Medical malpractice litigation related to choking accidents in older people in Japan.

OBJECTIVE: To analyse malpractice litigation cases in Japan and identify the factors related to choking accidents in older people. BACKGROUND: Choking while eating is common in older people and has potentially severe consequences. METHODS: This study analysed court decisions related to choking accidents occurring in Japan between 2000 and 2015 that involved the death of an older person or permanent severe choking-related injury. A database of court decisions (n = 23) was constructed according to patient and caregiver characteristics, and nursing services. An analysis was performed on caregiver liability, and to identify factors related to choking accidents. RESULTS: The court ruled that the caregiver was liable in 10 of the 23 cases. Liability was related to appropriate food choices, failure to monitor of eating or the non-performance of resuscitation after an accident. Prior knowledge of aspiration (P < .001), inappropriate assistance during the meal (P < .001), and inappropriate emergency treatment (P = .028) were more likely to be present in cases in which caregivers were judged liable than in those in which they were not. CONCLUSIONS: Lack of appropriate assistance during the meal was the factor most strongly associated with a court ruling of caregiver liability for choking accidents in older people.

Association between sensory processing and dental fear among female undergraduates in Japan.

Objectives: The aim of cross-sectional study was to investigate the association between sensory processing patterns and dental fear among female undergraduates. Material and methods: Three hundred and ten female university students were included in the present study. Dental fear and sensory processing patterns were measured using the Dental Fear Survey and Adolescent/Adult Sensory Profile with other possible confounders, respectively. Sensory processing patterns were categorized into sensory sensitivity, sensory avoidance, low registration and sensation seeking. We conducted structural equation modelling based on the hypothesis that sensory processing directly affects dental fear, including the confounding role of negative experiences with dentistry, autistic traits and the mediating role of trait anxiety. Results: Based on our proposed model, sensory processing patterns, excluding sensation seeking and negative experiences significantly contributed to dental fear (ß = 0.33, p < .001 and ß = 0.32, p < .001, respectively) and autistic traits and trait anxiety did not significantly contribute to dental fear. Conclusions: Extreme sensory processing patterns seem to be associated with a high level of dental fear; thus, the difference in sensory processing might play an important role in the aetiology of dental fear.

Association Between Dentist-Dental Hygienist Communication and Dental Treatment Outcomes.

Communication between physician and patient is critical in all fields of medicine, and various types of communication exist in healthcare settings. Cooperation among healthcare professionals is thought to be essential in providing high-quality services. Dental hygienists are key team members in the provision of dental care, and are known to play an important role in the health of their patients. This study aimed to determine the effect of communication between dentists and hygienists on patient satisfaction. Study subjects were dentists, patients, and dental hygienists, and we examined how dentist-dental hygienist communication affected patient outcome indices. A significant difference was observed only for satisfaction in terms of meeting expectations (p = 0.035). Results for patient satisfaction indicated significant differences in explanatory behavior in dentist-dental hygienist evaluations (p = 0.001). The results showed improved health and reduced fear, indicating significant differences for the dentist-dental hygienist evaluations in explanation behavior (p = 0.016). Our evaluation of the effects of dentist-dental hygienist communication on patient outcomes indicated a significant correlation, suggesting that inter-professional communication in the field of dentistry affects patient satisfaction.

A comparison of medical litigation filed against obstetrics and gynecology, internal medicine, and surgery departments.

