Study Profile of the Tsuruoka Metabolomics Cohort Study (TMCS).

The Tsuruoka Metabolomics Cohort Study (TMCS) is an ongoing population-based cohort study being conducted in the rural area of Yamagata Prefecture, Japan. This study aimed to enhance the precision prevention of multi-factorial, complex diseases, including non-communicable and aging-associated diseases, by improving risk stratification and prediction measures. At baseline, 11,002 participants aged 35-74 years were recruited in Tsuruoka City, Yamagata Prefecture, Japan, between 2012 and 2015, with an ongoing follow-up survey. Participants underwent various measurements, examinations, tests, and questionnaires on their health, lifestyle, and social factors. This study used an integrative approach with deep molecular profiling to identify potential biomarkers linked to phenotypes that underpin disease pathophysiology and provide better mechanistic insights into social health determinants. The TMCS incorporates multi-omics data, including genetic and metabolomic analyses of 10,933 participants and comprehensive data collection ranging from physical, psychological, behavioral, and social to biological data. The metabolome is used as a phenotypic probe because it is sensitive to changes in physiological and external conditions. The TMCS focuses on collecting outcomes for cardiovascular disease, cancer incidence and mortality, disability, functional decline due to aging and disease sequelae, and the variation in health status within the body represented by omics analysis that lies between exposure and disease. It contains several sub-studies on aging, heated tobacco products, and women's health. This study is notable for its robust design, high participation rate (89%), and long-term repeated surveys. Moreover, it contributes to precision prevention in Japan and East Asia as a well-established multi-omics platform.

Relationship between working hours and sleep quality with consideration to effect modification by work style: a community-based cross-sectional study.

BACKGROUND: Although longer working hours are associated with lower sleep quality, it is still necessary to work a certain number of hours to make a living. In this study, we investigated the relationship between working hours and sleep quality in a community setting. We then explored how to manage work style while maintaining the sleep quality of workers without markedly reducing working hours. METHODS: 4388 day-time workers in various occupations living in Ota ward in Tokyo were included in the analysis. The relationship between working hours and sleep quality measured by the Athens Insomnia Scale was examined by ANOVA and linear regression models. Effect modification by work style (work end time, shift in working start and end time, current work from home status, change in work place) on the relationship between working hours and sleep quality was investigated by multivariate linear regression models. RESULTS: Longer working hours were significantly associated with lower sleep quality. The magnitude of the relationship between long working hours and low sleep quality was significantly larger when work end time was later (p for trend of interaction < 0.01) and when working start and end time were shifted later (vs no change, p for interaction = 0.03). The relationship was marginally greater when the proportion of work from home was increased (vs no change, p for interaction = 0.07). CONCLUSIONS: A relationship between longer working hours and lower sleep quality was observed among workers. Leaving work earlier or optimizing the work environment at home may diminish the adverse effect of long working hours on sleep quality.

Factors affecting activities of daily living among patients with Wilson disease.

Wilson disease (WD) is a congenital copper metabolism disorder with various manifestations and can be treated with oral medication. This study examined the factors related to decline in activities of daily living (ADL) in patients with WD as research in this area remains limited. We enrolled 308 patients with WD, including patients who participated in a national survey and those who sought cares at the Department of Pediatrics, Toho University Ohashi Medical Center, from 2016 to 2017. We analyzed the association between ADL decline and factors including age at diagnosis, period from diagnosis to survey, hepatic symptoms, neurological signs, and psychiatric presentation at diagnosis. The relative risks (RRs) for ADL decline were estimated for each factor using multivariate modified Poisson regression analysis. Overall, 97 out of 308 (31.5%) patients experienced ADL decline. After adjusting for explanatory variables, regression analysis revealed that factors significantly associated with ADL decline were a period of ≥20 years from diagnosis to survey (adjusted RR = 2.34, 95% confidence interval [CI]: 1.47-3.74), hepatic symptoms with splenomegaly (adjusted RR = 2.57, 95% CI: 1.26-5.24), mild neurological signs (adjusted RR = 3.20, 95% CI: 1.96-5.23), and severe neurological signs (adjusted RR = 3.63, 95% CI: 2.28-5.77). Neurological signs, hepatic symptoms with splenomegaly, and a period of 20 years from diagnosis to survey are associated with ADL decline. Thus, careful assessment of patients for these factors is necessary, and these findings may guide future efforts to improve patient prognosis.

