Rural-Urban Disparity in Emergency Care for Acute Myocardial Infarction in Japan.

BACKGROUND: There are few reports examining regional differences between rural prefectures and metropolitan areas in the management of acute myocardial infarction (AMI) in Japan.Methods and Results:In the Rural AMI registry, a prospective, multi-prefectural registry of AMI in 4 rural prefectures (Ishikawa, Aomori, Ehime and Mie), a total of 1,695 consecutive AMI patients were registered in 2013. Among them, 1,313 patients who underwent primary percutaneous coronary intervention (PPCI) within 24 h of onset were enrolled in this study (Rural group), and compared with the cohort data from the Tokyo CCU Network registry for AMI in the same period (Metropolitan group, 2,075 patients). The prevalence of direct ambulance transport to PCI-capable facilities in the Rural group was significantly lower than that in the Metropolitan group (43.8% vs. 60.3%, P<0.01), which resulted in a longer onset-to-balloon time (OTB: 225 vs. 210 min, P=0.02) and lower prevalence of PPCI in a timely fashion (OTB ≤2 h: 11.5% vs. 20.7%, P<0.01) in the Rural group. Multivariate analysis revealed that direct ambulance transport was the strongest predictor for PPCI in a timely fashion (odds ratio=4.13, P<0.001). CONCLUSIONS: AMI patients in rural areas were less likely to be transported directly to PCI-capable facilities, resulting in time delay to PPCI compared with those in metropolitan areas.

Neighborhood social capital and sleep duration: a population based cross-sectional study in a rural Japanese town.

BACKGROUND: Studies on social capital and health outcomes have become common, but the relationship between neighborhood social capital and sleep duration by gender is still unclear. We examined the relationship between neighborhood social capital and sleep duration by gender in adults living in a rural community in Japan. METHOD: We conducted a cross-sectional survey of 12,321 residents aged ≥20 years in a town in Mie Prefecture in January-March 2013. Self-completed questionnaires were collected from the residents (n = 7782; valid participation rate, 63.2%). We used five items to assess the neighborhood social capital (Cronbach's α = 0.86). We summed up the scores of each item, and then divided the participants into four groups by quartile of total scores of neighborhood social capital (lowest, low, high, and highest). Sleep duration of < 7 h/day was defined as insufficient sleep duration according to previous studies. To adjust for potential confounders, we performed a multiple log-binominal regression analysis and estimated the prevalence ratios (PRs) and 95% confidence intervals (CIs) for insufficient sleep. RESULTS: Overall 42% of the men and 45% of the women had insufficient sleep. In the men, the lowest group of neighborhood social capital presented a 22% higher prevalence of insufficient sleep (PR 1.22; 95% CIs 1.08-1.38) compared to the highest group of neighborhood social capital. Similarly the low group of neighborhood social capital and the high group of neighborhood social capital had 20 and 19% higher prevalence of insufficient sleep (PR 1.20; 95% CIs 1.06-1.36; PR 1.19; 95% CIs 1.06-1.34, respectively) compared to the highest group of neighborhood social capital. For women there was no significant association between neighborhood social capital and insufficient sleep after controlling for all potential confounders. CONCLUSION: Having lower neighborhood social capital was associated with insufficient sleep among Japanese adults, particularly in the men. This suggests that the context of neighborhood social capital by gender should be considered to promote healthier behaviors with regard to getting enough sleep.

Effects of electromagnetic fields emitted from W-CDMA-like mobile phones on sleep in humans.

In this study, we investigated subjective and objective effects of mobile phones using a Wideband Code Division Multiple Access (W-CDMA)-like system on human sleep. Subjects were 19 volunteers. Real or sham electromagnetic field (EMF) exposures for 3 h were performed before their usual sleep time on 3 consecutive days. They were exposed to real EMF on the second or third experimental day in a double-blind design. Sleepiness and sleep insufficiency were evaluated the next morning. Polysomnograms were recorded for analyses of the sleep variables and power spectra of electroencephalograms (EEG). No significant differences were observed between the two conditions in subjective feelings. Sleep parameters including sleep stage percentages and EEG power spectra did not differ significantly between real and sham exposures. We conclude that continuous wave EMF exposure for 3 h from a W-CDMA-like system has no detectable effects on human sleep.

