Journal of Epidemiology
Online ISSN : 1349-9092
Print ISSN : 0917-5040
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  • Vien Quang Mai, Trịnh Thị Xuan Mai, Ngo Le Minh Tam, Le Trung Nghia, K ...
    Article ID: JE20170090
    [Advance publication] Released: May 19, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Dengue is a clinically important arthropod-borne viral disease with increasing global incidence. Here we aimed to estimate the prevalence of dengue infections in Khanh Hoa Province, central Viet Nam, and to identify risk factors for infection.

    Methods: We performed a stratified cluster sampling survey including residents of 3–60 years of age in Nha Trang City, Ninh Hoa District and Dien Khanh District, Khanh Hoa Province, in October 2011. Immunoglobulin G (IgG) and immunoglobulin M (IgM) against dengue were analyzed using a rapid test kit. Participants completed a questionnaire exploring clinical dengue incidence, socio-economic status, and individual behavior. A household checklist was used to examine environment, mosquito larvae presence, and exposure to public health interventions.

    Results: IgG positivity was 20.5% (urban, 16.3%; rural, 23.0%), IgM positivity was 6.7% (urban, 6.4%; rural, 6.9%), and incidence of clinically compatible dengue during the prior 3 months was 2.8 per 1,000 persons (urban, 1.7; rural, 3.4). For IgG positivity, the adjusted odds ratio (AOR) was 2.68 (95% confidence interval [CI], 1.24–5.81) for mosquito larvae presence in water pooled in old tires and was 3.09 (95% CI, 1.75–5.46) for proximity to a densely inhabited area. For IgM positivity, the AOR was 3.06 (95% CI, 1.50–6.23) for proximity to a densely inhabited area.

    Conclusions: Our results indicated rural penetration of dengue infections. Control measures should target densely inhabited areas, and may include clean-up of discarded tires and water-collecting waste.

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  • Takahiro Tabuchi, Sho Fujihara, Tomohiro Shinozaki, Hiroyuki Fukuhara
    Article ID: JE20170163
    [Advance publication] Released: May 19, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Our objective in this study was to find determinants of high-school dropout in a deprived area of Japan using longitudinal data, including socio-demographic and junior high school-period information.

    Methods: We followed 695 students who graduated the junior high school located in a deprived area of Japan between 2002 and 2010 for 3 years after graduation (614 students: follow-up rate, 88.3%). Multivariable log-binomial regression models were used to calculate the prevalence ratios (PRs) for high-school dropout, using multiple imputation (MI) to account for non-response at follow-up.

    Results: The MI model estimated that 18.7% of students dropped out of high school in approximately 3 years. In the covariates-adjusted model, three factors were significantly associated with high-school dropout: ≥10 days of tardy arrival in junior high school (PR 6.44; 95% confidence interval [CI], 1.69–24.6 for “10–29 days of tardy arrival” and PR 8.01; 95% CI, 2.05–31.3 for “≥30 days of tardy arrival” compared with “0 day of tardy arrival”), daily smoking (PR 2.01; 95% CI, 1.41–2.86) and severe problems, such as abuse and neglect (PR 1.66; 95% CI, 1.16–2.39). Among students with ≥30 days of tardy arrival in addition to daily smoking or experience of severe problems, ≥50% high-school dropout rates were observed.

    Conclusions: Three determinants of high-school dropout were found: smoking, tardy arrival, and experience of severe problems. These factors were correlated and should be treated as warning signs of complex behavioral and academic problems. Parents, educators, and policy makers should work together to implement effective strategies to prevent school dropout.

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  • Shama Virani, Jarin Chindaprasirt, Kosin Wirasorn, Aumkhae Sookprasert ...
    Article ID: JE20170045
    [Advance publication] Released: May 12, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: The northeast has the lowest incidence of breast cancer of all regions in Thailand, although national rates are increasing. The heterogeneity in subnational trends necessitates a comprehensive evaluation of breast cancer incidence trends and projections to provide evidence for future region-specific strategies that may be employed to attenuate this growing burden.

    Methods: Joinpoint regression and age-period-cohort modeling were used to describe trends from 1988–2012. Data was projected from three separate models to provide a range of estimates of incidence to the year 2030 by age group.

    Results: Age-standardized rates (ASRs) increased significantly for all women from 1995–2012 by 4.5% per year. Rates for women below age 50 increased by 5.1% per year, while women age 50 years and older increased by 6% per year from 1988–2012. Projected rates show that women age 50 years and older have the largest projected increase in ASRs by 2030 compared to younger women and all women combined.

    Conclusions: Breast cancer trends in Khon Kaen are presently lower than other regions but are expected to increase and become comparable to other regions by 2030, particularly for women ages 50 years and older.

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  • Hirokazu Tanaka, Koichi B. Ishikawa, Kota Katanoda
    Article ID: JE20170051
    [Advance publication] Released: May 12, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: There has been no nationwide analysis of travel time for hospital admission in Japan. Factors associated with travel time are also unknown. This study aimed to describe the distribution of travel time for hospital admission of cancer patients and identify underlying factors.

    Methods: The individual data from the Patient Survey in 2011 were linked to those from the Survey of Medical Institutions in the same year, and GIS data were used to calculate driving travel time between the addresses of medical institutions and the population centers of municipalities where patients lived. Proportions of patients with travel time exceeding versus not exceeding 45 minutes were calculated. To analyze the data with consideration of both individual factors of patients and geographical characteristics of areas where patients lived, multilevel logistic model analysis was performed.

