investigate how PHE is implemented across educational settings and to identify current challenges and best practices to inform future educational program development for university students, educators, and healthcare professionals.

Methods: Following Arksey and O’Malley’s framework and the PRISMA-ScR guidelines, we systematically searched the following databases for English and Japanese literature published up to September 30, 2025: Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Scopus, EMBASE, PubMed, OpenGrey, and Ichushi-Web. Using the Patient–Concept–Context framework, we extracted data on educational programs, implementation methods, challenges, outcomes, and curriculum integration.

Results: Forty-one studies met the inclusion criteria. These studies were predominantly from high-income countries with varying Climate Change Performance Index rankings. Implementation was concentrated in higher education institutions, particularly medical and nursing schools. Educational approaches included lecture-based teaching, group work, practical training, online learning, and simulations. Key content areas were most frequently climate change and health/climate-sensitive care and sustainability/SDG-related topics, whereas pollution/waste and environmental toxins, food systems, and equity/justice-related content were reported less frequently. Primary challenges included difficulties with curriculum integration, time constraints, and insufficient awareness among educators. Reported outcomes demonstrated improvements in knowledge, critical thinking, and motivation for sustainable practices; however, longitudinal impact studies were notably absent.

Conclusions: PHE requires expansion beyond medicine into diverse disciplines and geographical contexts, particularly in low-income countries. Longitudinal studies and randomized controlled trials are needed to assess the long-term educational impact. Successful implementation depends on interdisciplinary approaches, strategic curriculum integration, and educator development programs. These efforts will help address global health challenges through education that connects human health with environmental sustainability.

Background: How to measure sleep has been the primary focus of sleep epidemiological studies. To address the lack of systematic evaluation of sleep-related indicators, we reviewed large population-based cohort studies in Japan, focusing on whether sleep was measured subjectively or objectively.

Methods: PubMed, Ichushi-Web, and official cohort study websites were systematically searched from January 1, 2004, to March 31, 2025, to identify studies that measured sleep-related indicators as exposures or outcomes in 19 large population-based cohorts in Japan. Data on sleep measurement methods and main study results were extracted.

Results: Of 102 studies in 12 cohorts, 75 (74%) studies examined subjective sleep quantity or quality based on questionnaires, and 27 (26%) used objective measures of sleep. Among subjective measures, sleep duration was frequently self-reported (57 studies in 10 cohorts), while sleep quality was directly (e.g., “Do you think you get enough sleep?”) or indirectly asked as part of sleep-related scores such as the Pittsburgh Sleep Quality Index (51 studies in 10 cohorts). Regarding objective measures, the Circulatory Risk in Communities Study cohort measured 3% oxygen desaturation index by pulse oximetry (9 studies) and respiratory disturbance index by airflow monitor (1 study), Japan Multi-Institutional Collaborative Cohort Study used actigraphy (1 study), Nagahama cohort used pulse oximetry (12 studies) and actigraphy (13 studies), and Tohoku Medical Megabank Project used actigraphy (1 study) and contactless biomotion sleep sensor (2 studies).

Conclusions: Population-based cohort studies in Japan have predominantly relied on subjective measures of sleep, while the number of studies using objective measures has been increasing.

Background: Despite numerous recent studies linking height loss to the risk of cardiovascular disease, the underlying biological mechanisms are poorly understood. Subclinical hypothyroidism (SCH) has been positively associated with height loss in individuals with low-normal range free thyroxine (FT4) levels. This association may stem from impaired endothelial repair caused by an inadequate response to the increased thyroid hormone demand. Recent evidence has highlighted the clinical significance of thyroid cysts in terms of their endothelial-related activity. Consequently, it is plausible that thyroid cysts influence the relationship between SCH and height loss.

Method: A prospective-study was conducted in 1,601 Japanese individuals aged 40–74 years with normal serum free triiodothyronine (T3) and free T4 levels. Height loss was defined as being in the highest quartile of annual height decrease.

Results: SCH was significantly and positively associated with height loss among individuals with thyroid cysts, but not among those without thyroid cysts; the sex- and age-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for height loss were 1.00 (0.56, 1.94) in individuals without thyroid cysts and 2.45 (1.03, 5.81) in those with thyroid cysts. After further adjustment for free T4, atherosclerosis, hypertension, and chronic kidney disease, these associations essentially remained, with adjusted ORs (95% CIs) of 1.00 (0.53, 1.83) and 2.75 (1.12, 6.74), respectively.

Conclusion: Our findings clarify the biological basis of height loss as a cardiovascular risk factor. Endothelial dysfunction is associated with SCH and height loss. Given that urinary iodine concentration has previously been reported to be positively associated with the presence of thyroid cysts and that excess iodine intake is a major cause of SCH in the Japanese population, the observed relationship may reflect an inadequate thyroidal response to increased hormone demand following endothelial injury.

Background: Although marital status is a key social determinant of health, its prognostic relevance in cardiopulmonary exercise testing (CPX) cohorts remains unclear. We aimed to evaluate the association between marital status and mortality risk in patients with cardiac disease (CD) who underwent CPX.

