Association between excessive screen time and school-level proportion of no family rules among elementary school children in Japan: a multilevel analysis.

BACKGROUND: Excessive screen time (ST) in children is a global concern. We assessed the association between individual- and school-level factors and excessive ST in Japanese children using a multilevel analysis. METHODS: A school-based cross-sectional study was conducted in Toyama, Japan in 2018. From 110 elementary schools in Toyama Prefecture, 13,413 children in the 4th-6th grades (boys, 50.9%; mean, 10.5 years old) participated. We assessed lifestyle, recreational ST (not for study use), psychological status, and school and family environment including family rules. We defined ≥3 hours ST as excessive. We calculated the school-level proportions of no family rules and divided them into four categories (<20%, 20% to <30%, 30% to <40%, and ≥40%). A modified multilevel Poisson regression analysis was performed. RESULTS: In total, 12,611 children were included in the analysis (94.0%). The average school-level proportion of those with no family rules was 32.1% (SD = 9.6). The prevalence of excessive ST was 29.9% (34.9% in boys; 24.8% in girls). The regression analysis showed that excessive ST was significantly associated with both individual-level factors, such as boys (adjusted prevalence ratio (aPR); 1.39), older grades (aPR; 1.18 for 5th grades and 1.28 for 6th grades), late wakeup (aPR; 1.13), physical inactivity (aPR; 1.18 for not so much and 1.31 for rarely), late bedtime (aPR; 1.43 for 10 to 11 p.m. and 1.76 for ≥11 p.m.), frequent irritability (aPR; 1.24 for sometimes and 1.46 for often), feelings of school avoidance (aPR; 1.17 for sometimes and 1.22 for often), infrequent child-parental interaction (aPR; 1.16 for rare and 1.21 for none), no family rules (aPR; 1.56), smartphone ownership (aPR; 1.18), and the school-level proportion of no family rules (aPR; 1.20 for 20% to <30%, 1.29 for 30% to <40%, and 1.43 for ≥40%, setting <20% as reference). CONCLUSION: Besides individual factors, a higher school-level proportion of no family rules seemed influential on excessive ST. Increasing the number of households with family rules and addressing individual factors, could be deterrents against excessive ST in children.

Pathological Gaming and Its Association With Lifestyle, Irritability, and School and Family Environments Among Japanese Elementary School Children.

BACKGROUND: Pathological gaming (PG) has emerged as one of the major public health concerns worldwide. We aimed to assess PG and its associated factors among elementary school children in Japan. METHODS: We conducted a school-based observational study in Toyama, Japan in 2018. In total, 13,413 children in the 4th-6th grades (mean age, 10.5 years) participated in the study. We distributed questionnaires and inquired about their lifestyle, irritability, and school and family environments. Referring to criteria of gaming disorder in the International Statistical Classification of Disease (ICD-11), we asked about three core symptoms: impaired control over gaming, increasing priority given to gaming over other activities, and continuation of gaming despite the negative consequences. Children who had all three criteria in the questionnaire were defined as PG. RESULTS: The response rate was 97.6%, and 11,826 children were included in our analyses (88.2%). The prevalence of PG was 5.6% (7.8% in boys, 3.2% in girls). Besides sex, PG was significantly associated with lifestyles, including skipping breakfast (odds ratio [OR] 1.33; 95% confidence interval [CI], 1.05-1.68), physical inactivity (OR 2.23; 95% CI, 1.63-3.05 for rare), late bed time (OR 2.52; 95% CI, 1.96-3.25 for ≥11 p.m.), frequent irritability (OR 1.89; 95% CI, 1.47-2.43), frequent feeling of school avoidance (OR 1.92; 95% CI, 1.49-2.46), fewer close friends (OR 1.30; 95% CI, 1.08-1.56 for some), low academic performance (OR 1.53; 95% CI, 1.13-2.08), no child-parent interaction (OR 1.34; 95% CI, 1.02-1.75), and no rules at home (OR 1.21; 95% CI, 1.02-1.43). CONCLUSION: Unhealthy lifestyles, irritability, and low functioning in school and family environments were associated with PG. Besides having a healthy lifestyle, parental involvement appears to be an indispensable countermeasure for PG in children.