Social Capital and Self-Rated Health: A Cross-Sectional Study among Rural Japanese Working Residents.

Social capital is positively associated with self-rated health; however, this association among workers is still unclear. Thus, this study examined the relationship between social capital and self-rated health with special attention to the employment type. A cross-sectional survey was conducted with 6160 workers aged 20-64 years from two towns in Mie Prefecture in January-March 2013. Social capital was assessed using five items in 4816 income-earning workers. The social capital scores were summed and then divided into three groups. The self-rated health responses were dichotomised into 'poor' and 'good'. The association was examined using a stepwise binomial logistic regression stratified by employment type and adjusted for potential confounders. Regular employees with low social capital had a higher significant odds ratio of poor self-rated health than medium (OR 0.58 95% CIs 0.39-0.87) and high (OR 0.39; 95% CIs 0.26-0.59) social capital levels after controlling for all potential confounders. Similar patterns were observed for non-regular employees with medium and high social capital. There was a significant relationship between some indicators of social capital and poor self-rated health among self-employees. These results highlight that social capital acts as an unequal health resource for different types of workers.

Molecular Epidemiology of Norovirus (NoV) Infection in Mie Prefecture: The Kinetics of Norovirus Antigenemia in Pediatric Patients.

Few studies have shown the presence of norovirus (NoV) RNA in blood circulation but there is no data on norovirus antigenemia. We examined both antigenemia and RNAemia from the sera of children with NoV infections and studied whether norovirus antigenemia is correlated with the levels of norovirus-specific antibodies and clinical severity of gastroenteritis. Both stool and serum samples were collected from 63 children admitted to Mie National Hospital with acute NoV gastroenteritis. Norovirus antigen and RNA were detected in sera by ELISA and real-time RT-PCR, respectively. NoV antigenemia was found in 54.8% (34/62) and RNAemia in 14.3% (9/63) of sera samples. Antigenemia was more common in the younger age group (0-2 years) than in the older age groups, and most patients were male. There was no correlation between stool viral load and norovirus antigen (NoV-Ag) levels (rs = -0.063; Cl -0.3150 to 0.1967; p = 0.6251). Higher levels of acute norovirus-specific IgG serum antibodies resulted in a lower antigenemia OD value (n = 61; r = -0.4258; CI -0.62 to -0.19; p = 0.0006). Norovirus antigenemia occurred more commonly in children under 2 years of age with NoV-associated acute gastroenteritis. The occurrence of antigenemia was not correlated with stool viral load or disease severity.

Measurement of Intermediate Frequency Magnetic Fields Generated by Household Induction Cookers for Epidemiological Studies and Development of an Exposure Estimation Model.

INTRODUCTION: Exposure assessment of intermediate frequency (IF) electromagnetic fields (EMFs) is difficult and epidemiological studies are limited. In the present study, we aimed to estimate the exposure of pregnant women to IF-EMFs generated by induction cookers in the household using a questionnaire and discussed its applicability to epidemiological studies. METHOD: Two main home-visit surveys were conducted: a Phase 1 survey to develop an estimation model and a Phase 2 survey to validate the model. The estimation model included the following variables: wattage, cookware diameter, and distance from the hob center (center of the stove). Four models were constructed to determine the importance of each variable and the general applicability for epidemiological studies. In addition, estimated exposure values were calculated based on the Phase 2 survey questionnaire responses and compared with the actual measured values using the Spearman rank correlation coefficient. RESULT: The average value of the magnetic field measured in the Phase 1 survey was 0.23 µT (variance: 0.13) at a horizontal distance of 30 cm at the height of the cooking table. The highest validity model was inputted distance from the hob center to the body surface that is variable (correlation coefficient = 0.54, 95% confidence interval: 0.22-0.75). No clear differences were identified in the correlation coefficients for each model (z-value: 0.09-0.18, p-value: 0.86-0.93). DISCUSSION AND CONCLUSIONS: No differences were found in the validity of the four models. This could be due to the biased wattage of the validation population, and for versatility it would be preferable to use three variables (distance, wattage, and estimation using the diameter of the cookware) whenever possible. To our knowledge, this is the first systematic measurement of magnetic fields generated by more than 70 induction cookers in a real household environment. This study will contribute to finding dose-response relationships in epidemiological studies of intermediate-frequency exposure without the use of instrumentation. One of the limitations of this study is it estimates instantaneous exposure in place during cooking only.