BACKGROUND: The aim of this study was to review the typical factors related to physician's liability in obstetrics and gynecology departments, as compared to those in internal medicine and surgery, regarding a breach of the duty to explain. METHODS: This study involved analyzing 366 medical litigation case reports from 1990 through 2008 where the duty to explain was disputed. We examined relationships between patients, physicians, variables related to physician's explanations, and physician's breach of the duty to explain by comparing mean values and percentages in obstetrics and gynecology, internal medicine, and surgical departments with the t-test and χ(2) test. RESULTS: When we compared the reasons for decisions in cases where the patient won, we found that the percentage of cases in which the patient's claim was recognized was the highest for both physician negligence, including errors of judgment and procedural mistakes, and breach of the duty to explain, in obstetrics and gynecology departments; breach of the duty to explain alone in internal medicine departments; and mistakes in medical procedures alone in surgical departments (p = 0.008). When comparing patients, the rate of death was significantly higher than that of other outcomes in precedents where a breach of the duty to explain was acknowledged (p = 0.046). The proportion of cases involving obstetrics and gynecology departments, in which care was claimed to be substandard at the time of treatment, and that were not argued as breach of a duty to explain, was significantly higher than those of other evaluated departments (p <0.001). However, internal medicine and surgical departments were very similar in this context. In obstetrics and gynecology departments, the proportion of cases in which it had been conceded that the duty to explain had been breached when seeking patient approval (or not) was significantly higher than in other departments (p = 0.002). CONCLUSION: It is important for physicians working in obstetrics and gynecology departments to carefully explain the risk of death associated with any planned procedure, and to obtain genuinely informed patient consent.

[Relationship between the attitudes towards improving eating habits and prevalence of metabolic syndrome. Data from the 2005 National Health and Nutrition Survey and the Comprehensive Survey of Living Conditions].

OBJECTIVES: The aim of the present study was to examine the constructive attitudes towards improving eating habits and their relationship with the prevalence of metabolic syndrome (MetS) using data from the National Health and Nutrition Survey (2005) and the Comprehensive Survey of Living Conditions (2005). METHODS: Individuals aged >30 years (N=3084) were enrolled in this study. Exploratory factor analyses were performed to examine the constructive attitudes towards improving eating habits by using 14 parameters. In addition, confirmatory factor analysis was performed and the Cronbach α value was calculated. Furthermore, the relationship between attitudes towards improving eating habits and MetS prevalence was examined according to gender by using multinomial logistic regression analysis, after adjusting for age, number of members in a household, exercise habits, and rest by sleeping. RESULTS: Two factors were extracted: balanced diet (BD) and control of food intake (CFI) (Cronbach α, 0.82 and 0.75, respectively). The goodness of fit model, based on the structural equation models, was adequate (goodness of fit, 0.96). No relationship was noted between BD and MetS prevalence. The MetS prevalence differed according to gender: "Strongly suspected MetS (sure MetS)", 16.3% (male, 24.4%; female, 10.7%), "Preliminary MetS (pre MetS)", 15.2% (male, 24.1%; female, 8.9%), "non-suspected MetS (non MetS)", 68.5% (male, 51.5%; female, 80.5%). The odds ratios (95% confidence interval) for pre MetS and sure MetS were 0.57 (0.42-0.78) and 0.52 (0.38-0.71) in males and 0.36 (0.25-0.53) and 0.39 (0.27-0.56) in females, respectively, when non MetS was used as a reference. CONCLUSION: The results of this study indicated that the attitudes towards improving eating habits primarily focused on BD and CFI. Therefore, improving eating habits towards in terms of better CFI would be effective in preventing MetS in both genders.

Association between tooth loss and orodigestive cancer mortality in an 80-year-old community-dwelling Japanese population: a 12-year prospective study.

BACKGROUND: A growing body of evidence has indicated a possible association between oral and gastrointestinal (orodigestive) cancers and periodontal disease or tooth loss. However, the evidence remains contradictory. This study investigated whether tooth loss, which is indicative of poor oral health and a potential source of oral infections, is associated with death from orodigestive cancer. METHODS: The study included 656 subjects in Fukuoka prefecture, Japan, who were 80 years old at baseline in 1998. All subjects underwent oral clinical examination and answered a questionnaire to determine their background characteristics. Cause of death over the 12-year follow-up was recorded from the registers at the Public Health Centers and classified according to the WHO International Classification of Diseases. Statistical analysis of associations was performed using Kaplan-Meier and Cox multivariate regression analyses. RESULTS: A significant association was observed between tooth loss (continuous variable) and cancer death (hazard ratio (HR): 1.03, 95% confidence interval (CI): 1.00-1.07), after adjustment for potential confounders, including sex and smoking status. However, that association became insignificant in the fully adjusted model. On the other hand, tooth loss was significantly associated with orodigestive cancer (HR: 1.06, 95% CI: 1.01-1.13), even in the fully adjusted model including place of residence as a part of socioeconomic status. CONCLUSIONS: This study provides the first evidence in a prospective study in a Japanese population that tooth loss is associated with increased orodigestive cancer mortality, although the causality remains unclear.

