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1.
Int J Med Sci ; 18(15): 3574-3580, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34522184

RESUMEN

Background: Amiodarone is rich in iodine, so in clinical practice amiodarone-induced hypothyroidism (AIH) is a major side effect. This drug is used in patients with arrhythmias, especially atrial fibrillation, the most common sustained arrhythmia. Polypharmacy, which can result in complex drug-drug interactions, occurs in more than 70% of the patients with atrial fibrillation. Therefore, polypharmacy may be involved in the expression of AIH. In this study, we investigated the association between polypharmacy and AIH. Methods: We conducted a retrospective study using data from January 2006 to May 2020 collected from a large, organized database of prescriptions constructed by the Japan Medical Information Research Institute, Inc. (Tokyo, Japan). To investigate the association between number of prescribed drugs with amiodarone and AIH, we divided patients into two groups: polypharmacy (≥ 5 prescribed drugs) and non-polypharmacy (< 5 prescribed drugs). We then performed a sequence symmetry analysis on the two groups: incident thyroxine after incident amiodarone and incident thyroxine before incident amiodarone. Finally, we conducted a case-control study on two further groups: those prescribed thyroxine after incident amiodarone (AIH group; n=555) and those not prescribed thyroxine after incident amiodarone (non-AIH group; n=6,192). Results: Sequence symmetry analysis revealed a significant association between amiodarone and thyroxine in both the polypharmacy and non-polypharmacy groups. The ranges for the adjusted sequence ratio in the two groups were 12.0-16.7 and 7.3-9.0, respectively. The case-control study showed that ≥5 prescribed drugs at the first prescription of amiodarone were found to significantly increase the odds of AIH (odds ratio: 1.48, 95% confidence interval: 1.18-1.84). Conclusion: Polypharmacy was suggested as an independent risk factor for AIH. Careful assessment of the appropriateness of prescription is warranted.

2.
Arch Gerontol Geriatr ; 96: 104454, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34119808

RESUMEN

BACKGROUND: To investigate the association between green tea consumption and the annual rate of change of gray matter (GM), white matter (WM), and hippocampal volumes in community-dwelling middle-aged and older Japanese individuals. METHODS: A prospective cohort study with two years of follow-up was conducted as part of the National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA) project. A total of 1693 participants (862 men and 831 women, aged 40-89 years) were included. Green tea consumption (mL/day) data were collected with a 3-day dietary record. Volumes of GM, WM, and the hippocampus were estimated by T1-weighted brain magnetic resonance imaging and FreeSurfer software. The GM ratio, WM ratio, and hippocampal ratio (HR) were calculated as the percentages of total intracranial volume, respectively. RESULTS: The mean (SD) annual rate of change of hippocampal volume [(HR at baseline - HR at follow-up)/HR at baseline/follow-up years×100%] was 0.499 (1.128) (%). In the multivariable-adjusted general linear model, green tea consumption was negatively associated only with the annual rate of change of hippocampal volume (%) [ß (95% CI) for each 1 mL/day increase in green tea consumption = -20.2E-5 (-35.0E-5 to -5.3E-5); P-value = 0.008]. No associations were observed for the annual rate of change of GM or WM volumes. The results remained significant when the analysis was limited to those with stable green tea consumption and were especially evident among individuals aged 65 years and older and among women. CONCLUSIONS: In this study, higher green tea consumption was associated with less annual hippocampal atrophy, and each additional 100 mL/day of green tea intake was related to a reduction of approximately 5% in annual hippocampal atrophy. This association was especially evident among older individuals and among women. Further study in different settings is needed to confirm this association.


Asunto(s)
Vida Independiente , , Anciano , Femenino , Hipocampo/diagnóstico por imagen , Humanos , Japón , Estudios Longitudinales , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Prospectivos
3.
N Engl J Med ; 382(9): 822-834, 2020 02 27.
Artículo en Inglés | MEDLINE | ID: mdl-32101664

RESUMEN

BACKGROUND: Relationships between microbiota composition and clinical outcomes after allogeneic hematopoietic-cell transplantation have been described in single-center studies. Geographic variations in the composition of human microbial communities and differences in clinical practices across institutions raise the question of whether these associations are generalizable. METHODS: The microbiota composition of fecal samples obtained from patients who were undergoing allogeneic hematopoietic-cell transplantation at four centers was profiled by means of 16S ribosomal RNA gene sequencing. In an observational study, we examined associations between microbiota diversity and mortality using Cox proportional-hazards analysis. For stratification of the cohorts into higher- and lower-diversity groups, the median diversity value that was observed at the study center in New York was used. In the analysis of independent cohorts, the New York center was cohort 1, and three centers in Germany, Japan, and North Carolina composed cohort 2. Cohort 1 and subgroups within it were analyzed for additional outcomes, including transplantation-related death. RESULTS: We profiled 8767 fecal samples obtained from 1362 patients undergoing allogeneic hematopoietic-cell transplantation at the four centers. We observed patterns of microbiota disruption characterized by loss of diversity and domination by single taxa. Higher diversity of intestinal microbiota was associated with a lower risk of death in independent cohorts (cohort 1: 104 deaths among 354 patients in the higher-diversity group vs. 136 deaths among 350 patients in the lower-diversity group; adjusted hazard ratio, 0.71; 95% confidence interval [CI], 0.55 to 0.92; cohort 2: 18 deaths among 87 patients in the higher-diversity group vs. 35 deaths among 92 patients in the lower-diversity group; adjusted hazard ratio, 0.49; 95% CI, 0.27 to 0.90). Subgroup analyses identified an association between lower intestinal diversity and higher risks of transplantation-related death and death attributable to graft-versus-host disease. Baseline samples obtained before transplantation already showed evidence of microbiome disruption, and lower diversity before transplantation was associated with poor survival. CONCLUSIONS: Patterns of microbiota disruption during allogeneic hematopoietic-cell transplantation were similar across transplantation centers and geographic locations; patterns were characterized by loss of diversity and domination by single taxa. Higher diversity of intestinal microbiota at the time of neutrophil engraftment was associated with lower mortality. (Funded by the National Cancer Institute and others.).


