Association between Passive Smoking from the Mother and Pediatric Crohn's Disease: A Japanese Multicenter Study.

Smoking is a risk factor for adult-onset Crohn's disease (CD). Although passive smoking from family members is a major concern, especially in pediatric CD, the number of existing epidemiological studies is limited. This multicenter case-control study aimed to assess the effects of familial smoking on pediatric CD. We examined 22 pediatric CD cases and 135 controls. The subjects' mothers were given a self-administered questionnaire about family smoking before disease onset in the CD group or the corresponding period in the control group. Univariable logistic regression model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), whereas dose-response relationship analyses were performed for more in-depth evaluations. Univariable analyses indicated that passive smoking from the mother (OR, 2.09; 95% CI, 0.61-7.10) was not a significant, but a candidate risk factor for developing pediatric CD. In contrast, the dose-response relationship analyses revealed that passive smoking from the mother (OR, 1.17; 95% CI, 1.04-1.31) was significantly associated with pediatric CD. Therefore, passive smoking from the mother may be predominantly associated with the development of pediatric CD. Further follow-up studies comprising environmental measurements of passive smoking exposure doses and genetic factors interaction analysis are necessary.

[Agreement in the responses to self-reported and proxy-reported versions of QOL-HC: a new quality-of-life scale for patients receiving home-based medical care].

AIM: We developed quality-of-life (QOL) scales for patients receiving home medical care. The objective of this study was to examine the agreement between the scores of the scales answered by patients and those answered by their proxy, as cognitive decline may interfere with one's ability to understand complex topics, such as the QOL. METHODS: Participants were pairs of patients receiving home medical care and their proxy. The patients were asked to complete self-reported QOL scales (QOL-HC), and their proxies were asked to complete proxy-reported versions of the QOL scales (QOL-HC for caregivers). We then statistically examined the extent of agreement between the self- and proxy-reported QOL-HC scores using contingency tables and Spearman's rank correlation coefficient. The SPSS software program, version 24, was used for all statistical analyses. RESULTS: The concordance rate between patients and caregivers for questions 1 ( "Do you have peace of mind?" ), 2 ( "Do you feel satisfied with your life when you reflect on it?" ), 3 ( "Do you have someone that you spend time talking with?" ), and 4 ( "Are you satisfied with the home care service system?" ) were 52.3%, 52.3%, 79.5%, and 81.8%, respectively. The total scores for the patients and caregivers were significantly correlated (Spearman's ρ=0.364*). CONCLUSIONS: We created the first QOL scale for patients receiving home-based medical care and for caregivers. The findings of this study suggest that the QOL-HC can be used in clinical practice for the assessment of patients receiving professional home care.

Lifestyle Changes and Oxidative Stress in a High-incidence Area of Amyotrophic Lateral Sclerosis in the Southwestern Kii Peninsula, Japan.

Objective Lifestyle changes may play an important role in the incidence reduction and delay of onset age of amyotrophic lateral sclerosis (ALS) in the Koza/Kozagawa/Kushimoto (K) area. The aim of this study was to evaluate recent lifestyle changes in the K area and to investigate the relationships between lifestyle and oxidative stress among the residents. Methods We conducted a medical checkup for elderly residents in the K area and the control area and evaluated the urinary 8-OHdG levels, cognitive function test scores and metal contents in serum and scalp hair, coupled with a lifestyle questionnaire survey between 2010 and 2015. Results Recent lifestyle changes among the K residents, including a decrease in the Japanese pickle consumption, increase in fresh vegetable consumption and decrease in farm work, were evaluated in this study. Low consumption of Japanese pickles, high consumption of fresh vegetables, rare farm work and low levels of 8-OHdG/creatinine were all associated with high scores in the cognitive function tests. Frequent farm work and consumption of Japanese pickles was associated with high contents of transition metals, such as Mn, Al and V, in the scalp hair. Conclusion These lifestyle changes among residents in the K area may be associated with their oxidative stress.

Physical Function Differences Between the Stages From Normal Cognition to Moderate Alzheimer Disease.

