Gender differences in the relationship between personality, cognitive function and regular dental visits in Japanese community-dwelling older adults.

OBJECTIVES: Studies have examined the association between personality and health behaviour, but research focusing exclusively on regular dental visits has yet to be conducted. This study examined the association between personality traits and regular dental visits among Japanese community-dwelling older adults. METHODS: The participants in this cross-sectional study included 1,057 community-dwelling older adults aged 65-74 years from Ranzan and Yoshimi towns; data were collected from October to November 2015 and October to November 2016, respectively. Interviews were conducted to obtain sociodemographic, income, occupation and medical data. The Tokyo Metropolitan Institute of Gerontology Index of Competence was used to assess higher-level competence; general intelligence was also evaluated. The 'Big Five' personality traits-openness to experience, consciousness, neuroticism, extraversion and agreeableness-were also examined. A multivariable logistic regression analysis was performed to examine the relationship between regular dental visits and personality traits. RESULTS: Among men, the number of natural teeth, current employment status and conscientiousness were associated with dental care utilization. Among women, the number of natural teeth, current annual income, the intellectual activity domain of the Tokyo Metropolitan Institute of Gerontology Index of Competence and openness were significant. CONCLUSIONS: The factors associated with regular dental visits differed by gender. Overall, work was associated with men's visits, whereas intellectual activity and economic factors were relevant to women. Factors such as personality traits should be considered when addressing barriers to oral health. Understanding personality traits will help practitioners more effectively encourage older adults to make dental visits.

Relationship of Salivary Microbiome with the Worsening of the Periodontal Health Status in Young Adults: A 3-Year Cohort Study.

The purpose of this prospective cohort study was to investigate the influence of the salivary microbiome on the worsening of the periodontal health status among Japanese young adults. We assessed the data of systemically healthy and non-smoking young (18-22 years) university students (n = 457) from Okayama University at baseline (2013) and follow-up (2016). The worsening group was defined based on an increase in the percentage of bleeding on probing (%BOP) or an increase in probing pocket depth (PPD) from <4 mm to ≥4 mm. Unstimulated saliva samples were randomly collected from 69 students for microbiome analysis at follow-up. The salivary microbiome was assessed through 16S rRNA metagenomic sequencing. The type of community in the salivary microbiome clustered by statistical analysis and diversity was not significantly associated with the worsening of the periodontal health status in cases of increasing %BOP and PPD (p > 0.05). The prevalence of some species was significantly higher in the worsening group than in the non-worsening group (p < 0.05) in both cases. The worsening of the periodontal health status was associated with some species, but not the type of community and diversity in the salivary microbiome among Japanese young adults.

Associations between sleep bruxism, sleep quality, and exposure to secondhand smoke in Japanese young adults: a cross-sectional study.

OBJECTIVE: Sleep bruxism, a major sleep disorder that causes serious harm to oral health, is considered a multifactorial disease. Sleep bruxism can be induced by smoking, which also adversely affects sleep quality. The objective of present study was to clarify the associations between sleep bruxism, sleep quality, and exposure to secondhand smoke (SHS). METHODS: To assess the prevalence of sleep bruxism, sleep quality, and SHS exposure, we conducted oral examinations and self-report questionnaires on university students in Japan. Sleep bruxism and quality were screened using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI) and the third edition of the International Classification of Sleep Disorders (ICSD-3). The inclusion criteria were adults aged between 18 and 19 years, non-smokers and non-alcohol drinkers. The exclusion criteria was failing to complete the questionnaire in full. RESULTS: We analyzed a total of 1781 Japanese young adults. Young adult females who had been exposed to SHS had worse sleep quality (p = 0.019) than those who had not. Young adult female with worse sleep quality showed a higher prevalence of sleep bruxism (p = 0.034) than those with better sleep quality. Using structural equation modeling, direct associations were identified between SHS exposure and poor sleep quality (standardized coefficients, 0.153; p = 0.008) and between sleep bruxism and poor sleep quality (standardized coefficients, 0.187; p = 0.022) in young adult females. However, no association was found among young adult males. CONCLUSION: SHS exposure is indirectly associated with sleep bruxism through poor sleep quality in Japanese young adult females.

Association between maternal periodontal status and ultrasonographic measurement of fetal growth: A longitudinal study.

