Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jmii.2024.01.001

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Language：Japanese   Publisher：(一社)日本疫学会  

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Language：Japanese   Publisher：(一社)日本疫学会  

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Parechovirus-A (PeV-A) causes emerging infection in children, and clinical presentation depends on genotype. The virus has been investigated mainly in developed countries; however, data from developing countries, especially in Asia, are sparse. This study investigated whether PeV-A circulated in children in Myanmar. This retrospective study evaluated PeV-A in nasopharyngeal samples from children aged 1 month to 12 years who were hospitalized with acute lower respiratory infection at Yankin Children Hospital, Yangon, Myanmar, during the period from May 2017 to April 2019. Real-time polymerase chain reaction (PCR) was used to detect PeV-A, and PCR-positive samples were used for genotyping and phylogenetic analysis. In total, 11/570 (1.9%) of samples were positive for PeV-A; 7 were successfully genotyped by sequencing the VP3/VP1 region, as follows: PeV-A1 (n = 4), PeV-A5 (n = 1), PeV-A6 (n = 1), and PeV-A14 (n = 1). Median age was 10.0 months (interquartile range 4.0-12.0 months), and other respiratory viruses were detected in all cases. Phylogenetic analysis showed that all detected PeV-A1 strains were in clade 1 A, which was a minor clade worldwide. Four PeV-A genotypes were detected in Myanmar. The clinical impact of PeV-A in children should be evaluated in future studies.

DOI： 10.1002/jmv.28964

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Language：Japanese   Publisher：(一社)日本骨粗鬆症学会  

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Visual impairment is a possible cause of physical frailty. Reduced physical activity (PA) may be involved in the pathway from visual impairment to physical frailty, although the association between vision and objectively measured PA among older adults remains unclear. This study examined the sex-specific association of subjective vision with intensity-specific PA and bout-specific sedentary behavior (SB) among community-dwelling, older Japanese adults. STUDY DESIGN: Cross-sectional study METHODS: This study used data from the Neuron to Environmental Impact across Generations study analyzing older adults (527 participants, aged 65-84 years) living in rural areas of Niigata Prefecture, Japan. Subjective vision was assessed by use of a questionnaire. Intensity-specific PA (light-intensity PA and moderate-to-vigorous PA [MVPA]), bout-specific SB, and daily step count were objectively evaluated by use of an accelerometer. The association of subjective vison with PA and SB, stratified by sex, was analyzed by means of general regression analyses, with adjustment for covariates. RESULTS: The data of 512 participants (men: 46.9%; with poor subjective vision: 22.9%) were analyzed. Poor subjective vision was significantly associated with log MVPA (partial regression coefficient = -0.261, P = .013) and log steps (partial regression coefficient = -0.164; P = .021) among women, whereas a tendency of an association was observed with prolonged SB time among men (partial regression coefficient: 39.1; P = .073). CONCLUSION: Older Japanese women with poor subjective vision performed less MVPA and had fewer step counts than those of participants with good subjective vision, and men with poor subjective vision had longer prolonged SB, which may all accelerate the process to physical frailty.

DOI： 10.1007/s10384-023-00977-w

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Publishing type：Research paper (scientific journal)   Publisher：BMJ  

Objectives

This study aims to investigate whether there is a differential association between socioeconomic status (SES) and adherence to hypertension medication among older adults in rural and urban areas in Myanmar and assess what type of SES is associated with a difference.

Design

Cross-sectional study using baseline data from the Japan Gerontological Evaluation Study in Myanmar prospective cohort study. A multistage random sampling method was applied in each region.

Setting

An urban and a rural area in Myanmar.

Participants

A total of 1200 older adults over 60 years old in Myanmar were randomly selected in 2018 (600 each from rural and urban areas). Of them, 573 had hypertension and were eligible for the analysis (urban: 317, rural: 256).

Outcome

Adherence to hypertension medication (yes/no) is the outcome of interest. Three types of SES (wealth, education and current employment status) were the independent variables.

Results

We found that 21.5% of urban residents and 48.4% of rural residents were non-adherent in the study population. Poisson regression modelling stratified by area was performed to estimate the prevalence ratios (PRs) of not following treatment instructions. Demographic information and complications of hypertension were adjusted for in all models as possible confounders. In terms of SES, middle level of wealth compared with low level was significantly associated with poor adherence (PR 2.68, 95% CI 1.28 to 5.59) in the urban area, but education and employment status did not show similar associations. Lower education compared with middle/high school or higher was significantly associated with poor adherence in the rural area (no school: PR 3.22, 1.37–7.58; monastic: 3.42, 1.16–5.07; primary school: 2.41, 1.18–4.95), but wealth and income did not show similar associations.

Conclusions

SES and adherence to hypertension medication were differently associated among older adults in rural and urban areas in Myanmar. To ensure healthcare access to hypertension treatment for every citizen, the differential association between SES and adherence in urban/rural areas needs to be recognised.

DOI： 10.1136/bmjopen-2022-065370

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Language：English   Publishing type：Research paper (scientific journal)  

People have a preference for, and feel better in, beautiful natural environments. However, there are no epidemiological studies on the association between neighborhood beauty and neuroimaging measures. We aimed to determine association between neighborhood beauty and regional brain volume. Participants were 476 community-dwelling older adults from the Neuron to Environmental Impact across Generations (NEIGE) study. Subjective neighborhood beauty was assessed through participants' perception of beautiful scenery within 1 km of their home. Objective measures of neighborhood indicators (green spaces, blue spaces, and plant diversity) within 1 km of participants' homes were obtained using a geographic information system. Volumes of brain regions associated with experience of beauty were measured using magnetic resonance imaging. We estimated associations between neighborhood beauty and regional brain volume using linear regression. Of the participants, 42% rated their neighborhoods as very beautiful, and 17% rated them as not at all beautiful. Higher subjective neighborhood beauty was associated with larger bilateral medial orbitofrontal cortex and insula volumes (all p for trend < 0.01). Brain volume was not associated with objective neighborhood measures. Subjective neighborhood beauty was associated with brain regions related to rewards and decision making, suggesting that these brain regions underpin the perception of neighborhood beauty.

DOI： 10.3390/ijerph20010679

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Recently, several studies reported that pneumonia might increase the risk of cognitive decline and dementia due to increased frailty. OBJECTIVES: This study aims to examine the association between a history of pneumonia and subsequent dementia risk. METHODS: Participants were 9952 aged 65 years or older Japanese men and women from the Japan Gerontological Evaluation Study prospective cohort study, followed up from 2013 to 2019. Dementia was identified by public long-term care insurance registration. A history of pneumonia contracted 1 year before the baseline questionnaire in 2013. A cox regression model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for dementia risk, adjusted for potential confounding variables. We conducted competing risk analyses using a cause-specific hazard model. RESULTS: During the follow-up period of 6 years, 939 persons developed dementia. There was no association between having a prior history of pneumonia with dementia risk (HR 1.20, 95% CI:0.81-1.78). However, we observed an increased risk of dementia in persons with pre-frailty and frailty; the multivariable HR (95% CI) was 1.75 (1.48-2.07) and 2.42 (2.00-2.93) for pre-frailty and frailty, respectively. When pneumonia and frailty were combined, the risk of dementia was the highest for the persons with a history of pneumonia and frailty; the multivariable HR (95% CI) was 2.30 (1.47-3.62). The multivariable HR (95% CI) for those without pneumonia with frailty was 1.95 (1.66-2.28). Meanwhile, the multivariable HR (95% CI) for those with pneumonia without frailty was 1.64 (0.68-3.99). CONCLUSION: Our findings imply that a prior history of pre-frailty and frailty with or without pneumonia, but not a history of pneumonia per se, was associated with an increased risk of dementia among population-based-cohort of older Japanese people.

DOI： 10.1002/gps.5825

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Language：Japanese   Publisher：(一社)日本骨粗鬆症学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Providing appropriate immunization information during the perinatal period is important for improving immunization rates among infants and children; however, the distribution of immunization information by healthcare workers (HCWs) is not standardized in Japan. We investigated HCWs' attitudes toward childhood immunization and factors related to vaccine hesitancy. We conducted a cross-sectional descriptive survey of HCWs involved in childhood immunization in Niigata City, Japan, from November 2017 to January 2018. We assessed contextual, individual and group, and vaccine/vaccination-specific influences. Of 290 HCWs, 139 (47.9%) returned completed questionnaires. Most HCWs (87/139, 64.9%) reported providing immunization information verbally to parents; 51/87 (58.6%) spent fewer than five minutes doing so. Pediatricians provided vaccines based on the parents' best interest, whereas public health nurses and midwives emphasized government policy. Nurses had greater hesitancy related to personal perceptions and social/peer factors than pediatricians (p < 0.001). Nurses were significantly more likely than pediatricians to suggest that children receive more shots than necessary (p < 0.01). Nurses tended to have more negative attitudes toward vaccination and little awareness of immunization promotion compared to pediatricians. Thus, all HCWs involved in childhood immunization should receive sufficient information to provide timely and appropriate immunization to infants and children.

DOI： 10.3390/vaccines10071055

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: We investigated the association between tooth loss and structural brain volume and its mediating effect on the association between tooth loss and cognitive function in older Japanese. METHODS: A cross-sectional study was conducted by using the data of 494 randomly sampled community-dwelling individuals aged 65-84 years living in Tokamachi City, Japan. Total brain volume (TBV), gray matter volume (GMV), white matter volume (WMV), and hippocampal volume (HV) were measured with magnetic resonance imaging. The association of self-reported number of teeth (≥20, 1-19, and 0) with cognitive function assessed with the Japanese version of the Quick Mild Cognitive Impairment screen and structural brain volume was examined. Causal mediation analysis was performed to evaluate the mediating effect of structural brain volume. Age, sex, socioeconomic status, health behavior, comorbid conditions, and total intracranial volume were adjusted. RESULTS: Respondents with no teeth showed lower cognitive function (coefficient = -4.01; 95% confidence interval [CI]: -7.19, -0.82), lower TBV (coefficient = -10.34; 95% CI: -22.84, 2.17), and lower GMV (coefficient = -6.92; 95% CI: -14.84, 0.99) than those with ≥20 teeth (P for trends were 0.003, 0.035, and 0.047, respectively). The number of teeth was not significantly associated with WMV or HV. GMV showed a significant mediating effect on the association between the number of teeth and cognitive function (coefficient = -0.38; 95% CI: -1.14, -0.002, corresponding to 9.0% of the total effect), whereas TBV did not. CONCLUSIONS: GMV was suggested to mediate the relationship between tooth loss and lower cognitive function.

