Research Achievements - Original paper -

Moderating role of alcohol tolerance in the association between excessive drinking and psychological distress: a cross-sectional study among agricultural workers in Japan.

Syohei Miyamoto, Fumiya Tanji, Suguru Iwano, Atushi Iwasawa, Hidenobu Ohta, Kyoichi Ono

BMC public health   25 ( 1 ) 2765 - 2765   2025.08  [Refereed]

Research paper (journal)  

BACKGROUND: Excessive drinking is a known risk factor for psychological distress; however, the role of alcohol tolerance in this relationship remains unclear. This study examined the association between excessive drinking and psychological distress among agricultural workers in Japan by focusing on the potential moderating effect of alcohol tolerance. METHODS: A cross-sectional questionnaire survey was conducted among agricultural workers in City A, Akita Prefecture, Japan, between November 2024 and January 2025. Excessive drinking was defined as an alcohol use disorders identification test score ≥ 15, and psychological distress was assessed using the Kessler 6 scale (cut-off ≥ 13). Alcohol tolerance was determined based on self-reported facial flushing. Multivariate logistic regression analysis was performed to examine associations after adjusting for confounders. Stratified analyses were conducted to assess differences based on alcohol tolerance. RESULTS: Among the 169 participants, 15 (8.8%) reported psychological distress. Excessive drinking was significantly associated with psychological distress (odds ratio [OR] 6.41, 95% confidence interval [CI] 1.62-25.28, p < 0.001). Stratified analysis showed a significant association only among individuals with alcohol tolerance (OR 28.66, 95% CI 3.26-251.89, p < 0.001), whereas no significant association was observed among those without alcohol tolerance (OR 0.88, 95% CI 0.09-8.54, p = 0.91). CONCLUSIONS: Alcohol tolerance moderated the relationship between excessive drinking and psychological distress. These findings suggest that alcohol tolerance may be an important factor to consider when examining this association.

DOI PubMed

Uneven Impact of Andropause Symptoms on Daily Life Domains in Employed Men: A Cross-Sectional Study.

Fumiya Tanji, Maiko Kawajiri, Hirohito Nanbu, Daisaku Nishimoto

Journal of occupational health     2025.07  [Refereed]

Research paper (journal)  

OBJECTIVES: This study examined the extent to which the severity of andropause symptoms affects daily functioning, specifically in work, housework, outings, social relationships, and leisure activities, among employed Japanese men. METHODS: A cross-sectional internet-based survey was conducted in September 2024. Participants (N = 1,054), aged 20-69 years, completed the Aging Males' Symptoms scale to evaluate symptom severity. Impacts on daily life were assessed using a four-point scale. Multivariate logistic regression analyses estimated odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: After adjusting for relevant covariates, moderate and severe symptoms were significantly associated with greater difficulties in daily life. Compared to individuals with very mild symptoms, those with moderate symptoms had higher ORs for severe difficulties in work (OR = 7.2, 95% CI: 2.9-18.0), social relationships (OR = 17.7, 95% CI: 4.0-78.4), and housework (OR = 3.2, 95% CI: 1.2-9.0). Associations were stronger for severe symptoms: work (OR = 21.1, 95% CI: 8.0-55.5), social relationships (OR = 37.2, 95% CI: 7.9-174.3), and housework (OR = 8.5, 95% CI: 2.9-24.4). Severe symptoms were also linked to significant difficulties in outings (OR = 4.7, 95% CI: 1.8-12.4) and leisure (OR = 8.2, 95% CI: 3.0-22.5). CONCLUSIONS: Andropause symptoms significantly affect multiple areas of daily life, particularly work, social engagement, and household tasks. These findings underscore the importance of early recognition and intervention.

DOI PubMed

Factors Influencing Healthcare-Seeking Behavior for Late-Onset Hypogonadism (LOH) Syndrome in Aging Men (The J-MARS Study)

Hirohito Nanbu, Fumiya Tanji, Maiko Kawajiri, Daisaku Nishimoto

Journal of Japan Academy of Nursing Science   45   99 - 109   2025.06  [Refereed]

Research paper (journal)  

DOI

The association between loneliness, suicidal ideation, and psychological distress considering family compositions: a cross-sectional study in a Japanese rural area

Atsushi Iwasawa, Fumiya Tanji, Syohei Miyamoto, Kyoko Nomura

Scientific Reports ( Springer Science and Business Media LLC )  15 ( 1 )   2025.04  [Refereed]

Research paper (journal)  

DOI

Psychosocial Factors and Andropause Symptoms Among Japanese Men: An Internet-Based Cross-Sectional Study.

