Research Achievements - Original paper -
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A multicenter trial of extracorporeal cardiac shock wave therapy for refractory angina pectoris: report of the highly advanced medical treatment in Japan.
Yoku Kikuchi, Kenta Ito, Tomohiko Shindo, Kiyotaka Hao, Takashi Shiroto, Yasuharu Matsumoto, Jun Takahashi, Takao Matsubara, Akira Yamada, Yukio Ozaki, Michiaki Hiroe, Kazuo Misumi, Hideki Ota, Kentaro Takanami, Tomomichi Hiraide, Kei Takase, Fumiya Tanji, Yasutake Tomata, Ichiro Tsuji, Hiroaki Shimokawa
Heart and vessels 34 ( 1 ) 104 - 113 2019.01 [Refereed]
Research paper (journal)
We have previously demonstrated that cardiac shock wave therapy (CSWT) effectively improves myocardial ischemia through coronary neovascularization both in a porcine model of chronic myocardial ischemia and in patients with refractory angina pectoris (AP). In this study, we further addressed the efficacy and safety of CSWT in a single-arm multicenter study approved as a highly advanced medical treatment by the Japanese Ministry of Health, Labour and Welfare. Fifty patients with refractory AP [mean age 70.9 ± 12.6 (SD) years, M/F 38/12] without the indications of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) were enrolled in 4 institutes in Japan. Ischemic myocardial regions in the left ventricle (LV) were identified by drug-induced stress myocardial perfusion imaging (MPI). Shock waves (200 shots/spot at 0.09 mJ/mm2) were applied to 40-60 spots in the ischemic myocardium 3 times in the first week. The patients were followed up for 3 months thereafter. Forty-one patients underwent CSWT and completed the follow-up at 3 months. CSWT markedly improved weekly nitroglycerin use [from 3.5 (IQR 2 to 6) to 0 (IQR 0 to 1)] and the symptoms [Canadian Cardiovascular Society functional class score, from 2 (IQR 2 to 3) to 1 (IQR 1 to 2)] (both P < 0.001). CSWT also significantly improved 6-min walking distance (from 384 ± 91 to 435 ± 122 m, P < 0.05). There were no significant changes in LV ejection fraction evaluated by echocardiography and LV stroke volume evaluated by cardiac magnetic resonance imaging (from 56.3 ± 14.7 to 58.8 ± 12.8%, P = 0.10, and from 52.3 ± 17.4 to 55.6 ± 15.7 mL, P = 0.15, respectively). Percent myocardium ischemia assessed by drug-induced stress MPI tended to be improved only in the treated segments (from 16.0 ± 11.1 to 12.1 ± 16.2%, P = 0.06), although no change was noted in the whole LV. No procedural complications or adverse effects related to the CSWT were noted. These results of the multicenter trial further indicate that CSWT is a useful and safe non-invasive strategy for patients with refractory AP with no options of PCI or CABG.
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Nutritional characteristics of the Japanese diet: A cross-sectional study of the correlation between Japanese Diet Index and nutrient intake among community-based elderly Japanese.
Yasutake Tomata, Shu Zhang, Yu Kaiho, Fumiya Tanji, Yumi Sugawara, Ichiro Tsuji
Nutrition (Burbank, Los Angeles County, Calif.) 57 115 - 121 2019.01 [Refereed]
Research paper (journal)
OBJECTIVES: To our knowledge, the overall nutritional quality of the Japanese diet has not been assessed previously. The aim of this study was to investigate the relationship between adhering to a Japanese diet and nutrient intake. METHODS: We conducted a cross-sectional study of 1129 Japanese persons ≥70 y of age. Dietary habits were assessed using a food frequency questionnaire. The primary outcome was nutrient intake (12 components of NRF9.3 index). The overall nutrient adequacy (ONA) score was applied for assessing the potential of nutrient density. Correlation analysis was performed to compare the Japanese Diet Index (JDI) and nutrient intake, and multiple regression analysis was used to simulate the modified JDI (MJDI). RESULTS: The JDI was positively correlated with all nine beneficial nutrients, and negatively correlated with two nutrients (saturated fat and sugar). The JDI was significantly correlated with the ONA score (Spearman's coefficient = 0.248). The MJDI, which was defined by the coefficients for seven food items, was significantly correlated with the ONA score (Spearman's coefficient = 0.515). However, the JDI and MJDI were correlated with higher sodium intake. CONCLUSIONS: The present findings suggest that adhering to a Japanese diet defined by the JDI score is associated with better nutrient intake. However, this dietary pattern also appears to be associated with high sodium intake.