DOI： 10.1016/j.jagp.2022.06.005

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Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

Few studies have examined whether objective or subjective economic status (ES) has a greater association with the happiness of older adults, despite concerns regarding the growing economic cost of morbidity and their functional dependence in developing countries with aging populations. Thus, this study examined whether objective/subjective ES was associated with happiness in older adults in two Myanmar regions. A multistage random sampling procedure and face-to-face interviews were conducted in the urban and rural areas of Myanmar. The happiness of 1200 participants aged >60 years was evaluated using a single happiness score ranging from 0 (very unhappy) to 10 (very happy). The wealth index, used as an objective ES, was calculated from 17 household asset items, such as radio, washing machines, and television. Subjective ES was assessed by asking “Which of the following best describes your current financial situation in light of general economic conditions?” Responses ranged from “very difficult” to “very comfortable”. Both low objective and subjective ES were negatively associated with happiness, after adjusting for confounding variables and stratification by region (urban and rural areas). Although objective and subjective ES had similar associations with happiness in urban areas, subjective ES had a stronger association in rural areas.

DOI： 10.3390/ijerph19063216

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Language：Japanese   Publisher：(公財)日本眼科学会  

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Language：Japanese   Publisher：(公財)日本眼科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: There is no consensus regarding the impact of population density on the transmission of respiratory viral infections such as COVID-19 and seasonal influenza. Our study aimed to determine the correlation between population density and the incidence and duration of COVID-19 transmission. METHODS: Publicly available data for confirmed COVID-19 cases in Japan, from January 2020 through November 2021, were retrospectively collected. The average numbers of seasonal influenza cases reported in the national database from 2013-2014 through 2019-2020 were identified. Using data for COVID-19 and seasonal influenza population density and incidence rates (age-adjusted), the Pearson's correlation coefficient was determined. RESULTS: A significant positive correlation between log population density and length of outbreak period was observed for COVID-19 (r = 0.734; p < 0.001) but not for seasonal influenza. Additionally, a significant linear correlation was observed between population density and age-adjusted incidence rate for COVID-19 (r = 0.692; p < 0.001) but not for seasonal influenza. CONCLUSIONS: In Japan, areas with high population density experienced a prolonged and more intense COVID-19 outbreak compared with areas with low population density. This was not observed with seasonal influenza, suggesting that public health measures against COVID-19 should be tailored according to population density.

DOI： 10.1016/j.ijregi.2022.01.003

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BACKGROUND: Adverse childhood experiences (ACEs) can affect later-life health outcomes via brain structural differences. However, there is no sufficient empirical evidence about whether brain morphological differences remain until old ages. OBJECTIVE: We examined the association between ACEs and brain volumes among older individuals. PARTICIPANTS AND SETTING: Residents aged 65-84 years in Tokamachi City, Japan, were randomly recruited, and 491 participants were included in the analysis. METHODS: ACEs were assessed with a self-reported questionnaire. The volumes of seven brain regions of interests were evaluated via structural magnetic resonance imaging. RESULTS: In total, 143 (27.1%) participants experienced one ACE and 33 (6.7%) two or more ACEs. Participants with two or more ACEs had a larger anterior cingulate cortex volume (B = 0.346, 95% confidence interval [CI] = 0.04 to 0.66) and smaller hippocampal (B = -0.287, 95% CI = -0.58 to 0.001) and amygdala (B = -0.313, 95% CI = -0.59 to -0.03) volumes. Interestingly, we observed a distinct association between deprivation and threat. That is, deprivation was associated with a smaller amygdala volume (B = -0.164, 95% CI = -0.32 to -0.01) and threat with a larger anterior cingulate cortex volume (B = 0.401, 95% CI = 0.11 to 0.70). CONCLUSIONS: ACEs were associated with the volumes of brain regions such as anterior cingulate cortex, hippocampus, and amygdala, which are responsible for emotion and self-regulation in older population. The effect of ACEs on the amygdala was commonly driven by deprivation experiences and that on the anterior cingulate cortex by threat.

DOI： 10.1016/j.chiabu.2021.105456

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OBJECTIVES: Having gratitude is associated with reduced social isolation and depression, which are risk factors for dementia. However, it is unknown whether gratitude is directly associated with cognitive function. This study aimed to determine associations between gratitude and cognitive function and to elucidate the underlying biological mechanism by testing the mediating role of brain regions among healthy older people. METHODS: We used cross-sectional data from the 2017 Neuron to Environmental Impact across Generations (NEIGE) study of community-dwelling older adults aged ≥ 65 years (n = 478). Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Levels of gratitude were assessed using the two-items of Gratitude Questionnaire. Volumes of brain regions associated with emotional processing and social interaction were measured by magnetic resonance imaging. Linear regression models and structural equation models were used to examine associations between level of gratitude, brain volume, and cognitive function. RESULTS: The mean gratitude score was 6.3 (SD=0.9) and the mean MMSE score was 27.1 (SD=2.5). Regression analysis showed that higher levels of gratitude were associated with better cognitive function (coefficient=0.25, 95% CI: 0.01, 0.49), adjusting for age, sex, education, marital status, and depressive symptoms. Higher levels of gratitude were associated with larger volumes of right amygdala and left fusiform gyrus. Structural equation model analysis showed that amygdala volumes mediated the association between gratitude and cognitive function. CONCLUSION: Higher levels of gratitude were positively associated with cognitive function, partially mediated through the amygdala, which is involved in processing emotion and memory.

DOI： 10.1016/j.archger.2022.104645

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BACKGROUND: Childhood maltreatment can impede gratitude, yet little is known about the older population and its moderators. The aim of this study is to clarify the association between childhood maltreatment and levels of gratitude of the older population, and the moderating effect of social ties on the association. METHODS: We analyzed the data of 524 community-dwelling older adults aged 65-84 years without functional disabilities in Tokamachi City, Niigata, Japan, collected for the Neuron to Environmental Impact across Generations (NEIGE) study in 2017. Using a questionnaire, the participants rated three types of childhood maltreatment before the age of 18 (physical abuse, emotional neglect, and psychological abuse), level of gratitude, and social ties. RESULTS: We found an inverse association between emotional neglect and gratitude. Furthermore, emotional neglect was inversely associated with gratitude only for those with lower levels of social ties. CONCLUSIONS: Promoting social ties may mitigate the adverse impact of emotional neglect on the level of gratitude.

DOI： 10.3390/ijerph182111082

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Language：Japanese   Publisher：日本運動疫学会  

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Language：Japanese   Publisher：日本運動疫学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Non-pharmaceutical interventions (NPIs), such as sanitary measures and travel restrictions, aimed at controlling the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may affect the transmission dynamics of human respiratory syncytial virus (HRSV). We aimed to quantify the contribution of the sales of hand hygiene products and the number of international and domestic airline passenger arrivals on HRSV epidemic in Japan. METHODS: The monthly number of HRSV cases per sentinel site (HRSV activity) in 2020 was compared with the average of the corresponding period in the previous 6 years (from January 2014 to December 2020) using a monthly paired t-test. A generalized linear gamma regression model was used to regress the time-series of the monthly HRSV activity against NPI indicators, including sale of hand hygiene products and the number of domestic and international airline passengers, while controlling for meteorological conditions (monthly average temperature and relative humidity) and seasonal variations between years (2014-2020). RESULTS: The average number of monthly HRSV case notifications in 2020 decreased by approximately 85% (p < 0.001) compared to those in the preceding 6 years (2014-2019). For every average \1 billion (approximately £680,000/$9,000,000) spent on hand hygiene products during the current month and 1 month before there was a 0.29% (p = 0.003) decrease in HRSV infections. An increase of average 1000 domestic and international airline passenger arrivals during the previous 1-2 months was associated with a 3.8 × 10- 4% (p < 0.001) and 1.2 × 10- 3% (p < 0.001) increase in the monthly number of HRSV infections, respectively. CONCLUSIONS: This study suggests that there is an association between the decrease in the monthly number of HRSV cases and improved hygiene and sanitary measures and travel restrictions for COVID-19 in Japan, indicating that these public health interventions can contribute to the suppression of HRSV activity. These findings may help in public health policy and decision making.

DOI： 10.1186/s12879-021-06461-5

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.jinf.2021.08.016

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Inequalities exist between the 23-valent pneumococcal polysaccharide vaccination (PPSV23) rate in each municipality among Japanese older adults. Exploring individual-level and community-level intervenable factors is necessary to improve the vaccination rates. We examined the associations between community-level and individual-level social capital and the PPSV23 vaccination among older Japanese adults using multilevel Poisson regression analyses. DESIGN: Cross-sectional study. SETTING: We used data from the Japan Gerontological Evaluation Study, conducted between 3 October 2016 and 10 January 2017 in 631 districts, 39 municipalities and 18 prefectures. PARTICIPANTS: The target population comprised persons aged 65 years or older who are physically and cognitively independent (that is, not certified as needing long-term care). Further, 180 021 older adults from 39 Japanese municipalities were enrolled. PRIMARY OUTCOME MEASURE: The primary outcome was the PPSV23 vaccination among the Japanese older adults aged 65 years or older who did not have physical or cognitive disabilities. RESULTS: After adjusting for municipality-, community-, individual-levels effects with multiple imputation, 137 075 individuals who participated in one/more of the civic participation (participation of social groups), social cohesion (social tie), or reciprocity (mutual exchange of social support) were significantly associated with more vaccinations than those without the three social capitals among the 137 075 older adults (13.0% (95% CI 11.0% to 14.9%), 5.0% (95% CI 2.4% to 7.6%) or 33.9% (95% CI23.6% to 44.2%) increase, respectively, p>0.001 for all). The rich (≥+1 SD) community-level civic participation was significantly associated with 3.4% increase [95% CI 0.02% to 6.78%, p<0.05] of the PPSV23 vaccination among the older adults compared to those with the poor or standard one. CONCLUSIONS: Older adults with one/more of the three social capitals at the both levels received more PPSV23 vaccinations than those without those social capitals. Therefore, fostering of those social capitals may improve the inequality of the PPSV23 vaccination rate among older adults in each municipality.

