Association between flexibility activity and blood-pressure change among older adults in Japan: A 5-year longitudinal study.

This longitudinal study examined the relationship between flexibility-activity and blood-pressure (BP) change among older adults in Japan. Our study included 452 older adults who took part in our survey in both 2012/2013 and 2017/2018. The seated systolic blood pressure (SBP) and diastolic BP (DBP) were measured both at baseline and at the 5 years follow-up. The frequencies of the different physical activities at baseline were assessed using a questionnaire. A generalized linear mixed model was used to estimate the non-standardized coefficient (B) of BP change associated with flexibility activity, after adjustments for sex, age, body mass index, smoking status, alcohol consumption, antihypertensive medication use, history of heart disease, walking time, and muscle-strengthening activity as a fixed-effect, and area of residence as a random-effect. Higher flexibility-activity frequency was significantly associated with reduced SBP (B = -0.77 [95% confidence intervals = -1.36, -0.18], p for linear trend = 0.01, p for quadratic trend = 0.85) and DBP (-0.33 [-0.71, 0.05], p for linear trend = 0.09, p for quadratic trend = 0.04). Engaging in flexibility activity for 3 days per week was significantly associated with a reduction in DBP (B = -4.16, 95% CI [-7.53, -0.79], p = 0.02) compared with that in the reference group (0 days per week). Interaction tests were not significant between basic variables (sex, age, BMI, and antihypertensive medication) and flexibility. In conclusion, higher flexibility activity frequency was associated with a reduction in BP in older adults. Future longitudinal and interventional studies should examine the effects of flexibility activity on cardiovascular disease prevention.

Patient satisfaction and loyalty in Japanese primary care: a cross-sectional study.

BACKGROUND: This study aimed to explore associations between various elements of primary care, patient satisfaction, and loyalty. METHODS: This cross-sectional study used a modified version of the Primary Care Assessment Tool (PCAT), which was adapted for Japan. We distributed the PCAT questionnaire to patients aged 20 years or older at five rural primary care centres in Japan. We confirmed the validity and reliability of the measure for our study. Next, we examined which elements of primary care were related to patient satisfaction and loyalty using Spearman's correlation and structural equation modelling. RESULTS: Of 220 eligible patients, 206 participated in this study. We developed nine component scales: first contact (regular access), first contact (urgent access), longitudinality, coordination, comprehensiveness (variety of care), comprehensiveness (risk prevention), comprehensiveness (health promotion), family-centeredness, and community orientation. Longitudinality and first contact (urgent access) were related with patient satisfaction. Longitudinality, first contact (regular access), and family-centeredness were related to patient loyalty. In the structural equation modelling analysis, two variables were significantly related to loyalty, namely a combined variable including longitudinality and first contact (regular access), along with family-centeredness. CONCLUSIONS: While a patient satisfaction model could not be distilled from the data, longitudinality, first contact (urgent access), and family-centeredness were identified as important elements for the cultivation of patient loyalty. This implies that primary care providers need to develop a deep understanding of patients' contexts and concerns and pay attention to their level of access to cultivate greater patient loyalty.

Neighborhood social capital and incidence and mortality of prostate cancer: a Swedish cohort study.

BACKGROUND: There is a growing interest in the contextual effect of neighborhood linking social capital on different health outcomes, including cancer. AIMS: To examine associations between neighborhood linking social capital and incidence and mortality of prostate cancer. METHOD: This cohort study was based on national registers. Between 2002 and 2015, we included 1,196,563 men aged 50 years and above in the analyses. Multilevel logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) for the association between exposure and outcome, adjusting for potential confounding factors. RESULTS: The total incidence of prostate cancer and mortality in patients with prostate cancer were 8.22 (per 100) and 1.80 (per 100), respectively, during the follow-up period. Individuals living in neighborhoods with low (OR 0.90; 95% CI 0.88-0.93) and intermediate (OR 0.94; 95% CI 0.92-0.96) linking social capital were less likely to be diagnosed with prostate cancer than those living in neighborhoods with high linking social capital. Opposite effects were observed for mortality; prostate cancer patients living in neighborhoods with low (OR 1.15; 95% CI 1.08-1.23) and intermediate (OR 1.09; 95% CI 1.03-1.14) linking social capital were more likely to die from prostate cancer than those in neighborhoods with high linking social capital. CONCLUSIONS: Lower neighborhood linking social capital was associated with lower incidence but higher mortality in patients with prostate cancer. These findings suggest that men living in neighborhoods with low linking social capital may need additional surveillance for prostate cancer.

