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1.  Cardiac arrest in the toilet: clinical characteristics and resuscitation profiles 
Objectives
The great majority of non-traumatic cardiac arrests (CA) occur at home. The toilet is a closed and private room where CA occurs frequently. However, due to the feelings of privacy that are associated with this room, the circumstances and causes of CA in the toilet have rarely been investigated.
Methods
A retrospective study was conducted to clarify clinical characteristics and resuscitation profiles of patients sustaining CA in the toilet.
Results
Among 907 CA patients treated during a 4-year period, 101 (11 %) sustained CA in the toilet. While the collapse was witnessed in only 10 % of these patients, return of spontaneous circulation (ROSC) was achieved in 41 %. However, the long-term survival rate was 1 %. Multivariate regression analysis revealed that a history of cardiac diseases was predictive of CA in the toilet (odds ratio 3.045; 95 % confidence interval 1.756–5.282) but that there was no correlation with advanced age. The frequency of CA in the toilet may be influenced moderately by seasonal/circadian variations. The 101 patients were classified into four subgroups according to mode of discovery of CA. The frequency of ROSC was highest in those who collapsed in the presence of caregivers and lowest in those whose collapse were discovered later by family members being worried that the patient stayed in the toilet “too long.” Imaging studies revealed life-threatening extra-cardiac lesions responsible for CA, such as subarachnoid hemorrhage and aortic dissection, in 23 % of the patient cohort.
Conclusions
The rarity of long-term survival among individuals sustaining CA in the toilet is mainly due to the delay in discovering the individual who collapsed. Although a history of cardiac diseases is a risk factor, predicting who may sustain CA in the toilet remains difficult due to etiological heterogeneity.
doi:10.1007/s12199-012-0301-y
PMCID: PMC3590314  PMID: 22961350
Cardiac arrest; Return of spontaneous circulation; Toilet; Witnessed
2.  Maternal and paternal family history of type 2 diabetes differently influence lipid parameters in young nondiabetic Japanese women 
Objectives
We assessed the association of family history of type 2 diabetes (T2D) with parameters used for health checkups in young Japanese women.
Methods
The subjects were 497 nondiabetic women aged 19–39 years. Among them, the mothers of 34 subjects and fathers of 50 had T2D (MD group and PD group, respectively). The subjects were assessed for levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG).
Results
TC and LDL-C level showed a tendency to increase in the MD group compared with subjects without family history of T2D. LDL-C/HDL-C ratio ≥2.14 was found in 32.4 and 18.0 % of subjects in the MD and PD groups, respectively. When adjusted for differences in age, body mass index, smoking status, and drinking habits, the MD group was found to have a higher risk of abnormal TC and LDL-C levels than the PD group. LDL-C/HDL-C ratio was independently associated with maternal family history but not with paternal family history (odds ratio 3.44 [99 % confidence interval 1.11–10.6] and 1.21 [0.38–3.89], respectively). There was no association between TG/HDL-C ratio and family history type of T2D.
Conclusions
Maternal family history of T2D had a more pronounced effect on the lipid parameters generally evaluated during health checkups than did paternal family history of T2D. Therefore, we recommend systematic screening for early detection and appropriate healthcare guidance for Japanese women, particularly those with maternal family history of T2D.
doi:10.1007/s12199-012-0296-4
PMCID: PMC3590315  PMID: 22826007
Diabetes; Family history; Dyslipidemia; Low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio; Health checkup
3.  Tobacco use and impact of tobacco-free policy on university employees in an environment of high tobacco use and production 
Objective
To assess occupational tobacco use and the impact of a tobacco-free policy in the Central Appalachia, an environment characterized by high tobacco use and production.
Methods
This study was an Internet-based survey conducted on 2,318 university employees. Descriptive, chi-square, and logistic regression statistics were performed. Unadjusted and adjusted odds ratios (AOR) with respective 95 % confidence intervals (CI) were reported.
Results
The survey response rate was 50.8 %; of the respondents, 9.0 % were current smokers. Smoking prevalence among faculty, administrators/professionals, and clerical/support staff was 6.1, 8.1, and 13.1 %, respectively. While those respondents aged 30–39 years showed a significantly increased likelihood of being a current smoker (AOR 5.64, 95 % CI 1.31–9.26), knowledge that secondhand smoke is harmful (AOR 0.22, 95 % CI 0.07–0.70) and support for tobacco-free policy (AOR 0.11, 95 % CI 0.04–0.27) decreased the likelihood.
Conclusion
Low tobacco use among faculty and administrators confirmed the relationship between tobacco use and socio-economic status, even in a tobacco-producing environment. Disaggregation of tobacco use data assists the public health community in the efficient allocation of efforts and resources for cessation programs to reduce tobacco use in such environments.
