Self-management behavior concerning physical activity of Japanese type 2 diabetes patients, characterized by sex, daily energy intake and body mass index.

OBJECTIVES: We assess differences in physical activity self-management behavior in association with dietary intake and BMI between the sexes in patients with type 2 diabetes. METHODS: Patients with type 2 diabetes (n = 145) completed a self-administrated questionnaire. Patients were classified into four groups by BMI and dietary intake: non-obesity and non-overeating (NO/NOE); non-obesity and overeating (NO/OE); obesity and non-overeating (O/NOE); obesity and overeating (O/OE). Differences in physical activity self-management behavior between the four groups were determined by the analysis of variance using a Tukey-Kramer post hoc test. RESULTS: Male O/OE group showed higher HbA1c (p = 0.001) than the other groups. Male NO/OE group had higher steps/day than O/NOE (p = 0.036) and score of "Exercising to stimulate the enjoyment of eating" was higher than O/OE (p = 0.031). Female NO/OE group showed higher HbA1c (p = 0.001) than NO/NOE and O/NOE. CONCLUSIONS: BMI and dietary intake were associated with frequencies of physical activity self-management strategies in men. Self-management behavior peculiar to male NO/OE group is "Exercising to stimulate the enjoyment of eating". Health professionals should assess sex, BMI, and dietary intake of patients and endeavor to improve individuals' ability to regulate their caloric balance based on physical activity level.

The relationship between health-related quality of life and higher-level functional capacity in elderly women with mild cognitive impairment.

[Purpose] To clarify health-related quality of life (HR-QOL) in subjects with mild cognitive impairment (MCI), using EuroQOL (EQ-5D), and to investigate the relationship between HR-QOL and Tokyo Metropolitan Institute Gerontology Index of Competence (TMIG-IC) scores. [Subjects and Methods] The subjects included 25 women with MCI or frail constitutions. A variety of methods were used to assess mental states and activities of daily living (ADL). [Results] EQ-5D scores were significantly lower in the MCI group than in the normal cognitive (NC) group. Among the assessed subscales, the percentages of participants with "moderate problems" during self-care and "moderate and extreme problems" during usual activities were significantly higher in the MCI group. TMIG-IC scores were significantly lower in the MCI group than in the NC group. There was a positive correlation between TMIG-IC and EQ-5D scores in the MCI group. There were also significant positive correlations between instrumental activities of daily living and social roles between EQ-5D and TMIG-IC scores in the MCI group. [Conclusion] TMIG-IC scores may reflect cognitive disorders earlier than BI and FIM. The decline of TMIG-IC scores, especially for IADL and social roles, affects HR-QOL even in the early phases of cognitive impairment.

Relation between sleep quality and daily physical activity in hemodialysis outpatients.

The purpose of this study was to examine the correlations among objective sleep variables, sleep-wake cycle parameters, and daily physical activity in hemodialysis patients and controls. Twenty-four hemodialysis patients (HD group) were compared with a control group consisting of 24 healthy participants matched for age, height, and weight. Sleep variables (total sleep time [TST], sleep efficiency [SE], sleep latency [SL], and waking after sleep onset [WASO]), sleep-wake cycle parameters (the sleep-wake cycle period and the peak of sleep-wake cycle variance), and daily physical activity (steps per day) for each participant were assessed by objective methods for two weeks. While there was no difference in TST between the two groups, the HD group showed a significantly increased SL (HD: 0:29±0:20 vs control: 0:16±0:13, p < 0.05) and WASO (HD: 2:21±1:00 vs control: 1:35±0:41, p<0.05) and decreased SE (HD: 67.1±13.6% vs control: 77.5±9.7%, p<0.01) compared to the control group. There was no significant difference in sleep-wake cycle period between the HD and control groups. However, the peak of sleep-wake cycle variance in the HD group (0.050±0.028) was significantly lower (t = 2.49, p<0.05) than in the control group (0.068±0.019). The number of daily steps taken in the HD group (4,774± 2,845 steps) was also significantly lower than in the control group (8,696± 3,047). The peak of sleep-wake cycle variance was significantly correlated with SE (r = 0.532, p<0.01), SL (r = -0.501, p<0.01), and WASO (r = -0.436, p<0.01), whereas the number of steps showed a weak correlation only with WASO (r = -0.308, p<0.05) among the objective sleep parameters. Our results suggest that sleep quality in HD patients may be more effectively improved by maintaining the regular 24-hour sleep-wake cycle rather than by increasing the amount of daily physical activity, indicating that intervention such as measures to prevent napping during hemodialysis sessions may prove effective in improving the quality of sleep in HD patients.