Misreporting of height and weight by primary school children in Japan: a cross-sectional study on individual and environmental determinants.

BACKGROUND: Appropriate body constitution during childhood is important for future health. However, it has been suggested that thinness is increasing among adolescent girls and boys in Japan. Since misreporting of height/weight may be a possible reflection of the child's ideal body image, we investigated the magnitude and direction of height/weight misreporting and its determinants among Japanese young adolescents. METHODS: A total of 1019 children in public primary schools were included in the analysis. Both measured and self-reported values of height/weight were obtained. Misreporting of height/weight was calculated by subtracting the measured value from the self-reported value. The association between misreporting and several variables such as the BMI z-score of individuals and body constitution of surrounding children was explored by multivariate linear mixed models. RESULTS: As BMI z-score increased, 'overreporting' of height by boys and 'underreporting' of height by girls became larger (p = 0.06 in boys, p = 0.02 in girls). Both boys and girls with a larger body size tended to underreport their weight (p < 0.01 in boys, p < 0.01 in girls). Boys who belonged to a school with a larger average BMI z-score were more likely to overreport their weight. This tendency was not observed for girls. CONCLUSIONS: Self-reported height/weight was generally accurate in Japanese primary school children. However, even primary school children misreported their height/weight intentionally like adults, possibly due to social pressure to lose weight or that not to stand out. Thus, health education about appropriate body constitution should be provided from the beginning of adolescence, particularly for girls.

Current status and future prospects of the Japanese orthopaedic association national registry (JOANR), Japan's first national registry of orthopaedic surgery.

The Japanese Orthopaedic Association National Registry (JOANR) is Japan's first national registry of orthopaedic surgery, which has been developed after having been selected for the Project for Developing a Database of Clinical Outcome approved by the Health Policy Bureau of the Ministry of Health, Labour and Welfare. Its architecture has two levels of registration, one being the basic items of surgical procedure, disease, information on surgeons, surgery-related information, and outcome, and the other being detailed items in the affiliated registries of partner medical associations. It has a number of features, including the facts that, because it handles medical data, which constitute special care-required personal information, data processing is conducted entirely in a cloud environment with the imposition of high-level data security measures; registration of the implant data required to assess implant performance has been automated via a bar code reader app; and the system structure enables flexible collaboration with the registries of partner associations. JOANR registration is a requirement for accreditation as a core institution or partner institution under the board certification system, and the total number of cases registered during the first year of operation (2020) was 899,421 registered by 2,247 institutions, providing real-world evidence concerning orthopaedic surgery.

A Case-Crossover Analysis of the Association between Exposure to Total PM2.5 and Its Chemical Components and Emergency Ambulance Dispatches in Tokyo.

A limited number of studies have investigated the association between short-term exposure to PM2.5 components and morbidity. The present case-crossover study explored the association between exposure to total PM2.5 and its components and emergency ambulance dispatches, which is one of the indicators of morbidity, in the 23 Tokyo wards. Between 2016 and 2018 (mean mass concentrations of total PM2.5 13.5 µg/m3), we obtained data, from the Tokyo Fire Department, on the daily cases of ambulance dispatches. Fine particles were collected at a fixed monitoring site and were analyzed to estimate the daily mean concentrations of carbons and ions. We analyzed 1038301 cases of health-based all-cause ambulance dispatches by using a conditional logistic regression model. The average concentrations of total PM2.5 over one and the previous day were positively associated with the number of ambulance dispatches. In terms of PM2.5 components, the percentage increase per interquartile range (IQR) increase was 0.8% for elemental carbon (IQR = 0.8 µg/m3; 95% CI = 0.3-1.3%), 0.9% for sulfate (2.1 µg/m3; 0.5-1.4%), and 1.1% for ammonium (1.3 µg/m3; 0.4-1.8%) in the PM2.5-adjusted models. This is the first study to find an association between some specific components in PM2.5 and ambulance dispatches.