Asunto(s)
Microbioma Gastrointestinal , Trasplante de Células Madre Hematopoyéticas/mortalidad , Adulto , Biodiversidad , Heces/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Análisis de Supervivencia , Trasplante Homólogo/mortalidad
4.
Public Health Nutr ; 23(6): 1090-1097, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31608843

RESUMEN

OBJECTIVE: To examine associations between protein intake per day and at different meals and skeletal muscle mass declines. DESIGN: Two-year prospective cohort study among older community dwellers. SETTING: National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA) in Japan. PARTICIPANTS: Older men (n 292) and women (n 363) aged 60-87 years who participated in the baseline (2006-2008) and follow-up studies (2008-2010) of NILS-LSA and did not exhibit low skeletal muscle mass at baseline. Muscle mass was assessed using dual-energy X-ray absorptiometry at baseline and follow-up. Low muscle mass was defined as skeletal muscle mass index <7·0 kg/m2 for men and <5·4 kg/m2 for women at follow-up. Daily protein intake and protein intake at each meal were calculated from 3 d dietary records at baseline and sex-stratified tertiles were determined. RESULTS: Mean (sd) protein intake at breakfast, lunch and dinner was 22·7 (7·8), 26·7 (9·3) and 37·4 (10·5) g for men and 19·3 (6·3), 23·2 (7·3) and 28·5 (7·0) g for women, respectively. After adjusting for age, baseline skeletal muscle mass and other confounders in logistic modelling, greater total protein intake was associated with lower prevalence of skeletal muscle mass decline among men at follow-up (P = 0·024). Particularly, the OR (95 % CI) for high lunchtime protein intake was low (0·11 (0·02, 0·61); P = 0·01). No significant association between total protein intake and prevalence of skeletal muscle mass decline was found among women. CONCLUSIONS: High total protein intake, particularly at lunchtime, is associated with retention of skeletal muscle mass in men.


Asunto(s)
Proteínas en la Dieta/análisis , Ingestión de Alimentos/fisiología , Comidas/fisiología , Músculo Esquelético/efectos de los fármacos , Factores de Tiempo , Absorciometría de Fotón , Anciano , Anciano de 80 o más Años , Registros de Dieta , Femenino , Estudios de Seguimiento , Humanos , Vida Independiente/estadística & datos numéricos , Japón/epidemiología , Modelos Logísticos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Músculo Esquelético/diagnóstico por imagen , Prevalencia , Estudios Prospectivos , Sarcopenia/diagnóstico por imagen , Sarcopenia/epidemiología , Sarcopenia/etiología , Factores Sexuales
5.
BMC Geriatr ; 19(1): 309, 2019 11 13.
Artículo en Inglés | MEDLINE | ID: mdl-31722665

RESUMEN

BACKGROUND: Instrumental Activities of Daily Living (IADL) is an indicator of whether a community-dwelling elderly can live independently. IADL decline was reported to be associated with aging and depression. The present study aimed to investigate whether the association between IADL decline and depressive symptoms differs with aging, using two age groups of community-dwelling Japanese elderly in their 70s and 80s. METHODS: We conducted longitudinal analysis among participants in their 70s and 80s at the baseline from Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians (SONIC) study. IADL was assessed by The Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence. As a main predictor, depressive symptoms were measured by the five-item version of the Geriatrics Depression Scale (GDS-5). As possible confounders, we considered cognitive function, body mass index, solitary living, education, economic status, medical history of stroke and heart disease, hypertension, dyslipidemia, diabetes, and sex. We obtained odds ratios (ORs) of IADL decline for having depressive symptoms in each age group (70s/80s) and tested interactions between depressive symptoms and age groups in relation to IADL decline in 3 years by logistic regression. Additionally, to confirm age group differences, we conducted multiple group analysis. RESULTS: There were 559 participants in their 70s and 519 in their 80s. Compared to participants without depressive symptoms, those with depressive symptoms had higher OR of IADL decline in 70s (OR [95% CI] = 2.33 [1.13, 4.78]), but not in 80s (OR [95% CI] = 0.85 [0.46, 1.53]). There were significant interactions between depressive symptoms and age groups in relation to IADL decline (p-value = 0.03). Multiple group analyses showed differences between the age groups by Akaike information criterion (AIC), and ORs (95%CI) decline for depressive symptoms was 2.33 (1.14, 4.77) in 70s and 0.85 (0.47, 1.54) in 80s. CONCLUSION: The association of depressive symptoms and IADL decline during the 3 years was significantly different between the 70s and 80s age groups, and significant association was found only in people in their 70s. Detecting depressive symptoms may be a key for preventing IADL decline in people in their 70s and not for those in their 80s.


