Earlier BMI rebound and lower pre-rebound BMI as risk of obesity among Japanese preschool children.

OBJECTIVES: Longitudinal growth data of children were analyzed to clarify the relationship between the timing of body mass index (BMI) rebound and obesity risk in later ages. SUBJECTS/METHODS: Of 54 558 children born between April 2004 and March 2005 and longitudinally measured in April and October every year in the preschool period, 15 255 children were analyzed wherein no longitudinal measurement is missing after 1 year of age. BMI rebound age was determined as the age with smallest BMI value across longitudinal individual data after 1 year of age. Rebound age was compared between overweight and non-overweight groups. The subjects were divided into groups based on the timing of rebound. The sex- and age-adjusted mean of the BMI, height and weight s.d. scores for age group, along with 6 months weight and height gain, were compared among groups using analysis of covariance. RESULTS: Among those who were overweight at 66-71 months of age, BMI rebound age obtained at approximately 3 years of age was compared with the non-overweight group, whose BMI rebound age was utmost 66 months or later (P<0.001). The comparison among BMI age group showed that earlier BMI rebound results in larger BMI (P<0.001) and larger weight and height gain after the rebound (P<0.001). Among the group with BMI rebound earlier than 30 months of age, low BMI was observed (P<0.001). Slight elevation of height and weight gain was observed before the BMI rebound among groups with rebound age earlier than 60 months of age (P<0.001). CONCLUSION: Earlier BMI rebound timing with pre-rebound low BMI leads to greater childhood obesity risk; hence, early detection and prevention is necessary for such cases.

Longitudinal changes in body mass index of children affected by the Great East Japan Earthquake.

BACKGROUND: The evacuation and disruption in housing caused by the 2011 Great East Japan Earthquake and following nuclear radiation may have influenced child health in many respects. However, studies regarding longitudinal childhood growth are limited. Therefore, in this study we aimed to explore the influence of the earthquake on longitudinal changes in body mass index in preschool children. METHODS: Participants were children from nursery schools who cooperated with the study in the Iwate, Miyagi and Fukushima prefectures. The exposed group consisted of children who experienced the earthquake during their preschool-age period (4-5 years old). The historical control group included children who were born 2 years earlier than the exposed children in the same prefectures. Trajectories regarding body mass index and prevalence of overweight/obesity were compared between the two groups using multilevel analysis. Differences in the changes in BMI between before and after the earthquake, and proportion of overweight/obesity was compared between the two groups. We also conducted subgroup analysis by defining children with specific personal disaster experiences within the exposed group. RESULTS: A total of 9722 children were included in the study. Children in the exposed group had higher body mass indices and a higher proportion of overweight after the earthquake than the control group. These differences were more obvious when confined to exposed children with specific personal disaster experiences. CONCLUSIONS: Children's growth and development-related health issues such as increased BMI after natural disasters should evoke great attention.

Association of incompleteness of the anterior part of the circle of Willis with the occurrence of lacunes in the basal ganglia.

BACKGROUND AND PURPOSE: This study investigated whether incompleteness of the anterior part of the circle of Willis affects the occurrence of lacunes in the basal ganglia. METHODS: One thousand and seventy-seven healthy individuals examined by magnetic resonance (MR) imaging and MR angiography were divided into eight subgroups according to our new classification. RESULTS: Logistic regression analysis demonstrated that healthy individuals with incompleteness of the anterior circle of Willis had significantly higher frequency of lacunes [odds ratio (OR): 2.121, 95% confidence interval (CI): 1.477-3.108; or OR: 2.46, 95% CI: 1.377-4.384 in cases without or with fetal type posterior communicating artery, respectively] and higher numbers of lacunes (P < 0.001 or P < 0.001 in cases without or with fetal type posterior communicating artery, respectively) compared to patients with complete circle of Willis. CONCLUSIONS: Incompleteness of the anterior part of the circle of Willis significantly affected the occurrence of lacunes.

Gender differences in the association between maternal smoking during pregnancy and childhood growth trajectories: multilevel analysis.

