Influence of post-disaster evacuation on incidence of hyperuricemia in residents of Fukushima Prefecture: the Fukushima Health Management Survey.

AIM: After the Great East Japan Earthquake, over 160,000 residents in Fukushima Prefecture were forced to evacuate the area around the Fukushima Daiichi power plant following nuclear accident there. Health problems in these evacuees have since become a major issue. We have examined the association between evacuation and incidence of hyperuricemia among residents in Fukushima. METHODS: We conducted a cohort study of residents aged 40-90 years without hyperuricemia at the time of the Fukushima disaster. Among 8173 residents who met the inclusion criteria before the disaster, 4789 residents (men: 1971, women: 2818; follow-up duration: 1.38 years; and follow-up rate: 58.6%) remained available for follow-up examinations at the end of March 2013. The main endpoint was incidence of hyperuricemia, defined by the Japanese committee guidelines, using local health data from before and after the disaster. We divided participants by evacuation status and compared outcomes between groups. Using a logistic regression model, we estimated the odds ratio for incidence of hyperuricemia, adjusting for potential confounders, age, gender, waist circumference, physical activity, and alcohol consumption. RESULTS: Incidence of hyperuricemia was higher in evacuees (men 10.1%; women 1.1%) than in non-evacuees (men 7.4%, women 1.0%). Evacuees had higher body mass index, waist circumference, triglycerides, LDL-cholesterol, fasting plasma glucose, HbA1c, and lower HDL-cholesterol after the disaster than non-evacuees. We found that evacuation was associated with incidence of hyperuricemia (adjusted odds ratio: 1.38; 95% confidence interval: 1.03-1.86). CONCLUSION: This is the first study to demonstrate an association between evacuation after a disaster and increased incidence of hyperuricemia.

Association between hand-grip strength and depressive symptoms: Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS).

BACKGROUND: no study has examined the longitudinal association between hand-grip strength and mental health, such as depressive symptoms. OBJECTIVE: we investigated the relationship between baseline hand-grip strength and the risk of depressive symptoms. DESIGN: a prospective cohort study. SETTING AND SUBJECTS: a prospective cohort study with a 1-year follow-up was conducted using 4,314 subjects from community-dwelling individuals aged 40-79 years in two Japanese municipalities, based on the Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS, 2008-10). METHODS: we assessed baseline hand-grip strength standardised using national representative data classified by age and gender, and depressive symptoms at baseline and after the follow-up using the five-item version of the Mental Health Inventory (MHI-5). RESULTS: the 4,314 subjects had a mean age of 66.3 years, 58.5% were women, and mean unadjusted hand-grip strength was 29.8 kg. Multivariable random-effect logistic regression analysis revealed that subjects with lower hand-grip strength (per 1SD decrease) had higher odds of having depressive symptoms at baseline [adjusted odds ratio (AOR) 1.15, 95% confidence interval (CI) 1.06-1.24; P = 0.001]. Further, lower hand-grip strength (per 1SD decrease) was associated with the longitudinal development of depressive symptoms after 1 year (AOR 1.13, 95% CI 1.01-1.27; P = 0.036). CONCLUSIONS: using a large population-based sample, our results suggest that lower hand-grip strength, standardised using age and gender, is both cross-sectionally and longitudinally associated with depressive symptoms.

Associations among chronic obstructive pulmonary disease and sleep-disordered breathing in an urban male working population in Japan.

BACKGROUND: There are few reports about sleep disturbances in patients with chronic obstructive pulmonary disease (COPD) in Asian countries. OBJECTIVES: To investigate the associations between sleep-disordered breathing (SDB) with hypoxemia and sleep quality, including sleep duration, in patients with COPD, we measured SDB and sleep quality including the objective sleep duration determined by an actigraph and portable monitoring. METHODS: A cross-sectional epidemiological health survey of 303 male employees (means ± SD: age 43.9 ± 8.2 years; BMI 24.0 ± 3.1) was conducted. Sleep quality was measured using the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). A respiratory disturbance index (RDI) ≥5 indicated SDB. RESULTS: Nineteen subjects (6.3%) had COPD. Among these, 11 (3.6%) had COPD with SDB (overlap syndrome). Sleep duration, ESS, and PSQI scores were not significantly different between COPD patients and normal control subjects. However, COPD patients had significantly longer sleep latency (p = 0.019), a lower sleep efficiency (p = 0.017), and a higher sleep fragmentation index (p = 0.041) and average activity (p = 0.0097) during sleep than control subjects. They also had a significantly higher RDI and more severe desaturation during sleep than control subjects (p < 0.01). The differences remained after adjustment for age and BMI but disappeared following adjustment for RDI. CONCLUSIONS: COPD patients with even mild-to-moderate airflow limitations had nocturnal desaturation and RDI-related impaired sleep quality without significant symptoms.

Development and internal validation of a clinical prediction model for acute adjacent vertebral fracture after vertebral augmentation : the AVA score.