The aim of this prospective cohort study was to investigate the association between intrauterine fetal growth patterns and periodontal status in pregnant women. Fifty-three pregnant women were recruited. Periodontitis was diagnosed based on probing pocket depth and clinical attachment level. Maternal urinary 8-hydroxy-2'-deoxyguanosine levels and body mass index were recorded. Ultrasonographic measurements of the biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL) were recorded, and estimated fetal weight (EFW) was calculated. In addition, approximation spline curves of BPD, AC, FL, and EFW were obtained throughout the gestation period. Recorded delivery outcomes were gestational age (GA), birth weight and length, sex, placental weight, and umbilical cord length. Forty-four participants (34.1 ± 4.9 years) were analyzed. Mean neonatal birth weight was 2906.0 ± 544.4 g. On multiple regression analysis, birth weight was related with periodontitis (standardized ß = -0.21, P = 0.001). For EFW and BPD, the curves of the periodontitis group were located lower than those of the non-periodontitis group, with significant differences after 32 weeks and 20 weeks of GA, respectively. In conclusion, periodontal treatment before conception may be recommended and a good periodontal condition in the early stage of pregnancy at the latest is desirable for infant growth.

Association between intensive health guidance focusing on eating quickly and metabolic syndrome in Japanese middle-aged citizens.

PURPOSE: The purpose of this intervention study was to investigate whether intensive health guidance focusing on eating quickly can prevent metabolic syndrome (MetS) more effectively than standard routine guidance in Japanese citizens living in rural areas. METHODS: This controlled, non-randomized, intervention study analyzed 141 participants with MetS at baseline. Participants in the intervention group received health guidance focusing on eating quickly and standard health guidance about MetS in accordance with the guidelines of the Ministry of Health, Labour and Welfare in Japan, whereas participants in the control group received only standard health guidance about MetS. The primary study outcome was the prevalence of MetS at a 1-year follow-up. RESULTS: At 1-year follow-up, the prevalence of MetS in the intervention group was significantly lower than that in the control group (p = 0.003). The decreases in body weight, body mass index, waist circumference and triglycerides from baseline to 1 year were significantly greater in the intervention group than in the control group (p < 0.05). CONCLUSION: Intensive health guidance focusing on eating quickly is more effective for improving MetS than standard Japanese health guidance alone. LEVEL OF EVIDENCE: Level II, Evidence obtained from well-designed controlled trials without randomization. TRIAL REGISTRY NAME, REGISTRATION IDENTIFICATION NUMBER, AND URL FOR THE REGISTRY: UMIN, UMIN000030600, http://www.umin.ac.jp/ctr/index-j.htm.

Assessment of the skin tissue structure using an ultrasonic diagnostic imaging device in patients undergoing open surgery.

BACKGROUND: Perioperative skin injury is a major issue; therefore, several preventative measures have been developed. However, no previous studies have visualized the effects of stromal edema caused by surgical invasion of skin tissue, and therefore, the details remain unknown. We used an ultrasonic diagnostic imaging device to clarify changes in the skin tissue structure of patients after open surgery. MATERIALS AND METHODS: Twenty subjects who underwent open hepatectomy were enrolled. We selected the lateral abdomen, upper arms, and lower legs as ultrasonic imaging measurement sites. We performed measurements on the day before surgery and on postoperative days 1, 3, and 5. We calculated the epidermal/dermal tissue thickness, subcutaneous tissue thickness, and skin tissue thickness. We performed a one-way analysis of variance with repeated measurements for each of the postoperatively measured values on the basis of the preoperative values. Significantly different variables were subjected to the Bonferroni method. We evaluated ultrasonic imaging findings and skin injury. RESULTS: Epidermal/dermal tissue thickness at all measurement sites exhibited sustained thickening on postoperative day 5 compared to that preoperatively. The lateral abdomen exhibited thickening of the subcutaneous tissue and skin tissue on postoperative day 1. In addition, increased echogenicity, increased opacity of the layer structure, and a cobblestone appearance occurred during the postoperative course. Postoperatively, 80% of subjects exhibited skin injury. CONCLUSION: We evaluated the effects of surgical invasion on skin tissue over time. Continual observation and protective skincare are necessary near the surgical wound, where significant invasiveness occurs. Prevention of skin injury due to skin tissue thickening requires further study.

Circadian production of melatonin in cartilage modifies rhythmic gene expression.

