Effectiveness of allergen immunotherapy with house dust mite extract for pediatric bronchial asthma.

Aim: We compared the effectiveness of rush subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) using standardized house dust mite (HDM) extract for pediatric bronchial asthma (BA). Methods: We followed the pediatric BA treatment score during 3 years of treatment. We assessed the median time to no longer requiring long-term control pharmacotherapy (LTCP) for BA (LTCP-free). We compared the outcomes after adjustment for confounding factors and propensity score matching. Results: Patients in the HDM SCIT group achieved the LTCP-free status significantly earlier than those in the HDM SLIT group after adjustment for confounding factors and propensity score matching. Conclusion: Patients treated for pediatric BA with rush HDM SCIT had earlier onset of therapeutic effects than those with HDM SLIT.

Smaller household size and higher prevalence of serious psychological distress in younger people and never-married people: a nationwide cross-sectional survey in Japan.

Background: Small-member households are increasing worldwide. However, most previous studies have focused on older people and living alone. Using the latest national survey data, we investigated a dose-response relationship between household size and serious psychological distress (SPD). Methods: We analyzed data from the 2019 Comprehensive Survey of Living Conditions in Japan. The study participants were 405,560 community-dwelling adults aged 20 or older. Household size was classified into 5 or more, 3 or 4, two, and one (i.e., living alone). SPD was defined as ≥13 points based on the Kessler 6-item Psychological Distress Scale. We used multivariable logistic regressions and included age, education, equivalent household expenditures, housing tenure, employment contract, smoking, and illness under treatment as covariates. Results: After stratified analyses by age and gender, a dose-response relationship between smaller household size and more common SPD was significant for younger, but not for older people (p-trend was <0.001 in men aged 20-59 and women aged 20-39). After stratified analyses by gender and marital status, a dose-response relationship was significant only for the never-married group in both genders (p-trend was <0.001 in never-married men and women). Conclusion: Smaller households were associated with higher prevalence of SPD in younger adults and in never-married individuals, regardless of gender. Our findings suggest a need to focus on younger people and never-married people to reduce the mental health risks due to small household sizes.

Blood pressure, pulse rate, and skin temperature during hot-water bathing in real-world settings among community-dwelling older adults: the HEIJO-KYO Study.

BACKGROUND: Home hot-tub bathing substantially increases drowning mortality rates among older adults in Japan. Previous laboratory studies on hemodynamic responses during hot-tub bathing have been inconsistent depending on the thermal conditions. Furthermore, real-world hemodynamic changes that occur during bathing remain poorly understood. This study investigated the association between individual thermal states and hemodynamic parameters during hot-tub bathing among community-dwelling older adults. METHODS: In this cross-sectional study conducted between January 2016 and April 2019, which involved 1,479 older adults (median [range] age, 68 [40-90] years), skin temperature on the abdominal surface was measured every minute. Ambulatory blood pressure and pulse rate were recorded at 15-min intervals for 24 h. Participants underwent simultaneous living room temperature measurements in their homes, and the time and methods of bathing were recorded. Associations between skin temperature and hemodynamic parameters during bathing and between the pre-bath living room temperature and in-bath maximum proximal skin temperature were evaluated using mixed-effects and linear regression models, respectively. RESULTS: A 1 °C increase in skin temperature was significantly associated with a 2.41 mmHg (95% confidence interval [CI]: 2.03-2.79) increase in systolic blood pressure and a 2.99 bpm (95% CI: 2.66-3.32) increase in pulse rate, after adjusting for potential confounders, including age, sex, body mass index, antihypertensive medication use, dyslipidemia, diabetes, and living room and outdoor temperatures. Significant interactions were not observed between sex and skin temperature in relation to systolic blood pressure and pulse rate (P = 0.088 and 0.490, respectively). One standard deviation lower living room temperature before bathing was significantly associated with a 0.41 °C (95% CI: 0.35-0.47) higher maximum skin temperature during bathing. CONCLUSIONS: Our findings suggest that pre-bath cold exposure may increase the skin temperature during hot-tub bathing, possibly resulting in excessive hemodynamic changes. This provides a framework for future interventions that utilize pre-bath thermal conditions and bathing environments to prevent bath-related deaths.

