The potential importance of the built-environment microbiome and its impact on human health.

There is increasing evidence that interactions between microbes and their hosts not only play a role in determining health and disease but also in emotions, thought, and behavior. Built environments greatly influence microbiome exposures because of their built-in highly specific microbiomes coproduced with myriad metaorganisms including humans, pets, plants, rodents, and insects. Seemingly static built structures host complex ecologies of microorganisms that are only starting to be mapped. These microbial ecologies of built environments are directly and interdependently affected by social, spatial, and technological norms. Advances in technology have made these organisms visible and forced the scientific community and architects to rethink gene-environment and microbe interactions respectively. Thus, built environment design must consider the microbiome, and research involving host-microbiome interaction must consider the built-environment. This paradigm shift becomes increasingly important as evidence grows that contemporary built environments are steadily reducing the microbial diversity essential for human health, well-being, and resilience while accelerating the symptoms of human chronic diseases including environmental allergies, and other more life-altering diseases. New models of design are required to balance maximizing exposure to microbial diversity while minimizing exposure to human-associated diseases. Sustained trans-disciplinary research across time (evolutionary, historical, and generational) and space (cultural and geographical) is needed to develop experimental design protocols that address multigenerational multispecies health and health equity in built environments.

The hygiene hypothesis, the COVID pandemic, and consequences for the human microbiome.

The COVID-19 pandemic has the potential to affect the human microbiome in infected and uninfected individuals, having a substantial impact on human health over the long term. This pandemic intersects with a decades-long decline in microbial diversity and ancestral microbes due to hygiene, antibiotics, and urban living (the hygiene hypothesis). High-risk groups succumbing to COVID-19 include those with preexisting conditions, such as diabetes and obesity, which are also associated with microbiome abnormalities. Current pandemic control measures and practices will have broad, uneven, and potentially long-term effects for the human microbiome across the planet, given the implementation of physical separation, extensive hygiene, travel barriers, and other measures that influence overall microbial loss and inability for reinoculation. Although much remains uncertain or unknown about the virus and its consequences, implementing pandemic control practices could significantly affect the microbiome. In this Perspective, we explore many facets of COVID-19-induced societal changes and their possible effects on the microbiome, and discuss current and future challenges regarding the interplay between this pandemic and the microbiome. Recent recognition of the microbiome's influence on human health makes it critical to consider both how the microbiome, shaped by biosocial processes, affects susceptibility to the coronavirus and, conversely, how COVID-19 disease and prevention measures may affect the microbiome. This knowledge may prove key in prevention and treatment, and long-term biological and social outcomes of this pandemic.

Accounting for variation in and overuse of antibiotics among humans.

Worldwide, antibiotic use is increasing, but many infections against which antibiotics are applied are not even caused by bacteria. Over-the-counter and internet sales preclude physician oversight. Regional differences, between and within countries highlight many potential factors influencing antibiotic use. Taking a systems perspective that considers pharmaceutical commodity chains, we examine antibiotic overuse from the vantage point of both sides of the therapeutic relationship. We examine patterns and expectations of practitioners and patients, institutional policies and pressures, the business strategies of pharmaceutical companies and distributors, and cultural drivers of variation. Solutions to improve antibiotic stewardship include practitioners taking greater responsibility for their antibiotic prescribing, increasing the role of caregivers as diagnosticians rather than medicine providers, improving their communication to patients about antibiotic treatment consequences, lessening the economic influences on prescribing, and identifying antibiotic alternatives.

Diabetes and acculturation in African immigrants to the United States: analysis of the 2010-2017 National Health Interview Survey (NHIS).