    Results: The analysis included 50,845 cancer inpatients. The majority of the cancer patients (approximately 80%) were admitted to hospitals located less than a 45-minute drive from their residences. The travel time tended to be longer for younger patients. The proportion of patients with travel time ≥45 minutes was lower among those with stomach or colorectal cancer (approximately 15%) than those with cervical cancer or leukemia (approximately 30%). The lack of designated cancer care hospitals in the secondary healthcare service areas was significantly associated with travel time.

    Conclusions: Selection of hospitals by cancer inpatients is affected by age, cancer sites, and availability of designated cancer care hospitals in the secondary healthcare service areas where patients live.

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  • Takeshi Makiuchi, Tomotaka Sobue, Tetsuhisa Kitamura, Norie Sawada, Mo ...
    Article ID: JE20180011
    [Advance publication] Released: May 11, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Smoking and alcohol are established risk factors for several types of cancer, but the effects on biliary cancers comprising biliary tract cancer (BTC) and intrahepatic bile duct cancer (IHBDC) have been inconclusive.

    Methods: In this population-based prospective cohort study in Japan, we investigated the association of smoking and alcohol consumption with the risks of BTC and its subtypes, and IHBDC incidence in men and women. Furthermore, the association of smoking stratified by drinking status was investigated. The hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using the Cox proportional hazard model.

    Results: A total of 48,367 men and 54,776 women aged 40–69 years were enrolled between 1990 and 1994 and followed up for 846,417 person-years in men and 1,021,330 person-years in women until 2012, during which 246 BTC and 80 IHBDC male cases and 227 BTC and 60 IHBDC female cases were identified. In men, smoking was significantly associated with an increased risk of IHBDC (HR = 2.25 [95% CI, 1.19–4.25] for current smokers with ≥30 pack-years), and the risk was enhanced among regular drinkers (HR = 3.48 [95% CI, 1.41–8.61]). A non-significant increase of IHBDC risk associated with alcohol was observed. Neither smoking nor alcohol consumption was associated with BTC risk. In women, the association of smoking and alcohol consumption with IHBDC and BTC was unclear because current smokers and regular drinkers were very few.

    Conclusion: Our findings suggest that smoking increases IHBDC risk in men, especially among regular drinkers.

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  • Huanhuan Hu, Tohru Nakagawa, Hiroko Okazaki, Chihiro Nishiura, Teppei ...
    Article ID: JE20170093
    [Advance publication] Released: May 04, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: We estimated the cumulative risk of type 2 diabetes from age 30 to 65 years in a large working population in Japan.

    Methods: We used data from the Japan Epidemiology Collaboration on Occupational Health Study. Participants (46,065 men and 7,763 women) were aged 30–59 years, free of diabetes at baseline, and followed up for a maximum of 7 years. Incident type 2 diabetes was defined based on fasting and casual glucose, glycated hemoglobin, and current medical treatment for type 2 diabetes. We calculated the sex-specific cumulative risk of type 2 diabetes using the Practical Incidence Estimator macro, which was created to produce several estimates of disease incidence for prospective cohort studies based on a modified Kaplan-Meier method.

    Results: During 274,349 person-years of follow-up, 3,587 individuals (3,339 men and 248 women) developed type 2 diabetes. The cumulative risk was 34.7% (95% confidence interval, 33.1–36.3%) for men and 18.6% (95% confidence interval, 15.5–21.7%) for women. In BMI-stratified analysis, obese (BMI ≥30 kg/m2) and overweight (BMI 25–29.9 kg/m2) men and women had a much higher cumulative risk of type 2 diabetes (obese: 77.3% for men and 64.8% for women; overweight: 49.1% and 35.7%, respectively) than those with BMI <25 kg/m2 (26.2% and 13.4% for men and women, respectively).

    Conclusions: The present data highlight the public health burden of type 2 diabetes in the working population. There is a need for effective programs for weight management and type 2 diabetes screening, especially for young obese employees, to prevent or delay the development of type 2 diabetes.

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  • Masae Otake, Kenichi Sakurai, Masahiro Watanabe, Chisato Mori
    Article ID: JE20170019
    [Advance publication] Released: April 28, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Several studies have reported the adverse effects of caffeine intake during pregnancy on fetal health. However, the effects of caffeine intake from green and oolong teas has not been investigated, despite the considerable consumption of these teas in Japan and the potential inhibitory effects of catechins—chemicals present at relatively high levels in green and oolong teas—on folic acid absorption. The potential associations of serum folate levels with caffeinated beverage consumption and catechin levels remain largely unstudied. The present study aimed to determine these associations in pregnant Japanese women.

    Methods: Pregnant women (n = 2,701) not receiving folate supplementation were enrolled at the Chiba Unit Center, a regional site of the Japan Environment and Children’s Study (JECS). Serum folate levels were measured using an Access folate assay kit, and nutrient and caffeine intakes were assessed using a self-administered food frequency questionnaire that was previously evaluated in Japanese populations.

    Results: The low and normal serum folate groups reported caffeine intakes of 42.3 mg/1,000 kcal and 34.4 mg/1,000 kcal, respectively, and tannin intakes of 40.8 mg/1,000 kcal and 36.3 mg/1,000 kcal, respectively. Multiple regression analyses revealed negative associations of serum folate levels with caffeine and tannin intakes and a positive association between serum folate levels and dietary folate intake.