Fumiya Tanji, Hirohito Nanbu, Daisaku Nishimoto, Maiko Kawajiri

American journal of men's health   19 ( 1 ) 15579883241312836 - 15579883241312836   2025  [Refereed]

Research paper (journal)  

This study aimed to investigate the relationship between psychosocial factors and andropause symptoms among Japanese men in an internet-based cross-sectional study. We conducted an internet-based cross-sectional study in 2024, named Japanese Men's health and Andropause Related Symptoms (J-MARS) study. Data on demographics, medical history, andropause symptoms, lifestyles (physical activity, insomnia, height, weight, and smoking and drinking habits), and psychological distress were collected from 1,489 men aged 20-69 years who participated in the J-MARS study. Andropause symptoms were measured using the Aging Males' Symptoms (AMS) rating scale, which was included in the analysis. We conducted a multivariate logistic regression analysis, and estimated odds ratios and 95% confidence intervals to examine the associated factors with severe andropause symptoms. Severe andropause symptoms according to the AMS score were noted in 125 men (8.4%). Severe andropause symptoms were associated with former smoking, current smoking, strength training (≥1.0 hr/day), probable insomnia, moderate psychological distress, and severe psychological distress. After excluding 289 participants with cardiovascular disease, cerebrovascular disease, cancer, or depression, severe andropause symptoms were associated with age, absence of a spouse, and suspected insomnia in addition to the above factors. Age, insomnia, and psychological distress were also significantly associated with all AMS subdomains (somatic, psychological, and sexual symptoms). Psychological stress, insomnia, and smoking habits are strongly associated with severe andropause symptoms. These findings may be useful for the prevention of andropause and for patient education.

DOI PubMed

Association of Suicidal Ideation With Physical Health Conditions, Mental Health Conditions, and Multimorbidity and the Modifying Role of Emotional Social Support: A Cross-Sectional Study in Japan

Fumiya Tanji, Atsushi Iwasawa

Journal of Primary Care & Community Health   15   1 - 8   2024.09  [Refereed]

Research paper (journal)  

INTRODUCTION: It is unclear whether the risk of suicide differs among individuals with only physical health condition, those with only mental health conditions, and those with both types of conditions (multimorbidity) and how emotional social support modifies these associations. This study aimed to examine differences in the association of suicidal ideation with the presence of only physical health conditions, only mental health conditions, and multimorbidity and the modifying role of emotional social support in these associations. METHODS: A cross-sectional survey was conducted between August and September 2023 in a Japanese rural town to collect data. The exposure variable was the health condition, and it was classified into 4 groups: disease-free, only physical health conditions, only mental health conditions, and multimorbidity. The outcome variable was suicidal ideation. The data collected were analyzed using multivariate logistic regression analysis and stratified analysis. RESULTS: Suicidal ideation was found to have a significant positive association with the presence of only mental health conditions and multimorbidity. These associations remained unchanged in the absence of emotional social support. However, the odds ratio for the only mental health conditions group decreased in the presence of emotional social support, while the odds ratio for the multimorbidity group remained significantly higher. CONCLUSIONS: Suicidal ideation is positively associated with the presence of only mental health conditions and multimorbidity, but emotional social support modifies only the association between suicidal ideation and the presence of only mental health conditions. These results suggest that it may be important to identify the type of social support one needs based on one's health condition to prevent suicide.

DOI PubMed

Association Between History of Psychiatric Disorder and Degree of Physical Injury Among Suicide Attempters: Secondary Data Analysis in a Japanese Rural Area

Fumiya Tanji, Syohei Miyamoto, Atsushi Iwasawa, Hidenobu Ohta, Kyoichi Ono

Journal of Primary Care &amp; Community Health ( SAGE Publications )  14   2023.11  [Refereed]

Research paper (journal)  

Introduction:

While there may be differences in the choice of suicide methods between attempters with and those without a history of psychiatric disorders, it is not clear whether these differences predict the actual degree of physical injury. The present study aimed to investigate the association between the history of psychiatric disorder and the degree of physical injury among suicide attempters in a Japanese rural area.