Guardianship dietary and other behavioural factors associated with skipping breakfast in Japanese primary school children: A child-guardian dyad study.

BACKGROUND AND OBJECTIVES: Regular breakfast consumption is widely considered an important component of healthy dietary habits. In this study, we assessed differences in nutrient/food intake between breakfast consumers and skippers. We also investigated behavioural factors related with breakfast skipping utilizing data collected from both children and their guardians. METHODS AND STUDY DESIGN: This cross-sectional study was conducted in 14 public primary schools in Japan. Two questionnaires were distributed: a behavioural questionnaire and a brieftype, self-administered diet history questionnaire. In total, 1816 child (10-12 y/o)-guardian dyads were included in the analysis. Intakes of nutrients and foods were compared between breakfast consumers and skippers by the ttest. The relationship between breakfast skipping and behavioural factors was investigated by logistic regression analysis by child sex. RESULTS: The proportion of breakfast skippers in the children was 9.8%. Daily intakes of nutrients/foods were better in the breakfast consumers. Later bedtime, lower nutrition knowledge level, and frequent incomplete consumption of home meals was significantly or marginally associated with breakfast skipping. Guardians' breakfast skipping was also associated with children's breakfast skipping. Some relationships between behavioural factors and breakfast skipping differed between boys and girls. CONCLUSIONS: Breakfast consumers had a more nutritious meal quality. To increase breakfast consumption, morning time schedules may need to be rearranged to avoid time pressure. Nutritional knowledge and dietary behaviour appear relevant. Guardians played a major role in coping with breakfast avoidance, in part as role models.

Estimated Prevalence of Cronkhite-Canada Syndrome, Chronic Enteropathy Associated With SLCO2A1 Gene, and Intestinal Behçet's Disease in Japan in 2017: A Nationwide Survey.

BACKGROUND: Cronkhite-Canada syndrome (CCS), chronic enteropathy associated with SLCO2A1 gene (CEAS), and intestinal Behçet's disease (BD) are classified as intractable intestinal disorders in Japan. However, the national prevalence of these diseases remains unknown. We performed a nationwide survey to estimate the patient numbers and prevalence rates of these diseases throughout Japan in 2017. METHODS: We conducted a mail-based survey targeting hospitals across Japan to estimate the annual numbers of patients with CCS, CEAS, and intestinal BD in 2017. Using a stratified random sampling method, we selected 2,979 hospital departments and asked them to report the number of patients who met specific diagnostic criteria. The total number of patients for each disease was estimated by multiplying the reported numbers by the reciprocal of the sampling rate and response rate. The corresponding prevalence rates per 1,000,000 population were calculated based on the mid-year population of Japan in 2017. RESULTS: The overall survey response rate was 68.1% (2,029 departments). The estimated numbers of patients with CCS, CEAS, and intestinal BD were 473 (95% confidence interval [CI], 357-589), 388 (95% CI, 289-486), and 3,139 (95% CI, 2,749-3,529), respectively; the prevalence rates per 1,000,000 population were 3.7 (male: 4.0; female: 3.5), 3.1 (male: 3.0; female: 3.1), and 24.8 (male: 24.5; female: 25.0), respectively. The male-to-female ratios were 1.10, 0.94, and 0.93 for patients with CCS, CEAS, and intestinal BD, respectively. CONCLUSIONS: Estimates of the national prevalence of CCS, CEAS, and intestinal BD in Japan were generated and found to be higher than those previously reported.

Respiratory function declines in children with asthma associated with chemical species of fine particulate matter (PM2.5) in Nagasaki, Japan.