Endochondral ossification, including bone growth and other metabolic events, is regulated by circadian rhythms. Herein, we provide evidence that melatonin has a direct effect on the circadian rhythm of chondrocytes. We detected mRNA expression of the genes which encode the melatonin-synthesizing enzymes AANAT (arylalkylamine N-acetyltransferase) and HIOMT (hydroxyindole O-methyltransferase), as well as the melatonin receptors MT1 and MT2 in mouse primary chondrocytes and cartilage. Production of melatonin was confirmed by mass spectrometric analysis of primary rat and chick chondrocytes. Addition of melatonin to primary mouse chondrocytes caused enhanced cell growth and increased expression of Col2a1, Aggrecan, and Sox9, but inhibited Col10a1 expression in primary BALB/c mouse chondrocytes. Addition of luzindole, an MT1 and MT2 antagonist, abolished these effects. These data indicate that chondrocytes produce melatonin, which regulates cartilage growth and maturation via the MT1 and MT2 receptors. Kinetic analysis showed that melatonin caused rapid upregulation of Aanat, Mt1, Mt2, and Pthrp expression, followed by Sox9 and Ihh. Furthermore, expression of the clock gene Bmal1 was induced, while that of Per1 was downregulated. Chronobiological analysis of synchronized C3H mouse chondrocytes revealed that melatonin induced the cyclic expression of Aanat and modified the cyclic rhythm of Bmal1, Mt1, and Mt2. In contrast, Mt1 and Mt2 showed different rhythms from Bmal1 and Aanat, indicating the existence of different regulatory genes. Our results indicate that exogenous and endogenous melatonin work in synergy in chondrocytes to adjust rhythmic expression to the central suprachiasmatic nucleus clock.

Correction to: Targeted therapy against Bcl-2-related proteins in breast cancer cells.

After the publication of this work [1] errors were noticed in Figs. 1a, 6a, and 8a-in which the ß-actin bands were mistakenly presented.

Does Instruction of Oral Health Behavior for Workers Improve Work Performance?-Quasi-Randomized Trial.

Oral disease can cause economic loss due to impaired work performance. Therefore, improvement of oral health status and prevention of oral disease is essential among workers. The purpose of this study was to investigate whether oral health-related behavioral modification intervention influences work performance or improves oral health behavior and oral health status among Japanese workers. We quasi-randomly separated participants into the intervention group or the control group at baseline. The intervention group received intensive oral health instruction at baseline and a self-assessment every three months. Both groups received oral examinations and answered the self-questionnaire at baseline and at one-year follow-up. At follow-up, the prevalence of subjects who use fluoride toothpastes and interdental brushes/dental floss were significantly higher in the intervention group than in the control group. Three variables (tooth brushing in workplace, using fluoride toothpaste, and experience of receiving tooth brushing instruction in a dental clinic) showed significant improvement only in the intervention group. On the other hand, work performance and oral status did not significantly change in either group. Our intensive oral health-related behavioral modification intervention improved oral health behavior, but neither work performance nor oral status, among Japanese workers.

Up-regulation of NSP3 by Oligomeric Aß Accelerates Neuronal Death Through Cas-independent Rap1A Activation.

ß-Amyloid (Aß) plays an important role in the early pathogenesis of Alzheimer's disease (AD). In vitro studies have demonstrated that Aß oligomers induce hippocampal and neocortical neuronal death. However the neurotoxic mechanisms by which soluble Aß oligomers cause neuronal damage and death remain to be fully elucidated. To this end, we analyzed the gene expression profile of rat cerebral cortical neurons treated with Aß oligomers in vitro. Aß treatment induced the expression of novel SH2-containing protein 3 (NSP3), an adaptor molecule interacting with Cas family proteins. NSP3 expression was upregulated not only in oligomeric-Aß-treated cultured neurons but also in the neocortex of aged Tg2576 mice. NSP3 overexpression in cultured cortical neurons accelerated neuronal death. The C-terminal region of NSP3 unbound to a Cas protein was necessary for the NSP3-induced acceleration of neuronal death, as was Cas-independent Rap1A activation downstream of NSP3. Moreover, NSP3 RNAi knockdown partially rescued Aß-oligomer-treated neurons. These results indicate that NSP3 upregulation by soluble Aß oligomers may accelerate neuronal death via Cas-independent Rap1A activation, implicating NSP3 in the pathogenesis of AD.

Commensal Microbiota Enhance Both Osteoclast and Osteoblast Activities.