DOI： 10.1136/bmjopen-2020-043723

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Pneumonia is a leading cause of mortality among older adults worldwide. Recently, several studies reported that frailty was associated with mortality among older adults hospitalized due to respiratory infectious diseases, including pneumonia. However, it is unknown whether frailty is associated with susceptibility to and severity of pneumonia in functionally-independent community-dwelling older adults. In this study, we examined whether frailty increased the susceptibility to pneumonia and hospitalization in older adults. We used cross-sectional data from the Japan Gerontological Evaluation Study; the data was collected by using mail-based, self-reported questionnaires from 177,991 functionally-independent community-dwelling older adults aged ≥ 65 years. Our results showed that frailty was significantly associated with both occurrence of and hospitalization due to pneumonia after adjustments with covariates; (Preference ratio {PR} 1.92, 95% confidence interval {95% CI} [1.66-2.22] and PR 1.80, 95% CI [1.42-2.28], respectively, p < 0.001 for the both). Pre-frailty was associated only with the occurrence of pneumonia. Besides, the instrumental activity of daily living, physical strength, nutrition status, oral function, homeboundness, and depression status in frail older adults were associated with either or both occurrence of and hospitalization due to pneumonia. Our results suggest that frailty influenced the susceptibility to and severity of pneumonia in older adults.

DOI： 10.1038/s41598-021-86854-3

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BACKGROUND: The hippocampus is a brain structure important for memory and cognitive function. Physical activity may help prevent hippocampal atrophy. However, few studies have measured sedentary behavior (SB) and intensity-specific physical activity using an accelerometer. This study aimed to examine the cross-sectional associations of objectively-determined SB, light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) measured by an accelerometer with hippocampal volume among community-dwelling older adults using compositional data analysis (CoDa) approach. METHODS: This cross-sectional study was part of the Neuron to Environmental Impact across Generations (NEIGE) study. A randomly recruited sample of 485 Japanese older adults (47% male; aged 65-84 years) wore tri-axial accelerometers (Omron Healthcare) for seven consecutive days in 2017. Hippocampal volume was measured with magnetic resonance imaging and the left and right hippocampal volumes were automatically segmented using FreeSurfer software. Associations of sedentary and physically active behaviors with hippocampal volume were examined with compositional linear regression analysis based on isometric log-ratio transformations of time use adjusted for potential confounding factors. RESULTS: The relative proportion of time spent in MVPA, compared to the other two activities, was significantly positively associated with right hippocampal volume (β: 57.1, p-value = 0.027).However, no association existed between higher proportions of MVPA and left hippocampal volume, or between proportions of SB or LPA with either left or right hippocampal volumes. CONCLUSIONS: The proportion of time spent in MVPA, relative to the other two activities, was significantly positively associated with right hippocampal volume. MVPA may be beneficial for maintaining hippocampal volume.

DOI： 10.2188/jea.JE20200534

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Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

The aim of the study was to investigate rural–urban differences in depressive symptoms in terms of the risk factors among older adults of two regions in Myanmar to provide appropriate intervention for depression depending on local characteristics. This cross-sectional study, conducted between September and December, 2018, used a multistage sampling method to recruit participants from the two regions, for face-to-face interviews. Depressive symptoms were assessed using the 15-item version of the Geriatric Depression Scale (GDS). Depressive symptoms were positively associated with living in rural areas (B = 0.42; 95% confidence interval (CI): 0.12,0.72), female (B = 0.55; 95% CI: 0.31,0.79), illness during the preceding year (B = 0.68; 95% CI: 0.45,0.91) and non-Buddhist religion (B = 0.57; 95% CI: 0.001,1.15) and protectively associated with education to middle school level or higher (B = −0.61; 95% CI: −0.94, −0.28) and the frequency of visits to religious facilities (B = −0.20; 95% CI: −0.30, −0.10). In women in urban areas, depressive symptoms were positively associated with illness during the preceding year (B = 0.78; 95% CI: 0.36, 1.20) and protectively associated with education to middle school level or higher (B = −0.67; 95% CI: −1.23, −0.11), middle or high wealth index (B = −0.92; 95% CI: −1.59, −0.25) and the frequency of visits to religious facilities (B = −0.20; 95% CI: −0.38, −0.03). In men in rural areas, illness during the preceding year was positively associated with depressive symptoms (B = 0.87; 95% CI: 0.33, 1.42). In women in rural areas, depressive symptoms were positively associated with illness during the preceding year (B = 0.83; 95% CI: 0.36, 1.30) and protectively associated with primary education (B = −0.62; 95% CI: −1.12, −0.12) and the frequency of visits to religious facilities (B = −0.44; 95% CI: −0.68, −0.21). Religion and wealth could have different levels of association with depression between older adults in the urban and rural areas and men and women. Interventions for depression in older adults should consider regional and gender differences in the roles of religion and wealth in Myanmar.

DOI： 10.3390/ijerph18062818

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The overall coronavirus disease secondary attack rate (SAR) in family members was 19.0% in 10 prefectures of Japan during February 22-May 31, 2020. The SAR was lower for primary cases diagnosed early, within 2 days after symptom onset. The SAR of asymptomatic primary cases was 11.8%.

DOI： 10.3201/eid2703.203882

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BACKGROUND: Increasing the coverage of vaccinations recommended by the World Health Organization in the older adult population is an urgent issue, especially in the context of avoiding co-epidemics during the current coronavirus disease 2019 crisis. The aim of this study was to examine factors associated with the quality of perceived patient-physician communication and whether this variable was associated with increased odds of vaccination. METHODS: We used cross-sectional data from the Japan Gerontological Evaluation Study conducted from October 2016 to January 2017. The participants were 22,253 physically and cognitively independent individuals aged 65 or older living in 39 municipalities in Japan. Multilevel logit models were used to estimate the odds of vaccination. RESULTS: Among the participants, 40.0% and 58.8% had received pneumococcal and influenza vaccinations as per the recommended schedule, respectively. People with low educational levels were more likely to have a family physician but rate their experience in asking questions lower than those with higher educational levels. Having a family physician and high rating for physicians' listening attitude were positively associated with increased odds of pneumococcal and influenza vaccinations. High rating for patients' questioning attitude and shared decision-making, compared to an ambiguous attitude toward medical decision-making, were positively associated with increased odds of pneumococcal vaccination. CONCLUSION: The results suggest that promotion of having a family physician, better patient-physician communication, and shared decision-making may encourage older adults to undergo recommended vaccinations.

DOI： 10.2188/jea.JE20200505

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

The need for assistance among the elderly is rising, which poses challenges for healthcare systems. Thus, this study aims to determine the factors associated with the need for assistance in the daily living activities of Malaysia’s elderly population. A total of 1204 elderly individuals, aged 60 years and above, were recruited. An interview was conducted using the Bahasa Malaysia version of the Japan Gerontological Evaluation Study (JAGES-BM) questionnaire. Overall, 7.7% of the elderly participants required assistance. A logistic regression model showed that difficult financial statuses (aOR 4.56), hearing difficulties (aOR 1.78), and severe limitations in daily activity over the past 6 months (aOR 11.99) were associated with a higher likelihood of needing assistance. In addition, daily activities such as an inability to feed (aOR 8.46), stand without support (aOR 2.06), or walk for 15 min without stopping (aOR 1.99) were significantly associated with the need for assistance. Factors associated with the need for assistance are health status, disability, and the financial status of the elderly. Preventive measures should be included in policies to ensure the sustainability of the care provided to the elderly in terms of promoting healthy ageing and a good quality of life.

DOI： 10.3390/ijerph18020730

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.exger.2020.111149

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Low objective socioeconomic status (SES) has been correlated with poor physical and mental health among older adults. Some studies suggest that subjective SES is also important for ensuring sound physical and mental health among older adults. However, few studies have been conducted on the impact of both objective and subjective SES on mental health among older adults. This study examines whether objective or subjective SES is associated with depressive symptoms in older adults in Myanmar. This cross-sectional study, conducted between September and December, 2018, used a multistage sampling method to recruit participants from two regions of Myanmar, for face-to-face interviews. The Geriatric Depression Scale (GDS) was used to evaluate the depressive symptoms. Participants were classified as having no depressive symptom (GDS score <5) and having depressive symptoms (GDS score ≥5). Objective and subjective SES were assessed using the wealth index and asking participants a multiple-choice question about their current financial situation, respectively. The relationship between objective/subjective SES and depressive symptoms was examined using a multivariable logistic regression analysis. The mean age of the 1,186 participants aged 60 years and above was 69.7 (SD: 7.3), and 706 (59.5%) were female. Among them, 265 (22.3%) had depressive symptoms. After adjusting for objective SES and other covariates, only low subjective SES was positively associated with depressive symptoms (adjusted odds ratio, AOR: 4.18, 95% confidence interval, CI: 2.98-5.87). This association was stronger among participants in the rural areas (urban areas, AOR: 2.10, 95% CI: 1.08-4.05; rural areas, AOR: 5.65, 95% CI: 3.69-8.64). Subjective SES has a stronger association with depressive symptoms than objective SES, among older adults of the two regions in Myanmar, especially in the rural areas. Interventions for depression in older adults should consider regional differences in the context of subjective SES by reducing socioeconomic disparities among the communities.