Oral health in patients on haemodialysis for diabetic nephropathy and chronic glomerulonephritis.

OBJECTIVE: The objective of this study was to clarify differences in oral health status between patients who needed haemodialysis (HD) owing to diabetic nephropathy (DN) and chronic glomerulonephritis (CGN). MATERIALS AND METHODS: Ninety-eight HD patients who were 50-70 years old were selected as the study subjects [DN group (29 subjects) and CGN group (69 subjects)] to compare with 106 control subjects (control group) not undergoing HD. All HD subjects underwent oral- and systemic-related examination just before HD therapy. RESULTS: The mean number of teeth present in the DN group was significantly less than in the CGN and control groups. The mean percentage of sites with bleeding on probing in the DN group was greater than in the CGN and control groups. The mean salivary flow rate in the DN and CGN groups was significantly lower compared with the control group. CONCLUSION: The patients undergoing HD for DN were found to have fewer teeth and worse periodontal health compared with those undergoing HD for CGN and with the control subjects not undergoing HD. Furthermore, the dental and periodontal health of the patients undergoing HD for CGN was comparable to that of the controls. CLINICAL RELEVANCE: For effective measures of prevention and improvement of oral health in HD patients, clinicians should be aware of the differences in the characteristics of the oral health between patients undergoing HD for DN and CGN.

Effects of Both Japanese-Style Dietary Patterns and Nutrition on Falling Incidents among Community-Dwelling Elderly Individuals: A Cross-Sectional Study.

Approximately 20% of the community-dwelling Japanese elderly (≥65 years) experience falling annually, with injury frequency rising with age. Increased nursing home admission/hospitalization risk influences healthy aging and QOL. Nutrition for musculoskeletal health is necessary, though the relationship of falling with nutritional status in the elderly is largely unknown. We investigated falling incidents and nutritional status, including a Japanese-style diet in a community-dwelling cohort. Using a cross-sectional design, 186 subjects (median age 83.0 years, males/females 67/119) were analyzed. Oral and systemic health conditions were assessed. A brief-type self-administered diet history questionnaire (BDHQ) was given for nutritional status. Analysis of covariance (adjusted for gender, age, BMI, articular disease/osteoporosis history, present tooth number, educational level) and the Japanese-Mediterranean diet (jMD) score adapted for Japan were used. The jMD score and falling incidents were significantly associated, with point increases related to a significantly decreased falling risk of 28% (OR: 0.72; 95%CI: 0.57−0.91). Of the 13 jMD food components, fish, eggs, and potatoes had a significant relationship with reduced falling, while significant associations of intake of animal protein, potassium, magnesium, zinc, and cholesterol (p < 0.05) were also observed. The results suggest that the jMD dietary pattern is an important factor for the prevention of falling incidents in elderly individuals.

The CLOCK 3111T/C polymorphism is associated with hour-by-hour physical activity levels only on weekends among Japanese male and female university students.