Asunto(s)
Actividades Cotidianas/psicología , Envejecimiento/psicología , Depresión/psicología , Vida Independiente/psicología , Anciano , Anciano de 80 o más Años , Depresión/economía , Depresión/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Vida Independiente/economía , Vida Independiente/tendencias , Japón/epidemiología , Estudios Longitudinales , Masculino , Factores Socioeconómicos
6.
J Gerontol A Biol Sci Med Sci ; 74(2): 211-218, 2019 01 16.
Artículo en Inglés | MEDLINE | ID: mdl-29596617

RESUMEN

Background: Higher-level functional capacity is crucial component for independent living in later life. We used repeated-measures analysis to identify aging trajectories in higher-level functional capacity. We then determined whether these trajectories were associated with all-cause mortality and examined differences in medical and long-term care costs between trajectories among community-dwelling older Japanese. Methods: 2,675 adults aged 65-90 years participated in annual geriatric health assessments and biennial health monitoring surveys during the period from October 2001 through August 2011. The average number of follow-up assessments was 4.0, and the total number of observations was 10,609. Higher-level functional capacity, which correspond to the fourth and fifth sublevels of Lawton's hierarchical model, was assessed with the Tokyo Metropolitan Institute of Gerontology-Index of Competence (TMIG-IC). Results: We identified four distinct trajectory patterns (high-stable, late-onset decreasing, early-onset decreasing, and low-decreasing) on the TMIG-IC through age 65-90 years. As compared with the high-stable trajectory group, participants in the late-onset decreasing, early-onset decreasing, and low-decreasing TMIG-IC trajectory groups had adjusted hazard ratios for mortality of 1.22 (95% confidence interval: 1.01-1.47), 1.90 (1.53-2.36), and 2.87 (2.14-3.84), respectively. Participants with high-stable and late-onset decreasing higher-level functional capacity trajectories had lower mean monthly medical costs and long-term care costs. In contrast, mean total costs were higher for those with low-decreasing trajectories, after excluding the large increase in such costs at the end of life. Conclusions: People with a low-decreasing aging trajectory in higher-level functional capacity had higher risks of death and had high monthly total costs.


Asunto(s)
Actividades Cotidianas , Envejecimiento/fisiología , Tolerancia al Ejercicio/fisiología , Evaluación Geriátrica/métodos , Vida Independiente/economía , Cuidados a Largo Plazo/economía , Actividad Motora/fisiología , Anciano , Anciano de 80 o más Años , Causas de Muerte/tendencias , Análisis Costo-Beneficio , Femenino , Humanos , Japón/epidemiología , Masculino , Tasa de Supervivencia/tendencias
7.
PLoS One ; 13(11): e0207426, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30462711

RESUMEN

BACKGROUND: Although social participation (SP) is valid in active aging, it is vague which types and the frequency of SP are effective in maintaining instrumental activities of daily living (IADL). We conducted a community-based prospective cohort study and investigated the association of the types and frequency for SP with IADL decline in community-dwelling older adults. METHODS: The target population were all individuals aged ≥65 living in a commuter town in Nara, Japan. A total of 6,013 participants with independent IADL at baseline were analyzed. IADL was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Six SP types were assessed: volunteer groups, sports groups, hobby clubs, senior citizens' clubs, neighborhood community associations, and cultural clubs. The frequency of SP was categorized into frequent (i.e., weekly or more), moderate (i.e., monthly or yearly), and non-participation. Using multiple logistic regression models, the odds ratio (OR) and a 95% confidence interval (CI) for IADL decline were calculated. Covariates included age, marital status, education, subjective economic status, work status, body mass index, chronic medical conditions (i.e., hypertension, diabetes mellitus, heart disease, and cerebrovascular disease), lifestyle factors (i.e., alcohol, smoking, and exercise), self-rated health, depression, and cognitive functioning. To examine gender differences, stratified analyses by gender were performed. RESULTS: During the 33-month follow-up, 16.4% of men and 8.7% of women exhibited IADL decline. After adjustment for all covariates, compared to those who never participated, women with moderate participation had significantly lower odds of IADL decline in volunteer groups (OR = 0.53, 95% CI = 0.31-0.88), hobby clubs (OR = 0.55, 95% CI = 0.38-0.79), neighborhood community associations (OR = 0.58, 95% CI = 0.42-0.81), and cultural clubs (OR = 0.51, 95% CI = 0.31-0.82), and women with frequent participation had lower odds of IADL decline in hobby clubs (OR = 0.63, 95% CI = 0.43-0.93). In contrast, among men, the significant association between SP and less risk of IADL decline was limited to moderate participation in neighborhood community associations (OR = 0.79, 95% CI = 0.63-0.99), and there were no differences between frequent participation and non-participation in all types of SP. Regarding volunteer groups, compared to women with frequent participation, women with moderate participation had a significantly lower risk of IADL decline (OR = 0.37, 95% CI = 0.18-0.77). The results of additional stratified analyses by self-rated health, depression, and cognitive functioning showed that the associations of the type and frequency of SP with IADL decline varied according to physical and mental functioning. CONCLUSIONS: Several types of SP have a favorable effect on IADL through moderate participation rather than frequent participation, and women with moderate participation in volunteer groups have a more beneficial effect on IADL than women with frequent participation. When advising community-dwelling older adults on SP for IADL maintenance, health professionals may need to take into account plateau effects, gender differences, and physical and mental functioning.