OBJECTIVES: This study examines the gender differences in the association between maternal smoking during pregnancy and later growth in childhood. DESIGN: Ongoing prospective cohort study, which is called 'the Project Koshu', initiated in the foetal stage to the age of 9-10 years. SETTING: Koshu City which was in Japanese rural area. PARTICIPANTS: The study population comprised children born between 1 April 1991 and 31 March 1999 in Koshu City, Japan, and their mothers. Maternal smoking during early pregnancy was the exposure studied. MAIN OUTCOME MEASURES: Childhood body mass index (BMI) and BMI z-score trajectories of the children born to the smoking and non-smoking mothers by gender. Multilevel analysis that includes both individual and age as different-level variables was used for statistical analyses. RESULTS: The participating mothers delivered 1619 babies during the study period. Birth weight and anthropometric data were collected from 1603 (at birth, 99.0%), 1358 (at age 3, 83.9%), 1248 (at age 5, 77.1%), 1270 (at age 7-8, 78.4%) and 1274 (at age 9-10, 78.7%) of these children. The mean birth weight of both the male and female children whose mothers had smoked during pregnancy was significantly low compared with those born to non-smoking mothers (P < 0.01). However, the childhood BMI at each subsequent checkup age significantly increased only among the male children born to the smoking mothers. Moreover, this increase was continuously observed after 3 years of age. The results of BMI z-score analysis were also similar to these of BMI analysis. CONCLUSIONS: Smoking by pregnant women decreases the infant birth weight irrespective of gender but increases childhood weight gain especially by male children. The results might be valuable to explore the mechanism of fetal programming.

Relative deprivation and incident functional disability among older Japanese women and men: prospective cohort study.

BACKGROUND: A prospective observational study was conducted to test the hypothesis that relative deprivation was associated with incident physical or cognitive disability, independent of absolute income. METHODS: Study subjects consist of 9463 non-disabled people aged 65+ years in the Aichi Gerontological Evaluation Study (AGES), Aichi prefecture, Japan. Baseline mail-in survey in 2003 gathered information on income, educational attainment, lifestyle factors (smoking, alcohol consumption and health check-up) and healthcare utilisation. Three-year incidence of disability was assessed through public long-term care insurance databases and resident registry. RESULTS: A total of 7673 subjects (81%) with complete information were analysed. Our measure of relative deprivation was the Yitzhaki index across eight reference groups, which calculates the deprivation suffered by each individual as a function of the aggregate income shortfall for each person relative to everyone else with higher incomes in that person's reference group. Cox regression demonstrated that, after controlling for sociodemographic factors (including absolute income), the hazard ratio (and 95% confidence intervals) of incident physical/cognitive disability per one standard deviation increase in relative deprivation ranged from 1.13 (0.99 to 1.29) to 1.15 (1.01 to 1.31) in men and from 1.11 (0.94 to 1.31) to 1.18 (1.00 to 1.39) in women, depending on the definition of the reference group. Additional adjustment for lifestyle factors attenuated the hazard ratios to statistical non-significance. CONCLUSION: Relative deprivation may be a mechanism underlying the link between income inequality and disability in older age, at least among men. Lifestyle factors in part explain the association between relative deprivation and incident disability.

Economic recession and health inequalities in Japan: analysis with a national sample, 1986-2001.

OBJECTIVE: Little is known about whether economic crises widen health inequalities. Japan experienced more than 10 years of economic recession beginning in the 1990s. The question of whether socioeconomic-based inequality in self-rated health widened after the economic crisis was examined. DESIGN, SETTING AND PARTICIPANTS: Repeated cross-sectional survey design. Two pooled datasets from 1986 and 1989 and from 1998 and 2001 were analysed separately, and temporal change was examined. The study took place in Japan among the working-age population (20-60 years old). The two surveys consisted of 168 801 and 150 016 people, respectively, with about an 80% response rate. RESULTS: The absolute percentages of people reporting poor health declined across all socioeconomic statuses following the crisis. However, after controlling for confounding factors, the odds ratio (OR) for poor self-rated health (95% confidence intervals) among middle-class non-manual workers (clerical/sales/service workers) compared with the highest class workers (managers/administrators) was 1.02 (0.92 to 1.14) before the crisis but increased to 1.14 (1.02 to 1.29) after the crisis (p for temporal change = 0.02). The association was stronger among males. The adjusted ORs among professional workers and young female homemakers also marginally increased over time. Unemployed people were twice as likely to report poor health compared with the highest class workers throughout the period. Self-rated health of people with middle to higher incomes deteriorated in relative terms following the crisis compared with that of lower income people. CONCLUSIONS: Self-rated health improved in absolute terms for all occupational groups even after the economic recession. However, the relative disparity increased between the top and middle occupational groups in men.