DOI： 10.1371/journal.pone.0245489

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Background: Recent findings indicate that leisure activity (LA) delays cognitive decline and reduces the risk of dementia. However, the association between LA and brain volume remains unclear. This study aimed to examine the association between LA variety and brain volume with a focus on the hippocampus and gray matter. Methods: Data were obtained from the baseline survey of the Neuron to Environmental Impact across Generations study, which had targeted community-dwelling older adults living in Niigata, Japan. We divided LAs into 10 categories, and counted the number of categories of activities in which the participants engaged. We classified them as follows: 0 (i.e., no activity), 1, 2, or ≥ 3 types. Brain volume was assessed through magnetic resonance imaging, and hippocampal and gray matter volumes were ascertained. Results: The sample size was 482. Multiple linear regression analysis showed that hippocampal and gray matter volumes were significantly greater among participants with ≥ 3 types of LAs than among their no-activity counterparts. Hippocampal volume was significantly greater among those who engaged in one type of LA than among those who engaged in no such activity. Sex-stratified analysis revealed that hippocampal volumes were significantly greater among males who engaged in ≥ 3 types of LAs and one type of LA. However, no such association was found among females. Conclusion: The present findings suggest that engaging in a wide range of LAs is related to hippocampal and gray matter volumes. Furthermore, there was a sex difference in the association between LA variety and brain volume.

DOI： 10.3389/fnagi.2021.758562

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Language：Japanese   Publisher：グローバルヘルス合同大会事務局  

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© 2020 The Authors We conducted a prospective, multicenter, non-randomized observational study to assess the duration of fever and symptoms of influenza A/H1N1pdm09 and A/H3N2 infected children < 19 years old treated with either baloxavir or oseltamivir. Additionally, these symptoms were investigated in association with pre- and post-baloxavir treatment-emergent polymerase acidic unit (PA) variants as compared to non-substituted viruses. Following receipt of informed consent, baloxavir was administered to 102 influenza A patients, and oseltamivir to 52 patients during the 2018–2019 influenza season in Japan. The average age was higher in the baloxavir treatment group compared to the oseltamivir treatment group (10.6 ± 2.7 versus 6.9 ± 2.9 years old, p < 0.01). The duration of fever and symptoms in baloxavir-treated A/H1N1pdm09 and A/H3N2-infected children did not differ from those in oseltamivir-treated groups (median 22.0, 11.8, 23.0, and 21.0 h, and median 114.5, 121.0, 123.0, and 122.0 h, respectively). One (1.2%) of 83 A/H3N2 patients possessed a PA/I38T substituted virus prior to treatment. The frequency of PA variants in post-treatment samples obtained 2–11 days after beginning of baloxavir was 12.5% (4/32) for A/H1N1pdm09 and 14.1% (9/64) for A/H3N2 when the total number of cases was used as the denominator, however, were 57.1% (4/7) and 33.3% (9/27) when PCR-positive cases at the time of second sampling was used as the denominator. The most frequent PA substitution was I38T (9), with E23K (1), I38K (1), I38M (1), and PA/I38S (1) also observed. The duration of fever and overall symptoms did not differ significantly following baloxavir treatment in individuals with PA variant viruses, non-substituted virus, or in those that were PCR negative at the second sampling (median 20, 24 and 11 h, and median 121, 115 and 121 h, respectively). Rebound of viral RNA load was observed in 13.5% (2/13) of PA variants but it was not associated with recurrence of fever and symptoms. Hence, prolonged fever or symptoms were not observed in children treated with baloxavir following emergence of PA variants, however, further studies are needed to evaluate the clinical impact of PA variants.

DOI： 10.1016/j.antiviral.2020.104951

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Language：Japanese   Publisher：日本公衆衛生学会  

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<sec><title>Purpose</title>Myanmar is rapidly ageing. It is important to understand the current condition of older adults in the country. To obtain such information, we conducted home-visit surveys to collect data for evaluating social determinants of health on older adults in Yangon (representative of an urban) and Bago (representative of a rural) regions of Myanmar.

</sec><sec><title>Participants</title>Overall, 1200 individuals aged 60 years or older and who were not bedridden or had severe dementia (defined as an Abbreviated Mental Test score ≤6) were recruited from Yangon and Bago in 2018. A population-proportionate random-sampling method was used for recruitment.

</sec><sec><title>Findings to date</title>Overall, 600 individuals from Yangon (222 men; 378 women) and 600 from Bago (261 men; 339 women) were surveyed. The average age of Yangon-based men and women was 69.4±7.6 and 69.4±7.3 years; in Bago, this was 69.2±7.1 and 70.6±7.5 years, respectively. Compared to their Yangon-based counterparts, Bago-based respondents showed significantly lower socioeconomic status and more commonly reported poor self-rated health (Bago-based men: 32.2%, women: 42.5%; Yangon: 10.8% and 24.1%, respectively). Meanwhile, some Yangon-based respondents rarely met friends (men: 17.1%, women: 27.8%), and Yangon-based respondents scored higher for instrumental activities of daily living and body mass index when compared to their Bago-based counterparts. For both regions, women showed higher physical-function decline (Yangon-based women: 40.7%, men: 17.1%; Bago: 46.3% and 23.8%, respectively) and cognitive-function decline (Yangon: 34.1% and 10.4%, respectively; Bago: 53.4% and 22.2%, respectively). Being homebound was more common in urban areas (urban-based men: 11.3%, rural-based men: 2.3%; urban-based women: 13.0%, rural-based women: 4.7%, respectively).

</sec><sec><title>Future plans</title>A follow-up survey is scheduled for 2021. This will afford longitudinal data collection concerning mortality, becoming bedridden, and developing dementia and long-term care-related diseases. This will allow us to calculate long-term care risks for older adults in Myanmar.

</sec>

DOI： 10.1136/bmjopen-2020-042877

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© 2020 Centers for Disease Control and Prevention (CDC). All rights reserved. We analyzed 3,184 cases of coronavirus disease in Japan and identified 61 case-clusters in healthcare and other care facilities, restaurants and bars, workplaces, and music events. We also identified 22 probable primary case-patients for the clusters; most were 20-39 years of age and presymptomatic or asymptomatic at virus transmission.

DOI： 10.3201/eid2609.202272

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© 2020 The Author(s). Background: Levels of physical activity change throughout the year. However, little is known to what extent activity levels can vary, based on accelerometer determined sedentary and physically-active time. The aim of this longitudinal study was to examine older adults' activity changes from a non-snowfall season to a subsequent snowfall season, with consideration of the co-dependence of domains of time use. Methods: Participants were 355 older Japanese adults (53.1% women, aged 65-84 years) living in a rural area of heavy snowfall who had valid accelerometer (Active style Pro HJA-750C) data during non-snowfall and snowfall seasons. Activity was classified as sedentary behavior (SB), light-intensity PA (LPA), and moderate-to-vigorous PA (MVPA). Compositional changes from the non-snowfall to the snowfall season were analyzed using Aitchison's perturbation method. The ratios of each component in the composition, such as [SBsnow/SBnon-snow, LPAsnow/LPAnon-snow, MVPAsnow/MVPAnon-snow] for seasonal changes, were calculated and were then divided by the sum of these ratios. Results: In men, the percentages of time spent in each activity during the non-snowfall/snowfall seasons were 53.9/64.6 for SB; 40.8/31.6 for LPA; and 5.3/3.8 for MVPA; these corresponded to mean seasonal compositional changes (ΔSB, ΔLPA, ΔMVPA) of 0.445, 0.287, and 0.268 respectively. In women, the percentages of time spent in each activity during the non-snowfall/snowfall seasons were 47.9/55.5 for SB; 47.9/41.0 for LPA; and 4.2/3.5 for MVPA; these corresponded to mean seasonal compositional changes (ΔSB, ΔLPA, ΔMVPA) of 0.409, 0.302, and 0.289 respectively. The degree of seasonal change was greatest in men. Conclusions: In older adults, activity behaviors were changed unfavorably during snowfall season, particularly so for men. The degree of seasonal change was greatest for SB. Development of strategies to keep rural older adults active during the snowfall season may be needed for maintaining a consistently-active lifestyle for their health.

DOI： 10.1186/s12889-020-09343-8

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

© 2020 Wolters Kluwer Health, Inc. Background: We investigated the association between age, duration of clinical symptoms and viral shedding in outpatient children infected with respiratory syncytial virus (RSV) in Japan. Methods: Outpatients younger than 2 years of age, with suspected RSV infection between 2014 and 2018, were enrolled in the study. Following informed consent, nasal samples were collected at first and second clinic visits (with 0-9 days gap). RSV-A or -B infection and viral load were determined by real-time polymerase chain reaction. Clinical symptoms were recorded at first clinic visit, and fever and symptoms were recorded at home for up to 8 days. Association between clinical symptoms and patient characteristics, such as age, sex and birth weight, were analyzed using ordered logistic regression analysis. The association between viral reduction and estimated shedding period was examined using linear regression analysis. Results: Among the 205 cases enrolled in the study, no difference was found in patient characteristics between RSV-A and -B infection. Duration of fever was prolonged with increased age. Duration of rhinorrhea and cough was shorter in females than in males and in groups with birth weight ≥3 kg than in those with <2.5 kg. Daily viral reduction increased and estimated viral elimination period decreased with age. Conclusions: Fever duration was found to increase while viral shedding decreased with patient age.

