Awareness, Attitudes, and Concerns Regarding Heated Tobacco Products Among Physicians in Japan.

BACKGROUND: New tobacco products, particularly heated tobacco products (HTPs), have been introduced across several international markets as alternatives to combustible products, such as cigarettes. However, there are limited studies on physicians' perceptions of HTPs. This study analyzes the awareness of HTPs among physicians and assesses their concerns and attitudes toward patients using HTPs. METHODS: A self-administered questionnaire was sent to a sample of 7,500 member physicians (6,000 male and 1,500 female) from the Japan Medical Association (JMA). The smoking status of physicians was categorized as never smokers, ever HTP smokers, current HTP smokers, and ever and current smokers of other products. Physicians' awareness and attitudes toward patients using HTPs were analyzed using descriptive statistics. The correlation between the outcomes was examined using logistic regression models, whereas physicians' concerns about HTPs were analyzed using descriptive statistics. RESULTS: Data were obtained from 5,492 physicians (21.9% women; aged 60.4; standard deviation, 12.1 years) with a response rate of 74.6%. Overall, 76.7% of the physicians had awareness of HTP, and about half of whom asked patients about using HTPs. Physicians who took longer to discuss cessation were more likely to discourage patient use. Smoking status was associated with discouraging HTP use in patients. Physicians who had experience with HTP use were primarily concerned about the products' long-term safety and less about product regulation. CONCLUSION: Japanese physicians do not have sufficient information and knowledge about HTPs. Therefore, evidence-based guidelines are required to support physicians in advising patients against HTP use.

Differential treatment responses to immune checkpoint inhibitor (ICI) therapy in a case of multiple primary malignancies: the programmed death ligand-1 (PD-L1) negative ureteral and lung metastasis from a clear cell renal cell carcinoma appearing after robotic-assisted partial nephrectomy progressed after ICI therapy, while synchronous PD-L1-positive primary lung squamous cell carcinoma responded very well to ICI therapy: a case report.

BACKGROUND: Renal cell carcinoma (RCC) and non-small cell lung cancer (NSCLC) are representative malignancies that respond well to immune checkpoint inhibitors (ICIs). Research has been conducted to identify biomarkers, such as programmed death ligand-1 (PD-L1), that would allow the response to ICI therapy to be predicted; however, the complex tumor immune system consisting of both host and tumor factors may also exert an influence. CASE PRESENTATION: Computed tomographic imaging (CT) incidentally revealed a left renal mass, and a left pulmonary nodule with multiple lymph node metastases (LNMs). Firstly, video-assisted thoracic surgery revealed a lung tumor invading the chest wall. Histologically, the findings of the tumor were consistent with squamous cell carcinoma (SCC), and immunohistochemistry (IHC) showed positive PD-L1 expression. The renal tumor was excised by robotic-assisted partial nephrectomy (RAPN). Histologically, the renal tumor showed the features of clear cell carcinoma (CCC). Four months after the RAPN, CT revealed left hydronephrosis caused by an enhancing ureteral tumor. Then, multiple right lung metastases appeared, and the left lung tumor increased. Following treatment including atezolizumab, the primary lung SCC and the multiple LNMs almost disappeared completely, while the ureteral and right lung metastases showed progression. The ureteral metastasis was resected by left open nephroureterectomy. Histology of the ureteral tumor revealed features consistent with CCC. Histological examination of the multiple right lung metastases that were resected by partial lobectomy via a small thoracic incision also revealed features consistent with CCC. Two months after nephroureterectomy, a solitary left lung metastasis was treated by nivolumab and ipilimumab. Six months after nephroureterectomy, the patient died of RCC. Further studies of specimens revealed that the tumor cells in the primary RCC and the ureteral and lung metastases showed negative results of IHC for PD-L1. CONCLUSIONS: The responses to ICI therapy of concomitant RCC and NSCLC were quite different. The PD-L1 expression status in individual tumors in cases of multiple primary malignancies (MPMs) may directly predict the response of each malignancy to ICI therapy, because the host immune system, which may affect the response to ICI therapy, could be the same in MPMs.

Association and dose-response relationship between exposure to alcohol advertising media and current drinking: a nationwide cross-sectional study of Japanese adolescents.