    Conclusions: Considering the negative associations of caffeine and tannin levels with serum folate levels, pregnant women should consume caffeinated beverages, such as coffee and green/oolong teas, with caution.

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  • Hiroyuki Sasai, Yoshio Nakata, Haruka Murakami, Ryoko Kawakami, Satosh ...
    Article ID: JE20170129
    [Advance publication] Released: April 28, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Physical activity questionnaires (PAQs) used in large-scale Japanese cohorts have rarely been simultaneously validated against the gold standard doubly labeled water (DLW) method. This study examined the validity of seven PAQs used in Japan for estimating energy expenditure against the DLW method.

    Methods: Twenty healthy Japanese adults (9 men; mean age, 32.4 [standard deviation {SD}, 9.4] years, mainly researchers and students) participated in this study. Fifteen-day daily total energy expenditure (TEE) and basal metabolic rate (BMR) were measured using the DLW method and a metabolic chamber, respectively. Activity energy expenditure (AEE) was calculated as TEE − BMR − 0.1 × TEE. Seven PAQs were self-administered to estimate TEE and AEE.

    Results: The mean measured values of TEE and AEE were 2,294 (SD, 318) kcal/day and 721 (SD, 161) kcal/day, respectively. All of the PAQs indicated moderate-to-strong correlations with the DLW method in TEE (rho = 0.57–0.84). Two PAQs (Japan Public Health Center Study [JPHC]-PAQ Short and JPHC-PAQ Long) showed significant equivalence in TEE and moderate intra-class correlation coefficients (ICC). None of the PAQs showed significantly equivalent AEE estimates, with differences ranging from −547 to 77 kcal/day. Correlations and ICCs in AEE were mostly weak or fair (rho = 0.02–0.54, and ICC = 0.00–0.44). Only JPHC-PAQ Short provided significant and fair agreement with the DLW method.

    Conclusions: TEE estimated by the PAQs showed moderate or strong correlations with the results of DLW. Two PAQs showed equivalent TEE and moderate agreement. None of the PAQs showed equivalent AEE estimation to the gold standard, with weak-to-fair correlations and agreements. Further studies with larger sample sizes are needed to confirm these findings.

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  • Masayoshi Zaitsu, Ichiro Kawachi, Toyo Ashida, Katsunori Kondo, Naoki ...
    Article ID: JE20170152
    [Advance publication] Released: April 28, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Participation in community activities (eg, sports and hobby groups or volunteer organizations) is believed to be associated with better health status in the older population. We sought to (1) determine whether a greater diversity of group membership is associated with better self-rated health and (2) identify the key dimension of the membership diversity (eg, gender, residential area, or age).

    Methods: We performed a cross-sectional study of 129,740 participants aged 65 years and older who were enrolled in the Japan Gerontological Evaluation Study in 2013. We assessed the diversity of group membership using (1) a continuous variable (range 0–4) accounting for the total degree of each diversity dimension or (2) dummy variables for each dimension. We estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for better self-rated health according to the diversity of group membership, using Poisson regression and robust variance with multiple imputation, adjusted for other covariates.

    Results: The participants involved in social groups with greater diversity had better self-rated health: the PR per one point unit increase in diversity was 1.03 (95% CI, 1.02–1.04). Participation in gender-diverse groups was associated with the best profile of health (PR 1.07; 95% CI, 1.04–1.09).

    Conclusions: Among the older population in Japan, higher group diversity is associated with better self-rated health. Gender is the key dimension of diversity that is associated with better self-rated health.

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  • Zhongyu Ren, Cong Huang, Haruki Momma, Yufei Cui, Kaijun Niu, Shota Su ...
    Article ID: JE20170029
    [Advance publication] Released: April 21, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: There is scarce epidemiological evidence regarding the relationships of the consumption of different types of vegetables or fruits with change in skeletal muscle strength. We prospectively examined the relationships among Japanese adults, using handgrip strength to assess skeletal muscle strength.

    Methods: A 3-year study was carried out with 259 Japanese adults who were 22–68 years of age. The frequency of consumption of different types of vegetables or fruits were obtained using a validated self-administered dietary history questionnaire. Handgrip strength was measured with a handheld digital Smedley dynamometer.

    Results: After adjustment for confounding factors, the mean change in handgrip strength in participants stratified according to the level of tomato and tomato product consumption at baseline were −3.2 (95% confidence interval [CI], −4.0 to −2.3) for <1 time/week, −2.7 (95% CI, −3.6 to −1.8) for 1 time/week, −1.6 (95% CI, −2.5 to −0.8) for 2–3 times/week, and −1.7 (95% CI, −2.8 to −0.7) for ≥4 times/week, (P for trend = 0.022). However, the significant relationships of consumption of other types of vegetables and different types of fruits with change in handgrip strength were not observed.

    Conclusion: Higher consumption of tomato and tomato product at baseline was significantly associated with reduced decline in handgrip strength among Japanese adults over a 3-year follow-up period. This study suggests that consumption of tomato and tomato product could be protective against the decline in skeletal muscle strength associated with aging.

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  • Jeevitha Mariapun, Chiu-Wan Ng, Noran N. Hairi
    Article ID: JE20170001
    [Advance publication] Released: April 14, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Economic development is known to shift the distribution of obesity from the socioeconomically more advantaged to the less advantaged. We assessed the socioeconomic trends in overweight, obesity, and abdominal obesity across a period of significant economic growth.