Methods: This retrospective, single-center observational study involved consecutive patients with CD who underwent post-discharge CPX between 2008 and 2020. Participants (mean age: 69 years; 73% male) were categorized as either unmarried (never married, divorced, or widowed) or married. The primary outcome was all-cause mortality, and the secondary outcome was cardiovascular mortality. We used Cox proportional hazards models to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Model 1 was adjusted for age and sex to estimate the overall association between marital status and outcomes. Model 2 was adjusted for Model 1 covariates and peak VO₂ to account for objectively measured exercise capacity.

Results: Of 4,681 patients analyzed, 1,117 were unmarried and 3,564 were married. In Model 1, being married was associated with a lower risk of all-cause mortality (aHR: 0.75, 95% CI: 0.62–0.91, P < 0.001). This association persisted after adjusting for peak VO₂ in Model 2 (aHR: 0.79, 95% CI: 0.65–0.96, P = 0.002). For cardiovascular mortality, the estimates were consistent in direction (Model 1; aHR: 0.64, 95% CI: 0.44–0.93, P = 0.019, Model 2; aHR: 0.69, 95% CI: 0.47–1.02, P = 0.061).

Conclusions: In a large CPX cohort of patients with CD, married status was associated with a lower risk of all-cause mortality. The association was attenuated but remained after adjustment for peak VO₂, suggesting that differences in exercise capacity may contribute but do not fully account for the observed association. Marital status should be interpreted as a social marker rather than a causal or interventional exposure, and future studies should clarify modifiable factors related to prognosis.

Background: Evidence regarding the association between ambient polycyclic aromatic hydrocarbon (PAH) mixtures and non-neoplastic gastrointestinal diseases in general populations remains limited. This study examined whether provincial ambient particulate-phase PAH burden was associated with prevalent gastrointestinal disease among middle-aged and older adults in China.

Methods: Provincial annual mean concentrations of particulate-phase PAHs for 2015 were compiled from published monitoring studies across 12 Chinese provinces and linked to participants in the 2015 wave of the China Health and Retirement Longitudinal Study. Gastrointestinal disease was defined as a self-reported physician diagnosis and/or current treatment, excluding tumors and cancer. Using multivariable logistic regression, we estimated odds ratios and 95% confidence intervals for prevalent gastrointestinal disease per doubling (log2) of total PAHs and of 17 individual PAHs, adjusting for demographic, socioeconomic, and health-related covariates. The Benjamini–Hochberg procedure controlled the false discovery rate. Likelihood ratio tests for interaction were used to assess effect modification.

Results: Of 3,671 adults aged 45 years or older, 1,056 (28.8%) reported a gastrointestinal disease. In fully adjusted models, each doubling of total PAH concentration was associated with increased odds of gastrointestinal disease (odds ratio 1.07, 95% confidence interval 1.02–1.12; false discovery rate–adjusted q = 0.014). Following multiple-comparison correction, naphthalene, fluorene, phenanthrene, and pyrene each demonstrated consistent positive associations. The association for total PAHs was more pronounced among non-drinkers (odds ratio 1.43, 95% confidence interval 1.19–1.71; P for interaction = 0.015) and rural residents (odds ratio 1.37, 95% confidence interval 1.15–1.65; P for interaction = 0.035).

Conclusions: Higher provincial ambient particulate-phase PAH burden was associated with a greater prevalence of self-reported non-neoplastic gastrointestinal disease among middle-aged and older Chinese adults, with potential heterogeneity by residence and alcohol consumption. Given the cross-sectional design and province-level exposure assignment, longitudinal studies with individual-level exposure assessment and validated outcomes are needed.

Background: New tobacco products, including heated tobacco products and electronic cigarettes, are rapidly increasing in popularity among younger populations worldwide, particularly in Japan. Thus, clarifying the effects of both active and passive smoking of new tobacco products during pregnancy is an urgent public health concern. We focused on nausea and vomiting in pregnancy (NVP) which is traditionally and epidemiologically considered an indicator of healthy pregnancy progression. In this study, we classified maternal and paternal smoking status focussing on new tobacco product use and investigated its association with the absence of NVP.

Methods: This cross-sectional study used control data from a case–control study designed to explore modifiable factors for anorectal malformations. The questionnaire survey was conducted within seven Japanese regions between December 2019 and March 2023, enrolling a total of 1,522 postpartum women. The study included 1,450 postpartum women who delivered singleton babies and provided complete information. The main outcome was the absence of NVP. The exposure was the smoking status of mothers and their partners, classified into four categories: dual users (combustible cigarettes and new tobacco products), new tobacco product-only users, combustible cigarette-only users, and non-smokers (reference). Logistic regression analysis was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the absence of NVP.

Results: Based on maternal smoking status, the absence of NVP was reported in 27.1% of dual users, 25.0% of new tobacco product–only users, 18.0% of combustible cigarette–only users, and 15.2% of non-smokers. Maternal dual use was associated with an increased OR of the absence of NVP (adjusted OR = 2.07, 95% CI: 1.02–4.22). After restricting to non-smoking mothers, the adjusted OR for paternal combustible cigarette smoking was 2.62 (95% CI: 1.25–5.50).

Conclusion: Our main finding was the positive association between maternal dual use of new tobacco products and combustible cigarettes during pregnancy and the absence of NVP. This suggests that smoking cessation guidance during pregnancy, including new tobacco products, is particularly warranted.

Trial registration: Not applicable.