Methods:

We conducted a cross-sectional study analyzing secondary data of 806 suicide attempters from April 2012 to March 2022 obtained from a Japanese rural city. The exposure variable was a history of psychiatric disorders. The primary outcome was the degree of physical injury of suicide attempters: moderate and severe. We conducted a multivariate Poisson regression analysis to estimate the prevalence ratios (PRs) and 95% confidence intervals (CIs).

Results:

Among 806 suicide attempters, a significant negative association between the history of psychiatric disorder and the degree of physical injury was observed (PR = 0.40; 95% CI, 0.28-0.59). Those with and without psychiatric disorders were more likely to choose low- and severe-lethality suicide methods such as drug or psychotropic overdoses and hanging or deep wrist injuries, respectively ( P &lt; .001).

Conclusions:

The present study highlights the importance of considering suicide attempters, both with and without psychiatric disorders, while formulating targeted suicide prevention strategies.

DOI

The association between resilience and academic performance among nursing students: a cross-sectional study in Japan.

Fumiya Tanji, Hirohito Nanbu, Mayuko Ono, Noriko Abe, Junko Nitta

Journal of rural medicine : JRM   16 ( 4 ) 206 - 213   2021.10  [Refereed]

Research paper (journal)  

Objective: Medical science students, especially nursing students, are more likely to experience academic stress; therefore, resilience helps them focus on their lessons attentively. However, the results of a few existing studies regarding how resilience impacts the academic performance of medical science students are incongruent. This study aimed to investigate whether resilience impacts the academic performance of Japanese nursing students. Methods: We conducted a cross-sectional, self-administered questionnaire survey from September to November 2020. A total of 229 undergraduate nursing students participated in this study; here, resilience was measured using the Bidimensional Resilience Scale, which includes innate factors (optimism, control, sociability, and vitality) and acquired factors (problem-solving, self-understanding, and understanding others). Academic performance was measured using the functional grade point average (f-GPA). Covariates were demographics, pre-entry academic performance levels, medical history, time spent walking, psychological distress, subjective economic status, and part-time jobs. Multivariate regression analyses were performed. Results: Among the 229 participants, the f-GPA mean (standard deviation) was 2.93 (0.46). Only vitality was significantly associated with a higher f-GPA after multiple imputations (β = 0.06; 95% confidence interval = 0.03-0.09; P<0.01). The Poisson regression analysis of 212 participants with all data indicated that vitality was associated with the fourth quartile f-GPA (prevalence ratio, 1.05; 95% confidence interval, 1.03-1.08; P<0.01). Conclusion: There was a significant association between the vitality of resilience components and academic performance among Japanese nursing students. This study suggests that an approach that develops resilience is necessary for the academic success of nursing students.

DOI PubMed

Smoking status and unruptured intracranial aneurysm among brain health check-up examinees: a cross-sectional study in Japan.

Fumiya Tanji, Hirohito Nanbu, Susumu Fushimi, Kenichi Shibata, Rui Kondo

Journal of rural medicine : JRM ( Japanese Association of Rural Medicine )  15 ( 4 ) 183 - 188   2020.10  [Refereed]

Research paper (journal)  

Objective: Although it is well known that smoking is a risk factor for subarachnoid hemorrhage, the association between smoking and unruptured intracranial aneurysms remains unclear. The aim of the present study was to investigate whether smoking status was associated with unruptured intracranial aneurysms among Japanese brain health check-up examinees. Materials and Methods: We conducted a cross-sectional study of 1,496 adults (aged 26-90 years) undergoing brain health check-ups at a single community medical support hospital in Akita, Japan between 2009 and 2013. In Japan, people can discretionarily undergo a brain health check-up for early detection of unruptured intracranial aneurysms or subarachnoid hemorrhages. Participants responded to a questionnaire on lifestyle, such as smoking status, and were classified into three groups: never, former, and current smoker. The evaluation of unruptured intracranial aneurysms detected by magnetic resonance angiography was performed by an expert physician. Multiple logistic regression models were used to estimate the odds ratio for unruptured intracranial aneurysms. We performed statistical analyses by age, sex, and family history of stroke. Results: The number of participants with unruptured intracranial aneurysms was 43 (2.9%). The mean age (standard deviation) and proportion of males was 55.8 (9.5) years and 53.3%, respectively. The adjusted odds ratios (95% confidence intervals) for unruptured intracranial aneurysms of 1.21 (0.48-3.08) among former smokers and 2.88 (1.10-7.50) among current smokers were compared to those of never smokers (p-trend = 0.041). After stratifying by age, sex, and family history of stroke, no interactions were found. Conclusion: This cross-sectional study conducted in Japan showed that smoking was positively associated with unruptured intracranial aneurysms among brain health check-up examinees.