Longitudinal association between frequency of Internet use and incident disability among community-dwelling older people during the COVID-19 pandemic.

BACKGROUND: There is limited evidence of a protective effect of Internet use for incident disability (ID) during the COVID-19 pandemic. We investigated the association between frequency of Internet use (FIU) and ID among community-dwelling older people. METHODS: We used longitudinal data from the 2019 and 2022 surveys, including 7,913 residents aged ≥65 without disability at baseline. ID was defined as a new public long-term care insurance certification. FIU at baseline was categorized into daily, weekly, monthly, yearly, and non-users. Changes in FIU before and during the COVID-19 pandemic were categorized into continuing frequent (i.e., daily or weekly), continuing moderate (i.e., monthly or yearly), increase in frequency, from non-users to users, decrease in frequency, from users to non-users, and continuing non-users. Covariates included age, gender, education, perceived economic situation, family structure, body mass index, chronic medical conditions, dietary variety, working status, walking time, and cognitive functioning. Multivariable Poisson regression models were used to estimate adjusted cumulative incidence ratio (aCIR) and 95% confidence interval (CI) for ID. RESULTS: During the 3-year follow-up, 132 of 4,453 people aged 65-74, 595 of 3,460 people aged ≥75, 287 of 3,660 men, and 440 of 4,253 women developed ID. For FIU at baseline, among people aged ≥75 or men, there was a dose-response relationship between more frequent Internet use at baseline and a lower risk of ID (P-trend was 0.005 in people aged ≥75, and <0.001 in men). Compared to non-users, daily users had a significantly lower risk of ID [aCIR (95% CI) = 0.69 (0.53-0.90) in people aged ≥75, and 0.49 (0.34-0.70) in men]. For changes in FIU, "continuing frequent" and "from non-users to users" had a lower risk of ID than continuing non-users. After stratified analyses, "continuing frequent" remained a significant association in people aged ≥75 or in men, while "from non-users to users" had a significant association in those with daily walking time <30 minutes. CONCLUSIONS: Although FIU may act as a marker of disability, or indicate individual adaptability, our findings suggest that Internet use may be a potential preventive measure against ID in community-dwelling older people when social distancing is required.

Nationwide epidemiological survey of polyarteritis nodosa in Japan in 2020.

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that predominantly affects medium-sized arteries. With advances in our understanding of the pathogenesis and classification of vasculitis, PAN and microscopic polyangiitis (MPA), a disease of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), were separated from the group of diseases previously diagnosed as periarteritis nodosa (PN) at the Chapel Hill Consensus Conference (CHCC) in 1994 (1).

Daily light exposure profiles and the association with objective sleep quality in patients with Parkinson's disease: The PHASE study.

STUDY OBJECTIVES: Light information crucially influences the sleep initiation and continuity. The purpose of this study was to compare daily light exposure between patients with Parkinson's disease (PD) and non-PD older adults and evaluate the association of daily light exposure with objective sleep measures in patients with PD. METHODS: In this cross-sectional study of 189 outpatients with PD and 1101 community dwelling older adults (controls), daily light exposure was measured using wrist light meters during the daytime and light meters set in the bedrooms during the nighttime, and objective sleep quality was measured by wrist actigraphy. RESULTS: The median duration of exposure to ≥1000 lux light was significantly shorter in patients with PD than in controls. The median nighttime light intensity was higher in patients with PD than in controls. Among patients with PD, multivariable analysis suggested that the highest quartile of exposure to ≥1000 lux light during the daytime was linked to significantly higher sleep efficiency by 8.0% and shorter wake after sleep onset (WASO) by 36.9 min than the lowest quartile. During the nighttime, the highest quartile of mean light intensity had significantly lower sleep efficiency by 6.8%, longer WASO by 24.1 min, longer sleep onset latency, and higher fragmentation index, than the lowest quartile. Importantly, daytime and nighttime light levels were independently associated with objective sleep measures. CONCLUSION: The present study illustrated that greater daytime light exposure and lower nighttime light exposure are significantly associated with better objective sleep measures in patients with PD.