Is Neighbourhood Linking Social Capital Associated With Colorectal Cancer Incidence and Mortality? A National Cohort Study From Sweden.

Past research on the social determinants of colorectal cancer (CRC) has shown that lower socioeconomic status (SES) is associated with a higher risk of CRC. Similar to SES at the individual level, the neighbourhood social environment may partly affect the development of CRC. Although one important aspect of the neighbourhood social environment is social capital, no large-scale follow-up study has examined its potential effect on CRC. We examined whether neighbourhood "linking social capital," which is established through social relationships and may enable individuals to gain health-promotional resources, is associated with the incidence of and mortality related to CRC, after adjusting for individual- and familial-level factors. This longitudinal study, conducted in Sweden, comprised over 2 million men and over 2 million women aged 25 years or older. The follow-up period started on January 1, 2002 and continued until first incidence of CRC, death due to CRC, death from any other cause, emigration, or the end of the study period on December 31, 2015. We identified over 20,000 CRC cases during the follow-up period. We used multilevel logistic regression models to calculate odds ratios (ORs) with 95% confidence intervals. After adjustment for potential confounding factors, higher ORs of CRC were observed in individuals who lived in neighbourhoods with low, relative to high social capital. Our results suggest that neighbourhood linking social capital has independent effects on CRC. Future studies could explore how simple interventions that can build linking social capital can enhance people's health.

Fast food outlets, physical activity facilities, and obesity among adults: a nationwide longitudinal study from Sweden.

BACKGROUND: While neighborhood deprivation is a well-known predictor of obesity, the mechanisms behind this association are unclear and these are important to clarify before designing interventions focusing on modifiable neighborhood environmental factors in order to reduce obesity risk. OBJECTIVES: This study examined the longitudinal association between availability of fast-food outlets and physical activity facilities and the risk of obesity among adults. METHODS: This study used multiple national register data from Sweden. During the 11-year follow-up period between 2005 and 2015, data from 1,167,449 men and 542,606 women, aged 20-55 years, were accessible for inclusion in this analysis. Incidence of obesity was identified based on a diagnosis of obesity during the follow-up period derived from clinical register data. Neighborhood availability of fast-food outlets and physical activity facilities were assessed in 2005 and Cox regression was used in the statistical analysis. Individual socio-demographic factors and neighborhood deprivation were used as covariates. RESULTS: There were no meaningful associations between neighborhood fast-food outlets or physical activity facilities and obesity in men or women. Neighborhood deprivation was, however, consistently and strongly associated with incidence of obesity in both men and women. CONCLUSIONS: Availability of fast-food outlets and lack of physical activity facilities appear unlikely to cause obesity in Swedish adults. Other potentially modifiable environmental factors within specific social and cultural settings that may influence obesity risk should be examined in future studies.

Additive Effect of Physical Activity and Sedentary Time on Depressive Symptoms in Rural Japanese Adults: A Cross-Sectional Study.

