Identification of actin network proteins, talin-1 and filamin-A, in circulating extracellular vesicles as blood biomarkers for human myalgic encephalomyelitis/chronic fatigue syndrome.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a serious, debilitating disorder with a wide spectrum of symptoms, including pain, depression, and neurocognitive deterioration. Over 17 million people around the world have ME/CFS, predominantly women with peak onset at 30-50 years. Given the wide spectrum of symptoms and unclear etiology, specific biomarkers for diagnosis and stratification of ME/CFS are lacking. Here we show that actin network proteins in circulating extracellular vesicles (EVs) offer specific non-invasive biomarkers for ME/CFS. We found that circulating EVs were significantly increased in ME/CFS patients correlating to C-reactive protein, as well as biological antioxidant potential. Area under the receiver operating characteristic curve for circulating EVs was 0.80, allowing correct diagnosis in 90-94% of ME/CFS cases. From two independent proteomic analyses using circulating EVs from ME/CFS, healthy controls, idiopathic chronic fatigue, and depression, proteins identified from ME/CFS patients are involved in focal adhesion, actin skeletal regulation, PI3K-Akt signaling pathway, and Epstein-Barr virus infection. In particular, talin-1, filamin-A, and 14-3-3 family proteins were the most abundant proteins, representing highly specific ME/CFS biomarkers. Our results identified circulating EV number and EV-specific proteins as novel biomarkers for diagnosing ME/CFS, providing important information on the pathogenic mechanisms of ME/CFS.

[Subjective happiness among Japanese adults: An upward tendency associated with age].

Objectives　The present study investigated subjective happiness in Japanese adults and offers basic knowledge for future studies. In addition, how subjective happiness varies in relation to certain demographic variables, such as gender and age, as well as factors that influence this variability, are examined.Methods　A total of 2,000 Japanese people (1,000 females and 1,000 males) over the age of 20 completed an anonymous self-report internet survey. There were approximately the same number of participants in each of six age groups ranging from the 20s to 70s. How Subjective Happiness Scale (SHS) scores were related to various demographic variables, including gender and age, as well as happiness, life satisfaction, and stress response, were analyzed.Results　The validity of the SHS was supported by positive correlations with happiness and life satisfaction scores and negative correlation with stress response scores. The results also showed that females had higher SHS scores than males, and this gender difference was distinctive, especially among young adults. In addition, there was a U-shaped change in SHS score by age. That is, subjective happiness dropped with age, but started increasing again after the 50s. The same findings were reconfirmed by an additional survey one year later. Moreover, those with a spouse showed higher SHS scores than unmarried participants. Lastly, SHS scores were low among those whose highest education was junior high school and those who lived alone, although the limitations of sampling bias should be considered.Conclusion　The SHS is an internationally accepted measure of subjective happiness consisting of only four items and can easily be used in public health research and practice. The current study offers basic information regarding SHS scores as well as subjective happiness in Japanese adults of different age groups and genders. The findings of the present study clearly indicate higher levels of subjective happiness among older age groups than younger ones, those with a spouse than those without a spouse, and females than males. As many studies conducted in other cultures have shown no such gender difference, further cross-cultural comparison studies are needed to clarify this discrepancy. The SHS as an indicator of personal well-being can be strongly expected to show extended utility in the future.

Fatigue and sleep under large summer temperature differences.

BACKGROUND: It has been recognized that an increase in outdoor ambient temperatures has a negative impact on health, particularly fatigue and sleep quality; however, the relationship among fatigue, sleep quality, and air temperature has yet to be sufficiently elucidated. OBJECTIVES: To examine whether fatigue and sleep quality in a healthy Japanese population were affected by rising air temperature at three time points in summer and to investigate the confounding factors for fatigue. METHODS: A total of 602 healthy volunteers in Osaka, Japan, participated in a survey that was conducted at the end of July, August, and September in 2010. The questionnaire consisted of four sections; demographic variables, accommodation status, fatigue, and sleep quality. We used the Chalder fatigue scale for assessment of fatigue, and the Japanese version of the Pittsburgh Sleep Quality Index (PSQI) for assessment of sleep quality. RESULTS: The fatigue score was positively correlated with the sleep quality score in the total cohort. All the questionnaires at the three time points were completed by 162 participants. There were significant differences in fatigue scores among the surveys. We stratified the subjects into two groups of good and poor sleepers using a cutoff value of the PSQI. The good sleepers did not show differences in fatigue score regardless of the change in air temperature. However, the fatigue score of poor sleepers was greater at higher air temperatures. The use of air conditioners, accommodation type, and subject's age were confounding factors for fatigue. CONCLUSIONS: High air temperatures in summer increased fatigue in healthy volunteers, especially those with poor sleep patterns, depending on the use of air conditioners, accommodation status, and subject's age.