BACKGROUND: CLOCK 3111T/C has been shown to be closely associated with morningness-eveningness, such as sleep-wake rhythms in healthy humans. However, previous studies examined the physical activity (PA) in a single day, and no study has investigated the relationships between CLOCK 3111T/C polymorphism and PA for an entire week. It was hypothesized that the CLOCK 3111T/C polymorphism might be associated with diurnal PA patterns, especially on the weekends. METHODS: Eighty-one university students (male, n = 14; female, n = 67; age, 20.4 ± 2.9 years) wore a digital accelerometer for 7 successive days, including the weekend, to collect hour-by-hour objectively-measured PA. CLOCK 3111T/C polymorphism was assessed using the oral mucosa. During the study, participants recorded their wake time and bedtime each day. Furthermore, lifestyle-related variables (i.e. morningness-eveningness, habitual meal and sleep timings) were collected using questionnaires. Linear mixed-effects models assessed the association of polymorphism (TT carriers vs. TC+CC carriers) with wake time and bedtime as well as daily PA throughout the week (time). RESULTS: TT carriers had an earlier wake time (weekly mean: 44 min [95% CI, -82 to -5 min], time interaction: p = 0.026) and bedtime (weekly mean: 30 min [95% CI, -61 min to - 15 s], time interaction: p = 0.048) than TC+CC carriers. Furthermore, TT carriers' wake time and bedtime on Saturday were significantly later than on other days (gene interaction: all p < 0.05). On Saturday, the hour-by-hour PA in TT carriers was significantly greater than that in TC+CC carriers (hourly mean 1.7 min [95% CI, 0.2 to 3.4 min], time: p < 0.001, group: p = 0.028, interaction: p = 0.155). CONCLUSIONS: CLOCK 3111T/C polymorphism may be associated with objectively measured hour-by-hour PA only on Saturday. Academic/social obligations may mask the genetically determined biological rhythm of PA on weekdays.

Physicians' explanatory behaviours and legal liability in decided medical malpractice litigation cases in Japan.

BACKGROUND: A physician's duty to provide an adequate explanation to the patient is derived from the doctrine of informed consent and the physician's duty of disclosure. However, findings are extremely limited with respect to physicians' specific explanatory behaviours and what might be regarded as a breach of the physicians' duty to explain in an actual medical setting. This study sought to identify physicians' explanatory behaviours that may be related to the physicians' legal liability. METHODS: We analysed legal decisions of medical malpractice cases between 1990 and 2009 in which the pivotal issue was the physician's duty to explain (366 cases). To identify factors related to the breach of the physician's duty to explain, an analysis was undertaken based on acknowledged breaches with regard to the physician's duty to explain to the patient according to court decisions. Additionally, to identify predictors of physicians' behaviours in breach of the duty to explain, logistic regression analysis was performed. RESULTS: When the physician's explanation was given before treatment or surgery (p = 0.006), when it was relevant or specific (p = 0.000), and when the patient's consent was obtained (p = 0.002), the explanation was less likely to be deemed inadequate or a breach of the physician's duty to explain. Patient factors related to physicians' legally problematic explanations were patient age and gender. One physician factor was related to legally problematic physician explanations, namely the number of physicians involved in the patient's treatment. CONCLUSION: These findings may be useful in improving physician-patient communication in the medical setting.

Dentists' Legal Liability and Duty of Explanation in Dental Malpractice Litigation in Japan.

INTRODUCTION: Dental litigation accounts for approximately 10% of medical cases in Japan. This study sought to identify factors related to dentists' legal liability in Japan, including their duty to explain procedures and treatments to their patients. METHODS: We analysed court decisions in 166 dental malpractice cases litigated in Japan between 1978 and 2017. To identify factors related to the legal liability of dentists, an analysis was performed to evaluate the associations among patient characteristics, dentist characteristics, litigation, and dentists' explanatory behaviour. RESULTS: Of the 36 cases related to dentist liability, the study identified 23 cases (63.9%) of litigation in which the dentists were found to be in violation of their duty to provide an explanation. Regarding the severity of injury, the ratio of death and permanent disability was significantly higher in decisions in which the purpose of the explanation was something other than obtaining the patient's consent compared with decisions to obtain the patient's consent (P = .014). CONCLUSIONS: In cases in which the dentist was found legally responsible, the proportion of cases involving procedural negligence with the explanation of medical guidance was significantly higher. Dentists should pay careful attention not only to the patient's consent but also to their explanations, including "medical guidance." Moreover, they should recognise that inappropriate explanations correlate with serious errors.

Relationship between tooth loss and mortality in 80-year-old Japanese community-dwelling subjects.