BACKGROUND: Previous studies have reported an additive effect of moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) on depressive symptoms. However, no studies have been conducted in rural community settings. This cross-sectional study investigated whether the additive effect of MVPA and ST was associated with depressive symptoms in rural Japanese adults. METHODS: We identified 2,814 participants from health examinations conducted in Shimane, rural Japan, in 2012 and analyzed data from 1,958 participants. We assessed depressive symptoms using the Zung Self-Rating Depression Scale and measured the total time spent on MVPA and ST using a Japanese short version of the International Physical Activity Questionnaire. Poisson regression analysis examined the prevalence ratios (PR) of depressive symptoms in nine category combinations of MVPA level (no, insufficient, or sufficient MVPA) and ST level (high, moderate, or low ST). RESULTS: A total of 117 (6.0%) participants had depressive symptoms. Compared with the reference category (no MVPA/high ST), multivariate analysis showed that the likelihood of depressive symptoms was significantly lower in the sufficient MVPA/low ST category (PR 0.23; 95% confidence intervals [CI], 0.08-0.66), insufficient MVPA/low ST category (PR 0.37; 95% CI, 0.16-0.86), and insufficient MVPA/moderate ST category (PR 0.39; 95% CI, 0.17-0.90). CONCLUSION: Analysis of the additive effect of MVPA and ST showed that the combinational category of sufficient MVPA and low ST had the lowest prevalence of depressive symptoms in rural Japanese adults. Moderate ST and low ST showed significantly lower likelihoods of depressive symptoms, regardless of insufficient MVPA.

Hilly neighborhoods are associated with increased risk of weight gain among older adults in rural Japan: a 3-years follow-up study.

BACKGROUND: Neighborhood environments have been regularly associated with the weight status. Although the evidence is mostly limited to adults residing in western urban settings, the weight status of older adults living in rural areas is also assumed to be significantly affected by their neighborhood environments. This study aimed to identify environmental attributes specific to rural areas that could affect the risk of longitudinal weight gain among older adults (≥ 65 years) in Japan. METHODS: We examined five environmental attributes, i.e., land slope, public transportation accessibility, residential density, intersection density, and the availability of parks and recreational centers, measured by the geographic information system. Our analysis was based on 714 subjects participated in Shimane Community-based Healthcare Research and Education study in 2012 and 2015. Multinomial logistic regression model was conducted to examine the association between each neighborhood environmental attribute and weight change status (gain, loss and unchanged). RESULTS: We observed a significant increase in the risk of weight gain as the steepness of the neighborhood land slope increased. There was no significant association between other environmental attributes and risk of weight gain as well as weight loss among older adults. CONCLUSION: Living in hilly neighborhoods was associated with increased risk of weight gain among rural Japanese older adults. Future research should consider region-specific environmental attributes when investigating their effect on older adults' weight status.

Development of the Japanese version of the general practice assessment questionnaire: measurement of patient experience and testing of data quality.

BACKGROUND: Physicians' interpersonal performance is critical in medical practice, especially primary care practice. The General Practice Assessment Questionnaire (GPAQ) was developed in the United Kingdom to evaluate the quality of primary care from the viewpoint of patients. This questionnaire highlights the evaluation of interpersonal skills and interactions between physicians and patients. Though several other tools also exist to evaluate primary care quality, the GPAQ has several distinctive evaluation items, covering receptionists, access to primary care, and enablement (patients' understanding of self-care and of their own health after consultation). Our purpose was to develop and validate a Japanese version of the GPAQ. METHODS: This cross-sectional study tested the validity and reliability of the Japanese version of the questionnaire. We translated the original GPAQ into Japanese and assessed its reliability and validity among patients aged ≥20 years at five rural primary care centres located in Shimane and Okayama prefectures, Japan. We also examined its internal reliability using Cronbach's alpha coefficient and construct validity-including item-scale correlations, item-other scale correlations, and inter-scale correlations. Moreover, we examined correlations between each score and overall satisfaction using Spearman's correlation coefficient for criterion-related validity. RESULTS: The translated version of the GPAQ was administered, and we received 252 responses (mean age: 68 ± 12.3 years, male: 42.9%); all data were analysed. The translated questionnaire showed good reliability and validity, with Cronbach's alphas ranging from 0.79-0.92 for all scales, and satisfactory item-scale, item-other scale, and inter-scale correlations. Correlations with overall satisfaction were strong (Spearman's correlation coefficients: 0.31-0.38) for all scales except 'continuity of care'. CONCLUSIONS: The Japanese version of the GPAQ was acceptable, reliable, and valid. This could be a useful instrument to evaluate key areas of primary care performance in Japan, particularly physicians' communication skills. Further work is required to evaluate its utility in urban areas.