Asunto(s)
Actividades Cotidianas/psicología , Enfermedad Crónica/psicología , Cognición/fisiología , Participación Social/psicología , Anciano , Anciano de 80 o más Años , Enfermedad Crónica/epidemiología , Femenino , Estado de Salud , Pasatiempos , Humanos , Vida Independiente , Japón , Modelos Logísticos , Masculino , Factores Sexuales , Factores Socioeconómicos
8.
BMC Geriatr ; 18(1): 132, 2018 06 04.
Artículo en Inglés | MEDLINE | ID: mdl-29898678

RESUMEN

BACKGROUND: There is insufficient evidence regarding the relationship of home environment with functional capacity among community-dwelling older people without disabilities. We conducted a population-based longitudinal cohort study and examined whether stairs in the home were associated with capability to perform instrumental activities of daily living (IADL) in community-dwelling high-functioning older adults. METHODS: The target population was individuals aged 65 years or older living in two municipalities in Nara Prefecture in Japan. At the baseline survey, residents who were independent in IADL (n = 6722) were included as survey subjects. Subjects were divided into three groups according to their home type; one-storey residences, walk-up residences, or residences with an elevator. IADL was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Multiple logistic regression analyses stratified by gender were used to calculate the odds ratio (OR) and a 95% confidence interval (CI) for a decline in IADL, with one-storey residences as a reference. Age, studied area, marital status, working status, self-perceived economic status, body mass index, chronic diseases, smoking, drinking, eating habits, basic activities of daily living, cognitive functioning, depression, self-rated health, and social participation were used as covariates. RESULTS: During the 3-year follow-up, 11.6% of the subjects showed a decline in IADL. After adjusting for covariates, women who lived in walk-up residences had a lower risk for IADL decline (adjusted OR = 0.72, 95% CI = 0.52-0.99), while living in a home with an elevator was not associated with IADL decline (adjusted OR = 0.94, 95% CI = 0.49-1.77). In contrast, there was no association between home type and IADL decline in men (walk-up residences, adjusted OR = 0.90, 95% CI = 0.71-1.14; residences with an elevator, adjusted OR = 0.82, 95% CI = 0.39-1.72). CONCLUSIONS: The presence of stairs in the home was associated with prevention of IADL decline over a 3-year period in older women without disabilities. Although a barrier-free house is recommended for older people, our findings indicate that a home with stairs may maintain the capability to perform IADL among older adults without disabilities.


Asunto(s)
Actividades Cotidianas/psicología , Planificación Ambiental , Vida Independiente/psicología , Subida de Escaleras/fisiología , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Cognición/fisiología , Estudios de Cohortes , Personas con Discapacidad/psicología , Planificación Ambiental/tendencias , Femenino , Humanos , Vida Independiente/tendencias , Japón/epidemiología , Estudios Longitudinales , Masculino , Estudios Prospectivos , Participación Social/psicología , Factores Socioeconómicos
9.
Prev Med ; 112: 23-30, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29596918

RESUMEN

Exercise can delay the decline of instrumental activities of daily living (IADL), although it remains unclear which specific exercise types are associated with such a delay. This 4-year prospective cohort study in Japan aimed to identify the longitudinal associations between exercise types and the onset of IADL decline in older women. Between 2008 and 2012, 1082 community-dwelling older women aged ≥75 years participated in this study. Participations in 16 exercise types based on a face-to-face interview at baseline were used as independent variables. The primary study outcome was a decline in IADL as assessed using the instrumental self-maintenance subscale of the Tokyo Metropolitan Institute of Gerontology index of competence. An IADL decline was defined as a decrease of ≥1 point over the 4-year follow-up period and was used as the dependent variable. Adjusted odds ratios (ORs) and 95% confident intervals (CIs) for IADL decline based on participation or non-participation in each exercise type were obtained using logistic regression analyses. An IADL decline was observed in 151 participants (13.9%) over the 4-year follow-up period. After adjustment for potential confounders, participation in calisthenics had a significantly lower OR (0.62; 95% CI 0.42-0.90) for IADL decline. There were no significant associations between other specific exercise types and IADL decline. In conclusion, participation in calisthenics was significantly and independently associated with delayed IADL decline in older women aged ≥75 years. Thus, calisthenics may be a useful exercise to slow IADL decline in this age group.


Asunto(s)
Actividades Cotidianas , Ejercicio Físico/fisiología , Vida Independiente , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Japón , Estudios Longitudinales , Estudios Prospectivos , Tokio
10.
J Alzheimers Dis ; 55(2): 613-624, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-27716666

RESUMEN

BACKGROUND: The Hisayama study is a prospective cohort study of lifestyle-related diseases that commenced in 1961. Through it, a significant increasing trend in the prevalence of Alzheimer's disease has been observed over the past 18 years. OBJECTIVES: We sought to investigate the increases in brain pathology related to Alzheimer's disease using automated MATLAB morphometric analyses for quantifying tau pathology. METHODS: We examined a series of autopsied cases from Hisayama residents obtained between 1998 and 2003 (group A: 203 cases), and between 2009 and 2014 (group B: 232 cases). We developed custom software in MATLAB to analyze abnormal tau deposits quantitatively. Specimens were immunostained with both anti-amyloid-ß-protein and anti-phosphorylated tau antibodies. RESULTS: Both the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) criteria for senile plaques and Braak stage for NFT were higher in group B. Morphometric analyses of the hippocampi also revealed a trend toward increased tau pathology in both men and women over 80 years of age in group B. The increases were also significant when the subjects were examined independently according to high or low CERAD scores and in all levels of AD neuropathologic change according to the National Institute on Aging-Alzheimer's Association guidelines (2012). CONCLUSION: We revealed a recent trend of increased tauopathy in the older people, which is partly independent of amyloid-ß pathology.