Risk factors for the association of intracranial and aortic aneurysms.

This study investigated the association of intracranial aneurysms and abdominal aortic aneurysms to elucidate the incidence and independent risk factors for this association. Ultrasonography of the abdominal aorta was performed in 181 patients with 224 intracranial aneurysms. Six patients had suffered subarachnoid haemorrhage and the others had chronic disease or no symptoms. Magnetic resonance angiography was performed for confirmation if abdominal aortic aneurysm was identified by ultrasonography. Thirteen patients (7.2%) with 23 intracranial aneurysms had abdominal aortic aneurysms. Univariate analysis demonstrated that age (p < 0.01), size of intracranial aneurysms (p < 0.001), male sex (p < 0.01), multiplicity of intracranial aneurysms (p < 0.001), history of cerebrovascular diseases (p < 0.05), and current smoking (p < 0.0001) were significantly different between patients with and without this association. Multiple logistic analysis indicated that age (odds ratio [OR] 1.27, 95% confidence interval 1.08-1.48, p < 0.01), multiplicity (OR 22.1, 95% confidence interval 1.83-266.3, p = 0.01), size of intracranial aneurysms (OR 1.30, 95% confidence interval 1.10-0.54, p < 0.01), and current smoking (OR 33.3, 95% confidence interval 2.43-456.7, p = 0.01) were independent risk factors for the association. Patients with intracranial aneurysms who are older males with multiple or large intracranial aneurysms, and current smokers should be examined for abdominal aortic aneurysms using ultrasonography.

The impact of multiple role occupancy on health-related behaviours in Japan: differences by gender and age.

OBJECTIVES: We examined gender and age differences in the impact of multiple role occupancy on health-related behaviours and health status among working age Japanese adults. METHODS: We analysed the individually linked, nationally representative data of 5693 respondents aged 20-59, who completed the Comprehensive Survey of the Living Conditions of People on Health and Welfare and the National Nutrition Survey, conducted by the Japanese government in 1995. RESULTS: Younger women benefited from multiple roles (less smoking), while younger men demonstrated more high-risk behaviours (more smoking, heavier drinking). By contrast, middle-aged men benefited from multiple roles (less smoking, fewer health problems), while middle-aged women reported lower health maintenance behaviours (less exercise, fewer health check-ups). CONCLUSIONS: Japanese society appears to be undergoing a transition in gender roles, as reflected by age and gender differences in the impact of multiple roles on health and health-related behaviours. Middle-aged males benefit from multiple roles (being the primary bread-winner and being married), while middle-aged women do not. This pattern seems to break down for younger Japanese men and women.

Musculoskeletal disorders among hospital nurses in rural Japan.