Rapid detection of heavy elements in blood extracted from wounds using x-ray fluorescence analysis.

In radiation emergency situations involving persons having plutonium (Pu)-contaminated wounds, rapid assessment of the degree of Pu contamination is required to determine the appropriate course of treatment. Currently, rapid on-site detection of Pu is usually performed by analysis of α-particles emitted from the adhesive tape peeled off the wound. However, the detection of α-particles is difficult, especially in traumatic skin lesions with oozing blood, because of the low permeability of α-particles in blood. Therefore, we focused on x-ray fluorescence (XRF) analysis because x-rays easily pass through several millimetres of blood. In this study, we developed a new methodology for the rapid detection of heavy elements in wounds based on XRF analysis of the contaminated blood collected by gauze patch and filter paper, using stable lead (Pb) as a model contaminant substitute for Pu. Mouse blood samples contaminated with Pb were dropped on gauze patches or absorbed by filter papers and were subjected to XRF measurement. Small pieces of filter paper served as more suitable extraction materials than gauze patches because the entire amount of blood absorbed could be measured. When we used filter paper, the signal intensity of the Pb Lα peak was proportional to the Pb concentration in the blood. With a measurement time of 30 s, the minimum detection limit of Pb in blood collected by filter paper was 2.4 ppm.

Determination of the thermal and epithermal neutron sensitivities of an LBO chamber.

An LBO (Li2B4O7) walled ionization chamber was designed to monitor the epithermal neutron fluence in boron neutron capture therapy clinical irradiation. The thermal and epithermal neutron sensitivities of the device were evaluated using accelerator neutrons from the 9Be(d, n) reaction at a deuteron energy of 4 MeV (4 MeV d-Be neutrons). The response of the chamber in terms of the electric charge induced in the LBO chamber was compared with the thermal and epithermal neutron fluences measured using the gold-foil activation method. The thermal and epithermal neutron sensitivities obtained were expressed in units of pC cm2, i.e., from the chamber response divided by neutron fluence (cm-2). The measured LBO chamber sensitivities were 2.23 × 10-7 ± 0.34 × 10-7 (pC cm2) for thermal neutrons and 2.00 × 10-5 ± 0.12 × 10-5 (pC cm2) for epithermal neutrons. This shows that the LBO chamber is sufficiently sensitive to epithermal neutrons to be useful for epithermal neutron monitoring in BNCT irradiation.

Impact of neighborhood resources on cardiovascular disease: a nationwide six-year follow-up.

BACKGROUND: Living in a socially deprived neighborhood is associated with lifestyle risk factors, e.g., smoking, physical inactivity and unhealthy diet, as well as an increased risk of cardiovascular disease, i.e., coronary heart disease and stroke. The aim was to study whether the odds of cardiovascular disease vary with the neighbourhood availability of potentially health-damaging and health-promoting resources. METHODS: A nationwide sample of 2 040 826 men and 2 153 426 women aged 35-80 years were followed for six years for first hospitalization of coronary heart disease or stroke. Neighborhood availability of health-damaging resources (i.e., fast-food restaurants and bars/pubs) and health-promoting resources (i.e., health care facilities and physical activity facilities) were determined by use of geographic information systems (GIS). RESULTS: We found small or modestly increased odds ratios (ORs) for both coronary heart disease and stroke, related to the availability of both health-damaging and health-promoting resources. For example, in women, the unadjusted OR (95 % confidence interval) for stroke in relation to availability of fast-food restaurants was 1.18 (1.15-1.21). Similar patterns were observed in men, with an OR = 1.08 (1.05-1.10). However, the associations became weaker or disappeared after adjustment for neighborhood-level deprivation and individual-level age and income. CONCLUSIONS: This six year follow-up study shows that neighborhood availability of potentially health-damaging as well as health-promoting resources may make a small contribution to the risk of coronary heart disease and stroke. However, most of these associations were attenuated or disappeared after adjustment for neighborhood-level deprivation and individual-level age and income. Future studies are needed to further examine factors in the causal pathway between neighborhood deprivation and cardiovascular disease.