DOI PubMed

Association between improved adherence to the Japanese diet and incident functional disability in older people: The Ohsaki Cohort 2006 Study.

Sanae Matsuyama, Shu Zhang, Yasutake Tomata, Saho Abe, Fumiya Tanji, Yumi Sugawara, Ichiro Tsuji

Clinical nutrition (Edinburgh, Scotland)   39 ( 7 ) 2238 - 2245   2020.07  [Refereed]

Research paper (journal)  

BACKGROUND & AIMS: Although it has been reported that the Japanese dietary pattern is associated with a lower risk of incident functional disability among older people, the potential benefits of improving adherence to the Japanese diet remain unclear. The aim of the present study was to evaluate the association between 12-year change in adherence to the Japanese diet and the subsequent risk of incident functional disability in older people in Japan. METHODS: We analyzed 10-year follow-up data from a cohort study of 2923 Japanese older adults (age ≥65 years) in 2006. We collected dietary information using a validated 39-item food frequency questionnaire at two time points (1994 and 2006). Adherence to the Japanese diet (high intake of rice, miso soup, seaweeds, pickles, green and yellow vegetables, fish, green tea; low intake of beef and pork, and coffee) was assessed using the Japanese Diet Index (JDI), which ranges from 0 to 9. Participants were categorized into five groups according to changes in the JDI score at these two time points. Data on incident functional disability from December 2006 to November 2016 were retrieved from the public 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. RESULTS: During 22,466 person-years of follow-up, 1093 cases of incident functional disability were documented. Compared with participants in the group with the largest decrease in the JDI score (≤-2), the multivariate-adjusted HR (95% CI) of incident functional disability was 0.77 (0.61-0.98) for those in the largest increase group (≥+2). CONCLUSIONS: Improved adherence to the Japanese diet was associated with a significantly lower risk of incident functional disability in older people in Japan.

DOI PubMed

Contribution of systemic inflammation and nutritional status to the relationship between tooth loss and mortality in a community-dwelling older Japanese population: a mediation analysis of data from the Tsurugaya project.

Takako Hiratsuka, Takamasa Komiyama, Takashi Ohi, Fumiya Tanji, Yasutake Tomata, Ichiro Tsuji, Makoto Watanabe, Yoshinori Hattori

Clinical oral investigations   24 ( 6 ) 2071 - 2077   2020.06  [Refereed]

Research paper (journal)  

OBJECTIVES: To assess whether systemic inflammation and nutritional status contribute to a relationship between tooth loss and mortality in community-dwelling older Japanese individuals using mediation analyses. MATERIALS AND METHODS: This longitudinal study targeted community-dwelling older Japanese individuals (N = 891). The exposure variable was the number of teeth (edentulous, 1-9, 10-19, ≥ 20), while the outcome was all-cause mortality from 2003 to 2016. Nutritional status and systemic inflammation were evaluated as mediators and based on serum albumin and high-sensitivity C-reactive protein levels, respectively. Covariates included age, sex, smoking, alcohol consumption, medical history, educational level, depressive symptoms, cognitive impairment, and physical function. The Cox proportional hazards model was applied to calculate hazard ratios (HRs) for the association between tooth loss and mortality and the contributions of systemic inflammation and nutritional status to this association. RESULTS: Edentulous participants (HR, 1.84; 95 % confidence interval [CI], 1.30-2.59) and those with 1-9 teeth (HR, 1.75; 95% CI, 1.28-2.40) groups exhibited a significantly higher risk of mortality than did those with ≥ 20 teeth. Mediation analyses showed that nutritional status contributed to the association between tooth loss and mortality in participants with 1-9 teeth, whereas systemic inflammation played no role in this association. CONCLUSIONS: Nutritional status may contribute to the association between tooth loss and mortality in community-dwelling older Japanese individuals with fewer remaining teeth. CLINICAL RELEVANCE: The data from this prospective cohort study help in elucidating parts of the biological mechanism underlying tooth loss and all-cause mortality in older individuals.