Electronic supplementary material
The online version of this article (doi:10.1007/s12199-012-0297-3) contains supplementary material, which is available to authorized users.
doi:10.1007/s12199-012-0297-3
PMCID: PMC3590316  PMID: 22893255
Tobacco use prevalence; Tobacco-producing state; Socio-economic status; Tobacco-free campus policy; University personnel or employees
4.  Association of genotypes of carcinogen-metabolizing enzymes and smoking status with bladder cancer in a Japanese population 
Objectives
Arylamines are considered to be the primary causative agent of bladder cancer in tobacco smokers. To test the hypothesis that variation in the genes that metabolize tobacco carcinogens contribute to bladder cancer, we examined the effects of single nucleotide polymorphisms in the genes of four key enzymes: cytochrome P4501A2, N-acetyltransferase (NAT) 2, sulfotransferase1A1, and UDP-glucuronosyltransferase (UGT) 2B7.
Methods
In this study, 282 Japanese patients with transitional cell carcinoma, the most common bladder cancer, and 257 healthy controls were surveyed and compared for frequencies of the genotypes of the four enzymes. Genotypes were determined using PCR-restriction fragment length polymorphism and TaqMan assays. Smoking information was collected by personal interview. Logistic regression analysis and the chi-square test were employed as statistical methods.
Results
The NAT2 slow genotype was significantly associated with the risk of bladder cancer [odds ratio (OR) 3.41, 95 % confidence interval (95 % CI) 1.68–6.87; p < 0.05). The NAT2 slow genotype also significantly increased the risk of bladder cancer in heavy smokers (OR 8.57, 95 % CI 1.82–40.25; p < 0.05). Among the different combinations of the four enzyme genotypes, the highest OR (4.20; 95 % CI 1.34–13.14; p < 0.05) was obtained with the NAT2 slow genotype when present in combination with the UGT2B7*2/*2 or *1/*2 genotype.
Conclusions
Our results suggest that individuals with different genotypes for the enzymes involved in metabolizing carcinogenic arylamines have a different risk of developing bladder cancer. In particularly, the combination of the NAT2 slow genotype with UGT2B7*1/*2 or *2/*2 genotype is a high risk factor for bladder cancer.
doi:10.1007/s12199-012-0302-x
PMCID: PMC3590317  PMID: 22961351
Genetic susceptibility; N-acetyltransferase; UDP-glucuronosyltransferase B7; Polymorphism; Bladder cancer
5.  Smoking topography and biomarkers of exposure among Japanese smokers: associations with cigarette emissions obtained using machine smoking protocols 
Objectives
Although the relative risk of lung cancer due to smoking is reported to be lower in Japan than in other countries, few studies have examined the characteristics of Japanese cigarettes or potential differences in smoking patterns among Japanese smokers.
Methods
To examine tar, nicotine and carbon monoxide (TNCO) emissions from ten leading cigarettes in Japan, machine smoking tests were conducted using the International Organization for Standardization (ISO) protocol and the Health Canada Intense (HCI) protocol. Smoking topography and tobacco-related biomarkers were collected from 101 Japanese smokers to examine measures of exposure.
Results
The findings indicate considerable variability in the smoking behavior of Japanese smokers. On average, puffing behaviors observed among smokers were more similar to the parameters of the HCI protocol, and brands with greater ventilation that yielded lower machine values using the ISO protocol were smoked more intensely than brands with lower levels of ventilation. The smokers of “ultra-low/low” nicotine-yield cigarettes smoked 2.7-fold more intensively than those of “medium/high” nicotine-yield cigarette smokers to achieve the same level of salivary cotinine (p = 0.024). CO levels in expiratory breath samples were associated with puff volume and self-reported smoking intensity, but not with nominal values of nicotine-yield reported on cigarette packages.
Conclusions
Japanese smokers engaged in “compensatory smoking” to achieve their desired nicotine intake, and levels of exposure were greater than those suggested by the nominal value of nicotine and tar yields reported on cigarette packages.
doi:10.1007/s12199-012-0293-7
PMCID: PMC3590318  PMID: 22810309
CReSSmicro device; Cotinine; Carbon monoxide; HCI protocol; Japanese smokers
6.  Workers' load and job-related stress after a reform and work system change in a hospital kitchen in Japan 
Objectives
Many kitchen work environments are considered to be severe; however, when kitchens are reformed or work systems are changed, the question of how this influences kitchen workers and environments arises. The purpose of this study is to examine whether there was a change in workload and job-related stress for workers after a workplace environment and work system change in a hospital kitchen.
Methods
The study design is a pre–post comparison of a case, performed in 2006 and 2008. The air temperature and humidity in the workplace were measured. Regarding workload, work hours, fluid loss, heart rate, and amount of activity [metabolic equivalents of task (METs)] of 7 and 8 male subjects pre- and post-reform, respectively, were measured. Job-related stress was assessed using a self-reporting anonymous questionnaire for 53 and 45 workers pre- and post-system change, respectively.