DOI： 10.1097/INF.0000000000002626

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© 2020 by the authors. Licensee MDPI, Basel, Switzerland. Sekentei (social appearance) is a Japanese concept that describes a person’s sense of implicit societal pressure to conform to social norms. However, evidence of a relationship between sekentei and health outcomes is sparse. This study examined the association between sekentei and cognitive function among community-dwelling older Japanese people. Baseline data were obtained from the Neuron to Environmental Impact across Generations (NEIGE) study conducted in 2017; 526 randomly sampled community-dwelling individuals aged 65–84 years living in Tokamachi, Niigata Prefecture, Japan were analyzed. The 12-item Sekentei Scale was used to assess sekentei. Cognitive function levels were evaluated with the Japanese version of Mini-Mental State Examination (MMSE-J; ranging from 0–30). Approximately 10% and 25% had cognitive decline and mild cognitive impairment, respectively (MMSE-J scores of ≤23 and 24–26, respectively). Multinomial logistic regression analysis showed that both high and low levels of sekentei were associated with lower cognitive function, particularly mild cognitive impairment, after adjusting for sociodemographic factors, health behaviors, health conditions, and genetic factors. The current findings suggest that a moderate level of sekentei consciousness is beneficial for cognitive health, and that sekentei could be an important socio-cultural factor affecting cognitive function.

DOI： 10.3390/ijerph17124480

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© 2019, © 2019 Japan College of Rheumatology. Objectives: To clarify changes in the incidence of cervical lesions in rheumatoid arthritis (RA) patients with advanced treatment and the impact of cervical lesions on the patients’ quality of life (QOL). Methods: Incidence of radiographic cervical lesions in 1333 RA patients in 2015 was compared with that in our 1999 survey. The association between cervical lesions and QOL evaluated using three different patient-based questionnaires was also analyzed. Results: The incidence of atlantoaxial subluxation (AAS), vertical subluxation (VS), and subaxial subluxation (SAS) in 2015 decreased by 50%, 75%, and 5%, respectively, compared to the 1999 survey. Although QOL, evaluated using the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ; specific to myelopathy), deteriorated as the cervical lesion progressed, there was no association between cervical lesion progression and QOL evaluated using the Short Form-8™ (SF-8™; comprehensive health-related QOL). Cervical lesion progression was also associated with QOL deterioration evaluated using the Health Assessment Questionnaire Disability Index (HAQ-DI; specific to RA), but age and disease duration had stronger influences. Conclusion: The incidence of cervical lesions decreased in 2015 compared to 1999. Cervical lesion progression may be associated with QOL deterioration due to myelopathy. Age and disease duration have more impact on disease-specific QOL.

DOI： 10.1080/14397595.2019.1621428

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© 2020 by the authors. Licensee MDPI, Basel, Switzerland. Poor sleep is associated with lifestyle, however, few studies have addressed the association between sleep quality and the neighborhood environment. This study aimed to investigate the associations between living environment factors and sleep quality in older people. Participants were community-dwelling people aged ≥65 years who participated in the 2010 Japanese Gerontological Evaluation Study. The data of 16,650 people (8102 men, 8548 women) were analyzed. Sleep quality (good or poor) was evaluated using a self-administered questionnaire. Multilevel Poisson regression analysis stratified by depressive status (measured by the Geriatric Depression Scale-15 [GDS]) was conducted with sleep quality as the dependent variable and social and physical environmental factors as explanatory variables. The 12,469 non-depressive respondents and 4181 depressive respondents were evaluated. The regression analysis indicated that non-depressive participants slept better if they lived in environments with few hills or steps (prevalence ratio [PR] = 0.75, 95% CI: 0.56–0.9) and with places where they felt free to drop in (PR = 0.51, 95% CI: 0.26–0.98). For depressive participants, these associations were not evident. Living alone, poor self-rated health, low income, and unemployment were associated with poor sleep quality. In addition to support with these individual factors, improving environmental factors at the neighborhood level may improve the sleep quality of community-dwelling older adults.

DOI： 10.3390/ijerph17041398

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPAN EPIDEMIOLOGICAL ASSOC  

© 2019 Yugo Shobugawa et al. Background: Studies have shown that rural residents face disadvantages concerning medical access and socio-economic conditions. However, the social determinants of health among older people in rural areas are still unclear. The Neuron to Environmental Impact across Generations (NEIGE) study investigated the social determinants of health among older rural adults. Methods: A survey was conducted among the older residents of Tokamachi City, Japan. We randomly selected study participants (N = 1,346) from four stratified groups by age (65–74 and 75–84 years) and residential area (Tokamachi center [downtown] and Matsunoyama [mountain]). The survey collected data on socio-economic status, lifestyle, health, and neighborhood environment. Blood and urine sampling were also conducted, and physical activity was assessed. Magnetic resonance brain imaging (MRI) and Apo-E gene were also examined in the analysis. Results: In total, 527 people participated in the NEIGE study (participation rate: 39.2%). The average age of the participants was 73.5 (standard deviation, 5.6) years, and 47.3% were male. No differences in demographics were found between downtown and mountain residents, except for educational attainment, which was lower among mountain residents. Lifestyles were similar, except for the higher percentage of everyday drinkers (33.3–35.3%) in the mountain area. Concerning physical health, muscle mass, grip strength, and measured physical activity were significantly higher among mountain residents. However, gait speed and balance were better among downtown residents. Conclusion: The findings of the NEIGE study will help elucidate the social determinants of health in older rural adults in Japan, and emphasize the different outcomes between downtown and mountain areas.

DOI： 10.2188/jea.JE20190036

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DOI： 10.7883/yoken.JJID.2020.271

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© 2019 Mawatari et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Neuraminidase inhibitors (NAIs) effectively treat influenza. The clinical effectiveness of four NAIs (oseltamivir, zanamivir, laninamivir, and peramivir) was evaluated against influenza A/ H1N1pdm09, A/H3N2, and B viruses. Additionally, fever duration in patients infected with oseltamivir-resistant influenza A/H1N1pdm09 with the H275Y mutation was evaluated. Methods Patients aged <20 years who visited outpatient clinics in Japan with influenza-like illnesses were enrolled during 4 influenza seasons from 2012/2013 to 2015/2016. After obtaining informed consent, patients who tested positive for influenza with rapid tests received one of the four NAIs. Patients recorded their body temperature daily for 8 days from the first visit. The influenza strain was identified using real-time polymerase chain reaction. Univariate and multivariable analyses were used to evaluate factors influencing fever duration. In children aged ≤5 years treated with oseltamivir, fever duration in oseltamivir-resistant A/ H1N1pdm09-infected patients was compared to that in oseltamivir-sensitive A/ H1N1pdm09-infected patients. Results Of the 1,368 patients analyzed, 297 (21.7%), 683 (49.9%), and 388 (28.4%) were infected with influenza A/H1N1pdm09, A/H3N2, and B, respectively. In multivariable analysis factors associated with significantly prolonged fever duration included: treatment with laninamivir (hazard ratio [HR]: 0.78, p = 0.006, compared to oseltamivir), influenza B (HR: 0.58, p<0.001, compared to influenza A/H1N1pdm09), and a higher body temperature at the clinic visit (HR: 0.87 per degree Celsius, p<0.001). Increasing age was associated with a significantly shorter duration of fever (HR: 1.31 for 6–9 years old, p<0.001; and HR: 1.65 for 10–19 years old, p<0.001, respectively, compared to 0–5 years old). Following treatment with oseltamivir, fever duration was significantly longer for oseltamivir-resistant A/H1N1pdm09-infected patients (n = 5) than for oseltamivir-sensitive A/H1N1pdm09 infected patients (n = 111) (mean, 89 versus 40 hours, p<0.001). Conclusions Our results revealed characteristic information on the effectiveness of the four NAIs and also on oseltamivir-resistant viruses that may affect patients’ clinical care.

DOI： 10.1371/journal.pone.0224683

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BACKGROUND: Physical activity can help to protect against cognitive decline in older adults. However, little is known about the potential combined relationships of time spent in sedentary behavior (SB), light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) with indices of cognitive health. We examined the cross-sectional associations of objectively-determined sedentary and physically-active behaviors with an indicator of cognitive function decline (CFD) in older adults. METHODS: A randomly-recruited sample of 511 Japanese older adults (47% male; aged 65-84 years) wore a tri-axial accelerometer (HJA-750C, Omron) for seven consecutive days in 2017. Cognitive function was assessed by interviewers using the Japanese version of Mini-Mental State Examination, with a score of ≤23 indicating CFD. Associations of sedentary and physically-active behaviors with CFD were examined using a compositional logistic regression analysis based on isometric log-ratio transformations of time use, adjusting for potential confounders. RESULTS: Forty one (9.4%) of the participants had an indication of CFD. Activity compositions differed significantly between CFD and normal cognitive function (NCF); the proportion of time spent in MVPA was 39.1% lower, relatively to the overall mean composition in those with CFD, and was 5.3% higher in those with NCF. There was a significant beneficial association of having a higher proportion of MVPA relative to other activities with CFD. LPA and SB were not associated with CFD when models were corrected for time spent in all activity behaviors. CONCLUSIONS: Larger relative contribution of MVPA was favorably associated with an indicator of CFD in older adults.

DOI： 10.2188/jea.JE20190141

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© 2019 The Author(s). Background: The concept of sekentei (social appearance), defined as sensitivity about one's reputation, reflects Japanese behavioral principles and involves pressure to conform to social norms, particularly among people living in rural areas. However, data regarding the relationship between sekentei and health behaviors are sparse. In this study, we examined the relationship between sekentei and objectively-measured physical activity among community-dwelling older people in Japan. Methods: We used data from the Neuron to Environmental Impact across Generations Study (NEIGE Study), which is a prospective cohort study of randomly-sampled community-dwelling individuals aged 65-84 years living in Tokamachi City, Niigata Prefecture, Japan. The baseline survey was conducted in 2017 and included 527 independent older people. We analyzed the baseline data cross-sectionally. To measure activity behaviors, participants wore a tri-axial accelerometer for seven consecutive days. Physically active individuals were defined based on the World Health Organization recommendation guidelines on physical activity. Sekentei was measured using the 12-item Sekentei Scale (score range: 12-60). Results: After excluding 15 people for whom we had three or fewer days of valid accelerometer-assessed activity data, we used data from 512 participants in our analysis (average 73.4 years old; 46.9% men). Physically active individuals made up 22.3% of the sample, and the proportion of physically active men was higher than that of women. A logistic regression analysis showed that higher levels of sekentei were inversely associated with physical activity after adjusting for demographic factors, socioeconomic status, and health conditions (odds ratio [95% confidence interval]: 0.58 [0.36-0.91] for every 10-point increase in the Sekentei Scale score). This association was stronger in women than in men (0.66 [0.34-1.26] for men and 0.51 [0.26-1.00] for women). Conclusions: Our findings indicate that an individual's sense of sekentei may be an important socio-cultural factor affecting their level of physical activity. Culturally appropriate approaches may be beneficial in addressing insufficient physical activity in older adults.