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Education level and incident functional disability in elderly Japanese: The Ohsaki Cohort 2006 study.
Dieta Nurrika, Shu Zhang, Yasutake Tomata, Yumi Sugawara, Fumiya Tanji, Ichiro Tsuji
PloS one 14 ( 3 ) e0213386 2019 [Refereed]
Research paper (journal)
As the factors that link education level with incident functional disability in elderly Japanese have never been investigated, the present study investigated this issue in an elderly Japanese population. A 9-year prospective cohort study (2006-2015) was conducted among 8,680 Japanese individuals (≥65 years), Ohsaki city, Japan. In a baseline survey, we collected data on education level and potential mediators. Data on incident functional disability were retrieved from the Long-term Care Insurance database. The Cox proportional hazards model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident functional disability by education level (below upper-secondary education (reference), and upper secondary education and above). Mediating effects were estimated using accelerated failure time model and a logistic regression model. During 9-year follow-up period, 2,742 cases (31.6%) of incident functional disability were observed, and education level showed an inverse association with functional disability (P for trend <0.01). Participation in community activities had the largest mediating effect (34.7%) on the relationship between education level and incident functional disability. This effect remained among those aged 65-74 years (19.9%) but became negligible among those aged ≥75 years. Other potential mediators (such as smoking and drinking status) were also tested, but these showed only small mediating effects. The inverse association between education level and the incident risk of functional disability appears to be largely mediated by participation in community activities among elderly Japanese, especially those aged 65-74 years.
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Dietary Inflammatory Index and Disability-Free Survival in Community-Dwelling Older Adults.
Yasutake Tomata, Nitin Shivappa, Shu Zhang, Dieta Nurrika, Fumiya Tanji, Yumi Sugawara, James R Hébert, Ichiro Tsuji
Nutrients 10 ( 12 ) 2018.12 [Refereed]
Research paper (journal)
Background: Previous studies have reported that a higher dietary inflammatory index (DII®) score is related to a higher risk of mortality and conditions that result in functional disability, such as cardiovascular disease, dementia, and fractures. Although these findings suggest that higher DII scores would affect disability-free survival, this has never been investigated directly. The present study investigated the association between the DII score and disability-free survival. Methods: We analyzed follow-up data covering a 12-year period for 793 older adults (≥70 years) participating in a Japanese community-based cohort study. DII scores were computed on the basis of dietary intake and assessed using the Brief Self-Administered Diet History Questionnaire. Data on incident functional disability were retrieved from the public Long-Term Care Insurance database. We applied the Cox model for estimating the adjusted hazard ratios (HRs) of the composite outcome (incident functional disability or death) according to DII score tertiles (T1⁻T3). Results: The proportion of men was 47.3%; mean (SD) age was 75.2 (4.5) years. The 12-year incidence of the composite outcome was 65.5%. A higher DII score was related to a higher risk for the composite outcome: HRs (95% confidence interval) were 1.05 (0.84, 1.32) for T2 and 1.26 (1.01, 1.57) for T3 (p-trend = 0.040) compared to the most anti-inflammatory T1 reference (HR = 1.00). Conclusions: These results suggest that a pro-inflammatory diet might be a modifiable factor affecting disability-free survival in the older population. Additional prospective studies are needed to confirm this relationship.
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Psychological distress and completed suicide in Japan: A comparison of the impact of moderate and severe psychological distress.
Fumiya Tanji, Yasutake Tomata, Shu Zhang, Tatsui Otsuka, Ichiro Tsuji
Preventive medicine 116 99 - 103 2018.11 [Refereed]
Research paper (journal)
It has already been established that severe psychological distress is a major risk factor for completed suicide. However, the impact (population attributable fraction; PAF) of moderate psychological distress on completed suicide has not been clarified. The present study investigated the association between various severities of psychological distress and completed suicide. We analyzed follow-up data covering a 7.3-year period (2006-2014) for 43,473 adults (aged ≥ 40 years) participating in a community-based, prospective cohort study. Psychological distress was measured using the K6 psychological distress scale at the baseline. Participants were classified into three groups according to their K6 score (low: 0-4; moderate: 5-12; severe: 13-24). Completed suicide was determined from a Japanese national database. The Cox model was used to estimate hazard ratios (HRs) for completed suicide. The PAFs of moderate and severe psychological distress for completed suicide were also estimated. The multivariate-adjusted HRs (95% confidence interval) for completed suicide were 2.37 (1.49-3.78) among participants with moderate psychological distress, and 4.16 (2.13-8.15) among those with severe psychological distress, relative to those with low psychological distress (P for trend < 0.001). The PAF of the moderate group for completed suicide was 26.8%, whereas that of the severe group was 10.9%. Not only severe but also moderate psychological distress was significantly associated with an increased risk of completed suicide. The PAF of moderate psychological distress for completed suicide was larger than that of severe psychological distress. Public health actions for suicide prevention should focus on moderate as well as severe psychological distress.