Neighbourhood Deprivation, Individual-Level and Familial-Level Socio-demographic Factors and Risk of Congenital Heart Disease: A Nationwide Study from Sweden.

OBJECTIVES: The purpose of the study is to examine whether there is an association between neighbourhood deprivation and incidence of congenital heart disease (CHD), after accounting for family- and individual-level potential confounders. METHODS: All children aged 0 to 11 years and living in Sweden (n = 748,951) were followed between January 1, 2000 and December 31, 2010. Data were analysed by multilevel logistic regression, with family- and individual-level characteristics at the first level and level of neighbourhood deprivation at the second level. RESULTS: During the study period, among a total of 748,951 children, 1499 (0.2%) were hospitalised with CHD. Age-adjusted cumulative hospitalisation rates for CHD increased with increasing level of neighbourhood deprivation. In the study population, 1.8 per 1000 and 2.2 per 1000 children in the least and most deprived neighbourhoods, respectively, were hospitalised with CHD. The incidence of hospitalisation for CHD increased with increasing neighbourhood-level deprivation across all family and individual-level socio-demographic categories. The odds ratio (OR) for hospitalisation for CHD for those living in high-deprivation neighbourhoods versus those living in low-deprivation neighbourhoods was 1.23 (95% confidence interval (CI) = 1.04-1.46). In the full model, which took account for age, paternal and maternal individual-level socio-economic characteristics, comorbidities (e.g. maternal type 2 diabetes, OR = 3.03; maternal hypertension, OR = 2.01), and family history of CHD (OR = 3.27), the odds of CHD were slightly attenuated but did not remain significant in the most deprived neighbourhoods (OR = 1.20, 95% CI = 0.99-1.45, p = 0.057). CONCLUSIONS: This study is the largest so far on neighbourhood influences on CHD, and the results suggest that deprived neighbourhoods have higher rates of CHD, which represents important clinical knowledge. However, the association does not seem to be independent of individual- and family-level characteristics.

Depression, stroke and gender: evidence of a stronger association in men.

BACKGROUND/AIMS: Depression is associated with an increased risk for stroke. The aim of this study was to examine whether demographic and socioeconomic factors modify this association. METHODS: This follow-up study comprised 137 305 men and 188 924 women aged ≥30 years from a nationwide sample of primary healthcare centres in Sweden. We identified 4718 first-ever stroke cases (2217 men and 2501 women) during the follow-up period (2005-2007). Multilevel logistic regression models were used to calculate ORs and examine interactions in order to determine whether the association between depression and stroke differs by demographic or socioeconomic factors. RESULTS: Depression was associated with significantly greater odds of stroke after adjustment for potential confounding factors (OR=1.22, 95% CI 1.08 to 1.38). Interaction tests showed that the effect of depression on stroke was higher in men compared with women (the difference in OR between men and women was 1.30, 95% CI 1.01 to 1.68), that is, the association between depression and stroke was modified by gender. CONCLUSIONS: Our findings suggest that the depression-stroke association is modified by gender. Further studies are required to examine the underlying mechanisms in men and women.

Job and life satisfaction and preference of future practice locations of physicians on remote islands in Japan.