Results
After the reform and work system change, the kitchen space had increased and air-conditioners had been installed. The workplace environment changes included the introduction of temperature-controlled wagons whose operators were limited to male workers. The kitchen air temperature decreased, so fluid loss in the subjects decreased significantly. However, heart rate and METs in the subjects increased significantly. As for job-related stress, although workplace environment scores improved, male workers’ total job stress score increased.
Conclusions
These results suggest that not only the workplace environment but also the work system influenced the workload and job stress on workers.
doi:10.1007/s12199-012-0291-9
PMCID: PMC3590319  PMID: 22791208
Workplace environment; Work load; Job-related stress; Work system; Kitchen
7.  Reference value and annual trend of white blood cell counts among adult Japanese population 
Objectives
This study was initiated to establish the reference values (the 95 % lower limit in particular) for white blood cell (WBC) counts in peripheral blood of general Japanese population. Additional attempts were made to examine whether the reference range had changed in the past 100 years, and which factors had induced such change in WBC counts.
Methods
Data employed were WBC counts of >100 thousand apparently healthy Japanese men, collected in 2002 and in 2010, respectively. Information on smoking habits was collected simultaneously.
Results
The distribution of WBC counts was essentially normal. Arithmetic mean (AM) WBC was 6,248 cells/mm3 in 2002 and 6,162 cells/mm3 in 2010. Based on the 2010 observation, 3 × 103 WBCs/mm3 (after rounding of the figure) was identified as the 95 % lower limit of the reference value for the population. No clear age dependency was detected. Smoking induced elevation in WBC, whereas WBC returned to the level of never smokers after quitting for 3 or more years.
Conclusions
Historical review disclosed a secular trend of decrease in WBC in the past 100 years, so that about 8 % of never-smoking men would be considered leukocytopenic according to the conventional cutoff of 4 × 103 cells/mm3 as a screening level. Decreased smoking rates and improved general hygiene are discussed as possible factors for WBC count reduction. Thus, WBC count of 3 × 103 cells/mm3 is recommended as the 95 % lower limit of the reference value for screening cases with reduced WBC counts.
doi:10.1007/s12199-012-0304-8
PMCID: PMC3590320  PMID: 23054993
Annual trend; Japanese; Leukocyte counts; Men; Reference value; White blood cell counts
8.  P.R4810K, a polymorphism of RNF213, the susceptibility gene for moyamoya disease, is associated with blood pressure 
Background
Moyamoya disease—an idiopathic vascular disorder of intracranial arteries—is often accompanied by hypertension. RNF213 has been identified as a susceptibility gene for moyamoya disease. In the present study, the association of p.R4810K (G>A) with blood pressure (BP) was investigated in a Japanese population.
Methodology/principal findings
Three independent study populations, the Nyukawa (n = 984), Noshiro (n = 2,443) and Field (n = 881) studies, joined this study. BP, body weight and height were measured. Past and present symptoms and disease and medication histories were assessed by interview. Associations of p.R4810K (rs112735431, ss179362673) of RNF213 with BP were investigated. Two linkage disequilibrium blocks were constructed for moyamoya patients with p.R4810K (n = 140) and the general population (n = 384) using 39 single nucleotide polymorphisms (SNPs) spanning 390 kb around RNF213. A total of 60 carriers (3 for AA genotype and 57 for GA genotype) were found in these samples, and the minor allele frequencies were 1.4 % in the Nyukawa and Field studies and 0.2 % in the Noshiro study. Regression analyses adjusted for age, sex and body mass index based on an additive model demonstrated significant associations with systolic BP (mmHg/allele): β (standard error) was 8.2 (2.9) in the Nyukawa study (P = 4.7 × 10−3), 18.7 (5.4) in the Noshiro study (P = 4.6 × 10−4) and 8.9 (2.0) (P = 1.0 × 10−5) in the three populations. In contrast, diastolic BP showed significant associations only in the Noshiro study. Linkage disequilibrium blocks contained none of the BP-associated proxy SNPs reported by previous studies.
Conclusions/significance
Our study suggests that p.R4810K of RNF213 is associated strongly with systolic BP.
Electronic supplementary material
The online version of this article (doi:10.1007/s12199-012-0299-1) contains supplementary material, which is available to authorized users.
doi:10.1007/s12199-012-0299-1
PMCID: PMC3590321  PMID: 22878964
RNF213; Moyamoya disease; P.R4810K; Systolic blood pressure; Hypertension
9.  Abnormality of risk factors for atherosclerotic disease among young Japanese aged 19–39 years old: an evaluation of health checkup data 
Objectives
Japanese public health policies on the prevention of atherosclerotic diseases have focused on controlling obesity. The aim of this study was to assess the prevalence of abnormality in risk factors for atherosclerotic disease among young Japanese classified according to body mass index (BMI).
Methods
Data were obtained from 359 men (mean age 32 ± 5 years) and 1,108 women (mean age 33 ± 4 years) between 2005 and 2010. Abnormal levels of aspartate aminotransferase, alanine aminotransferase, and/or gamma-glutamyltranspeptidase were considered to indicate liver dysfunction, and abnormal levels of low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and/or triglycerides were considered to indicate dyslipidemia. The cutoff points for high blood pressure (HBP) and hyperglycemia were set as a reference in the high–normal range.