Neighbourhood walkability and obesity among adults in rural Japan: results from a Japanese health database.

BACKGROUND: Walkable neighbourhoods promote physical activity and prevent obesity, but there is limited evidence to inform urban planning strategies for public health within the context of rural Japan. This study describes associations between neighbourhood walkability and obesity in Toyama, a regional municipality in Japan. METHODS: A cross-sectional analysis of the Toyama Prefecture National Health Insurance data (n = 3454) in 2016 using Analysis of Covariance (ANCOVA) and binary logistic regression. Walk Score® was used to estimate neighbourhood walkability. RESULTS: Residents from highly walkable neighbourhoods generally had lower mean body mass index (BMI), but significant associations between neighbourhood walkability and BMI and prevalence of obesity were only observed in women (adjusted OR: 0.46, 95% CI: 0.26-0.80). Men below 65 years old had higher obesity prevalence (adjusted OR: 1.76, 95% CI: 1.34-2.30). Daily alcohol consumption was associated with lower odds of being obese among men (adjusted OR: 0.72, 95% CI: 0.55-0.95). Hypertension, diabetes mellitus and dyslipidaemia were associated with higher obesity prevalence among residents, regardless of gender. CONCLUSIONS: Walkable environment may improve health outcomes for rural communities in Japan. Further studies are required to create equitable and inclusive living spaces for men and women to access healthier lifestyle choices.

Short-term and long-term associations with sleep onset latency in school children in Japan.

BACKGROUND: This study aims to examine the relationships between sleep onset latency and multiple sleep-related factors of seventh and tenth graders during the transition from childhood to adolescence. METHODS: Regarding sleep onset latency, we examined the short-term associations in Phase IV (2002) and long-term associations in Phase V (2005) of the Toyama Birth Cohort Study. In total, 4,673 boys and 4,694 girls in Phase IV and 2,969 boys and 3,108 girls in Phase V answered the questionnaire items regarding sleep, physical and mental health, lifestyle, socioeconomic status, and family and school factors. Considering sleep onset latency as the outcome and 13 sleep-related factors as independent variables, we calculated the odds ratio using binary logistic regression. The longitudinal study was conducted with 1,703 boys and 1,919 girls whose sleep onset latency was within 30 min in Phase IV. RESULTS: The following factors were found to be related to longer sleep onset latency in the short term: sleep duration, physical activity, game time, and self-esteem in boys and sleep duration, bedroom environment, game time, abdominal pain, long-standing illness, onset of puberty, mental health difficulties, and school avoidance feelings in girls. Regarding its long-term effects, having a single parent and self-esteem in boys and breakfast, game time, long-standing illness, obesity, onset of puberty, and school avoidance feelings in girls were associated with longer sleep onset latency. CONCLUSIONS: Education of adolescent health and sleep hygiene at home and school should include both short-term and long-term associations between sleep and a healthy lifestyle by gender.

[Non-participation in social activities of rural older adults: Results from the Toyama dementia survey].

Objective　Social activities play an important role in the maintenance of health and well-being of the older adults. The aim of this study was to identify characteristics of the rural older adults who do not participate by type of social activities.Methods　This survey examined 1,537 older adults randomly selected at a sampling rate of 0.5% from among those living in Toyama prefecture of Japan, in 2014. Of the total, 947 ambulatory older adults living in their own homes were analyzed using Poisson regression. Results were presented as prevalence ratio (PR). The level of statistical significance was set at P<0.05 (two-sided test).Results　The participants included 426 men (mean age 73.9 ± 6.5 years) and 521 women (mean age 74.8 ± 7.0 years).　In terms of work, both men and women did not work at an older age (men PR 1.15 over 75 years old, women PR 1.11 over 70 years old). Men did not work during outpatient treatment (PR 1.09) and the Revised Hasegawa Dementia Scale (HDS-R) 21-25 points (PR 1.09) and 20 points or below. Women who did not drink alcohol did not work (PR 0.93).　Both men and women did not participate in residential activities at older ages (men PR 1.12 over 70 years old, women PR 1.11 over 80 years old). Men with 20 points or below on HDS-R (PR 1.16) and with work history of only physical labor (PR 1.12), and women living with family (PR 0.92) were less likely to participate in residential activities.　In the hobby group, both men and women with work history of only physical labor were less likely to participate (men PR 1.05, women PR 1.08). Men with education of 9 years or below (PR 1.05) and women living alone (PR 1.07) were less likely to participate. Hobby groups did not relate with age and cognitive decline.　In the senior citizens' club, men and women who did not drink alcohol were less likely to participate (men PR 0.91, women PR 0.89). Men who smoked (PR 1.06), men with psychological symptoms (PR 1.09), and women with 20 points or below on HDS-R (PR 1.13) were less likely to participate.Conclusion　Factors related to non-participation of older adults in rural cities depended on the type of social activities. In order to promote social activity among the older adults in rural cities, it is important to consider specific measures taking into account the type of social activities.