Objective: This study sought to assess the association between unidimensional acculturation and diabetes, and analyze mediating pathways of the association in African immigrants to the United States (U.S.).Hypothesis: Acculturation would be positively associated with diabetes and that BMI (Body mass index), physical activity, and psychological distress would mediate this association.Methods: An analysis of cross-sectional data from the 2010-2017 National Health Interview Surveys was performed. Adults aged ≥ 18 years who were born in Africa (African immigrants) and residing in the U.S. were considered. The outcome was self-reported diabetes, and acculturation was defined by percent of life spent in the U.S. and citizenship. Multivariable logistic regression analysis was used to assess the association between acculturation and diabetes, and mediation analysis was used to examine the mediating effects of BMI, physical activity, and psychological distress on this association.Results: The analytic sample included 1648 African immigrants with mean (SD) age of 41.3 ± 0.45 years; 56.4% male. Additionally, 46% had ≥ college education, and 21.4% lived below the poverty threshold. About two-thirds were overweight/obese. Less than 50% exercised at adequate levels of physical activity levels. A small percentage (1.8%) reported psychological distress. The prevalence of self-reported diabetes was 6.1%, and 76.5% reported being acculturated. In the multivariate logistic regression analysis, higher levels of acculturation were associated with higher odds of diabetes diagnosis (Odds Ratio (OR) = 2.2; 95% CI = 1.1-4.4). Although BMI mediated the association between acculturation and diabetes (ZMediation = 2.11, p = 0.036), only 18.9% of the total effect of acculturation on diabetes was explained by BMI.Conclusions: Acculturation increased the odds of diabetes diagnosis, and BMI mediated the association. Thus, tailoring culturally-appropriate interventions to control BMI may contribute to preventing diabetes within African immigrant communities to the U.S.

The Microbiome Mediates Environmental Effects on Aging.

Humans' indigenous microbes strongly influence organ functions in an age- and diet-dependent manner, adding an important dimension to aging biology that remains poorly understood. Although age-related differences in the gut microbiota composition correlate with age-related loss of organ function and diseases, including inflammation and frailty, variation exists among the elderly, especially centenarians and people living in areas of extreme longevity. Studies using short-lived as well as nonsenescent model organisms provide surprising functional insights into factors affecting aging and implicate attenuating effects of microbes as well as a crucial role for certain transcription factors like forkhead box O. The unexpected beneficial effects of microbes on aged animals imply an even more complex interplay between the gut microbiome and the host. The microbiome constitutes the major interface between humans and the environment, is influenced by biosocial stressors and behaviors, and mediates effects on health and aging processes, while being moderated by sex and developmental stages.

One size does not fit all: Examining ethnicity in gestational weight gain guidelines.

Pregnancy-related metrics vary by race/ethnicity, yet most gestational weight gain (GWG) guidelines are ethnicity-blind. We estimated small-for-gestational age (SGA) risk in a Japanese population, examining GWG adequacy categorized by Institute of Medicine (IOM) and Japanese guidelines in male (N = 192) and female (N = 191) full-term singleton infants. For predicting SGA, IOM guidelines had high sensitivity ( ≥ 0.75), but low specificity ( ≤ 0.25); Japanese guidelines had high specificity ( ≥ 0.80) but low sensitivity ( ≤ 0.50). GWG guidelines' implicit notions of Caucasian-Americans as optimal may lead to 'One Size Fits All' recommendations that can obscure important biocultural factors contributing to maternal child health outcomes.

Who eats with family and how often? Household members and work styles influence frequency of family meals in urban Japan.

Family commensality, or meals eaten together with family members, is a key practice to understand the socio-cultural organization of eating and family lives. Yet empirical evidence is limited outside of western societies, which have different household structures, work styles, and socio-cultural constructions of the practice. This study examined frequencies of family commensality based on 242 surveys of Japanese adults aged between 20 and 85 in two metropolitan areas. Results showed that family commensality is less frequent not only among those living alone, but also among those living with only non-partners including adult children, parents, and non-family members, than among those living with partners. Full-time employment was associated with late dinner times on weekdays. Later weekday dinner times were strongly associated with reduced frequency of dinners together. Late dinners have become commonplace among full-time workers in postwar Japan, and the peak dinner time in Japan occurs later than in other developed countries. Thus, work and lifestyle constraints impacting schedules appear to influence the frequency of family commensality. Our results suggest that frequencies of family commensality are influenced by co-residents and work styles of participants rather than household sizes. The idea that reduction of household size drives reduction of family commensality may be biased by previous studies conducted in western countries where most people reside in either single or nuclear households. Our study highlights complex determinants of family commensality, beyond presence of other household members, and demonstrates a need for rigorous investigation of family commensality across cultures.

Spatial, temporal, and health associations of eating alone: A cross-cultural analysis of young adults in urban Australia and Japan.

