Medical researchers' perceptions regarding research evaluation: a web-based survey in Japan.

OBJECTIVES: Japanese medical academia continues to depend on quantitative indicators, contrary to the general trend in research evaluation. To understand this situation better and facilitate discussion, this study aimed to examine how Japanese medical researchers perceive quantitative indicators and qualitative factors of research evaluation and their differences by the researchers' characteristics. DESIGN: We employed a web-based cross-sectional survey and distributed the self-administered questionnaire to academic society members via the Japanese Association of Medical Sciences. PARTICIPANTS: We received 3139 valid responses representing Japanese medical researchers in any medical research field (basic, clinical and social medicine). OUTCOMES: The subjective importance of quantitative indicators and qualitative factors in evaluating researchers (eg, the journal impact factor (IF) or the originality of the research topic) was assessed on a four-point scale, with 1 indicating 'especially important' and 4 indicating 'not important'. The attitude towards various opinions in quantitative and qualitative research evaluation (eg, the possibility of research misconduct or susceptibility to unconscious bias) was also evaluated on a four-point scale, ranging from 1, 'strongly agree', to 4, 'completely disagree'. RESULTS: Notably, 67.4% of the medical researchers, particularly men, younger and basic medicine researchers, responded that the journal IF was important in researcher evaluation. Most researchers (88.8%) agreed that some important studies do not get properly evaluated in research evaluation using quantitative indicators. The respondents perceived quantitative indicators as possibly leading to misconduct, especially in basic medicine (strongly agree-basic, 22.7%; clinical, 11.7%; and social, 16.1%). According to the research fields, researchers consider different qualitative factors, such as the originality of the research topic (especially important-basic, 46.2%; social, 39.1%; and clinical, 32.0%) and the contribution to solving clinical and social problems (especially important-basic, 30.4%; clinical, 41.0%; and social, 52.0%), as important. Older researchers tended to believe that qualitative research evaluation was unaffected by unconscious bias. CONCLUSION: Despite recommendations from the Declaration on Research Assessment and the Leiden Manifesto to de-emphasise quantitative indicators, this study found that Japanese medical researchers have actually tended to prioritise the journal IF and other quantitative indicators based on English-language publications in their research evaluation. Therefore, constantly reviewing the research evaluation methods while respecting the viewpoints of researchers from different research fields, generations and genders is crucial.

Blood pressure classification using the Japanese Society of Hypertension Guidelines for the Management of Hypertension and cardiovascular events among young to middle-aged working adults.

The Japanese Society of Hypertension updated guidelines for hypertension management (JSH2019), changing the blood pressure (BP) classification. However, evidence is sparse regarding the association of the classification with cardiovascular disease (CVD) events among young to middle-aged workers in Japan. We examined this issue using longitudinal data from Japan Epidemiology Collaboration on Occupational Health Study with a prospective cohort design. Participants were 81,876 workers (aged 20-64 years) without taking antihypertensive medication at baseline. BP in 2011 or 2010 was used as exposure. CVD events that occurred from 2012 to 2021 were retrieved from a within-study registry. Cox regression was used to calculate multivariable-adjusted hazard ratios of CVD events. During 0.5 million person-years of follow-up, 334 cardiovascular events, 75 cardiovascular deaths, and 322 all-cause deaths were documented. Compared with normal BP (systolic BP [SBP] < 120 mmHg and diastolic BP [DBP] < 80 mmHg), multivariable-adjusted hazard ratios (95% confidence intervals) of cardiovascular events were 1.98 (1.49-2.65), 2.10 (1.58-2.77), 3.48 (2.33-5.19), 4.12 (2.22-7.64), and 7.81 (3.99-15.30) for high normal BP (SBP120-129 mmHg and DBP < 80 mmHg), elevated BP (SBP130-139 mmHg and/or DBP80-89 mmHg), stage 1 hypertension (SBP140-159 mmHg and DBP90-99 mmHg), stage 2 hypertension (SBP160-179 mmHg and/or DBP100-109 mmHg), and stage 3 hypertension (SBP ≥ 180 mmHg and/or DBP ≥ 110 mmHg), respectively. The highest population attributable fraction was observed in elevated BP (17.8%), followed by stage 1 hypertension (14.1%). The present data suggest that JSH2019 may help identify Japanese workers at a higher cardiovascular risk.