Background: Although the prevalence of early childhood caries (ECC) has declined over the past few decades, it remains a significant public health concern in Japan. Socioeconomic disparities in ECC risk have been reported; however, the extent to which these disparities exist across different indicators of socioeconomic status (SES) and the degree to which early oral health practices help explain them remain unclear. This study evaluated the association between parental SES and ECC and examined the extent to which early oral health behaviors contributed to these associations.

Methods: We analyzed the data from 68,312 children and their parents participating in the Japan Environment and Children’s Study, a nationwide birth cohort recruited between 2011 and 2014. Parental SES, including household income equivalized using the OECD-modified equivalence scale and educational attainment, was assessed using self-reported questionnaires. Diagnoses of dental caries from birth to age 4 years were reported retrospectively by caregivers when the child was 4 years old. Multivariable logistic regression was used to examine associations between SES and ECC. Mediation analyses were conducted to evaluate whether oral health behaviors at age 2, including fluoride application, tooth brushing practices, continued bottle feeding, and frequency of between-meal snacks, mediated these associations. All models were adjusted for demographic and potential confounding factors.

Results: Overall, 23.0% of children had been diagnosed with caries by age 4 years. The higher prevalence was consistently observed among children from lower SES backgrounds starting at around age 2 years. Both lower household income and lower parental educational attainment were associated with higher odds of ECC. The highest odds were observed among children whose parents had secondary-level education (adjusted odds ratio: 1.52; 95% confidence interval: 1.44–1.59). Although oral health behaviors mediated these associations, each behavior accounted for less than 5% of the total effect.

Conclusion: Lower household income and parental educational attainment were consistently associated with a higher risk of ECC from early childhood. Mediation analyses using oral health behaviors assessed at age 2 indicated that these behaviors explained a small proportion of the observed socioeconomic disparities, suggesting a small contribution of individual behaviors to early-life socioeconomic inequalities in ECC.

Background: Japan is experiencing a rapid demographic shift toward a super-aged society, making the extension of healthy life expectancy a national priority. Oral self-care, particularly tooth brushing habits, may play a critical role in preventing functional decline among older adults, yet evidence in this population remains limited. This study aimed to examine the association between specific tooth brushing behaviors—frequency, timing (especially before bedtime), and use of interdental cleaning tools—and incident disability among community-dwelling older adults in Japan.

Methods: A three-year prospective cohort study was conducted in City A, Nara Prefecture, involving 7,785 older adults aged 65 and above who were free of disability at baseline. Tooth brushing habits were assessed via self-administered questionnaires, and incident disability was defined as new certification under Japan’s Long-Term Care Insurance system. Covariates included age, gender, socio-economic status, lifestyle habits, physical and mental health, and oral health indicators. Multiple logistic regression analyses were used to estimate adjusted odds ratio (AOR) and 95% confidence interval (CI) for incident disability.

Results: During the follow-up period, 713 participants (9.2%) developed incident disability. After adjustment for covariates and mutual adjustment for other tooth brushing habits, non-daily brushing before bedtime and non-use of interdental cleaning tools were associated with higher odds of incident disability (AOR for non-daily vs daily brushing before bedtime = 1.55, 95% CI: 1.19–2.01; AOR for non-use vs use of interdental cleaning tools = 1.34, 95% CI: 1.11–1.62). These associations were particularly evident among individuals aged 75 and older.

Conclusion: Daily brushing before bedtime and the use of interdental cleaning tools were independently associated with lower odds of incident disability among community-dwelling older adults. Nevertheless, causal inference is limited, and residual confounding cannot be ruled out.

Background: Thyroid hormones support endothelial repair, whereas bedtime snacking is linked to a higher risk of chronic kidney disease (CKD). Since endothelial dysfunction is a core feature of CKD, bedtime snacking could potentially contribute to subclinical hypothyroidism (SCH) by elevating the demand for endothelial repair. This study aimed to explore the association between bedtime snacking and SCH.

Method: In this cross-sectional study, 1,478 Japanese individuals aged 40–69 years with normal thyroid function were enrolled; normal thyroid function was defined as free triiodothyronine (T3) and free thyroxine (T4) levels within the reference ranges and the absence of thyroid-related medication use. Individuals with elevated serum concentrations of TSH (>4.01 µIU/mL) were defined as having SCH. Bedtime snacking was determined in the basis of participants’ affirmation to the question “Do you consume a night meal or snack after dinner, within two hours of bedtime, three or more times per week? (Yes, No)”.

Results: In the study population, 263 individuals reported a bedtime snacking habit, whereas SCH was identified in 81 individuals. A statistically significant association was found between bedtime snacking and SCH. The sex- and age-adjusted odds ratios (OR) and 95% confidence intervals (CI) were 1.77 (1.05, 2.99). This association remained significant after additional adjustment for skipping breakfast and late dinner; 1.83 (1.07, 3.11), and further adjustment for free T4, atherosclerosis, hypertension, diabetes, CKD, and thyroid cysts; 1.93 (1.11, 3.35), respectively.

Conclusion: Bedtime snacking is positively associated with SCH, potentially due to an increased physiological demand for endothelial repair. This finding is not only an efficient tool for diagnosing the early stages of endothelial and thyroid dysfunction, but also for clarifying the mechanism underlying the regulation of thyroid hormones related to endothelial health.