Zinc Supplementation and an Improved Quality of Life in Patients with Autoimmune Hepatitis.

Objecive Patients with autoimmune hepatitis (AIH) reportedly have an impaired quality of life (QOL), mainly due to depression, even during remission. In addition, hypozincaemia has been demonstrated in patients with chronic liver disease, including AIH, and is known to be related to depression. Corticosteroids are known to cause mental instability. We therefore investigated the longitudinal association between zinc supplementation and changes in the mental status among AIH patients treated with corticosteroids. Materials This study enrolled 26 patients with serological remission of AIH routinely treated at our facility after excluding 15 patients who either discontinued polaprezinc (150 mg/day) within 24 months or interrupted treatment. Two questionnaires, the Chronic Liver Disease Questionnaire (CLDQ) and SF-36, were adopted to evaluate the QOL before and after zinc supplementation. Results Serum zinc levels were significantly elevated after zinc supplementation (p<0.0001). The CLDQ worry subscale significantly improved after zinc supplementation (p=0.017), but none of the SF-36 subscales was affected. Multivariate analyses demonstrated that daily prednisolone dosing was inversely related to both the CLDQ worry domain score (p=0.036) and the SF-36 mental health component (p=0.031). There was a significant negative correlation between the changes in the daily steroid dose and the CLDQ worry domain scores before and after zinc supplementation (p=0.006). No serious adverse events occurred during the observation period. Conclusion Zinc supplementation safely and efficiently improved mental impairment, possibly caused by continuous treatment with corticosteroids, in patients with AIH.

Effects of a violet-excitation light-emitting diode on melatonin secretion and sleepiness: preliminary findings from a randomized controlled trial.

STUDY OBJECTIVES: A new type of lighting using violet-excitation light-emitting diodes (LEDs) with an action spectrum centered at approximately 405 nm was developed. Although violet-excitation LEDs can reduce melatonin suppression compared with blue-excitation LEDs, no studies have compared the effects of violet-excitation LEDs with those of blue-excitation LEDs on melatonin suppression. This study was designed to compare the effects of violet-excitation LEDs with those of blue-excitation LEDs on melatonin suppression, psychomotor vigilance, and sleepiness. METHODS: Sixteen healthy Japanese males aged 20-39 years were exposed to violet- and blue-excitation LEDs for 3 hours in a crossover randomized manner. The primary outcome was changes in salivary melatonin levels compared with the baseline levels. The secondary outcomes were changes in psychomotor vigilance and the Karolinska Sleepiness Scale. Melatonin suppression was calculated from the difference in the area under the curves between the baseline and intervention. RESULTS: Of the 16 participants, 15 completed the measurements. The baseline characteristics did not differ significantly between the 2 groups. After adjusting for age, a difference of 16.28 pg/mL in mean melatonin suppression was observed between the violet- and blue-excitation LED groups (-2.15 pg/mL vs -18.43 pg/mL; P = .006). The overall melatonin suppression by violet-excitation LEDs was 48.6% smaller than that by blue-excitation LEDs. No significant differences in psychomotor vigilance and sleepiness were observed between the 2 groups. CONCLUSIONS: Melatonin suppression in healthy Japanese males exposed to violet-excitation LEDs was significantly smaller than that in those exposed to blue-excitation LEDs. Our preliminary findings indicate that violet-excitation LEDs may have the potential to reduce the magnitude of blue-excitation LED-induced melatonin suppression. CITATION: Mitsui K, Saeki K, Sun M, Yamagami Y, Tai Y, Obayashi K. Effects of a violet-excitation light-emitting diode on melatonin secretion and sleepiness: preliminary findings from a randomized controlled trial. J Clin Sleep Med. 2024;20(1):101-109.