Comparing the effects of different individualized music interventions for elderly individuals with severe dementia.

BACKGROUND: Individuals with dementia often experience poor quality of life (QOL) due to behavioral and psychological symptoms of dementia (BPSD). Music therapy can reduce BPSD, but most studies have focused on patients with mild to moderate dementia. We hypothesized that music intervention would have beneficial effects compared with a no-music control condition, and that interactive music intervention would have stronger effects than passive music intervention. METHODS: Thirty-nine individuals with severe Alzheimer's disease were randomly and blindly assigned to two music intervention groups (passive or interactive) and a no-music Control group. Music intervention involved individualized music. Short-term effects were evaluated via emotional response and stress levels measured with the autonomic nerve index and the Faces Scale. Long-term effects were evaluated by BPSD changes using the Behavioral Pathology in Alzheimer's Disease (BEHAVE-AD) Rating Scale. RESULTS: Passive and interactive music interventions caused short-term parasympathetic dominance. Interactive intervention caused the greatest improvement in emotional state. Greater long-term reduction in BPSD was observed following interactive intervention, compared with passive music intervention and a no-music control condition. CONCLUSION: Music intervention can reduce stress in individuals with severe dementia, with interactive interventions exhibiting the strongest beneficial effects. Since interactive music intervention can restore residual cognitive and emotional function, this approach may be useful for aiding severe dementia patients' relationships with others and improving QOL. The registration number of the trial and the name of the trial registry are UMIN000008801 and "Examination of Effective Nursing Intervention for Music Therapy for Severe Dementia Elderly Person" respectively.

Significance of ELF3 mRNA expression for detection of lymph node metastases of colorectal cancer.

BACKGROUND: Lymph node (LN) evaluation is an important factor for the prognosis of colorectal cancer (CRC). The purpose of our study was to investigate the effectiveness of E74-like factor 3 (ELF3) and carcinoembryonic antigen (CEA) as useful markers to detect LN metastases in CRC. MATERIALS AND METHODS: We examined the mRNA expression of ELF3 and CEA in LNs and tissues from 22 patients with CRC and in controls with ulcerative colitis (UC) by real-time quantitative reverse transcription polymerase chain reaction, as well as by hematoxylin-eosin staining. RESULTS: ELF3 and CEA expression showed statistically significant differences among four LN groups: LNs from patients with CRC categorized into three Dukes' stages and LNs from patients with UC (p<0.001 and p<0.001, respectively). We found a statistical correlation between the expression levels of both markers in patients with CRC compared with each Dukes' stage. CONCLUSION: ELF3, as a gene marker, may be sufficiently practical to detect LN metastases of CRC, rather than CEA.

A modified simple questionnaire to estimate dietary energy intake for the Japanese.

To produce a simple food questionnaire for estimating total energy intake and intake of three major nutrients which medical or health care staff such as nurses can rapidly use for the determination of health guidance for individuals. The study group comprised 116 normal healthy subjects (mean age ± S.D. = 40.0 ± 17.8 years), 76 women and 40 men. Using findings based on our previous research and experiences and the simple food questionnaire (MHW-FQ) that the "Kenkoh Shihyoh Sakutei Iinkai" established by the then Ministry of Health and Welfare developed in 1975, we produced a modified version of the MHW-FQ and named it M-MHW-FQ. The study presented here was conducted for the statistical determination of the usefulness of M-MHW-FQ. M-MHW-FQ yielded much better results than MHW-FQ as evidenced by improved correlation coefficients, which ranged between 0.56 and 0.75. The findings showed that, despite its simplicity, M-MHW-FQ yielded relatively accurate results and was satisfactory for the rapid estimation of total energy intake including that of three major nutrients. This study provides evidence that our simple questionnaire, M-MHW-FQ, is useful for the rapid estimation of individual total dietary energy intake and nutrient balance. We expect that our questionnaire can make a significant contribution to an improvement in lifestyle-related diseases.