Prevalence and Associated Factors of Pathological Internet Use and Online Risky Behaviors Among Japanese Elementary School Children.

BACKGROUND: Little is known about pathological Internet use (PIU) and online risky behaviors among elementary school children. We aimed to investigate the prevalence and factors associated with PIU and online risky behaviors. METHODS: A school-based cross-sectional study was conducted in Toyama, Japan in 2018. The study included 13,413 children in the 4th-6th grades (mean, 10.5 years old) from 110 elementary schools (61.1% of elementary schools in Toyama). We assessed PIU using Young's Diagnostic Questionnaire (YDQ) and risky behaviors. Poisson regression analysis was conducted. RESULTS: Totally, 13,092 children returned questionnaires (response rate 97.6%). The prevalence of PIU was 4.2% and that of each risky behavior was as follows: 21.6% for spending money online, 6.6% for uploading personal movies, 5.2% for interpersonal issues, and 2.4% for having met strangers. PIU was significantly associated with boys (prevalence ratio [PR] 1.26; 95% confidence interval [CI], 1.04-1.52), skipping breakfast (PR 1.43; 95% CI, 1.14-1.79), Internet time (for 2∼3 h, PR 3.49; 95% CI, 2.63-4.65; for 3∼4 h, PR 4.45; 95% CI, 3.27-6.06; and for ≥4 h, PR 8.25; 95% CI, 6.45-10.55), physical inactivity (PR 2.63; 95% CI, 2.00-3.47), late bedtime (PR 1.86; 95% CI, 1.45-2.39 for ≥11 p.m.), no rules at home (PR 1.22; 95% CI, 1.01-1.46), no child-parent interaction (PR 1.37; 95% CI, 1.06-1.77), and no close friends in real life (PR 1.69; 95% CI, 1.30-2.19). CONCLUSIONS: PIU and risky behaviors were not rare among the elementary school children. Besides unhealthy lifestyles, social and family environments were associated with PIU. Having child-parent interaction and helping children develop close friendships in real life are effective deterrents to PIU.

Future projections of the prevalence of dementia in Japan: results from the Toyama Dementia Survey.

BACKGROUND: This study aimed to make future projections of the nationwide prevalence of dementia in Japan using the prevalence of dementia from the Toyama Dementia Survey and population projections. METHODS: We performed linear regression analysis using the prevalence of dementia by sex and age in 1985, 1990, 1996, 2001, and 2014 from the Toyama Dementia Survey to calculate the estimated future prevalence by sex and age. The estimated prevalence was then multiplied by the estimated future population of people aged 65 years and older by sex and age in each of the 47 prefectures from 2020 to 2045 and added together to calculate the total number of people with dementia. The estimated future prevalence of dementia was calculated by dividing the calculated number of people with dementia by the estimated future population of people aged 65 years and older in each of the 47 prefectures. In addition, the estimated future prevalence of dementia in each of the 47 prefectures from 2020 to 2045 was presented on a map of Japan and grayscale-coded in four levels. RESULTS: In 2020, the estimated future prevalence of dementia did not exceed 20% in any prefecture, but in 2025, five prefectures, mainly rural prefectures, had projected rates exceeding 20%. In 2030, the prevalence rate is projected to exceed 20% nationwide, and by 2035, the rate will exceed 25% in 42 prefectures. In 2045, all prefectures excluding Tokyo are projected to have a dementia prevalence rate exceeding 25%, and the rate will exceed 30% in 12 of 47 prefectures. CONCLUSIONS: Over the next 25 years, the prevalence of dementia in people older than 65 years is projected to exceed 25% nationwide, including metropolitan areas.