OBJECTIVES: We investigated the differences in the physical function test results across stages from normal cognition (NC) to moderate Alzheimer disease (AD) and how risk factors of physical function decline are correlated with the physical function test results. DESIGN: A cross-sectional study of outpatients at the Memory Disorder Outpatient Center of Japan's National Center of Geriatrics and Gerontology. PARTICIPANTS: We enrolled 882 individuals aged ≥65 diagnosed with NC (n = 210), amnestic mild cognitive impairment (aMCI; n = 273), mild AD (n = 181) or moderate AD (n = 197). MEASUREMENTS: We measured the participants' results for functional reach (FR), the one-leg standing (OLS) test, the Timed Up and Go (TUG) test, tandem gait (TG), and grip strength (GS). A one-way analysis of covariance (ANCOVA) was used to identify significant differences among the groups' results on the physical function tests, controlling for age, sex, educational year, Mini-Nutritional Assessment, senior activity and exercise frequency, low-density lipoprotein, body mass index, free-fat mass index, and assistance for the TUG test. Multiple regression analysis was also used to investigate the correlation between these covariates and physical function tests results. RESULTS: The ANCOVA showed that FR, OLS, and TG were significantly worse among the individuals with aMCI, mild AD, or moderate AD compared with NC. However, TUG was significantly worse only in the moderate AD group compared with the NC, aMCI, and mild AD group. Multiple regression analysis showed that aging was correlated with poorer scores on all physical function tests, women had poorer scores on FR and GS than men, and low frequency of senior activity was significantly correlated with poorer scores on FR, OLS, and TG. CONCLUSION: Postural impairment and instability on TG was seen in earlier AD stages compared with instability on TUG. As were the covariates of age and sex, senior activity frequency was significantly related to 2 or more physical function tests.

Development and validation of a new quality of life scale for patients receiving home-based medical care: The Observational Study of Nagoya Elderly with Home Medical Care.

AIM: To develop and validate a scale that assesses quality of life in patients receiving home-based medical care. METHODS: A new quality of life scale was developed and evaluated in four phases: (i) item generation; (ii) first field study with a 14-item questionnaire; (iii) preliminary validation study, to reduce the number of items to four; and (iv) second field study comprising 40 patients, to evaluate the validity of the final version. Participants were requested to answer both the final version of the scale and the Short Form-8, to enable identification of any relationship between the two. RESULTS: Items were generated after discussions with doctors and care managers, and 14 items were selected for the draft version. In the preliminary validation study, 10 items were deleted, based on the results of statistical analysis of the data from the first field study. A psychometric analysis showed that the final four-item questionnaire had internal consistency (Cronbach's α = 0.7), and a significant association with the Short Form-8. CONCLUSIONS: We created the first quality of life scale for patients receiving home-based medical care. The scale's internal consistency was confirmed, as well as its external validity. This scale can be used independently of factors such as a patient's age, sex, level of independence in the presence of dementia or disability, swallowing function, hearing ability and communication ability, and can be used with ease in routine clinical practice. Geriatr Gerontol Int 2017; 17: 440-448.

Vision and hearing impairments, cognitive impairment and mortality among long-term care recipients: a population-based cohort study.

BACKGROUND: Vision and hearing impairments among elders are common, and cognitive impairment is a concern. This study assessed the association of vision and hearing impairments with cognitive impairment and mortality among long-term care recipients. METHODS: Data of 1754 adults aged 65 or older were included in analysis from the Gujo City Long-Term Care Insurance Database in Japan for a mean follow-up period of 4.7 years. Trained and certified investigators assessed sensory impairments and cognitive impairment using a national assessment tool. Five-level scales were used to measure vision and hearing impairments. Cognitive performance was assessed on two dimensions, namely communication/cognition and problem behaviors. We performed logistic regression analysis to estimate odd ratios (ORs) and 95 % confidence intervals (CIs) for the association of vision and hearing impairments with cognitive impairment. Using Cox proportional hazard regression models, we obtained hazard ratios (HRs) for mortality. RESULTS: Of 1754 elders, 773 (44.0 %) had normal sensory function, 252 (14.4 %) vision impairment, 409 (23.3 %) hearing impairment, and 320 (18.2 %) dual sensory impairment. After adjusting for potential cofounders, ORs of cognitive impairment were 1.46 (95 % CI 1.07-1.98) in individuals with vision impairment, 1.47 (95 % CI 1.13-1.92) in those with hearing impairment, and 1.97 (95 % CI 1.46-2.65) in those with dual sensory impairment compared to individuals with normal sensory function. The adjusted HR of overall mortality was 1.29 (95 % CI 1.01-1.65) in individuals with dual sensory impairment and cognitive impairment relative to normal sensory and cognitive functions. CONCLUSIONS: Cognitive impairment was most common in individuals with dual sensory impairment, and those with dual sensory impairment and cognitive impairment had increased mortality.

Computerized assessment of communication for cognitive stimulation for people with cognitive decline using spectral-distortion measures and phylogenetic inference.