Results
No significant difference was observed in both sexes in all items among each year. In men, HBP (12.9 %), liver dysfunction (33.9 %), dyslipidemia (29.9 %), and hyperglycemia (2.7 %) were observed in the normal BMI group (18.5 < BMI ≤ 25 kg/m2). In women, these abnormalities were observed in both the normal BMI group and lean group.
Conclusions
Asymptomatic abnormalities, particularly liver dysfunction and dyslipidemia, were observed in a substantial percentage of subjects without obesity. Therefore, we recommend that the comprehensive public health policy should be directed at all individuals, including the non-obese group, for the early prevention/detection against atherosclerotic diseases.
doi:10.1007/s12199-012-0289-3
PMCID: PMC3590322  PMID: 22760262
Obesity; Dyslipidemia; Liver dysfunction; Atherosclerotic disease; Japanese
10.  Relationship between the degree of property damage and changes in red blood cells, hematocrit, and hemoglobin among victims of the Noto Peninsula Earthquake 
Objectives
The aim of this study was to assess the impact of the Noto Peninsula Earthquake on various hematologic parameters. We studied the relationships between the degree of property damage and changes in red blood cells (RBCs), hemoglobin (Hb), and hematocrit (Ht) among residents before and after the March 2007 Noto Peninsula Earthquake.
Methods
A total of 5,563 residents of Wajima City who were not receiving oral treatment for anemia and who had received basic health screenings for fiscal years (FYs) 2006 and 2007, before and after the earthquake. We analyzed changes in their RBCs, Hb, and Ht levels by gender, age, body mass index (BMI), level of property damage, and evaluation standards.
Results
RBCs, Hb, and Ht for FY2007 showed a trend of decreasing values compared to FY2006 in both male and female subjects. RBCs and Hb significantly decreased in females aged between 65 and 74 years who experienced total property damage, and Ht significantly increased for those younger than 65 years who experienced the same level of damage. In addition, significant differences by degree of property damage and FY2007/FY2006 ratio were seen only among subjects with a BMI ratio <1. Furthermore, we found a significant relationship between reduction of RBCs or Hb and increasing age in females; however, no significant relationship to property damage was found. No significant relationships were found for males.
Conclusions
A significant association between property damage and changes in RBCs, Hb, and Ht was not found in this population of residents who experienced the Noto Peninsula Earthquake.
doi:10.1007/s12199-012-0305-7
PMCID: PMC3590323  PMID: 23132633
Noto Peninsula Earthquake; Depopulated area; Elderly; Basic health screening; Anemia
12.  An overview of the China National Tobacco Corporation and State Tobacco Monopoly Administration 
Objectives
China is facing a serious public health problem in active and passive smokers. Confronted with this, China has taken some measures to control tobacco. However, this information has not been surveyed at academic level. Our aim is to investigate information relating to tobacco controls in China.
Methods
To find information relating to tobacco control, we reviewed and analysed the China National Tobacco Corporation (CNTC) and State Tobacco Monopoly Administration (STMA) mainly by systematic examination of documents made available in the University of California, San Francisco Legacy Tobacco Documents Library and China Tobacco database.
Results
Eleven relevant documents met our research purpose, and 18 further relevant documents were found on the CNTC, STMA and Tobacco China database websites. As a result, 29 relevant articles were included in our analysis. We describe the CNTC and STMA’s history, structure, and relation to the Chinese Government ministry and to other tobacco companies, and China’s tobacco control in detail.
Conclusions
The Chinese cigarette market is dominated by a state-owned monopoly, the STMA. Under the protection of the Law of the People’s Republic of China on Tobacco Monopoly, the STMA controls all aspects of the tobacco industry. As far as the Chinese tobacco monopoly is concerned, although smoking harms people’s health, restraining smoking threatens social stability and government income, which may be more serious problems for any government. China still has a long way to go in creating smoke-free environments.
doi:10.1007/s12199-012-0288-4
PMCID: PMC3541807  PMID: 22696197
China; Epidemiology; Public health; Smoking; Tobacco control
13.  Social development conditions and related factors for children in Japanese kindergarten in Shanghai, China 
Objective
The aim of this study is to clarify the social development conditions and related factors for children in Japanese kindergarten in Shanghai, China.
Methods
The target schools were three Japanese kindergartens in Shanghai, three in Wakayama, Japan, and three in Osaka, Japan. The target kindergarten children were all 5- or 6-year-olds. We used an anonymous questionnaire to the guardian of the child. The question items related to social development, lifestyle and daily activities of the child, and rearing awareness and conditions of the guardian. Social development was scored by Strength and Difficulties Questionnaires (SDQ).