BACKGROUND: The objective of this research is to investigate job and life satisfaction and preference of future practice locations of physicians in rural and remote islands in Japan. METHODS: A cross-sectional study was conducted for physicians who reside or resided on the Oki islands: isolated islands situated in the Sea of Japan between the Eurasian continent and the mainland of Japan. A questionnaire was sent to physicians on the Oki islands to evaluate physician satisfaction regarding job environment, career development, living conditions, salary, and support by local government. RESULTS: Data was analysed for 49 physicians; 47 were male and 2 were female, and the mean ± SD age was 44.3 ± 10.9 years. Among the variables related to physicians' satisfaction, most of the physicians (>90%) were satisfied with "team work" and "salary". On the other hand, the majority of physicians (approximately 70%) were not satisfied with the "opportunity to continue professional development". Age ≥ 50 years, graduates of medical schools other than Jichi Medical University (established in 1972 with the aim to produce rural physicians), self-selected the Oki islands as a practice location, and satisfaction in "work as a doctor", "opportunity to consult with peers about patients", "relationship with people in the community", and "acceptance by community" were found to be significant factors influencing the choice of the Oki islands as a future practice location. Factors influencing future practice locations on the remote islands were included in a self-reported questionnaire which illustrated the importance of factors that impact both the spouses and children of physicians. CONCLUSIONS: Improving work satisfaction, providing outreach support programmes for career development and professional support in rural practice, and building appropriate relationships between physicians and people in the community, which can in turn improve work satisfaction, may contribute to physicians' choices of practising medicine on rural and remote islands in Japan. Addressing family issues is also crucial in encouraging the choice of a rural medical practice location.

Relationship between physical activity and chronic musculoskeletal pain among community-dwelling Japanese adults.

BACKGROUND: Both little and excessive physical activity (PA) may relate to chronic musculoskeletal pain. The primary objective of this study was to characterize the relationship of PA levels with chronic low back pain (CLBP) and chronic knee pain (CKP). METHODS: We evaluated 4559 adults aged 40-79 years in a community-based cross-sectional survey conducted in 2009 in Shimane, Japan. We used self-administered questionnaires to assess sociodemographics and health status: PA was assessed by the International Physical Activity Questionnaire, and CLBP and CKP were assessed by a modified version of the Knee Pain Screening Tool. We examined relationships of PA with prevalence of CLBP and CKP using Poisson regression, controlling for potential confounders. RESULTS: CLBP and CKP were both prevalent (14.1% and 10.7%, respectively) and associated with history of injury, medication use, and consultation with physicians. PA was not significantly related to CLBP or CKP (P > 0.05) before or after adjustment for potential confounders. For example, compared with adults reporting moderate PA (8.25-23.0 MET-hours/week), prevalence ratios for CKP adjusted for sex, age, education years, self-rated health, depressive symptom, smoking, chronic disease history, and body-mass index were 1.12 (95% confidential interval [CI] 0.84-1.50) among those with the lowest PA and 1.26 (95% CI 0.93-1.70) among those with the highest PA (P quadratic = 0.08). The prevalence ratios were further attenuated toward the null after additional adjustment for history of injury, medication use, and consultation (P quadratic = 0.17). CONCLUSIONS: This cross-sectional study showed that there were no significant linear or quadratic relationships of self-reported PA with CLBP and CKP. Future longitudinal study with objective measurements is needed.

MC4R rs17782313 gene polymorphism was associated with glycated hemoglobin independently of its effect on BMI in Japanese: the Shimane COHRE study.