Lifestyle, psychological stress, and incidence of adolescent constipation: results from the Toyama birth cohort study.

BACKGROUND: We aimed to clarify the predisposing factors for adolescent constipation in a longitudinal study, because while factors associated with childhood constipation have been reported, prospective studies on the incidence of constipation are lacking. METHODS: We enrolled 5540 adolescents aged 12 to 13 years from the Toyama Birth Cohort Study-a community-based prospective study examining children's health. The incidence of constipation, defined as bowel movement frequency of less than once every 2 days, was surveyed during the three-year period from baseline (grade 4) to follow-up (grade 7). Multivariate logistic regression analyses were performed to explore the association between the incidence of adolescent constipation and their lifestyle variables. RESULTS: A total of 261 adolescents (4.7%) developed constipation during the three-year period. Female sex (odds ratio [OR] = 2.62,) overweight (OR = 0.60), and infrequent intake of fruits (OR = 1.50) at baseline were associated with the incidence of constipation. Furthermore, factors related to lifestyle changes and psychological status such as skipping breakfast (OR = 1.73), becoming physically inactive (OR = 1.55), and being persistently irritated (OR = 1.80) were significantly associated with the incidence of constipation. CONCLUSION: Our prospective study demonstrated that female sex, insufficient fruit intake, and deteriorating lifestyles such as skipping breakfast and becoming inactive during the 3-year period were associated with the incidence of adolescent constipation. Beyond anecdotal, maintaining a healthy lifestyle is recommended to reduce the incidence of adolescent constipation.

Effect modification by workplace social capital on the association between depression and workplace and family stress: the Japanese civil servant study.

BACKGROUND: Mental health problems among workers have become an issue in Japan. The working environment for civil servants is becoming excessively stressful, and there is a need to prevent the onset of depression. In addition to stress at the workplace and at home, social capital has been reported as a factor associated with depression. This study examined whether workplace social capital reduces the association between depression and work-related stress or depression and home-related stress. METHODS: A total of 3015 Japanese civil servants (1867 men and 1148 women) from Toyama Prefecture were included in this study. Data on depression and workplace social capital, work status, work stress, work-life balance, and physical health were collected. RESULTS: The odds ratio for depression was higher for both men and women with low workplace social capital. For those with low workplace social capital, the adjusted odds ratio for depression was 2.93 (95% confidence interval [CI], 2.16-3.98) for men and 2.46 (95% CI, 1.74-3.49) for women. After adjusting for workplace social capital, the associations between depression and low job position, low job support, and moderate family-to-work conflict declined in men and were no longer significant. For women, the strength of the association between depression and unmarried status along with moderate control at work decreased and also lost significance. When the ORs for depression were stratified by high and low workplace social capital and compared with the ORs before stratification, the ORs for depression of long working hours and work-to-family conflict increased for both men and women in the low workplace social capital group. CONCLUSIONS: Workplace social capital mitigated the effect of workplace and family stress leading to depression in both men and women.

Regional disparity of certified teaching hospitals on physicians' workload and wages, and popularity among medical students in Japan.

BACKGROUND: Regional disparities in the working conditions of medical doctors have not been fully assessed in Japan. We aimed to clarify these differences in hospital characteristics: doctors' workload, wages, and popularity among medical students by city population sizes. METHODS: We targeted 423 teaching hospitals certified by the Japanese Society of Internal Medicine and assessed the working conditions of physicians specializing in internal medicine. We calculated their workload (the annual number of discharged patients per physician) and retrieved data on junior residents' monthly wages from the Resinavi Book which is popular among medical students in Japan to know the teaching hospital's information and each hospital's website. Furthermore, we explored the interim matching rate of each hospital as its popularity among medical students. Next, we classified cities in which all hospitals were located into eight groups based on their population size and compared the characteristics of these hospitals using a one-way analysis of variance. RESULTS: The average workload was 110.3, while the average workload in hospitals located in most populated cities (≥ 2,000,000) was 88.4 (p < 0.05). The average monthly wage was 351,199 Japanese yen, while that in most populated cities was 305,635.1 Japanese yen. The average popularity (matching rate) was 101.9%, and the rate in most populated areas was 142.7%, which was significantly higher than in other areas. CONCLUSIONS: Hospitals in most populated areas had significantly lower workloads and wages; however, they were more popular among medical students than those in other areas. This study was the first to quantify the regional disparities in physicians' working conditions in Japan, and such disparities need to be corrected.