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The Impact of Psychological Distress on Incident Functional Disability in Elderly Japanese: The Ohsaki Cohort 2006 Study.
Yasutake Tomata, Takashi Watanabe, Fumiya Tanji, Shu Zhang, Yumi Sugawara, Ichiro Tsuji
International journal of environmental research and public health 15 ( 11 ) 2018.11 [Refereed]
Research paper (journal)
Background: Although psychological distress is known to be a risk factor for death, there are relatively few data on the impact of psychological distress on incident functional disability in older adults. The aim of this study was to examine the impact of psychological distress on incident functional disability in older adults. Methods: We conducted a cohort study of 12,365 disability-free individuals aged ≥65 years who live in Ohsaki City, Japan. In 2006, the level of psychological distress was assessed using the K6 (range: 0⁻24 points). Data on 10-year functional disability were retrieved from the public Long-term Care Insurance database. The multivariate-adjusted hazard ratios (HRs) and population attributable fractions (PAFs) according to the K6 groups (<5, 5⁻9, 10⁻12, and ≥13 points) were estimated. Results: Among 94,636 person-years, incident functional disability occurred in 4533 persons (36.7%). Significantly higher risk was observed in higher K6 score groups. The multiple-adjusted HRs (95% CIs) of incident functional disability were 1.14 (1.06⁻1.22) for 5⁻9 points, 1.28 (1.15⁻1.43) for 10⁻12 points, and 1.62 (1.44⁻1.84) for ≥13 points, in comparison with <5 points (p-trend < 0.001). The PAFs in each of the K6 score groups were 3.0% for 5⁻9 points, 1.7% for 10⁻12 points, and 2.6% for ≥13 points. Conclusions: Even when mild to moderate, psychological distress had a considerable impact on incident functional disability in this cohort.
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Influence of subjective economic hardship on new onset of neck pain (so-called: katakori) in the chronic phase of the Great East Japan Earthquake: A prospective cohort study.
Takuya Sekiguchi, Yoshihiro Hagiwara, Yumi Sugawara, Yasutake Tomata, Fumiya Tanji, Takashi Watanabe, Yutaka Yabe, Masashi Koide, Nobuyuki Itaya, Eiji Itoi, Ichiro Tsuji
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 23 ( 5 ) 758 - 764 2018.09 [Refereed]
Research paper (journal)
BACKGROUND: Studies have suggested that musculoskeletal symptoms increase after natural disasters. The Great East Japan Earthquake (GEJE) and accompanying tsunami placed a huge financial burden on the local population. This study determined whether subjective economic hardship influenced the new onset of neck pain (katakori) in the chronic phase after the GEJE. METHODS: This study used longitudinal data from 1359 adults who had responded to the self-report questionnaire at 2 and 3 years after the GEJE. New-onset neck pain was defined as neck pain absent at 2 years and present at 3 years. Subjective economic hardship at 2 years after the GEJE was categorized into 4 groups: "normal," "a little bit hard," "hard," and "very hard." Multiple logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) in order to examine the association between subjective economic hardship and new-onset neck pain. RESULTS: Among the participants, 12.9% (n = 175) reported new-onset neck pain. A significantly higher rate of new-onset neck pain was observed in participants who considered their subjective economic hardship to be "hard" (OR = 2.10, 95% CI = 1.34-3.30) or "very hard" (OR = 3.26, 95% CI = 1.83-5.46; p for trend <0.001) compared with those who considered their hardship to be "normal." CONCLUSIONS: Subjective economic hardship was significantly associated with new-onset neck pain in the chronic phase of the GEJE. (228/300).
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Association between social participation and incident risk of functional disability in elderly Japanese: The Ohsaki Cohort 2006.
