Sedentary behavior and the combination of physical activity associated with dementia, functional disability, and mortality: A cohort study of 90,471 older adults in Japan.

OBJECTIVE: To examine the associations of sedentary behavior (SB) and the combination of moderate-to-vigorous intensity physical activity (MVPA) with dementia, functional disability, and mortality in older adults, and the heterogeneity in different subpopulations. METHODS: Nation-wide cohort with 90,471 individuals aged ≥65 years in Japan. SB (<3, 3-<8, and ≥ 8 h per day [h/d]) and MVPA (0, 0 < MVPA<1, and ≥ 1 h/d) were measured in 2016. Long-term care registry-based incidence of outcomes was ascertained through 2021. Cox proportional hazard models were performed. RESULTS: Compared with SB < 3 h/d group, SB ≥ 8 h/d was associated with higher risks of dementia, functional disability, and mortality with hazard ratios (95% confidence interval) of 1.36 (1.22-1.52), 1.32 (1.19-1.48), and 1.31 (1.18-1.45). The combination of MVPA and SB demonstrated a dose-respond trend of increasing risks of dementia, functional disability, and mortality with increased SB and decreased MVPA, where participants who spent no MVPA with SB ≥ 8 h/d had the highest risks. High MVPA attenuated but didn't eliminate the risks. Participants who spent MVPA≥1 h/d with SB ≥ 8 h/d had comparable risks to those who spent no MVPA with SB < 3 h/d. No heterogeneity was found by MVPA levels, sex, education, comorbidity, and depression conditions. CONCLUSIONS: Prolonged daily SB was associated with higher risks of dementia, functional disability, and mortality in older adults, regardless of MVPA, sex, education, and chronic conditions. Individuals with high MVPA also face considerable risks when engaging in high SB. High MVPA with high SB revealed a comparable risk to no MVPA with low SB.

Scoping Review of Screening and Assessment Tools for Social Determinants of Health in the Field of Cardiovascular Disease.

BACKGROUND: Despite the importance of implementing the concept of social determinants of health (SDOH) in the clinical practice of cardiovascular disease (CVD), the tools available to assess SDOH have not been systematically investigated. We conducted a scoping review for tools to assess SDOH and comprehensively evaluated how these tools could be applied in the field of CVD.Methods and Results: We conducted a systematic literature search of PubMed and Embase databases on July 25, 2023. Studies that evaluated an SDOH screening tool with CVD as an outcome or those that explicitly sampled or included participants based on their having CVD were eligible for inclusion. In addition, studies had to have focused on at least one SDOH domain defined by Healthy People 2030. After screening 1984 articles, 58 articles that evaluated 41 distinct screening tools were selected. Of the 58 articles, 39 (67.2%) targeted populations with CVD, whereas 16 (27.6%) evaluated CVD outcome in non-CVD populations. Three (5.2%) compared SDOH differences between CVD and non-CVD populations. Of 41 screening tools, 24 evaluated multiple SDOH domains and 17 evaluated only 1 domain. CONCLUSIONS: Our review revealed recent interest in SDOH in the field of CVD, with many useful screening tools that can evaluate SDOH. Future studies are needed to clarify the importance of the intervention in SDOH regarding CVD.

Measuring functional ability in Healthy Ageing: testing its validity using Japanese nationwide longitudinal data.

BACKGROUND: The United Nations Decade of Healthy Ageing 2021-2030 suggests nations should monitor functional ability as an indicator of healthy ageing progress. Functional ability is the attribute of people to do something they value and consists of five domains. We examined its validity in terms of a construct, cross-validation across multiple waves' data, and predictivity for subsequent well-being. METHODS: Using panel data from 35,093 community-dwelling adults aged ≥65 years from the Japan Gerontological Evaluation Study, we performed factor analyses to explore the construct of functional ability domains in both 2013 and 2016. A modified Poisson regression analysis was employed to test their associations with well-being (subjective health and happiness) in 2019. RESULTS: The mean age (standard deviation) of participants was 72.1 (5.0) years, and 52.0% were women. A total of 85.0% reported good subjective health, and 50.6% reported high happiness levels. Factor analyses with 31 logically checked candidate items from 2016 data suggested a three-factor model comprising 24 items, which were compatible with the 2013 data results. Based on the World Health Organization's original domains, we named domains as domain #1: ability to build and maintain relationships; domain #2: ability to meet basic needs + ability to move around and domain #3: ability to learn, grow and make decisions + ability to contribute. All three domains predicted both subjective health and happiness in 2019. CONCLUSIONS: Empirical data from Japan supports the functional ability concept among older individuals. Validating this concept with data from other nations is warranted.