[Relationship between the number of public health nurses and the total number of people receiving home-visit nursing services for mental health/intractable diseases, and those numbers' regional differences].

Objectives　The primary aim of this study was to clarify the relationship between the number of public health nurses (PHNs) and the total number of people who received home-visit nursing services for mental health or intractable diseases. The secondary aim was to clarify the extent of regional differences in the number of PNHs and mental health or intractable diseases.Methods　This study used the total number of people who received home-visit nursing services for mental health or intractable diseases in 2019 from the Portal Site of Official Statistics of Japan (e-Stat) and population and area data in January 2020. Single and multiple regression analyses (covariates: population and area) were performed on the relationship between the number of PHNs per 100,000 population (abbreviated as "ratios of PHNs") and the total number of people who received home-visit nursing services for mental health or intractable diseases per 100,000 population (abbreviated as "mental health/intractable disease achievements"). Regional differences in ratios of PHNs and mental health/intractable disease achievement were examined using mean, standard deviation, maximum/minimum values, and Gini coefficients. Analyses were performed for each of the five units: the prefectures as a whole, prefectural public health centers, municipalities within the jurisdiction of prefectural public health centers, and cities in which public health centers are established (including or not including special wards).Results　Regression analyses indicated a positive relationship between the ratios of PHNs and mental health/intractable disease achievements. Multiple regression analysis indicated that both achievements were positively associated with population size and negatively associated with area size. The largest regression coefficients between the ratios of PHNs and achievements were 34.07 and 5.48 regarding mental health achievements and intractable disease achievements, respectively. For regional differences, the smallest Gini coefficient was the ratios of PHNs, and the largest was intractable disease achievements. The smallest and largest coefficient of the prefectures as a whole was 0.15 and 0.34, respectively. The maximum/minimum values of the prefectures as a whole also indicated that the smallest was 3.8 in the ratio of PHNs and the largest was 30.0 in intractable disease achievement.Conclusions　Increasing number of PHNs is needed to provide more home-visit nursing services for mental health and intractable diseases. It is particularly important to fill up the larger number of PHNs in smaller populations or larger area prefectures. Due to regional differences in the home-visit nursing service, it is important to promote the increase in the level of these activities.

Post-Illumination Pupil Response and Sleep Quality in Patients With Glaucoma: The LIGHT Study.

Purpose: This study aimed to investigate whether intrinsically photosensitive retinal ganglion cell function evaluated using post-illumination pupil response (PIPR) in patients with glaucoma is associated with sleep quality. Methods: This cross-sectional study measured the PIPR in 138 patients with glaucoma (mean age, 70.3 years) using pupil diameter after red and blue light exposure. The net PIPR change was classified into three groups according to tertiles (i.e., low, intermediate, and high groups), with lower net PIPR change indicating lower intrinsically photosensitive retinal ganglion cell (ipRGC) function. Subjective and objective sleep qualities were assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and actigraphy, respectively, with a total PSQI score of ≥6 indicating sleep disturbance. Results: The prevalence of subjective sleep disturbance significantly increased with decreasing tertile groups of net PIPR change (P = 0.036). Subgroup analysis obtained the same results in the severe glaucoma group (P = 0.004) but not in the non-severe glaucoma group. In the severe glaucoma group, multivariable logistic regression analysis adjusted for potential confounders showed a higher odds ratio for subjective sleep disturbance in the low-tertile group of net PIPR compared with the high-tertile group (odds ratio = 6.22; 95% confidence interval, 1.76-21.90; P = 0.004). Significant associations between PIPR and objective sleep quality (total sleep time, sleep efficiency, and wake after sleep onset) were found in the severe glaucoma group (P = 0.015, P = 0.013, and P = 0.015, respectively). Conclusions: The PIPR in patients with glaucoma was significantly associated with decreased sleep quality, independent of potential confounders.