BACKGROUND: The differential effects of PM2.5 fractions on children's lung function remain inconclusive. This study aimed to examine whether lung function in asthmatic children was associated with increased PM2.5 fractions in urban areas in Nagasaki prefecture, Japan, where the air pollution level is relatively low but influenced by transboundary air pollution. METHODS: We conducted a multiyear panel study of 73 asthmatic children (boys, 60.3%; mean age, 8.2 years) spanning spring 2014-2016 in two cities. We collected self-measured peak expiratory flow (PEF) twice a day and daily time-series data for PM2.5 total mass and its chemical species. We fitted a linear mixed effects model to examine short-term associations between PEF and PM2.5, adjusting for individual and time-varying confounders. A generalized linear mixed effects model was also used to estimate the association for worsening asthma defined by severe PEF decline. Back-trajectory and cluster analyses were used to investigate the long-range transboundary PM2.5 in the study areas. RESULTS: We found that morning PEFs were adversely associated with higher levels of sulfate (- 1.61 L/min; 95% CI: - 3.07, - 0.15) in Nagasaki city and organic carbon (OC) (- 1.02 L/min; 95% CI: - 1.94, - 0.09) in Isahaya city, per interquartile range (IQR) increase at lag1. In addition, we observed consistent findings for worsening asthma, with higher odds of severe PEF decline in the morning for sulfate (odds ratio (OR) = 2.31; 95% CI: 1.12, 4.77) and ammonium (OR = 1.73; 95% CI: 1.06, 2.84) in Nagasaki city and OC (OR = 1.51; 95% CI: 1.06, 2.15) in Isahaya city, per IQR increase at lag1. The significant chemical species were higher on days that could be largely attributed to the path of Northeast China origin (for sulfate and ammonium) or both the same path and local sources (for OC) than by other clusters. CONCLUSIONS: This study provides evidence of the differential effects of PM2.5 fractions on lung function among asthmatic children in urban areas, where the Japanese national standards of air quality have been nearly met. Continuous efforts to promote mitigation actions and public awareness of hazardous transboundary air pollution are needed to protect susceptible children with asthma.

A school-based nutrition education program involving children and their guardians in Japan: facilitation of guardian-child communication and reduction of nutrition knowledge disparity.

BACKGROUND: Since the risk of noncommunicable diseases is closely associated with dietary intake, it is important to establish healthy dietary habits in childhood. Although several dietary education programs for children have been attempted, their implementation at school was often difficult due to overcrowded study curricula. We developed a new program which included homework for children and guardians, and evaluated its effect. Determinants of the effect were also investigated. METHODS: The school-based nutrition education program including a 45-min lecture, a series of homework assignments involving children and guardians, and two handouts was implemented in 14 public primary schools in Japan. Seven schools each underwent the intervention in an alternating manner. Nutrition knowledge (percentage (%) of correct answers in the nutrition knowledge questionnaire) and attitude/behavior toward diet was evaluated three times (May (baseline), October, February) as outcomes. These factors and their changes following the intervention were assessed by linear mixed models to adjust for individual factors, with consideration to clustering of the participants and repeated measurements. RESULTS: In total, 2227 children aged 10-12 years and their guardians participated. All schools completed the program. Children's nutrition knowledge level was significantly increased (8.7%, 95% confidence interval [7.7-9.7]) following the intervention. Communication between children and their guardians, which was positively related with nutrition knowledge, was facilitated by the intervention. The increase in nutrition knowledge was greater among children with a lower knowledge level at baseline. CONCLUSIONS: This school-based nutrition education program was effective and feasible. Appropriate teaching materials for homework can reduce the burden on schools and facilitate communication between children and guardians. Public schools can be crucial venues for decreasing disparities in nutrition knowledge. TRIAL REGISTRATION: This study was registered as an intervention study in the UMIN Clinical Trials Registry (trial ID: UMIN000029252 ) on Sep 22, 2017.