Autonomic function is associated with health-related quality of life in patients with end-stage renal disease: a case-control study.

OBJECTIVE: In the present study, we assessed the associations among fatigue, quality of life (QOL), clinical parameters, and body mass index (BMI) with autonomic function in end-stage renal disease (ESRD) patients undergoing hemodialysis as well as fatigue-free healthy subjects. DESIGN AND METHODS: This was a case-control study. This study compared autonomic function in ESRD patients (n = 192) to that of healthy subjects (n = 282) and evaluated its association with fatigue, QOL, and clinical parameters such as glucose, albumin, cholesterol, and BMI. Fatigue was evaluated by a recently established fatigue questionnaire and performance status, and QOL was evaluated with the kidney disease QOL questionnaire. With regards to autonomic function, spontaneous beat-to-beat variations were measured, according to time- (standard deviation of all normal a-wave intervals [CVa-a%]) and frequency domains (low frequency [LF] power, high frequency [HF] power, and LF/HF ratio) with acceleration plethysmography. RESULTS: CVa-a%, LF power, HF power, and LF/HF ratio were significantly lower in ESRD patients than healthy subjects. There were significant inverse correlations between these factors and age in healthy subjects, but not in ESRD patients. Although the fatigue score was not associated with any autonomic parameters, ESRD patients with impaired performance status exhibited a significantly lower LF/HF ratio. Moreover, in ESRD patients, the LF/HF ratio was significantly and positively associated with several components of QOL, including physical functioning and role emotional, independent of other clinical parameters and BMI. CONCLUSIONS: Impaired autonomic function is significantly associated with fatigue and impaired QOL in dialysis patients.

Loss of disability-adjusted life years due to heat-related sleep disturbance in the Japanese.

The purpose of this study was to quantify the sleep disturbances caused by climate change using disability-adjusted life years (DALY). The revised sleep quality index for daily sleep (SQIDS2), a self-administered questionnaire for daily sleep quality, was developed to assess daily sleep disturbances. This questionnaire referenced and simplified the Pittsburgh Sleep Quality Index (PSQI). This study was conducted in Nagoya City in August 2011 and 2012. Sleep quality was measured using SQIDS2 and PSQI. A total of 574 participants in 2011 and 710 in 2012 responded to the survey. The sleep disturbance prevalence calculated from the SQIDS2 score was correlated with the daily minimum temperature (p = 0.0067). This score increased when the daily minimum temperature was above 24.8 °C. When correcting for the PSQI score, DALY loss due to heat-related sleep disturbances in Nagoya City (population: 2,266,851) was estimated to be 81.8 years in 2012. This value was comparable to the DALY loss due to heatstroke. Sleep disturbance due to climate change was quantified using the DALY based on the PSQI. Legislators must recognize the critical impact of the damage caused by sleep disturbances due to high temperatures at night. Additionally, a daily minimum temperature of 25 °C should be the starting point when establishing a goal or guideline for nighttime temperature.

Relationship between cognitive function and prevalence of decrease in intrinsic academic motivation in adolescents.

BACKGROUND: Decrease in intrinsic motivation is a common complaint among elementary and junior high school students, and is related to poor academic performance. Since grade-dependent development of cognitive functions also influences academic performance by these students, we examined whether cognitive functions are related to the prevalence of decrease in intrinsic academic motivation. METHODS: The study group consisted of 134 elementary school students from 4th to 6th grades and 133 junior high school students from 7th to 9th grades. Participants completed a questionnaire on intrinsic academic motivation. They also performed paper-and-pencil and computerized cognitive tests to measure abilities in motor processing, spatial construction, semantic fluency, immediate memory, short-term memory, delayed memory, spatial working memory, and selective, alternative, and divided attention. RESULTS: In multivariate logistic regression analyses adjusted for grade and gender, scores of none of the cognitive tests were correlated with the prevalence of decrease in intrinsic academic motivation in elementary school students. However, low digit span forward test score and score for comprehension of the story in the kana pick-out test were positively correlated with the prevalence of decrease in intrinsic academic motivation in junior high school students. CONCLUSIONS: The present findings suggest that decrease in capacity for verbal memory is associated with the prevalence of decrease in intrinsic academic motivation among junior high school students.