Results
The number of respondents was 246 (Shanghai group 72, Wakayama group 86, Osaka group 88). The median value of the score of total difficulties and prosocial behavior, SDQ subscale, and the proportion of children judged as low need showed no significant difference. Results of multiple logistic regression analysis showed that the frequency of eating fast-foods and the rearing condition “I become anxious or lose enthusiasm for childrearing when the child is recalcitrant” were the factors relevant to prosocial behavior in the Shanghai group. In the Wakayama group, the hours spent daily watching TV was designated as the relevant factor. In the Osaka group, hours spent daily playing outdoors was found to be the relevant factor.
Conclusions
Social development of children in Japanese kindergarten in Shanghai was the same as that of those living in Japan. The factors relevant to prosocial behavior in the Shanghai group were different from those in the two cities in Japan. This study may show the important points to keep in mind for childrearing abroad.
doi:10.1007/s12199-012-0290-x
PMCID: PMC3541808  PMID: 22797971
Kindergarten children; Social development; Raising environment; Living overseas; Multiple logistic regression analysis
14.  Can methanolic extract of Nigella sativa seed affect glyco-regulatory enzymes in experimental hepatocellular carcinoma? 
Background and aim
To investigate the possible modulating role of “Nigella sativa” (NS), a plant commonly used in Egyptian traditional medicine, on premalignant perturbations in three glycol-regulatory enzymes in an experimental rat model of hepatocellular carcinoma (HCC).
Methods
Thirty-six (36) male albino rats were divided into four groups (n = 9). Group 1 served as a normal control, group 2 was treated with methanolic extract of Nigella sativa (MENS) (1 g/kg/day, orally) for 14 weeks, group 3 received a single intraperitoneal dose of diethyl nitrosamine (DENA) (200 mg/kg), followed 2 weeks later by a subcutaneous injection of carbon tetrachloride (CCl4, 3 ml/kg/week/6 weeks) and group IV was treated with MENS for 2 weeks prior to administration of the carcinogenic combination (DENA + CCl4, as in group 3) until the end of the experiment. The total period of the experiment was 14 weeks.
Results
In the DENA + CCl4-treated group, there was a significant increase in the relative liver weight, serum alpha fetoprotein level and the activities of hexokinase, glyceraldehyde phosphate dehydrogenase and glucose 6 phosphate dehydrogenase in both the serum and liver homogenate; this was accompanied by a subsequent decrease in body weight. Pre-treatment with MENS significantly maintained these parameters close to the normal condition.
Conclusion
Based on these results, we conclude that MENS has a chemo-preventive effect against the progression into liver malignancy through its modulation of the energy metabolic pathways (i.e. glycolysis) that may be involved in hepatocarcinogenesis.
doi:10.1007/s12199-012-0292-8
PMCID: PMC3541809  PMID: 22767221
Premalignant hepatocellular changes; Glyco-regulatory enzymes; Nigella sativa; Glucose metabolism; Chemoprevention
15.  The effects of continuing and discontinuing smoking on the development of chronic kidney disease (CKD) in the healthy middle-aged working population in Japan 
Objectives
The strength of the association between smoking and the development of chronic kidney disease (CKD) in the healthy middle-aged working age population has not been established.
Methods
This was a retrospective 6-year observational study involving 4,121 male and 2,877 female workers who were free of primary kidney disease, diabetes mellitus, severe hypertension, and the signs and symptoms of CKD. Proteinuria was detected by a dipstick method, and glomerular filtration rate (GFR) was estimated by the equation of the Japan Society of Nephrology.
Results
Sixty men (1.5 %) and 21 women (0.7 %) developed proteinuria over the 6 years of the study. Irrespective of sex, in comparison with non-smokers, those who continued smoking showed an odds ratio (OR) of 2.52 with a 95 % confidence interval (CI) of 1.50–4.25 for developing proteinuria while those who quit smoking showed an OR of 1.29 (95 % CI 0.48–3.42), following adjustment for confounders. Among the study population, 443 men (10.7 %) and 356 women (12.4 %) developed a GFR of <60 mL/min/1.73 m2, corresponding to stage III CKD. Continuing smokers had a low OR (0.74, 95 % CI 0.60–0.90) for developing a low GFR, as well as a higher mean GFR than non-smokers. The reduction in GFR during the 6-year study period was not different between smokers and non-smokers, but it was larger in those who developed proteinuria than in those who did not, irrespective of smoking.
Conclusions
Continuing smokers showed a twofold or more higher risk of developing proteinuria. Discontinuation of smoking substantially reduced the risk. A longer observational period may be required to detect the smoking-induced risk of developing stage III CKD in the middle-aged working population.
doi:10.1007/s12199-012-0285-7
PMCID: PMC3541810  PMID: 22623223
Smoking; Chronic kidney disease; Proteinuria; Estimated glomerular filtration rate; Healthy person
16.  Association of urinary 8-OHdG with lifestyle and body composition in elderly natural disaster victims living in emergency temporary housing 
Objectives
Residents who lost land and houses due to disasterous heavy rainfall-related events on July 13, 2004 and the Chuetsu Earthquake on October 23, 2004 were moved to emergency temporary housing. The change in life style due to living under such conditions is assumed to increase oxidative stress level. In this study, we investigated the oxidative stress level in elderly residents of emergency temporary housing, and analyzed its association with lifestyle and body composition following these disasters.