INTRODUCTION: Although musculoskeletal disorders (MSD) represent a significant occupational problem for hospital nurses, few investigations target nurses in rural facilities. This study investigated the prevalence and correlates of MSD among nurses within an affiliated hospital conglomerate of rural Japan. METHODS: A self-reporting survey was used as diagnostic tool; the reliability, validity and cost-effectiveness of this method has been established. RESULTS: An initial group of 329 nurses was recruited from three affiliated, rural locations in Yamanashi prefecture, central Japan; 247 usable replies were obtained (final response rate: 75.1%). The 12-month period-prevalence of self-reported MSD at any body site was 91.9% (95% CI 87.8-94.7). Low back pain (LBP) was the most commonly reported MSD with a prevalence of 82.6% (95% CI 77.4-86.8). Next most reported were shoulder (61.1%, 95% CI 54.9-67.0), neck (36.8%, 95% CI 31.1-43.0), upper back (29.1%, 95% CI 23.8-35.1), knee (23.5%, 95% CI 18.6-29.1) and upper leg MSD (19.4%, 95% CI 15.0-24.8). MSD of the wrist (14.2%, 95% CI 10.4-19.1), upper arm (13.0%, 95% CI 9.3 -17.7) and lower arm (11.7% 95% CI 8.3-16.4) were less common. Logistic regression indicated that nurses who were regularly involved in the manual handling of patients had an increased LBP risk of 16.7 (OR 16.7, 95% CI 1.3-412.7, p = 0.0340) when compared with nurses who were not involved in manual handling of patients. CONCLUSION: Overall, our study indicated that MSD is common among rural Japanese nurses and its prevalence is consistent between related facilities. The excessive amount of LBP, however, suggests that Japanese nurses are at higher risk of this condition compared with their foreign counterparts.

[Structural quantification of bone from radiographs using power spectral analysis].

Bone mineral density (BMD) and bone structure are very important indices for prevention of fracture. However, it is very difficult to quantify bone structure, and only a few indices for structural quantification of bone have been reported. The purpose of this research was to investigate a new index for bone structure. The subjects were 52 women aged from 20 to 85 years. Directivity index (DI) is a new index of bone structure calculated by directivity of power spectrum from radiographs of metacarpal bone using fast Fourier transform (FFT). DI was obtained by subtracting the integral power value at 0 and 90 degree directions on the x-y plane of the two-dimensional power spectrum of bone from the integral power value at a direction of 45 degrees. A significant relationship between BMD and DI was indicated by correlation coefficient. However, no significant relationship between BMD and the first moment of the Fourier power spectrum or the fractal dimension was found. There is a possibility that DI estimates a slight deformation of bone structure. In the future, we will apply DI to the prevention of fractures and osteoarthritis.

Analysis of myocilin gene mutations in Japanese patients with normal tension glaucoma and primary open-angle glaucoma.

The myocilin gene was identified as a gene (MYOC) that caused primary open-angle glaucoma (POAG). Although a normal tension glaucoma (NTG) patient with the myocilin gene mutation was previously reported, no study using large numbers of patients with NTG has been reported. Single-strand conformation polymorphism analysis and subsequent sequence analysis were performed for genotyping the myocilin gene in 114 unrelated Japanese patients with NTG. One hundred and nineteen patients with POAG and 100 control subjects without glaucoma were studied as reference subjects. Five amino acid sequence changes of the myocilin were identified: Arg46Stop (one NTG), Arg76Lys (four NTG, 10 POAG, seven control), Arg158Gln (one NTG, one POAG, one control) found in only Japanese, Asp208Glu (four NTG, three POAG, one control), Pro481Ser (one control). Pro481Ser was novel. Arg76Lys always occurred with 1-83 from G to A in the promoter as it was reported in Chinese. Although some Japanese patients with NTG had sequence changes of the myocilin gene, there were no apparent specific mutations in patients with NTG.

A sequence change (Arg158Gln) in the leucine zipper-like motif region of the MYOC/TIGR protein.

The myocilin/trabecular meshwork-inducible glucocorticoid response (MYOC/TIGR) gene was identified as a gene that caused open angle glaucoma (OAG). Single-strand conformation polymorphism analysis and subsequent sequence analysis were performed for the MYOC/TIGR gene in 120 unrelated Japanese OAG patients with increased intraocular pressure (IOP), 116 unrelated OAG patients without increased IOP, and 106 unrelated control subjects without glaucoma. An Arg158Gln sequence change in the leucine zipper-like motif (LZM) region in the myosin-homology domain was found in 2 OAG patients with or without increased IOP, and in a 56-year-old control subject without glaucoma. This is the first report of missense sequence change in the LZM region of the MYOC/TIGR protein in subjects showing various phenotypes, including a control subject. These findings suggest that Arg158Gln in the LZM region is probably a rare nondisease-causing polymorphism, despite its important role in this region, because it was found in a control subject, although Arg158Gln was previously reported as a probable disease-causing mutation.