Relationship between maternal employment status and children's food intake in Japan.

BACKGROUND: Although long maternal working hours are reported to have a negative effect on children's dietary habits, few studies have investigated this issue in Japan. Healthy dietary habits in childhood are important because they may reduce the risk of future disease. Here, we examined the relationship between maternal employment status and children's dietary intake in 1693 pairs of Japanese primary school 5th and 6th graders and their mothers. METHODS: The survey was conducted using two questionnaires, a brief-type self-administered diet history questionnaire and a lifestyle questionnaire. The analysis also considered mothers' and children's nutrition knowledge, attitudes toward diet, and some aspects of family environment. RESULTS: Longer maternal working hours were associated with children's higher intake of white rice (g/1000kcal) (ß 11.4, 95%CI [1.0, 21.9]; working ≥8h vs. not working), lower intake of confectioneries (g/1000kcal) (ß -4.0 [-7.6, -0.4]), and higher body mass index (BMI) (kg/m2) (ß 0.62 [0.2, 1.0]). Although maternal employment status was not significantly associated with lower intake of healthy food (e.g., vegetables) or higher intake of unhealthy food (e.g., sweetened beverages) in the children, in contrast with previous studies, it may have affected children's energy intake through their higher intake of white rice. Further, children's nutrition knowledge and attitudes toward diet, mothers' food intake, and some family environment factors were significantly associated with intakes of vegetables and sweetened beverages in the children. CONCLUSIONS: Longer maternal working hours were significantly associated with higher intake of white rice and lower intake of confectioneries, as well as higher BMI among children. Even when a mother works, however, it may be possible to improve her child's dietary intake by other means such as nutrition education for children or enhancement of food environment.

Knee pain and future decline in higher-level functional competence in community-dwelling older Japanese: the Kurabuchi cohort study.

BACKGROUND: The effect of knee osteoarthritis, which causes knee pain, on higher-level functional competence (HLFC) is not clear. OBJECTIVE: To clarify the effect of knee pain on HLFC in older people. DESIGN: Community-based prospective cohort study. SETTING: Kurabuchi town, Gumma prefecture, Japan. SUBJECTS: Community-dwelling individuals aged 65 and older. METHODS: A total of 808 residents participated to the baseline examinations. The frequency of knee pain, degree of pain and functional impairment resulting from the pain were asked at baseline (2005-2006) via a self-administered questionnaire in Japanese based on an English version of the Western Ontario and McMaster Universities Osteoarthritis Index. Information on HLFC at baseline and during home visits were collected annually until 2014 with the Tokyo Metropolitan Institute of Gerontology Index of Competence. The association between baseline knee pain and HLFC decline was assessed with a Cox proportional hazards model. RESULTS: Two factors, persistent knee pain and severe functional impairment caused by the pain, were significantly associated with future declines in total HLFC, with adjusted hazard ratios (95% confidence intervals) of 1.51 (1.08-2.11) and 1.49 (1.10-2.00). In analysis by subcategory, persistent knee pain had a significant adverse effect on participants' intellectual and social activities, and that severe physical functional impairment also had a significant impact on social activities. CONCLUSIONS: The clear association of the frequency of knee pain and resultant functional impairment with future HLFC decline indicates that collecting information about these factors may be useful in identifying older people at high risk of future HLFC decline.

Relationship of living arrangement with the decline in functional capacity in elderly people by gender: a longitudinal observational study.