Methods
A noninvasive oxidative stress marker, urinary 8-hydroxydeoxyguanosine (8-OHdG), and body composition were measured in 73 elderly residents of emergency temporary housing.
Results
In the elderly female residents, the urinary 8-OHdG level tended to decrease with time after the disasters. 8-OHdG levels were slightly higher in females than males and significantly higher among those who exercised regularly compared to those who did not, particularly in females. A weak correlation was noted between the urinary 8-OHdG level and muscle ratio in females.
Conclusions
The in vivo oxidative stress level in our study cohort of elderly residents of emergency temporary housing changed following the change in life style, but remained within the normal range. The increase in oxidative stress levels of elderly females was related to menopause. A decrease in estrogen levels due to menopause inhibits its antioxidant effects, which increases 8-OHdG levels. Although it is difficult to determine, a decrease in daily stressors over time following the disaster could be a cause of the decrease in oxidative stress levels. We suggest that the close evaluation of the stress level of disaster victims is desirable, in combination with evidence of antioxidative substances and the psychosocial influence of suffering as a consequence of the disaster.
doi:10.1007/s12199-012-0284-8
PMCID: PMC3541811  PMID: 22623222
Disaster; Emergency temporary housing; 8-Hydroxy-2′-deoxyguanosine; In vivo oxidative stress; Elderly
17.  Folate-deficiency induced cell-specific changes in the distribution of lymphocytes and granulocytes in rats 
Objective
Folate (vitamin B9) plays key roles in cell growth and proliferation through regulating the synthesis and stabilization of DNA and RNA, and its deficiency leads to lymphocytopenia and granulocytopenia. However, precisely how folate deficiency affects the distribution of a variety of white blood cell subsets, including the minor population of basophils, and the cell specificity of the effects remain unclear. Therefore, we examined the effects of a folate-deficient diet on the circulating number of lymphocyte subsets [T-lymphocytes, B-lymphocytes, and natural killer (NK) cells] and granulocyte subsets (neutrophils, eosinophils, and basophils) in rats.
Methods
Rats were divided into two groups, with one receiving the folate-deficient diet (FAD group) and the other a control diet (CON group). All rats were pair-fed for 8 weeks.
Results
Plasma folate level was dramatically lower in the FAD group than in the CON group, and the level of homocysteine in the plasma, a predictor of folate deficiency was significantly higher in the FAD group than in the CON group. The number of T-lymphocytes, B-lymphocytes, and NK cells was significantly lower in the FAD group than in the CON group by 0.73-, 0.49-, and 0.70-fold, respectively, indicating that B-lymphocytes are more sensitive to folate deficiency than the other lymphocyte subsets. As expected, the number of neutrophils and eosinophils was significantly lower in the FAD group than in the CON group. However, the number of basophils, the least common type of granulocyte, showed transiently an increasing tendency in the FAD group as compared with the CON group.
Conclusion
These results suggest that folate deficiency induces lymphocytopenia and granulocytopenia in a cell-specific manner.
doi:10.1007/s12199-012-0286-6
PMCID: PMC3541812  PMID: 22644659
Dietary folate-deficiency; Lymphocyte subsets; Granulocyte subsets
18.  Community factors to promote parents’ quality of child-nurturing life 
Objectives
The purpose of this study was to clarify the role of community factors in parents’ quality of child-nurturing life (QCNL).
Methods
We developed a questionnaire to evaluate the degree of QCNL and determine the structural factors related to QCNL as community factors related to parents’ QCNL derived from focus group interviews and the Delphi technique. The questionnaire also included the battery of the self-rating depression scale and Tsumori-Inage Infant's Developmental Test. Using the questionnaire, we then conducted a quantitative survey of parents whose children attended nursery schools in Kumamoto Prefecture. Factor analysis, calculation of the mean score and/or ratio to each item, Pearson’s correlation coefficient, t test, multiple regression analysis, and covariance structure analysis were performed.
Results
The questionnaire we developed consisted of seven items with 75 elements, involving ten elements as community factors. Subjects included 699 parents (mean age 33.6 ± 5.4 years) and 965 children (age range 0–6 years). Factor analysis revealed that community factors consisted of five factors, such as “lifestyle rooted in the ground,” “balance of housekeeping and work,” “community network,” “amenity,” and “regeneration of life”. These factors may be dominant in a rural area. Finally, we developed a structural model with “community factors,” QCNL, QOL, and “child growth” by covariance structural analysis. The analysis revealed that community factors had a positive relation to parents’ QCNL (r = 0.81, p < 0.001) and that parental SDS score had a negative relation to parents’ QCNL (r = −0.59, p < 0.001). The analysis did show that community factors were positively related to the sound growth of children.
