Associations Between Social Support and Subjective Symptoms in Disaster-Stricken Ishinomaki, Japan.

OBJECTIVES: Natural disasters affect long-term health by directly disrupting or destroying health-care systems and social support. We examined the associations between social support and subjective symptoms (SS) among disaster victims living in their homes approximately 1-2 years after the Great East Japan Earthquake and tsunami on March 11, 2011, which devastated the northeastern Japan seaboard and far inland, focusing on Ishinomaki, Miyagi Prefecture. METHODS: The Health and Life Revival Council of Ishinomaki District conducted door-to-door household surveys between April 2012 and January 2013. Replies to 12 questions regarding social support, specifically emotional, informational, and instrumental, were investigated. SS prevalence was calculated as the proportion of those having any of 8 predetermined symptoms including back pain, neck stiffness, sleep difficulty, dizziness, heart palpitations, poor appetite, or stomachache. Logistic regression analysis by sex was used to obtain crude and adjusted odds ratios for the association between SS prevalence and forms of social support. RESULTS: From 4023 households, self-reported data on 2593 individuals from 1709 households were obtained. SS prevalence was 29.1%. Adjusted logistic regression analysis revealed that instrumental support with others and emotional support with personal and others were specific associated with SS in men and women, respectively. CONCLUSIONS: Our findings suggest that providing social support depending on needs is potentially effective in preventing SS in disaster areas.

Exercise Habits Are Associated with Improved Long-Term Mortality Risks in the Nationwide General Japanese Population: A 20-Year Follow-Up of the NIPPON DATA90 Study.

Exercise habits are known as a protective factor for a variety of diseases and thus recommended worldwide; however, few studies have examined long-term effects of exercise habits on mortality. We continuously monitored death status in a nationwide population sample of 7,709 eligible persons from the National Integrated Project for Prospective Observation of Noncommunicable Disease and its Trends in the Aged in 1990 (NIPPON DATA90), for which baseline data were obtained in 1990. To investigate the long-term impact of baseline exercise habits, we calculated the relative risk of non-exercisers (participants without regular voluntary exercise habits) in reference to exercisers (those with these habits) for all-cause or cause-specific mortality using a Cox proportional hazard model, in which the following confounding factors were appropriately adjusted: sex, age, body mass index, total energy intake, smoking, drinking, and history of cardiovascular disease. During a median 20 years of follow-up, 1,747 participants died, 99 of heart failure. The risk for all-cause mortality was 12% higher in non-exercisers than in exercisers (95% confidence interval, 1%-24%), which was also observed for mortality from heart failure, as 68% higher in non-exercisers than in exercises (95% confidence interval, 3%-173%). These associations were similarly observed when the participants were divided to subgroups by sex, age, and the light, moderate, or vigorous intensity of physical activity, without any significant heterogeneities (P > 0.1). The present study has revealed significant impact of exercise habits on long-term mortality risks, supporting worldwide recommendations for improvement of exercise habits.

[The process of community building by Community Social Coordinators: The possibility of enhancing social capital in a disaster-affected city].

Objectives　To build a healthy and safe community, it is important to provide direct services, such as health, medical, and social welfare services. However, it is also crucial to enhance the community's social capital by promoting self-help and mutual aid within the community. The development and utilization of resources/networks as well as community empowerment are possible methods to enhance social capital, but there is no conclusive method to facilitate effective coordination within the community. The purpose of this study is to clarify the community building process. This is achieved through qualitative research on community social coordinators (CSCs) who worked in an area that was significantly damaged by the Great East Japan Earthquake.Methods　A qualitative approach was employed to assess 10 individuals who worked as CSCs in a city within Miyagi Prefecture. Semi-structured interviews were conducted, which were between 40-90 minutes in length. A modified grounded theory approach (M-GTA) was used to analyze the data obtained from the interviews.Results　The CSCs "built a relationship with the community," "assessed the community," and "intervened in the community." While assessing the community, they considered both its strengths and weaknesses, not limiting the fields it covered. To "solve the issues in the community," the CSCs "intervened in the community by themselves," "supported the autonomy of the residents," and "connected the residents to resources." This intervention was facilitated through "cooperation with the community" or "cooperation with other supporters."Conclusion　Three stages were observed in the community building process. First, the CSCs built a relationship with the community. They then assessed the community, and intervened as required. It was found that the intervention-which was based on the CSCs' assessment of the community's strengths and weaknesses-was facilitated by the cooperation of the community or that of other supporters. Additionally, the CSCs aimed to promote the autonomy of the residents.

Nedaplatin use in patients with hypersensitivity reaction episodes to carboplatin.