Positive Association between Macular Pigment Optical Density and Glomerular Filtration Rate: A Cross-Sectional Study.

Although decreased macular pigment density is associated with the development of age-related macular degeneration (AMD), exactly how this decrease may contribute to the development of AMD is still not fully understood. In this study, we investigated the relationship between macular pigment optical density (MPOD) and estimated glomerular filtration rate (eGFR). MPOD was measured using MPS II (Electron Technology, Cambridge, UK) in 137 participants who showed no clinical signs of AMD at 3 months after cataract surgery, and simple and multiple linear regression analyses were performed to determine the associations with age, sex, abdominal circumference, diabetes, hypertension, smoking, intraocular lens color, visual acuity before and after surgery, and eGFR. The participants were divided into two groups based on the median MPOD (0.58): the high-pigment and low-pigment groups. The mean value of eGFR in the high-pigment group was significantly higher than that in the low-pigment group (64.2 vs. 58.1, p = 0.02). The simple linear regression analysis revealed a significant positive association between MPOD and eGFR (ß = 0.0034, 95% confidence interval [CI]: 0.0011-0.0056, p = 0.0038), and this association was independent of age, sex, abdominal circumference, diabetes, smoking, hypertension, best-corrected visual acuity (BCVA) before surgery, BCVA after surgery, and intraocular lens color (ß = 0.0033, 95% CI: 0.00090-0.0058, p = 0.0076). These results show a strong association of renal dysfunction with the decrease in MPOD.

Association between circadian skin temperature rhythms and actigraphic sleep measures in real-life settings.

STUDY OBJECTIVES: Skin temperature manipulation with little or no change in core body temperature affects sleep-wake states; however, the association of 24-hour skin temperature variation with sleep quality has not been investigated in a large-scale population. We examined the association between the circadian rhythm of distal skin temperature and sleep quality in real-life settings and aimed to provide additional evidence of the link between thermoregulation and sleep-wake states. METHODS: In this cross-sectional study of 2,187 community-dwelling adults, we measured distal skin temperature at the ventral forearm at 3-minute intervals for 7 consecutive days to calculate nonparametric indicators of a circadian skin temperature rhythm, including intradaily variability, interdaily stability, and relative amplitude. Participants underwent simultaneous 7-day wrist actigraphy to objectively measure sleep quality. The association between nonparametric circadian skin temperature rhythm indicators and 7-day sleep measures was evaluated using multivariable linear regression models. RESULTS: Lower intradaily variability and higher interdaily stability and relative amplitude of distal skin temperature were significantly associated with higher sleep efficiency, shorter wake after sleep onset, and longer total sleep time (all P < .001). After adjusting for demographic, clinical, and environmental factors, the coefficients for the linear trend of sleep efficiency were -1.20 (95% confidence interval: -1.53, -0.87), 1.08 (95% confidence interval: 0.80-1.36), and 1.47 (95% confidence interval: 1.04-1.89) per quartile increase in intradaily variability, interdaily stability, and relative amplitude, respectively (all P < .001). CONCLUSIONS: Distal skin temperature with lower fluctuations and higher regularity and rhythm amplitudes was associated with better sleep quality. Our results could be applied in chronobiological interventions to improve sleep quality. CITATION: Tai Y, Obayashi K, Yamagami Y, Saeki K. Association between circadian skin temperature rhythms and actigraphic sleep measures in real-life settings. J Clin Sleep Med. 2023;19(7):1281-1292.

Parents' Fears about Hospital Visits and Trait Anxiety in the COVID-19 Pandemic.