Background: Bone fractures pose a significant socioeconomic burden for both women and men in aging societies. It has been reported that lean mass (LM) measured by dual-energy X-ray absorptiometry (DXA) may be associated with fractures. However, evidence regarding the relationship between DXA-measured LM and fractures remains inconsistent.

Methods: We investigated the association between DXA-measured LM and clinical bone fractures in community-dwelling elderly Japanese men from the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) cohort study. The source population consisted of 948 elderly men who underwent LM measurement by DXA at the time of the 2017–2019 survey. Among these, 780 participants who provided complete information regarding clinical fracture experience in the follow-up survey conducted in 2022–2023 were included in the analysis (mean age at the time of the 2017–2019 survey, 80.2 years; standard deviation, 3.8).

Results: From the 2017–2019 survey to the 2022–2023 follow-up survey, 52 participants had experienced one or more clinical bone fractures including osteoporotic and non-osteoporotic fractures. Odds ratios of clinical bone fracture for arm LM, leg LM, and leg-to-trunk LM ratio were significantly lower than 1.0 after adjusting for potential confounding factors including age, nutrition intake, and physical performance.

Conclusion: DXA-based appendicular LM predicts future clinical bone fractures in elderly Japanese men, suggesting that elderly men with low skeletal muscle mass, which can be accurately estimated from appendicular LM, may be prone to future clinical fractures. DXA-measured LM thus provides additional information useful for the management of bone fractures.

Background: Although previous studies have reported that exercising with others has a more beneficial effect on the health of older adults than exercising alone, gender differences in the association between exercise patterns and health are unknown. We investigated the cross-sectional association between exercise patterns and physical and mental health by gender.

Methods: We analyzed 4,211 men and 4,944 women aged ≥65 years without disabilities. Physical and mental health was assessed using the SF-8 Health Survey. Exercise patterns were measured based on three types: participation in exercise groups, non-group-based exercise with others, and exercising alone. Each exercise pattern was classified into five groups according to frequency and continuity: maintained frequent (i.e., daily or weekly), increase in frequency, maintained moderate (i.e., monthly or yearly), decrease in frequency, and continuing non-exercise. Modified Poisson regression with generalized estimating equations was used to estimate adjusted prevalence ratio (APR) for poor physical/mental health. Covariates included age, marital status, education, economic status, body mass index, chronic medical conditions, smoking, dietary variety, cognition, working status, and social participation.

Results: For physical health, among both genders, all exercise patterns had a significant dose-response relationship between lower levels of exercise frequency and continuity and a higher prevalence of poor physical health, after adjustment for covariates and mutual adjustment for other exercise patterns (all P for trend <0.036). For mental health, among men, only exercising alone had a significant dose-response relationship (P for trend <0.001) [APR: 1.22 (95% CI: 1.07–1.39) for continuing non-exercise, 1.32 (1.11–1.57) for decrease in frequency, compared to maintained frequent]. Among women, the cross-sectional association with mental health was limited to participation in exercise groups (P for trend: 0.006) [APR: 1.24 (95% CI: 1.09–1.40) for continuing non-exercise, 1.26 (1.09–1.47) for decrease in frequency, and 1.37 (1.13–1.66) for maintained moderate, compared to maintained frequent].

Conclusions: All exercise patterns were cross-sectionally associated with physical health across genders. However, mental health outcomes varied: Cross-sectional associations with mental health were observed for men when exercising alone, and for women when exercising in groups. These results highlight the importance of gender-sensitive public health strategies, such as tailored community exercise programs. Due to the cross-sectional design, causality cannot be determined. However, the results do suggest that future longitudinal research is needed.

Background: Epidemiological evidence increasingly implicates ambient particulate matter (PM) as a contributor to diabetes progression and premature mortality; however, the strength and consistency of these associations remain uncertain. This systematic review and meta-analysis quantified the relationship between exposure to major PM fractions—particularly PM_2.5 and PM₁₀—and the risk of diabetes-related mortality in adult populations.

Methods: Following PRISMA and MOOSE guidelines, five databases were searched through September 30, 2025. Eligible observational studies assessed long- or short-term exposure to ambient PM and reported quantitative estimates for diabetes-associated deaths. Effect sizes were pooled using random-effects models and expressed as relative risk (RR) per 10 µg/m³ increment in PM concentration. Subgroup and meta-regression analyses explored sources of heterogeneity.

Results: Thirty-six studies (41 datasets) were included. Pooled analysis showed a significant positive association between PM_2.5 exposure and diabetes-related mortality (RR = 1.123; 95%CI: 1.099–1.147; I² = 95.3%). The effect was stronger for long-term exposure (RR = 1.296; 95%CI: 1.197–1.395) and prospective cohorts (RR = 1.327; 95%CI: 1.189–1.466). PM₁₀ was also associated with increased risk, though with smaller magnitude (RR = 1.021; 95%CI: 1.007–1.035; I² = 81.7%). Meta-regression confirmed exposure duration as a significant modifier (p = 0.014).

Conclusions: Both fine (PM_2.5) and coarse (PM₁₀) particulate matter are significantly associated with increased diabetes-related mortality, with the strongest and most consistent effects observed for chronic PM_2.5 exposure. These findings highlight the metabolic health burden of air pollution and underscore the importance of stringent air-quality standards to reduce premature diabetes deaths globally.