Eating alone is driven by social and cultural factors, not solely by individual preferences. In academic research, eating alone is often simply treated as an alternative to social, commensal eating, and little is known about the practice of eating alone itself. This study employs a cross-cultural analysis to explore social and cultural associations of eating alone. The analysis is based on 1) cultural domain data, derived from principal component analysis of freelist responses, a set of words or phrases related to the topic of eating alone; and 2) in-depth interviews with 72 young adults aged 20-40 in urban Australia and Japan. Many Australian and Japanese young adult participants associated eating alone with both pleasure and stress of being isolated from others. However, the comparison of principal components between Australian and Japanese groups and gender subgroups showed cross-cultural variations and complexity in the context of eating alone including: locations and timings of eating alone, and associations with healthy/unhealthy eating. Analyses of interviews are included to deepen understandings of cultural domains. These key associations are influenced by a range of social and cultural environments such as fast food cultures, work and life environments, and the scope of public health nutrition programs. The association between eating alone and healthy eating among young adults indicates that individualistic understandings of food intake in current public health nutrition programs are more favorable to eating alone and foster a gap between ideas of healthy eating and commensal eating as a cultural ideal.

Inadequate gestational weight gain increases risk of small-for-gestational-age term birth in girls in Japan: A population-based cohort study.

OBJECTIVES: Babies born small for gestational age (SGA) have a higher risk of neonatal morbidity and mortality as well as later life chronic disease. The objectives of this study were to examine the extent to which prepregnancy body mass index (BMI) and gestational weight gain (GWG) influenced risk of SGA among Japanese, and to evaluate physician response to, and potential effects on, GWG. METHODS: We examined SGA risk as a function of maternal BMI and GWG using logistic regression with data from maternal child health handbooks obtained from women in Japan (N = 383). Physicians' written comments on weight and dietary restriction were analyzed for responses to and influence on GWG. RESULTS: SGA babies comprised 8.6% of the sample, with 13% and 6% of the mothers being underweight and overweight, respectively, and 21.7% and 19.8% of mothers gaining less and more than the recommended amounts, respectively. In adjusted models, higher prepregnancy BMI and GWG were associated with lower risk of SGA (OR 0.71, 95% CI 0.56, 0.90; 0.75, 95% CI 0.61, 0.92 respectively) in models for girls, but not for boys. Inadequate GWG was associated with higher risk of SGA in girls (OR 6.64, 95% CI 2.18, 20.22). Physician written instructions to restrict dietary intake and weight gain followed an average weight gain of 0.69 kg/week from the previous prenatal exam, and were followed by weight gains that decreased to 0.30 kg/week. CONCLUSIONS: Prepregnancy BMI and GWG significantly influence SGA risk in female babies. GWG may be influenced by physicians' recommendations. Am. J. Hum. Biol. 28:714-720, 2016. © 2016 Wiley Periodicals, Inc.

Lessons on aging: Hopes and concerns of Japanese women at midlife.

Japan is leading the global trend of decreasing birth rates and the graying of society. In this study we examine women's changing gender and intergenerational relationships and how these affect their concerns and hopes for their futures. Many of the 121 midlife women (aged 45-55) interviewed viewed themselves as sandwiched between their mothers-in-law and actual or potential daughters-in-law, at the nadir of intergenerational status within their families, in large part due to changing social patterns in marriage and birth rates. Doubts about the marriageability of their sons arising from role expectations for brides to care for parents-in-law cause concern for many and highlight the gendered and intergenerational nature of aging concerns. Yet, midlife in the 21st century, with changing gender and intergenerational roles, appears to create opportunities for many Japanese women to reflect on the meaning of the next stage of their lives. Changing gender and intergenerational relationships may contribute to their hopes to live a life of self-actualization and to be true to one's self (jibun rashiku ikiru).

Lifestyle constraints, not inadequate nutrition education, cause gap between breakfast ideals and realities among Japanese in Tokyo.