Prevalence of anemia and its associated factors among children aged 6-59 months in the Lao People's Democratic Republic: A multilevel analysis.

Anemia is a major public health concern among children aged <5 years in the Lao People's Democratic Republic. Thus far, no study has determined the factors associated with anemia among children aged <5 years in the Lao People's Democratic Republic using a nationwide representative sample. Therefore, this study aimed to evaluate the prevalence of anemia and its associated factors with multilevel variations among children aged 6-59 months. This quantitative, cross-sectional study used a nationally representative sample from the Lao Social Indicator Survey II, 2017. Children aged 6-59 months tested for anemia were included in this study through multistage sampling approaches. Anemia was defined as a hemoglobin level of <11.0 g/dL. Multilevel binary logistic regression analyses were used to determine the adjusted effect of the factors associated with anemia. Among the 5,087 children included, the overall prevalence of anemia was 43.0%. Three factors were associated with higher odds of developing anemia-male sex (adjusted odds ratio, 1.16; 95% confidence interval, 1.01-1.34), underweight (adjusted odds ratio, 1.30; 95% confidence interval, 1.09-1.55), and residence in central provinces (adjusted odds ratio, 1.59; 95% confidence interval, 1.30-1.95) and southern provinces (adjusted odds ratio, 1.42; 95% confidence interval, 1.11-1.81). However, the other three factors-age, educational level of the household head, and Hmong-Mien ethnicity-were inversely associated with anemia. To resolve the problem regarding the severity of the anemia among children aged <5 years in the Lao People's Democratic Republic. Our findings highlight the need for designing an effective approach to address each factor associated with childhood anemia. Interventions should focus on the prevention of childhood anemia, which is considered a major priority of public health intervention in the Lao People's Democratic Republic.

Prevalence of Anemia and Its Associate Factors among Women of Reproductive Age in Lao PDR: Evidence from a Nationally Representative Survey.

INTRODUCTION: Anemia continues to be a major public health problem significant among women of reproductive age (WRA) in developing countries, including Lao People's Democratic Republic (Lao PDR), where the prevalence of anemia among women remains high. This study aimed to assess the prevalence of anemia and its associated factors among WRA 15-49 years in Lao PDR. METHODS: We conducted a cross-sectional study, using the Lao Social Indicator Survey II, 2017 dataset. A total of 12,519 WRA tested for anemia were included in this study, through multistage sampling approaches. Binary logistic regression was used to determine the associated factors of anemia. RESULTS: Of 12,519 women, 4,907 (39.2%) were anemic. Multivariate logistic regression revealed that living in central provinces (aOR: 2.16, 95% CI: 1.96-2.38), rural area (aOR: 1.1, 95% CI: 1.00-1.20), large family size with more than 6 persons (aOR: 1.14, 95% CI: 1.01-1.29), pregnancy (aOR: 1.46, 95% CI: 1.22-1.74), having any adverse pregnancy outcomes (aOR: 1.14, 95% CI: 1.03-1.25), poor drinking water (aOR: 1.24, 95% CI: 1.10-1.39), and poor sanitation facility (aOR: 1.15, 95% CI: 1.03-1.28) were significantly associated with an increased risk of anemia. Conversely, four factors were associated with anemia preventively, including being aged 25-34 years (aOR: 0.81, 95% CI: 0.74-0.90), postsecondary education (aOR: 0.76, 95% CI: 0.60-0.97), Hmong-Mien ethnicity (aOR: 0.48, 95% CI: 0.39-0.59), and watching television almost daily (aOR: 0.84, 95% CI: 0.75-0.95). CONCLUSION: Anemia continues to be a major public health challenge in Lao PDR. Interventions should be considered on geographic variations, improving safe water and sanitation facility, promoting of iron supplements during pregnancy, and health education through mass media for women in rural areas.

Power-frequency magnetic fields and childhood brain tumors: a case-control study in Japan.