BACKGROUND: Underage drinking is a public health concern. However, few studies have examined the association between alcoholic beverage advertising and underage drinking, particularly in countries with low underage drinking rates, such as Japan. Therefore, we aimed to investigate the relationship between exposure to advertising in various media and alcohol drinking among Japanese adolescents. METHODS: We conducted a cross-sectional study involving 15,683 adolescents (51% girls) using data from a nationwide lifestyle survey in 2021 among junior and senior high schools across Japan. Media types were websites, stores, and public transportation. We defined current drinking as alcohol consumption of ≥1 day in the 30 days preceding the survey. Multivariable logistic regression was used to examine the association between exposure to alcohol advertisements and current drinking, adjusting for sex, grades, school area, lifestyle (bedtime and having fun at school), and addictive behaviors (smoking status and parents' alcohol consumption). RESULTS: The prevalence of current drinking was 2.2% (2.3% of boys and 2.0% of girls). Students who were exposed to any alcohol advertising media had higher odds of current drinking compared with those who were not (odds ratio, 1.48; 95% confidence interval [CI], 1.18-1.87). Students who were exposed to web, in-store, and public transportation advertisements had odds ratios of 1.44 (95% CI, 1.14-1.81), 1.62 (1.28-2.05), and 1.45 (1.06-1.98) of current drinking, respectively, compared with those who were not. The association of exposure to alcohol advertising media with the prevalence of current drinking was similar among boys and girls (all p for sex interaction >0.1), except for that of exposure to web advertisements; its association with current drinking was more pronounced in girls (p for sex interaction = 0.046). Exposure to a larger cumulative number of different alcohol advertising media was independently associated with a higher prevalence of current drinking among all students, boys, and girls (p-values for trend <0.001, 0.031, and <0.001, respectively; p for sex interaction = 0.085). CONCLUSIONS: We found an association with a dose-response relationship between exposure to alcohol advertisements and current drinking among adolescents in junior and senior high schools across Japan. Our findings highlight the need for further advertising regulations to prevent underage drinking.

Association between nighttime urinary frequency and sleep problems among Japanese adolescents.

OBJECTIVE: To conduct a cross-sectional study to investigate the relationship between nighttime urinary frequency and sleep problems in Japanese adolescents. METHODS: A self-administered questionnaire survey was conducted among 1757 adolescents (mean age 15.6 ± 1.1 years; 49.0% boys). The survey assessed sleep problems (sleep duration, sleep quality, and insomnia symptoms), nighttime urinary frequency, eating habits (breakfast, late-night eating, energy drink consumption), problematic internet use, engagement in club activities, and mental health. We analyzed the association between nighttime urinary frequency and sleep problems using descriptive statistics and logistic regression models. RESULTS: The response rate was 99.6% (1699 students). The prevalence of nighttime urinary frequency ≥2 was 5.6% in boys and 4.6% in girls. The prevalence rates of sleep problems were: insomnia, 16.4%; difficulty initiating sleep, 11.8%; difficulty maintaining sleep, 5.9%; early-morning awakening, 5.4%; and poor sleep quality, 19.9%. Analysis of the relationship with sleep problems differentiating between zero, one, and two nighttime urinations showed that an increase in nighttime urinary frequency corresponded to an increase in the prevalence of insomnia, difficulty initiating sleep, and difficulty maintaining sleep. Logistic regression analysis also showed that insomnia, difficulty initiating sleep, and difficulty maintaining sleep had a linear, significant relationship with increased nighttime urinary frequency. CONCLUSION: This study suggests that adolescents with high nighttime urinary frequency experience increased sleep problems. Consideration of urinary frequency is required when tackling adolescent sleep problems.

Comparison of subjective symptoms associated with exposure to low levels of formaldehyde between students enrolled and not enrolled in a gross anatomy course.