Associations between joint lifestyle behaviors and depression among children and adolescents: A large cross-sectional study in China.

BACKGROUND: Lifestyles in children and adolescents are associated with mental health, yet the combined effects of diet-related joint lifestyles on depression are unclear. METHODS: A cross-sectional study was conducted in January 2020 in primary and secondary schools in Shanghai, China, with 6478 participants in the analysis. Lifestyle behaviors (physical activity, sleep duration, screen time, and diet quality) and depressive symptoms were measured using validated questionnaires. A series of multivariable logistic regressions were performed to examine the associations between lifestyle behaviors and their combinations and depression. RESULTS: The prevalence of depressive symptoms 12.2 % (n = 788). Compared to those considered physically active, physically inactive individuals showed higher odds of depression (adjusted odds ratio [aOR] = 1.206). Similarly, insufficient sleep duration (aOR = 1.449), long screen time (aOR = 1.457) and poor diet quality (aOR = 1.892) were all associated with higher odds of depression. Compared to participants with behaviors meeting all guidelines, the odds of depression increased as the number of behaviors not meeting guidelines increased in a dose-response relationship, with an average increase in depression odds of 49 % on average for each additional unhealthy behavior. Moreover, different combinations of behaviors not meeting guidelines showed varied odds of depression. CONCLUSIONS: Our research suggests that lifestyle behaviors not meeting guidelines in children and adolescents are associated with poorer mental health, and the risk varies with the number and specific combination of behaviors not meeting guidelines. Diet-related joint behaviors may be overlooked, and practical measures targeting joint lifestyles are needed to prevent and alleviate mental health problems among children and adolescents.

Declines in Physical Activity and Cardiorespiratory Fitness After Implementing new National School Guidelines.

PURPOSE: We examined whether introduction of national guidelines limiting sports club activities at school was associated with adolescents' exercise and cardiorespiratory fitness. METHODS: We conducted interrupted time-series analysis to quantify the changes in prefecture-level aggregated data on exercise or sports activities and 20-m shuttle run (indicator of cardiorespiratory fitness) among adolescents in Japan before (2013-2017) and after (2018-2022) the introduction of the guidelines using data from the National Survey of Physical Fitness, Athletic Performance and Exercise Habits. RESULTS: The introduction of the guidelines was associated with reductions in exercise and sports activities duration (boys, -4.8 [95% CI -5.9, -3.8] min/day; girls, -5.5 [95% CI -6.2, -4.8] min/day) and performance of 20-m shuttle run (boys, -1.2 [95% CI -1.4, -1.0] laps; girls, -2.3 [95% CI -2.5, -2.2] laps). DISCUSSION: After introducing guidelines limiting sports club activities at school, levels of exercise or sports and cardiorespiratory fitness declined among adolescents.

Relationships of Total and Domain-Specific Moderate-to-Vigorous Physical Activity with All-Cause and Disease-Specific Mortality.

PURPOSE: This study aimed to investigate the relationships of moderate-to-vigorous physical activity (MVPA) with all-cause and disease-specific mortality. We also investigated how the association between MVPA at leisure time (LT-MVPA) and health outcomes differs at different MVPA at work (WT-MVPA) levels. METHODS: The 81,601 community-dwelling Japanese persons age 50-79 yr who responded to a questionnaire in 2000-2003 were followed until 2018. Cox proportional hazard model was used to examine the association of total MVPA with risks of all-cause, cancer, heart disease, stroke, and respiratory disease mortality. Then, we compared the mortality risk according to the tertile of LT-MVPA, stratified by the tertile of WT-MVPA. RESULTS: During the 15.1 yr of average follow-up, 16,951 deaths were identified. Even total MVPA below the recommended volume (i.e., 0.1-1.49 MET·h·d -1 ) was associated with 11% to 24% reductions in all-cause (hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.82-0.96) and heart disease mortality (HR, 0.76; 95% CI, 0.61-0.94), compared with no MVPA at all. The further reduced risks were seen in MVPA up to 10 MET·h·d -1 . The inverse association between LT-MVPA and mortality risks was more evident at lower WT-MVPA, which was also inversely associated with the risks. CONCLUSIONS: Health benefits were observed at low levels of MVPA and up to 10 MET·h·d -1 , although the fine threshold for excessive MVPA was not clear. LT-MVPA had distinct health benefits especially for persons with lower WT-MVPA.