AIMS: To develop and internally validate a preoperative clinical prediction model for acute adjacent vertebral fracture (AVF) after vertebral augmentation to support preoperative decision-making, named the after vertebral augmentation (AVA) score. METHODS: In this prognostic study, a multicentre, retrospective single-level vertebral augmentation cohort of 377 patients from six Japanese hospitals was used to derive an AVF prediction model. Backward stepwise selection (p < 0.05) was used to select preoperative clinical and imaging predictors for acute AVF after vertebral augmentation for up to one month, from 14 predictors. We assigned a score to each selected variable based on the regression coefficient and developed the AVA scoring system. We evaluated sensitivity and specificity for each cut-off, area under the curve (AUC), and calibration as diagnostic performance. Internal validation was conducted using bootstrapping to correct the optimism. RESULTS: Of the 377 patients used for model derivation, 58 (15%) had an acute AVF postoperatively. The following preoperative measures on multivariable analysis were summarized in the five-point AVA score: intravertebral instability (≥ 5 mm), focal kyphosis (≥ 10°), duration of symptoms (≥ 30 days), intravertebral cleft, and previous history of vertebral fracture. Internal validation showed a mean optimism of 0.019 with a corrected AUC of 0.77. A cut-off of ≤ one point was chosen to classify a low risk of AVF, for which only four of 137 patients (3%) had AVF with 92.5% sensitivity and 45.6% specificity. A cut-off of ≥ four points was chosen to classify a high risk of AVF, for which 22 of 38 (58%) had AVF with 41.5% sensitivity and 94.5% specificity. CONCLUSION: In this study, the AVA score was found to be a simple preoperative method for the identification of patients at low and high risk of postoperative acute AVF. This model could be applied to individual patients and could aid in the decision-making before vertebral augmentation. Cite this article: Bone Joint J 2022;104-B(1):97-102.

Examination of the effectiveness of DVD decision support tools for patients with unruptured cerebral aneurysms.

Preventative treatments for unruptured cerebral aneurysms include craniotomy, endovascular treatment, and follow up. Since there is no agreement as to the best procedure, it is important to provide adequate information so that the patient and physician can share in the decision-making process. A multi-media DVD was created to inform patients of the facts. This study examined how effectively this DVD changes patients' recognition including knowledge of unruptured cerebral aneurysms. Forty-seven patients with unruptured cerebral aneurysms who sought neurosurgery consultation between December 2005 and February 2006 completed a questionnaire before and after watching the DVD, as well as at 3 months follow up. Before watching the DVD, the average knowledge score was 8.72 out of 15 total points. The average score increased to 12.4 after watching the DVD (p < 0.001). At 3 months follow up, the average score was 10.34, which was still higher than before watching the DVD (p < 0.01). Participants' knowledge about treatment methods also increased after watching the DVD (p < 0.001). Compared to 63.2% who were satisfied with their treatment decision before watching the DVD, 69.6% were satisfied with their decision after watching the DVD. All participants responded that the use of multi-media images was helpful in better understanding treatment options and in making informed decisions. The DVD was favorably accepted as a decision support tool by patients with unruptured cerebral aneurysm and effectively increased patients' knowledge.

Psychosocial Stress After a Disaster and Low Back Pain-Related Interference With Daily Living Among College Students: A Cohort Study in Fukushima.

STUDY DESIGN: A cohort study. OBJECTIVE: To investigate the association between psychosocial stress and low back pain (LBP)-related interference with daily living among college students. SUMMARY OF BACKGROUND DATA: Few longitudinal studies have examined the likelihood of developing LBP in the presence of a designated psychosocial stressor. All participants in the present study were suddenly affected by the Great East Japan disaster after enrolment in our cohort study. METHODS: The present study was initiated among 95 students at Fukushima Medical University in January 2011. We assessed psychosocial stress in students using the Japanese version of the Perceived Stress Scale (JPSS). Follow-up surveys were conducted in July 2011 and May 2013, analyzing 94 students. Students were then divided into three groups (improved, -19 to -4; Maintained, -3 to +4; Aggravated, +5 to +22) based on the tertile points of JPSS change from baseline to 4 months after the disaster. LBP-related interference with daily living was assessed using the Brief Pain Inventory (BPI) questionnaire. Linear regression modeling was performed with BPI at 4 months after the disaster as the outcome, and JPSS change, sex, history of LBP, baseline physical activity, and baseline BPI as explanatory variables. RESULTS: We found a significant increase in BPI score for the aggravated stress group (ß coefficient, +0.79; 95% confidence interval, +0.06-+1.53), compared with the improved stress group. History of LBP and higher physical activity were also significantly associated with BPI. CONCLUSION: The present study suggests that perceived psychosocial stress induced by the disaster may be associated with LBP-related interference with daily living among college students in Fukushima. LEVEL OF EVIDENCE: 3.

Influence of Post-disaster Evacuation on Incidence of Metabolic Syndrome.