OBJECTIVES: This study aimed to evaluate students' subjective symptoms associated with exposure to low levels of formaldehyde (FA) during a gross anatomy course and to survey how the risk of subjective symptoms was affected by exposure to FA. METHODS: We conducted three questionnaire surveys of 125 students enrolled in an anatomy course (FA exposure group) and 124 students not enrolled in the course (FA nonexposure group) before, during, and 6 months after the course. The questionnaire included questions inquiring about subjective symptoms, sex, age, and allergies. We analyzed differences in the prevalence of subjective symptoms in distinct survey periods. Furthermore, we analyzed the relationship between the subjective symptoms and exposure to FA after adjusting for allergy, sex, and age using multiple logistic regression analysis. RESULTS: The prevalence of some of the ocular, nasal, and nonspecific symptoms in the FA exposure group was low before the course, increased during the course and decreased 6 months after the course. A significant positive relationship was observed between exposure to FA and some symptoms after adjusting for allergy, sex, and age. CONCLUSIONS: We identified some concrete symptoms associated with exposure to FA. We suggest that the exposure to low levels of FA influences students' subjective symptoms.

Design, synthesis and pharmacology of 1,1-bistrifluoromethylcarbinol derivatives as liver X receptor ß-selective agonists.

A novel series of 1,3-bistrifluoromethylcarbinol derivatives that act as liver X receptor (LXR) ß-selective agonists was discovered. Structure-activity relationship studies led to the identification of molecule 62, which was more effective (Emax) and selective toward LXRß than T0901317 and GW3965. Furthermore, 62 decreased LDL-C without elevating the plasma TG level and significantly suppressed the lipid-accumulation area in the aortic arch in a Bio F1B hamster fed a diet high in fat and cholesterol. We demonstrated that our LXRß agonist would be potentially useful as a hypolipidemic and anti-atherosclerotic agent. In this manuscript, we report the design, synthesis and pharmacology of 1,3-bistrifluoromethylcarbinol derivatives.

Investigation of the relationship between convenient visits and doctors' fatigue using burnout and work engagement scales.

OBJECTIVES: Fatigue caused by high workload is often responsible for the high attrition among doctors, and has contributed to a disruption in community medicine. In order to address this problem, institutional mechanisms at the hospital level are required. Previous studies have shown that systemic measures at the hospital level and a change in the mindset of patients can help manage the problem. "Convenient visits" refer to emergency visits for non-emergency problems. It is an avoidable cause of high workload on doctors. Convenient visits also refer to emergency consultation for non-emergency symptoms. As this is a new phenomenon, its relationship with doctors' fatigue needs further research. We investigated the relationship between convenient visits and doctors' fatigue using burnout and work engagement scales. METHODS: We selected 44 hospitals, with >200 beds each, in provincial cities of prefectures with a doctor-population ratio lower than the national average. These cities were considered likely to manifest the phenomenon of 24-hour society and include overworked doctors. Ordinance-designated cities were excluded from this study owing to wide population variability. Three doctors from each hospital were randomly selected from among physicians, surgeons, and pediatricians. We distributed questionnaires (a questionnaire concerning convenient visits, Maslach Burnout Inventory-Human Services Survey, and Utrecht Work Engagement Scale) to 132 doctors. RESULTS: Forty-two doctors responded to the survey. The median proportion of convenient visits among emergency visits was 50%. Sixty percent of the doctors surveyed were annoyed by convenient visits. Other doctors indicated good collaboration between the hospitals and communities or that they were not currently annoyed by convenient visits, although they had been annoyed previously. The emotional exhaustion in doctors, who worked in hospitals that did not restrict convenient visits, was significantly higher than in those who worked in hospitals that restricted these visits. A significant risk of serious burnout was found via crude and multiple logistic regression analysis (adjusted for age and gender, or adjusted for age, gender, clinical department, frequency of work shifts, and sleep duration during work shifts). CONCLUSION: Doctors working in hospitals that do not protect them against convenient visits are more prone to burnout. Although the number of convenient visitors is increasing, many hospitals lack systemic measures to manage them. This contributes to doctors' burnout. We suggest that hospitals control convenient visits for preventing doctors' burnout. Collaboration between hospitals and communities is required to help alleviate this problem.

[A Case of Urachal Carcinoma Treated by TS-1/CDDP as Adjuvant Chemotherapy].