[Report: Symposium "Fostering the Power to Open Up the Future and Collaboration among Academic Societies in the Field of Social Medicine: How to Promote and Support the Activities of Young Scientists"].

The recruitment and training of early-career researchers are important for the development of science, especially in countries with low birth rates, such as Japan. In several academic societies for social medicine, early-career researchers have formed associations for the purposes of networking and career development. However, to date, little information about the activities of these associations has been shared. Therefore, we organized a symposium at the 93rd Annual Meeting of the Japanese Society for Hygiene (March 4, 2023) to introduce the early-career researcher associations that have been formed within five academic societies namely the Japanese Society for Hygiene, Japan Epidemiological Association, Japan Society for Occupational Health, Japan Society for Medical Education, and Japan Society for Healthcare Administration. In this paper, we summarize the activities, challenges, and future prospects of each association and their strategies for future development and collaboration on the basis of presentations and discussions at the symposium.

Effect of digital messages from health professionals on COVID-19-related outcomes: A systematic review of randomized controlled trials.

Effectiveness of health professionals' messages via digital tools on COVID-19-related outcomes remains unknown. In this systematic review, we examined this issue by searching randomized controlled trials in six databases until August, 2022 (PROSPERO, CRD 42022350788). Risk of bias was assessed using revised Cochrane risk-of-bias tool. Primary outcomes were COVID-19 infections, preventive behaviors, and factors that support behavioral change. Seven trials with 16 reports (some reported two or more outcomes) were included. One trial showed that physician videos distributed by Facebook ads significantly reduced COVID-19 infections. Five of 6 reports showed that interventions can promote non-pharmaceutical preventive behaviors, vaccination, or information-seeking behaviors and half of the results were significant. Interventions improved the factors that support behavioral change. 14 reports had some concerns of bias risk and 2 had high risk of bias. Our findings suggest that digital messages by health professionals may help reduce COVID-19 infections through promoting behavioral change.

[Current issues related to education in the five core disciplines of public health at the school of public health in a private university].

Objectives　In Japan, schools of public health (SPH) have engaged in professional education focusing on five core disciplines: epidemiology, biostatistics, social and behavioral science, health policy and management, and occupational and environmental health. However, empirical information is lacking regarding the current state of this education and its associated challenges in Japan. In this article, we showcase this issue, using the master of public health (MPH) course at Teikyo University Graduate School of Public Health (Teikyo SPH) as an example.Methods　We summarized the current objectives and classes required to complete the MPH course at Teikyo SPH, using the course guideline published in 2022. Current issues and possible future directions in the course were summarized based on the opinions of Teikyo SPH faculty members.Results　For epidemiology, lectures and exercises were designed to focus on how to formulating public health issues, collecting and evaluating data, and causal inference. Issues related to the design included ensuring that students had the necessary skills to apply epidemiology to emerging issues, and catching the course up with evolving techniques. For biostatistics, lectures and exercise classes focused on understanding data and statistics, as well as performing analyses. Issues included the understanding of theories, setting the course level, and a lack of appropriate education materials for emerging analytical methods. For social and behavioral science, lectures and exercise classes focused on understanding human behaviors and actions for problem solving. Issues included learning various behavioral theories in a limited timeframe, the gap between the lectures and various needs, and nurturing professionals who had the skills to perform in practical settings. For health policy and management, lectures, exercise classes, and practical training classes focused on identifying and solving problems in the community and around the world, and on integrating the disparate viewpoints of health economics and policy. Issues included few alumni who actually found work globally, a lack of students working in local or central administrations, and insufficient perspectives on rational/economic thinking and macro-economic transitions. For occupational and environmental health, lectures, exercise classes, and practical training classes focused on learning the occupational and environmental impacts of public health issues, and their countermeasures. Challenges included enriching the topics with regard to advanced technologies, environmental health, and socially vulnerable populations.Conclusion　Through these reflections on MPH education at Teikyo SPH, the following recommendations are considered essential in order to prepare improvements to the program: reorganizing the curriculum to meet the needs of the day, accepting students with various backgrounds, addressing the increasing knowledge and skills that need to be acquired by the students, and enhancing the powers of professors to implement changes.