Japanese public health nutrition often promotes 'traditional' cuisine. In-depth interviews with 107 Japanese adults were conducted in Tokyo from 2009 to 2011, using free-listing methods to examine dietary ideals and realities to assess the extent to which realities reflect inadequate nutrition education or lifestyle constraints. Ideal-reality gaps were widest for breakfast. Most people reported Japanese ideals: rice and miso soup were prototypical foods. However, breakfast realities were predominantly western (bread-based). While those aged 40-59 were more likely to hold Japanese ideals (P=0.063), they were less likely to achieve them (P=0.007). All those reporting western ideals achieved them on weekdays, while only 64% of those with Japanese ideals achieved them (P<0.001). Partial correlations controlling for age and gender showed achievement of Japanese ideals were positively correlated with proportion of cooking-related housework, and negatively correlated with living standard and income. Ideal menu content was in line with current Japanese nutrition advice, suggesting that more nutrition education may not change dietary ideals or behavior. Participant-reported reasons for ideal-reality discordance demonstrate that work-life balance issues, especially lack of time and family structure/life rhythm, are the largest obstacles to the attainment of dietary ideals. People reporting 'no time' as a primary reason for ideal-reality gaps were less likely to achieve their Japanese ideals (odds ratio=0.212). Time realities of people's lives may undermine educational efforts promoting Japanese breakfasts. When dietary reality/behavior departs from guidelines, it is often assumed that people lack knowledge. If ideals are in line with dietary guidelines, then lack of knowledge is not the likely cause and nutrition education is not the optimal solution. By asking people about the reasons for gaps between their ideals and realities, we can identify barriers and design more effective policies and programs to achieve dietary ideals.

Time to rethink academic publishing: the peer reviewer crisis.

There is concern that the time taken to publish academic papers in microbiological science has significantly increased in recent years. While the data do not specifically support this, evidence suggests that editors are having to invite more and more reviewers to identify those willing to perform peer review.

Postpartum Depressive Symptoms as a Mediator Between Intimate Partner Violence During Pregnancy and Maternal-Infant Bonding in Japan.

Studies show that experiencing intimate partner violence (IPV) during pregnancy is related to poor maternal-infant bonding. However, the mechanisms underlying this relationship are unclear. This article aims to examine whether maternal postpartum depressive (PPD) symptoms mediate the association between pregnancy IPV and maternal-infant bonding, and whether the relationship differs by maternal-infant bonding subscales-lack of affection, anger/rejection. A survey was conducted among women who participated in a postpartum health check-up program in Aichi prefecture, Japan (N = 6,590) in 2012. We examined whether experiences of emotional and physical IPV were related to maternal-infant bonding and whether PPD symptoms mediated this relationship. Path analysis showed that emotional and physical IPV were associated with PPD symptoms, and PPD symptoms predicted poor bonding. The total effect of emotional IPV on poor bonding was significant, showing a marginally significant direct effect and statistically significant indirect effect. The total effect of physical IPV on poor bonding was not statistically significant. Emotional IPV was significantly associated with both lack of affection and anger/rejection bonding subscales, which were similarly mediated by PPD symptoms. Findings revealed a modest indirect association between IPV, emotional IPV in particular, and poor maternal-infant bonding, which was mediated by PPD symptoms. While prevention of IPV is the ultimate goal, the treatment of PPD symptoms among women who experience IPV during pregnancy may improve maternal-infant bonding and mitigate cross-generational effects of IPV. Identifying opportunities for detection of IPV and PPD symptoms, as well as prevention and early intervention, may improve maternal-infant bonding.

Differences in demographics and complementary and alternative medicine use between patients attending integrative kampo versus biomedical clinics in Japan.

OBJECTIVES: Growing interest in integrative medicine motivates examination of who seeks integrative care, and why. By examining differences in demographics and complementary and alternative medicine (CAM) use between patients recruited from Japanese Kampo (traditional herbal medicine) versus biomedical clinics, this study aimed to identify whether integrative medicine options might attract different patients. DESIGN AND SETTING: In this cross-sectional, observational study we administered the International Complementary and Alternative Medicine-Questionnaire (I-CAM-Q) to 209 patients recruited from four hospital clinics. Demographics, use of different types of CAM (self-help CAM, CAM practitioners, CAM products), and motivations were compared between Kampo and Non-Kampo patients and by gender. Factors influencing attendance at the Kampo clinic and CAM use were identified using logistic regression. RESULTS: While some demographic characteristics, CAM provider and total CAM use differed between Kampo and non-Kampo patients, self-help CAM use did not. Motivations (for acute, long-term, health maintenance, or other reasons) differed between Kampo and non-Kampo clinic patients for going to non-Kampo physicians (P = 0.02) and Kampo physicians (P = 0.1). Logistic regression results for 'any CAM' use showed odds ratio of 0.32 (95%CI 0.15-0.67) for self-rated health, and 1.60 (95%CI 1.10-2.32) for Macarthur subjective social status scale. Attendance at the Kampo clinic showed odds ratios of 1.50 (95%CI 1.11-2.02) for education and 0.56 (95%CI 0.39-0.80) for employment status. CONCLUSIONS: Better understanding of factors such as motivation, self-rated health, and socioeconomic conditions that influence patients' CAM use and integrative clinic attendance may enable more effective targeting of populations and integration of CAM into biomedical settings.