A 49-year-old female presented complaining of gross hematuria. Cystoscopy and magnetic resonance imaging revealed a papillary tumor on the bladder dome. At biopsy pathology the tumor was diagnosed as adenocarcinoma. We diagnosed the tumor as urachal adenocarcinoma and performed partial cystectomy of bladder dome with en-bloc resection of the urachal ligament up to the umbilicus. In surgical pathology, the tumor had invaded to the fat tissue around the urachal ligament with metastasis to the lymph node. Therefore the tumor was diagnosed as a stage IVA (Sheldon's category) urachal adenocarcinoma. After surgery, 6 cycles of chemotherapy with TS-1 and cisplatin (CDDP) were performed. There has been no relapse 5 years after surgery. This is the first report of successful adjuvant chemotherapy with TS-1/CDDP for advanced urachal adenocarcinoma.

Relationship between sexual function and prostate-specific antigen bounce after iodine-125 permanent implant brachytherapy for localized prostate cancer.

OBJECTIVE: To analyze clinical and dosimetric factors involved in prostate-specific antigen bounce in patients who underwent permanent implant brachytherapy for localized prostate cancer, and to study the relationships among prostate-specific antigen bounce, age and sexual function. METHODS: Between March 2007 and April 2012, 116 patients with localized prostate cancer underwent permanent implant, iodine-125 brachytherapy. Patients receiving external-beam radiotherapy or who used phosphodiesterase-5 inhibitor pre- or post-treatment were excluded. Prostate-specific antigen bounce was defined as an increase of ≥0.2 ng/mL and ≥0.4 ng/mL above an initial prostate-specific antigen nadir followed by a subsequent decline to or below the initial nadir without treatment. Clinical and dosimetric factors involved in prostate-specific antigen bounce were analyzed using multivariate logistic regression analysis with the forced entry method. RESULTS: The median age was 66 years (range 51-80 years), and prostate-specific antigen bounce on a prostate-specific antigen rise of ≥0.2 ng/mL occurred in 47 of the 116 participants (40.5%). The median period before the prostate-specific antigen bounce was 17.5 months (range 8-36 months). Patients with prostate-specific antigen bounce were younger and had higher sexual function before treatment (P = 0.003) than those who not show prostate-specific antigen bounce. Regression analysis results showed that young age and a high level of pretreatment sexual function were significant predictive factors for prostate-specific antigen bounce (P = 0.028 and P = 0.048). CONCLUSION: Sexual function seems to be associated with a prostate-specific antigen bounce in patients undergoing permanent implant brachytherapy for localized prostate cancer, and it can be preserved after treatment if it is well present before treatment. Highly maintained sexual function after treatment might influence prostate-specific antigen bounce.

Structure-H methane + 1,1,2,2,3,3,4-heptafluorocyclopentane mixed hydrate at pressures up to 373 MPa.

Thermodynamic stability boundary of structure-H hydrates with large guest species and methane (CH4) at extremely high pressures has been almost unclear. In the present study, the four-phase equilibrium relations in the structure-H CH4 + 1,1,2,2,3,3,4-heptafluorocyclopentane (1,1,2,2,3,3,4-HFCP) mixed hydrate system were investigated in a temperature range of (281.05 to 330.12) K and a pressure range up to 373 MPa. The difference between equilibrium pressures in the structure-H CH4 + 1,1,2,2,3,3,4-HFCP mixed hydrate system and the structure-I simple CH4 hydrate system gets larger with increase in temperature. The structure-H CH4 + 1,1,2,2,3,3,4-HFCP mixed hydrate survives even at 330 K and 373 MPa without any structural phase transition. The maximum temperature where the structure-H CH4 + 1,1,2,2,3,3,4-HFCP mixed hydrate is thermodynamically stable is likely to be beyond that of the structure-H simple CH4 hydrate.

Low-molecular-weight adiponectin is more closely associated with episodes of asthma than high-molecular-weight adiponectin.

Adiponectin is divided into high-molecular-weight (HMW), middle-molecular-weight (MMW) and low-molecular-weight (LMW) types. While HMW adiponectin has been studied by many researchers, the roles of MMW and LMW adiponectin have not yet been sufficiently elucidated. In addition, there are conflicting findings regarding the role of adiponectin in chronic inflammatory diseases, especially asthma. Therefore, we compared patients who suffered episodes of asthma in the past (=asthmatics) with those who did not (=non-asthmatics) in order to investigate the relationship between asthma and HMW, MMW and LMW adiponectin. The subjects in this study included 76 university students. None of the subjects were smokers, on regular medications or seeing a doctor regularly at the time. Fourteen subjects reported past histories of asthma. We also measured and compared the levels of leptin and ghrelin to that of adiponectin, as these hormones are connected with inflammatory conditions. Although the physical data of the asthmatics were similar to those of the non-asthmatics, the levels of ghrelin and all fractions of adiponectin tended to be lower in the asthmatics than in the non-asthmatics. While the levels of MMW and LMW adiponectin in the asthmatics were found to be significantly low, the levels of ghrelin and HMW adiponectin were not clear. According to a multivariate regression analysis of the MMW and LMW adiponectin levels, asthma was found to be more significantly associated with the LMW adiponectin level than age, waist circumference or HDL-C. The results suggest that LMW adiponectin may be associated with episodes of asthma in males.