BACKGROUND: Findings from several studies suggest associations between tooth loss and health outcomes, including malnutrition, poor quality of life, and mortality, in older individuals. However, limited information is available regarding whether those associations remain true in very elderly subjects after adequately considering confounding factors such as sex and smoking status. Herein, we determined whether the number of teeth in 80-year-old subjects is an independent predictor of mortality. METHODS: We initially contacted 1282 80-year-old community-dwelling individuals born in 1917, of whom 697 responded and participated in a baseline study, with follow-up examinations conducted 4 and 5.5 years later. Data from interviews and medical and oral examinations were obtained, and oral health was determined according to the number of teeth remaining in the oral cavity. RESULTS: A total of 108 and 157 subjects died in 4 years and 5.5 years, respectively, after the baseline study. Tooth loss was significantly associated with mortality at age 85.5, but not at age 84, after adjusting for potential confounders. When the analysis was stratified by sex, we found a stronger association in females in follow-up examinations conducted at both 4- and 5.5 years. On the other hand, the effect of tooth loss on mortality was not significantly different between smokers and non-smokers. CONCLUSION: Tooth loss is a significant predictor of mortality independent of health factors, socio-economic status, and lifestyle in octogenarians, with a stronger association in females.

IgA level is associated with risk for mortality in an eighty-year-old population.

BACKGROUND: Immunoglobulin levels are elevated in the older people. However, it is unknown whether these levels are related to mortality. OBJECT: To evaluate the association between immunoglobulin levels and mortality. METHODS: The study population included 697 individuals (277 males and 420 females) of 1,282 eighty-year-old individuals residing in the Fukuoka prefecture, Japan. The participants were followed for 4 years after the baseline examination. RESULTS: The hyper-IgA group, defined as a serum IgA level >400 mg/dl, had high mortality using Kaplan-Meier analysis (log rank, p=0.037). Multivariate Cox regression analyses revealed a high risk of mortality (hazard rate=1.233, 95% confidence interval 1.109-1.491, p=0.031) after adjusting for covariates. The high risk of mortality in the hyper-IgA group was significant in males, but not in females. Moreover, Kaplan-Meier analysis revealed that IgA was related to cancer mortality in males (log rank, p=0.031), but not to pneumonia or cardiovascular disease. IgM and IgG levels were not related to high risk of mortality. CONCLUSION: Serum IgA levels appear to be a predictor of mortality, especially cancer mortality in males.

Associations among hair loss, oral sulfur-containing gases, and gastrointestinal and metabolic linked diseases in Japanese elderly men: pilot study.

BACKGROUND: Male pattern baldness (MPB), an observable trait, has been reported to be associated with various diseases, such as prostate cancer and cardiovascular disease. Oral sulfur-containing gases have also been suggested to be useful as markers of systemic health condition. However, there are no known reports regarding the associations among MPB, and oral sulfur-containing gases, and systemic health conditions in males. METHODS: We studied 170 male subjects aged either 60 or 65 years old. The degree of MPB was assessed using the Norwood-Hamilton Baldness scale. Oral sulfur-containing gases were measured using a compact-designed device. All subjects completed physical and laboratory blood examinations, a face-to-face medical questionnaire, and an oral examination. RESULTS: There were significant differences between the levels of CH3SCH3 and baldness patterns, independent of age. When we analyzed whether the association was linked to systemic health condition, a strong significant association was observed between the level of CH3SCH3 and severe MPB in subjects with gastrointestinal diseases, hypertension, and hypercholesterolemia. CONCLUSION: These results suggest that MPB is associated with the level of CH3SCH3, a sulfur-containing gas that causes oral malodor, in elderly Japanese males. Further, the association was intensified by the existence of gastrointestinal tract and metabolic disorders.

Does decreased diastolic blood pressure associate with increased mortality in 80-year-old Japanese?