Asunto(s)
Envejecimiento/patología , Hipocampo/metabolismo , Proteínas tau/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Péptidos beta-Amiloides/metabolismo , Autopsia , Estudios de Cohortes , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Ovillos Neurofibrilares/patología , Índice de Severidad de la Enfermedad
11.
J Am Geriatr Soc ; 64(11): 2336-2342, 2016 11.
Artículo en Inglés | MEDLINE | ID: mdl-27613339

RESUMEN

OBJECTIVES: To describe associations between tooth loss and changes in higher-level functional capacity. DESIGN: Prospective cohort study. SETTING: Twenty-four Japanese municipalities between 2010 and 2013. PARTICIPANTS: Functionally independent community-dwelling persons aged 65 and older (N = 62,333). MEASUREMENTS: Self-reported number of teeth was used as an exposure variable. The outcome was changes in higher-level functional capacity measured using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), which consists of three domains: instrumental activities of daily living, intellectual activity, and social roles. The TMIG-IC score ranges from 0 (lowest function) to 13 (highest function). All covariates were chosen from baseline demographic, socioeconomic, health behavior, and health variables based upon evidence from previous studies. Inverse-probability weighting (IPW) with propensity score and multiple linear regression, estimating nonstandardized coefficients (ß) and 95% confidence intervals (CIs), were used. RESULTS: The baseline response rate was 65.2%, and the follow-up rate was 70.1%. During the follow-up period, participants' TMIG-IC score declined by an average of 0.247 points (standard deviation: 1.446). The results showed a significant dose-response association between tooth loss and decline in higher-level functional capacity in multiple linear regression models. IPW models estimated the increment in TMIG-IC score (ß = 0.170, 95% CI = 0.114 to 0.227) if edentulous participants gained 20 or more natural teeth. CONCLUSION: Tooth loss is associated with future decline in higher-level functional capacity. IPW models suggest that treatment for tooth loss attenuates decline in higher-level functional capacity.


Asunto(s)
Evaluación Geriátrica , Conductas Relacionadas con la Salud , Pérdida de Diente/epidemiología , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Cognición , Femenino , Humanos , Japón/epidemiología , Masculino , Estudios Prospectivos , Factores de Riesgo , Autoinforme , Conducta Social
12.
J Phys Act Health ; 13(3): 303-9, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26181652

RESUMEN

BACKGROUND: This cross-sectional study was performed to examine associations of objectively measured sedentary time (ST) and breaks in sedentary time (BST) with instrumental activities of daily living (IADL) disability in Japanese community-dwelling older adults. METHODS: The sample comprised 1634 older adults (mean age: 73.3 y, men: 38.4%). Sedentary behavior was measured using a triaxial accelerometer. Disability was defined as inability in at least 1 of the IADL tasks using the Tokyo Metropolitan Institute of Gerontology Index of Competence. RESULTS: After adjusting for potential confounders and moderate-to-vigorous physical activity (MVPA), longer ST was significantly associated with higher likelihood of IADL disability, whereas a greater number of BST was associated with lower likelihood of IADL disability. ST and BST remained statistically significant after mutual adjustment with odds ratio of 1.30 (95% confidence interval [CI)], 1.00-1.70) and 0.80 (95% CI, 0.65-0.99), respectively. CONCLUSIONS: This study first demonstrated that shorter ST and more BST were associated with lower risk of IADL disability independent of MVPA and that the association for ST was independent of BST and vice versa. These findings suggest not only total ST but also the manner in which it is accumulated may contribute to the maintenance of functional independence in older adults.


Asunto(s)
Actividades Cotidianas , Envejecimiento/etnología , Evaluación Geriátrica/métodos , Actividad Motora , Conducta Sedentaria/etnología , Acelerometría , Anciano , Anciano de 80 o más Años , Estudios Transversales , Personas con Discapacidad , Femenino , Humanos , Japón , Modelos Logísticos , Masculino , Características de la Residencia
13.
PLoS One ; 10(9): e0137656, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26360380

RESUMEN

BACKGROUND: This study examined the factors related to intellectual activity in community-dwelling elderly persons. METHODS: Self-administered questionnaires mailed to all people aged ≥65 years in a dormitory suburb in Japan (n = 15,210). The response rate was 72.2%. Analytical subjects (n = 8,910) were those who lived independently and completely answered questions about independent and dependent variables and covariates. Independent variables included psychosocial conditions (i.e., social activities, hobbies, and a sense that life is worth living (ikigai)), oral health (i.e., dental health behaviors and oral function evaluated by chewing difficulties, swallowing difficulties, and oral dryness), and dietary variety measured using the dietary variety score (DVS). A dependent variable was intellectual activity measured using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Covariates included age, gender, family structure, pensions, body mass index, alcohol, smoking, medical history, self-rated health, medications, cognitive function, depression, and falling. Logistic regression was used to estimate the odds ratio (OR) for poor intellectual activity. RESULTS: Poor intellectual activity was reported by 28.9% of the study population. After adjustment for covariates and independent variables, poor intellectual activity was significantly associated with nonparticipation in social activities (OR = 1.90, 95%CI = 1.61-2.24), having neither hobbies nor ikigai (3.13, 2.55-3.84), having neither regular dental visits nor daily brushing (1.70, 1.35-2.14), the poorest oral function (1.61, 1.31-1.98), and the lowest DVS quartile (1.96, 1.70-2.26). CONCLUSION: These results indicate that psychosocial conditions, oral health, and dietary variety are independently associated with intellectual activity in elderly persons. The factors identified in this study may be used in community health programs for maintaining the intellectual activity ability of the elderly.