Association between polymorphisms in UDP-glucuronosyltransferase 1A6 and 1A7 and colorectal cancer risk.

Genetic polymorphisms of uridine diphosphate-glucuronosyltransferases 1A6 (UGT1A6) and 1A7 (UGT1A7) may lead to genetic instability and colorectal cancer carcinogenesis. Our objective was to measure the interaction between polymorphisms of these repair genes and tobacco smoking in colorectal cancer (CRC). A total of 68 individuals with CRC and 112 non-cancer controls were divided into non-smoker and smoker groups according to pack-years of smoking. Genetic polymorphisms of UGT1A6 and UGT1A7 were examined using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). We found a weak association of UGT1A6 polymorphisms with CRC risk (crude odds ratio [OR], 1.65; 95% confidence interval [95%CI], 0.9-3.1, P=0.107; adjusted OR 1.95, 95%CI 1.0-3.8, P=0.051). The ORs for the UGT1A7 polymorphisms were statistically significant (crude OR: 26.40, 95%CI: 3.5-198.4, P=0.001; adjusted OR: 21.52, 95%CI: 2.8-164.1, P=0.003). The joint effect of tobacco exposure and UGT1A6 polymorphisms was significantly associated with colorectal cancer risk in non-smokers (crude OR, 2.11; 95%CI, 0.9-5.0, P=0.092; adjusted OR 2.63, 95%CI 1.0-6.7, P=0.042). In conclusion, our findings suggest that UGT1A6 and UGT1A7 gene polymorphisms are associated with CRC risk in the Japanese population. In particular, UGT1A6 polymorphisms may strongly increase CRC risk through the formation of carcinogens not associated with smoking.

Regional chest wall volume changes during various breathing maneuvers in normal men.

PURPOSE: The purpose of this study is to investigate the regional chest wall volume changes during various breathing maneuvers in normal men with an optical reflectance system (OR), which tracks reflective markers in three dimensions. METHODS: Chest wall volume was measured by the OR system [VL(CW)], and lung volume was measured by hot wire spirometry [VL(SP)] in 15 healthy men during quiet breathing (QB), during breathing at a rate of 50 tidal breaths/min paced using a metronome (MT: metronome-paced tachypnea), and during a maximal forced inspiratory and expiratory maneuver (MFIE maneuver). RESULTS: There were few discrepancies between VL(CW) and VL(SP) for QB and MT. In the MFIE maneuver, however VL(CW) was often underestimated compared with VL(SP), particularly during forced maximal expiration, because of pulmonary rib cage volume changes. Furthermore, the regional chest wall volume changes were affected by breathing maneuver alternation. In the pulmonary and abdominal rib cage, inspiratory reserve volume was larger than expiratory reserve volume, respectively, and in the abdomen, expiratory reserve volume was larger than inspiratory reserve volume. CONCLUSION: Alternation of breathing maneuvers affects regional chest wall volume changes.

APEX1 Asp148Glu gene polymorphism is a risk factor for lung cancer in relation to smoking in Japanese.