DOI PubMed

Dental Status is Associated With Incident Functional Disability in Community-Dwelling Older Japanese: A Prospective Cohort Study Using Propensity Score Matching.

Takamasa Komiyama, Takashi Ohi, Yasutake Tomata, Fumiya Tanji, Ichiro Tsuji, Makoto Watanabe, Yoshinori Hattori

Journal of epidemiology   30 ( 2 ) 84 - 90   2020.02  [Refereed]

Research paper (journal)  

BACKGROUND: A growing number of epidemiology studies have shown that poor oral health is associated with an increased incidence of functional disability. However, there are few studies in which the confounding bias is adjusted appropriately. In this study, we examined whether dental status is associated with functional disability in elderly Japanese using a 13-year prospective cohort study after elimination of confounding factors with propensity score matching. METHODS: Participants were community-dwelling Japanese aged 70 years or older who lived in the Tsurugaya district of Sendai (n = 838). The number of remaining teeth (over 20 teeth vs 0-19 teeth) was defined as the exposure variable. The outcome was the incidence of functional disability, defined as the first certification of long-term care insurance (LTCI) in Japan. The variables that were used to determine propensity score matching were age, sex, body mass index (BMI), medical history (stroke, hypertension, myocardial infarction, cancer, and diabetes), smoking, alcohol consumption, educational attainment, depression symptoms, cognitive impairment, physical function, social support, and marital status. RESULTS: As a result of the propensity score matching, 574 participants were selected. Participants with 0-19 teeth were more likely to develop functional disability than those with 20 or more teeth (hazard ratio 1.33; 95% confidence interval, 1.01-1.75). CONCLUSIONS: In this prospective cohort study targeting community-dwelling older adults in Japan, having less than 20 teeth was confirmed to be an independent risk factor for functional disability even after conducting propensity score matching. This study supports previous publications showing that oral health is associated with functional disability.

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The relationship between body mass index and disability-free survival in elderly Japanese: the Ohsaki Cohort 2006 Study.

Shu Zhang, Yasutake Tomata, Fumiya Tanji, Yumi Sugawara, Ichiro Tsuji

International journal of obesity (2005)   43 ( 11 ) 2254 - 2263   2019.11  [Refereed]

Research paper (journal)  

BACKGROUND: The relationship between body mass index (BMI) and disability-free survival (DFS) remains unclear. METHODS: We conducted a 10-year prospective cohort study of 12,666 Japanese individuals aged ≥ 65 y. Information on BMI and lifestyle factors was collected via a questionnaire in 2006. Functional disability data were retrieved from the public Long-term Care Insurance database. Subjects were divided into seven groups according to BMI (<19, 19-21, 21-23, 23-25, 25-27, 27-29 and ≥29). Fiftieth percentile differences (PDs) and 95% confidence intervals (CIs) in the DFS period (differences of period until the first 50% of the composite outcome (disability or death) occurred in each of the BMI groups) were calculated using the Laplace regression model. RESULTS: There was a U-shaped relationship between BMI and the risk of incident composite outcome, with a BMI nadir of 25-27. Based on BMI 25-27 as a reference, the 50th PDs (95% CIs) (in months) in age at disability or death (median DFS) were -20.8 (-26.4, -15.2) (P < 0.001) months for BMI <19, -13.5 (-18.2, -8.7) (P < 0.001) months for BMI 19-21, -9.8 (-14.2, -5.4) (P < 0.001) months for BMI 21-23, -2.9 (-7.5, 1.7) (P = 0.21) months for BMI 23-25, -2.7 (-8.4, 2.9) (P = 0.34) months for BMI 27-29, and -11.5 (-19.6, -3.5) (P = 0.005) months for BMI ≥ 29. These relationships did not differ by sex. CONCLUSION: Older individuals with a BMI of <23 or ≥29 have a significantly shorter DFS period than those with a BMI of 25-27. It is suggested that the optimal BMI range for maximization of disability-free life expectancy in the elderly population is 23-29.

DOI PubMed

Combined Healthy Lifestyle Behaviors and Disability-Free Survival: the Ohsaki Cohort 2006 Study.