BACKGROUND: Type 2 diabetes (T2D) is among the leading public health problems in Japan, and glycated hemoglobin (HbA1c) can be used to screen the population for T2D. Gene polymorphisms, known to be associated with obesity, may predispose individuals to T2D. Rs17782313 the melanocortin 4 receptor (MC4R) has shown one of the strongest associations with body mass index (BMI). We conducted a study to investigate whether rs17782313 (TT versus TC + CC) was associated with HbA1c. METHOD: We conducted a cross-sectional study including 1142 Japanese adults (446 men: 64.9 ± 14.4 years and 696 women: 66.7 ± 12.3 years). MC4R rs17782313 was genotyped using fast real-time polymerase chain reaction. RESULTS: TC + CC genotype group showed significantly greater BMI (p = 0.039) and HbA1c (p = 0.001) than TT genotype group after adjustment for gender, age and, for HbA1c, BMI. Further analysis using linear regression analysis confirmed that the effect of MC4R rs17782313 on HbA1c (ß = 0.08; p = 0.003) was independent of the effect age, gender, BMI, low density lipoprotein cholesterol, homeostasis model assessment of insulin resistance and of beta cell function. This significant independent association was similarly noticed in non-obese (ß = 2.82; p = 0.005) subgroups. CONCLUSION: MC4R rs17782313 was associated with obesity and could confer a certain susceptibility to T2D that could be independent of its pro-obesity effect.

Neighborhood deprivation in relation to lung cancer in individuals with type 2 diabetes-A nationwide cohort study (2005-2018).

BACKGROUND: Neighborhood deprivation has been found associated with both type 2 diabetes and lung cancer. The aim of this study was to examine the potential association between neighborhood deprivation and lung cancer incidence or mortality in individuals diagnosed with type 2 diabetes. The results may identify a new risk or prognostic factor for lung cancer in this important subgroup and help develop a more contextual approach to prevention that includes neighborhood environment. METHODS AND FINDINGS: The study population included adults (n = 613,650) aged ≥ 30 years with type 2 diabetes during 2005 to 2018 in Sweden. Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incidence or mortality of lung cancer associated with neighborhood deprivation. All models were conducted in both men and women and adjusted for individual-level characteristics (e.g. age, smoking- and alcohol-related comorbidities, sociodemographic factors). The cumulative incidence and mortality for lung cancer were 1.08% (95% CI, 1.06 to 1.11) and 0.93% (0.90 to 0.95), respectively, in the study population during the study period. Neighborhood deprivation was associated with both incidence and mortality of lung cancer in patients with type 2 diabetes independently of the individual-level characteristics. In the fully adjusted models, comparing high- with low-deprivation neighborhoods, the HRs for lung cancer incidence were 1.21 (1.10 to 1.33) in men and 1.08 (0.95 to 1.21) in women. The corresponding HRs for lung cancer mortality were 1.04 (1.00 to 1.07) in men and 0.97 (0.94 to 1.00) in women. Competing risk analyses including cardiovascular mortality attenuated the results. CONCLUSION: In this large cohort of individuals with type 2 diabetes, we found higher lung cancer incidence and mortality in patients living in areas with high neighborhood deprivation, even after adjusting for individual-level characteristics. These findings may help develop a more contextual approach that includes the neighborhood environment when allocating resources for disease prevention and care in patients with type 2 diabetes. These findings could also help inform clinical care for patients with type 2 diabetes, particularly those living in deprived neighborhoods.

Changes in masticatory performance and the new onset of diabetes mellitus in older adults: a 5-year longitudinal study.