Association between social support and ambulance use among older people in Japan: an empirical cross-sectional study.

BACKGROUND: Ambulance service demand and utilization are increasing worldwide. To address this issue, the factors that affect ambulance use must be identified. Few studies have examined factors that can intervene and thus reduce the frequency of ambulance use. This study aimed to examine the association between social support and ambulance use among older adults in Japan. We hypothesize that social support is associated with reduced ambulance use. METHODS: This cross-sectional study was conducted as part of the Japan Gerontological Evaluation Study. In December 2019 and January 2020, we collaborated with individuals aged 65 years or above with no long-term care needs. A total of 24,581 participants were included in the analysis. The objective and explanatory variables were ambulance use and social support, respectively. Binomial regression analysis was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Social support was associated with ambulance use. People who had no one to listen to their complaints or worries were significantly more likely to use ambulance services than those who did (OR [95% CI] = 1.26 [1.03-1.53]). People with no one to take care of them when they were ill were also significantly more likely to use ambulance services than those who had someone to provide care (1.15 [1.01-1.31]). Moreover, the results of binomial logistic regression analysis indicated that individuals who called an ambulance but were not hospitalized had significantly lower social support compared to those who did not call an ambulance. CONCLUSIONS: The results suggest that the presence and quality of social support play a significant role in ambulance use among older adults in Japan. Our findings can help policymakers to plan and implement strategies for reducing the burden on emergency medical care.

[Communication between pregnant women and maternal and child health professionals and trust in professionals and awareness of source of help in the postpartum period: Evaluation using JACSIS Pregnant-Postpartum Women's Data 2020-2021].

Objective　This study aims to estimate the impact of maternal and child health professional consultation and development of support plans during pregnancy on trust in community health professionals (trust) and awareness of sources of public/private institutional support (awareness) in the postpartum period.Methods　A web-based panel survey was conducted in July-August 2021 and January-February 2022, targeting women who were pregnant during the 2021 survey and 0-5 months postpartum in 2022. We collected information about consultation opportunities and development of a support plan during pregnancy, trust and recognition, demographic characteristics, employment status, and pregnancy- and childbirth-related variables. First, logistic regression analysis was conducted by setting trust and recognition during postpartum as outcomes. Exposure variables were the consultation opportunities and development of a support plan during the pregnancy period. Second, we added the presence of a comprehensive support center for raising children, the financial index of the municipality of residence, the per capita child welfare expenditure, and the number of nurses at the comprehensive support center for maternal and child health to the analytical model as overall level of municipal support in order to check the robustness of our results.Results　Responses were obtained from pregnant women across Japan. Of the 616 respondents included in the analysis, 74.0% had opportunities for consultation, 23.7% made support plans, 69.8% trusted local maternal and child health professionals, and 63.6% recognized public/private institutional support as places for help-seeking. Logistic regression analysis showed that trust and recognition were higher among those who had opportunities to consult and had created a support plan compared to those who did not. With regard to trust, for those who had opportunities to consult, the odds ratio (OR) was 2.05 (95% confidence interval [95% CI] 1.37-3.07), and for those who developed a support plan, the OR was 2.25 (95% CI 1.41-3.60). As for recognition, the OR was 1.46 (95% CI 0.98-2.16) if given the opportunity for consultation. For development of a support plan, the OR was 3.05 (95% CI 1.94-4.80). These results did not change even after adjusting for municipal finances and the level of support for pregnant women in general.Conclusions　Consultation opportunities and developing support plans during pregnancy increased trust and recognition in the postpartum period while municipal finances or overall support for child rearing were not associated with these outcomes, thus suggesting the importance of engagement with professionals during pregnancy.

Rheumatoid Arthritis and Reactive Oxygen Species: A Review.

Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease that causes progressive joint damage and can lead to lifelong disability. Numerous studies support the hypothesis that reactive oxygen species (ROS) are associated with RA pathogenesis. Recent advances have clarified the anti-inflammatory effect of antioxidants and their roles in RA alleviation. In addition, several important signaling pathway components, such as nuclear factor kappa B, activator-protein-1, nuclear factor (erythroid-derived 2)-like 2/kelch-like associated protein, signal transducer and activator of transcription 3, and mitogen-activated protein kinases, including c-Jun N-terminal kinase, have been identified to be associated with RA. In this paper, we outline the ROS generation process and relevant oxidative markers, thereby providing evidence of the association between oxidative stress and RA pathogenesis. Furthermore, we describe various therapeutic targets in several prominent signaling pathways for improving RA disease activity and its hyper oxidative state. Finally, we reviewed natural foods, phytochemicals, chemical compounds with antioxidant properties and the association of microbiota with RA pathogenesis.

Effectiveness of mHealth consultation services for preventing postpartum depressive symptoms: a randomized clinical trial.

BACKGROUND: Although many conventional healthcare services to prevent postpartum depression are provided face-to-face, physical and psychosocial barriers remain. These barriers may be overcome by using mobile health services (mHealth). To examine the effectiveness of mHealth professional consultation services in preventing postpartum depressive symptoms in real-world settings, we conducted this randomized controlled trial in Japan, where universal free face-to-face perinatal care is available. METHODS: This study included 734 pregnant women living in Yokohama city who could communicate in Japanese, recruited at public offices and childcare support facilities. The participants were randomized to the mHealth group (intervention, n = 365), where they could use a free app-based mHealth consultation service with gynecologists/obstetricians, pediatricians, and midwives whenever and as many times as they wanted between 6 p.m. and 10 p.m. on weekdays throughout their pregnancy and postpartum periods (funded by the City of Yokohama government) or the usual care group (control, n = 369). The primary outcome was the risk of elevated postpartum depressive symptoms, defined as Edinburgh Postnatal Depression Scale score ≥ 9. Secondary outcomes were self-efficacy, loneliness, perceived barriers to healthcare access, number of clinic visits, and ambulance usage. All outcomes were collected three months post-delivery. We also conducted subgroup analyses assessing the differences in the treatment effect by sociodemographic status. RESULTS: Most women completed all questionnaires (n = 639 of 734, response rate: 87%). The mean baseline age was 32.9 ± 4.2 years, and 62% were primipara. Three months post-delivery, women in the mHealth group had a lower risk of elevated postpartum depressive symptoms (47/310 [15.2%]) compared to the usual care group (75/329 [22.8%], risk ratio: 0.67 [95% confidence interval: 0.48-0.93]). Compared with the usual care group, women in the mHealth group had higher self-efficacy, less loneliness, and fewer perceived barriers to healthcare access. No differences were observed in the frequency of clinic visits or ambulance usage. Furthermore, in the subgroup analyses, we did not find differences in the treatment effect by sociodemographic status. CONCLUSIONS: Local government-funded mHealth consultation services have a preventive effect on postpartum depressive symptoms, removing physical and psychological barriers to healthcare access in real-world settings. TRIAL REGISTRATION: UMIN-CTR identifier: UMIN000041611. Registered 31 August 2021.

Machine Learning-Based Prediction of Functional Disability: a Cohort Study of Japanese Older Adults in 2013-2019.

BACKGROUND: It is important to identify older adults at high risk of functional disability and to take preventive measures for them at an early stage. To our knowledge, there are no studies that predict functional disability among community-dwelling older adults using machine learning algorithms. OBJECTIVE: To construct a model that can predict functional disability over 5 years using basic machine learning algorithms. DESIGN: A cohort study with a mean follow-up of 5.4 years. PARTICIPANTS: We used data from the Japan Gerontological Evaluation Study, which involved 73,262 people aged ≥ 65 years who were not certified as requiring long-term care. The baseline survey was conducted in 2013 in 19 municipalities. MAIN MEASURES: We defined the onset of functional disability as the new certification of needing long-term care that was ascertained by linking participants to public registries of long-term care insurance. All 183 candidate predictors were measured by self-report questionnaires. KEY RESULTS: During the study period, 16,361 (22.3%) participants experienced the onset of functional disability. Among machine learning-based models, ridge regression (C statistic = 0.818) and gradient boosting (0.817) effectively predicted functional disability. In both models, we identified age, self-rated health, variables related to falls and posture stabilization, and diagnoses of Parkinson's disease and dementia as important features. Additionally, the ridge regression model identified the household characteristics such as the number of members, income, and receiving public assistance as important predictors, while the gradient boosting model selected moderate physical activity and driving. Based on the ridge regression model, we developed a simplified risk score for functional disability, and it also indicated good performance at the cut-off of 6/7 points. CONCLUSIONS: Machine learning-based models showed effective performance prediction over 5 years. Our findings suggest that measuring and adding the variables identified as important features can improve the prediction of functional disability.