Anxiety in parents of children with allergic diseases during the COVID-19 pandemic may impact hospital visits. This study explored the effect of the pandemic on parents' fears about hospital visits and their relationship with their personality traits. A cross-sectional, questionnaire-based study was conducted between September 2020 and March 2021, with parents of children aged 0-15 years, who regularly visited 24 outpatient facilities for allergic disease. The survey included patient information, fears about hospital visits, desired information, and the State-Trait Anxiety Inventory. Responses were compared between parents with high and low trait anxiety. The response rate was 97.6% (2439/2500). The most common fear was "Fear of getting medical care as usual (85.2%)" and "Fear of COVID-19 infection during hospital visits (87.1%)". High trait anxiety showed a significant association with "Fear of worsening of children's allergies" (adjusted OR: 1.31, 95%CI: 1.04 to 1.65, p = 0.022), and "Fear of worsening of COVID-19 due to allergy" (adjusted OR: 1.52, 95%CI: 1.27 to 1.80, p < 0.01). Healthcare professionals should share updates on COVID-19 and healthcare system to reduce parents' fear. Subsequently, they should communicate the importance of continuing treatment to prevent worsening of COVID-19 and avoid emergency visits, considering parental trait anxiety.

Circadian blood pressure variability and asymmetric dimethylarginine in patients with glaucoma: cross-sectional study of The LIGHT cohort.

OBJECTIVE: Glaucoma is reportedly associated with asymmetric dimethylarginine (ADMA) and circadian blood pressure (BP) variability, including night-time SBP. We determined whether ADMA level is associated with night-time SBP in patients with glaucoma. METHODS: In this cross-sectional study, we measured the serum ADMA level and ambulatory BP of 163 patients with glaucoma and 705 participants without glaucoma. Based on the tertiles of serum ADMA level, the patients were divided into three groups: low, intermediate, and high-ADMA. Night-time SBP was determined based on ambulatory BP measured every 30 min for 48 h. The nondipper BP pattern was defined as having a night-time mean SBP decline of less than 10% relative to the mean daytime SBP. RESULTS: In the glaucoma group, the night-time SBP in the high-ADMA group was significantly higher than in the low-ADMA group (123.0 and 114.4 mmHg, respectively; P  = 0.003). Multivariable analysis adjusted for the potential confounders showed the night-time SBP, and the odds ratio for nondipper in the high-ADMA group were also significantly higher than in the low-ADMA group ( P  = 0.030 and P  = 0.021, respectively). Significant associations between continuous serum ADMA levels with night-time SBP and nondipper were also found ( P  = 0.002 and 0.006, respectively). In the control group, however, no significant associations were found between serum ADMA levels and night-time SBP and nondipper. A significant interaction effect of the serum ADMA levels and glaucoma on nondipper was found ( P  = 0.004). CONCLUSION: Serum ADMA level was significantly associated with the disturbance of circadian BP variability in patients with glaucoma.

An ecological association of number of civil servants and physicians with prefectural-level rapid COVID-19 vaccination of older people in Japan.

BACKGROUND: Civil servants and physicians play an important role in combating COVID-19. However, it is unclear whether the number of civil servants and physicians is associated with rapid COVID-19 vaccine uptake among older people (i.e., smoother rollout of priority vaccination for older people). METHODS: Using Poisson regression models of the generalized estimating equations, we examined the ecological association of the number of civil servants and physicians with prefectural-level rapid COVID-19 vaccination in older people. Prefectural-level data were based on publicly available government surveys. The outcome variable was the proportion of fully vaccinated people aged 65 and older on the day with the largest standard deviation across 47 prefectures (i.e., July 6, 2021). The explanatory variable was the number of civil servants and physicians per population by prefecture. RESULTS: After adjusting for population density, influenza vaccination coverage, socioeconomic factors, natural environmental factors, health indicators, and the number of civil servants and physicians, in all 3 models, prefectures with the highest number of civil servants and physicians had faster COVID-19 vaccine uptake than prefectures with the lowest number. A significant trend between higher staffing levels and more rapid vaccination was observed for the number of physicians in all 3 models, but for the number of civil servants only in one model. CONCLUSION: We found that COVID-19 vaccine uptake among older people was more rapid in prefectures with more civil servants and physicians per population, with the number of physicians having a stronger association. This study may point the way to future areas of research on vaccine policies that include other age groups and infectious diseases.