[A study of the relation between providing healthcare information and behavior changes of people in Japan. Parental behavior changes after receiving information about the sudden infant death syndrome].

OBJECTIVE: Considering the lack of evidence concerning the relationship between providing healthcare information and behavior of people in Japan, we utilized a questionnaire to survey the parents of infants to evaluate behavior change after receiving information about the Sudden Infant Death Syndrome (SIDS). METHODS: A questionnaire about SIDS information was administered in 234 municipalities in Niigata, Gifu, Shizuoka, and Hiroshima Prefectures and in Yokohama City in November and December of 1999 to 14,879 parents who visited for the 18-month health examination of their children. The questionnaire did not ask for the participants' names. Logistic regression analysis was used to study the connection between behavior change and SIDS information sources. RESULTS: 10,900 parents returned the questionnaire to give a 73.3% response rate, 19.0% of these receiving information about SIDS risk factors from hospitals or clinics, 3.7% from public health centers, and 9.2% from their friends. More received information from the mass media such as TV programs, which provided the main source for 71.1% of the parents. The degree of behavior change was evaluated after adjustment for variables concerning a variety of information sources and other appropriate factors such as the age and sex of parents and the number of their children. We found that receiving information from hospitals or clinics significantly influences behavior changes for all kinds of risk factors. Information from public health centers, baby-care groups, and friends influenced behavior changes relevant to the risk factors for feeding methods, sleeping position, and parents' smoking. There was no relation between receiving information from the mass media and behavior change of parents. CONCLUSIONS: The mass media provide far more information than do medical facilities, public health centers, baby-care groups and personal contacts but the latter played much more effective roles in making parents change their baby care behavior. These results point to an obvious discrepancy between efficiency in providing information and the degree of behavior change elicited. We should thus take the source of information and the target population into consideration when we examine the best way to provide healthcare information for people in the future.

Associations between retrospectively recalled napping behavior and later development of Alzheimer's disease: association with APOE genotypes.

To evaluate putative risk factors for Alzheimer's disease (AD), we conducted a case-control study with exposure assessment performed after disease onset. In this study, we evaluated the effect of recalled habitual napping according to its duration and examined whether APOE genotype modifies the effect. The subjects were 337 patients (144 men, 193 women, age at onset and the time of study (years): 69+/-10, 73+/-9) with a diagnosis of probable AD based on the NINCDS-ADRDA criteria. Two hundred and sixty spouses of the subjects (94 men, 166 women, age at the time of study: 69+/-9) served as controls. We asked retrospectively about habitual (3 or more days per week) napping and its duration observed between 5 and 10 years before the onset of AD for cases, and between 5 and 10 years before the time of the study for controls. The analysis revealed that limited napping for up to 60 min had an apparently protective effect against the development of AD, especially for carriers of the APOEepsilon 4 allele. By contrast, napping for more than 60 min increased the risk of AD morbidity among the carriers of the allele. Habitual napping may modulate or disturb the physiological functions of sleep and circadian time-keeping according to its duration, and this might be associated with some mechanism that leads to the development of AD.

Statistical analysis of factors affecting the outcome of patients with ruptured distal anterior cerebral artery aneurysms.