    Methods: We used the Malaysian National Health and Morbidity Survey data sets for the years 1996, 2006, and 2011 to analyze the trends among adults aged 30 years and above. The World Health Organization’s Asian body mass index cut-off points of ≥23.0 kg/m2 and ≥27.5 kg/m2 were used to define overweight and obesity, respectively. Abdominal obesity was defined as having a waist circumference of ≥90 cm for men and ≥80 cm for women. Household per-capita income was used as a measure of socioeconomic position. As a summary measure of inequality, we computed the concentration index.

    Results: Women in Peninsular Malaysia demonstrated patterns that were similar to that of developed countries in which the distributions for overweight, obesity, and abdominal obesity became concentrated among the poor. For women in East Malaysia, distributions became neither concentrated among the rich nor poor, while distributions for men were still concentrated among the rich. Chinese women, particularly from the richest quintile, had the lowest rates and lowest increase in overweight and obesity. All distributions of Chinese women were concentrated among the poor. The distributions of Malay men were still concentrated among the rich, while distributions for Chinese and Indian men and Malay and Indian women were neither concentrated among the rich nor poor.

    Conclusion: As the country continues to progress, increasing risks of overweight and obesity among the socioeconomically less advantaged is expected.

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  • Shinichiro Uehara, Kyoko Kogawa Sato, Hideo Koh, Mikiko Shibata, Shige ...
    Article ID: JE20170082
    [Advance publication] Released: April 07, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Metabolically healthy obesity seems to be a unique phenotype for the risk of cardiometabolic diseases. However, it is not known whether this phenotype is associated with the risk of proteinuria.

    Methods: Study subjects were 9,185 non-diabetic Japanese male workers aged 40–55 years who had no proteinuria, an estimated glomerular filtration rate ≥60 mL/min/1.73 m2, no history of cancer, and no use of antihypertensive or lipid-lowering medications at baseline. Obesity was defined as body mass index ≥25.0 kg/m2. Metabolic health was defined as the presence of no Adult Treatment Panel III components of the metabolic syndrome criteria, excluding waist circumference, and metabolic unhealth was defined as the presence of one or more metabolic syndrome components, excluding waist circumference. “Consecutive proteinuria” was considered positive if proteinuria was detected twice consecutively as 1+ or higher on urine dipstick at annual examinations to exclude chance proteinuria as much as possible.

    Results: During the 81,660 person-years follow-up period, we confirmed 390 cases of consecutive proteinuria. Compared with metabolically healthy non-obesity, metabolically healthy obesity was not associated with the risk of consecutive proteinuria (multiple-adjusted hazard ratio [HR] 0.86; 95% confidence interval [CI], 0.37–1.99), but metabolically unhealthy non-obesity with ≥2 metabolic syndrome components (HR 1.77; 95% CI, 1.30–2.42), metabolically unhealthy obesity with one component (HR 1.71; 95% CI, 1.12–2.61), and metabolically unhealthy obesity with ≥2 metabolic syndrome components (HR 2.77; 95% CI, 2.01–3.82) were associated with an increased risk of consecutive proteinuria.

    Conclusions: Metabolically healthy obesity did not increase the risk of consecutive proteinuria in Japanese middle-aged men.

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  • Fuminari Miura, Ryota Matsuyama, Hiroshi Nishiura
    Article ID: JE20170040
    [Advance publication] Released: March 31, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Foodborne norovirus outbreak data in Japan from 2005–2006, involving virological surveillance of all symptomatic and asymptomatic individuals, were reanalyzed to estimate the asymptomatic ratio of norovirus infection along with the risk of infection and the probability of virus shedding.

    Methods: Employing a statistical model that is considered to capture the data-generating process of the outbreak and virus surveillance, maximum likelihood estimation of the asymptomatic ratio was implemented.

    Results: Assuming that all norovirus outbreaks (n = 55) were the result of random sampling from an identical distribution and ignoring genogroup and genotype specificities, the asymptomatic ratio was estimated at 32.1% (95% confidence interval [CI], 27.7–36.7). Although not significant, separate estimation of the asymptomatic ratio of the GII.4 genotype appeared to be greater than other genotypes and was estimated at 40.7% (95% CI, 32.8–49.0).

    Conclusion: The present study offered the first explicit empirical estimates of the asymptomatic ratio of norovirus infection in natural infection settings. The estimate of about 30% was consistent with those derived from volunteer challenge studies. Practical difficulty in controlling GII.4 outbreaks was supported by the data, considering that a large estimate of the asymptomatic ratio was obtained for the GII.4 genotype.

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  • Vita Rovite, Yael Wolff-Sagi, Linda Zaharenko, Liene Nikitina-Zake, El ...
    Article ID: JE20170079
    [Advance publication] Released: March 24, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: The Genome Database of the Latvian Population (LGDB) is a national biobank that collects, maintains, and processes health information, data, and biospecimens collected from representatives of the Latvian population. These specimens serve as a foundation for epidemiological research and prophylactic and therapeutic purposes.

    Methods: Participant recruitment and biomaterial and data processing were performed according to specifically designed standard protocols, taking into consideration international quality requirements. Legal and ethical aspects, including broad informed consent and personal data protection, were applied according to legal norms of the Republic of Latvia.