Association between marital status and cognitive function in Japan: results from the Toyama Dementia Survey.

BACKGROUND: This study aims to clarify the association between marital status and dementia in Japan, adjusting for socioeconomic, lifestyle, and lifestyle-related disease factors. METHODS: Data from the Japanese Toyama Dementia Survey were used. Individuals aged ≥65 years living in Toyama Prefecture were randomly selected, and 1171 participants were analysed, with a sampling rate of 0.5%. The participants' marital status, socioeconomic status, lifestyle factors, and lifestyle-related diseases were assessed. The odds ratio (OR) of marital status for each lifestyle factor and medical histories were calculated by logistic regression analysis. The OR of marital status for dementia was also calculated by logistic regression analysis. RESULTS: The prevalence of dementia was 7.4% for married, and 20.6% for non-married participants. Non-married participants showed a higher prevalence of a history of stroke than married participants. The age- and sex-adjusted OR of marital status for dementia was 1.99 (95% confidence interval (CI) 1.24-3.18) for non-married compared with married participants. Following variable adjustments, the OR for dementia was higher for non-married participants (adjusted OR 1.71; 95% CI 1.03-2.85). CONCLUSIONS: Non-marital status was an independent risk factor for dementia in Japan even after adjusting for socioeconomic, lifestyle, and lifestyle-related disease factors. Non-married people were more likely to have dementia because of their history of stroke.

Relationship Between Parental Lifestyle and Dietary Habits of Children: A Cross-Sectional Study.

BACKGROUND: Although parents seek the best for their children, nutrition education for parents has attracted little attention to improve their children's dietary habits. To address this gap, this study aimed to examine the relationship between parental lifestyle factors and children's dietary habits. METHODS: We used data from the questionnaire survey of the Super Shokuiku School Project conducted in January 2016. The participants consisted of 1,632 elementary school children who answered questions about their lifestyle, while their parents answered parental lifestyle questions, including Breslow's seven health practice score (BHPS). Logistic regression analysis was performed to evaluate the strength of the relationship between parental lifestyle factors and parental dietary attitudes or children's dietary habits. RESULTS: Compared with good maternal BHPS (scores of 6-7), poor maternal BHPS (scores of 0-3) was significantly associated with less parental interest in Shokuiku, less parental consideration of nutrient balance, and an increased rate of children eating breakfast alone (adjusted odds ratio [aOR] 2.95; 95% confidence interval [CI], 1.82-4.78, aOR 3.86; 95% CI, 2.50-5.96, and aOR 2.42; 95% CI, 1.34-4.35, respectively). There was no significant difference between parental BHPS and the following children's dietary habits: frequency of eating breakfast, vegetable intake, and snacking. These habits of children were associated with their personal lifestyle factors. CONCLUSION: Two types of dietary habits among children were associated with lifestyle factors of both parents and children. Nutrition education might be especially important for parents to improve their dietary attitude and children's dietary habits. However, different nutrition education interventions would be needed to appropriately address each dietary habit.

Association between self-reported hearing loss and low socioeconomic status in Japan: findings from the Toyama dementia survey.