BACKGROUND: The strength of the association between brain tumors in children and residential power-frequency magnetic fields (MF) has varied in previous studies, which may be due in part to possible misclassification of MF exposure. This study aimed to examine this association in Japan by improving measurement techniques, and by extending measurement to a whole week. METHODS: This population-based case-control study encompassed 54% of Japanese children under 15 years of age. After excluding ineligible targeted children, 55 newly diagnosed brain tumor cases and 99 sex-, age-, and residential area-matched controls were included in the analyses. The MF exposures of each set of matching cases and controls were measured in close temporal proximity to control for seasonal variation; the average difference was 12.4 days. The mean interval between diagnosis and MF measurements was 1.1 years. The weekly mean MF level was defined as the exposure. The association was evaluated using conditional logistic regression analysis that controlled for possible confounding factors. RESULTS: The odds ratios (95% CI) for exposure categories of 0.1 to 0.2, 0.2 to 0.4, and above 0.4 microT, against a reference category of <0.1 microT, were 0.74 (0.17-3.18), 1.58 (0.25-9.83), and 10.9 (1.05-113), respectively, after adjusting for maternal education. This dose-response pattern was stable when other variables were included in the model as possible confounding factors. CONCLUSIONS: A positive association was found between high-level exposure-above 0.4 microT-and the risk of brain tumors. This association could not be explained solely by confounding factors or selection bias.

Does Father's Social Capital Matter to Child Undernutrition in Myanmar?

This article examined the association between social capital of fathers and child undernutrition using a community-based survey in Myanmar in 2018. The anthropometric measurements of 1546 children aged 6 to 59 months and face-to-face interviews of 1546 respective biological fathers were performed. The three social capital indicators (institutional trust, social supports, and collective action) were included in 2-level logistic regression models for child wasting and child stunting. Social supports from fathers' social networks were protective measures for child wasting and child stunting at individual and community levels, respectively. The collective action of fathers was positively associated with child stunting at individual level. No association was found between institutional trust and both indicators of child undernutrition at all levels. The individual-level collective action on child stunting was conditional on the community-level social supports. Our findings suggest that existing nutritional strategies in Myanmar may be strengthened by targeting fathers to increase their support in child nutrition and by targeting the community to engage in the nutritional programs with their full support.

Simple four-variable screening tool for identification of patients with sleep-disordered breathing.

OBJECTIVES: To aid in the identification of patients with moderate-to-severe sleep-disordered breathing (SDB), we developed and validated a simple screening tool applicable to both clinical and community settings. METHODS: Logistic regression analysis was used to develop an integer-based risk scoring system. The participants in this derivation study included 132 patients visiting one of 2 hospitals in Japan, and 175 residents of a rural town. The participants in the present validation study included 308 employees of a company in Japan who were undergoing a health check. RESULTS: The screening tool consisted of only 4 variables: sex, blood pressure level, body mass index, and self-reported snoring. This tool (screening score) gave an area under the receiver operating characteristic curve (ROC) of 0.90, sensitivity of 0.93, and specificity of 0.66, using a cutoff point of 11. Predicted and observed prevalence proportions in the validation dataset were in close agreement across the entire spectrum of risk scores. In the validation dataset, the area under the ROC for moderate-to-severe SDB and severe SDB were 0.78 and 0.85, respectively. The diagnostic performance of this tool did not significantly differ from that of previous, more complex tools. CONCLUSION: These findings suggest that our screening scoring system is a valid tool for the identification and assessment of moderate-to-severe SDB. With knowledge of only 4 easily ascertainable variables, which are routinely checked during daily clinical practice or mass health screening, moderate-to-severe SDB can be easily detected in clinical and public health settings.

Effects of short-term W-CDMA mobile phone base station exposure on women with or without mobile phone related symptoms.