Conclusion
The covariance structure analysis revealed that community factors were associated with parents’ QCNL, SDS, and “child growth.”
doi:10.1007/s12199-012-0303-9
PMCID: PMC3541813  PMID: 23054992
Maternal and child health; Quality of child-nursing life; Qualitative study; Quantitative study
19.  An overview of health forecasting 
Health forecasting is a novel area of forecasting, and a valuable tool for predicting future health events or situations such as demands for health services and healthcare needs. It facilitates preventive medicine and health care intervention strategies, by pre-informing health service providers to take appropriate mitigating actions to minimize risks and manage demand. Health forecasting requires reliable data, information and appropriate analytical tools for the prediction of specific health conditions or situations. There is no single approach to health forecasting, and so various methods have often been adopted to forecast aggregate or specific health conditions. Meanwhile, there are no defined health forecasting horizons (time frames) to match the choices of health forecasting methods/approaches that are often applied. The key principles of health forecasting have not also been adequately described to guide the process. This paper provides a brief introduction and theoretical analysis of health forecasting. It describes the key issues that are important for health forecasting, including: definitions, principles of health forecasting, and the properties of health data, which influence the choices of health forecasting methods. Other matters related to the value of health forecasting, and the general challenges associated with developing and using health forecasting services are discussed. This overview is a stimulus for further discussions on standardizing health forecasting approaches and methods that will facilitate health care and health services delivery.
doi:10.1007/s12199-012-0294-6
PMCID: PMC3541816  PMID: 22949173
Health forecasting; Principles; Prediction; Forecasting horizon; Health services
21.  Decreased activity of daily living produced by the combination of Alzheimer’s disease and lower limb fracture in elderly requiring nursing care 
Objectives
Alzheimer’s disease (AD) impairs cognitive functions, subsequently decreasing activity of daily living (ADL), and is frequently accompanied by lower limb fracture including hip fracture in the elderly. However, there have been few studies on what kinds of physical functions are affected or what degrees of dysfunction are produced by this combination. This study aims to clarify the relationship between decreased ADL and the combination of AD and lower limb fracture.
Methods
We examined present illness and ADL in 4340 elderly aged 82.8 ± 9.36 years [average ± standard deviation (SD)] requiring nursing care and compared ADL between elderly with and without AD or lower limb fracture treated with surgery or conservatively using analysis of covariance (ANCOVA), with age and sex as covariants.
Results
We recognized that activities of cognitive function (p < 0.001), eating (dysphagia) (p < 0.001), eating (feeding) (p < 0.001), and toilet use (p < 0.001) in the elderly with AD were significantly lower than in those without the disease, even after adjusting for sex and age. Activities of bed mobility (p < 0.05), transfer and locomotion (p < 0.001), and bathing (p < 0.05) in the elderly with a fracture treated with surgery were significantly lower, which differed from the results of AD. Significant interactions of AD and fracture treated with surgery on the ADL scores for bed mobility (p < 0.001), dysphagia (p < 0.01), feeding (p < 0.001), and toilet use (p < 0.05) show that the combination had a much more profound influence on the ADL scores than AD or fracture alone. We obtained almost the same results for fractures treated conservatively as for fractures treated with surgery.
Conclusions
These results demonstrated that the combined effects of AD and lower limb fracture were significantly greater than expected additive effects of AD and fracture, suggesting that the combination of AD and lower limb fracture has synergistic effects on almost all types of ADL except cognitive functions.
doi:10.1007/s12199-012-0283-9
PMCID: PMC3541818  PMID: 22576453
Alzheimer’s disease; Hip fracture; Elderly; Activity of daily living; Physical function
22.  Changes in mental health and quality of life with dental implants as evaluated by General Health Questionnaire (GHQ) and Health Utilities Index (HUI) 
Objectives
The purpose of this study was to assess and compare the improvement in oral and systemic conditions and health-related quality of life in patients with missing teeth receiving dental implants and conventional treatment.
Methods
A total of 97 patients with missing teeth, of whom 59 received dental implants and 38 received conventional treatment, were included in this study. The patients were divided into two age groups for a more detailed analysis: a 30- to 59-year age group (young) and a >60-year age group. The changes in oral condition, mental health, and health utility level before and after (pre- and post-, respectively) the procedures were assessed using an original questionnaire, the General Health Questionnaire 12 (GHQ12), and Health Utilities Index Mark 3.
Results
Responses to the GHQ12 indicated that treatment with implants significantly improved the oral health of patients in all treatment groups, except for the young group receiving partial dentures (PD). The mental state improved with a lower GHQ score; in terms of pre- versus post-procedure, mental state improved after the procedure in the young group receiving full dentures (FD) (1.75 ± 2.12 vs. 0.88 ± 2.10, p < 0.05), in the old group receiving PD (2.61 ± 3.91 vs. 0.72 ± 1.71, p < 0.05), and in the old group receiving FD (2.63 ± 3.12 vs. 0.44 ± 0.27, p < 0.05). The sleep score also improved by implant in FD of the old group (2.00 vs. 1.00, p < 0.05); it also is better with a lower score.