BACKGROUND: Age-related hearing loss reduces the quality of life in older adults. Low socioeconomic status (SES) has been reported as a risk factor for hearing loss, although this has not been verified in Japan. This study aimed to assess the association between low SES and hearing loss, excluding people with dementia, in Japan. METHODS: Data from the Toyama Dementia Survey, Japan, were used. Overall, 126 patients with hearing loss and 913 unimpaired controls were identified. Participants' presentation of dementia, self-reported hearing loss, history of medically diagnosed disease (hypertension, hyperlipidemia, diabetes, stroke, or angina pectoris/cardiovascular disease), lifestyle factors (alcohol consumption and smoking), and SES (educational attainment and occupation) were assessed. Any association between low SES and hearing loss was investigated using logistic regression analysis. RESULTS: The odds ratio (OR) for hearing loss was higher for participants with low educational attainment than for those with high educational attainment (age- and sex-adjusted OR 3.08; 95% confidence intervals [CI], 1.51-6.28). After adjusting the models for SES, lifestyle factors, and medical history, the OR increased from 2.90 (95% CI, 1.40-6.01) to 3.43 (95% CI, 1.62-7.27). The OR for hearing loss for participants with blue-collar jobs compared with that of participants with white-collar jobs was not significant (age- and sex-adjusted OR, 1.45; 95% CI, 0.93-2.25). Older age and a history of angina pectoris or cardiovascular disease were found to increase the risk of hearing loss. CONCLUSIONS: Low educational attainment was independently associated with hearing loss in older adults without dementia in Japan.

Association of short sleep duration and long media use with caries in school children.

BACKGROUND: Individual lifestyle factors are associated with dental caries in children. The aim of this study was to investigate comprehensively the association between dental caries in elementary school children and lifestyle factors of the children and their parents. METHODS: Children from five elementary schools in Takaoka city, Toyama Prefecture, Japan (1,699: 848 boys, 851 girls, age range 6-12 years) participated in a survey conducted in March 2016. Questions on socioeconomic status (SES) and lifestyle factors in the children and their parents were included. Children who received treatment for three or more dental caries were defined as having many caries. Logistic regression analysis was performed to evaluate whether these factors were associated with the number of caries. RESULTS: The percentage of children with many caries (≥3) was 38.4%. In univariate analysis, being in 5th or 6th grade, frequent snacking, short sleep duration, long hours of media use, paternal smoking, and parental skipping of breakfast were significantly associated with many caries. Lack of affluence was marginally significant. In multivariate analysis, the association of short hours of sleep and long hours of media use remained significant. The adjusted odds ratio (OR) for media use of 1-2 h and more than 2 h were 1.79 (95% confidence interval [CI]: 1.30-2.46) and 2.24 (95% CI: 1.61-3.11) respectively. The adjusted OR for less than 8 h of sleep was 1.49 (95% CI: 1.07-2.06). CONCLUSIONS: Long duration of media use and short duration of sleep were associated with dental caries. Establishing a healthy lifestyle is necessary for preventing dental caries in children.

Social and family factors as determinants of exercise habits in Japanese elementary school children: a cross-sectional study from the Super Shokuiku School Project.

BACKGROUND: Many studies have already reported on the relationship between exercise habits and health among schoolchildren. However, few have examined social and/or family factors as determinants of exercise habits. METHODS: This study's participants included 1721 schoolchildren aged between 6 and 13 who were involved in the Super Shokuiku School Project in January 2016. A survey was conducted to assess gender, grade level, physical activity, lifestyle, overall health, enrichment of school life, social background, and parental lifestyles. Both dislike and lack of physical activity were used to measure poor exercise habits; correlates were analyzed using logistic regression. RESULTS: "Lack of close friends" had the strongest links with both dislike (adjusted odds ratio [OR] 5.30; 95% confidence interval [CI], 2.78-10.1) and lack of (adjusted OR 5.40; 95% CI, 2.81-10.4) physical activity. Further, children who engaged in long periods of screen time and lacked parental communication also tended to dislike and lack physical activity. Children with mothers who were unemployed (housewives) and had unhealthy lifestyles, as well as those with poor health, were also more likely to lack physical activity. CONCLUSION: Social and family factors (e.g., having close friends) may be determinants of exercise habits among schoolchildren, independent of their own lifestyle factors. Although a longitudinal study is needed to determine causality, substantial attention may thus be required to these factors when promoting physical activity in children.

Associations of socioeconomic status and lifestyle factors with dental neglect of elementary school children: the MEXT Super Shokuiku School Project.