BACKGROUND: The living arrangement has been suggested as an important factor affecting health. Recent studies have also suggested that there was a risk among elderly persons who were not alone. This study examined whether the detailed living arrangement was associated with a future decline in functional capacity in the elderly, by gender, in a Japanese suburban city. METHODS: A 3-year longitudinal questionnaire survey (baseline: 2011; follow-up: 2014) for aged 65 years or older was conducted in Kurihara city, Japan. Of the respondents in the baseline survey, we analyzed those who scored 13 points (a perfect score which indicates the highest functional capacity; n = 2627) on the Tokyo Metropolitan Institute of Gerontology Index of Competence at the baseline. The exposure was living arrangement at baseline, divided into five categories: "with spouse only," "living alone," "with child and his/her spouse," "with child without his/her spouse," and "with other family/person." The outcome was the decline in functional capacity at the follow-up survey (score decreased to 10 points or less from 13 points). RESULTS: Of the 2627 analyzed population, 1199 (45.6%) were men. The incidence of the decline was 5.8% in men and 5.9% in women. Multivariable logistic regression analyses adjusted for age, educational attainment, and health behavior and condition revealed that in women, the odds ratio of the decline was higher in living with child and his/her spouse (2.41, 95% confidence interval; 1.10-5.28) referring to living with spouse only. When adjusting activities inside and outside the home such as housework additionally, the association was attenuated to marginal significance (2.25, 0.98-5.18). No statistical significance was observed in men. CONCLUSIONS: These results suggested that living with child and spouse of a child was associated with the future decline in women's functional capacity.

Correction to: Relationship of living arrangement with the decline in functional capacity in elderly people by gender: a longitudinal observational study.

An amendment to this paper has been published and can be accessed via the original article.

Association between Asian dust exposure and respiratory function in children with bronchial asthma in Nagasaki Prefecture, Japan.

BACKGROUND: Studies on the adverse effects of Asian dust (AD) on respiratory function in children are scarce. The objective of this study was to examine the association between AD and respiratory function by measuring peak expiratory flow rates (PEFRs) in asthmatic children. METHODS: The study was carried out from March to May from 2014 through 2016. One hundred ten children with bronchial asthma were recruited from four hospitals in the Goto Islands and south Nagasaki area in Nagasaki prefecture. The parents were asked to record their children's PEFRs every morning/evening and clinical symptoms in an asthma diary. AD was assessed from light detection and ranging data, and a linear mixed-effects model was used to estimate the effects of AD on daily PEFR. Time-stratified case-crossover analyses were performed to examine the association between AD and asthma attacks defined by reduction levels in PEFR. RESULTS: AD was detected on 11 days in the Goto Islands, and on 23 days in the south Nagasaki area. After adjusting for age, sex, temperature, and daily oxidants, we found a consistent association between AD and a 1.1% to 1.7% decrease in PEFR in the mornings and a 0.7% to 1.3% decrease in the evenings at a lag of 0 to 5 days. AD was not associated with the number of asthma attacks, respiratory symptoms, or other symptoms at any lag days examined. CONCLUSIONS: Exposure to AD was associated with reduced PEFR, although the effects were not large enough to induce clinically apparent symptoms, in clinically well-controlled asthmatic children.

A 20-year prospective longitudinal MRI study on cervical spine after whiplash injury: Follow-up of a cross-sectional study.

BACKGROUND: Some patients suffer from long-lasting symptoms after whiplash injury. However, there are few reports on the long-term changes in the cervical spine after whiplash injury using imaging tests. The purpose of this longitudinal study was to determine the changes on MRI of the cervical spine 20 years after whiplash injury, and to examine the relationships between changes in the cervical spine on MRI and changes in related clinical symptoms. METHODS: Eighty-one subjects finally participated in this study (follow-up rate 16%). The mean follow-up duration was 21.7 years. All subjects filled out a questionnaire about their clinical symptoms. The MRI findings were assessed using numerical grading system applied in the original study. Statistic analyses were used to investigate whether the progression of each MRI finding was associated with the severity of neck pain, stiff shoulders, dizziness and tinnitus. RESULTS: All subjects had complained of some clinical symptoms in the original study: 71 had neck pain, 53 stiff shoulders, and others. In the present study, 66 subjects (81.5%) complained of some clinical symptoms: 57 had stiff shoulders, 20 neck pain, and others. The progression of degeneration on MRI was observed in 95% of the subjects, with C4/5 and 5/6 being the most frequently involved levels. Changes in the severity of neck pain, stiff shoulders, dizziness and tinnitus over 20 years were not significantly associated with the progression of degenerative changes in the cervical spine on MRI. CONCLUSIONS: Twenty years after whiplash injury, 95% of the subjects showed a progression of degeneration in the cervical spine. The progression of the intervertebral disc degeneration in the cervical spine on MRI after whiplash injury was not significantly associated with changes in the severity of related clinical symptoms, indicating that the degenerative changes on MRI may reflect the physiological aging process rather than post-traumatic sequelae.