Identifying meaningful subpopulation segments among older public assistance recipients: a mixed methods study to develop tailor-made health and welfare interventions.

BACKGROUND: Public assistance recipients have diverse and complex needs for health and social support in addition to financial support. Segmentation, which means dividing the population into subgroups (segments) with similar sociodemographic characteristics, is a useful approach for allocating support resources to the targeted segments. Clustering is a commonly used statistical method of segmentation in a data-driven marketing approach. This explanatory sequential mixed methods study applied a clustering technique, aiming to identify segments among older public assistance recipients quantitatively, and assess the meaningfulness of the identified segments in consultation and support activities for older recipients qualitatively. METHODS: We identified the segments of older recipients in two municipalities using probabilistic latent semantic analysis, a machine learning-based soft clustering method. Semi-structured interviews were subsequently conducted with caseworkers to ask whether the identified segments could be meaningful for them in practice and to provide a reason if they could not think of any older recipients from the segment. RESULTS: A total of 3,165 older people on public assistance were included in the analysis. Five distinct segments of older recipients were identified for each sex from 1,483 men and 1,682 women. The qualitative findings suggested most of identified segments reflected older recipients in practice, especially two of them: female Cluster 1 (facility residents aged over 85 years with disability/psychiatric disorder), and female Cluster 2 (workers). Some caseworkers, however, did not recall older recipients in practice when working with certain segments. CONCLUSIONS: A clustering technique can be useful to identify the meaningful segments among older recipients and can potentially discover previously unrecognized segments that may not emerge through regular consultation practices followed by caseworkers. Future research should investigate whether tailored support interventions for these identified segments are effective.

Addressing health inequity during the COVID-19 pandemic through primary health care and public health collaboration: a multiple case study analysis in eight high-income countries.

BACKGROUND: The COVID-19 pandemic substantially magnified the inequity gaps among vulnerable populations. Both public health (PH) and primary health care (PHC) have been crucial in addressing the challenges posed by the pandemic, especially in the area of vulnerable populations. However, little is known about the intersection between PH and PHC as a strategy to mitigate the inequity gap. This study aims to assess the collaboration between PHC and PH with a focus on addressing the health needs of vulnerable populations during the COVID-19 pandemic across jurisdictions. METHODS: We analyzed and compared data from jurisdictional reports of COVID-19 pandemic responses in PHC and PH in Belgium, Canada (Ontario), Germany, Italy, Japan, the Netherlands, Norway, and Spain from 2020 to 2021. RESULTS: Four themes emerge from the analysis: (1) the majority of the countries implemented outreach strategies targeting vulnerable groups as a means to ensure continued access to PHC; (2) digital assessment in PHC was found to be present across all the countries; (3) PHC was insufficiently represented at the decision-making level; (4) there is a lack of clear communication channels between PH and PHC in all the countries. CONCLUSIONS: This study identified opportunities for collaboration between PHC and PH to reduce inequity gaps and to improve population health, focusing on vulnerable populations. The COVID-19 response in these eight countries has demonstrated the importance of an integrated PHC system. Consequently, the development of effective strategies for responding to and planning for pandemics should take into account the social determinants of health in order to mitigate the unequal impact of COVID-19. Careful, intentional coordination between PH and PHC should be established in normal times as a basis for effective response during future public health emergencies. The pandemic has provided significant insights on how to strengthen health systems and provide universal access to healthcare by fostering stronger connections between PH and PHC.

Trends in Cardiovascular Risk Factors by Income Among Japanese Adults Aged 30-49 Years From 2017 to 2020: A Nationwide Longitudinal Cohort Study.