To investigate possible health effects of mobile phone use, we conducted a double-blind, cross-over provocation study to confirm whether subjects with mobile phone related symptoms (MPRS) are more susceptible than control subjects to the effect of electromagnetic fields (EMF) emitted from base stations. We sent questionnaires to 5,000 women and obtained 2,472 valid responses from possible candidates; from these, we recruited 11 subjects with MPRS and 43 controls. There were four EMF exposure conditions, each of which lasted 30 min: continuous, intermittent, and sham exposure with and without noise. Subjects were exposed to EMF of 2.14 GHz, 10 V/m (W-CDMA), in a shielded room to simulate whole-body exposure to EMF from base stations, although the exposure strength we used was higher than that commonly received from base stations. We measured several psychological and cognitive parameters pre- and post-exposure, and monitored autonomic functions. Subjects were asked to report on their perception of EMF and level of discomfort during the experiment. The MPRS group did not differ from the controls in their ability to detect exposure to EMF; nevertheless they consistently experienced more discomfort, regardless of whether or not they were actually exposed to EMF, and despite the lack of significant changes in their autonomic functions. Thus, the two groups did not differ in their responses to real or sham EMF exposure according to any psychological, cognitive or autonomic assessment. In conclusion, we found no evidence of any causal link between hypersensitivity symptoms and exposure to EMF from base stations.

Worker resignation due to patient nuisance in hospitals: Determinants and prevention.

To investigate determinants and protective strategies for the resignation of health care workers resulting from patient-derived nuisance in medical institutions, we conducted a cross-sectional survey in the 57 hospitals in Mie Prefecture, Japan. A random sampling of 775 employees (physicians, nurses, administrators, and other health care workers) was provided self-administered questionnaires. Among 480 participants who experienced patient-derived nuisance, 132 participants considered resignation as a result, giving an estimated prevalence of 17.1% (95% CI: 14.4%-19.8%) of all respondents. Nonphysical nuisances such as "demand for an unwarranted apology" (OR: 2.57; 95% CI: 1.61-4.12) had higher ORs for considering resignation than other kinds of nuisance. By contrast, OR for the provision of human support by medical institutions was 0.49 (95% CI: 0.28-0.86). Human support was associated with alleviation of the intention to resign.

Does a mandibular overdenture improve nutrient intake and markers of nutritional status better than conventional complete denture? A systematic review and meta-analysis.

OBJECTIVES: The need for denture treatment in public health will increase as the population ages. However, the impact of dentures on nutrition, particularly overdenture treatment, remains unclear although the physical and psychological effects are known. We investigated whether treatment with a mandibular implant supported overdenture improves nutrient intake and markers of nutritional status better than a conventional complete denture in edentulous patients. DESIGN: Systematic review and meta-analysis. METHODS: Medline, EMBASE and the Cochrane Central Register of Controlled Trials were searched for eligible studies published up to April 2016. We included studies which compared the treatment effect of an overdenture to conventional denture on nutrition, in which primary outcomes included changes in intake of macronutrients and/or micronutrients and/or indicators of nutritional status. Two reviewers independently evaluated eligible studies and assessed the risk of bias. We used a fixed effects model to estimate the weighted mean difference (WMD) and 95% CI for change in body mass index (BMI), albumin and serum vitamin B12 between overdenture and conventional denture 6 months after treatment. RESULTS: Of 108 eligible studies, 8 studies involving 901 participants were included in the narrative appraisal. Four studies reported changes in markers of nutritional status and nutrient intake after treatment with a prosthetic, regardless of type. In a meta-analysis of 322 participants aged 65 years or older from three studies, pooled analysis suggested no significant difference in change in BMI between an overdenture and conventional denture 6 months after treatment (WMD=-0.18 kg/m(2) (95% CI -0.52 to 0.16)), and no significant difference in change in albumin or vitamin B12 between the two treatments. CONCLUSIONS: The modifying effect of overdenture treatment on nutritional status might be limited. Further studies are needed to evaluate the effectiveness and efficacy of denture treatments.

[An estimation of the prevalence of excessive daytime sleepiness based on age and sex distribution of epworth sleepiness scale scores: a population based survey].