Chilliness: a vasomotor symptom in Japan.

OBJECTIVE: To examine the differences between biomedical and Japanese women's concepts of vasomotor symptoms and the relationships between the symptom of chilliness (hiesho) and menopause status, other vasomotor symptoms, and environmental factors such as soy isoflavone intake and exposure in Japan. DESIGN: Participants were healthy Japanese women, aged 45 to 55, living in Kyoto and Fukushima prefectures, divided into menopausal groups based on menstrual patterns. Women recalled 82 general health symptoms during the previous 2 weeks and collected finger-prick dried blood spots and matched 24-hour dietary records, which were analyzed, respectively, for isoflavone concentration by high-performance liquid chromatography coulometric electrode array detection and for soy isoflavone intake using a Japanese phytochemical database. RESULTS: An examination of konenki (Japanese for climacteric) symptoms suggests that chilliness (hiesho), which was reported by 29.3% of participants compared with a range of 3.0% to 22.1% for hot flushes, constitutes an important vasomotor symptom. Chilliness prevalence differed significantly between premenopausal and other menopausal status groups, with positive correlations with other estrogen-influenced sexual-vasomotor symptoms and negative correlations with isoflavone concentrations. Negative correlations with soy isoflavone intake were also found for sweating, although not for nobose and hoteri (two Japanese terms for hot flush). CONCLUSIONS: Chilliness seems to be a more important vasomotor symptom than hot flushes and sweats in Japanese women and may reflect differing thermoregulatory physiology, possibly influenced by dietary soy.

Broadening our perspectives on complementary and alternative medicine for menopause: A narrative review.

Complementary and alternative medicine (CAM) is widely used for menopause, although not all women disclose use to their healthcare providers. This narrative review aims to expand providers' understanding of cross-cultural approaches to treating and managing menopause by providing an overarching framework and perspective on CAM treatments. Increased provider understanding and awareness may improve not only provider-patient communication but also effectiveness of treatments. The distinction between illness (what patients suffer) and disease (what physicians treat) highlights the gap between what patients seek and doctors provide, and may help clarify why many women seek CAM at menopause. For example, CAM is often sought by women for whom biomedicine has been unsuccessful or inaccessible. We review the relevance to menopause of three CAM categories: natural products, mind-body practices including meditation, and other complementary health approaches including traditional Chinese medicine (TCM) and Japanese Kampo. Assessing the effectiveness of CAM is challenging because of the individualized nature of illness patterns and associated treatments, which complicate the design of randomized controlled trials. Because many women seek CAM due to inefficacy of biomedical treatments, or cultural or economic marginalization, biomedical practitioners who make an effort to learn about CAM and ask patients about their CAM use or interest may dramatically improve the patient-provider relationship and rapport, as well as harnessing the 'meaning response' (Moerman, 2002) imbued in the clinical encounter. By working with women to integrate their CAM-related health-seeking behaviors and treatments, providers may also boost the efficacy of their own biomedical treatments.

Beyond Medical "Missions" to Impact-Driven Short-Term Experiences in Global Health (STEGHs): Ethical Principles to Optimize Community Benefit and Learner Experience.