OBJECTIVE: Income is a major social determinant of cardiovascular health. However, individual-level evidence regarding the trends in cardiovascular risk factors by income level among young working-age adults is limited. We thus aimed to examine the trends in cardiovascular risk factors among men and women aged 30-49 years by their income levels. METHODS: This nationwide longitudinal study included Japanese adults aged 30-49 years, who annually participated in the national health screening program from 2017 to 2020. Modified Poisson regression models were used to investigate trends in the prevalence of cardiovascular risk factors (obesity, hypertension, diabetes, and dyslipidemia) according to tertiles of individuals' annual income, adjusting for potential confounders. RESULTS: Among 58 814 adults, 50 024 (85%) were men; the mean (SD) age was 42.1 (5.4) years. Over the study period, the low-income group consistently showed a higher prevalence of obesity, hypertension, and diabetes than the high-income group. The difference in the prevalence of these diseases, particularly hypertension, across income groups increased from 2017 to 2020 among both men (low-income vs high-income: +5.73% [95% CI, 4.72-6.73] in 2017 and +8.26% [95% CI, 7.11-9.41] in 2020) and women (low-income vs high-income: +2.53% [95% CI, 0.99-4.06] in 2017 and +3.83% [95% CI, 1.93-5.73] in 2020). CONCLUSION: Among adults aged 30-49 years in Japan, a country with a universal healthcare coverage system, we found an increase in the gap of cardiovascular risk factors by income levels over the last 4 years. Careful monitoring of the increasing social disparities is needed to achieve cardiovascular health equity at this life stage.

Community gender norms, mental health, and suicide ideation and attempts among older Japanese adults: a cross-sectional study.

OBJECTIVES: Gender norms embedded in communities may restrict opportunities and harm the mental health of older adults, yet this phenomenon has received little attention. This study investigates the connection between older adults' perceptions of community gender norms and mental health and suicide-related outcomes. DESIGN: Cross-sectional. SETTING: This study analyzed data from the 2019 wave of the Japan Gerontological Evaluation Study. PARTICIPANTS: In total, 25,937 participants aged 65 years or older in 61 municipalities. MEASUREMENTS: Perceptions of community gender norms were assessed by the respondents' perceptions of the gender-differentiating language used by those around them such as "You should/should not do XXX, because you are a man/woman." RESULTS: The prevalence of all mental health outcomes was higher among both men and women who perceived community gender norms as restrictive. These associations remained in fully adjusted multivariable analyses. Prevalence ratios for men were 1.36 [95% confidence interval: 1.13, 1.65] for psychological resistance to obtaining help, 1.85 [1.54, 2.23] for depressive symptoms, 1.99 [1.34, 2.96] for suicidal ideation, and 2.15 [1.21, 3.80] for suicide attempts. The corresponding figures for women were 1.39 [1.17, 1.65], 1.80 [1.55, 2.10], 2.13 [1.65, 2.74], 2.62 [1.78, 3.87]. There was a more pronounced association between perceiving community gender norms as restrictive and depressive symptoms and suicidal behaviors among those with nonconventional gender role attitudes compared to those with conventional attitudes. CONCLUSIONS: Considering the effects of community gender norms, in addition to individual gender role attitudes, may be critical in designing effective public health interventions for improving mental health.

Married women's decision to delay childbearing, and loneliness, severe psychological distress, and suicidal ideation under crisis: online survey data analysis from 2020 to 2021.

BACKGROUND: The COVID-19 pandemic has affected every aspect of our lives, including the decision to become pregnant. Existing literature suggests that infertility and the decision to delay childbearing at a younger age are associated with a lower level of well-being and regrets when women start to desire a baby. Thus, the decision to delay childbearing due to the pandemic could negatively affect the well-being of women. This study focuses on how pregnancy decisions affect the well-being of women during the COVID-19 pandemic. METHODS: From the Japan COVID-19 and Society Internet Survey, a nationally representative web-based survey, 768 observations of married women aged 18 to 50 years who had the intention of getting pregnant during the pre-pandemic period (conducted in 2020 and 2021) were used. Loneliness, severe psychological distress, and suicidal ideation were used as well-being indicators. For pooled data, a generalised estimated equation (GEE) model was used to estimate how pregnancy decision related to well-being indicators. For a sub-analysis, the sample was divided by the survey year and a Poisson regression model was used. RESULTS: The GEE analysis showed an association between delaying childbearing and severe psychological distress, with the prevalence ratio (PR) being 2.06 [95% CI (1.40-3.03)]. Furthermore, loneliness and suicidal ideation that occurred after the beginning of the pandemic were significantly related to the decision to delay childbearing-1.55 [95% CI (1.03,2.34)] and 2.55 [95% CI (1.45-4.51)], respectively. Moreover, these PRs were larger for 2021 compared to 2020. CONCLUSION: During the COVID-19 pandemic, approximately one-fifth of married women who had childbearing intentions before the pandemic decided to postpone pregnancy. They exhibited a deteriorated mental health state. Furthermore, the negative associations were larger in 2021 compared to 2020. Loneliness has negative consequences for both mental and physical health, as well as elevated severe psychological distress and suicidal ideation among those who decided to postpone pregnancy. Therefore, the current results should not be overlooked by society.