Association between watching wide show as a reliable COVID-19 information source and preventive behaviors: A nationwide survey in Japan.

INTRODUCTION: Current pandemic prompted a surge in the television (TV) news watching. However, its influence is poorly understood. In Japan, wide show, a major genre of soft news TV programs, broadcasted COVID-19 for long hours, and was pointed out that it broadcasted COVID-19 sensationally, arousing fear and anxiety, and that it criticized individuals gathering in closed places. Thus, wide show may promote preventive behaviors but also produce fear or anxiety and aggressiveness towards others not engaging in preventive behaviors. We examined this issue using large-scale nationwide data. METHODS: We analyzed the cross-sectional data of 25,482 individuals from the Japan COVID-19 and Society Internet Survey conducted in 2020. Participants reported the type of COVID-19 information sources including TV news and wide show, and their trustworthiness. We calculated multivariable-adjusted prevalence ratios (PRs) of engaging in recommended preventive behaviors strictly (defined as always engaging in hand washing, mask wearing, and attempting to keep physical distancing) and alerting others not engaging in preventive behaviors, respectively. RESULTS: About 72.4% of the participants obtained information from TV news with reliance, while corresponding values were 50.3% for wide show. Overall, 32.8% engaged in recommended preventive behaviors strictly, and 9.6% alerted others. Watching wide show both with and without reliance were significantly associated with alerting others (adjusted PRs: 1.48 and 1.34, respectively) but not associated with preventive behaviors. Watching TV news was neither associated with strict preventive behaviors nor alerting others. CONCLUSION: Watching TV news and wide show was not associated with strict preventive behaviors; watching wide show was associated with only alerting others. Although causality is unclear, actions may be needed for TV stations broadcasting wide show to understand own influences on society in a timely manner amid the health emergencies.

Metabolic Syndrome and the Increased Risk of Medically Certified Long-term Sickness Absence: A Prospective Analysis Among Japanese Workers.

BACKGROUND: Metabolic syndrome (MetS) has been associated with various chronic diseases that may lead to long-term sickness absence (LTSA), but there is lacking information on the direct association between MetS and LTSA. The present study aimed to investigate the all-cause and cause-specific associations between MetS and the risk of medically certified LTSA among Japanese workers. METHODS: We recruited 67,403 workers (57,276 men and 10,127 women), aged 20-59 years from 13 companies in Japan during their health check-ups in 2011 (11 companies) and 2014 (2 companies), and we followed them for LTSA events (≥30 consecutive days) until March 31, 2020. MetS was defined according to the Joint Interim Statement. A Cox proportional hazards regression model was used to estimate hazard ratios (HRs) and its 95% confidence intervals (CIs) for LTSA associated with MetS and its components. RESULTS: During 408,324 person-years of follow-up, 2,915 workers experienced LTSA. The adjusted HR for all-cause LTSA was 1.54 (95% CI, 1.41-1.68) among those with MetS compared to those without MetS. In cause-specific analysis, HRs associated with MetS significantly increased for LTSA due to overall physical disorders (1.76); cardiovascular diseases (3.16); diseases of the musculoskeletal system and connective tissue (2.01); cancers (1.24); obesity-related cancers (1.35); mental, behavioral, and neurodevelopmental disorders (1.28); reaction to severe stress and adjustment disorders (1.46); and external causes (1.46). The number of MetS components were also significantly associated with increased LTSA risk. CONCLUSION: MetS was associated with an increase in the risk of LTSA due to various diseases among Japanese workers.

Current Issues in Social Medicine and Public Health from the Viewpoint of Early-career Researchers: Summary of Opinions at the Social Medicine Young Retreat.