Hypertension is one of the greatest risk factors for cardiovascular disease, but its contribution to cardiovascular mortality weakens with aging. We have previously demonstrated that at the age of 80, higher systolic blood pressure (SBP) is not correlated with increased mortality in Japan. However, we did not examine in detail whether diastolic blood pressure (DBP) independently affects mortality. In the present study, 639 participants, who were 80 years old in 1997, were enrolled. The subjects were divided by their DBP [below 70 mmHg (group 1, n = 136), from 70 mmHg to 80 mmHg (group 2, n = 200), from 80 mmHg to 90 mmHg (group 3, n = 194), over 90 mmHg (group 4, n = 109)]. During the 4-year follow-up period, 90 individuals died. Cox multivariate regression analysis revealed that group 1 showed a significantly higher mortality rate than group 4 [relative risk (RR) 2.47, confidence interval (CI) 1.07-5.70, p = 0.03)]. The relative risks of deaths from cardiovascular diseases, pneumonia, and cancer tended to be higher in group 1 than in group 4, but the difference did not reach statistical significance. These results suggest that decreased DBP is associated with higher mortality in the Japanese elderly.

Atrophic gastritis, but not antibody to Helicobacter pylori, is associated with body mass index in a Japanese population.

BACKGROUND: The relationship between Helicobacter pylori (HP) infection and body mass index (BMI) is controversial. Several reports have indicated that eradication of HP infection induces an increase in BMI. In contrast, epidemiological case-control studies have failed to show an association between HP infection and BMI. Therefore, we investigated whether HP and atrophic gastritis (AG) were associated with BMI. METHODS: A total of 617 individuals were recruited for the measurements of BMI, serum leptin, pepsinogens (PGs) I and II, and IgG antibody to HP (HP-IgG). BMI and leptin of the subjects were compared when the subjects were stratified by HP-IgG and PGs. RESULTS: The subjects were divided into AG-positive and AG-negative groups according to PGs (AG-positive: PG I < or = 70 ng/ml and PG I/II ratio < or =3.0). BMI after adjusting for sex and age was significantly lower in the AG-positive group than in the AG-negative group (23.47 +/- 3.05 vs. 24.18 +/- 3.25, P = 0.010). When the subjects were divided into two groups according to HP-IgG, BMI tended to be lower in the HP-IgG-positive group, though the difference was not large. When the subjects were divided into four groups for different combinations of AG and HP-IgG, BMI was the lowest in the AG-positive and HP-IgG-negative group. CONCLUSIONS: BMI was associated with AG, as diagnosed by PGs, but not with HP infection status. These results mean that HP infection affects BMI via atrophic gastritis.

Association of cortisol and dehydroepiandrosterone sulphate levels in serum with periodontal status in older Japanese adults.

BACKGROUND AND AIM: The associations between periodontitis and stress-related steroid hormone levels released by the hypothalamic-pituitary-adrenal axis are poorly understood. In this study, we examined the association between levels of the stress-related steroid hormones cortisol and dehydroepiandrosterone-sulphate (DHEAS) and periodontitis in elderly subjects. METHODS: A total of 467 subjects participated in this study. Serum cortisol and DHEAS levels were determined, and a medical questionnaire regarding medical conditions and lifestyle was administered. In addition, clinical examinations including probing depth (PD), bleeding on probing (BOP), and clinical attachment loss (CAL) were conducted. RESULTS: The subjects were divided into tertiles on the basis of periodontitis severity. When the analysis was stratified by smoking status, we found that cortisol levels were significantly higher in those with severe CAL among subjects who had never smoked. Furthermore, multiple regression analysis showed that a higher level of cortisol was significantly associated with greater numbers of sites with severe CAL only in those who had never smoked, while a somewhat weaker association was also observed regarding cortisol/DHEAS ratio. In contrast, the level of DHEAS in serum was not associated with periodontitis. CONCLUSION: There were significant associations between serum cortisol level, including cortisol/DHEAS ratio, and periodontitis severity in elderly subjects who had never smoked.

Physicians' communication skills with patients and legal liability in decided medical malpractice litigation cases in Japan.