Circadian variability of objective sleep measures predicts the relapse of a mood episode in bipolar disorder: findings from the APPLE cohort.

AIM: Sleep disturbance, a core feature of bipolar disorder, is closely associated with mood symptoms. We examined the association between actigraphy sleep parameters and mood episode relapses in patients with bipolar disorder. METHODS: This prospective cohort study analyzed 193 outpatients with bipolar disorder who participated in the Association between the Pathology of Bipolar Disorder and Light Exposure in Daily Life (APPLE) cohort study. The participants' sleep was objectively evaluated via actigraphy over seven consecutive days for the baseline assessment and then at the 2-year follow-up appointment for mood episode relapses. The actigraphy sleep parameters were presented using the mean and variability (standard deviation) of each sleep parameter for 7 days. RESULTS: Of the 193 participants, 110 (57%) experienced mood episodes during follow-up. The participants with higher variability in total sleep time had a significantly shorter mean estimated time to mood episode relapses than those with lower variability (12.5 vs. 16.8 months; P < 0.001). The Cox proportional hazards model, when adjusted for potential confounders, demonstrated that variability in total sleep time was significantly associated with an increase in the mood episode relapses (per hour; hazard ratio [HR], 1.407; 95% confidence interval (CI), 1.057-1.873), mainly in the depressive episodes (per hour; HR, 1.477; 95% CI, 1.088-2.006). CONCLUSIONS: Our findings suggest that consistency in sleep time might be useful, as an adjunct therapy, in preventing the recurrence or relapse of mood episodes in bipolar disorder.

Comparison of rush-subcutaneous and sublingual immunotherapy with house dust mite extract for pediatric allergic rhinitis: A prospective cohort study.

BACKGROUND: We aimed to compare the effectiveness and safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) with standardized house dust mite (HDM) extract for allergic rhinitis. METHODS: Participants with allergic rhinitis selected their treatment between HDM SCIT or HDM SLIT, according to their wishes. We prospectively followed symptoms of allergic rhinitis using the allergic rhinitis symptom medication score (ARSMS), along with adverse reactions, during the dose escalation and maintenance phases for two years. We compared the outcomes between propensity score-matched groups to adjust the confounding factors. RESULTS: After propensity score matching, 88 patients in the HDM SCIT (n = 44) and HDM SLIT groups (n = 44) remained for analysis. The HDM SCIT group showed significantly earlier effectiveness than the HDM SLIT group (median time to decrease in ARSMS [≥2 points]: 5.5 vs. 18.0 months, p < 0.001). The incidence of systemic reactions was not significantly different between the two groups in the dose escalation phase (68.2% vs. 56.8%, p = 0.379). In the maintenance phase, the incidence of systemic reactions was higher in the HDM SCIT group than in the HDM SLIT group (18.2% vs. 0%, p < 0.006). All 44 patients in the HDM SCIT group completed two years of treatment, while nine patients in the HDM SLIT group discontinued treatment. CONCLUSIONS: The HDM SCIT group showed an earlier onset of therapeutic effect and a lower discontinuation rate than the HDM SLIT group, although more severe systemic reactions were observed during the maintenance phase.

Increased depressive symptoms in Parkinson's disease during the COVID-19 pandemic: Preliminary findings from longitudinal analysis of the PHASE study.