Shu Zhang, Yasutake Tomata, Andrea Discacciati, Tatsui Otsuka, Yumi Sugawara, Fumiya Tanji, Ichiro Tsuji

Journal of general internal medicine   34 ( 9 ) 1724 - 1729   2019.09  [Refereed]

Research paper (journal)  

BACKGROUND: Previous studies have suggested that a healthy lifestyle (HL) may prolong the years of life spent in good health. However, the impact of HL on disability-free survival (DFS) among the elderly is still uncertain. OBJECTIVE: To investigate the relationship between HL and DFS in the general elderly population. DESIGN: Prospective cohort study with a 10-year follow-up (2006-2016). PARTICIPANTS: 9910 community-dwelling elderly people (≥ 65 years). MAIN MEASURES: A HL index derived by summing the number of HL behaviors. Data on incident disability were retrieved from the public Long-term Care Insurance database. Multivariate-adjusted 50th percentile differences (PDs) in age at disability or death (months) and their 95% CIs were estimated with the Laplace regression model. KEY RESULTS: During the 10 years, 4562 disability or death events occurred. Participants who adhered to all three HL behaviors lived 17.1 (95% CI 12.7, 21.5) months longer without disability than those who adhered to zero or one. Each 1-point increase of the index score conferred 8.8 months additional life without disability. The tendency for the 50th PDs to increase with a higher HL index score did not differ according to age (< 75 or ≥ 75 years), sex, or the presence of chronic conditions (none, or ≥ 1 chronic condition). CONCLUSIONS: A combination of HL behaviors may substantially increase DFS, even for late-elderly (≥ 75 years), or elderly people with chronic conditions.

DOI PubMed

The association between emotional and instrumental social support and risk of suicide death: A population-based cohort study.

Tatsui Otsuka, Yasutake Tomata, Shu Zhang, Fumiya Tanji, Yumi Sugawara, Ichiro Tsuji

Journal of psychiatric research   114   141 - 146   2019.07  [Refereed]

Research paper (journal)  

Suicide is an important public health issue and previous studies have suggested that social support can one preventive factor. However, the association between emotional and instrumental social support and suicide death has not been investigated in detail. The purpose of this study was to investigate the association between each type of social support and suicide death based on a population-based cohort study. We analyzed follow-up data for 47,223 subjects (aged ≥40 y) participating in a community-based, prospective cohort study. At the baseline, the subjects were asked five questions about social support. The end point of the study was suicide mortality, based on data from the National Vital Statistics. The Cox model was used to estimate the multivariate-adjusted hazard ratios of suicide death. In addition, stratified analysis was conducted to test the interaction of each type of social support with gender (male/female) and age (<65/≥65 y) separately. Among 320,880 person-years of follow-up, 90 cases of suicide death were documented. There were significant association between instrumental social support and lower risk of suicide death, and the hazard ratio was 0.60 (95% CI: 0.38-0.94). Emotional social support was also associated with a lower risk of suicide death, but not to a significant degree, and the hazard ratio was 0.70 (95% CI: 0.42-1.17). It is suggested that instrumental social support was significantly associated with a lower risk of suicide death, and emotional social support tended to be associated with a lower risk of suicide death.

DOI PubMed

Randomised controlled trial of a financial incentive for increasing the number of daily walking steps: study protocol.

Yasutake Tomata, Fumiya Tanji, Dieta Nurrika, Yingxu Liu, Saho Abe, Koichi Matsumoto, Shu Zhang, Yumika Kotaki, Sanae Matsuyama, Yukai Lu, Yumi Sugawara, Shino Bando, Teiichiro Yamazaki, Tatsui Otsuka, Toshimasa Sone, Ichiro Tsuji

BMJ open   9 ( 6 ) e026086   2019.06  [Refereed]

Research paper (journal)  