A School-Based Program for Problematic Internet Use for Adolescents in Japan.

Despite the serious influence of problematic Internet use on mental health among Japanese adolescents, no randomized clinical trials have investigated universal school-based interventions for this potential health challenge. Therefore, this study aimed to assess the efficacy of a school-based educational program. This two-armed, parallel, cluster-based randomized clinical trial included 5312 students from 13 high schools situated in a mid-sized Japanese city. The students in the intervention arm received 10 weekly standardized sessions, including a combination of information provision and interactive sessions by schoolteachers. The students in the control group followed a standard school curriculum. A generalized estimating equation model was applied to assess the primary (Korean Scale for Internet Addiction [K-scale] score) and secondary (behavioral change status according to changes in the transtheoretical model smartphone addiction score and Internet usage time) outcomes two months after intervention completion. The intention-to-treat analysis included 2597 (97.2%) and 2504 (94.9%) students in the intervention and control groups, respectively. Nevertheless, a significant discrepancy emerged regarding the behavioral change status. Therefore, this school-based program did not improve the Internet or smartphone addiction scores among Japanese adolescents. Further studies are needed to develop appropriate interventions for adolescents.

Development and validation of the Work Style Reform Scale.

In Japan, the "Act on the Arrangement of Related Acts to Promote Work Style Reform" was enforced in 2019 to reduce long working hours. However, work style reforms largely depend on workers' and companies' awareness and abilities. This study aimed to develop the Work Style Reform scale to assess the competencies required for work style reform and to examine its validity and reliability. This study was conducted with a diverse sample of 1,641 Japanese workers, and 17 questions across three subscales-Work Style, Personal Style, and Work Environment-were developed. After a response bias analysis, some items were discarded based on an exploratory factor analysis; the reliability coefficients were calculated; and a confirmatory factor analysis was performed. The convergent and discriminant validity were evaluated through a multi-trait multi-method analysis. Finally, nine questions remained. Construct validity, reliability and convergent validity were sufficient for all Subscales, and discriminant validity was sufficient only for Work Style. In conclusion, while Work Style was sufficient, issues remained in other subscales. To improve the accuracy of them in the future, it is necessary to examine the validation of discriminant validity using different indicates and the addition of new items to the smallest subscale; Personal Style.

Optimal telework frequency in terms of sleep and labor productivity depends on the workers' psychological distress: A cross-sectional study in Tokyo, Japan.

OBJECTIVES: This study aimed to determine that workers' sleep and labor productivity differ with the telework frequency and that the optimal telework frequency depends on workers' psychological distress. METHODS: A cross-sectional study using an online-based questionnaire was conducted with 2,971 workers employed by Japanese companies from October to December 2021. We used the 6-item Kessler Scale, K6, as a nonspecific psychological distress scale to screen mental health conditions. A score of ≤ 4 was defined as low psychological distress (LPD), and a score of ≥ 5 was defined as high psychological distress (HPD). We used the Athens Insomnia Scale (AIS) as a measure of sleep quality. The Utrecht Work Engagement (UWES) and Work Functioning Impairment (WFun) scales were used as measures of labor productivity. Series of analysis of covariance (ANCOVA) was used for the data analysis. RESULTS: The analysis included 2,013 participants (1,390 men and 623 women; mean age 43.2 years, standard deviation 11.3). Multiple comparison tests showed that among the participants categorized HPD (HPD type), the AIS estimates were lowest in the 1-2 d/wk group, with significant differences between the 0-3 d/m and ≥ 5 d/wk groups. UWES estimates were lowest in the 3-4 d/wk group with significant differences between the participants categorized LPD (LPD type) and HPD type, while no significant differences were observed among the LPD type. The WFun estimates among the LPD type decreased significantly with increasing telework frequency, while no significant differences were observed among the HPD type. CONCLUSIONS: The optimal telework frequency for sleep and labor productivity may depend on the workers' psychological distress. The finding of this study could make a great contribution to occupational health activities and health promotion for teleworkers, which is necessary to make teleworking a sustainable work style.

