Excessive Game Playing Is Associated with Poor Toothbrushing Behavior among Athletic Children: A Cross-Sectional Study in Miyagi, Japan.

Dental problems among athletes have been cautioned due to negative impacts not only on their oral health but also on athletic performance. Acquirement of appropriate oral health behavior mainly composed of toothbrushing in childhood can be one of the most important strategies for advancing children's athletic possibilities. Although habits of screen viewing, including game playing, and TV viewing have direct impacts on children's health and behavioral development, little is known about the association between these habits and toothbrushing frequency. A cross-sectional survey examining sports activities was conducted using a self-report questionnaire among school-aged athletic children belonging to the Miyagi Amateur Sports Association (n = 6,658). All statistical analyses were performed with SPSS, and P-values less than 0.05 were considered statistically significant. The association between a lower brushing frequency (< 2 times a day) and screen-viewing behavior was examined using multivariate logistic models after adjusting for sex, age, body mass index (BMI), studying time, and sleep duration. After adjustment for all covariates, longer game playing (> 2 hrs a day), but not TV viewing, significantly correlated with lower brushing frequency (P for trend < 0.001). Importantly, longer game-playing behavior was also associated with unhealthy dental behavior defined as a lower brushing frequency regardless of the awareness of dental caries (P for trend < 0.001). In conclusion, this is the first study indicating a type-specific unfavorable impact of screen viewing on oral health behavior among athletic children. Excessive game playing may adversely affect oral health literacy more strongly than TV viewing.

Long-term Tai Chi training is related to depressive symptoms among Tai Chi practitioners.

BACKGROUND: Due to the close association with physical and psychological health and quality of life, mood disorders, especially depressive symptoms, are an important global public-health issue. It is hypothesized that long-term physical training and mood adjustment may have a beneficial effect on the prevention of the onset of depressive symptoms. The aim of this study was to investigate the relationship between long-term Tai Chi training and depressive symptoms among Tai Chi practitioners. METHODS: This study analyzed a cross-sectional survey including 529 Japanese Tai Chi practitioners. Tai Chi training information, including total training time and a Tai Chi grade, was assessed using a structured questionnaire, and depressive symptoms were evaluated using the 15-item Geriatric Depression Scale (GDS) for subjects aged ≥65 and the 20-item Self-rating Depressive Scale (SDS) for subjects aged <65 with cut-off points: GDS ≥5 and SDS ≥11. RESULTS: The prevalence of depressive symptoms was 15.9%. After adjustments for potential confounding factors, the odds ratios of having depressive symptoms by increasing levels of Tai Chi training time were 1.00, 0.64 (0.37-1.11), 0.65 (0.37-1.13), 0.34 (0.18-0.65) (P for trend <0.01). LIMITATIONS: This is a cross-sectional study, and not for making a clinical diagnosis of depressive symptoms. CONCLUSIONS: This study has demonstrated that long-term Tai Chi training is independently related to a lower prevalence of depressive symptoms. These results suggest that long-term Tai Chi training may have a beneficial effect on the prevention of depressive symptoms. Further studies are needed to confirm these findings.

Impact of blunted perception of dyspnea on medical care use and expenditure, and mortality in elderly people.

Dyspnea is an alarming symptom responsible for millions of patient visits each year. Poor perception of dyspnea might be reasonably attributed to an inappropriately low level of fear and inadequate earlier medical treatment for both patients and physicians, resulting in subsequent intensive care. This study was conducted to evaluate medical care use and cost, and mortality according to the perception of dyspnea in community-dwelling elderly people. We analyzed baseline data from a community-based Comprehensive Geriatric Assessment in 2002. The perception of dyspnea in 479 Japanese community-dwelling elderly people with normal lung function was measured in August 2002. The sensation of dyspnea during breathing with a linear inspiratory resistance of 10, 20, and 30 cmH(2)O/L/s was rated using the Borg scale. According to the perception of dyspnea, we divided the elderly into tertiles and compared all hospitalizations, out-patient visits, costs, and death through computerized linkage with National Health Insurance beneficiaries claims history files between August 2002 and March 2008. In-patient hospitalization days and medical care costs significantly increased with the blunted perception of dyspnea, resulting in an increase in total medical-costs with blunted perception of dyspnea. With low perception group as reference, the hazard ratios of all-cause mortality were 0.65 (95% CI 0.23-1.89) for intermediate perception group and 0.31 (0.10-0.97) for high perception group, indicating the mortality rate also significantly increased with the blunted perception of dyspnea after multivariates adjustment (p = 0.04). The blunted perception of dyspnea is related to hospitalization, large medical costs, and all-cause mortality in community-dwelling elderly people. These findings provide a rational for preventing serious illness with careful monitoring of objective conditions in the elderly.

C-reactive protein (CRP) is a predictor of high medical-care expenditures in a community-based elderly population aged 70 years and over: the Tsurugaya project.