Recent studies suggest that the commensal microbiota affects not only host energy metabolism and development of immunity but also bone remodeling by positive regulation of osteoclast activity. However, the mechanism of regulation of bone cells by the commensal microbiota has not been elucidated. In this study, 8-week-old specific pathogen-free (SPF) and germ-free (GF) mice were compared in terms of alveolar bones and primary osteoblasts isolated from calvarias. Micro-CT analysis showed that SPF mice had larger body size associated with lower bone mineral density and bone volume fraction in alveolar bones compared with GF mice. Greater numbers of osteoclasts in alveolar bone and higher serum levels of tartrate-resistant acid phosphatase 5b were observed in SPF mice. Tissue extracts from SPF alveolar bone showed higher levels of cathepsin K, indicating higher osteoclast activity. SPF alveolar extracts also showed elevated levels of γ-carboxylated glutamic acid⁻osteocalcin as a marker of mature osteoblasts compared with GF mice. Polymerase chain reaction (PCR) array analysis of RNA directly isolated from alveolar bone showed that in SPF mice, expression of mRNA of osteocalcin, which also acts as an inhibitor of bone mineralization, was strongly enhanced compared with GF mice. Cultured calvarial osteoblasts from SPF mice showed reduced mineralization but significantly enhanced expression of mRNAs of osteocalcin, alkaline phosphatase, insulin-like growth factor-I/II, and decreased ratio of osteoprotegerin/receptor activator of nuclear factor-kappa B ligand compared with GF mice. Furthermore, PCR array analyses of transcription factors in cultured calvarial osteoblasts showed strongly upregulated expression of Forkhead box g1. In contrast, Gata-binding protein 3 was strongly downregulated in SPF osteoblasts. These results suggest that the commensal microbiota prevents excessive mineralization possibly by stimulating osteocalcin expression in osteoblasts, and enhances both osteoblast and osteoclast activity by regulating specific transcription factors.

Impact of commensal flora on periodontal immune response to lipopolysaccharide.

BACKGROUND: Commensal flora are involved in the appropriate development of the mature immune system. However, it is unclear how commensal flora contribute to immune responses against periodontal pathogens, including the response to lipopolysaccharide (LPS). The purpose of this study was to evaluate the expression of immune responses after topical application of LPS in germ-free (GF) and specific-pathogen-free (SPF) mice. METHODS: GF and SPF mice at 8 weeks of age were randomly divided into four groups each: a baseline group (n = 4/group) and three experimental groups (n = 6/group). Experimental groups received topical application of Porphyromonas gingivalis LPS (10 µg/µL) into the palatal gingival sulcus. Sampling was performed before LPS application (baseline) and at 3, 24, or 72 hours after LPS application. The numbers of neutrophils, CD4+ , and CD8+ T cells in periodontal tissue were evaluated by immunohistochemistry. Expression of genes encoding cytokines, chemokines, and a transcription factor was determined by real-time PCR. RESULTS: SPF mice, but not GF mice, showed an increased number of CD4+ T cells in the periodontal tissue at 3 hours after LPS application, compared with the number at baseline (p < 0.05). Gene expressions of tumor necrosis factor-α (Tnf-α) and forkhead box protein p3 (Foxp3) was also significantly higher in the SPF mice than in the GF mice at 3 hours after LPS application (p < 0.05). The number of neutrophils peaked at 24 hours in both GF and SPF mice. CONCLUSIONS: LPS-exposed SPF mice exhibited increases in the number of CD4+ T cells and in Tnf-α and Foxp3 gene expression in periodontal tissue compared with LPS-exposed GF mice.

Age-related changes of CD4+ T cell migration and cytokine expression in germ-free and SPF mice periodontium.