DNA repair enzymes play an important role in the development of various kinds of cancer. We here analyzed associations of XPD Lys751Gln, APEX1 Asp148Glu, XRCC1 Arg399Gln, and XRCC3 Thr241Met gene polymorphisms in DNA repair pathways in relation to the risk of lung cancer using PCR-RFLP. The study involved 104 lung cancer patients and 120 non-cancer controls divided into non-smokers and smokers. We found a statistically significant interaction between APEX1 Asp148Glu and the risk for lung cancer (adjusted OR 2.78, 95% CI 1.58-4.90, p=0.0004), of both adenocarcinoma (adjusted OR 2.24, 95%CI 1.18-4.25, p=0.014) and squamous cell carcinoma (adjusted OR 4.75, 95%CI 1.79-12.6, p=0.002) types. XRCC1 Arg399Gln showed a borderline significant association with adenocarcinoma (adjusted OR 1.89, 95%CI 1.00-3.57, p=0.051). The combined effect of smoking and presence of the APEX1 Asp148Glu demonstrated a significant association with risk of lung cancer (adjusted OR 3.61, 95% CI 1.74-7.50, p=0.001). The XPD Lys751Gln and XRCC3 Thr241Met genotypes displayed no statistically significant risk. Our findings suggest that the APEX1 Asp148Glu is associated with increased risk for primary lung cancer in Japanese individuals partaking in smoking.

MUTYH Gln324His gene polymorphism and genetic susceptibility for lung cancer in a Japanese population.

BACKGROUND: Genetic polymorphisms of DNA repair enzymes in the base excision repair (BER) pathway, may lead to genetic instability and lung cancer carcinogenesis. We investigated the interactions among the gene polymorphisms in DNA repair genes and lung cancer. METHODS: We analyzed associations among OGG1 Ser326Cys and MUTYH Gln324His gene polymorphisms in relation to lung cancer risk using PCR-RFLP. The study involved 108 lung cancer patients and 121 non-cancer controls divided into non-smokers, smokers according to pack-years smoked in Japanese. RESULTS: The results showed that the MUTYH His/His genotype compared with Gln/Gln genotype showed an increased risk for lung cancer (adjusted odds ratio [OR] 3.03, confidence interval [95%CI], 1.31-7.00, p = 0.010), whereas there was no significant increase for the Gln/His genotype (adjusted OR 1.35, 95%CI 0.70-2.61, p = 0.376). The MUTYH His/His genotype was at a borderline increased risk for both adenocarcinoma and squamous cell carcinoma (adjusted OR 2.50, 95%CI 0.95-6.62, p = 0.065 for adenocarcinoma; adjusted OR 3.20, 95%CI 0.89-11.49, p = 0.075 for squamous cell carcinoma, respectively). However, the OGG1 Ser/Cys or Cys/Cys genotypes compared with the Ser/Ser genotype did not have significantly increased risk for lung cancer, containing either adenocarcinoma or squamous cell carcinoma. The joint effect of tobacco exposure and the MUTYH His/His genotype compared with the Gln/Gln genotype showed a significant association with lung cancer risk in smokers, and there was not significantly increased in non-smokers (adjusted OR 3.82, 95%CI 1.22-12.00, p = 0.022 for smokers; adjusted OR 2.60, 95%CI 0.60-11.25, p = 0.200 for non-smokers, respectively). The effect of tobacco exposure and the OGG1 Ser326Cys showed also no significant risk for lung cancer. CONCLUSION: Our findings suggest that the MUTYH Gln324His polymorphism appear to play an important role in modifying the risk for lung cancer in the Japanese population.

Association of MUTYH Gln324His and APEX1 Asp148Glu with colorectal cancer and smoking in a Japanese population.