Low visual information-processing speed and attention are predictors of fatigue in elementary and junior high school students.

BACKGROUND: Fatigue is a common complaint among elementary and junior high school students, and is known to be associated with reduced academic performance. Recently, we demonstrated that fatigue was correlated with decreased cognitive function in these students. However, no studies have identified cognitive predictors of fatigue. Therefore, we attempted to determine independent cognitive predictors of fatigue in these students. METHODS: We performed a prospective cohort study. One hundred and forty-two elementary and junior high school students without fatigue participated. They completed a variety of paper-and-pencil tests, including list learning and list recall tests, kana pick-out test, semantic fluency test, figure copying test, digit span forward test, and symbol digit modalities test. The participants also completed computerized cognitive tests (tasks A to E on the modified advanced trail making test). These cognitive tests were used to evaluate motor- and information-processing speed, immediate and delayed memory function, auditory and visual attention, divided and switching attention, retrieval of learned material, and spatial construction. One year after the tests, a questionnaire about fatigue (Japanese version of the Chalder Fatigue Scale) was administered to all the participants. RESULTS: After the follow-up period, we confirmed 40 cases of fatigue among 118 students. In multivariate logistic regression analyses adjusted for grades and gender, poorer performance on visual information-processing speed and attention tasks was associated with increased risk of fatigue. CONCLUSIONS: Reduced visual information-processing speed and poor attention are independent predictors of fatigue in elementary and junior high school students.

Protein Composition of Circulating Extracellular Vesicles Immediately Changed by Particular Short Time of High-Intensity Interval Training Exercise.

INTRODUCTION/PURPOSE: High-intensity interval training (HIIT) promotes various biological processes and metabolic effects in multiple organs, but the role of extracellular vesicles (EVs) released from a variety of cells is not fully understood during HIIT exercise (HIIT-Ex). We investigated the changes in circulating number and proteomic profile of EVs to assess the effect of HIIT-Ex. METHODS: Seventeen young men (median age, 20 years) were enrolled in the study. Total duration of the HIIT-Ex was 4 min. Blood samples were collected from before HIIT-Ex (pre-HIIT-Ex), at the immediate conclusion of HIIT-Ex (T0), at 30 min (T30), and at 120 min after HIIT-Ex. The pulse rate and systolic blood pressure were measured. Circulating EVs were characterized, and EV proteins were detected via nano liquid chromatography tandem mass spectrometry. RESULTS: The pulse rate and systolic blood pressure at T0 to pre-HIIT-Ex were significantly higher. Circulating EV number was significantly altered throughout the HIIT-Ex, and the source of circulating EVs included skeletal muscle, hepatocytes, and adipose tissue. Proteomic analysis identified a total of 558 proteins within isolated circulating EVs from pre-HIIT-Ex, T0, and T30. Twenty proteins in total were significantly changed at pre-HIIT-Ex, T0, and T30 and are involved in a variety of pathways, such as activation of coagulation cascades, cellular oxidant detoxification, and correction of acid-base imbalance. Catalase and peroxiredoxin II were increased at T0. CONCLUSION: The circulating EV composition can be immediately changed by particularly a short time of HIIT-Ex, indicating that EVs may intercommunicate across various organs rapidly in response to HIIT-Ex.

Premorbid personality in chronic fatigue syndrome as determined by the Temperament and Character Inventory.

BACKGROUND: Using the Temperament and Character Inventory (TCI), we examined personality characteristics in patients with chronic fatigue syndrome (CFS) compared with healthy control subjects, and CFS patients with and without psychiatric diseases. There have been no previous reports assessing personality in CFS patients using the TCI. METHODS: A total of 211 CFS patients and 90 control subjects completed the TCI and the Chalder Fatigue Scale questionnaires. RESULTS: Compared with control subjects, CFS patients demonstrated significantly lower premorbid Novelty Seeking, and higher Harm Avoidance and persistence. The fatigue score for CFS patients with psychiatric diseases was higher than that for CFS patients without psychiatric diseases. Patients with CFS with psychiatric diseases showed lower premorbid Self-Directedness when compared with CFS patients without psychiatric diseases. The fatigue score was negatively correlated with premorbid Self-Directedness and Cooperativeness, and positively correlated with Harm Avoidance among CFS patients. CONCLUSION: This study supported the stereotyped image of CFS patients as perfectionists, which is similar to the Persistence score, and neurotics, which is similar to the Harm Avoidance score. Patients displaying greater neuroticisms and poorer social and communication skills, similar to the Self-Directedness and Cooperativeness scores, tend to have intercurrent psychiatry diseases and show more severe symptoms of CFS.