    Results: Since its start in 2006, the LGDB is comprised of biosamples and associated phenotypic and clinical information from over 31,504 participants, constituting approximately 1.5% of the Latvian population. The LGDB represents a mixed-design biobank and includes participants from the general population as well as disease-based cohorts. The standard set of biosamples stored in the LGDB consists of DNA, plasma, serum, and white blood cells; in some cohorts, these samples are complemented by cancer biopsies and microbiome and urine samples. The LGDB acts as a core structure for the Latvian Biomedical Research and Study Centre (BMC), representing the national node of Latvia in Biobanking and BioMolecular resources Research Infrastructure – European Research Infrastructure Consortium (BBMRI-ERIC).

    Conclusions: The development of the LGDB has enabled resources for biomedical research and promoted genetic testing in Latvia. Further challenges of the LGDB are the enrichment and harmonization of collected biosamples and data, the follow-up of selected participant groups, and continued networking and participation in collaboration projects.

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  • Reiji Kojima, Shigekazu Ukawa, Wenjing Zhao, Koji Suzuki, Hiroya Yamad ...
    Article ID: JE20170087
    [Advance publication] Released: March 24, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Most studies of plasma adiponectin (APN) and mortality among community-dwelling elderly focus on cardiovascular disease, but data on the relationship between plasma APN and cancer mortality is exiguous. We investigated whether APN is associated with cancer mortality in community-dwelling elderly people.

    Methods: We conducted a case-cohort study within the New Integrated Suburban Seniority Investigation (NISSIN) Project using a randomly drawn sub-cohort of 697 subjects (351 men and 346 women; mean age 64.5 [standard deviation, 0.5] years) among whom we compared cases of all-cause death (n = 269) and cancer death (n = 149) during a mean follow-up duration of 10.8 (standard deviation, 3.7) years. Associations between APN and mortality were assessed using weighted Cox regression analyses.

    Results: We observed significant positive associations between the APN concentration and cancer death in the first and third APN tertiles compared with the second APN tertile (hazard ratio [HR]T1 vs T2, 1.67; 95% confidence interval [CI], 1.00–2.79 and HRT3 vs T2, 2.10; 95% CI, 1.30–3.40). Further adjustment for possible confounders attenuated the association (HRT1 vs T2, 1.63; 95% CI, 0.93–2.84 and HRT3 vs T2, 2.10; 95% CI, 1.26–3.50). A similar but weaker association was seen for all-cause mortality (multivariate HRT1 vs T2, 1.45; 95% CI, 0.95–2.21 and HRT3 vs T2, 1.51; 95% CI, 1.01–2.25).

    Conclusion: Plasma APN and cancer mortality have a significant relationship among community-dwelling elderly people, which warrants further study.

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  • Keiko Murakami, Takayoshi Ohkubo, Hideki Hashimoto
    Article ID: JE20170088
    [Advance publication] Released: March 24, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Socioeconomic inequalities in oral health have been reported in developed countries, but the influence of marital status has rarely been considered. Our aim was to examine marital status differentials in the association between socioeconomic status (SES) and oral health among community-dwelling Japanese women.

    Methods: From 2010 to 2011, a questionnaire survey was conducted among residents aged 25–50 years in Japanese metropolitan areas. Valid responses were received from 626 unmarried women and 1,620 married women. Women’s own and husbands’ educational attainment and equivalent income were used to assess SES. Self-rated “fair” or “poor” oral health was defined as poor oral health. Multiple logistic regression analysis was conducted to examine which SES indicators were associated with oral health.

    Results: The prevalence of poor oral health was 21.1% among unmarried women and 23.8% among married women. Among unmarried women, equivalent income was not associated with oral health, but women’s own education was significantly associated with oral health; the multivariate-adjusted odds ratio of poor oral health among those with high school education or lower compared to those with university education or higher was 2.14 (95% confidence interval, 1.19–3.87). Among married women, neither women’s own nor husbands’ education was associated with oral health, but equivalent income was significantly associated with oral health, particularly among housewives; the multivariate-adjusted odds ratio of poor oral health among those in the lowest compared with highest income quartile was 1.57 (95% confidence interval, 1.08–2.27).

    Conclusions: These findings indicate that marital status should be considered when examining associations between SES and oral health among Japanese women.

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  • Masaaki Yamada, Michikazu Sekine, Takashi Tatsuse
    Article ID: JE20170100
    [Advance publication] Released: March 24, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Prolonged screen time (ST), which includes TV viewing and gaming on smartphones and computers, is linked to poor health. Our aim was to explore the associations between school children with prolonged ST and parental internet use (IU) and lifestyles in Japan.

    Methods: Children aged 6 to 13 years from the Super Shokuiku School Project, were surveyed using questionnaires in 2016. The survey assessed the grade, sex, and lifestyle of 1,659 children and parental internet use (IU) and lifestyle using Breslow’s seven health behaviors. IU consisted of internet surfing and gaming on personal computers (PC), smartphones, or consoles. Three or more hours of ST was defined as prolonged ST, and its correlates were analyzed using logistic regression.

    Results: Of all, 643 (38.8%) children spent ≥2 hours/day of ST on a week day, whilst 153 (9.2%) children spent ≥3 hours/day. Prolonged ST was significantly associated with children in higher grade (odds ratio [OR] 1.74; 95% confidence interval [CI], 1.20–2.51), boys (OR 2.16; 95% CI, 1.49–3.14), skipping breakfast (OR 1.88; 95% CI, 1.05–3.35), late bedtime (OR 1.80; 95% CI, 1.15–2.82), physical inactivity (OR 1.79; 95% CI, 1.12–2.87), father’s IU ≥2 hours/day (OR 2.35; 95% CI, 1.52–3.63), mother’s prolonged IU ≥2 hours/day (OR 2.55; 95% CI, 1.43–4.52), mothers with unhealthy behaviors (OR 1.81; 95% CI, 1.05–3.13), no rule setting governing screen time (OR 2.41; 95% CI, 1.63–3.58), and mothers with full-time employment (OR 1.95; 95% CI, 1.06–3.64).