OBJECTIVE: To evaluate the benefits of nedaplatin treatment in patients with a history of hypersensitivity reactions to carboplatin. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients with ovarian, fallopian, and peritoneal cancers and with a history of hypersensitivity to carboplatin between January 2010 and December 2016 at the Department of Gynecology in the Saitama Medical Center associated with Jichi Medical University. We studied the response rate to treatment with a nedaplatin-based regimen compared to that of a carboplatin regimen. Fisher's exact test was used to determine statistical significance. RESULTS: Thirty-one patients with a past hypersensitivity to carboplatin were treated with nedaplatin-based regimen, while ten patients were treated with other drugs. The response rates in the nedaplatin- and non-nedaplatin-treated patient groups were 71.4% and 30.0%, respectively (P = 0.021). Among all the patients, only one experienced hypersensitivity reaction to nedaplatin. CONCLUSION: The nedaplatin regimen following hypersensitivity to carboplatin was safe, feasible, and effective in achieving complete or partial response.

Huge fetal ovarian cyst.

Most fetal ovarian cysts increase in size during the late stages of pregnancy. Early treatment of a huge neonatal cyst may reduce the risk of gastrointestinal obstruction.

Gender-Based Risk and Protective Factors for Psychological Distress in the Midterm Recovery Period Following the Great East Japan Earthquake.

OBJECTIVES: Women and men might experience psychological distress differently during a disaster. This study investigated gender differences in the factors associated with psychological distress among working-age people 1 to 2 years after the Great East Japan Earthquake. METHODS: A cross-sectional household survey of victims who remained living in their homes was conducted between May and December 2012 in Ishinomaki City, Japan. Psychological distress was defined as a Kessler Psychological Distress Scale ≥5, and gender differences were examined using a logistic regression analysis. RESULTS: Data were obtained from 2593 individuals, and 1537 participants were included in the analyses. Psychological distress was observed in 28.0% of the participants. Living in a household without a salaried income and a low frequency of leaving the house were associated with psychological distress among women. Young age, lack of occupation and no informational support were associated with psychological distress among men. Income change due to the disaster and health complaints were associated with psychological distress in both genders. CONCLUSIONS: For women, stable household income and frequently leaving the house can be protective factors. For men, intervention focusing on young people, occupational support, and informational support may be useful. Income change after the disaster and health complaints may be risk factors in both genders. (Disaster Med Public Health Preparedness. 2019;13:487-496).

Factors Associated With Attainment of Specialty Board Qualifications and Doctor of Medical Science Degrees Among Japanese Female Doctors.

PURPOSE: Specialty board qualifications or doctor of medical science (DMSc) degrees are essential for women's promotion to leadership positions in medicine in Japan. The authors examined what personal and professional characteristics of female doctors were associated with attainment of specialty board qualifications and DMSc degrees. METHOD: This study was based on alumnae surveys of 13 private medical schools in Japan conducted from 2009 to 2011 and investigating 882 alumnae who had at least one child (mean age 47 years). Multinomial logistic regression models were applied to investigate factors associated with attainment of specialty board qualifications alone, DMSc degrees alone, and both, compared with attainment of neither specialty board qualifications nor DMSc degrees. RESULTS: In total, 34% of the sample obtained both specialty board qualifications and DMSc degrees, 33% obtained specialty board qualifications only, 9% obtained DMSc degrees only, and 24% obtained neither. A one-year increase in age at the time of first birth was associated with an increased likelihood of attaining a specialty board qualification and/or a DMSc versus having neither qualification (P < .0001). Women who resigned from their jobs instead of taking maternity leave at the time of first childbirth had a significantly lower likelihood ratio of obtaining specialty board qualifications either alone or in conjunction with DMSc degrees (P < .0001). CONCLUSIONS: Earlier age and job resignation at the time of first childbirth among physician-mothers in Japan were associated with failure to attain specialty board qualifications and DMSc degrees, with important implications for future career advancement.

Impaired Higher-Level Functional Capacity as a Predictor of Stroke in Community-Dwelling Older Adults: The Ohasama Study.

BACKGROUND AND PURPOSE: Functional capacity is a predictor, as well as a consequence, of stroke. However, little research has been done to examine whether higher-level functional capacity above basic activities of daily living is a predictor of stroke. METHODS: We followed 1493 Japanese community-dwelling adults aged ≥60 years (mean age, 70.1 years) who were independent in basic activities of daily living and had no history of stroke. Baseline data were collected using a self-administered questionnaire. Higher-level functional capacity was measured using the total score and 3 subscales (instrumental activities of daily living, intellectual activity, and social role) derived from the Tokyo Metropolitan Institute of Gerontology Index of Competence. Adjusted hazard ratios and 95% confidence intervals were calculated by the Cox proportional hazards model. RESULTS: During a mean follow-up of 10.4 years, 191 participants developed a first stroke. Impaired higher-level functional capacity based on total score of the Tokyo Metropolitan Institute of Gerontology Index of Competence was significantly associated with stroke (hazard ratio, 1.64; 95% confidence interval, 1.15-2.33). Among the 3 subscales, only intellectual activity was significantly associated with stroke (hazard ratio, 1.64; 95% confidence interval, 1.21-2.22). Social role was significantly associated with stroke only among those aged ≥75 years (hazard ratio, 1.78; 95% confidence interval, 1.07-2.98). CONCLUSIONS: Impaired higher-level functional capacity, especially in the domain of intellectual activity, was a predictor of stroke, even among community-dwelling older adults with independent basic activities of daily living at baseline. Monitoring of higher-level functional capacity might be useful to detect those at higher risk of developing stroke in the future.