Background: Exposure to microplastics (MPs) can have adverse gastrointestinal effects by inducing inflammation and oxidative stress. The types of MPs in stool vary with the dietary intake. However, how MPs in the intestinal tract influence the inflammatory cytokine levels in the gastrointestinal tract in healthy individuals remains unclear, particularly in Japan, characterized by a high intake of vegetables and seafood. In this study, we investigated the relationship between food intake, stool MPs, and inflammatory markers in healthy Japanese individuals, and estimated the sources of the stool MPs.

Methods: Twenty-two participants completed a questionnaire on daily food intake for 7 days. Thereafter, stool samples were collected to examine MP density via Fourier-transform infrared spectrophotometry. On day 8, blood samples were collected and analyzed for serum oxidative stress markers and cytokine levels. Next, the effect of total stool MP particle density (Low vs. High) on oxidative stress markers and cytokines levels was analyzed.

Results: The median total MP particle density of the participants (median age: 44 years) was 7.20 MP particles per g of stool. Seafood intake was higher in the High MP group than in the Low MP group, with a Mann-Whitney U test yielding p = 0.035 for seafood intake. However, after the false discovery rate (FDR) correction, this effect was not significant. Nevertheless, the effect size for seafood intake was large, suggesting an association with MP level. Relative to the Low MP group, the High MP group showed significantly higher thymic stromal lymphopoietin (TSLP) levels (odds ratio: 13.5; 95% confidence interval: 0.99–183, p = 0.050). The analysis further revealed that the seafood consumed by the High MP group contained significant amounts of polyethylene (PE) and polypropylene (PP), MPs commonly used in plastic packaging (PE, p = 0.028; PP, p = 0.053).

Conclusion: This study showed that stool MP particle density is likely associated with seafood intake and the TSLP level, implying that excessive MP intake may adversely affect human health. Therefore, measures to reduce MP exposure are urgently required.

Background: The prevalence of constipation is increasing with the aging of the population, significantly impacting the quality of life in older adults. However, a comprehensive analysis of the physical, psychological, and social correlates of constipation in Japan remains limited. This study aimed to examine factors associated with defecation status in community-dwelling older adults in Japan.

Methods: We conducted a cross-sectional analysis of 8,009 community-dwelling residents aged 65 years and older who completed the baseline health and lifestyle questionnaire as part of the Yamagata Cohort Study. Constipation was defined as fewer than three bowel movements per week. Physical, psychological, and social factors were assessed using self-administered questionnaires. Associations with constipation were examined using chi-square tests and multivariable logistic regression, including sex-stratified models.

Results: Constipation was observed in 407 participants (5.1%). In the multivariable analysis, it was significantly associated with being female (odds ratio [OR] = 1.26, 95% confidence interval [CI]: 1.02–1.56; reference: male), having a body mass index (BMI) ≥25 kg/m² (OR = 0.74, 95% CI: 0.58–0.96: reference: <25 kg/m²), feeling unhappy (OR = 1.94, 95% CI: 1.16–3.22; reference: happy), experiencing residual stool sensation (OR = 2.77, 95% CI: 2.11–3.64; reference: no sensation), having moderate overactive bladder (OAB) symptoms (OR = 1.42, 95% CI: 1.13–1.79; reference: no OAB symptoms), and perceived living situation on current income as difficult (OR = 1.70, 95% CI: 1.36–2.12; reference: comfortable). Sex-stratified analyses revealed partially different patterns of associated factors between men and women.

Conclusion: Constipation in community-dwelling older adults in Japan was associated with multiple physical, psychological, and social factors, with sex-specific differences. Given the cross-sectional design, causality cannot be inferred. These findings suggest that constipation in older adults may be associated with a complex interplay of physical, psychological, and social factors, highlighting the need for comprehensive and integrated approaches in community settings. Integrated geriatric care that addresses these dimensions may be effective in preventing and managing constipation in this population.

Background: Child maltreatment, traditionally considered a maternal issue in Japan, increasingly involves fathers. Despite the rise in paternal participation, the recognition of and engagement in child maltreatment remains poorly investigated in Japan. We explored the association between parental recognition and engagement in maltreatment, stratified by parental sex.

Methods: An Internet survey was conducted in Japan from July to August 2021, involving 8,819 parents (1,671 fathers, and 7,148 mothers) with children under 24 months of age. A self-report questionnaire assessed recognition of and engagement in maltreatment behaviors, including physical and psychological maltreatment and neglect. Poisson regression analysis estimated prevalence ratios of engagement in maltreatment behaviors by recognition status, stratified by parental sex.