DOI： 10.1186/s12889-019-7702-4

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DOI： 10.1249/01.mss.0000561149.75370.cd

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PURPOSE: To investigate the prevalence of and factors associated with dysfunctional low back pain (LBP) in patients with rheumatoid arthritis (RA). METHODS: This cross-sectional study included 1276 RA outpatients from two hospitals. The Roland-Morris Disability Questionnaire was used to address the functional-dysfunctional state criterion. Clinical variables, such as medical status, disease activity, bone mineral density, and spinopelvic alignment parameters, were compared between patients with and without dysfunctional LBP. RESULTS: Mean age and disease duration were 64.6 and 13.4 years, respectively; the prevalence of dysfunctional LBP was 32.8%. On univariate analysis, significant differences existed in many variables, except sex, body weight, C-reactive protein (CRP) level, and prevalence of biological agent users, between patients with and without dysfunctional LBP. Multivariate logistic regression analysis revealed body mass index (BMI; odds ratio [OR], 1.116; P < 0.001), onset age of RA (OR, 1.020; P = 0.020), disease duration of RA (OR, 1.043; P < 0.001), methotrexate (MTX) use (OR, 0.609; P = 0.007), vertebral fractures (OR, 2.189; P = 0.001), vertebral endplate and/or facet erosion (OR, 1.411; P = 0.043), disease activity score (DAS) in 28 joints-CRP (DAS-28CRP) (OR, 1.587; P = 0.001), pelvic tilt (PT; OR, 1.023; P = 0.019), and sagittal vertical axis (SVA; OR, 1.007; P = 0.043) as associated factors. CONCLUSION: The factors associated with dysfunctional LBP in patients with RA were more vertebral fractures, higher DAS-28CRP, vertebral endplate and/or facet erosion, higher BMI, longer disease duration, greater PT, older onset age, greater SVA, and less MTX use. Strictly controlling patients' body weight and disease activity with MTX and avoiding spinopelvic malalignment through vertebral fracture prevention are important. These slides can be retrieved under Electronic Supplementary Material.

DOI： 10.1007/s00586-019-05938-x

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The aim of this study was to survey the incidence of osteoporotic fragility fractures, which include vertebral, hip, distal radius, and proximal humerus fractures, in patients ≥ 50 years of age, from 2004 to 2015, in Sado City, Japan. We examined temporal changes in the incidence of these fractures from 2010 through 2015. The incidence of vertebral (p < 0.001) and radius fractures (p = 0.001) was lower in 2015 than in 2010, with only the incidence of hip fracture (p = 0.013) being lower in 2015 than in 2004. With regard to age-specific incidences, there was a sharp increase in vertebral and hip fractures among the segment of the population 70-89 years old, with no remarkable change in the incidence of radial and humeral fractures. Pre-existing vertebral fractures were identified in 69.6% of patients with a hip fracture, 35.6% of patients with a distal radius fracture, and 55% of patients with a humeral fracture. Among patients with pre-existing vertebral fractures, 42.5% had a single fracture, whereas 57.5% had 2 or more fractures. The proportion of patients on anti-osteoporotic agents before the occurrence of fractures increased to 14.5% in 2015, compared to 4% in 2004 and 7.6% in 2010. We speculate that the increase in the use of anti-osteoporotic agents is the main reason for the declining incidence of fractures. Therefore, considering the sharp increase in hip and vertebral fractures among individuals in their mid-1970s and older, judicious use of anti-osteoporotic agents among these individuals could be useful for lowering the occurrence of these fractures.

DOI： 10.1007/s00774-018-0937-9

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Early detection of dementia provides opportunities for interventions that could delay or prevent its progression. We developed the Japanese version of the Quick Mild Cognitive Impairment (Qmci-J) screen, which is a performance-based, easy-to-use, valid and reliable short cognitive screening instrument, and then we examined its validity. Community-dwelling adults aged 65⁻84 in Niigata prefecture, Japan, were concurrently administered the Qmci-J and the Japanese version of the standardized Mini-Mental State Examination (sMMSE-J). Mild cognitive impairment (MCI) and dementia were categorized using established and age-adjusted sMMSE-J cut-offs. The sample (n = 526) included 52 (9.9%) participants with suspected dementia, 123 (23.4%) with suspected MCI and 351 with likely normal cognition. The Qmci-J showed moderate positive correlation with the sMMSE-J (r = 0.49, p &lt; 0.001) and moderate discrimination for predicting suspected cognitive impairment (MCI/dementia) based on sMMSE-J cut-offs, area under curve: 0.74, (95%CI: 0.70⁻0.79), improving to 0.76 (95%CI: 0.72 to 0.81) after adjusting for age. At a cut-off of 60/61/100, the Qmci-J had a 73% sensitivity, 68% specificity, 53% positi

DOI： 10.3390/ijerph16060917

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Early detection of dementia provides opportunities for interventions that could delay or prevent its progression. We developed the Japanese version of the Quick Mild Cognitive Impairment (Qmci-J) screen, which is a performance-based, easy-to-use, valid and reliable short cognitive screening instrument, and then we examined its validity. Community-dwelling adults aged 65⁻84 in Niigata prefecture, Japan, were concurrently administered the Qmci-J and the Japanese version of the standardized Mini-Mental State Examination (sMMSE-J). Mild cognitive impairment (MCI) and dementia were categorized using established and age-adjusted sMMSE-J cut-offs. The sample (n = 526) included 52 (9.9%) participants with suspected dementia, 123 (23.4%) with suspected MCI and 351 with likely normal cognition. The Qmci-J showed moderate positive correlation with the sMMSE-J (r = 0.49, p < 0.001) and moderate discrimination for predicting suspected cognitive impairment (MCI/dementia) based on sMMSE-J cut-offs, area under curve: 0.74, (95%CI: 0.70⁻0.79), improving to 0.76 (95%CI: 0.72 to 0.81) after adjusting for age. At a cut-off of 60/61/100, the Qmci-J had a 73% sensitivity, 68% specificity, 53% positive predictive value, and 83% negative predictive value for cognitive impairment. Normative data are presented, excluding those with any sMMSE-J < 27. Though further research is required, the Qmci-J screen may be a useful screening tool to identify older adults at risk of cognitive impairment.

DOI： 10.3390/ijerph16060917

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PURPOSE: The purpose of this study was to investigate the association of early social environment with Kawasaki disease (KD). METHODS: We analyzed the data of children aged up to 10 years derived from the 21st Century Longitudinal Survey in Newborns (n = 41,872) in Japan. Parental education, total household income, and family size were obtained via a questionnaire at 0.5 years after birth. Physician's diagnosis of KD during the past year was surveyed via a questionnaire for caregiver with children aged up to 10 years. We used Cox proportional hazards modeling to examine the risk factors for KD onset. RESULTS: Children born in households with an annual income of JPY 10 million or more were 1.76 times more likely to have KD onset compared with children born in households with an income of less than JPY 4 million (hazard ratio: 1.76, 95% confidence interval [CI]: 1.15-2.69). Children born in households with three or less persons were 1.62 times more likely to have KD onset compared with those born in households with six or more persons (95% CI: 1.10-2.40). The children who were born in urban municipalities also showed higher risk of KD onset compared with those born in rural municipalities (hazard ratio: 1.55, 95% CI: 1.06-2.26). CONCLUSIONS: Higher household income, smaller family size, and urbanization at birth were associated with increased KD incidence. This study, however, did not find a significant association between lack of exposure to infection in early life and onset of KD.

DOI： 10.1016/j.annepidem.2018.10.010

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We investigated the circulation patterns of human influenza A and B viruses in Myanmar between 2010 and 2015 by analyzing full HA genes. Upper respiratory tract specimens were collected from patients with symptoms of influenza-like illness. A total of 2,860 respiratory samples were screened by influenza rapid diagnostic test, of which 1,577 (55.1%) and 810 (28.3%) were positive for influenza A and B, respectively. Of the 1,010 specimens that were positive for virus isolation, 370 (36.6%) were A(H1N1)pdm09, 327 (32.4%) were A(H3N2), 130 (12.9%) B(Victoria), and 183 (18.1%) were B(Yamagata) viruses. Our data showed that influenza epidemics mainly occurred during the rainy season in Myanmar. Our three study sites, Yangon, Pyinmana, and Pyin Oo Lwin had similar seasonality and circulating type and subtype of influenza in a given year. Moreover, viruses circulating in Myanmar during the study period were closely related genetically to those detected in Thailand, India, and China. Phylogeographic analysis showed that A(H1N1)pdm09 viruses in Myanmar originated from Europe and migrated to other countries via Japan. Similarly, A(H3N2) viruses in Myanmar originated from Europe, and disseminated to the various countries via Australia. In addition, Myanmar plays a key role in reseeding of influenza B viruses to Southeast Asia and East Asia as well as Europe and Africa. Thus, we concluded that influenza virus in Myanmar has a strong link to neighboring Asian countries, Europe and Oceania.