BACKGROUND: Genetic polymorphisms of DNA repair enzymes may lead to genetic instability and colorectal cancer carcinogenesis. Our objective was to measure the interactions between polymorphisms of repair genes and tobacco smoking in colorectal cancer. METHODS: The case-control study involved sixty-eight colorectal cancer patients and 121 non-cancer controls divided into non-smokers and smokers according to pack-years of smoking. The genetic polymorphisms of DNA repair enzymes,OGG1 Ser326Cys, MUTYH Gln324His, APEX1 Asp148Glu and XRCC1 Arg399Gln, were examined using PCR-RFLP. RESULTS: The MUTYH Gln324His showed strong significant associations with a risk of colorectal cancer (crude odds ratio [OR] 3.30, 95% confidence interval [95%CI] 1.44-7.60, p = 0.005; adjusted OR3.53, 95%CI 1.44-8.70, p = 0.006). The ORs for the APEX1 Asp148Glu were statistically significant (crude OR 2.69, 95%CI 1.45-4.99, p = 0.002; adjusted OR 2.33, 95%CI 1.21-4.48, p = 0.011). The ORs for the MUTYH Gln324His and the APEX1 Asp148Glu were statistically significant for colon cancer (adjusted OR 3.95, 95%CI 1.28-12.20, p = 0.017 for MUTYH Gln324His ; adjusted OR 3.04, 95%CI 1.38-6.71, p = 0.006 for APEX1 Asp148Glu). The joint effect of tobacco exposure and the MUTYH Gln324His showed a significant association with colorectal cancer risk in non-smokers (adjusted OR 4.08, 95%CI 1.22-13.58, p = 0.022) and the APEX1 Asp148Glu was significantly increased in smokers (adjusted OR 5.02, 95%CI 1.80-13.99, p = 0.002). However, the distributions of OGG1 Ser326Cys and XRCC1 Arg399Gln were not associated with a colorectal cancer risk. CONCLUSION: Our findings suggest that the MUTYH Gln324His and the APEX1 Asp148Glu constitutes an increased risk of colorectal cancer, especially colon cancer. The MUTYH Gln324His is strongly associated with colorectal cancer susceptibility in never smoking history, whereas the APEX1 Asp148Glu genotype constitutes an increased risk of colorectal cancer when accompanied by smoking exposure.

Gender differences of dietary self-management behavior affecting control indices in type II diabetes.

AIM: To establish effective dietary self-management behavior for type II male and female diabetics, by focusing on how dietary intake and dietary self-management affect control indices of type II diabetics. METHODS: The study group comprised 170 type II diabetics, 93 men (mean age, 63.1+/-8.8 years old) and 77 women (mean age 63.4 +/- 10.2 years old). The final analyses of data collected from subjects comprised three control indices of type II diabetics, several factors related to control indices, and several items on a dietary self-management behavior questionnaire. Multiple regression analyses used control indices as dependent variables, and related factors as independent variables. Multiple regression analyses were also used for the relationships between dietary intakes as dependent variables and dietary self-management factors as independent variables. RESULTS: Males showed a significant correlation between total energy intake per standard body weight per day and body mass index, and a significantly positive correlation between body mass index and waist circumference. Carbohydrate intake was significantly related to HbA1c. Other results showed characteristic relationships between various questionnaire items and "total energy intake, lipids intake, and carbohydrate intake", respectively. Females showed significant correlation between carbohydrate intake and both body mass index and waist circumference, as well as characteristic correlations between various questionnaire items and both reductions and increases in carbohydrate intake. CONCLUSION: Our study discloses significant differences in dietary self-management behavior between males and females with type II diabetes. We anticipate that educational support using findings of our study can make a significant contribution to improvement in control indices of type II diabetics.

Association of CYP1A1, CYP1A2, GSTM1 and NAT2 gene polymorphisms with colorectal cancer and smoking.