    Conclusions: Prolonged ST among Japanese children was strongly associated with parental IU, no set rules for ST, and mother’s unhealthy lifestyles. To reduce children’s ST, parental engagement is warranted in the intervention strategy.

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  • Hiroshi Yatsuya, Yuanying Li, Yoshihisa Hirakawa, Atsuhiko Ota, Masaak ...
    Article ID: JE20170048
    [Advance publication] Released: March 17, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Relatively little evidence exists for type 2 diabetes mellitus (T2DM) prediction models from long-term follow-up studies in East Asians. This study aims to develop a point-based prediction model for 10-year risk of developing T2DM in middle-aged Japanese men.

    Methods: We followed 3,540 male participants of Aichi Workers’ Cohort Study, who were aged 35–64 years and were free of diabetes in 2002, until March 31, 2015. Baseline age, body mass index (BMI), smoking status, alcohol consumption, regular exercise, medication for dyslipidemia, diabetes family history, and blood levels of triglycerides (TG), high density lipoprotein cholesterol (HDLC) and fasting blood glucose (FBG) were examined using Cox proportional hazard model. Variables significantly associated with T2DM in univariable models were simultaneously entered in a multivariable model for determination of the final model using backward variable selection. Performance of an existing T2DM model when applied to the current dataset was compared to that obtained in the present study’s model.

    Results: During the median follow-up of 12.2 years, 342 incident T2DM cases were documented. The prediction system using points assigned to age, BMI, smoking status, diabetes family history, and TG and FBG showed reasonable discrimination (c-index: 0.77) and goodness-of-fit (Hosmer-Lemeshow test, P = 0.22). The present model outperformed the previous one in the present subjects.

    Conclusion: The point system, once validated in the other populations, could be applied to middle-aged Japanese male workers to identify those at high risk of developing T2DM. In addition, further investigation is also required to examine whether the use of this system will reduce incidence.

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  • Kimi Estela Kobayashi-Cuya, Ryota Sakurai, Hiroyuki Suzuki, Susumu Oga ...
    Article ID: JE20170041
    [Advance publication] Released: March 10, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Deterioration of hand motor function is a possible risk factor of cognitive impairment in older adults. Despite a growing body of research, a lack of clarity exists regarding the relationships. This review offers a synthesis of existing observational studies evaluating the associations of handgrip strength and hand dexterity with cognitive performance in community-dwelling older adults.

    Methods: PubMed, PsycINFO, and ScienceDirect were systematically searched (search dates: 1990–2016), and relevant articles were cross-checked for related and relevant publications.

    Results: Twenty-two observational studies assessed the association of handgrip strength or hand dexterity with cognitive performance; none evaluated handgrip strength and hand dexterity together. Handgrip strength was associated with global cognition, mostly assessed using the Mini-Mental State Examination, cross-sectionally and longitudinally. Also, one cross-sectional and three longitudinal studies found an association with cognitive domains, such as language, memory, visuospatial ability, working memory, and processing speed. Hand dexterity was only assessed cross-sectionally in four studies. These studies found an association with cognitive domains, such as executive function.

    Conclusions: Although handgrip strength was associated with cognitive performance, it is unclear which variable at baseline affects the other in the long-term. Cross-sectional studies indicate an association between hand dexterity and cognitive performance, yet longitudinal studies are needed to elucidate this association. The interaction effects of both decreased grip strength and hand dexterity on cognitive performance is still unclear; therefore, future studies will need to consider the interaction of the three variables cross-sectionally and longitudinally.

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  • Mitsuya Yamakita, Miri Sato, Kohta Suzuki, Daisuke Ando, Zentaro Yamag ...
    Article ID: JE20170078
    [Advance publication] Released: February 24, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Lower birth weight (BW) is associated with increased chronic disease risk later in life. Previous studies suggest that this may be mediated principally via physical activity (PA). However, the association between BW and PA in children has not been clarified. The purpose of this study was to examine the association between BW and PA in school-aged children in Japan.

    Methods: Participants were children from a prospective birth cohort study (Project Koshu) who were born from 1996 through 2002 in rural Japan. BWs were obtained from the Maternal and Child Health Handbook. Data on PA during childhood were collected using a self-reported questionnaire when participants were 9–15 years of age in July 2011. Analysis of covariance was used to evaluate exercise duration; Poisson regression analysis was used to evaluate if the recommended PA amount was met.

    Results: Data from 657 children (boys: 54.8%, follow-up rate: 77.6%) were analyzed. Compared with the normal BW group, only girls in the low-BW group had significantly lower PA level (normal BW, 11.4 [standard error, 1.0] hours/week; low BW, 5.8 [standard error, 3.6] hours/week, P = 0.010), and were more likely to not meet the recommended PA level (prevalence ratio 1.57; 95% CI, 1.14–2.16).

    Conclusion: Low BW was associated with a lower PA level in school-aged girls but not boys. Earlier consideration of BW may be an important public health strategy to prevent physical inactivity in school-aged girls.