OBJECTIVES: To describe the distribution of subjective daytime sleepiness among local residents using the Epworth Sleepiness Scale (ESS) and estimate the prevalence of excessive daytime sleepiness (EDS) in a general Japanese adult population. METHODS: Subjects consisted of all residents aged 20 years and over from a self-governing body of approximately 10,000 people located in the Hokkaido region. Questionnaires, which included a Japanese version of the ESS, were distributed and later collected by a health promoter who visited subjects' residences between October and December 2000. Subjects of the analysis were restricted to those who answered five items or more out of a total of eight items. Means and standard deviations of the ESS global score were calculated for each age group by gender. And differences with reference to sex and age were examined by ANOVA. The prevalence of EDS in the Japanese general population was estimated from this study's results by direct age adjustment using the Japanese census figures for 2000. Factors related to EDS were also examined. RESULTS: A total of 5,327 residents responded to the survey (86.0%). Of these, 4,412 (71.2%) were entered for analysis. The average (+/- standard deviation) ESS global score were with 5.18 +/- 3.75 (males 5.25 +/- 3.89, females 5.12 +/- 3.75). Differing significantly age, regardless of sex (P<0001). From the overall prevalence of EDS of 9.2% (males 9.6%, females 8.8%), the estimated prevalence in the Japanese general population was to be 8.9% (males 9.3%, females 8.4%). EDS was found to be related to age, sleep duration under six hours and to snoring (P=0.002, P=0.008 and P<0.001). CONCLUSION: This study provided baseline data for the distribution by sex and age group of subjective daytime sleepiness in a community using the ESS and was used to generate the first ever estimated prevalence of EDS in the general Japanese adult population. The finding should prove useful for clinicians and researchers interested in (1) screening for daytime sleepiness, (2) evaluating changes between pre and post-interventions, (3) comparing epidemiological findings across studies, and lastly, (4) making of health policy. Daytime sleepiness estimated by ESS differs with the sex and age, possibly related to bio-medical and socio-medical factors. Further research is need to detail this problem.

Seismic intensity and risk of cerebrovascular stroke: 1995 Hanshin-Awaji earthquake.

INTRODUCTION: No epidemiological data exist concerning the influence of an earthquake on the risk of stroke. Whether the incidence of cerebrovascular stroke increased after the 1995 Hanshin-Awaji earthquake (EQ) in Japan and whether seismic intensity affected stroke risk dose-dependently was examined. METHODS: A retrospective cohort study was conducted among residents, who were living in two towns on the island of Awaji and were participants of the National Health Insurance (NHI) program. The two towns were divided into 11 districts and their respective damage and socioeconomic states were investigated. Reviewing the NHI documents issued before and after the EQ, people who had strokes (9th International Classification of Diseases, codes 430-431 or 433-434.9) were identified. Risk of stroke in relation to the seismic intensities, was assessed with the Cox proportional hazard model. RESULTS: Among subjects aged 40 to 99 years, 45 of 8,758 (0.514%) had a stroke the year before the EQ 72 of 8,893 (0.810%) had a stroke in the first year following the EQ, and 49 of 8,710 (0.566%) had a stroke in the second year following the EQ. In districts where the earthquake's intensity was < or = 9.5 on the modified Mercalli intensity (MMI), compared with the year prior to the EQ, the relative risk (RR) of stroke was 2.4 (95% confidence interval (CI) = 1.1, 5.0) in the first year following the EQ, after adjusting for age, gender, and income. In that year, compared with MMI of < 8.5-9.0, RRs for 9.0-9.5 and > or = 9.5 were 1.6 (CI = 0.9, 2.1) and 2.0 (CI = 1.1, 3.7), respectively (p for trend 0.02). No trend for the RR was observed in the year before the EQ or in the second year following the EQ. CONCLUSION: The incidence of stroke increased in the first year following the EQ. The increase was associated with seismic intensity in a dose-response manner. Results suggest a potential threshold for RR of > or = 2.0 in areas near 9.5 on the MMI scale.

[Lifestyle differences between conjugal bereaved women and non-bereaved women in later life].