Conclusions
Recovery of oral function and oral stability in middle-aged people who did not receive implants was possible with PD. However, the results suggest that implant treatment in edentulous denture cases and particularly in elderly people with dentures has a certain efficacy on the physical condition mediated through an improvement in aspects of the mental state.
doi:10.1007/s12199-012-0275-9
PMCID: PMC3493630  PMID: 22528208
Dental implants; HRQOL (health-related quality of life); Japanese HUI3; Mental health; Oral health
23.  Factors influencing caregivers’ burden among family caregivers and institutionalization of in-home elderly people cared for by family caregivers 
Objectives
The purpose of this study was to determine the factors related to changes in the burden of caregivers who look after the elderly at home, as well as factors related to the institutionalization of the elderly who require care. The types of care services associated with reducing caregivers’ burden and continuing in-home care were also studied.
Methods
The study subjects were adults aged ≥65 years who used the services of in-home care management centres located in Osaka Prefecture, Japan, and their caregivers. This 2-year longitudinal study began in October 2007, with a total of three surveys undertaken once a year. The survey methods included self-administered questionnaires and the review of clinical records.
Results
Dementia and its accompanying behavioural disturbances were found to be significantly related to the increased burden of caregivers and the institutionalization of those requiring care. A significantly higher proportion of caregivers with an increasing burden or those who maintained a high level of burden used day care services compared to those in the other groups.
Conclusion
Preventive intervention against dementia and its accompanying behavioural disturbances should be considered in the day care service to reduce caregivers’ burden and to decrease institutionalization.
doi:10.1007/s12199-012-0276-8
PMCID: PMC3493627  PMID: 22454030
Caregiver; Caregiving; Elderly; Caregiver burden; Institutionalization
24.  Effect of laughter on salivary flow rates and levels of chromogranin A in young adults and elderly people 
Objectives
Salivary chromogranin A (CgA) levels and salivary flow rates were measured to evaluate the stress relief effect of laughter on the young and the elderly.
Methods
Thirty healthy volunteers (15 aged 20–25 years; 15 aged 62–83 years) performed a serial arithmetic task for 15 min and then watched a comedy video for 30 min. On a different day, as a control, they watched a non-humorous video after performing a task similar to the first one. Saliva samples were collected immediately before and after the arithmetic task, 30 min after completing the task (immediately after watching the film), and 30 min after watching the film (60 min after completing mental task). Salivary CgA levels were determined by enzyme-linked immunosorbent assay.
Results
In the elderly group, salivary flow rates, which had declined by the end of the arithmetic task, were statistically significantly higher after watching the comedy video. In the young group, salivary CgA levels, which had increased by the end of the task, had statistically significantly declined after watching the comedy video. No such post-task changes were apparent in control results; in the young group, there was a statistically significant interprotocol difference in salivary CgA levels.
Conclusions
These findings suggest that laughter may relieve stress, particularly in the young people.
doi:10.1007/s12199-012-0279-5
PMCID: PMC3493625  PMID: 22481535
Chromogranin A; Laughter; Salivary flow rates; Stress; The elderly
25.  Lack of an association human dioxin detoxification gene polymorphisms with endometriosis in Japanese women: results of a pilot study 
Objectives
Endometriosis is a chronic disease caused by the presence of endometrial tissue in ectopic locations outside the uterus. Chronic exposure to the environmental pollutant dioxin has been correlated with an increased incidence in the development of endometriosis in non-human primates. We have therefore examined whether there is an association between the polymorphisms of ten dioxin detoxification genes and endometriosis in Japanese women.
Methods
This was a pilot study in which 100 patients with endometriosis and 143 controls were enrolled. The prevalence of five microsatellite and 28 single nucleotide polymorphism markers within ten dioxin detoxification genes (AhR, AHRR, ARNT, CYP1A1, CYP2E1, EPHX1, GSTM1, GSTP1, GSTT1, NAT2) was examined.
Results
Taking into account that this analysis was a preliminary study due to its small sample size and genetic power, the results did not show any statistically significant difference between the cases and controls for any of the allele and genotype frequency distributions examined. In addition, no significant associations between the allele/genotype of all polymorphisms and the stage (I–II or III–IV) of endometriosis were observed.
Conclusion
Based on the findings of this pilot study, we conclude the polymorphisms of the ten dioxin detoxification genes analyzed did not contribute to the etiology of endometriosis among our patients.
Electronic supplementary material
The online version of this article (doi:10.1007/s12199-012-0281-y) contains supplementary material, which is available to authorized users.
doi:10.1007/s12199-012-0281-y
PMCID: PMC3493626  PMID: 22547312
Endometriosis; Dioxin detoxification genes; Single nucleotide polymorphisms; Microsatellite; Association study

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