Temperament and character as predictors of fatigue-induced symptoms among school children in Japan: a 1-year follow-up study.

OBJECTIVE: This 1-year follow-up study was performed to examine the association of temperament and character dimensions with new onset of fatigue-induced symptoms among school children in Japan, focusing on the transition from childhood to early adolescence. METHOD: This study prospectively reviewed data from 1512 school children from four elementary and four junior high schools in Japan. The survey was conducted in 2006 and 2007. Multivariate logistic regression analyses were performed to examine the association of psychological dimensions, assessed by the Junior Temperament and Character Inventory, with fatigue-induced symptoms. RESULTS: The correlation between temperament and character dimensions with new-onset of fatigue-induced symptoms differed as the students advanced into higher grades. In terms of physical symptoms in males, traits correlated with fatigue-induced symptoms included Novelty Seeking (headaches OR, 1.36; 95% CI, 1.07-1.73) or Reward Dependence (extreme tiredness OR, 1.84; 95% CI, 1.09-3.12; muscle weakness OR, 2.32; 95% CI, 1.28-4.20) during elementary school, whereas in females, Novelty Seeking was mainly associated with both physical (morning fatigue OR, 1.40; 95% CI, 1.10-1.77; headaches OR, 1.22; 95% CI, 1.04-1.43) and mental (mood changes OR, 1.30; 95% CI, 1.09-1.56) symptoms. Among ninth graders, more mental symptoms of fatigue were associated with Harm Avoidance (males, poor motivation OR, 1.20; 95% CI, 1.02-1.42; females, mood changes OR, 1.25; 95% CI, 1.06-1.49) and Self Directedness (males, poor motivation OR, 0.75; 95% CI, 0.59-0.96; females, difficulty thinking OR, 0.78; 95% CI, 0.62-0.98). CONCLUSION: Confirmation that the correlation between personality traits and fatigue-induced symptoms changes with grade at school has implications for screening susceptible children and adolescents and may help prevent the occurrence of such symptoms at an early stage.

Effort-reward imbalance for learning is associated with fatigue in school children.

We examined relationships among fatigue, sleep quality, and effort-reward imbalance for learning in school children. We developed an effort-reward for learning scale in school students and examined its reliability and validity. Self-administered surveys, including the effort reward for leaning scale and fatigue scale, were completed by 1,023 elementary school students (grades 4-6) and 1,361 junior high school students (grades 7-9) at the end of 2006. Effort-reward imbalance for learning was associated with a high incidence of fatigue and sleep problems in elementary and junior high school students of both genders. A good relationship with family was associated with a low fatigue score in junior high school boys, and a good relationship with friends was associated with a low fatigue score in junior high school girls by multiple regression analysis. Fatigue score was associated with effort-reward imbalance and fatigue and quality of sleep in schoolchildren. Fatigue may lead to a decline in school performance, negative health outcomes, or refusal to attend school. These results suggest that it is desirable to consider social support, quality of sleep, and effort-reward imbalance when managing fatigue in school children.

Personality and fatigue in medical students.

Among medical students, fatigue is a common complaint and is related to poor academic outcomes. Associations of scores on personality traits and fatigue in medical students were examined. A group of 125 healthy second-year medical students completed a questionnaire about fatigue, the Japanese version of the Chalder Fatigue Scale, and the Temperament and Character Inventory. On simple regression analyses, the Temperament and Character Inventory dimension of Harm Avoidance was positively associated with Fatigue scores and those on Self-directedness were negatively associated. Similarly, on multiple regression analyses adjusted for age and sex, scores on the Temperament and Character Inventory dimension of Harm Avoidance were positively associated with Fatigue scores, and those for Self-directedness were negatively associated. These correlations were evident even after adjustment for other Temperament and Character Inventory dimensions. The temperament dimension of Harm Avoidance and the character dimension of Self-directedness were both associated with Fatigue in medical students.