The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of research, practice, social contribution, and education in social medicine and public health, which relate to the core mission of universities. Early-career researchers and professionals play an important role in these domains, but little is known about the challenges and issues they encountered or recognized during this pandemic. Therefore, we summarized the opinions of 37 participants (30 early-career researchers and seven senior researchers) on this issue from discussions at the Social Medicine Young Retreat, 2019, of the Japanese Medical Science Federation. The retreat was initially planned to be held during March 5-6, 2020 in Yamanashi but was changed to be held virtually on March 5, 2021. Early-career researchers participated in group discussions on how social medicine should transform itself to serve the public during the COVID-19 pandemic. Afterward, each group provided opinions on challenges and issues in social medicine. For example, participants perceived difficulties in implementing research in a timely way and the lack of multidisciplinary collaboration. They recognized challenges in continuing practice because of the limited evidence on COVID-19. On social contribution, they described difficulties in communicating risk as professionals. They also noted issues arising from online teaching and learning. One group suggested that the essence of social medicine did not need to be changed, but methodologies should be updated to tackle multiple existing challenges. These opinions may not cover all issues but could help establish a better relationship between medicine and society in a bottom-up manner. The continuous promotion of interdisciplinary collaboration in social medicine (and basic and clinical medicine) would provide ideas to solve these issues at scale. Organizational support is warranted to ensure sustainability and scalability of these actions.

Association of Changes of lifestyle behaviors before and during the COVID-19 pandemic with mental health: a longitudinal study in children and adolescents.

BACKGROUND: We examined the prospective associations of changes in lifestyle behaviors before/during the COVID-19 pandemic, namely physical activity and screen time, with mental health. Furthermore, the impacts of physical activity and screen time on mental health during the pandemic were examined cross-sectionally. METHODS: A two-wave longitudinal study was conducted among 2423 children and adolescents in Shanghai, China. Lifestyle behavior variables (physical activity and screen time) and psychological variables (depressive symptoms, anxiety, and stress) were measured using a self-reported questionnaire in January and March 2020. A series of multivariable logistic regressions were performed to examine the associations between changes in lifestyle behaviors in two waves and psychological problems. The combined associations of physical activity and screen time with psychological problems were also explored using the second wave data. RESULTS: Compared to students with persistently short screen time before and during the COVID-19 pandemic, those with prolonged screen time (OR = 1·36 for depression, OR = 1·48 for anxiety) and those with persistently long screen time (OR = 1·70 for depression, OR = 2·13 for anxiety) reported a higher risk of psychological symptoms. The association between changes in physical activity and psychological symptoms was not statistically significant after adjustment for demographic factors, socioeconomic status, and screen time. During the COVID-19 pandemic, engaging in longer screen time (OR = 1·44 for depression, OR = 1·55 for anxiety) was associated with worsened psychological conditions, while engaging in increased physical activity (OR = 0·58 for depression, OR = 0·66 for anxiety) was associated with better psychological conditions. CONCLUSIONS: Our study suggests that promoting physical activity and limiting leisure screen time during the COVID-19 pandemic are important to prevent and mitigate psychological problems in children and adolescents. Therefore, effective interventions targeting lifestyle behaviors are needed to protect children and adolescents' physical and mental health.

Relationship of chronotype and social jetlag with adherence to the Japanese dietary guidelines among workers.

While late chronotype and greater social jetlag have been associated with poor dietary behavior among the general population, these associations have not been investigated among workers, who struggle to align their sleep timings with work schedules. We aimed to explore the cross-sectional association of social jetlag and a late chronotype with adherence to a healthy diet among Japanese workers. Participants were 1,435 non-shift workers (18-78 years) who attended a nutritional survey. Social jetlag was defined as the difference in the midpoint of sleep times between weekdays and weekends, while chronotype was estimated using the mid-sleep time on weekends that was corrected with sleep debt on weekdays. We calculated the adherence score of the Japanese Food Guide Spinning Top (JFGST) - healthy diet guidelines for Japanese. Multivariable linear regression analyses were used to calculate the adjusted means and 95% confidence intervals (CI) for adherence scores of social jetlag and chronotype. We found that greater social jetlag was associated with a lower JFGST score. The multivariable-adjusted mean (95% CI) of JFGST scores were 39.7 (39.1-40.2), 38.7 (37.9-39.6), and 38.1 (36.6-39.7) for <1 hour, 1 to <2 hours, and ≥2 hours of social jetlag, respectively (P-trend = 0.02). Workers with late chronotypes had significantly lower adherence scores on JFGST [36.3 (34.7-37.8); P-trend = 0.002]. Results suggest that a late chronotype and social jetlag are inversely associated with adherence to a healthy diet among Japanese workers.