Therapeutic communication and interpersonal relationships in care homes can help people to improve their mental wellbeing. Assessment of the efficacy of these dynamic and complex processes are necessary for psychosocial planning and management. This paper presents a pilot application of photoplethysmography in synchronized physiological measurements of communications between the care-giver and people with dementia. Signal-based evaluations of the therapy can be carried out using the measures of spectral distortion and the inference of phylogenetic trees. The proposed computational models can be of assistance and cost-effectiveness in caring for and monitoring people with cognitive decline.

Neutron activation analysis of scalp hair from ALS patients and residents in the Kii Peninsula, Japan.

The aim of this study was to evaluate the accumulation of transition metals in the scalp hair of amyotrophic lateral sclerosis (ALS) patients in the Koza/Kozagawa/Kushimoto (K) area (K-ALS) in the Kii Peninsula, Japan. Metal contents were measured in the unpermed, undyed hair samples of 88 K-residents, 20 controls, 7 K-ALS patients, and 10 sporadic ALS patients using neutron activation analysis at the Research Reactor Institute, Kyoto University. A human hair standard and elemental standards were used as comparative standards. The contents of Zn, Mn, and V were higher, while that of S was lower in K-ALS patients than in the controls. The content of Mn in K-ALS patients negatively correlated with clinical durations. The content of Al was significantly higher in K-residents than in the controls, with 15.9 % of K-residents having high Mn contents over the 75th percentile of the controls. The contents of Zn, Mn, and V were high in the scalp hair of K-ALS patients and correlated with the content of Al. The accumulation of these transition metals may chronically increase metal-induced oxidative stress, which may, in turn, trigger the neuronal degeneration associated with K-ALS.

Environmental characteristics and oxidative stress of inhabitants and patients with amyotrophic lateral sclerosis in a high-incidence area on the Kii Peninsula, Japan.

OBJECTIVE: Although Oshima, in the Kii Peninsula of Japan, is located within a high incidence area of amyotrophic lateral sclerosis (ALS) (Koza/Kozagawa/Kushimoto area, K area), no patients with ALS were detected between 1960 and 1999. However, the incidence recently increased between 2000 and 2009. On Oshima, the source of drinking water was changed from a regional river/wells to the Kozagawa River in the K area in 1975. We speculate that this change in water source may have played a role in the recent increase in the incidence of ALS. The aim of this study is to find contributing factors that may have triggered the locally high incidence of ALS. METHODS: We investigated a possible association between the mineral content of drinking water and serum and oxidative stress markers among patients with ALS in the K area (K-ALS), residents of Oshima and controls. RESULTS: We found that the levels of Ca and Zn in the recent drinking water in Oshima are low and that the serum levels of Ca and Zn in the Oshima residents and patients with K-ALS were significantly lower, while the oxidative stress markers were significantly higher, than those of the controls. The serum Zn and urinary 8-OHdG/creatinine levels explained 60% and 58% of the variations among the three groups, respectively. The serum Zn levels were negatively correlated with the serum Cu levels in the patients with K-ALS, and the serum Cu levels exhibited a tendency to be positively correlated with the 8-OHdG/creatinine levels in both the patients with K-ALS (r: 0.64) and the residents free from K-ALS (r: 0.32, p<0.01). CONCLUSION: Taken together, we suggest that the low levels of Ca and Zn in the drinking water are possibly associated with an imbalance of metal metabolism in Oshima residents and an increase in oxidative stress markers in patients with K-ALS, although the causative relationship is not clear. This is a cross-sectional study, and a prospective study is needed in the future.

Does the Japanese Society for Hygiene need its own Code of Conduct? A comparison of the responses of councilors and junior members based on a questionnaire survey.