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  • Akiyo Yoshimura, Hidemi Ito, Yoshikazu Nishino, Masakazu Hattori, Tomo ...
    Article ID: JE20170103
    [Advance publication] Released: February 24, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Recent improvements in 5-year survival of breast cancer have been reported in Japan and other countries. Though the number of long-term breast cancer survivors has been increasing, recent improvements in 10-year survival have not been reported. Moreover, the degree of improvement according to age and disease stage remains unclear.

    Methods: We calculated long-term survival using data on breast cancer diagnosed from 1993 through 2006 from six prefectural population-based cancer registries in Japan. The recent increase in 10-year relative survival was assessed by comparing the results of period analysis in 2002–2006 with the results of cohort analysis in 1993–1997. We also conducted stratified analyses by age group (15–34, 35–49, 50–69, and 70–99 years) and disease stage (localized, regional, and distant).

    Results: A total of 63,348 patients were analysed. Ten-year relative survival improved by 2.4% (76.9% vs 79.3%) from 1993 through 2006. By age and stage, 10-year relative survival clearly improved in the age 35–49 years (+2.9%; 78.1% vs 81.0%), 50–69 years (+2.8%; 75.2% vs 78.0%) and regional disease (+3.4%; 64.9% vs 68.3%). In contrast, the degree of improvement was small in the age 15–34 years (+0.1%; 68.2% vs 68.3%), 70–99 years (+1.0%; 87.6% vs 88.6%), localized disease (+1.1%; 92.6% vs 93.7%) and distant metastasis (+0.9%; 13.8% vs 14.7%).

    Conclusions: These population-based cancer registry data show that 10-year relative survival improved 2.4% over this period in Japan. By age and stage, improvement in the age 15–34 years and distant metastasis was very small, which suggests the need for new therapeutic strategies in these patients.

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  • Yui Yamaoka, Naho Morisaki, Haruko Noguchi, Hideto Takahashi, Nanako T ...
    Article ID: JE20160188
    [Advance publication] Released: February 10, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Public attention is given to infants with socially high risks of child abuse and neglect, while clinical attention is provided to infants with a biologically high risk of diseases. However, few studies have systematically evaluated how biological or social factors cross over and affect cause-specific infant mortality.

    Methods: We linked birth data with death data from the Japanese national vital statistics database for all infants born from 2003–2010. Using multivariate logistic regression, we examined the association between biological and social factors and infant mortality due to medical causes (internal causes), abuse (intentional external causes), and accidents (unintentional external causes).

    Results: Of 8,941,501 births, 23,400 (0.26%) infants died by 1 year of age, with 21,884 (93.5%) due to internal causes, 175 (0.75%) due to intentional external causes, and 1,194 (5.1%) due to unintentional external causes. Infants with high social risk (teenage mothers, non-Japanese mothers, single mothers, unemployed household, four or more children in the household, or birth outside of health care facility) had higher risk of death by intentional, unintentional, and internal causes. Infant born with small for gestational age and preterm had higher risks of deaths by internal and unintentional causes, but not by intentional causes.

    Conclusions: Both biological as well as social factors were associated with infant deaths due to internal and external causes. Interdisciplinary support from both public health and clinical-care professionals is needed for infants with high social or biological risk to prevent disease and injury.

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  • Naoki Kondo
    Article ID: JE20170235
    [Advance publication] Released: February 10, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION
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  • Keisuke Kuwahara, Teppei Imai, Toshiaki Miyamoto, Takeshi Kochi, Masaf ...
    Article ID: JE20170024
    [Advance publication] Released: February 03, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Evidence linking working hours and the risk of type 2 diabetes mellitus (T2DM) is limited and inconsistent in Asian populations. No study has addressed the combined association of long working hours and sleep deprivation on T2DM risk. We investigated the association of baseline overtime work with T2DM risk and assessed whether sleep duration modified the effect among Japanese.

    Methods: Participants were Japanese employees (28,489 men and 4,561 women) aged 30–64 years who reported overtime hours and had no history of diabetes at baseline (mostly in 2008). They were followed up until March 2014. New-onset T2DM was identified using subsequent checkup data, including measurement of fasting/random plasma glucose, glycated hemoglobin, and self-report of medical treatment. Hazard ratios (HRs) of T2DM were estimated using Cox regression analysis. The combined association of sleep duration and working hours was examined in a subgroup of workers (n = 27,590).

    Results: During a mean follow-up period of 4.5 years, 1,975 adults developed T2DM. Overtime work was not materially associated with T2DM risk. In subgroup analysis, however, long working hours combined with insufficient sleep were associated with a significantly higher risk of T2DM (HR 1.42; 95% CI, 1.11–1.83), whereas long working hours with sufficient sleep were not (HR 0.99; 95% CI, 0.88–1.11) compared with the reference (<45 hours of overtime with sufficient sleep).

    Conclusions: Sleep duration modified the association of overtime work with the risk of developing T2DM. Further investigations to elucidate the long-term effect of long working hours on glucose metabolism are warranted.

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  • Kaori Honjo, Yukako Tani, Masashige Saito, Yuri Sasaki, Katsunori Kond ...
    Article ID: JE20170065
    [Advance publication] Released: February 03, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: There is little longitudinal evidence on the impact of specific living arrangements (ie, who individuals live with) on mental health among older adults, and no studies have examined the modifying effect of residential social cohesion level on this association. We aimed to examine the association between living arrangements and depressive symptoms and whether this association varies with residential neighborhood social cohesion level among 19,656 men and 22,513 women aged 65 years and older in Japan.