Sociodemographic inequalities in mortality from drowning in the Baltic countries and Finland in 2000-2015: a register-based study.

BACKGROUND: Drowning is an important public health problem. Some evidence suggests that the risk of drowning is not distributed evenly across the general population. However, there has been comparatively little research on inequalities in drowning mortality. To address this deficit, this study examined trends and sociodemographic inequalities in mortality from unintentional drowning in the Baltic countries and Finland in 2000-2015. METHODS: Data for Estonia, Latvia and Lithuania came from longitudinal mortality follow-up studies of population censuses in 2000/2001 and 2011, while corresponding data for Finland were obtained from the longitudinal register-based population data file of Statistics Finland. Deaths from drowning (ICD-10 codes W65-W74) were obtained from national mortality registries. Information was also obtained on socioeconomic status (educational level) and urban-rural residence. Age-standardised mortality rates (ASMRs) per 100 000 person years and mortality rate ratios were calculated for adults aged 30-74 years old. Poisson regression analysis was performed to assess the independent effects of sex, urban-rural residence and education on drowning mortality. RESULTS: Drowning ASMRs were significantly higher in the Baltic countries than in Finland but declined by nearly 30% in all countries across the study period. There were large inequalities by sex, urban-rural residence and educational level in all countries during 2000-2015. Men, rural residents and low educated individuals had substantially higher drowning ASMRs compared to their counterparts. Absolute and relative inequalities were significantly larger in the Baltic countries than in Finland. Absolute inequalities in drowning mortality declined in all countries across the study period except between urban and rural residents in Finland. Changes in relative inequalities were more variable during 2000-2015. CONCLUSION: Despite a sharp reduction in deaths from drowning in the Baltic countries and Finland in 2000-2015, drowning mortality was still high in these countries at the end of the study period with a substantially larger risk of death seen among men, rural residents and low educated individuals. A concerted effort to prevent drowning mortality among those most at risk may reduce drownings considerably in the general population.

Does disaster-related relocation impact mental health via changes in group participation among older adults? Causal mediation analysis of a pre-post disaster study of the 2016 Kumamoto earthquake.

BACKGROUND: Disaster-related relocation is associated with depression and post-traumatic stress disorder, especially in older adults. Disaster-related relocation often deprives survivors of opportunities for social group participation, potentially deteriorating their mental health. On the contrary, the relocation could also be an opportunity for optimizing social relationships, ending/reducing unwanted participation. This study examined the potential mediation effects of changing participation for the link of disaster-related relocation to mental health. METHODS: We analyzed a pre-post disaster dataset of functionally independent older adults from the Japan Gerontological Evaluation Study. Following the 2013 survey, a follow-up survey was conducted seven months after the 2016 Kumamoto earthquake (n = 828). RESULTS: The causal mediation analyses indicated that compared to no relocation, the relative risk for experiencing major depressive episodes among those relocating to temporary housing was 3.79 [95% confidence interval: 1.70-6.64] (natural direct effect). By contrast, the relative risk for those renewing (either ceased or started) group participation was 0.60 [95% CI: 0.34-0.94] (natural indirect effect). CONCLUSIONS: Optimization of social ties according to a renewal of group participation status might have protected older adults in temporary housing against depression.

Educational inequalities in hypothermia mortality in the Baltic countries and Finland in 2000-15.