Objective: Although masticatory performance is affected by age-related reduction in number of teeth (or treatment), the relationship between longitudinal changes in masticatory performance and diabetes mellitus is unknown. This longitudinal study investigated the association between changes in masticatory performance and new-onset diabetes mellitus among community-dwelling Japanese older adults. Methods: The data of 214 older adults living in Ohnan Town, Shimane, Japan, who participated in two surveys conducted between 2012 and 2017 were analyzed. Diabetes mellitus was defined as a hemoglobin A1c level ≥ 6.5% or self-reported diabetes mellitus. The masticatory performance (measured by number of gummy jelly pieces collected after chewing) was evaluated by dental hygienists. Masticatory performance was categorized into two groups (high or low) based on the median in each survey; further, four groups (Group A: remained consistently high, Group B: changed from low to high, Group C: remained consistently low, Group D: changed from high to low) were used to determine longitudinal changes in masticatory performance. Logistic regression was used to analyze the association between changes in masticatory performance and new-onset diabetes mellitus. Results: Overall, 10.3% of participants had diabetes mellitus at the follow-up survey. Multivariate analysis showed that Group D (odds ratio 8.69, 95% confidence interval 1.98-38.22) was positively associated with the development of diabetes mellitus compared with Group A after adjusting for sex, age, body mass index, alcohol consumption, physical activity, and eating speed. Conclusions: Deteriorating masticatory performance for 5 years may cause diabetes mellitus among older adults.

Changes in the Urinary Sodium-to-Potassium Ratio Are Associated with Blood Pressure Change in Older Japanese Adults: A 7-Year Longitudinal Study.

Studies on the association between sodium-to-potassium (Na/K) ratio changes and blood pressure (BP) changes among older adults are limited. This 7-year longitudinal study examined the association between Na/K ratio changes (evaluated using spot urine tests) and BP changes among older Japanese adults. Data were collected from 432 participants (mean age: 70.3±4.4; range: 65−84 years) in 2012 and 2019. Changes in BP and the Na/K ratio over 7 years were calculated by subtracting baseline values from values noted during a follow-up survey. The median systolic and diastolic BP (SBP) and (DBP) changes after 7 years were 4 (IQR, −7, 14) and −1 (IQR, −9, 5) mmHg, respectively. The median Na/K ratio was changed during the follow-up period by −0.2 (IQR, −1.3, 0.7). A generalized linear model indicated that Na/K ratio changes were positively associated with SBP (B = 2.03, p < 0.001) and DBP (B = 0.62, p = 0.021) changes. In the non-antihypertensive medication-using group, urinary Na/K ratio changes were associated with SBP and DBP changes (B = 2.39, p = 0.001; B = 0.99, p = 0.033). In the antihypertensive medication user group, urinary Na/K ratio changes were associated with SBP changes (B = 1.62, p = 0.015). We confirmed the association between changes in the Na/K ratio and changes in BP.

Reduced masticatory performance and not using dentures are associated with hypertension in older adults with tooth loss: the Shimane CoHRE study.

The relationship between masticatory performance and hypertension has seldom been studied. The association between hypertension and tooth loss with/without denture use is unclear. This cross-sectional study examined the relationship between hypertension and masticatory performance and whether the relationship between hypertension and the number of teeth varied with denture use among older Japanese adults. Hypertension was defined as a systolic or diastolic blood pressure ≥140 or ≥90 mm Hg, respectively, or the use of antihypertensive medications. Masticatory performance was assessed using a chewable gummy jelly. The number of teeth and denture use were visually assessed by a trained dental hygienist. Poisson regression analyses were carried out to estimate the prevalence ratio and 95% confidence interval (CI) of hypertension with the number of teeth (≥28, 20-27, or 0-19 teeth), quartiles of masticatory performance (Q1: highest [reference] to Q4: lowest), and tooth loss with/without denture use. Hypertension was significantly associated with masticatory performance in participants in Q3 (prevalence ratio = 1.35; 95% CI = 1.07, 1.72) and Q4 (prevalence ratio = 1.31; 95% CI = 1.01, 1.69). There was no association between tooth loss and hypertension. Compared to participants with >28 teeth, the prevalence ratios and 95% CIs of those without dentures and those with 20-27 teeth were 1.33 (95% CI = 1.06, 1.68) and 1.69 (95% CI = 1.21, 2.37), respectively, in those with 0-19 teeth. Masticatory performance was inversely associated with hypertension, and tooth loss without the use of dentures was related to hypertension. Therefore, masticatory function may be important for preventing hypertension among older adults.