DOI： 10.1371/journal.pone.0210550

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER JAPAN KK  

We investigated the incidence of hip fracture in patients aged >= 50 years in 2015 in Niigata Prefecture, Japan. We also determined the long-term trend in hip fracture incidence from 1985 to 2015. In 2015, 3214 hip fractures occurred in Niigata Prefecture. The crude incidence rate of hip fracture was 282.7 per 100,000 persons per year (122.9 in men and 416.4 in women). The incidence of hip fracture decreased from 2010 to 2015 in all age groups except in men aged 65-69 years and women aged 60-64 years. The percentage of patients who took anti-osteoporotic medication before their hip fractures increased from 10.2% in 2010 to 14.9% in 2015. The age-specific incidence in women tended to increase until 2010, but significantly decreased from 2010 to 2015 (p < 0.001). Similarly, the incidence in men decreased from 2010 to 2015 but was not significantly different from that in 1994 (p = 0.633); this incidence had been increasing since 1999. In conclusion, a generally increasing trend was observed in the incidence of hip fractures for 30 years in both men and women in Niigata Prefecture; however, it turned into a descending trend beginning in 2010.

DOI： 10.1007/s00774-017-0863-2

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE BV  

Influenza B viruses of both the Yamagata and the Victoria lineages are implicated in a large proportion of the morbidity and mortality associated with influenza outbreaks. In this study, we characterized the full genomes of 53 influenza B viruses isolated during 2012-2015 in three Asian countries: Japan, Myanmar, and Vietnam. Analysis of the hemagglutinin (HA) genes revealed co-circulation of both the Yamagata and Victoria lineages within the same season in these countries. Our analysis revealed, that a large proportion of viruses circulating during 2013-2014 in Japan and Vietnam were mismatched to the vaccine supporting the rationale for using quadrivalent vaccines. Molecular analysis of the neuraminidase (NA) genes did not reveal any of the previously reported substitutions associated with reduced susceptibility to neuraminidase inhibitors (NAIs). However, one isolate from Nagasaki displayed reduced inhibition by NAIs, associated with an NA-M426I substitution (N2-numbering). Phylogenetic analysis of the eight genome segments identified a 6 + 2 reassortant strain belonging to the Victoria lineage that circulated in Japan during the 2013-2014 season. This strain appears to have evolved from a descendent of a B/Brisbane/60/2008-like strain in an intra-lineage reassortment event involving the nucleoprotein (NP) and nonstructural (NS) genes. Therefore, influenza B strains circulating worldwide continue to evolve via complex reassortment events, which contribute to their survival and the emergence of new strains. These findings highlight the need for ongoing genome-wide studies of circulating viruses and assessing the implications of these evolutionary events on the vaccines.

DOI： 10.1016/j.meegid.2018.04.016

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMJ PUBLISHING GROUP  

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. Objectives Influenza infection can cause severe pneumonia, which is sometimes fatal, particularly in older adults. Influenza results in 3-5 million cases of severe illness and about 250 000 to 500 000 deaths annually worldwide. Social participation in the context of influenza infection is controversial because, although social participation is beneficial in maintaining physical function and mental health, it also increases the risk of contact with infected people. This study examined the association between social participation and influenza infection in Japanese adults aged 65 years or older. Design Cross-sectional study. Setting Japanese functionally independent adults aged 65 years or older. Participants Among the respondents to the Japan Gerontological Evaluation Study (JAGES) 2013 survey, which took place during the period from October to December 2013, 12 231 men and 14 091 women responded to questions on influenza vaccination and influenza infection. Outcome measures Using JAGES data for 12 231 men and 14 091 women aged ≥65 years, we examined the association between social participation and influenza infection. The association between influenza infection and number of groups in which respondents participated was investigated among adults aged≥65 years, stratified by vaccination status and sex. Results Unvaccinated women who participated in two or more social activities were 2.20 times (95% CI 1.47 to 3.29) as likely to report an influenza infection as those who reported no social participation. In contrast, vaccinated women who participated in two or more social groups had no additional risk of influenza infection as compared with female elders with no social participation. Among men, participation in social activities was not significantly associated with influenza infection, regardless of vaccination status. Conclusions Social participation was associated with a higher risk of influenza infection among unvaccinated older women, which suggests a need for further efforts to promote influenza vaccination, particularly among socially active elderly women.

DOI： 10.1136/bmjopen-2017-016876

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We investigated the genetic diversity, the circulation patterns, and risk for hospital admission of human respiratory syncytial virus (HRSV) strains in Japan between 2012 through 2015. During the study period, 744 HRSV-positive cases were identified by rapid diagnostic test. Of these, 572 samples were positive by real-time PCR; 400 (69.9%) were HRSV-A, and 172 (30.1%) were HRSV-B. HRSV-A and -B alternated as the dominant strain in the subsequent seasons. Phylogenetic tree analysis of the second hyper-variable region of the G protein classified the HRSV-A specimens into NA1 (n = 242) and ON1 (n = 114) genotypes and the HRSV-B specimens into BA9 (n = 60), and BA10 (n = 27). The ON1 genotype, containing a 72-nucleotide duplication in the G protein's second hyper-variable region, was first detected in the 2012-2013 season but it predominated and replaced the older NA1 HRSV-A in the 2014-2015 season, which also coincided with a record number of HRSV cases reported to the National Infectious Disease Surveillance in Japan. The risk of hospitalization was 6.9 times higher for the ON1 genotype compared to NA1. In conclusion, our data showed that the emergence and predominance of the relatively new ON1 genotype in Japan was associated with a record high number of cases and increased risk for hospitalization.

DOI： 10.1371/journal.pone.0192085

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

Background: Although living in a hilly environment may promote muscular activity in the daily lives of residents, and such activity may prevent diabetes mellitus, few studies have focused on the impact of living in a hilly environment on diabetes mellitus. The purpose of this study was to investigate the impact of a hilly neighborhood environment on DM in older people.Methods: We used data from the Japan Gerontological Evaluation Study, a population-based, cross-sectional study of individuals aged 65 or older without long-term care needs in Japan, which was conducted in 2010. A total of 8904 participants in 46 neighborhoods had responded to the questionnaire and undergone a health check. Diabetes mellitus was diagnosed as HbA(1c) >= 6.5% and those undergoing treatment for diabetes mellitus. Poorly controlled diabetes mellitus was diagnosed in those without other chronic diseases who had an HbA(1c) > 7.5%, and in those with other chronic diseases if their HbA(1c) was > 8.0%. Neighborhood environment was evaluated based on the percentage of positive responses in the questionnaire and geographical information system data. A multilevel analysis was performed, adjusted for individual-level risk factors. Furthermore, sensitivity analysis was conducted for those who were undergoing treatment for diabetes mellitus (n = 1007).Results: After adjustment for other physical environmental and individual covariates, a 1 interquartile range increase (1.48 degrees) in slope in the neighborhood decreased the risk of poorly controlled diabetes mellitus by 18% (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.70-0.97). Sensitivity analysis confirmed that larger slopes in the neighborhood showed a significant protective effect against diabetes mellitus among those who were undergoing treatment for diabetes mellitus (OR: 0.73, 95% CI: 0.59-0.90).Conclusion: A hilly neighborhood environment was not associated with diabetes mellitus, but was protective against poorly controlled diabetes mellitus. (C) 2017 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.socscimed.2017.04.008

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BACKGROUND: Although living in a hilly environment may promote muscular activity in the daily lives of residents, and such activity may prevent diabetes mellitus, few studies have focused on the impact of living in a hilly environment on diabetes mellitus. The purpose of this study was to investigate the impact of a hilly neighborhood environment on DM in older people. METHODS: We used data from the Japan Gerontological Evaluation Study, a population-based, cross-sectional study of individuals aged 65 or older without long-term care needs in Japan, which was conducted in 2010. A total of 8904 participants in 46 neighborhoods had responded to the questionnaire and undergone a health check. Diabetes mellitus was diagnosed as HbA1c ≥ 6.5% and those undergoing treatment for diabetes mellitus. Poorly controlled diabetes mellitus was diagnosed in those without other chronic diseases who had an HbA1c > 7.5%, and in those with other chronic diseases if their HbA1c was >8.0%. Neighborhood environment was evaluated based on the percentage of positive responses in the questionnaire and geographical information system data. A multilevel analysis was performed, adjusted for individual-level risk factors. Furthermore, sensitivity analysis was conducted for those who were undergoing treatment for diabetes mellitus (n = 1007). RESULTS: After adjustment for other physical environmental and individual covariates, a 1 interquartile range increase (1.48°) in slope in the neighborhood decreased the risk of poorly controlled diabetes mellitus by 18% (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.70-0.97). Sensitivity analysis confirmed that larger slopes in the neighborhood showed a significant protective effect against diabetes mellitus among those who were undergoing treatment for diabetes mellitus (OR: 0.73, 95% CI: 0.59-0.90). CONCLUSION: A hilly neighborhood environment was not associated with diabetes mellitus, but was protective against poorly controlled diabetes mellitus.

DOI： 10.1016/j.socscimed.2017.04.008

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY  

AimSerum glycosylated Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA(+)-M2BP) is a reliable, non-invasive marker of liver fibrosis. This study assessed the ability of WFA(+)-M2BP to diagnose liver fibrosis in patients with chronic hepatitis B virus (HBV) infection and evaluated WFA(+)-M2BP as a predictor of hepatocellular carcinoma (HCC) development.MethodsSerum WFA(+)-M2BP values were retrospectively evaluated in 112 treatment-naive patients with HBV-related chronic hepatitis and cirrhosis who had undergone liver biopsy at our hospital.ResultsSerum WFA(+)-M2BP levels were significantly related with liver fibrosis (r=0.3725, P=0.001). Fibrosis stage F2, F3, and F4 had a cut-off index of 0.94, 1.26, and 1.26, respectively. For diagnosing F2 fibrosis, the area under the receiver-operating characteristic curve for WFA(+)-M2BP was 0.713 and comparable with those of other non-invasive fibrosis markers, such as hyaluronic acid, type IV collagen 7S, aspartate aminotransferase-to-platelet ratio index, fibrosis-4 index, serum albumin, and platelet count. Multivariate analysis identified male, WFA(+)-M2BP 0.71, alanine aminotransferase 80IU/L, and platelet count <14.5x10(9)/L as independent risk factors for the development of HCC in patients with HBV infection.ConclusionsSerum WFA(+)-M2BP values appear to be useful for assessing liver fibrosis stage and are independently associated with HCC development in patients with chronic HBV infection.