Relationship between Telework Jetlag and Perceived Psychological Distress among Japanese Hybrid Workers.

Social jetlag is associated with physical and mental health problems. With the increased popularity of telework, we investigated a specific form of social jetlag that we termed "telework jetlag". This study aimed to clarify the relationship between telework jetlag-the difference in sleep and wake-up times between in-office and telework days-and mental health problems among Japanese hybrid workers. A cross-sectional study was conducted with 1789 participants from October to December 2021 using an online-based questionnaire. Telework jetlag, defined as the difference in the midsleep point between in-office and telework days, was investigated using two groups according to telework jetlag-those lagging <1 h versus ≥1 h. We used the six-item Kessler Scale as a nonspecific psychological distress scale for the outcome. Telework jetlag was significantly associated with psychological distress, and the ≥1 h group had a higher risk (odds ratio: 1.80) of developing high psychological distress (HPD) than the <1 h group in the multivariate analysis. Since most teleworkers are forced to have a hybrid work style that mixes going to work and teleworking, telework jetlag must be addressed to maintain the health of teleworkers.

Longitudinal assessment of lifestyle factors associated with nonrestorative sleep in Japan.

OBJECTIVE: Nonrestorative sleep (NRS) is common in the general global population. This study surveyed the incident/remission rate of NRS and identified related lifestyle factors in a general Japanese adult cohort. METHODS: Data from a Japanese health check-based cohort between the fiscal years 2011 and 2018 were obtained. NRS was assessed through a single item question, and socio-demographic and clinical data were assessed through self-reports. To identify potential correlates of NRS incidence/remission, Cox regression analysis (or survival analysis) was performed. RESULTS: Among the 135 609 individuals surveyed at baseline, data from 93 548 were considered for analysis. NRS exhibited incidence and remission rates of 11.3% and 15.4%, respectively. New NRS incidence was predicted by eating fast (hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 1.04-1.10), dining close to bedtime (HR: 1.33, 95% CI: 1.27-1.38), midnight snacking (HR: 1.09, 95% CI: 1.04-1.13), skipping breakfast (HR: 1.16, 95% CI: 1.10-1.22), non-regular exercise (HR: 1.12, 95% CI: 1.07-1.17), lower levels of physical activity (HR: 1.19, 95% CI: 1.14-1.24), and slow walking speed (HR: 1.34, 95% CI: 1.29-1.39), while heavy drinking was less predictive of NRS. However, the same factors (except for heavy drinking) were found to predict NRS remission. CONCLUSIONS: We found that unhealthy lifestyle behaviors, particularly dining close to bedtime and slow walking speed, were positively associated with NRS incidence, while they were negatively associated with NRS remission. These results can be useful in developing more effective health promotion policies to achieve good sleep.

Gradual resolution over time of recurrent dystrophic calcification after bipolar transurethral resection of the prostate: A case report.

Dystrophic calcification (DC) after transurethral resection of prostate (TURP) is rare. In our patient, bipolar TURP was performed by an experienced urologist, without complications. Seven months later, he developed a tingling urethral sensation, difficulty in urination, urgency, and perineal discomfort. Computed tomography (CT) showed a high-density area occupying the prostatic resection cavity. Re-surgery involved laser ablation of the DC. Two months later, the DC recurred. At the second re-surgery, the DC was removed without using electricity. Repeat CT at 13 months showed near complete disappearance of the DC. Wound healing might interrupt the vicious cycle of DC recurrence.

Trends and socioeconomic inequities in insomnia-related symptoms among Japanese adults from 1995 to 2013.