OBJECTIVE: The purpose of this study was to compare current awareness of the "On a Code of Conduct for Scientists" (OCCS) among members of the Japanese Society for Hygiene (JSH). METHOD: An anonymous self-administered questionnaire was mailed to JSH members, including 439 councilors and 376 junior members (who were under 50 years of age with a membership of 3 years or longer, excluding councilors). Councilors were surveyed from November to December 2007, while junior members were surveyed from November to December 2008. RESULTS: The overall response rate was 40.6% (n = 331/815), with responses from 46.7% of the councilors (n = 205/439) and 33.5% of the junior members (n = 126/376). Among the respondents, 36.0% of councilors (n = 68) and 59.8% of junior members (n = 73) did not know the contents of "On the Code of Conduct for Scientists" (P < 0.01), while 76.3% of councilors (n = 145) and 61.4% of junior members (n = 75) had not heard of it (P < 0.05). However, a majority of the respondents reported interest in the Code [70.0% of councilors (n = 133), 68.6% of junior members (n = 83)] (P < 0.05) and a favorable attitude towards research ethics education [69.3% of councilors (n = 133), 68.9% of junior members (n = 84)] (P < 0.54). In addition, 24.3% of the responding councilors (n = 46) and 15.7% of the responding junior members (n = 19) believe it necessary for JSH to formulate its own code of conduct for scientists (P < 0.01). CONCLUSION: We clarified the current state of awareness of the OCCS among JSH members as well as the opinion of members for the JSH to have its own Code of Conduct for Scientists. This result provides important information that should be considered during the formulation of an individual code of conduct for scientists in the JSH.

[Blood pressure control through awareness of hypertension among female in-home caregivers].

OBJECTIVES: Our purpose was to clarify the situation regarding blood pressure control through awareness of hypertension among female groups of in-home caregivers and non-caregivers. METHODS: We used one existing data generated between December 2005 and April 2007. The subjects were females who were suffering from hypertension (66 caregivers were aged 49-84 years; 52 non-caregivers were aged 47-81 years). We defined persons suffering from hypertension on the basis of results of a self-administered questionnaire and blood pressure values. On the question of awareness of hypertension, we defined the persons who replied positively to any one of "I have hypertension," "I have suffered from hypertension," or "I take antihypertensive agents" as belonging to the "awareness group." We categorized the other respondents, who replied to all three questions in the negative as belonging to the "non-awareness group." We used blood pressure values, to build an index of the control with the chi2 test and the t-test for statistical comparisons. Values of P < 0.05 were considered statistically significant. RESULTS: The results showed that blood pressure values of caregivers in both the awareness group and the non-awareness group were high (awareness group vs non-awareness group overall SBP: 148 +/- 20 mmHg vs 154 +/- 9 mmHg, DBP: 79 +/- 13 mmHg vs 82 +/- 10 mmHg, P > 0.05). Furthermore, values were significantly lower for the awareness than non-awareness group with respect to the non-caregivers (SBP: 135 +/- 15 mmHg vs 149 +/- 7 mmHg, DBP: 73 +/- 10 mmHg vs 78 +/- 6 mmHg). Caregivers who took the antihypertensive agent in the awareness group demonstrated high values exceeding SBP 140 mmHg, which was the hypertensive standard value, not different from the values for caregivers not taking such medication. (taking vs non-taking SBP: 148 +/- 21 mmHg vs 149 +/- 8 mmHg). CONCLUSION: Among the caregivers, it was not only the members of the non-awareness group but also those of the awareness group who were found to have high blood pressure values. Though the caregivers took antihypertensive agents, their blood pressure values remained high.

Prediction of symptomatic depression by discriminant analysis in Japanese community-dwelling elderly.

Although a number of studies have examined depression risk factors for elderly persons, little attention has been paid to the prediction of individuals at risk. This study constructed a predictive model for discrimination between individuals at a higher risk of depression and normal subjects in Japanese community-dwelling elderly persons, using linear discriminant analysis. Data were collected from 754 non-institutionalized elderly men and women aged 65 years and older living in the community in Japan, using face-to-face interviews in 2002. Stepwise linear discrimination analysis was used to construct a predictive model to select individuals who have a higher risk of depression. The stepwise discriminant analysis selected the five predictor variables (frequent hearing problems, poor appetite, less financial leeway, low emotional support and less subjective usefulness) and yielded a statistically significant function (λ=0.816; χ2=113.0, df=5, p<0.001). This function showed that the rate of correct prediction was 78.2% for depressed. The calculated discriminate function based on the above five predictor variables (hearing problem, less appetite, less financial leeway, low emotional support and less subjective usefulness) is useful for detecting individuals at high risk of depression and preventing its development among community-dwelling elderly persons. Prospective studies are needed to confirm the validity and feasibility of the model for earlier screening for depression among such people.

Impaired quality of sleep in Ménière's disease patients.