Long-Term Stroke Risk Due to Partial White-Coat or Masked Hypertension Based on Home and Ambulatory Blood Pressure Measurements: The Ohasama Study.

The prognostic significance of white-coat hypertension (WCHT) is controversial, and different findings on self-measured home measurements and 24-h ambulatory monitoring make identifying WCHT difficult. We examined whether individuals with partially or completely defined WCHT, as well as masked hypertension, as determined by different out-of-office blood pressure measurements, have a distinct long-term stroke risk. We followed 1464 participants (31.8% men; mean age, 60.6±10.8 years) in the general population of Ohasama, Japan, for a median of 17.1 years. A first stroke occurred in 212 subjects. Using sustained normal blood pressure (events/n=61/776) as a reference, adjusted hazard ratios for stroke (95% confidence intervals; events/n) were 1.38 (0.82-2.32; 19/137) for complete WCHT (isolated office hypertension), 2.16 (1.36-3.43; 29/117) for partial WCHT (either home or ambulatory normotension with office hypertension), 2.05 (1.24-3.41; 23/100) for complete masked hypertension (both home and ambulatory hypertension with office normotension), 2.08 (1.37-3.16; 38/180) for partial masked hypertension (either home or ambulatory hypertension with office normotension), and 2.46 (1.61-3.77; 42/154) for sustained hypertension. When partial WCHT and partial masked hypertension groups were further divided into participants only with home hypertension and those only with ambulatory hypertension, all subgroups had a significantly higher stroke risk (adjusted hazard ratio ≥1.84, P≤0.04). In conclusion, impacts of partial WCHT as well as partial masked hypertension for long-term stroke risk were comparable to those of complete masked hypertension or sustained hypertension. We need both home and 24-h ambulatory blood pressure measurements to evaluate stroke risk accurately.

Identification of disaster-vulnerable communities by use of census data prior to the Great East Japan Earthquake.

OBJECTIVES: The role of the community is becoming increasingly recognized as a crucial determinant of human health, particularly during a disaster and during disaster recovery. To identify disaster-vulnerable communities, we sought factors related to communities in need of support by using census information from before the Great East Japan Earthquake. METHODS: We identified vulnerable communities by using a needs-assessment survey conducted 6 to 12 months after the Great East Japan Earthquake in Ishinomaki City, Miyagi Prefecture, as indicated by higher proportions of households with at least 1 of 3 major support needs (medical, elderly, psychological, and dwelling environment). The associations between the need for support and 9 demographic characteristics of the community from census data prior to the Great East Japan Earthquake were examined for 71 communities by use of logistic regression analysis. RESULTS: The need for elderly support was positively associated with the proportions of aged people (odds ratio [OR]=1.5; 95% confidence interval [CI]: 1.2-1.8) and one-person households (OR=1.3; 95% CI: 1.0-1.7), whereas the need for psychological support was associated with the proportion of people engaged in agriculture (OR=4.6; 95% CI: 1.0-20.7). The proportion of fisheries was negatively associated with the need for dwelling environment support (OR=0.5; 95% CI: 0.3-0.9). CONCLUSIONS: The consideration of simple demographic characteristics from the census may be useful for identifying vulnerable communities and preparing for future disasters.

Long working hours and pregnancy complications: women physicians survey in Japan.

BACKGROUND: Previous studies have investigated the impact of occupational risk factors on health outcomes among physicians. However, few studies have investigated the effects on pregnancy outcomes among physicians. In this study, we examined the association between working hours during pregnancy and pregnancy complications among physicians. METHODS: A cross-sectional study was based on a survey conducted in 2009-2011 of 1,684 alumnae (mean age, 44 ± 8 years) who had graduated from 13 private medical schools in Japan. Data on threatened abortion (TA), preterm birth (PTB), and the number of working hours during the first trimester of pregnancy were obtained via retrospective assessments. RESULTS: Of the 939 physicians with a first pregnancy, 15% experienced TA and 12% experienced PTB. Women who experienced TA (mean weekly working hours: 62 h vs. 50 h, P < .0001) or PTB (62 h vs. 50 h, P < .0001) had longer weekly working hours during the first trimester than did those without pregnancy complications. Compared with women who worked 40 hours or less per week, women who worked 71 hours or more per week had a three-fold higher risk of experiencing TA (95% confidence interval (CI): 1.7-6.0) even after adjusting for medical specialty, maternal age, and current household income. The risk of experiencing PTB was 2.5 times higher (95% CI:1.2-5.2) in women who worked 51-70 hours and 4.2 times higher (95% CI: 1.9-9.2) in women who worked 71 hours or more even after adjusting for specialty, maternal age, and current household income. The trend in the P statistic reflecting the effect of the quartile of hours worked per week (40 hours, 41-50 hours, 51-70 hours, ≥ 71 hours) on TA or PTB was 0.0001 in the multivariate logistic regression models. CONCLUSION: These results suggest that working long hours during the first trimester of pregnancy is associated with TA and PTB.