Results: Harsh behaviors widely recognized as maltreatment (unrecognition was less than 15% for both sexes) included beating the child (fathers: 13.5%, mothers: 6.9%), repeatedly insulting the child (fathers: 13.3%, mothers: 7.7%), and not feeding the child (fathers: 13.1%, mothers: 6.3%). Engagement in any form of maltreatment was reported by 14.2% of fathers and 9.6% of mothers in this sample. The overall prevalence of physical maltreatment was 10.5% among fathers and 5.7% among mothers. Similarly, fathers reported 6.1% overall neglect and mothers reported 1.9%. The prevalence of psychological maltreatment was 4.4% among fathers and 3.5% among mothers. For both sexes, lack of recognition of maltreatment was associated with a higher prevalence of engagement in such behaviors (fathers: adjusted prevalence ratio [aPR] 2.06, 95% confidence interval [CI] 1.43–2.99; mothers: aPR 1.88, 95% CI 1.53–2.33). This association was consistent across all subtypes, with the strongest for neglect (physical maltreatment [fathers: aPR 2.49, 95% CI 1.63–3.79; mothers: aPR 2.06, 95% CI 1.59–2.66], psychological maltreatment [fathers: aPR 2.22, 95% CI 1.30–3.78; mothers: aPR 1.43, 95% CI 1.09–1.88], and neglect [fathers: aPR 4.28, 95% CI 2.71–6.78; mothers: aPR 4.75, 95% CI 3.23–6.99]).

Conclusions: Lack of recognition was associated with greater engagement in maltreatment, particularly neglect, for both parents, based on these findings. Findings underscore the need for parenting education and support targeting both parents.

Background: Competing endogenous RNAs (ceRNAs) represent a novel mechanism involving interactions among different RNAs, playing a crucial role in the gene regulatory networks throughout the life cycle. CeRNAs are implicated in cardiovascular diseases (CVDs) caused by environmental endocrine disruptors (EDCs); however, existing studies are not yet systematic, and the mechanisms underlying their effects remain unclear.

Objective: This study aimed to systematically elucidate the role of ceRNAs in EDC-induced CVDs and provide valuable insights regarding disease mechanisms and developing new therapeutic strategies.

Methods: Comprehensive searches for research related to EDC-induced cardiovascular diseases were conducted across PubMed, Web of Science, and ScienceDirect databases. Eligible studies were screened, and those containing information on the regulatory mechanisms of ceRNAs were extracted and analyzed.

Results: Notably, ceRNA-mediated effects of EDC exposure on CVDs mainly occurred through four pathways. First, upon exposure to EDCs, micro RNAs, messenger RNAs (mRNAs), long-chain non-coding RNAs, circular RNAs are differentially regulated, activating signaling pathways such as nuclear factor erythroid 2-related factor 2 and p38 mitogen-activated protein kinase/nuclear factor-κB, which lead to atherosclerosis. Second, EDC exposure alters mRNAs and proteins involved in ceRNA networks, activating the PTEN-induced kinase 1/Parkin and transforming growth factor-β1/LIM domain kinase 1 signaling pathways, leading to cardiomyopathy. Third, EDCs increase ceRNA-related mRNA levels, thereby raising the risk of CVDs. Lastly, ceRNAs participate in EDC exposure to upregulate nitric oxide or reactive oxygen species, ultimately causing vascular diseases.

Conclusion: Altogether, the findings of this study show that ceRNAs hold significant potential for identifying target genes and signaling pathways associated with CVDs, which may facilitate deeper studies into CVD management.

Background: In Japan, specific health guidance is a program based on health checkups to prevent metabolic syndrome. However, dropout from the program is an issue and reduces opportunities to improve cardiovascular risk. Lack of awareness of health checkup results is thought to be associated with dropout, but the association remains unclear. This study aimed to investigate the impact of awareness of health checkup results with related attitude on dropout from specific health guidance among teachers.

Methods: Data from medical insurance providers primarily serving teachers (n = 7,031; mean age = 51.19 years old) were analysed. Participants were categorized into 3 groups based on awareness of health checkup results and attitude toward adopting healthy lifestyles at the first time of the health guidance: awareness with the attitude (level 1 group), awareness without the attitude (level 2 group), and lack of awareness (level 3 group). Dropout rates from specific health guidance and improvement in health checkup results in the following year were compared across groups.

Results: Dropout rates were 19.88% in the level 1 group, 22.03% in the level 2 group, and 27.77% in the level 3 group (P < 0.001 in a trend test). Compared with the level 1 group (reference), adjusted risk ratios for dropout were 1.139 (95% confidence interval: 1.001–1.295) for the level 2 group and 1.320 (95% confidence interval: 1.132–1.540) for the level 3 group. The degree of improvement in health checkup results decreased progressively from level 1 to level 3.

Conclusions: Among the participants who received the first health guidance, awareness of health checkup results combined with attitude to adopt healthy lifestyles was associated with lower dropout from specific health guidance and greater improvements in cardiovascular risk. Such individuals’ awareness and attitudes may help predict individuals at risk of dropout from health guidance in this population.

Background: Few studies have investigated the association between ambient temperature and the risk of mental disorders in Japan. In this study, we investigated a short-term association between the risk of hospitalizations for mental disorders and ambient temperature using municipal health insurance data.

Methods: We used the data of the Longevity Improvement & Fair Evidence Study in Japan, and the data of 17 municipalities were employed in the analysis. The daily number of hospitalizations for schizophrenia, depressive disorders, and anxiety disorders was used as the outcome variable. The time-stratified case-crossover design was employed in this ecological time-series study, and a distributed-lag non-linear model using a conditional quasi-Poisson regression model was employed to investigate an association between ambient temperature and hospitalizations for the abovementioned mental disorders. The model was applied to each municipality, and a multivariate meta-analysis was conducted to pool the results of municipalities. In addition, subgroup analyses by sex and age groups were conducted, and temperature-related attributable fractions of the mental disorders were also calculated.