Modic changes in the cervical spine: Prospective 20-year follow-up study in asymptomatic subjects.

BACKGROUND: Few studies have characterized the development of Modic changes in the cervical spine over time. We evaluated Modic changes of the cervical spine that developed over a 20-year period in a healthy cohort, and sought to clarify the relationship between Modic changes and the development of clinical symptoms. METHODS: For this multicenter prospective cohort study, we recruited 193 subjects from an original cohort of asymptomatic volunteers who underwent MRI of the cervical spine between 1993 and 1996. Each cervical level from C2/3 to C7/T1 (total n = 1158 intervertebral levels) was assessed on current MRIs as normal or showing type 1, 2, or 3 Modic change, and we asked about symptoms related to the cervical spine. Relationships between the presence of Modic changes and patient characteristics, pre-existing disc degenerations or clinical symptoms were evaluated by logistic regression analysis. RESULTS: After 20-year follow-up, Modic changes affected 31 subjects (16.1%) at 47 intervertebral disc levels. Of these 47 intervertebral disc levels, type 2, found at 30 levels (63.8%), was the most frequent, followed by type 1 at 15 levels (31.9%) and type 3 at two levels (4.3%). The most frequent changes were observed at the C5/6 segment with type 2 Modic changes. The presence of Modic changes correlated with pre-existing posterior disc protrusion (odds ratio 3.31, 95% confidence interval 1.21-9.05) and neck pain (odds ratio 2.71, 95% confidence interval 1.08-6.80). CONCLUSIONS: In the cervical spine over a 20-year period, type 2 Modic changes were most frequent at the C5/6 segment. The Modic changes were associated with pre-existing disc degeneration and neck pain but not with age, BMI, smoking, shoulder stiffness, arm pain or numbness.

[Association between time-appropriate vaccinations in early childhood and individual and community-level factors in Japan].

Objective　Recently, in Japan, the compulsory vaccinations administered during early childhood have been becoming increasingly varied. As a result, the vaccination schedule has become complicated. In this study, we aimed to identify the association of time-appropriate vaccination during early childhood (dependent variable) with individual-level factors including socioeconomic status and having a family doctor. We also studied the association of time-appropriate vaccination with community-level factors including the number of pediatricians in a community.Methods　Multilevel logistic regression models were used for analysis. Time-appropriate BCG, DPT, and measles vaccinations were the dependent variables. Individual-level data were obtained through a survey of parents of 18-month-old children as part of the final evaluation of "Healthy Parents and Children 21"; community-level data were obtained through a survey of municipalities as part of the aforementioned final evaluation as well as through a national survey. There were 23,583 parents in 430 municipalities who were eligible for analysis.Results　Time-appropriate vaccination of infants was carried out by 88.3% of parents. The results of the multilevel logistic regression showed that time-appropriate vaccination was significantly lower for those who did not have a family doctor (adjusted odds ratio [AOR], 0.45; 95% confidence interval [CI], 0.36-0.55), the fourth or later birth order (0.23; 0.19-0.28), mothers aged less than 19 years at childbirth (0.17; 0.13-0.24), full-time working mothers (0.52; 0.47-0.58), and those under very difficult economic conditions (0.66; 0.57-0.77). Among community-level factors, only use of vaccination data by a municipality had a significantly negative association with the dependent variable.Conclusion　Not having a family doctor, the mother's young age, late birth order, poor economic status, and full-time working mothers were risk factors associated with delayed vaccinations. It is necessary to improve environments that promote infants having a family doctor as well as to promote special approaches toward families at risk for delayed vaccinations.