INTRODUCTION: Physical activity is one of the major modifiable factors for promotion of public health. Although it has been reported that financial incentives would be effective for promoting health behaviours such as smoking cessation or attendance for cancer screening, few randomised controlled trials (RCTs) have examined the effect of financial incentives for increasing the number of daily steps among individuals in a community setting. The aim of this study is to investigate the effects of financial incentives for increasing the number of daily steps among community-dwelling adults in Japan. METHODS AND ANALYSIS: This study will be a two-arm, parallel-group RCT. We will recruit community-dwelling adults who are physically inactive in a suburban area (Nakayama) of Sendai city, Japan, using leaflets and posters. Participants that meet the inclusion criteria will be randomly allocated to an intervention group or a waitlist control group. The intervention group will be offered a financial incentive (a chance to get shopping points) if participants increase their daily steps from their baseline. The primary outcome will be the average increase in the number of daily steps (at 4-6 weeks and 7-9 weeks) relative to the average number of daily steps at the baseline (1-3 weeks). For the sample size calculation, we assumed that the difference of primary outcome would be 1302 steps. ETHICS AND DISSEMINATION: This study has been ethically approved by the research ethics committee of Tohoku University Graduate School of Medicine, Japan (No. 2018-1-171). The results will be submitted and published in a peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER: UMIN000033276; Pre-results.

DOI PubMed

Joint impact of seven risk factors on incident dementia in elderly Japanese: the Ohsaki Cohort 2006 Study.

Yumika Kotaki, Yasutake Tomata, Fumiya Tanji, Shu Zhang, Yumi Sugawara, Ichiro Tsuji

Journal of neurology   266 ( 5 ) 1222 - 1229   2019.05  [Refereed]

Research paper (journal)  

BACKGROUND: This cohort study estimated the population attributable fraction (PAF) of seven combined major risk factors for incident dementia. METHODS: We conducted a cohort study of 8563 community-dwelling individuals aged ≥ 65 years. In a baseline survey (2006), we collected data on major seven risk factors: diabetes mellitus, hypertension, obesity, physical inactivity, severe psychological distress, smoking, and low educational attainment. The total number of risk factors was applied as an exposure variable. Subjects were categorized into four groups according to the total number of risk factors they possessed (0, 1, 2, ≥ 3 risk factors). Data on incident dementia were retrieved from the public Long-term Care Insurance database. Hazard ratios (HRs) and 95% confidence interval (95% CI) were estimated using the Cox proportional regression model. We also calculated the PAF using HRs and the prevalences in our cohort data. RESULTS: The number of cases of incident dementia was 577 (6.7%). A dose-response relationship between the total number of risk factors and incident dementia was observed; in comparison with no risk factors (reference), the age- and sex-adjusted HRs (95% CIs) were 1.25 (0.92-1.70) for one risk factor, 1.59 (1.18-2.15) for two, and 2.21 (1.62-3.01) for three or more (P trend < 0.001). If subjects had adhered to none of the risk factors, the PAF would have been 32.2%. If subjects had improved toward one better category, the PAF would have been 23.0%. CONCLUSION: Our findings suggest that reducing the combined number of risk factors would contribute significantly to reducing the incidence of dementia.

DOI PubMed

Preventive Effect of Oral Self-Care on Pneumonia Death among the Elderly with Tooth Loss: The Ohsaki Cohort 2006 Study.

Kaoru Manabe, Fumiya Tanji, Yasutake Tomata, Shu Zhang, Ichiro Tsuji

The Tohoku journal of experimental medicine   247 ( 4 ) 251 - 257   2019.04  [Refereed]

Research paper (journal)  

Tooth loss is a risk factor for pneumonia mortality, but it is unclear whether oral care negates excess mortality due to pneumonia among community-dwelling elderly with tooth loss. The purpose of this study was to examine the influence of oral care on the association between the number of remaining teeth and the risk of pneumonia death. We analyzed for 18,098 individuals (aged ≥ 65 years) participating in a prospective cohort study. In a 2006 baseline survey, the following data were collected: the number of remaining teeth, oral care, history of disease, smoking, alcohol drinking, education level and so forth. We also obtained data on dates and causes of death between 2006 and 2014. The primary outcome was mortality due to pneumonia. Compared with those having ≥ 20 teeth, the risk of pneumonia mortality was increased among participants having 10-19 or 0-9 teeth; the multivariate hazard ratios (HRs) (95% confidence intervals [CI]) were 1.45 (1.03-2.04) and 1.38 (1.01-1.87), respectively. Among those having 0-9 teeth, a significantly increased risk of mortality due to pneumonia was disappeared for those who brushed their teeth ≥ 2 times per day, for those with visiting a dentist, and for those with use of denture, whereas the risk persisted among those who brushed their teeth ≤ 2 times per day, for those without visiting a dentist, and for those without use of denture. Tooth-brushing, visiting a dentist or use of denture may negate the increased risk of pneumonia death among the elderly with tooth loss.