Asunto(s)
Actividades Cotidianas , Cognición , Dieta , Evaluación Geriátrica , Salud Bucal , Medio Social , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Japón , Masculino , Oportunidad Relativa , Encuestas y Cuestionarios
14.
Arthritis Rheumatol ; 67(7): 1744-50, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25777156

RESUMEN

OBJECTIVE: The shared epitope is associated with increased joint destruction in rheumatoid arthritis (RA) as well as susceptibility to RA and the production of anti-citrullinated protein antibody (ACPA). However, previous studies addressing whether the association of the shared epitope with joint destruction is independent of ACPA have shown different results in different populations. Different allele distributions in the shared epitope may explain this ethnic heterogeneity. This study was undertaken to assess the associations of the shared epitope and HLA-DRB1*04:05, the most common shared epitope allele in the Japanese population, with joint destruction in patients with ACPA-positive RA. METHODS: A total of 861 patients with ACPA-positive RA who had not received any biologic agents were recruited from the institute of Rheumatology, Rheumatoid Arthritis cohort (sets 1 and 2) and the Kyoto University Rheumatoid Arthritis Management Alliance cohort (set 3). Joint destruction was assessed using the modified Sharp/van der Heijde score (SHS). The associations of the shared epitope alleles, HLA-DRB1*04:05, and other shared epitope allele groups with the SHS were analyzed in a linear regression analysis. Amino acid variations associated with the SHS were also analyzed. RESULTS: The shared epitope was significantly associated with an increased SHS (P = 0.0017). Although HLA-DRB1*04:05 was significantly associated with an increased SHS (P = 2.7 × 10(-5)), the group of other shared epitope alleles, including HLA-DRB1*01:01, did not show an association with the SHS in spite of sufficient power (P = 0.67). HLA-DRB1*04:05 was associated with joint destruction in a dose-dependent manner. Analyses of amino acid associations of HLA-DRB1 revealed that serine at position 57, recently shown to have a susceptibility effect for ACPA-positive RA in Asian populations, showed a significant association (P = 5.0 × 10(-6)). CONCLUSION: HLA-DRB1*04:05, characterized by serine at position 57, accounts for the detrimental association between the shared epitope and SHS in Japanese patients with ACPA-positive RA.


Asunto(s)
Anticuerpos Antiidiotipos/sangre , Artritis Reumatoide/genética , Artritis Reumatoide/inmunología , Epítopos/genética , Cadenas HLA-DRB1/genética , Articulaciones de la Mano/diagnóstico por imagen , Péptidos Cíclicos/inmunología , Serina/genética , Adulto , Anciano , Alelos , Aminoácidos/genética , Artritis Reumatoide/etnología , Grupo de Ascendencia Continental Asiática/etnología , Grupo de Ascendencia Continental Asiática/genética , Femenino , Predisposición Genética a la Enfermedad/etnología , Predisposición Genética a la Enfermedad/genética , Genotipo , Articulaciones de la Mano/patología , Humanos , Japón , Masculino , Persona de Mediana Edad , Radiografía , Análisis de Regresión
15.
JAMA Psychiatry ; 71(6): 647-56, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24718902

RESUMEN

IMPORTANCE: One approach to understanding the genetic complexity of schizophrenia is to study associated behavioral and biological phenotypes that may be more directly linked to genetic variation. OBJECTIVE: To identify single-nucleotide polymorphisms associated with general cognitive ability (g) in people with schizophrenia and control individuals. DESIGN, SETTING, AND PARTICIPANTS: Genomewide association study, followed by analyses in unaffected siblings and independent schizophrenia samples, functional magnetic resonance imaging studies of brain physiology in vivo, and RNA sequencing in postmortem brain samples. The discovery cohort and unaffected siblings were participants in the National Institute of Mental Health Clinical Brain Disorders Branch schizophrenia genetics studies. Additional schizophrenia cohorts were from psychiatric treatment settings in the United States, Japan, and Germany. The discovery cohort comprised 339 with schizophrenia and 363 community control participants. Follow-up analyses studied 147 unaffected siblings of the schizophrenia cases and independent schizophrenia samples including a total of an additional 668 participants. Imaging analyses included 87 schizophrenia cases and 397 control individuals. Brain tissue samples were available for 64 cases and 61 control individuals. MAIN OUTCOMES AND MEASURES: We studied genomewide association with g, by group, in the discovery cohort. We used selected genotypes to test specific associations in unaffected siblings and independent schizophrenia samples. Imaging analyses focused on activation in the prefrontal cortex during working memory. Brain tissue studies yielded messenger RNA expression levels for RefSeq transcripts. RESULTS: The schizophrenia discovery cohort showed genomewide-significant association of g with polymorphisms in sodium channel gene SCN2A, accounting for 10.4% of g variance (rs10174400, P = 9.27 × 10(-10)). Control individuals showed a trend for g/genotype association with reversed allelic directionality. The genotype-by-group interaction was also genomewide significant (P = 1.75 × 10(-9)). Siblings showed a genotype association with g parallel to the schizophrenia group and the same interaction pattern. Parallel, but weaker, associations with cognition were found in independent schizophrenia samples. Imaging analyses showed a similar pattern of genotype associations by group and genotype-by-group interaction. Sequencing of RNA in brain revealed reduced expression in 2 of 3 SCN2A alternative transcripts in the patient group, with genotype-by-group interaction, that again paralleled the cognition effects. CONCLUSIONS AND RELEVANCE: The findings implicate SCN2A and sodium channel biology in cognitive impairment in schizophrenia cases and unaffected relatives and may facilitate development of cognition-enhancing treatments.