Results: The results of the overall cumulative effect of ambient temperature on hospitalizations for mental disorders indicated that the risk ratio (RR) tended to increase with an increase in temperature regardless of the type of mental disorder. An analysis by sex indicated that the RR tended to increase with an increase in temperature regardless of sex. In addition, an analysis by age group indicated that an increase in RR with increasing temperature was more evident in persons aged <65 years compared to those aged ≥65 years regardless of mental disorders, and that the temperature-related attributable fractions were also higher in persons aged <65 years.

Conclusions: Higher temperatures were associated with a higher risk of hospitalization for mental disorders in Japan, while the degree of the association differed by age group.

Background: A meta-analysis reported a positive association between Helicobacter pylori (H. pylori) infection and dementia incidence. H. pylori infection leads to atrophic gastritis (AG) and affects the absorption of nutrients needed for nerve growth, such as vitamin B12 and folate. We aimed to clarify the associations of H. pylori IgG titer, AG, and their combination with disabling dementia incidence and to examine the interaction with vitamin B12 and folate.

Methods: Anti-H. pylori immunoglobulin G (IgG) titer and pepsinogen levels were measured in 6,817 participants in 1993 (40–69 years), and the incidence of disabling dementia was followed during a median follow-up of 11.0 years. Associations of anti-H. pylori IgG titer, AG, and their combination with disabling dementia were examined using a multivariable-adjusted Cox proportional hazard model, with stratified analyses by dietary intake of vitamin B12 and folate.

Results: 1,325 (19.4%) developed disabling dementia during the follow-up period from 2006 to 2016. Among participants with low vitamin B12 intake, H. pylori infection and severe AG were positively associated with the risk of disabling dementia, with HRs of 1.26 (95% CI: 1.01–1.58) for H. pylori infection (H. pylori IgG titer ≥10 U/mL) and 1.34 (95% CI: 1.06–1.68) for severe AG. Additionally, having both H. pylori infection and AG was associated with an increased risk of dementia among individuals consuming less vitamin B12 than the median (HR 1.30, 95% CI: 1.05–1.61), compared with H. pylori-seronegative and AG-negative.

Conclusions: The combination of H. pylori infection, subsequent AG, and low vitamin B12 intake may be related to increased risk of dementia.

Background: Vertigo is characterized by the illusion of motion, typically described as a spinning sensation. Seasonal variations in vertigo incidence, particularly in Meniere’s disease and Benign Paroxysmal Positional Vertigo, have been reported, though underlying mechanisms remain unclear.

Objective: This study investigates key environmental drivers by analyzing seasonal patterns of vertigo while accounting for temperature, barometric pressure, humidity, and viral infections in Israel’s semi-arid Negev desert. We hypothesized that environmental conditions are associated with the onset of vertigo, and that specific meteorological factors contribute to its seasonal variation.

Methods: A case-crossover study was conducted using data from 9,382 patients diagnosed with vertigo at Soroka Medical Center (2014–2019). Environmental exposure data were collected from local meteorological station, and viral infection trends were analyzed.

Results: Exposure to barometric pressure above the 90th percentile for two consecutive days was linked to a 21% increase in vertigo risk (p = 0.024), rising to 40% (p = 0.073) among hypertensive patients. In spring, exposure to extreme dry heat (>2 days) showed a trend toward increased vertigo risk. Similarly, vertigo onset was likely to be triggered by heatwaves stress and extremely humid conditions in fall although none reached a statistical significance.

Conclusions: This study suggests that atmospheric conditions, particularly high barometric pressure, may influence vertigo onset. While not all associations were statistically significant, observed trends highlight the potential role of environmental factors in vertigo and warrant further research.

Background: Gut microbiota plays a crucial role not only in digestion but also in systemic physiological functions, including immune and neural regulation. High microbial diversity contributes to intestinal homeostasis, whereas reduced diversity has been associated with various diseases. Physical activity is reported to influence both the composition and function of gut microbiota; however, the impact of daily physical activity on gut microbiota in older adults remains poorly understood. This study exploratorily investigated the association between objectively measured daily physical activity and gut microbial diversity and composition in older women who are at increased risk of reduced physical activity and gut microbial dysbiosis.

Methods: A cross-sectional study assessed daily physical activity using an accelerometer-based activity monitor in 73 community-dwelling older women. We classified participants as meeting (n = 56) or not meeting (n = 17) the World Health Organization (WHO) physical activity guidelines. Fecal samples were collected and analyzed using 16S rRNA sequencing to evaluate gut microbial diversity and composition.

Results: Participants not meeting the WHO activity guidelines exhibited lower gut microbial diversity (Observed Features: 134 ± 23 vs. 161 ± 45, Chao1 index: 137 ± 24 vs. 167 ± 49, all p < 0.05) and distinct microbial community structures (weighted UniFrac distances, PERMANOVA, p < 0.05) as compared with those meeting the guidelines. In particular, the relative abundance of short-chain fatty acid–producing Ruminococcus was reduced in the less active group.

Conclusion: Habitual daily physical activity was associated with gut microbiota diversity and composition in older women in this exploratory study. In particular, the relative abundance of Ruminococcus may reflect differences in gut microbial function. Future longitudinal and interventional studies are needed to further clarify causal relationships and support the development of personalized strategies to promote gut health and healthy aging.