We investigated CYP1A1*2A, CYP1A1*2C, CYP1A2*1C, CYP1A2*1F, GSTM1 and NAT2 gene polymorphisms, involving enzymes which metabolize many carcinogens, with reference to colorectal cancer risk. The distribution of these genotypes was not associated with risk overall. However, the CYP1A1*2A T/C genotype showed a significant association with colorectal cancer risk in never-smokers (odds ratio [OR], 3.06; 95% confidence interval [95% CI], 1.11-8.40; p = 0.030). The risk of the NAT2 rapid genotype in never-smokers was also statistically significantly increased (OR, 5.38; 95%CI, 1.80-16.1; p = 0.003). Furthermore, the joint effects of NAT2 rapid plus other genotypes were associated with colorectal cancer overall (OR, 3.12; 95%CI, 1.15-8.51; p = 0.026, for NAT2 rapid plus combined CYP1A1*2C Ile/Val and Val/Val, OR, 3.25; 95%CI, 1.09-9.74; p = 0.035, for NAT2 rapid plus CYP1A2*1C G/G, and OR, 4.20; 95%CI, 1.09-16.1; p = 0.037, for NAT2 rapid plus GSTM1 null, respectively). In never-smokers, the joint effects of NAT2 rapid plus other genotypes were remarkable (OR, 15.9; 95%CI, 1.87-135.8; p = 0.011, for NAT2 rapid plus combined CYP1A1*2A T/C and C/C, OR, 5.71; 95%CI, 1.49-21.9; p = 0.011, for NAT2 rapid plus combined CYP1A1*2C Ile/Val and Val/Val, and OR, 9.14; 95%CI, 2.05-40.7; p = 0.004, for NAT2 rapid plus CYP1A2*1F A/A, respectively). The joint effect of CYP1A2*1F A/A plus CYP1A2*1C G/G genotypes was also increased in never-smokers (OR, 6.16; 95%CI, 1.26-30.1; p = 0.025). Our findings suggest that the CYP1A1*2A T/C and NAT2 rapid genotypes is associated with colorectal cancer susceptibility without smoking exposure. These results also indicate that the NAT2 in combination with CYP1A1*2C, CYP1A2*1C, or GSTM1 genotypes may strongly confer susceptibility to colorectal cancer. In particular, the combination of NAT2 plus CYP1A1*2A, CYP1A1*2C, or CYP1A2*1F genotypes, and that of CYP1A2*1F plus CYP1A2*1C genotype may define a group of persons who are genetically susceptible to colorectal cancer in never smokers.

Development of an evaluation scale for self-management behavior related to physical activity of type 2 diabetic patients.

OBJECTIVE: The aim of this study was to assess the reliability and validity of an evaluation scale for self-management behavior related to physical activity of type 2 diabetic patients (ES-SMBPA-2D). RESEARCH DESIGN AND METHODS: Outpatients with type 2 diabetes (n = 146) completed a self-administered questionnaire supported by a semistructured interview based on a literature review. The content, factor, and concurrent validity and internal consistency and reproducibility of the scale were analyzed. Pearson's correlation coefficients for the ES-SMBPA-2D and International Physical Activity Questionnaire (IPAQ) subscale scores were calculated to evaluate the concurrent validity. RESULTS: The ES-SMBPA-2D was divided into two parts, the first dealing with self-management behavior to enhance physical activity in daily life and the second with behavior to maintain the level of physical activity. Factor analysis showed that the first part comprised four factors and the second five. The ES-SMBPA-2D correlated with the IPAQ subscales. Cronbach's alpha coefficient was between 0.56 and 0.90, and the intraclass test-retest correlation coefficient of the subscales was between 0.60 and 0.88. CONCLUSIONS: The ES-SMBPA-2D is reasonably reliable and valid and is expected to prove useful for the assessment of patients' self-management behavior and for individualized instruction.

NAT2 and CYP1A2 polymorphisms and lung cancer risk in relation to smoking status.

We investigated the associations between lung cancer and the gene polymorphisms of the drug metabolizing enzymes, containing cytochrome P450 1A1 (CYP1A1), cytochrome P450 1A2 (CYP1A2), glutathione S-transferase class mu (GSTM1), and N-acetyltransferase 2 (NAT2). The study involved 113 lung cancer patients and 121 non-cancer controls divided into never, light and heavy smokers according to pack-years of smoking in Japanese by using PCR-RFLP. For light smokers, the lung cancer risk of NAT2 intermediate-slow was significantly increased [the adjusted odds ratio (OR): 10.9, 95% confidence intervals (95%CI): 1.75-67.5, P-value: 0.010]. Moreover, never smokers having joint genotypes of NAT2 intermediate-slow and CYP1A2*1F A/A was also associated with increased the lung cancer risk (OR: 4.95, 95% CI: 1.19-20.6, P-value: 0.028). We suggested that light smokers with intermediate-slow NAT2 activity were at highest risk for lung cancer and the gene-gene interaction based on intermediate-slow NAT2 activity and high CYP1A2 activity would be increased a lung cancer risk among never smokers.