Tatsui Otsuka, Yasutake Tomata, Shu Zhang, Kemmyo Sugiyama, Fumiya Tanji, Yumi Sugawara, Ichiro Tsuji
Journal of psychosomatic research 111 36 - 41 2018.08 [Refereed]
Research paper (journal)
BACKGROUND: Although several longitudinal studies have examined the relationship between social participation and incident functional disability, the related mechanisms have remained unclear. The aim of this study was to examine the mechanisms linking social participation to incident functional disability. METHODS: We analyzed follow-up data for 11,992 older adults (≥65 years) participating in a community-based, prospective cohort study covering a 9-year period. At the baseline, the subjects were asked about three types of participation in community activities (volunteering, hobbies, and neighborhood associations) and the frequency of their participation. Data on incident functional disability were retrieved from the public Long-term Care Insurance database. The Cox model was used to estimate the multivariate-adjusted hazard ratios of incident functional disability. We then conducted mediation analysis to assess the magnitude of the mediating effect. RESULTS: Among 84,760 person-years of follow-up, there were 3,984 cases of incident functional disability. The hazard ratio was 0.79 (95% CI: 0.73-0.86) for participating in one type of activity, 0.82 (95% CI: 0.74-0.90) for two types of activity and 0.70 (95% CI: 0.64-0.77) for three types of activity in comparison with no participation in any activity. Among the estimated mediating effects, cognitive activity accounted for 9.3%, time spent walking for 8.3%, psychological state for 4.6%, and social support for 2.8% of the reduced risk of incident functional disability. CONCLUSION: The results of this population-based cohort study indicate that cognitive activity and time spent walking are important mechanisms linking social participation to incident functional disability.
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Period of residence in prefabricated temporary housing and psychological distress after the Great East Japan Earthquake: a longitudinal study.
Fumiya Tanji, Yasutake Tomata, Takuya Sekiguchi, Ichiro Tsuji
BMJ open 8 ( 5 ) e018211 2018.05 [Refereed]
Research paper (journal)
OBJECTIVES: Previous studies have reported that displacement from one's own home after a natural disaster is associated with a higher degree of psychological distress. The present study investigated the longitudinal association between the period of residence in prefabricated temporary housing and psychological distress after the Great East Japan Earthquake. DESIGN, SETTING AND PARTICIPANTS: We conducted a longitudinal observation of 284 adults (aged ≥18 years) who had lived in prefabricated temporary housing in Miyagi, Northeastern Japan. The period of residence in prefabricated temporary housing was classified into three categories: <3, 3-4 and >4 years (ie, still living in prefabricated temporary housing). OUTCOMES: The Kessler 6-item Psychological Distress Scale (K6) was assessed in both a baseline survey (2011) and a follow-up survey (2016). Higher psychological distress was defined by a K6 score of ≥5. We used Firth's penalised likelihood method in the multivariate logistic regression model to estimate the adjusted ORs and 95% CIs. RESULTS: Among the total participants, the proportion of individuals with higher psychological distress at the follow-up survey was significantly higher in the >4 years category (multivariate OR=4.00, 95% CI 1.67 to 10.16) than in the <3 years category. Among participants who had a lower degree of psychological distress at the baseline, the proportion of those whose psychological distress deteriorated was significantly higher in the >4 years category (multivariate OR=4.87, 95% CI 1.26 to 20.28) than in the <3 years category. On the other hand, among the participants who had a higher degree of psychological distress at the baseline, the proportion of those whose psychological distress ameliorated was significantly lower in the >4 years category (multivariate OR=0.26, 95% CI 0.06 to 0.85) than in the <3 years category. CONCLUSIONS: The proportion of individuals with more severe psychological distress was higher among participants who had lived in prefabricated temporary housing for a long period.
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Psychological distress and the incident risk of functional disability in elderly survivors after the Great East Japan Earthquake
Fumiya Tanji, Yumi Sugawara, Yasutake Tomata, Takashi Watanabe, Kemmyo Sugiyama, Yu Kaiho, Hiroaki Tomita, Ichiro Tsuji
JOURNAL OF AFFECTIVE DISORDERS ( ELSEVIER SCIENCE BV ) 221 145 - 150 2017.10 [Refereed]
Research paper (journal)
Background: We conducted a prospective cohort study to investigate whether psychological distress would have increased the incident risk of functional disability after the 2011 Great East Japan Earthquake.
Methods: First phase data pertaining to psychological distress and other lifestyle factors were collected from 1037 subjects aged >= 65 years, from June to December 2011, in four affected areas of Miyagi prefecture in Japan. Psychological distress was measured by the Kessler 6-item psychological distress scale (K6), and classified into three categories (K6 score <= 9, 10-12, >= 13). Outcome data on functional disability were collected from the public Long-term Care Insurance database. Participants were followed up for about 2.6 years. The Cox model was used to calculate the multivariate hazard ratios (HRs) and 95% confidence intervals (CIs).