Background: This letter highlights the importance of clinical epidemiology in COVID-19 prevention and control, based on experiences at a core hospital in northern Okinawa, Japan, and relevant literature.

Methods: Using data from 5,097 COVID-19 patients, we conducted: (1) a descriptive cross-sectional study analyzing cases by person, time, and place; (2) an analytical cross-sectional study linking health checkup data to identify factors associated with severity (published in Environmental Health and Preventive Medicine); and (3) a cohort study of healthcare workers exploring determinants of post-vaccination antibody titers (published in Journal of Clinical Virology Plus).

Results: The descriptive study showed cases rose from 70 in 2020 to 891 in 2021 and 3,995 in 2022, before declining to 141 in 2023. In the analytical cross-sectional study (n = 1,353), protective factors against severity included vaccination (odds ratio [OR] [2 doses vs. 0 or one doses]: 0.223, 95% confidence interval [CI] 0.114–0.436; OR [≥3 doses vs. 0 or one doses]: 0.090, 95% CI 0.035–0.229) and regular exercise (OR [“yes” vs. “no”]: 0.458, 95% CI 0.242–0.866). In the cohort study (n = 354), lower antibody titers (lowest quartile) were more likely among older adults (hazard ratio [HR] 5.82 for 40s vs. 20s, 95% CI 2.05–16.51; HR 9.96 for 60s vs. 20s, 95% CI 3.07–32.34) and drinking habits (HR 2.26 for “daily” vs. “never”, 95% CI 1.17–4.34).

Conclusion: These findings, supported by related literature, demonstrate that clinical epidemiology played vital roles in monitoring infection trends, evaluating diagnostic and preventive measures, establishing treatment strategies, optimizing healthcare resources, and guiding policy. Its continued application will be essential for preparedness against future emerging infectious diseases.

Background: While advancements in cancer treatment have improved survival rates, some survivors continue to experience emotional difficulties that adversely affect overall well-being. Forest therapy, a nature-based intervention, has demonstrated potential in alleviating psychological and physiological stress.

Methods: This single-arm pre–post study evaluated a two-hour guided forest therapy session in a submontane forest in Taiwan. Participants were recruited via posters and online registration forms disseminated by the Linsen Chinese Medicine and Kunming Branch (LCMKB) of Taipei City Hospital and were screened for eligibility according to predefined inclusion and exclusion criteria. Outcomes included psychological measures—the Profile of Mood States 2nd Edition–Adult Short (POMS 2-A), Beck Depression Inventory–Second Edition (BDI-II), and Beck Anxiety Inventory (BAI)—along with physiological indicators (heart rate, blood pressure, heart rate variability, salivary cortisol).

Results: Of the 40 participants, 38 completed the program. Significant improvements were observed in mood disturbance (The Total Mood Disturbance of POMS 2-A: 4.0 → −8.0), anxiety (BAI: 5.0 → 3.5), depression (BDI-II: 5.5 → 4.0), and salivary cortisol levels (1.07 → 0.42 µg/dL), all with large effect sizes. Regression analyses suggested that baseline emotional status and certain demographic factors may have influenced outcomes. Participants with higher initial anxiety and depression, younger age, and shorter cancer duration appeared to show relatively greater improvements.

Conclusions: This first study of forest therapy among cancer survivors in Taiwan provides preliminary evidence that guided forest therapy may be a useful complementary approach for enhancing emotional well-being and reducing physiological stress. Significant improvements were observed across multiple psychological measures (POMS 2-A, BAI, BDI-II) and in salivary cortisol. Benefits were more pronounced among participants with higher baseline distress, younger age, or shorter cancer duration, underscoring the importance of considering baseline health profiles and demographic characteristics when designing interventions.

Trial Registration: Approved by the Taipei City Hospital Research Ethics Committee (TCHIRB-11104010). ClinicalTrials.gov Identifier: NCT06001723.

Background: Mass gatherings during the peak summer months pose a notable risk for heat-related illnesses due to extreme heat and humidity. We aimed to identify trends in preventive measures taken against heat-related illnesses at mass gathering rock festivals in Japan during the summer of 2023, in terms of associations with online sources regarding the event details and heat risk communication; daily maximum wet bulb globe temperature (WBGT) values; and emergency heat-related illness transport data.

Methods: Four rock festivals (festivals A–D), held in July and August 2023, were analyzed. Publicly available online sources were reviewed to examine the event details, heat risk communication, and preventive measures. Daily maximum WBGT values were obtained from the meteorological observation points closest to each festival venue. Emergency heat-related illness transport data were assessed to identify trends during the rock festivals.

Results: Three festivals (festivals A, B, and D) recorded daily maximum WBGT values at or above the “Danger” threshold (≥31 °C), while festival C reached the “Severe Warning” level (≥28 °C and <31 °C). Despite the high WBGT, no heat advisories were issued on the websites of festivals A and B. Festival C gave a basic advisory on heat precautions. Festival D implemented more comprehensive countermeasures, including public warnings and recommendations to carry hats, towels, and portable fans. Notably, emergency transport for heat-related illnesses increased in the regions hosting festivals B and D.

Conclusions: All festivals posed substantial heat-related health risks. Enhanced public risk communication and consistent preventive measures are essential for mitigating preventable incidents during mass gatherings in extreme heat.