BACKGROUND: In medical malpractice litigations in recent years in Japan, it is notable that the growing number of medical litigation cases includes the issue of a doctor's explanation to the patient as a pivotal point. The objective of this study was to identify factors of physicians' communication skills with patients, as related to their legal liability, and differences in doctors' communication skills with patients by the type of medical facility. METHODS: Decisions of medical malpractice litigation cases between 1988 and 2005 in Japan, the pivotal issue of which was a physician's explanation, were analyzed in the study. The content of each decision was summarized using the study variables (information about the patient, doctor, manner of the doctor's explanation, and subsequent litigation), and a database comprising the content of each decision (N = 100) was constructed. In order to evaluate an association between doctors' communication skills with patients and the outcome of the litigation, the analysis was performed based on the outcome of litigation or the type of medical facility. RESULTS: The ratio of acknowledged physician liability by court decision was lower in cases in which the doctor's explanation occurred before treatment or surgery (p = 0.013). The ratio of acknowledged physician liability by court decision was higher in cases of elective or non-urgent treatment (p = 0.046). The ratio of acknowledged physician liability by court decision was higher in clinics than in hospital groups (p = 0.036). CONCLUSION: These findings are beneficial for the prevention of medical disputes and improvement of patient-physician communication.

Development and initial validation of the Morningness-Eveningness Exercise Preference Questionnaire (MEEPQ) in Japanese university students.

The aim of this study was to develop a questionnaire to conveniently assess the diurnal preferences of physical activity (PA) in Japanese university students. A total of 219 subjects completed our novel Morningness-eveningness Exercise Preference Questionnaire (MEEPQ). The MEEPQ consisted of 30 items (15 items for the morning and the same 15 items for the evening) rated on a 5-point Likert scale concerning their preference for participating in PA in the morning and evening. The morning score (MS) and evening score (ES) were determined by summing each of the respective 15 items. The internal consistency and construct validity were assessed, and a factor analysis was conducted. To examine the external validity of the MEEPQ, participants wore an accelerometer for seven consecutive days to measure their PA levels objectively. Finally, the test-retest reliability was evaluated at a one-month interval. The MEEPQ showed excellent internal consistency (Cronbach's alpha = 0.896) and construct validity (morning KMO = 0.913, evening KMO = 0.875). A factor analysis showed a three-factor structure involving Physical Wellness (MEEPQ-W), Psychological Well-Being (MEEPQ-P) and Exercise Barrier (MEEPQ-B). The percent of variance was largest for MEEPQ-W in the morning (45.2%) and MEEPQ-P in the evening (40.8%). Test-retest showed that MEEPQ scores had fair repeatability. Significant and positive associations between scores and objectively measured PA levels were found in the MS and 6-9 AM PA and in the ES and 6-9 PM and 9 PM- 0 AM PA (all p<0.05). In summary, the novel MEEPQ showed relatively good agreement and thus can be used for Japanese university student samples. In the MEEPQ, three factors (the physical wellness, psychological well-being and exercise barrier) contributed to a morning or evening PA preference. The summed scores were significantly associated with the objectively measured PA levels in both the morning and evening. Therefore the MEEPQ appears to be a suitable tool for assessing diurnal PA preferences.

Association between body mass index and mortality in an 80-year-old population.

OBJECTIVES: To evaluate the association between body mass index (BMI) and all-cause mortality and cardiovascular disease (CVD) in an 80-year-old population. DESIGN: Cohort study. SETTING: Community-based. PARTICIPANTS: Six hundred ninety-seven of 1,282 (54.4%) 80-year-old candidate individuals. MEASUREMENTS: The dates and causes of all deaths were followed up for 4 years. RESULTS: The relative hazard ratios (HRs) for all-cause mortality were lower in overweight subjects (BMI > or= 25.0) than in underweight (BMI<18.5) or normal-weight (BMI 18.5-24.9) subjects. Similarly, the HRs for mortality due to CVD in overweight subjects were 78% less (HR=0.22, 95% confidence interval (CI)=0.06-0.77) than those in underweight subjects, and those in normal weight subjects were 78% less (HR=0.22, 95% CI=0.08-0.60) than those in underweight subjects. Mortality due to CVD was 4.6 times (HR 4.64, 95% CI=1.68-12.80) as high in underweight subjects as in normal-weight subjects, and mortality due to cancers was 88% lower (HR=0.12, 95% CI=0.02-0.78) in the overweight group than in the underweight group. There were no differences in mortality due to pneumonia. CONCLUSION: Overweight status was associated with longevity and underweight with short life, due to lower and higher mortality, respectively, from CVD and cancer.