Results: During the follow-up period, 118 participants were certified as incident disability (43.8 disability events per 1000 person-years). Compared with the lowest category (K6 score <= 9), participants in the highest category (K6 score >= 13) had a significantly higher risk of functional disability (HR = 2.65, 95% CI = 1.35-5.18, p = 0.002). In order to consider reverse causality, we conducted analysis excluding all incidents and deaths that occurred within the first year of follow-up, but our findings remained unchanged.
Limitations: We did not consider all potential confounders and use of appropriate medication.
Conclusions: The present study has demonstrated that psychological distress was associated with an increased risk of functional disability among elderly survivors of a natural disaster. -
Association between housing type and γ-GTP increase after the Great East Japan Earthquake.
Murakami A, Sugawara Y, Tomata Y, Sugiyama K, Kaiho Y, Tanji F, Tsuji I
Social science & medicine (1982) ( PERGAMON-ELSEVIER SCIENCE LTD ) 189 76 - 85 2017.09 [Refereed]
Research paper (journal)
Background: It has been reported that alcohol consumption increases after natural disasters, with an impact on health. However, the impact of relocation upon drinking behavior has been unclear. The aim of this study was to clarify the association between housing type and the impact of alcohol consumption on health after the Great East Japan Earthquake (GEJE) of 2011.
Methods: We analyzed 569 residents living in devastated areas of Ishinomaki city, who had undergone assessment of their gamma-GTP levels at health check-ups in both 2010 and 2013, and had given details of the type of housing they occupied in 2013. The housing types were categorized into five groups: "same housing as that before the GEJE", "prefabricated temporary housing", "privately rented temporary housing/rental housing", "homes of relatives", and "reconstructed housing". We used fixed-effect regression analysis to examine the association between housing type after the GEJE and changes in gamma-GTP after adjustment for age, BMI, housing damage, number of people in household, smoking status, presence of illness, psychological distress, and social network.
Results: The mean age of the participants was 71.5 years and 46.2% of them were men. The proportion of individuals who drank heavily, and suffered from psychological distress and insomnia, was highest among those living in privately rented temporary housing/rental housing. Compared with individuals who continued to occupy the same housing as those before the GEJE, the effect of change in gamma-GTP was significantly higher in individuals who had moved to privately rented temporary housing/rental housing (b = 9.5, SE = 4.4, p < 0.05).
Conclusion: Our present findings reveal that disaster victims who have moved to privately rented temporary housing/rental housing are at highest risk of negative health effects due to alcohol drinking. (C) 2017 The Authors. Published by Elsevier Ltd. -
Sense of life worth living (ikigai) and incident functional disability in elderly Japanese: The Tsurugaya Project
Kentaro Mori, Yu Kaiho, Yasutake Tomata, Mamoru Narita, Fumiya Tanji, Kemmyo Sugiyama, Yumi Sugawara, Ichiro Tsuji
JOURNAL OF PSYCHOSOMATIC RESEARCH ( PERGAMON-ELSEVIER SCIENCE LTD ) 95 62 - 67 2017.04 [Refereed]
Research paper (journal)
Objective: To test the hypothesis that elderly persons who feel ikigai (a sense of life worth living) have a lower risk of incident functional disability than those who do not. Recent studies have suggested that ikigai impacts on mortality. However, its impact upon disability is unknown. The aim of the present study was to investigate the association between ikigai and incident functional disability among elderly persons.
Methods: We conducted a prospective cohort study of 830 Japanese elderly persons aged >= 70 years as a comprehensive geriatric assessment in 2003. Information on ikigai was collected by self-reported questionnaire. Data on functional disability were retrieved from the public Long-term Care Insurance database in which participants were followed up for 12 years. Hazard ratios (HRs) and 95% confidence intervals (Cls) for incidence of functional disability were calculated for three groups delineated according to the presence of ikigai ("no", "uncertain" or "yes") using the Cox proportional hazards regression model.
Results: The 12-year incidence of functional disability was 533% (442 cases). As compared with the "no" group, the multiple-adjusted HR (95% CI) of incident functional disability was 0.61 (0.36-1.02) for the "uncertain" group and 0.50 (030-0.84) for the "yes" group.
Conclusion: A stronger degree of ikigai is significantly associated with a lower risk of incident functional disability. (C) 2017 Elsevier Inc. All rights reserved.