BACKGROUND: Despite the fact that there are parents who do not take children with untreated dental caries to a dental clinic, few studies have been conducted to identify the responsible underlying social and family factors. The aim of this study was to investigate whether socioeconomic status and lifestyle factors are associated with dental neglect in elementary school children. METHODS: This study was conducted in 2016 with 1655 children from the Super Shokuiku School Project in Toyama. Using Breslow's seven health behaviors, the survey assessed: the grade, sex, and lifestyle of the children; parental internet and game use and lifestyle; socioeconomic status. The odds ratios (OR) and 95% confidence intervals (CIs) for having untreated dental caries were calculated using logistic regression analysis. RESULTS: Among the children participating, 152 (3.2%) had untreated dental caries. Among them, 53 (34.9%) had not been taken to a dental clinic despite the school dentist's advice. Dental neglect was significantly associated with children in higher grades (OR, 2.08; 95% CI, 1.14-3.78), father's Internet and game use ≥ 2 h/day (OR, 1.99; 95% CI, 1.02-3.88), not being affluent (OR, 2.78; 95% CI, 1.14-6.81), and non-engagement in afterschool activities (OR, 1.99; 95% CI, 1.10-3.62). CONCLUSIONS: Socioeconomic status was the strongest factor associated with dental neglect despite the fact that the children's medical expenses are paid in full by the National Health Insurance in Toyama, Japan. Future studies should investigate what factors prevent parents of non-affluent families from taking their children to dental clinics and how they can be socially supported to access adequate medical care.

Pre-conception status, obstetric outcome and use of medications during pregnancy of systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) in Japan: Multi-center retrospective descriptive study.

Objective: To describe the pre-conception status, pregnancy outcomes, and medication prevalence in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Crohn's disease (CD), and ulcerative colitis (UC).Methods: E-mail-based questionnaire survey for the Japan Maternal Fetal Intensive Care Unit Network hospitals inquiring prevalence and clinical features of SLE, RA, CD and UC complicated pregnancies for 2 years.Results: The number of SLE, RA, CD and UC among 69,810 deliveries was 184, 139, 27 and 178, respectively. Less than half of pregnancies were planned. Assisted reproductive technology (ART) pregnancy rates were higher in SLE, RA and UC than in the general population (11.4, 23.0 and 7.4 vs 5.1%, p < .001 each). Preterm delivery, preeclampsia, and fetal growth restriction (FGR) were more frequent in SLE than in the general population (39.4 vs. 5.6% p < .001, 15.0 vs. 6.0% p < .001, 12.9 vs 4.2% p < .001). Prevalence of preterm delivery in RA and UC (27.5 vs. 5.6% p < .001, 11.3 vs. 5.6% p < .05) and FGR in CD (28.6 vs. 4.2% p < .001) was also higher than that in the general population.Conclusion: SLE, RA, CD, and UC complicated pregnancies were at high risks of obstetric adverse outcome. High ART rates necessitate pre-conception counseling in SLE, RA, and UC pregnancies.

Discrepancy in the perception of symptoms of cognitive decline between older adults and their family members: results of the Toyama dementia survey.

BACKGROUND: Early consultation is important to delay the onset of dementia. The present study aimed to explore the reasons for delaying a consultation of dementia while focusing on the differences in the perception of cognitive decline between older adults and their family members. METHODS: A group of 663 older adults aged ≥65 years and living with family members in Toyama Prefecture was surveyed. The questionnaires included items that measured changes in cognitive function noticed by older adults and their family members, and the Revised Hasegawa Dementia Scale (HDS-R). The degrees of consistency on the perception of mental changes that accompanied cognitive decline were measured using the Kappa statistic. RESULTS: Both older adults and their family members were well aware of "forgetfulness" as a symptom of cognitive decline. Only the perception of "loss of appetite" at the late stage of cognitive decline was consistent between older adults and their family (κ = 0.707). When older adults often noticed their own forgetfulness, their mean HDS-R score was 22.7, whereas that of the family members was 14.7. The combinations of perception of forgetfulness by older adults and their family members, and the mean HDS-R scores were unaware/unaware (mean HDS-R score = 27.0), aware/unaware (mean HDS-R score = 24.9), aware/aware (mean HDS-R score = 15.5), and unaware/aware (mean HDS-R score = 13.0). CONCLUSIONS: There were discrepancies in the perception of cognitive decline between older adults and their family members. Cognitive decline had progressed by the time that family members had noticed the symptom of forgetfulness in their older adult relatives. The perception gap regarding cognitive decline deters consultation of dementia.