OBJECTIVE: To evaluate the quality of sleep in Ménière's disease patients with the use of polysomnography. STUDY DESIGN: Prospective study using polysomnography administered in patients diagnosed as "Definite Meniere's disease cases" according to the guidelines of the American Academy of Otolaryngology-Head and Neck Surgery. METHODS: Thirty-five patients, 17 male and 18 female, aged 31 to 71 (58 average) years with active, unilateral, cochleovestibular Ménière's disease refractory to medical management underwent polysomnography. The results were compared with 35 healthy controls matched for age and sex. All participants underwent full-night polysomnography, and a sleep medicine physician interpreted the results. RESULTS: Total sleeping time in Ménière's disease was significantly higher than in controls. Stage 2 sleep was significantly longer and stage 3+4 shorter in Ménière's disease than controls, while there was no difference of stage 1 and REM. Arousal index was significantly higher in Ménière's disease than in controls. Five cases of severe OSAS were found in Ménière's disease and 4 cases in controls; 4 cases of PLMD were found in patients and 3 in controls. CONCLUSIONS: Our finding of decreased deep sleep and an elevated arousal index is a striking new finding in Ménière's disease. This poor quality of sleep in Ménière's disease patients has received little attention in the past, but may cause additional stress and lead to a negative spiral of symptoms.

[Attitudes towards the code of conduct for scientists among council members of the Japanese Society for Hygiene].

OBJECTIVES: The aim of this study was to clarify the attitudes towards the code of conduct for scientists among council members of the Japanese Society for Hygiene (JSH). We also aimed to collect information to be used as baseline data for future studies. METHODS: From November to December 2007, 439 Council members of the Japanese Society for Hygiene completed a self-administered questionnaire. RESULTS: The valid response rate was 43.7% (n=192/439). The mean ages of the subjects were 56.2 years for males (n=171), and 53.0 years for females (n=19). Many council members were unfamiliar with the "Code of Conduct for Scientists" established by the Science Council of Japan, suggesting that most of the regular members were also unfamiliar with these guidelines. However, the high level of interest in the "Code of Conduct for Scientists" established by the Science Council of Japan indicated a positive attitude towards learning about research ethics. Moreover, one-half of the subjects responded that JSH should establish a code of conduct for scientists. Below are some of the reasons for requiring JSH to establish a code of conduct: 1. Private information is prevalent in the field of hygiene. 2. The overall stance as an academic society would be established and would encourage individuality in academic societies. 3. Members have various backgrounds within the field of hygiene, and they should have a code of conduct different from that of their institution of affiliation. CONCLUSION: We clarified attitudes towards the Code of Conduct for Scientists among council members of the Japanese Society for Hygiene.

Lifestyle factors and risk of amyotrophic lateral sclerosis: a case-control study in Japan.

PURPOSE: We examined the associations between lifestyle factors and the risk of amyotrophic lateral sclerosis (ALS) using a case-control study in Aichi Prefecture, Japan. METHODS: The study comprised 183 ALS patients diagnosed by the El Escorial World Federation of Neurology criteria as well as 366 gender- and age-matched controls randomly selected from the general population with the use of the basic register of residents. Detailed information on lifestyle factors was obtained through a mailed self-administered questionnaire. The strength of association between ALS and a potential risk factor was assessed by calculating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Vigorous physical activity, self reported stress, a type A behavior pattern, and less frequent intakes of green-yellow vegetables were significantly associated with increased risk of ALS, whereas smoking and drinking habits were not. The greatest effect on risk for ALS was posed by the combination of a type A behavior pattern and less frequent intakes of green-yellow vegetables (adjusted OR, 11.2; 95% CI, 3.8 to 33.0). CONCLUSION: These data suggested that imbalances between excessive productions of oxidants as patient-specific factors and a diminished or missing antioxidant defense system in motor neurons may increase the risk of ALS.

Emotional support from family members and subjective health in caregivers of the frail elderly at home in Japan.

This study sought to determine the factors associated with subjective health in caregivers of the frail elderly living at home, using multivariate regression analysis. Data were collected from 130 caregivers of frail elderly persons listed on a roster for utilization of day service or short stay service from two Home Visit Nursing Care Stations, using self-administered questionnaire from January to February of 2005. Family caregivers were defined as co-residents family members who provided a minimum of 1 h of daily care for at least 3 months. Multiple logistic regression analysis was performed to examine the factors associated with subjective health in caregivers of the frail elderly at home. Subjects with good health had less depressive symptom (p=0.001), much emotional support (p=0.003) and low caregiver burden (p=0.03). Multivariate logistic regression analysis showed good health had a significantly positive association with only much emotional support after adjustment for confounders. Of the total effect of emotional support on subjective health, the direct effect (84.7%) was much greater than the indirect effect (15.3%). Results indicate that much emotional support from family member for caregiver is essential for better subjective health in caregivers.