BACKGROUND: Despite an increased focus on cold-related mortality in recent years, there has been comparatively little research specifically on hypothermia mortality and its associated factors. METHODS: Educational inequalities in hypothermia mortality among individuals aged 30-74 in the Baltic countries (Estonia, Latvia, Lithuania) and Finland in 2000-15 were examined using data from longitudinal mortality follow-up studies of population censuses (the Baltics) and from a longitudinal register-based population data file (Finland). RESULTS: Age-standardized mortality rates (ASMRs) were much higher in the Baltic countries than in Finland across the study period. From 2000-07 to 2008-15, overall ASMRs declined in all countries except among Finnish women. Although a strong educational gradient was observed in hypothermia mortality in all countries in 2000-07, inequalities were larger in the Baltic countries. Between 2000-07 and 2008-15, ASMRs declined in all educational groups except for high-educated women in Finland and low-educated women in Lithuania; the changes however were not always statistically significant. The absolute mortality decline was often larger among the low educated resulting in narrowing absolute inequalities (excepting Lithuania), whereas a larger relative decline among the high educated (excepting Finnish women) resulted in a considerable widening of relative inequalities in hypothermia mortality by 2008-15. CONCLUSION: Although some reduction was observed in absolute educational inequalities in hypothermia mortality in 2000-15, substantial and widening relative inequalities highlight the need for further action in combatting factors behind deaths from excessive cold in socioeconomically disadvantaged groups, including risky alcohol consumption and homelessness.

Sociodemographic inequities in unscheduled asthma care visits among public assistance recipients in Japan: additional risk by household composition among workers.

BACKGROUND: Public assistance programs aim to prevent financial poverty by guaranteeing a minimum income for basic needs, including medical care. However, time poverty also matters, especially in the medical care adherence of people with chronic diseases. This study aimed to examine the association between the dual burden of working and household responsibilities, with unscheduled asthma care visits among public assistance recipients in Japan. METHODS: This retrospective cohort study included public assistance recipients from two municipalities. We obtained participants' sociodemographic data in January 2016 from the public assistance database and identified the incidence of asthma care visits. Participants' unscheduled asthma visits and the frequency of asthma visits were used as the outcome variables. Unscheduled visits were defined as visits by recipients who did not receive asthma care during the first three months of the observation period. Participants' age, sex, household composition, and work status were used as explanatory variables. Multiple Poisson regression analyses were performed to calculate the cumulative incidence ratio (IR) with a 95% confidence interval (CI) of unscheduled visits across the explanatory variables. The effect of modification on the work status by household composition was also examined. RESULTS: We identified 2,386 recipients at risk of having unscheduled visits, among which 121 patients (5.1%) had unscheduled visits. The multivariable Poisson regression revealed that the working recipients had a higher incidence of unscheduled visits than the non-working recipients (IR 1.44, 95% CI 1.00-2.07). Among working recipients, the IRs of unscheduled visits were higher among recipients cohabiting with adults (IR 1.90 95% CI 1.00-3.59) and with children (IR 2.35, 95% CI 1.11-4.95) than for recipients living alone. Among non-working recipients, the IRs of unscheduled visits were lower for recipients living with family (IR 0.74, 95% CI 0.41-1.35) and those living with children (IR 0.50, 95% CI 0.20-1.23). A higher frequency in asthma visits was observed among working recipients living with family. CONCLUSIONS: Working adults cohabiting with children are at the greatest risk of unscheduled visits among adults receiving public assistance. To support healthy lifestyles of public assistance recipients, medical care providers and policymakers should pay special attention to the potentially underserved populations.

Remote Communication and Loneliness During the COVID-19 Pandemic: Cross-Sectional Study.