PURPOSES: In Japan, there has been limited research regarding lifestyle of elderly bereaved. The present study was conducted to clarify lifestyle characteristics in conjugal bereaved women compared to non-bereaved women. METHODS: Subjects consisted of 872 bereaved and 643 non-bereaved elderly women aged 65 or over in T prefecture. Bereaved subjects experienced the death of a spouse in 1994 and their family structure remained unchanged after the bereavement. Non-bereaved subjects were randomly selected from community registration lists in 1995 and matched for age and area of residence. Lifestyle characteristics were obtained by home visit and interview. For the analysis, we divided the subjects into 4 groups by age and family structure. Multiple logistic regression analysis was performed to identify lifestyle characteristics of bereaved elderly women, after adjustment for physical ability and disease, as confounding factors. RESULTS: Bereaved elderly women were significantly associated with no roles at home, no hobbies, lack of contact with friends, physical inactivity, sleeplessness and irregular meal patterns compared to the non-bereaved. Analysis of the 4 groups revealed bereaved women living with family members have more unfavorable lifestyle characteristics than bereaved women living alone. Bereaved women living with family members had no roll at home and sleeplessness. CONCLUSION: Bereaved women have unfavorable lifestyle characteristics. Those living with family members had more unfavorable lifestyle than bereaved women living alone. From the preventive point of view, interventions for bereaved women are needed. This is particularly the case for bereaved women living with family members. Not only health services but also social welfare services are needed to reconstruct favorable lifestyles and maintain health and well-being.

The association between socioeconomic status and prevalence of diabetes mellitus in rural Japan.

The objective of this study is to investigate the association between socioeconomic status and diabetes prevalence. A population-based cross-sectional survey was conducted in Japan. The association between household income tertile, duration of education (<12, 12, >12 years), or occupation (blue collar, white collar) and diabetes prevalence were assessed in 6,197 participants using multivariable-adjusted logistic regression models. Blue collar occupation and middle household income were found to be associated with high prevalence of diabetes mellitus.

Association between number of comorbid conditions, depression, and sleep quality using the Pittsburgh Sleep Quality Index: results from a population-based survey.

OBJECTIVES: Although sleep problems are a serious public concern, it is not clear if the presence of depression or multiple comorbid conditions has an additive or multiplicative effect on sleep quality. METHODS: We conducted a population-based, cross-sectional survey in a rural town in Japan. Multivariable-adjusted linear regression models were used to explore the association between the number of comorbid conditions and the Pittsburgh Sleep Quality Index (PSQI) global score. The association between the number of comorbid conditions and presence of depression, as defined by the five-item Mental Health Inventory (scores60), in those with poor quality sleep (PSQI global score>5) was determined using a non-parametric trend test. RESULTS: Of 5107 respondents, 3403 (mean age: 51.0years, women: 52.6%) were used for the analysis after exclusion of missing PSQI data. The PSQI global score (mean: 4.9) increased as the number of comorbid conditions increased in a linear and statistically significant manner (p<0.0001). The PSQI global score increased by 0.374 for each additional comorbid condition (p<0.0001). Among those with poor sleep quality, the proportion with depression increased significantly and linearly (p<0.0001) as the number of comorbid conditions increased (37.5% for 0 vs. 59.9% for 4 comorbid conditions). CONCLUSION: The number of comorbid conditions correlated positively with poor sleep quality, and as the number of comorbid conditions increased, the proportion of those also suffering from depression increased. Recognizing the signs of depression in patients with multiple comorbid conditions is important because of its exacerbation of poor sleep quality.

Gender differences in effects of physical activity on quality of life and resource utilization.

BACKGROUND: Physical activity is associated with health-related quality of life (HRQOL) in the general population, but the effects may be different between sexes. In addition, the effects on resource utilization are not well elucidated. METHODS: A population-based cross-sectional survey was conducted in a rural town, and follow-up data were obtained after 1 year. Physical activity was measured in two ways: amount and maximum intensity. The association between physical activity and the MOS Short Form-36 (SF-36) at baseline, and hospitalization, sick days, and medications in the following year were assessed by multiple regression models. RESULTS: Among 4018 adult residents eligible, 3529 (62.4%) had completed the follow-up questionnaire. A greater amount of exercise was positively correlated with all domains of the SF-36: 2.4-9.5 increase in 100-scale at baseline, but association between maximum intensity and SF-36 was observed in only women. It was also associated with a 20-50% higher utilization of over-the-counter drugs in the following year in both sexes, but the effects of maximum intensity on sick days had different directions for men (relative risk, 2.0-2.4) and women (relative risk, 0.3-0.5). CONCLUSION: The amount of physical activity had positive effects on HRQOL for both men and women, but women had more preferable effects of maximum intensity on HRQOL and resource utilization than men.