Predictor of increase in caregiver burden for disabled elderly at home.

In order to classify the caregivers at high risk of increase in their burden early, linear discriminant analysis was performed to obtain an effective discriminant model for differentiation of the presence or absence of increase in caregiver burden. The data obtained by self-administered questionnaire from 193 caregivers of frail elderly from January to February of 2005 were used. The discriminant analysis yielded a statistically significant function explaining 35.0% (Rc=0.59; d.f.=6; p=0.0001). The configuration indicated that the psychological predictors of change in caregiver burden with much perceived stress (1.47), high caregiver burden at baseline (1.28), emotional control (0.75), effort to achieve (-0.28), symptomatic depression (0.20) and "ikigai" (purpose in life) (0.18) made statistically significant contributions to the differentiation between no increase and increase in caregiver burden. The discriminant function showed a sensitivity of 86% and specificity of 81%, and successfully classified 83% of the caregivers. The function at baseline is a simple and useful method for screening of an increase in caregiver burden among caregivers for the frail elderly at home.

Life worth living for caregiving and caregiver burden among Japanese caregivers of the disabled elderly in Japan.

The aim of this study is to determine the relationship between life worth living and caregiver burden among caregivers in Japan. We used 111 caregivers of frail elders who completed a self-administered questionnaire including the 8 items developed by Arai et al. (J-ZBI) used as a scale to measure subjective burdens and psychological factors used as covariates other than life worth living. Total score (0-32) of the J-ZBI was dichotomized into "high burden" (> or =21 points) and "low burden" (<21 points). Multivariate logistic regression analysis revealed that only life worth living was significantly associated with caregiver burden. The direct effect of life worth living on caregiver burden (92.9%) was much greater than the indirect effect (7.1%). Our findings suggest that the increase of the sense of life worth living may play an important role in the prevention of the development of caregiver burden.

FokI variant of vitamin D receptor gene and factors related to atherosclerosis associated with ossification of the posterior longitudinal ligament of the spine: a multi-hospital case-control study.

STUDY DESIGN: A sex- and age-matched case-control study with genotyping of the FokI variant of the vitamin D receptor gene (VDR) was carried out. OBJECTIVES: To facilitate the early prediction, prevention, and treatment of ossification of the posterior longitudinal ligament (OPLL) of the spine, we analyzed the FokI variant of VDR and past body mass indexes, histories of past illness, family history, and body pliability along with lifestyle factors. SUMMARY OF BACKGROUND DATA: Many possible genetic and environmental risk factors for OPLL have been suggested, including male sex, high body mass index, diabetes mellitus, trauma, hormonal imbalance, and dietary and sleeping habits and genetic variants. METHODS: Both a self-administered questionnaire and whole blood samples were obtained from 63 patients with OPLL and 126 sex-, age-, and hospital-matched controls free of backbone diseases were randomly selected from hospital patients. VDR genotyping was carried out using PCR-RFLP methods. After univariate analysis, multivariate and subgroup analyses according to the VDR genotype was applied to clarify the confounding relationship between VDR genotype and other possible risk factors. RESULTS: A multivariate analysis revealed that the VDR FF genotype, family history of myocardial infarction, high body mass index at age 40, long working hours, and working with night shift to be independent potent risk factors for OPLL. CONCLUSION: The risk of developing OPLL may possibly be reduced gradually and effectively by removing or minimizing the effect of such lifestyle factors one at a time through targeted preventive intervention.

Gender differences in the relationship between self-rated health (SRH) and 6-year mortality risks among the elderly in Japan.

The purpose of this study was to investigate the relationship between SRH and mortality among 784 non-institutionalized community-living elderly in Japan from 1995 to 2001. The data were collected by face-to-face interviews. The direct effect was estimated by the ratio of regression coefficient of two adjacent models (full model entered all covariates to total effect of SRH), and composed of the direct and indirect effect. Cox analysis stratified by gender was employed to examine the relationship between SRH and mortality. At follow-up in 2001, 148 (18.9%) died, and 636 (81.1%) were alive. Mortality rates were significantly increased with worsening SRH responses for men, but not for women. Men had a significant dose-response association between SRH and mortality, in comparison with fair or poor SRH, the odds ratio for good SRH were multiplied by 0.63 and 0.48, respectively. The magnitude of the direct effect of SRH on mortality was much larger in men (95.7%) than in women (52.5%). These findings suggest that SRH may be more strongly and directly associated with mortality in men, compared to women. Further researches are needed to explore the relationship between the changes in SRH and mortality among elderly people.