Introduction: The cumulative number of patients has increased through the four waves of the pandemic in Japan. Many people experienced mental stress due to the fear of infection, and restrictions of leaving the house and leisure activities. No longitudinal study has assessed the fluctuation of neuropsychiatric symptoms during the COVID-19 pandemic using the same scale. We examined changes in non-motor symptoms, and the scores of a Parkinson's Disease (PD)-specific questionnaire between the early and later periods during the COVID-19 pandemic. Methods: We conducted a questionnaire survey during the first wave (from February to April 2020) and the fourth wave of the COVID-19 pandemic (from March to April 2021). We compared the number of symptoms from the two periods. Results: Compared with the first wave, the Geriatric Depression Scale score was significantly higher in the fourth wave of the pandemic (median score of GDS: 4.00 vs. 5.50, p = 0.022). Consistently, the scores of symptoms on MDS-UPDRS part 1 in the fourth wave were significantly higher in hygiene (p = 0.033), handwriting (p = 0.033), performing hobbies and other activities (p = 0.035), and turning in bed (p = 0.046) than in the first wave. Conclusions: Our observation over a year between the early and later phases of the COVID-19 pandemic showed an increase in the severity of depression in patients with PD.

Nationwide clinical and epidemiological study of large-vessel vasculitis in Japan in 2017.

OBJECTIVE: We conducted a nationwide epidemiological study to estimate the number of patients with Takayasu arteritis (TAK) and giant cell arteritis (GCA) in Japan and to describe the clinical characteristics of these patients. METHODS: The first survey was designed to estimate the number of patients with TAK and GCA who were treated at medical institutions in Japan in 2017. The second survey was designed to collect data on the clinical characteristics of the patients who were reported in the first survey. RESULTS: Of the 3495 institutions selected for the first survey, 1960 (56.1%) responded. The number of patients with clinically diagnosed TAK and GCA was estimated to be 5320 (95% confidence interval, 4810-5820) and 3200 (95% confidence interval, 2830-3570), respectively. Aortic regurgitation was reported in 35% of patients with TAK, and eye-related comorbidities were observed in 30.4% of patients with GCA. The common carotid and internal carotid arteries were the most frequently involved in patients with TAK (62.7%). Subclavian artery lesions and thoracic or abdominal aorta lesions were reported in 31% and 42.6% of patients with GCA, respectively. CONCLUSIONS: The number of patients with TAK and GCA was estimated simultaneously, and significant differences in clinical characteristics were observed between the two diseases.

Association between indoor noise level at night and objective/subjective sleep quality in the older population: a cross-sectional study of the HEIJO-KYO cohort.

STUDY OBJECTIVES: Noise exposure could be an important risk factor for low sleep quality; however, evidence on indoor noise in large-scale populations is limited. We evaluate the association between indoor noise at night and objective and subjective sleep quality in the older population. METHODS: In this cross-sectional study of 1076 participants (≥60 years), we measured indoor noise at night (A-weighted equivalent noise from bedtime to rising time [LAeq]) using a portable noise level meter set in bedrooms and sleep quality using actigraphy and a questionnaire for 2 nights. Using multivariable linear regression models, we examined the associations between indoor noise at night and objective and subjective sleep parameters independent of potential confounders such as age, body mass index, and sleep medication. RESULTS: Increased indoor noise at night by 1 dB of LAeq was significantly associated with lower objective sleep quality, such as lower sleep efficiency (regression coefficient [ß], -0.19%; 95% confidence interval [95% CI], -0.26 to -0.12; p < 0.001), longer log-transformed sleep onset latency (ß, 0.02 log min; 95% CI 0.01 to 0.03; p< 0.001) and wake after sleep onset (ß, 0.66 min; 95% CI 0.40 to 0.92; p < 0.001), and higher log-transformed fragmentation index (ß, 0.01; 95% CI 0.008 to 0.017; p < 0.001). These results remained consistent in the analysis using noise-event rate (≥45 dB) as an independent variable. CONCLUSION: This study revealed the quantitative association between indoor noise at night and objective and subjective sleep quality in the older population. Reducing noise and improving sleep quality may prevent fatal diseases.