Deep phenotyping of myalgic encephalomyelitis/chronic fatigue syndrome in Japanese population.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex and debilitating disease with no molecular diagnostics and no treatment options. To identify potential markers of this illness, we profiled 48 patients and 52 controls for standard laboratory tests, plasma metabolomics, blood immuno-phenotyping and transcriptomics, and fecal microbiome analysis. Here, we identified a set of 26 potential molecular markers that distinguished ME/CFS patients from healthy controls. Monocyte number, microbiome abundance, and lipoprotein profiles appeared to be the most informative markers. When we correlated these molecular changes to sleep and cognitive measurements of fatigue, we found that lipoprotein and microbiome profiles most closely correlated with sleep disruption while a different set of markers correlated with a cognitive parameter. Sleep, lipoprotein, and microbiome changes occur early during the course of illness suggesting that these markers can be examined in a larger cohort for potential biomarker application. Our study points to a cluster of sleep-related molecular changes as a prominent feature of ME/CFS in our Japanese cohort.

Personality traits associated with intrinsic academic motivation in medical students.

OBJECTIVES: Motivation is one of the most important psychological concepts in education and is related to academic outcomes in medical students. In this study, the relationships between personality traits and intrinsic academic motivation were examined in medical students. METHODS: The study group consisted of 119 Year 2 medical students at Osaka City University Graduate School of Medicine. They completed questionnaires dealing with intrinsic academic motivation (the Intrinsic Motivation Scale toward Learning) and personality (the Temperament and Character Inventory [TCI]). RESULTS: On simple regression analyses, the TCI dimensions of persistence, self-directedness, co-operativeness and self-transcendence were positively associated with intrinsic academic motivation. On multiple regression analysis adjusted for age and gender, the TCI dimensions of persistence, self-directedness and self-transcendence were positively associated with intrinsic academic motivation. CONCLUSIONS: The temperament dimension of persistence and the character dimensions of self-directedness and self-transcendence are associated with intrinsic academic motivation in medical students.

A two-year follow-up study of chronic fatigue syndrome comorbid with psychiatric disorders.

AIMS: Chronic fatigue syndrome patients often have comorbid psychiatric disorders such as major depressive disorders and anxiety disorders. However, the outcomes of chronic fatigue syndrome and the comorbid psychiatric disorders and the interactions between them are unknown. Therefore, a two-year prospective follow-up study was carried out on chronic fatigue syndrome patients with comorbid psychiatric disorders. METHODS: A total of 155 patients who met the Japanese case definition of chronic fatigue syndrome were enrolled in this study. Comorbid psychiatric disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria. Patients with comorbid psychiatric disorders received psychiatric treatment in addition to medical therapy for chronic fatigue syndrome. Seventy patients participated in a follow-up interview approximately 24 months later. RESULTS: Of the 70 patients with chronic fatigue syndrome, 33 patients were diagnosed as having comorbid psychiatric disorders including 18 major depressive disorders. Sixteen patients with psychiatric disorders and eight patients with major depressive disorders did not fulfill the criteria of any psychiatric disorders at the follow up. As for chronic fatigue syndrome, nine out of the 70 patients had recovered at the follow up. There is no significant influence of comorbid psychiatric disorders on the outcome of chronic fatigue syndrome. CONCLUSIONS: Chronic fatigue syndrome patients have a relatively high prevalence of comorbid psychiatric disorders, especially major depressive disorders. The outcomes of chronic fatigue syndrome and psychiatric disorders are independent. Therefore treatment of comorbid psychiatric disorders is necessary in addition to the medical treatment given for chronic fatigue syndrome.

Stress and coping styles are associated with severe fatigue in medical students.

Fatigue is a common complaint among medical students and researchers consider it to be related to poor academic outcomes. The authors' goal in the present study was to determine whether stress and coping strategies were associated with fatigue in medical students. The study group consisted of 73 second-year healthy students attending the Osaka City University Graduate School of Medicine. Participants completed a questionnaire about fatigue (Japanese version of Chalder Fatigue Scale), stress, stress coping (Japanese version of the Coping Inventory for Stressful Situations), overwork, and nocturnal sleeping hours. On univariate and multivariate logistic regression analyses adjusted for age and gender, stress was positively associated with fatigue. In addition, after adjustment for age, gender, and emotion- and task-oriented stress coping activities, avoidance-oriented stress coping activity was associated with fatigue. The results suggest that stress and the coping style are correlated with fatigue in medical students.

Relationships between dietary habits and the prevalence of fatigue in medical students.