The clinical factors affecting the outcome of patients with ruptured distal anterior cerebral artery (ACA) aneurysms were analyzed using multiple logistic regression analysis. The medical records were reviewed of 52 patients (57 aneurysms) with ruptured distal ACA aneurysms operated on by the same neurosurgeon over 25 years. The standard policy was early surgery for patients in Hunt and Kosnik grades I to IV. Age, sex, Hunt and Kosnik grade, timing of operation, size of aneurysms, number of aneurysms, association of intracerebral haemorrhage (ICH), intraventricular haemorrhage, and azygos ACA, use of temporary clipping, occurrence of premature rupture, and presence of psychiatric change were investigated. Univariant analysis disclosed that clinical grade (P = 0.0006), size of aneurysm (P = 0.005), and size of ICH (P = 0.012) affected the outcome of patients. Multiple logistic regression analysis found that Hunt and Kosnik grade (P = 0.010) and timing of operation (P = 0.033) affected the outcome. There was no significant relationship between long-term outcome and clinical factors, although a close relationship was found with Hunt and Kosnik grade (P = 0.071). Clinical grade and timing of the operation affected the outcome of patients with ruptured distal ACA aneurysms. Patients harboring ICH of over 3 cm diameter in poor grades should also be carefully treated.

[Sex differences in subjective well-being and related factors in elderly people in the community aged 75 and over].

Sex differences in factors related to subjective well-being were evaluated in people in their late old age by interviewing individuals aged 75 years and over living in 2 regions of Enzan City, Yamanashi Prefecture. The 17-item revised "Philadelphia Geriatric Center (PGC) Morale Scale" was used for evaluation of subjective well-being. Factors related to family status, employment, health related factors, activities of daily living, and results of physical examinations were each classified into two or more categories, and PGC Morale Scale points were compared among the categories for all subjects and separately for males and females using the Mann-Whitney test and the Kruskal-Wallis test. 1) Although the mean age of males (80.0 +/- 4.4 years) and females (80.4 +/- 4.3 years) was no significantly difference, PGC Morale Scale points were significantly higher in males than in females (p < 0.05), indicating a sex difference in subjective well-being. 2) In elderly females, subjective well-being was related to many factors, and there was a particularly strong relationship between subjective well-being and both health related factors and activities of daily living. 3) In elderly males, the factors related to subjective well-being were fewer than in females, consisting only of "social opportunities", "hobbies", and "grip strength". Since factors related to subjective well-being differ between the sexes, these differences must be taken into account when evaluating subjective QOL of the elderly.

[Distribution of genotypes of alcohol dehydrogenase 2 and aldehyde dehydrogenase 2 in Japanese twin children].

OBJECTIVE: In order to prevent alcohol related deseases, this study investigated the distribution of the genes controlling alcohol metabolism in Japan's twin. METHODS: Restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) technique was used to measure the control gene of alcohol metabolized enzymes and the genotypes of alcohol dehydrogenase 2 (ADH2) and aldehyde dehydrogenase 2 (ALDH2), which were distributed in Japan's twins. At the same time, according to the difference in genotypes, the sensitive individuals were screened from the study subjects. RESULTS: The distribution of ADH2 and ALDH2 genes were consistent with the Hardy-weinberg equation. The three genotypes of ADH2 gene were ADH2(1)/ADH2(1) (1.1%), ADH2(1)/ADH2(2) (44.6%) and ADH2(2)/ADH2(2) (54.3%). And those of ALDH2 gene were ALDH2(1)/ALDH2(1) (41.3%), ALDH2(1)/ALDH2(2) (39.1%) and ALDH2(2)/ALDH2(2) (19.6%). The frequency of ADH2 and ALDH2 genes was 0.255, 0.745 and 0.609, 0.391 respectively. CONCLUSION: Not only the distribution of genotypes of ADH2 and ALDH2 is known, but also the sensitive individuals are found, which can help prevent alcohol related disease.

Influence of pepsinogen gene polymorphisms on serum pepsinogen.

We identified pepsinogen C (PGC) gene polymorphisms by means of PCR, which amplified DNA in the region within the intron between exons 7 and 8, and by 6% polyacrylamide gel electrophoresis. Six alleles were found in a Japanese population. The frequencies of these alleles in 408 unrelated Japanese individuals were 0.074, 0.026, 0.335, 0.237, 0.016 and 0.314, respectively. The serum pepsinogen II level significantly decreased in the order of the allele 6 homozygote, the allele 6 heterozygote and the other genotypes (chi 2 = 7.850, D.F. = 2, p = 0.020). These findings indicated that the genetic background of serum pepsinogen should be considered when screening for stomach cancer by this procedure.