Asunto(s)
Encéfalo/fisiología , Cognición/fisiología , Predisposición Genética a la Enfermedad/genética , Canal de Sodio Activado por Voltaje NAV1.2/genética , Corteza Prefrontal/fisiopatología , Esquizofrenia/genética , Psicología del Esquizofrénico , Adolescente , Adulto , Encéfalo/metabolismo , Estudios de Casos y Controles , Femenino , Neuroimagen Funcional , Expresión Génica/genética , Expresión Génica/fisiología , Estudio de Asociación del Genoma Completo , Genotipo , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple/genética , Polimorfismo de Nucleótido Simple/fisiología , ARN Mensajero/metabolismo , Esquizofrenia/metabolismo , Esquizofrenia/fisiopatología , Hermanos , Adulto Joven
16.
Clin Interv Aging ; 8: 721-8, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23818769

RESUMEN

BACKGROUND: Little is known about the relationship between disease-specific mortality and high-level activities of daily living in the elderly. We examined whether mortality is associated with high-level activities of daily living in an octogenarian population. METHODS: We conducted a population-based cross-sectional and prospective cohort study in 693 older persons aged 80 years and living in Japan's Fukuoka Prefecture. We then evaluated the association between 12-year disease-specific mortality and high-level functional capacity as measured by the Tokyo Metropolitan Institute of Gerontology Index of Competence, which is a standardized multidimensional 13-item instrument; items 1 through 5 are classified as instrumental self-maintenance activity, items 6 through 9 as intellectual activity, items 10 through 13 as social roles activity, and all 13 items together yield total functional capacity. RESULTS: By the 12-year follow-up of the 693 participants, 413 had died, 242 survived, and 38 were unable to be located. Of the 413 who died, 105 died of cardiovascular disease, 73 of respiratory tract disease, 71 of cancer, and 39 of senility. Of the other 125 deaths, 59 were due to other diseases, and the cause of death for 66 participants is not known. The hazard ratio (HR) for all-cause mortality, adjusted for confounding factors with multivariate Cox analyses, fell by 6% (HR 0.937, 95% confidence interval [CI] 0.899-0.978, P = 0.003) with each one-point increase in participants' scores on the Tokyo Metropolitan Institute of Gerontology Index of total functional capacity. With one-point increases in instrumental self-maintenance activity and in intellectual activity, the HRs for all-cause mortality decreased by 14% (HR 0.856, 95% CI 0.787-0.930, P = 0.000) and 12% (HR 0.884, 95% CI 0.794-0.983, P = 0.023), respectively. Respiratory mortality with HR adjustment fell by 11% (HR 0.887, 95% CI 0.804-0.978, P = 0.016) and 24% (HR 0.760, 95% CI 0.627-0.922, P = 0.005) with one-point increases in the scores of total functional capacity and instrumental self-maintenance activity, respectively. Similarly, mortality due to senility fell by 16% (HR 0.838, 95% CI 0.743-0.946, P = 0.004), 29% (HR 0.707, 95% CI 0.564-0.886, P = 0.003), and 29% (HR 0.710, 95% CI 0.522-0.966, P = 0.029) with one-point increases in the scores of total functional capacity, instrumental self-maintenance activity, and intellectual activity, respectively. CONCLUSION: These findings suggest that high-level activities of daily living may be an independent predictor of mortality due to all causes, respiratory disease and senility in older persons.


Asunto(s)
Actividades Cotidianas , Causas de Muerte , Mortalidad/tendencias , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Estudios Transversales , Femenino , Estudios de Seguimiento , Evaluación Geriátrica , Humanos , Japón/epidemiología , Masculino , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Encuestas y Cuestionarios , Análisis de Supervivencia
17.
Arch Gerontol Geriatr ; 55(2): e9-13, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22795189

RESUMEN

This study aimed to determine the association between sarcopenia, defined by muscle mass, muscle strength, and physical performance, and higher-level functional capacity in community-dwelling Japanese elderly people. Subjects were 1158 elderly, community-dwelling Japanese people aged 65 or older. We used bioelectrical impedance analysis to measure muscle mass, grip strength to measure muscle strength, and usual walking speed to measure physical performance. Sarcopenia was characterized by low muscle mass, plus low muscle strength or low physical performance. Subjects without low muscle mass, low muscle strength, and low physical performance were classified as "normal." Examination of higher-level functional capacity was performed using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). The TMIG-IC is a 13-item questionnaire completed by the subject; it contains five questions on self-maintenance and four questions each on intellectual activity and social role. Sarcopenia was identified in 11.3% and 10.7% of men and women, respectively. The percentage of disability for instrumental activities of daily living (IADL) was 39.0% in men with sarcopenia and 30.6% in women with sarcopenia. After adjustment for age, in men, sarcopenia was significantly associated with IADL disability compared with intermediate and normal subjects. In women, sarcopenia was significantly associated with every subscale of the TMIG-IC disability compared with intermediate and normal subjects. This study revealed that sarcopenia, defined by muscle mass, muscle strength, and physical performance, had a significant association with disability in higher-level functional capacity in elderly Japanese subjects. Interventions to prevent sarcopenia may prevent higher-level functional disability among elderly people.