OBJECTIVE: Fatigue, which is a common complaint among medical students, is related to poor academic outcomes. Because impaired dietary habits, such as skipping breakfast and taking meals irregularly, are correlated with poor school performances, whether those dietary habits were associated with the prevalence of fatigue was determined in medical students. METHODS: The study group consisted of 127 healthy second-year medical students attending Osaka City University Graduate School of Medicine. They completed a questionnaire dealing with fatigue (Japanese version of the Chalder Fatigue Scale), lifestyle, and academic performance. RESULTS: On multivariate logistic regression analyses adjusted for age, gender, body mass index, and nocturnal sleeping hours, skipping breakfast (completely skipping breakfast everyday versus having breakfast everyday; odds ratio 7.81, 95% confidence interval 2.00-30.52, P = 0.003) and taking meals irregularly (completely irregular versus always regular; odds ratio 6.89, 95% confidence interval 1.20-39.55, P = 0.030) were positively correlated with the prevalence of fatigue. CONCLUSION: Skipping breakfast and taking meals irregularly are associated with the prevalence of fatigue in medical students.

Reliability and validity of the Japanese version of the Chalder Fatigue Scale among youth in Japan.

In the present study, the reliability and construct validity of the Japanese version of the Chalder Fatigue Scale was evaluated as a measure of severity of fatigue among young students in Japan. A healthy group comprised 27 Grade 6 primary school students and 28 Grade 1 junior high school students. The severely fatigued group were hospital outpatients with childhood chronic fatigue syndrome (n = 21). Principal components analysis with varimax rotation identified 4 factors which accounted for 63.2% of the total variance, as in the original English version. Internal consistency (Cronbach coefficient alpha) was .73, and test-retest reliability measured using Spearman rank correlation coefficient was .55. Scale scores of the healthy subjects were lower than those of the patients with childhood chronic fatigue syndrome. The reliability (alpha) and construct validity of the Japanese version of the scale among healthy students in Japan were satisfactory for research studies among healthy school students.

Differences in relaxation by means of guided imagery in a healthy community sample.

OBJECTIVE: This study investigated differences in relaxation induced by guided imagery in healthy community samples. METHODS: One hundred forty-eight people took part in our investigation. The mean age of the 50 males and 98 females was 39.36 +/- 11.86 years. We took saliva samples to measure salivary cortisol (SC) before the first session, after the first session, and after the second session. Subjects were asked to complete the short form of the Multiple Mood Scale (MMS) questionnaire before the first session and after the second session. The shortened form of Betts' Questionnaire upon Mental Imagery (QMI) was collected once before the first session, and vividness of the imagery was measured using a visual analogue scale once after the second session. RESULTS: SC levels were significantly decreased after the first session and after the second session in all participants. We found, most significantly, that age and QMI scores were strongly related to changes in SC level throughout the relaxation sessions. CONCLUSIONS: Unpleasant information, a cause of mental stress, is replaced by a comfortable image, and this replacement affects a participant's SC level. The greater one's imagery ability is, the more successful the displacement of stress and the shift toward a comfortable mental and emotional state will be. This study provides a basis for explaining the mechanism through which relaxation by means of guided imagery is effective in reducing stress.

[Use of complementary and alternative medicine and health problems].

OBJECTIVE: Remarkable growth in use of alternative and complementally medicine (CAM) has recently been noted from consume to trends, detail surveys are limited. In this study, to clarify the actual state of use of CAM and associated problem, we performed a cross sectional study in a town using a self-administrated questionnaire. METHODS: The questionnaire including demographic variables, subjective health status and health practices was addressed by people in Oguni town in Kumamoto. Use of kampo, supplements/healthy food, chiropractic, massage, yoga/meditation, acupuncture, kiko/thai-chi, aromatherapy/herbal medicine and hot springs was assessed in the questionnaire in terms of frequency, prescription or advice from physicians, purpose, and satisfaction. RESULTS: The response rate was 83.33%. Use increased with aging and female employed CAM more frequently than male subjects. Most frequently consumed were supplement/health foods in both females (47.0%) and males (35.3%). The most prescribed was Kampo in both sexes (24.8% and 11.4%) About 70% of the subjects had visited chiropractics therapies. CONCLUSION: From 57.0% of subjects had used at least one CAM in the past six months, a high value compared with results from other countries. The rates were particularly large in female and elderly subjects. It is thus possible that the impact of CAM on health promotion policy is not inconsequential.