Because CRP is a strong independent predictor of various diseases, it was hypothesized that CRP may be a useful predictor or treatment target for medical-care expenditures. The aim of this study was to investigate the relationship between CRP and medical-care expenditures in a community-dwelling elderly population. This prospective cohort study was conducted including 925 Japanese subjects aged ≥70 years. A high-sensitivity CRP assay was used by applying the nephelometric method. Hospitalizations, outpatient visits, and expenditures were ascertained through computerized linkage with claims lodged between August 2002 and March 2008 with the Miyagi National Health Insurance (NHI) Association. Since medical-care expenditures were not normally distributed, the category of high medical-care expenditures (>75th percentile of medical-care expenditures: inpatient expenditures >$494/month; outpatient expenditure >$522/month; total expenditures >$1103/month) was used to examine the relation of CRP levels with medical-care expenditures. Multiple logistic regression analysis was used to examine the relationship between CRP cutoff points (low concentrations: <1.0mg/L; intermediate concentrations: 1.0-3.0mg/L; or high concentrations: ≥3.0 mg/L) and medical-care expenditures during 6 year-follow up period. After adjustment for potential confounding factors, a positive association of CRP with hospitalization, and total expenditures (p for trend=0.03 and 0.02, respectively) was found. An elevated baseline CRP level is an independent predictor of increases in prospective medical-care expenditures among community-dwelling elderly. Further study is required to clarify whether reducing CRP by intervention is a cost-effective measure.

The predictive power of physical function assessed by questionnaire and physical performance measures for subsequent disability.

BACKGROUND AND AIMS: To compare the predictive power of physical function assessed by questionnaire and physical performance measures for subsequent disability in community-dwelling elderly persons. METHODS: Prospective cohort study. Participants were 813 aged 70 years and older, elderly Japanese residing in the community, included in the Tsurugaya Project, who were not disabled at the baseline in 2003. Physical function was assessed by the questionnaire of "Motor Fitness Scale". Physical performance measures consisted of maximum walking velocity, timed up and go test (TUG), leg extension power, and functional reach test. The area under the curve (AUC) of the receiver operating characteristic curve for disability was used to compare screening accuracy between Motor Fitness Scale and physical performance measures. Incident disability, defined as certification for long-term care insurance, was used as the endpoint. RESULTS: We observed 135 cases of incident disability during follow-up. The third or fourth quartile for each measure was associated with a significantly increased risk of disability in comparison with the highest quartile. The AUC was 0.70, 0.72, 0.70, 0.68, 0.69 and 0.74, for Motor Fitness Scale, maxi- mum walking velocity, TUG, leg extension power, functional reach test, and total performance score, respectively. CONCLUSIONS: The predictive power of physical function assessed by the Motor Fitness Scale was equivalent to that assessed by physical performance measures. Since Motor Fitness Scale can evaluate physical function safely and simply in comparison with physical performance tests, it would be a practical tool for screening persons at high risk of disability.

Impact of physical activity and performance on medical care costs among the Japanese elderly.

AIM: Physical activity (PA) is known to be inversely associated with medical care costs. The amount of PA is strongly associated with the level of physical performance among the elderly population. Therefore, it is possible that known relation between PA and medical care merely shows the relation between physical performance and medical care. To know whether PA itself relates to medical care, considering physical performance is necessary. The aim of this study was to ascertain the impact of PA on medical care expenditure by considering the physical performance in an elderly community-dwelling population. METHODS: We investigated 483 subjects who did not have any history of diseases relating to limited PA and who completed both a self-administered questionnaire including questions on PA and underwent a physical performance measurement. We ascertained the total medical care costs through a computerized linkage with claims lodged between August 2002 and March 2008 with the Miyagi National Health Insurance Association. RESULTS: The physical performance was positively associated with their level of PA. After multivariate adjustment for covariables including the levels of physical performance, the per capita medical care costs were found to be $US 827.3 (598.0-1056.7) (mean, 95% confidence interval), $US 711.1 (476.4-945.8) and $US 702.0 (461.6-942.4) (P for linear trend = 0.02) per month for those who had the lowest, average and the highest level of PA, respectively. CONCLUSION: This prospective study indicates that a higher level of PA is associated with lower medical care costs among the Japanese elderly irrespective of physical performance.

Factors associated with suicidal ideation in an elderly urban Japanese population: a community-based, cross-sectional study.

The objective of the present study was to evaluate the association between suicidal ideation and potentially related factors in an elderly urban Japanese population. This was a community-based, cross-sectional study. Urban community residents aged 70 years or more were interviewed regarding suicidal ideation and sociodemographic and health-related variables. Subjects with depressive symptoms underwent further evaluation by psychiatrists using criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Associations were evaluated using univariate and multivariate logistic regression analyses. Of the 1145 eligible participants, 52 (4.5%) reported thoughts of suicide. Of 143 subjects with depressive symptoms (Geriatric Depression Scale, 14+), 22 (15.4%) reported suicidal ideation over a 2-week period. After controlling for depressive symptoms, lack of social support and impaired instrumental activities of daily living were significantly associated with thoughts of suicide. After controlling for the potentially associated factors detected in the univariate analysis, depressive symptoms were strongly associated with thoughts of suicide. In the elderly with depressive symptoms, mental disorders, including depressive and alcohol-related disorders, were significantly associated with suicidal ideation over a 2-week period. In the urban community setting, screening for lack of social support, impaired instrumental activities of daily living, and depressive symptoms, followed by diagnostic evaluation for mental disorders, particularly for depressive syndromes and alcohol-related disorders, may provide a practical and effective means of identifying elders at high risk of suicide.