BACKGROUND: Although remote communication technologies have been widely used to maintain connections with others against interpersonal contact restrictions and exacerbated loneliness during the COVID-19 pandemic, it is unclear whether and what types of remote communication technologies are effective in mitigating loneliness. OBJECTIVE: This study aimed to investigate the association between remote communication and loneliness when face-to-face meetings with others were strongly prohibited and whether this association varied across types of communication tools, age, and gender. METHODS: We used cross-sectional data from the Japan COVID-19 and Society Internet Survey conducted from August to September 2020. From registered panelists of the research agency, 28,000 randomly sampled participants completed the survey on the website. We created 2 study cohorts who stopped meeting with family members living apart and friends during the pandemic. We categorized whether participants had technology-based remote communication (voice calling, text messaging, and video calling) with family and friends. Loneliness was assessed using the 3-item University of California, Los Angeles Loneliness Scale. We used a modified Poisson regression model to investigate the association between loneliness and remote communication with family members living apart or friends. We also conducted subgroup analyses based on age and gender. RESULTS: A total of 4483 participants stopped meeting with family members living apart, and 6783 participants stopped meeting with friends during the COVID-19 pandemic. Remote communication with family members living apart did not show an association with loneliness, whereas remote communication with friends was associated with a low prevalence of loneliness (family: adjusted prevalence ratio [aPR]=0.89, 95% CI 0.74-1.08; P=.24 and friends: aPR=0.82, 95% CI 0.73-0.91; P<.001). From analyses by tools, voice calling was associated with low loneliness (family: aPR=0.88, 95% CI 0.78-0.98; P=.03 and friends: aPR=0.87, 95% CI 0.80-0.95; P=.003). Similarly, text messaging was associated with low loneliness (family: aPR=0.82, 95% CI 0.69-0.97; P=.02 and friends: aPR=0.81, 95% CI 0.73-0.89; P<.001). However, we did not find an association between video calling and loneliness (family: aPR=0.88, 95% CI 0.75-1.02; P=.09 and friends: aPR=0.94, 95% CI 0.85-1.04; P=.25). Text messaging with friends was associated with low loneliness regardless of age, whereas voice calling with family or friends was associated with low loneliness only among participants aged ≥65 years. An association between remote communication with friends and low loneliness was found regardless of the type of remote communication tool among men, whereas it was found only for text messaging with friends among women. CONCLUSIONS: In this cross-sectional study of adults in Japan, remote communication, especially via voice calling and text messaging, was associated with low loneliness. Promoting remote communication may reduce loneliness when face-to-face contact is restricted, which should be the subject of future research.

Impact of the COVID-19 pandemic on pregnancy postponement - evidence from Japan.

Japan has faced a decline in fertility since the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to investigate the rate of pregnancy postponement and its contributing factors, with a particular focus on economic- and COVID-19 infection-related indicators. This study used data from 768 observations of married women aged 18 to 50 years with pregnancy intentions. The data were obtained from two rounds of a large web-based survey conducted by the Japan COVID-19 and Society Internet Survey (JACSIS) in 2020 and 2021. A generalised estimating equation (GEE) model was employed, as well as Poisson regression models for sub-sample analysis divided by year to estimate the year differential magnitude of the contributing factors' impacts. Approximately 20% of married women with childbearing intentions postponed their childbearing. The analyses revealed that declining income and anxiety about future household finances were significantly related to delayed childbearing, while fear of COVID-19 and infection rate were not. Additionally, the adverse effects of unfavourable economic conditions were stronger in 2021. Notably, age did not influence the decision of pregnancy postponement. Older women postponed pregnancy just as much as younger women. In conclusion, this study confirmed that the COVID-19 pandemic, particularly its related adverse economic conditions, contributed to Japan's current baby bust. Considering that advanced maternal age is already common in Japan, this decreased fertility may result in the long-term negative consequence of further population decline.

Geriatric symptoms associated with healthy life expectancy in older people in Japan.

BACKGROUND: We investigated the relationship between characteristic geriatric symptoms and healthy life expectancy in older adults in Japan. Additionally, we determined relationship predictors that would help formulate effective approaches toward promoting healthy life expectancy. METHODS: The Kihon Checklist was used to identify older people at high risk of requiring nursing care in the near future. We evaluated the association of geriatric symptoms with healthy life expectancy while considering risk factors (frailty, poor motor function, poor nutrition, poor oral function, confinement, poor cognitive function, and depression). Data from the 2013 and 2019 Japan Gerontological Evaluation Studies were used. Healthy life expectancy was assessed using the multistate life table method. RESULTS: Overall, 8,956 individuals were included. For both men and women, healthy life expectancy was shorter in the symptomatic group than in the asymptomatic group for several domains of the Kihon Checklist. For men, the difference between individuals with risk factors and those with no risk factors was the maximum for confinement (3.83 years) and the minimum for cognitive function (1.51 years). For women, the difference between individuals with risk factors and those with no risk factors was the maximum for frailty (4.21 years) and the minimum for cognitive function (1.67 years). Healthy life expectancy tended to be shorter when the number of risk factors was higher. Specifically, the difference between individuals with ≥3 risk factors and those with no risk factors was 4.46 years for men and 5.68 years for women. CONCLUSIONS: Healthy life expectancy was negatively associated with characteristic geriatric symptoms, with strong associations with frailty, physical functional decline, and depression. Therefore, comprehensive assessment and prevention of geriatric symptoms may increase healthy life expectancy.