OBJECTIVE: Increasing age is a potential risk factor for periodontal tissue breakdown, which may be affected by commensal flora. The aim of this study evaluated age-related changes in CD4+ T cells, C-C chemokine ligand 5 (CCL5), interleukin (IL)-17A, and receptor activator of nuclear factor-kappa B ligand (RANKL) expression using germ-free (GF) and conventionally reared (SPF) mice. DESIGN: GF and SPF mice at 8 (n = 6/group) and 22 weeks old (n = 6/group) were used. Immunohistochemical analyses were performed to determine the effects of aging on protein expression in periodontal tissues. Age-related changes in alveolar bone were quantified using micro-CT analysis. RESULTS: SPF mice, but not GF mice, showed an age-related increase in alveolar bone loss (P < 0.01). SPF mice at 22 weeks of age increased expression of CD4+ T cells, CCL5, IL-17A, and RANKL compared to those at 8 weeks of age in connective tissue and alveolar bone surface (P < 0.01). Furthermore, there was increased CD4+ T cells, which were co-expressed with IL-17A and RANKL in SPF mice at 22 weeks of age. On the other hand, the GF mice did not show any significant differences in CD4+ T cells, CCL5, IL-17A and RANKL expression between the two age groups. CONCLUSIONS: SPF mice induced an age-related increase in CD4+ T cells co- expressed with IL-17A and RANKL, with occurring alveolar bone loss. In contrast, GF mice did not show age-related changes in CD4+ T cell migration and cytokine expression.

Validity of a New Kit Measuring Salivary Lactate Dehydrogenase Level for Screening Gingivitis.

Aim. The aim of this study was to determine the usefulness of a new kit that can evaluate salivary lactate dehydrogenase (LD) level in real time for screening gingivitis. Materials and Methods. The study included 70 systemic healthy volunteers [29 males and 41 females; mean age ± SD: 24.1 ± 2.6 years]. Resting saliva was collected from each participant and LD level was evaluated in real time using the kit (a color-changing sheet with an integer scale ranging from 1 to 10). A dentist measured probing pocket depth, clinical attachment level, and the proportion of sites with bleeding on probing (% BOP) at six sites on all teeth. Gingivitis was diagnosed when the BOP value was ≥20%. Results. Salivary LD level was positively correlated with mean % BOP (odds ratio: 1.47, 95% confidence interval: 1.132-1.916, and P < 0.001) in a logistic regression model. The sensitivity and specificity of the kit were 0.89 and 0.98, respectively, at a cut-off value of 8.0 for LD level. Conclusions. The new kit for measurement of salivary LD level may be a useful tool to screen for gingivitis in young adults, which contributes to early detection of future periodontitis.

Visualization of Oxidative Stress Induced by Experimental Periodontitis in Keap1-Dependent Oxidative Stress Detector-Luciferase Mice.

The aim of this study was to investigate whether a Keap1-dependent oxidative stress detector-luciferase (OKD-LUC) mouse model would be useful for the visualization of oxidative stress induced by experimental periodontitis. A ligature was placed around the mandibular first molars for seven days to induce periodontitis. Luciferase activity was measured with an intraperitoneal injection of d-luciferin on days 0, 1, and 7. The luciferase activity in the periodontitis group was significantly greater than that in the control group at seven days. The expressions of heme oxygenase-1 (HO-1) and malondialdehyde in periodontal tissue were significantly higher in the periodontitis group than in the control group. Immunofluorescent analysis confirmed that the nuclear translocation of nuclear factor erythroid 2-related factor 2 (Nrf2) occurred more frequently in the periodontitis group than in the control group. This study found that under oxidative stress induced by experimental periodontitis, the Nrf2/antioxidant defense pathway was activated and could be visualized from the luciferase activity in the OKD-LUC model. Thus, the OKD-LUC mouse model may be useful for exploring the mechanism underlying the relationship between the Nrf2/antioxidant defense pathway and periodontitis by enabling the visualization of oxidative stress over time.

The role of calsyntenin-3 in dystrophic neurite formation in Alzheimer's disease brain.

ß-Amyloid (Aß) oligomers may play an important role in the early pathogenesis of Alzheimer's disease: cognitive impairment caused by synaptic dysfunction. Dystrophic neurites surrounding Aß plaques, another pathological feature of Alzheimer's disease, are plaque-associated neuritic alterations preceding the appearance of synaptic loss. In the present review, we focus on the mechanism of dystrophic neurite formation by Aß oligomers, and discuss the neurotoxic role of Aß-induced calsyntenin-3 in mediating dystrophic neurite formation.

Kinesin light chain-1 isoform E does not interact with calsyntenin-1.