BACKGROUND: Although insomnia prevalence is increasing in developed countries, little is known about trends in sleep problems among Japanese adults according to socioeconomic status. Therefore, we aimed to determine trends and socioeconomic inequalities in insomnia-related symptom (IRS) in Japan using nationally representative data. METHODS: The IRSs were based on past subjective sleeping difficulty. Using data from the Comprehensive Survey of Living Conditions for every 3 years from 1995 to 2013, we built multivariable Poisson regression models, with IRS as an outcome and survey year and socioeconomic status variables as explanatory variables. RESULTS: Data from 513,223 Japanese adults were analyzed. Age- and sex-adjusted IRS prevalence was the lowest in 1995, highest in 2007, and decreased from 2007 to 2013. The IRSs were more frequently reported in unemployed or self-employed individuals aged 20-64 years; those with the lowest household expenditure level, except among women aged ≥65 years; and those divorced, separated, or single, especially among women aged 20-64 years. LIMITATIONS: First, the repeated cross-sectional study design prevented the exclusion of the possibility of reversal of causality between factors. Second, data on insomnia-related lifestyle behaviors were unavailable. Third, the IRSs examined did not meet established clinical criteria for clinical insomnia. Fourth and fifth, information and selection biases could exist because of self-reported data and a small sample size, respectively. CONCLUSIONS: These results could aid in developing more effective prevention strategies for sleep problems and provide benchmarks for monitoring sleep health trends in Japan and other East Asian countries.

Nonrestorative sleep is a risk factor for metabolic syndrome in the general Japanese population.

BACKGROUND: This longitudinal study aimed to investigate the effects of nonrestorative sleep on developing metabolic syndrome (MetS) and related diseases in a general Japanese middle-aged population. METHODS: Overall, 83,224 adults without MetS (mean age: 51.5 ± 3.5 years) from the Health Insurance Association in Japan were followed up for a maximum of 8 years between 2011 and 2019. The Cox proportional hazard method was used to determine whether nonrestorative sleep, assessed using a single-item question, was significantly associated with the respective development of MetS, obesity, hypertension, diabetes, and dyslipidemia. The MetS criteria were adopted by the Examination Committee for Criteria of Metabolic Syndrome in Japan. RESULTS: The mean follow-up duration was 6.0 years. The incidence rate of MetS was 50.1 person-years/1,000 during the study period. Data suggested that nonrestorative sleep was associated with MetS (hazard ratio [HR]: 1.12, 95% confidence interval [CI]: 1.08-1.16) and other disorders, such as obesity (HR: 1.07, 95% CI: 1.02-1.12), hypertension (HR: 1.07, 95% CI: 1.04-1.11), and diabetes (HR: 1.07, 95% CI: 1.01-1.12) but not with dyslipidemia (HR: 1.00, 95% CI: 0.97-1.03). CONCLUSIONS: Nonrestorative sleep is associated with the development of MetS and many of its core components in the middle-aged Japanese population. Therefore, assessing nonrestorative sleep may help identify individuals at a risk of MetS development.

Associations between coping strategies and insomnia: a longitudinal study of Japanese workers.

STUDY OBJECTIVES: Coping with stress is important because stress disturbs sleep. However, only a few longitudinal studies have investigated the association between coping and insomnia. We examined whether individuals with insomnia symptoms used more maladaptive coping strategies than individuals without insomnia symptoms, and evaluated the association between insomnia symptoms and coping strategies. METHODS: In this prospective cohort study, Japanese workers were enrolled and observed over a 2-year period. During both years, self-administered questionnaires on coping and insomnia symptoms were administered. Coping was assessed using the Brief-Coping Orientation to Problems Experienced, and insomnia symptoms were examined using the Athens Insomnia Scale. Generalized estimating equation modeling identified the effects of coping strategies on insomnia severity. RESULTS: In total, 1358 of 1855 workers at baseline were followed up. Individuals with insomnia symptoms showed a higher use of maladaptive coping strategies and less use of humor and instrumental support than individuals without insomnia symptoms. Active coping, humor, emotional support, and instrumental support were negatively associated with insomnia severity. In contrast, venting, substance use, behavioral disengagement, and self-blame were positively associated with insomnia severity. CONCLUSIONS: This study showed that individuals with insomnia symptoms use both adaptive and maladaptive coping strategies and are more likely to use maladaptive strategies than individuals without insomnia symptoms. In the future, interventions focused on educating people about adaptive coping strategies should be conducted to determine whether coping strategies may prevent insomnia symptoms.