[A descriptive study on volunteer activities of providing meals during the early phase of the COVID-19 pandemic: clarifying the activities process and a preliminary investigation of the effect of activities on residents].

Objective　Although volunteer activities of providing meals have been conducted as measures to prevent isolation and loneliness and to secure meals, evidence is lacking regarding how to implement such activities. In this study, we describe the activities process at a community cafeteria located within a housing complex and operated by resident volunteers during the COVID-19 pandemic to provide inexpensive meals. We also report the preliminary results of the impact of such activities on the residents.Method　This case study was conducted at the community cafeteria Tate Kitchen 'Sakura' located within a Tokyo housing complex with a high ageing population. We collected data on the cafeteria activities during February to May, 2020. The data sources were daily activity records of the cafeteria, dialogues between volunteers and residents, and photos of activities. We qualitatively assessed the effects of the activities on the residents by classifying interviews with ten users and six volunteer staff based on the Kawakita Jiro (KJ) method.Results　During the observation period, regular meetings were held among board members and volunteers, and operations of the cafeteria were verified and modified by referring to the COVID-19 prevention guide for citizens, advice from health professionals, and residents' opinions. It was determined that activities would continue without cessation; the cafeteria, managed mainly by volunteers under the food hygiene control system required for commercial restaurants, was open five days a week to maintain food security and ensure the health of the residents. The number of meals sold at the cafeteria was halved in May (n = 2,149) as a result of the modification in operations. However, the number of meals delivered to each household increased from March because of increased demand. Qualitative analyses using KJ method showed that users perceived that these continued activities were effective in securing food, maintaining social interaction and promoting health, and health promotion, while volunteers perceived that the activities were effective in promoting social interaction and health.Conclusion　The resident volunteers continually confirmed their commitment to the principle of protecting food security and health within the community. They continued to operate the cafeteria by referring to available information on COVID-19 preventive measures, adopting the COVID-19 preventive measures, and involving all stakeholders. Qualitative analyses suggested that these continued efforts were useful for securing food and supporting health of the residents, looking after one other, and maintaining ties among residents.

Overtime Work and the Incidence of Long-term Sickness Absence Due to Mental Disorders: A Prospective Cohort Study.

BACKGROUND: Although previous research has focused on the association between long working hours and several mental health outcomes, little is known about the association in relation to mental health-related sickness absence, which is a measure of productive loss. We aimed to investigate the association between overtime work and the incidence of long-term sickness absence (LTSA) due to mental disorders. METHODS: Data came from the Japan Epidemiology Collaboration on Occupational Health Study (J-ECOH). A total of 47,422 subjects were followed-up in the period between April 2012 and March 2017. Information on LTSA was obtained via a study-specific registry. Baseline information was obtained at an annual health checkup in 2011; overtime working hours were categorized into <45; 45-79; 80-99; and ≥100 hours/month. RESULTS: During a total follow-up period of 211,443 person-years, 536 people took LTSA due to mental disorders. A Cox proportional hazards model showed that compared to those with less than 45 hours/month of overtime work, those with 45-79 hours/month were at a lower risk of LTSA due to mental health problems (hazard ratio [HR] 0.63; 95% confidence interval [CI], 0.56-0.71) while those with overtime work of ≥100 hours/month had a 2.11 (95% CI, 1.12-3.98) times higher risk of LTSA due to mental health problems. CONCLUSION: Engaging in excessive overtime work was linked with a higher risk of LTSA due to mental health problems while the lower risk observed among individuals working 45-79 hours/month of overtime work might have been due to a healthy worker effect.