Psychological Stress, Family Environment, and Constipation in Japanese Children: The Toyama Birth Cohort Study.

BACKGROUND: Childhood constipation is prevalent and negatively affects quality of life. Although psychological stress and family environment have been identified as risk factors, few epidemiological studies have examined this issue. We aimed to clarify associations of psychological stress and family environment with childhood constipation in a large-scale epidemiological study. METHODS: In total, 7,998 children aged 9-10 years from the Toyama Birth Cohort Study completed questionnaires. Constipation was defined as bowel movements "less frequently than once every 2 days". Children's lifestyles, including food frequency, psychological stress, family environment, frequency of irritability, unwillingness to attend school, and frequency of interaction with their parents, were analyzed via multivariate logistic regression analysis. Parental employment status and presence at dinner were also examined. RESULTS: In total, 312 children (3.9%) experienced constipation. Girls were more likely to experience constipation than boys (5.1% vs 2.8%). In addition, constipation was significantly associated with girl (odds ratio [OR] 1.97; 95% confidence interval [CI], 1.55-2.51), physical inactivity (OR 1.41; 95% CI, 1.01-1.95), overweight (OR 0.58; 95% CI, 0.40-0.85), infrequent fruit (OR 1.94; 95% CI, 1.42-2.66) and vegetable (OR 1.46; 95% CI, 1.03-2.05) consumption, frequent irritability (OR 1.76; 95% CI, 1.24-2.50), unwillingness to attend school (OR 1.66; 95% CI, 1.13-2.43), and infrequent interaction with parents (OR 1.48; 95% CI, 1.06-2.07). Children whose parents were absent at dinner were more likely to experience constipation compared to those whose parents were present at dinner; however, this differences were not statistically significant. CONCLUSION: Psychological stress and infrequent interaction with parents were as strongly associated with childhood constipation as conventional risk factors. Psychological stress and family environment should be more prioritized in caring childhood constipation.

Socioeconomic status and remaining teeth in Japan: results from the Toyama dementia survey.

BACKGROUND: The prevalence of periodontal disease is increasing among elderly individuals in Japan. Reports on the risk factors for tooth loss have included socioeconomic status (SES); however, few studies have addressed the association between remaining teeth and SES by examining whether education and occupation have a synergistic effect on tooth loss. Accordingly, the present study evaluated the association of remaining teeth with the socioeconomic factors of educational and occupational histories in Japanese elderly individuals. METHODS: This retrospective case-control study used data from the Toyama Dementia Survey, Japan. Toyama Prefecture residents aged ≥65 years were randomly selected for the study (sampling rate, 0.5%), and 1303 residents agreed to participate (response rate, 84.8%). Structured interviews with participants and family members (or proxies, if necessary) were conducted. Participants' lifestyle factors (e.g., smoking and alcohol consumption), medical history, and SES (educational and occupational history) as well as the presence or absence of remaining teeth were assessed. The association between SES and remaining teeth was examined using a logistic regression analysis. RESULTS: Overall, 275 cases with no remaining teeth and 898 controls with remaining teeth were identified. The odds ratio (OR) for complete tooth loss was higher among less educated participants (≤6 years) than among highly educated participants [age- and sex-adjusted OR, 3.29; 95% confidence interval (CI), 1.90-5.71]; furthermore, it was higher among participants with a blue-collar occupational history than among those with a white-collar occupational history (age- and sex-adjusted OR, 2.16; 95% CI, 1.52-3.06). After adjusting for employment history or educational attainment, the ORs for tooth loss were 2.79-3.07 among less educated participants and 1.89-1.93 among participants with a blue-collar occupational history. A current or former smoking habit and medical history of diabetes and osteoporosis increased the risk of tooth loss. The interaction term of a low level of education and a history of blue-collar occupation with tooth loss was not significant. CONCLUSIONS: In Japan, a low SES is a risk factor for tooth loss. A low level of education is a more important predictor of tooth loss than a blue-collar occupation.