Increasing demand for global health education in medical training has driven the growth of educational programs predicated on a model of short-term medical service abroad. Almost two-thirds of matriculating medical students expect to participate in a global health experience during medical school, continuing into residency and early careers. Despite positive intent, such short-term experiences in global health (STEGHs) may exacerbate global health inequities and even cause harm. Growing out of the "medical missions" tradition, contemporary participation continues to evolve. Ethical concerns and other disciplinary approaches, such as public health and anthropology, can be incorpo rated to increase effectiveness and sustainability, and to shift the culture of STEGHs from focusing on trainees and their home institutions to also considering benefits in host communities and nurtur ing partnerships. The authors propose four core principles to guide ethical development of educational STEGHs: (1) skills building in cross-cultural effective ness and cultural humility, (2) bidirectional participatory relationships, (3) local capacity building, and (4) long-term sustainability. Application of these principles highlights the need for assessment of STEGHs: data collection that allows transparent compar isons, standards of quality, bidirectionality of agreements, defined curricula, and ethics that meet both host and sending countries' standards and needs. To capture the enormous potential of STEGHs, a paradigm shift in the culture of STEGHs is needed to ensure that these experiences balance training level, personal competencies, medical and cross-cultural ethics, and educational objectives to minimize harm and maximize benefits for all involved.

Vasomotor symptom prevalence and language of menopause in Japan.

OBJECTIVE: To characterize the prevalence of vasomotor symptoms affecting menopausal women in Japan, the relationship between vasomotor symptoms and menopause status as defined by menstrual patterns versus self-assigned konenki (climacteric) status, and the salience and specificity of hot flash terminology. DESIGN: Participants were healthy Japanese women, aged 45 to 55 years, living in Kyoto and Fukushima prefectures, divided into menopause groups based on menstrual patterns and self-assigned konenki groups. Women recalled 82 general health symptoms during the previous 2 weeks, and provided detailed descriptions of hot flash symptom terms. RESULTS: Hot flash prevalence ranged from 3.0% (hotto furasshu) to 17.1% (hoteri) depending on the individual term used, and was 22.1% when all hot flash terms were combined. Prevalence of vasomotor symptoms was 25.7%, but peaked at 52.6% among late perimenopausal women. Hot flash prevalence was 13.2% among premenopausal women, but zero among self-assigned pre-konenki women. The three major hot flash terms (kaa, nobose, and hoteri) vary in their physical location, characteristics, and cultural salience. CONCLUSIONS: Vasomotor symptom prevalence rates in Japan have increased over the past 20 years but are still lower than in most Western populations, and vary according to hot flash term, and between menopause and self-assigned konenki status. Konenki status appears to be a better predictor of hot flashes than menopause status. Japanese women's language, including self-assessed konenki stage and hot flash terminology, seems to be more fine-grained than Western biomedical terms of menopause status and hot flash, and may offer insight into subtle differences in experiences and underlying physiology of menopause.

Sensitive high-performance liquid chromatographic method using coulometric electrode array detection for measurement of phytoestrogens in dried blood spots.

As the epidemiological and physiological investigation of isoflavones and lignans expands, the need for sensitive methods for analyzing large numbers of samples intensifies. We have developed a method using high-performance liquid chromatography (HPLC) equipped with a coulometric electrode array detector for separation and sensitive detection of daidzein (Da), equol (Eq), genistein (Ge) and enterolactone (Enl) in dried blood spots (DBS). Detection limits ranged from 4.5 pg or 0.09 ng/mL (Eq) to 19 pg or 0.38 ng/mL (Ge) on column. Signal linearities ranged from detection limits to 200 ng/mL (Eq, Enl) and 600 ng/mL (Da, Ge) sample concentration. Correlations between DBS and serum concentrations were 0.66 (Enl), 0.88 (Eq), 0.98 (Ge) and 0.99 (Da). Intra-assay coefficients of variation (CVs) were less than 8% and inter-assay CVs ranged from 2.4 to 20.2% for Da, Eq and Ge for three levels of controls. Enl intra-assay CV was 13.6% for the low pooled control. Analytic recovery ranged from 87% (inter-assay Ge) to 98% (inter-assay Enl). DBS concentrations of Da, Ge and Eq were stable for at least 8 weeks at 4 and 25 degrees C, and at 37 degrees C for at least 5 weeks, with Enl showing greater variability at all temperatures but relative stability for 7 weeks. Measurement of samples from 135 perimenopausal Japanese women consuming habitual diets in Kyoto and Fukushima prefectures showed the former to have the expected lower concentrations of Da and Eq (416 and 87 nM) as well as Enl (49 nM) compared to the latter locale (566, 145 and 72 nM, respectively). This method could be useful in large epidemiological research or detailed physiological studies.