ß-Amyloid is generated by the sequential cleavage of amyloid precursor protein. Calsyntenin-1 and kinesin light chain-1 splice variant E (KLC1-E) have been proposed to regulate ß-amyloid production from amyloid precursor protein. Vesicles containing calsyntenin-1 are transported from the Golgi apparatus to axons by interaction between calsyntenin-1 and KLC1 in their C-terminal regions. However, it is unclear whether KLC1 isoform E influences the interaction between KLC1 and calsyntenin-1, resulting in the impaired axonal transport of calsyntenin-1 vesicles. Here, we show that KLC1-E does not interact with calsyntenin-1 using a pull-down assay, coimmunoprecipitation, and immunocytochemistry. These findings suggest that KLC1-E enrichment may impair the axonal transport of calsyntenin-1 vesicles.

Repeated cross-sectional study of the longitudinal changes in attitudes toward interprofessional health care teams amongst undergraduate students.

The interprofessional education (IPE) program at Gunma University, Maebashi, Japan, uses a lecture style for first-year students and a training style for third-year students. To investigate the comprehensive implications of IPE, the change pattern of attitudes toward health care teams was examined longitudinally in pre-qualified students. The modified Attitudes Toward Health Care Teams Scale (mATHCTS) was used. The overall mean score of the mATHCTS improved significantly after the training-style IPE in their third year. Two individual items in the factor "quality of care delivery" decreased significantly during the first year. In contrast, two individual items in the factor "patient-centered care" increased significantly during the third year. These changes over time were confirmed by analyses using regression factor scores. There are at least two independent attitudes toward collaborative practice (CP) or IPE in response to IPE interventions: the attitude toward "value of IPE for health care providers" may response negatively to IPE in the early stages, and the attitude toward "value of IPE for health care receivers" positively in the later stages. These findings suggest that the continuation of mandatory IPE, which must be designed on the basis of students' high expectations for IPE and CP on entry, may result in profound changes in attitudes amongst participating students.

Calsyntenin-3 C-terminal fragment accumulates in dystrophic neurites surrounding aß plaques in tg2576 mouse and Alzheimer disease brains: its neurotoxic role in mediating dystrophic neurite formation.

Dystrophic neurites surrounding ß-amyloid (Aß) plaques precede neuronal death in Alzheimer disease. These neuritic alterations may be one of the initial stages for synaptic loss and dysfunction. However, intracellular pathways that cause local disruption of neuronal processes by Aß remain to be fully elucidated. The identification of Aß-induced genes that mediate neuritic pathology would provide considerable insight into the mechanisms of Alzheimer's disease. Previously, we reported that selective up-regulation of calsyntenin-3 (Cst-3) by Aß and accumulation of neurotoxic Cst-3 in dystrophic neurites surrounding Aß plaques may lead to local disruption of these neurites. Like amyloid precursor protein, Cst-3 undergoes two-step proteolytic processing: the primary cleavage with α-secretase generates an N-terminal ectodomain and a C-terminal fragment (CTF). The CTF is subsequently cleaved into p3 peptide and an intracellular domain via γ-secretase. It would be interesting to know whether accumulated Cst-3 in dystrophic neurites surrounding Aß plaques is the full-length version or a CTF. Herein, we show that the CTF but not full-length Cst-3 accumulated in dystrophic neurites surrounding Aß plaques in Tg2576 mouse and Alzheimer disease brains. In vitro experiments with Cst-3 fragments have revealed that only the CTF resulted in acceleration of neuronal death. These results indicate that accumulation of the neurotoxic CTF in neurites surrounding Aß plaques may lead to local disruption of neuronal processes and development of dystrophic neurites.

Attitudes toward interprofessional healthcare teams: a comparison between undergraduate students and alumni.

The goal of effective interprofessional education (IPE) is high-quality patient-care delivery and attaining a high level of patient satisfaction in clinical settings. We aimed to examine if alumni who have studied in an IPE program at a pre-licensure stage maintain a positive attitude toward collaborative practice (CP) in the postgraduate clinical experience. This paper presents a cross-sectional descriptive study which employed the modified attitudes toward health care teams scale (ATHCTS) to examine the relationship between exposure to clinical practice and the attitudes toward interprofessional healthcare teams. Results indicated that the overall mean score of alumni was significantly lower than that of undergraduate students on the modified ATHCTS. Only "team efficacy" had a significantly lower regression factor score in alumni than undergraduate students. Our findings suggest that changes in professional identity in a team may be due to contact with patients after graduation in the postgraduate clinical healthcare experience. The reduction of attitudes toward healthcare teams in the postgraduate clinical experience may be related to "team efficacy". We emphasize the need for in-service IPE for sustaining attitudes and providing a useful CP, which results in good clinical outcome.