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Moving from prefabricated temporary housing to public reconstruction housing and social isolation after the Great East Japan Earthquake: a longitudinal study using propensity score matching.

Takuya Sekiguchi, Yoshihiro Hagiwara, Yumi Sugawara, Yasutake Tomata, Fumiya Tanji, Yutaka Yabe, Eiji Itoi, Ichiro Tsuji

BMJ open   9 ( 3 ) e026354   2019.03  [Refereed]

Research paper (journal)  

OBJECTIVES: After the Great East Japan Earthquake (GEJE) of 2011, many survivors have been forced to live in prefabricated temporary housing, which is uncomfortable and insufficiently durable for permanent living. Public reconstruction housing has been built to improve their living conditions; however, those moving have to rebuild personal relationships and adapt to a new environment. This study examined whether survivors moving to public reconstruction housing became more socially isolated than those remaining in prefabricated temporary housing. DESIGN, SETTING AND PARTICIPANTS: Self-report questionnaire data collected in 2015 (4 years after the GEJE) were used as the baseline for follow-up surveys in 2016 and 2017, as many survivors moved from prefabricated temporary housing to public reconstruction housing from 2015. We analysed longitudinal data from 393 survivors, distinguishing those who moved to public reconstruction housing during the 5th year after the disaster from those who remained in prefabricated temporary housing. Participants were assessed using the Lubben Social Network Scale-6 (LSNS-6) in all three surveys, with social isolation defined by a score of <12/30. To reduce the effect of selection bias, propensity score analysis was performed (178 of 393 participants were retained). We used a generalised estimated equation to evaluate the association between moving from prefabricated temporary housing to public reconstruction housing and changes in social isolation over 2 years. RESULTS: LSNS-6 scores of the reconstruction housing group were worse than those of the prefabricated housing group between 4 and 6 years after the GEJE (P=0.006). Over the same period, social isolation worsened in the reconstruction housing group but improved in the prefabricated housing group (P=0.002). CONCLUSIONS: Social isolation should be monitored while supporting survivors who moved to public reconstruction housing, and further longitudinal research is needed to clarify the risk of social isolation.

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Weight change since age 20 and incident risk of obesity-related cancer in Japan: a pooled analysis of the Miyagi Cohort Study and the Ohsaki Cohort Study.

Mano Wakamatsu, Yumi Sugawara, Shu Zhang, Fumiya Tanji, Yasutake Tomata, Ichiro Tsuji

International journal of cancer   144 ( 5 ) 967 - 980   2019.03  [Refereed]

Research paper (journal)  

It is unclear whether weight change during adulthood affects the risk of obesity-related cancers such as those of the esophagus, colorectum, pancreas, breast, endometrium, and kidney among Japanese, where obesity is less frequent and less severe. We examined the association between weight change during adulthood and the risk of obesity-related cancer among Japanese by conducting a pooled analysis of two prospective studies of residents in Miyagi Prefecture, Japan. A total of 78,743 persons (40,422 women and 38,321 men) aged 40-79 years participated in the Miyagi Cohort Study in 1990 and in the Ohsaki Cohort Study in 1994. Weight change since age 20 was divided into four categories (weight loss; stable weight; moderate weight gain; high weight gain). Cox proportional hazards regression analysis was used to estimate the multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for obesity-related cancer incidence. During 1,057,899 person-years of follow up, 4,467 cases of obesity-related cancer (women; 1,916 cases, men; 2,551cases) were identified. In women, compared to the stable weight, weight gain was associated with an increased risk of obesity-related cancer (moderate weight gain; HRs = 1.10, 95%CIs: 0.97-1.26, high weight gain; HRs = 1.29, 95%CIs: 1.14-1.47). The results indicate that weight gain since age 20 was associated with a significantly increased risk of obesity-related cancer among Japanese women. By contrast, in men, our study found that weight change is not associated with the incidence of obesity-related cancer.

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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 &gt;= 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 &lt;= 9, 10-12, &gt;= 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 &lt;= 9), participants in the highest category (K6 score &gt;= 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.

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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 &lt; 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.

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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 &gt;= 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.

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