Asunto(s)
Actividades Cotidianas/psicología , Vida Independiente/psicología , Sarcopenia/fisiopatología , Sarcopenia/psicología , Anciano , Anciano de 80 o más Años , Impedancia Eléctrica , Femenino , Evaluación Geriátrica/métodos , Fuerza de la Mano , Humanos , Japón/epidemiología , Masculino , Fuerza Muscular , Músculo Esquelético/fisiopatología , Pruebas Neuropsicológicas , Encuestas y Cuestionarios , Caminata/psicología
18.
J Orthop Sci ; 17(1): 51-7, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22120702

RESUMEN

BACKGROUND: Postoperative wound complications, including surgical site infections, which frequently occur in the course of management of musculoskeletal sarcomas, sometimes necessitate repeat surgeries, including amputation, and may result in a prolonged healing time, prolonged hospital stay, or fatal outcome. A comprehensive understanding of surgical site infections associated with specific diseases is needed to reduce the risk. METHODS: This series comprised 84 patients with malignant soft tissue tumors treated at our institute. The occurrence rate, management modality and clinical course of surgical site infections, impact of surgical site infections on the length of hospitalization, risk factors for the development of surgical site infections, and the impact of surgical site infections on the oncological outcomes were analyzed. Surgical site infection was defined according to Centers for Disease Control and Prevention guidelines. RESULTS: Surgical site infections occurred in 7 cases (8.3%). Although successful clinical cure was achieved in all cases, surgical site infection was identified as one of the independent risk factors for prolongation of hospitalization. Both univariate and multivariate analyses identified larger intraoperative blood loss and a trunk location as risk factors associated with deep infections. No association was detected between age, tumor grade, chemotherapy, tumor volume, or plastic surgery and the risk of surgical site infections. Although the differences were not statistically significant, patients with surgical site infections showed worse oncological outcomes in terms of local recurrence and total survival. CONCLUSION: The incidence rate of surgical site infection was larger than that associated with conventional orthopedic surgeries, such as osteosynthesis, spine surgery, or arthroplasty. Surgical site infections remain a critical and frequent complication of surgical treatment of soft-tissue malignancies and often result in prolongation of hospital stay. Although practical options to prevent surgical site infections seem quite limited, the present data provide a rationale for perioperative evaluation in patients at a high risk of surgical site infections.


Asunto(s)
Neoplasias de los Tejidos Blandos/cirugía , Infección de la Herida Quirúrgica/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Incidencia , Japón/epidemiología , Tiempo de Internación/tendencias , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia/tendencias , Cicatrización de Heridas , Adulto Joven
19.
PLoS One ; 6(6): e20468, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21674006

RESUMEN

Schizophrenia is a devastating neuropsychiatric disorder with genetically complex traits. Genetic variants should explain a considerable portion of the risk for schizophrenia, and genome-wide association study (GWAS) is a potentially powerful tool for identifying the risk variants that underlie the disease. Here, we report the results of a three-stage analysis of three independent cohorts consisting of a total of 2,535 samples from Japanese and Chinese populations for searching schizophrenia susceptibility genes using a GWAS approach. Firstly, we examined 115,770 single nucleotide polymorphisms (SNPs) in 120 patient-parents trio samples from Japanese schizophrenia pedigrees. In stage II, we evaluated 1,632 SNPs (1,159 SNPs of p<0.01 and 473 SNPs of p<0.05 that located in previously reported linkage regions). The second sample consisted of 1,012 case-control samples of Japanese origin. The most significant p value was obtained for the SNP in the ELAVL2 [(embryonic lethal, abnormal vision, Drosophila)-like 2] gene located on 9p21.3 (p = 0.00087). In stage III, we scrutinized the ELAVL2 gene by genotyping gene-centric tagSNPs in the third sample set of 293 family samples (1,163 individuals) of Chinese descent and the SNP in the gene showed a nominal association with schizophrenia in Chinese population (p = 0.026). The current data in Asian population would be helpful for deciphering ethnic diversity of schizophrenia etiology.


Asunto(s)
Grupo de Ascendencia Continental Asiática/genética , Estudio de Asociación del Genoma Completo/métodos , Esquizofrenia/genética , Adulto , Encéfalo/metabolismo , Estudios de Casos y Controles , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , National Institute of Mental Health (U.S.) , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Esquizofrenia/epidemiología , Estados Unidos
20.
Psychogeriatrics ; 11(1): 19-27, 2011 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21447105

RESUMEN

BACKGROUND: Social role function is the capacity to maintain interpersonal relationships and is essential for being independent in the community. Limitations in social role function often coexist with depressive symptoms, suggesting a possible common mechanistic basis. We investigated whether the observed association between these traits is mainly a result of genetic or environmental influences. METHODS: In 2008, a questionnaire was sent to 745 male twins aged 65 years and older. Our sample included 397 male twins. The number of monozygotic twins was 302, and dizygotic was 95. Among the twin pairs for whom data were available for both twins, 75 twin pairs (150 individuals) were monozygotic and 28 pairs (56 individuals) were dizygotic. Social role function was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Depressive symptoms were measured by the 15-item version of the Geriatric Depression Scale. Relative importance of genes and environments for the phenotypes was calculated using structural equation analyses. RESULTS: Our results show that genetic influence was the major contributor to the relationship between social role function and depressive symptoms, and non-shared environmental influence was important for overall variation in each trait. CONCLUSIONS: We concluded that focusing on a non-shared environment is an essential approach for maintaining social role function and psychological well-being. It is suggested that treatments specific to depressive symptoms are more effective than indirect intervention targeting social role function.


Asunto(s)
Depresión/epidemiología , Depresión/genética , Enfermedades en Gemelos/epidemiología , Enfermedades en Gemelos/genética , Rol , Apoyo Social , Anciano , Estudios de Casos y Controles , Depresión/psicología , Enfermedades en Gemelos/psicología , Genética Conductual , Humanos , Japón/epidemiología , Funciones de Verosimilitud , Masculino , Modelos Genéticos , Gemelos Dicigóticos , Gemelos Monocigóticos
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