Clinical differences between elderly-onset ulcerative colitis and non-elderly-onset ulcerative colitis: A nationwide survey data in Japan.

BACKGROUND AND AIM: Studies on the characteristics of elderly-onset ulcerative colitis (EOUC) and non-elderly-onset ulcerative colitis (NEOUC) have reported conflicting findings. The aim of this study was to compare disease characteristics of EOUC and NEOUC by analyzing the database of the Japanese nationwide inflammatory bowel disease (IBD) registry. METHODS: We analyzed the age of disease onset, sex, disease severity, and disease extent in patients with ulcerative colitis that were newly diagnosed and registered within 1 year between 2004 and 2009 (n = 28 179). We also analyzed the medical treatment, rate of IBD-related surgery, and postoperative complications. We compared them between younger than 65 years old (NEOUC group) and 65 years old or older (EOUC group) patients. RESULTS: A total of 25 401 (90.1%) and 2778 (9.9%) patients were included in the NEOUC and EOUC groups, respectively. In the EOUC group, disease activity was significantly higher, and extent of pathological changes in the colon more extended significantly. Laboratory findings showed that inflammatory markers were elevated significantly in the EOUC group. The proportion of those with IBD-related hospitalization was significantly higher in the EOUC group (54.2% vs 35.7%, P < 0.001). The proportion of patients who were treated with corticosteroids was significantly higher in the EOUC group (36.7% vs 30.8%, P < 0.001). Significantly more number of patients underwent IBD-related surgery in the EOUC group (0.68% vs 0.27%, P < 0.001). CONCLUSION: Elderly patients show higher disease activity, with a higher proportion requiring IBD-related hospitalization and IBD-related surgery, according to the nationwide registry in Japan.

[Evaluation of real-time surveillance of influenza incidence in Kawasaki City by comparison using the National Epidemiological Surveillance of Infectious Diseases].

Objectives　In Japan, nationwide data of the incidence of infectious diseases have been collected via the National Epidemiological Surveillance of Infectious Diseases (NESID) since 1981. In addition, since March 2014, Kawasaki City has operated its own real-time surveillance (RTS) system to collect data of the incidence of influenza from medical institutions across the city. This study aimed to describe the characteristics of the RTS system and compare the two surveillance systems to improve measures against infectious diseases in the future.Methods　NESID and RTS data from March 2014 to October 2017 were obtained from the Kawasaki City Institute for Public Health. First, the operating methodologies of the two surveillance systems were compared. Second, RTS data were used to analyze the daily epidemic curve, and then the daily number of influenza cases was converted into weekly data for comparison with NESID data. Pearson's correlation coefficients and 95% confidence intervals (CIs) were calculated. Correlations were also analyzed after data for the last and first weeks of each year were excluded because few hospitals remain open around the New Year holiday, resulting in a disproportionately large number of patients visiting the few institutions that remain open.Results　The NESID relies on data provided by a fixed number of medical institutions determined each fiscal year (mean: 56.0±4.2 institutions), while the number of institutions providing data for the RTS varies daily or monthly. In September 2017, 691 of the 1,032 eligible institutions (67.0%) were registered for the RTS. Pearson's correlation coefficient for the two surveillance systems was 0.975 (95%CI, 0.967-0.981); when data for the last and first week of each year were excluded, it was 0.989 (95%CI 0.986-0.992). In each of the three seasons that were investigated, an increase in the incidence of type A influenza preceded an increase in the incidence of type B influenza.Conclusion　The operating methodologies of the two surveillance systems differed; however, the results identified a strong correlation, confirming the reliability of the RTS. The RTS collects daily data by influenza type; therefore, it detects epidemic onsets at an earlier stage, facilitating more detailed epidemiological analysis, compared with that of the NESID. It is necessary to understand differences in the characteristics between two surveillance systems when we analyze influenza surveillance data.