    Methods: We analyzed the association between baseline living arrangements in 2010 and depressive symptoms in 2013. We calculated gender-specific odds ratios (ORs) of living arrangements for depressive symptoms using a logistic regression and conducted subgroup analyses by neighborhood social cohesion level.

    Results: Among men (but not women), living alone (OR 1.43; 95% confidence intervals [CI], 1.18–1.73) and living with spouse and parent (OR 1.47, 95% CI, 1.09–1.98) were associated with increased odds of depressive symptoms compared with living with a spouse only. Living with spouse and child was a risk for men in the young age group but a protective factor for women. We also identified that the negative impact of living arrangements on depressive symptoms was attenuated in neighborhoods with higher levels of social cohesion.

    Conclusions: Living arrangements are associated with risk of depressive symptoms among men and women; these associations differ by gender and neighborhood social cohesion level. Our results suggest the need to pay more attention to whether individuals live alone, as well as who individuals live with, to prevent depressive symptoms among older adults.

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  • Ryusuke Ae, Yosikazu Nakamura, Hiroshi Tada, Yumi Kono, Eiko Matsui, K ...
    Article ID: JE20170032
    [Advance publication] Released: January 20, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Globally, few published studies have tracked the temporal trend of dioxin levels in the human body since 2000. This study describes the annual trend of dioxin levels in human breast milk in Japanese mothers from 1998 through 2015.

    Methods: An observational study was conducted from 1998 through 2015. Participants were 1,194 healthy mothers following their first delivery who were recruited annually in Japan. Breast milk samples obtained from participants were analyzed using gas chromatography and mass spectrometry for dioxins, including polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and coplanar polychlorinated biphenyls (PCBs).

    Results: Mean age was 29.5 years, and 53% of participants were 20–25 years old. A declining trend in total dioxin levels was found, from a peak of 20.8 pg toxic equivalence (TEQ)/g fat in 1998 to 7.2 pg TEQ/g fat in 2014. Data from the last 5 years of the study indicated a plateau at minimal levels. In contrast, an increasing trend was found in the mean age of participants during the last 5 years. Although significantly higher dioxin levels were observed in samples from older participants, an upward trend in dioxin levels was not observed, indicating that dietary and environmental exposure to dioxins had greatly diminished in recent years.

    Conclusions: Dioxin levels in human breast milk may be approaching a minimum in recent years in Japan. The findings may contribute to global reference levels for environmental pollution of dioxins, which remains a problem for many developing countries.

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  • Jinkyung Cho, Youngyun Jin, Hyunsik Kang
    Article ID: JE20170083
    [Advance publication] Released: January 20, 2018
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: This study aimed to explore the associations between weight status, physical activity, and depression in Korean older adults.

    Methods: We used the baseline data drawn from the 2008 baseline survey utilized in the Living Profiles of Older People Survey, comprised of 15,146 community-dwelling older people (42.6% men and 57.4% women) aged 60 years and older residing in the Republic of Korea. After excluding respondents with missing data on height, weight, and physical activity (PA), data on 10,197 samples (43.3% men and 56.7% women) were analyzed in this study.

    Results: Underweight and completely inactive individuals had poorer sociodemographic and health behavioral characteristics and increased risks of late-life depression compared with normal weight and sufficiently active individuals, respectively. In terms of the aerobic PA guidelines, completely inactive individuals had a significantly higher risk of late-life depression (odds ratio 1.730; 95% confidence interval, 1.412–2.120) compared with sufficiently active individuals, even after adjustments for age, education, household income, night sleeping, living status, marital status, smoking, number of comorbidities, nutritional status, self-reported health status, and cognitive performance as covariates. In addition, those who did not meet the PA guidelines and were underweight or overweight/obese were more likely to have late-life depression compared to those who were active and normal weight.

    Conclusions: The current findings of the study suggest that modifiable, lifestyle risk factors, such as physical inactivity, underweight, and overweight/obesity, are positively associated with late-life depression in Korean older adults.

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  • Kiyohide Tomooka, Isao Saito, Shinya Furukawa, Koutatsu Maruyama, Eri ...
    Article ID: JE20160169
    [Advance publication] Released: December 28, 2017
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Yellow tongue coating is one of the clinical signs for diabetes mellitus according to traditional East Asian medicine. Few reports have been available on the association between yellow tongue coating and the prevalence of type 2 diabetes in the general population. We examined that association among population samples of non-smoking men and women.

    Methods: The study subjects were Japanese non-smoking men (n = 315) and women (n = 654) aged 30–79 years who resided in Toon city and participated in the Toon Health Study from July 2011 through November 2014. Tongue coating was assessed by a nationally licensed acupuncturist and classified into three categories of white (normal), light yellow, and yellow. We performed an oral glucose tolerance test to confirm the presence of diabetes mellitus and prediabetes. The associations between yellow tongue coating and the prevalence of diabetes mellitus and prediabetes were examined using multivariable logistic regression analyses, adjusting for age, sex, body mass index, drinking status, and physical activity.

    Results: The multivariable odds ratios of diabetes mellitus were 1.39 (95% confidence interval [CI], 0.72–2.67) for light yellow tongue coating and 2.23 (95% CI, 1.16–4.30) for yellow tongue coating compared with white tongue coating. The respective multivariable odds ratios of prediabetes were 1.13 (95% CI, 0.80–1.61) and 1.43 (95% CI, 0.96–2.12).

    Conclusions: Yellow tongue coating was associated with higher prevalence of diabetes mellitus and tended to be associated with that of prediabetes among Japanese non-smoking men and women.

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