AIM: After the Great East Japan Earthquake, over 160,000 residents near the Fukushima Daiichi Nuclear Power Plant were forced to evacuate due to a nuclear accident. Health problems in these evacuees have since become major issues. We examined the association between evacuation and incidence of metabolic syndrome (METS) among residents in Fukushima. METHODS: We conducted a cohort study among residents aged 40-74 years without METS at the time of the disaster in Fukushima. Among 20,269 residents who met the inclusion criteria before the disaster, 8,547 residents (3,697 men and 4,850 women; follow-up proportion: 42.2%) remained available for follow-up examinations after the disaster by the end of March 2013. The main outcome was incidence of METS, defined by guidelines from the Japanese committee, using data from the Comprehensive Health Check before and after the disaster. We divided participants by evacuation status and compared outcomes between groups. Using a logistic regression model, we estimated the odds ratio for incidence of METS, adjusting for potential confounders, age, gender, waist circumference, exercise habit, and alcohol consumption. RESULTS: Incidence of METS was higher in evacuees (men 19.2%, women 6.6%) than in non-evacuees (men 11.0%, women 4.6%). Evacuees had higher body mass index, waist circumference, triglycerides, and fasting plasma glucose after the disaster than non-evacuees. We found a significant association between evacuation and incidence of METS (adjusted odds ratio 1.72, 95% confidence interval; 1.46-2.02). CONCLUSION: This is the first study to demonstrate that evacuation after a disaster is associated with increased incidence of METS.

[Validity and clinical applicability of the Japanese version of amyotrophic lateral sclerosis--assessment questionnaire 40 (ALSAQ-40)].

We studied validity and clinical applicability of the Japanese version of amyotrophic lateral sclerosis (ALS) assessment questionnaire 40 (ALSAQ-40). The original version contains forty questions measuring five areas (domains) of health status: Physical Mobility, ADL/Independence, Eating and Drinking, Communication and Emotional Functioning. Data were obtained from 39 ALS patients and from their physicians at 15 centers in Japan. Patients completed the ALSAQ-40 and the SF-36, and provided information on their age and their status of ventilator use. Their physicians provided information on the date of diagnosis, type of disease and clinical characteristics, and ALSFRS-R. The patients' average age was 58.5 years, and 64% were men. The mean duration since diagnosis was 39.1 months. Forty four percent were classical ALS patients and 46% were receiving a respiratory intervention. Although there was much heterogeneity, the scores for Physical Mobility and ADL/Independence were higher(indicating worse health status)than the scores for the other domains. Item-scale correlations were strong, except for the item "felt embarrassed in social situations" in the Emotional Functioning domain. All the domains had very high internal consistency: Cronbach's alphas ranged 0.95 to 0.97. With regard to the cluster structure of the forty items, the Eating and Drinking domain and the Communication clustered together. The reason might be that the former consisted of only three items and both domains measure bulbar symptoms. Domain scores correlated significantly with scores of related dimensions in the SF-36 and ALSFRS-R, and did not correlate strongly with unrelated domains. The five items of the ALSAQ-5 correlated with all five domain scores on the ALSAQ-40. These results should be interpreted with caution because we analyzed together data from ALS patients with various characteristics. In conclusion, although we may need to add and remove some items and modify the wording of others, the Japanese version of the ALSAQ-40 had high validity and is likely to be useful in evaluating of QOL in ALS patients. Whether the ALSAQ-5 can be used in place of the ALSAQ-40 is a matter for further study.

Association between sleep apnea, sleep duration, and serum lipid profile in an urban, male, working population in Japan.

BACKGROUND: Dyslipidemia is often comorbid with obstructive sleep apnea (OSA), but few population-based studies have investigated their relationship. Short sleep duration is associated with hypertension and diabetes; however, its association with dyslipidemia is not well known. We investigated relationships among OSA, sleep duration, and the lipid profile in a community-based study. METHODS: We measured the respiratory disturbance index (RDI) and sleep duration by a type 3 portable device and actigraph in 275 men in a Japanese company. Fasting blood parameters were obtained from periodic inspection data. RESULTS: According to Japanese criteria, 143 subjects had dyslipidemia. Percent sleep time of oxygen saturation as measured by pulse oximetry (SpO2) < 90% and prevalence of severe OSA were greater and sleep duration and mean SpO2 during sleep were lower in subjects with dyslipidemia than in those without. Univariate analysis showed that the RDI was positively correlated with serum triglyceride (TG) levels (ρ = 0.20, P < .01), and sleep duration was negatively correlated with serum total cholesterol (TC) levels (γ = -0.13, P = .03) and serum low-density lipoprotein cholesterol levels (γ = -0.12, P = .04). Stepwise multiple regression analysis revealed that TG was correlated with RDI (ß = 0.14, P = .02), BMI (ß = 0.20, P < .01), and alcohol intake (ß = 0.20, P < .01), and that TC was correlated with sleep duration (ß = -0.13, P = .03), age (ß = 0.15, P = .02), and waist/hip ratio (ß = 0.15, P = .02). CONCLUSIONS: Short sleep duration was associated with TC levels and RDI was positively associated with TG levels among working-aged men in an urban Japanese company. Correcting the status of OSA and/or short sleep duration might improve the lipid profile and cardiovascular consequences.