Improving and maintaining healthy lifestyles are associated with a lower risk of diabetes: A large cohort study.

AIMS: It is well known that healthy lifestyles measured at one time-point are inversely associated with diabetes risk. The impact of transitions in combined lifestyles in real settings remains unknown. MATERIALS AND METHODS: The trajectory patterns of combined lifestyles over three years were identified using group-based trajectory modeling in 26,647 adults in Japan. Two types of indices (not having the unhealthy lifestyle [easy goal] and having healthiest lifestyles [challenging goal]) were developed using five lifestyle factors: smoking, alcohol consumption, exercise, sleep duration, and body weight control. This index was calculated using the yearly total score (0-5; higher score indicated healthier lifestyles). Diabetes was defined by high plasma glucose level, high hemoglobin A1c level, and self-report. RESULTS: Five trajectory patterns were identified for each index and it was shown that healthier patterns are associated with a lower risk of type 2 diabetes during 6.6 years of average follow-up. For example, with a challenging-goal, compared with a persistently very unhealthy pattern, the adjusted hazard ratios (95% confidence intervals) were 0.65 (0.59, 0.73), 0.50 (0.39, 0.64), 0.43 (0.38, 0.48), and 0.33 (0.27, 0.41) for 'persistently unhealthy', 'improved from unhealthy to moderately healthy', 'persistently moderately healthy', and 'persistently mostly healthy' patterns, respectively. CONCLUSIONS: Our data reinforce the importance of improving and maintaining health-related lifestyles to prevent diabetes.

Shift work and the onset of type 2 diabetes: results from a large-scale cohort among Japanese workers.

AIMS: Data are limited regarding how shift work is linked to the development of type 2 diabetes, especially among workers at high risk of diabetes. We examined the risk of diabetes according to shift-work conditions over several years among Japanese adults. METHODS: This prospective study enrolled 17,515 workers (age 40-78 years). Shift work was self-reported at annual health examinations over time from 2004 to 2017 and categorized as shift workers or non-shift workers. Diabetes was defined as fasting plasma glucose, random glucose, HbA1c, and self-reported use of antidiabetic medications. The association of shift work and diabetes was quantified using Cox regression. RESULTS: During a follow-up of 8.1 years in median, 2071 incident cases of diabetes were documented. Compared with non-shift work, shift work showed a significantly elevated hazard ratios of developing diabetes. Shift work showed a 19% (95% confidence intervals: 3-37%) higher hazard ratios for diabetes, after adjustment for demographic-, cardiometabolic-, and work-related factors. Further adjustment for lifestyle factors and body mass index did not materially change this association (a 16% increase; 95% confidence intervals, 1-34%). This relationship was replicated among workers with prediabetes. CONCLUSIONS: Engaging in shift work may increase the risk of developing diabetes independently of lifestyle factors and body mass index, even among prediabetic workers.

Leisure-time, occupational, and commuting physical activity and the risk of chronic kidney disease in a working population.

Physical activity has been linked to a lower risk of chronic kidney disease (CKD); however, evidence on the relationship between domain-specific physical activity and CKD is scarce. This study aimed to examine the risk of CKD in relation to leisure-time, occupational, and commuting physical activities in a large occupational cohort in Japan. Participants were 17,331 workers (20-65 years old) without CKD and were followed-up for a maximum period of 13 years. Incident CKD was defined as an estimated glomerular filtration rate of < 60 mL/min/1.73 m2 and/or proteinuria determined using the dipstick test. The Cox proportional hazards models were used to examine the associations. During 147,752 person-years of follow-up, 4013 participants developed CKD. Workers who were standing or walking at work and those who were fairly active at work had adjusted hazard ratios of 0.88 (95% confidence interval 0.86-0.96) and 0.89 (95% confidence interval 0.78-1.02), respectively, for developing CKD than sedentary workers. Leisure-time physical activity and walking for commute were not associated with CKD risk. Our findings suggest that occupational, but not leisure-time and commuting physical activities, is associated with a lower CKD risk.