DOI： 10.1111/hepr.12712

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Language：Japanese   Publisher：Japanese Society of Public Health  

<p><b>Objectives</b> Personal income affects dental status in older people. However, the impact of income inequality on dental status at the community level (junior high school district) is unclear. The purpose of this study was to examine the association between dental status and community level income inequity after adjust for individual socio-economic status in Japanese older adults, and to verify the relative income hypothesis, also known as the Wilkinson hypothesis.</p><p><b>Methods</b> We used data from the Japan Gerontological Evaluation Study (JAGES) conducted in Niigata city. JAGES is a postal survey of functionally independent adults aged 65 years or older. We enrolled 4,983 respondents (response rate 62.3%) and used data on 3,980 of them after excluding incomplete data. We evaluated health condition and socio-economic status using questionnaires. The Gini coefficient, as an indicator of income inequality, was calculated by junior high school district (57 districts) based on the data from the questionnaire. Additionally, the Pearson's coefficient of correlation was calculated to evaluate the association between the mean number of remaining teeth and the community level Gini coefficient. Then we evaluated the mean number of remaining teeth among the groups stratified by the Gini coefficient conditions. Next, we conducted a multilevel analysis using an ordinal logistic regression model. The number of remaining teeth was set as the dependent variable, while sex, age, household size, education, smoking status, diabetes treatment, current living conditions, and equivalent income were used as independent variables at the individual level. The Gini coefficient and average equivalent income in the junior high school district were used as independent variables at the community level.</p><p><b>Results</b> The Pearson's correlation coefficient for the relationship between the Gini coefficient and the mean number of remaining teeth in the junior high school district was −0.44 (<i>P</i><0.01). Wider income disparity area (Gini coefficient≧0.35) revealed a significantly small number of remaining teeth (<i>P</i><0.001). The multilevel analysis showed that a higher Gini coefficient and a lower average equivalent income at the community level were significantly associated with a lower number of remaining teeth, and with educational attainment, smoking status, current living conditions, and equivalent income at the individual level, after adjusting for sex and age. On the other hand, educational attainment at the individual level, and average equivalent income at the community level were not significant factors after adjusting for all individual level variables.</p><p><b>Conclusion</b> This study showed that, in addition to individual socio-economic status, income inequality at the community level was significantly associated with number of remaining teeth in Japanese older adults. Although the precise mechanism of this association is still unclear, our result supports the relative income hypothesis.</p>

DOI： 10.11236/jph.64.4_190

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Publishing type：Research paper (international conference proceedings)   Publisher：Journal of the Physical Society of Japan  

DOI： 10.7566/jpscp.11.070007

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIOMED CENTRAL LTD  

© 2016 The Author(s). Background: Influenza A viruses of swine (IAV-S) cause acute and subclinical respiratory disease. To increase our understanding of the etiology of the subclinical form and thus help prevent the persistence of IAV-S in pig populations, we conducted active virologic surveillance in Vietnam, the second-largest pig-producing country in Asia, from February 2010 to December 2013. Results: From a total of 7034 nasal swabs collected from clinically healthy pigs at 250 farms and 10 slaughterhouses, we isolated 172 IAV-S from swine at the weaning and early-fattening stages. The isolation rate of IAV-S was significantly higher among pigs aged 3 weeks to 4.5 months than in older and younger animals. IAV-S were isolated from 16 large, corporate farms and 6 family-operated farms from among the 250 farms evaluated. Multivariate logistic regression analysis revealed that "having more than 1,000 pigs" was the most influential risk factor for IAV-S positivity. Farms affected by reassortant IAV-S had significantly larger pig populations than did those where A(H1N1)pdm09 viruses were isolated, thus suggesting that large, corporate farms serve as sites of reassortment events. Conclusions: We demonstrate the asymptomatic circulation of IAV-S in the Vietnamese pig population. Raising a large number of pigs on a farm has the strongest impact on the incidence of subclinical IAV-S infection. Given that only some of the corporate farms surveyed were IAV-S positive, further active monitoring is necessary to identify additional risk factors important in subclinical infection of pigs with IAV-S in Vietnam.

DOI： 10.1186/s12917-016-0844-z

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Publishing type：Research paper (scientific journal)   Publisher：Informa {UK} Limited  

DOI： 10.1080/2373566x.2016.1238721

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BackgroundLow serum albumin levels are associated with aging and medical conditions such as cancer, liver dysfunction, inflammation, and malnutrition and might be an independent predictor of long-term mortality in healthy older populations. We tested the hypothesis that economic status is associated with serum albumin levels and explained by nutritional and health status in Japanese older adults.DesignWe performed a cross-sectional analysis using data from the Japan Gerontological Evaluation study (JAGES). The study participants were 6528 functionally independent residents (3189 men and 3339 women) aged >= 65 years living in four municipalities in Aichi prefecture. We used household income as an indicator of economic status. Multiple linear regression was used to compare serum albumin levels in relation to household income, which was classified as low, middle, and high. Additionally, mediation by nutritional and health-related factors was analyzed in multivariable models.ResultsWith the middle-income group as reference, participants with low incomes had a significantly lower serum albumin level, even after adjustment for sex, age, residential area, education, marital status, and household structure. The estimated mean difference was -0.17 g/L (95% confidence interval, -0.33 to -0.01 g/L). The relation between serum albumin level and low income became statistically insignificant when "body mass index", "consumption of meat or fish", "self-rated health", "presence of medical conditions", "hyperlipidemia", or "respiratory disease "was included in the model.ConclusionSerum albumin levels were lower in Japanese older adults with low economic status. The decrease in albumin levels appears to be mediated by nutrition and health-related factors with low household incomes. Future studies are needed to reveal the existence of other pathways.

DOI： 10.1371/journal.pone.0155022

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：FRONTIERS MEDIA SA  

Influenza A viruses evolve at a high rate requiring continuous monitoring to maintain the efficacy of vaccines and antiviral drugs. We performed next generation sequencing analysis of 100 influenza A/H3N2 isolates collected in four Asian countries (Japan, Lebanon, Myanmar, and Vietnam) during 2012-2015. Phylogenetic analysis revealed several reassortment events leading to the circulation of multiple clades within the same season. This was particularly evident during the 2013 and 2013/2014 seasons. Importantly, our data showed that certain lineages appeared to be fitter and were able to persist into the following season. The majority of A/H3N2 viruses continued to harbor the M2-S31N mutation conferring amantadine-resistance. In addition, an S31D mutation in the M2-protein, conferring a similar level of resistance as the S31N mutation, was detected in three isolates obtained in Japan during the 2014/2015 season. None of the isolates possessed the NA-H274Y mutation conferring oseltamivir-resistance, though a few isolates were found to contain mutations at the catalytic residue 151 (D151A/G/N or V) of the NA protein. These variations did not alter the susceptibility to neuraminidase inhibitors and were not detected in the original clinical specimens, suggesting that they had been acquired during their passage in MDCK cells. Novel polymorphisms were detected in the PB1-F2 open-reading frame resulting in truncations in the protein of 24-34 aminoacids in length. Thus, this study has demonstrated the utility of monitoring the full genome of influenza viruses to allow the detection of the potentially fittest lineages. This enhances our ability to predict the strain(s) most likely to persist into the following seasons and predict the potential degree of vaccine match or mismatch with the seasonal influenza season for that year. This will enable the public health and clinical teams to prepare for any related healthcare burden, depending on whether the vaccine match is predicted to be good or poor for that season.

DOI： 10.3389/fmicb.2016.00262

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：TOHOKU UNIV MEDICAL PRESS  

The current School Health and Safety Act in Japan states that children with influenza infection should stay home until day 6th after symptoms onset. This was an amendment of a previous version recommending school return on day 3 after defervescence. Here, we investigated the duration of fever and virus shedding after laninamivir treatment in 7 children infected with influenza A(H3N2) virus and 21 children with influenza B virus in relation to the school return timing recommended by the School Health and Safety Act during the 2011-2012 influenza season. Nasal discharge was collected on the first, second, and third hospital visits and virus titers were assessed by virus culture and real-time PCR. Duration of fever after laninamivir treatment was 1 day longer for influenza B than for influenza A(H3N2). Virus detection rates with 50% tissue culture infectious dose and viral RNA were highest at the first visit and gradually decreased at subsequent visits. Virus positivity rates were detectable at the time of defervescence in less than half of the enrolled patients (14.3-42.9%). Virus shedding rates were similarly low (0.0-19.0%) on day 3 or later from defervescence and on day 6 or later from fever onset (school return dates per the old and current School Health and Safety Act) regardless of the influenza type. In conclusion, despite the higher efficacy of laninamivir against A(H3N2) viruses than B viruses, viral shedding is low after return to school for both types, regardless of the version of the School Health and Safety Act.

DOI： 10.1620/tjem.238.113

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Language：Japanese   Publisher：(一財)厚生労働統計協会  

目的 高齢者における中学校区別の肺炎球菌ワクチン接種率に関する調査を行い,接種率の背景要因について個人要因と環境要因の双方から実態を明らかにし,定期接種化された後に接種率の向上に必要な取り組みについて検討した。方法 N市在住の65歳以上の住民を対象として,要支援・要介護認定を受けていない8,000名の高齢者に郵送法で無記名自記式アンケート調査を実施した。57中学校区別に接種率を求め,住民構成を調整した後の地域差を分析した。接種の有無に関連する個人要因についてロジスティック回帰分析に加え,中学校区別の相関分析,個人と校区別集団の2つのレベルでマルチレベル相関分析を実施し,さらに,クラスタ標準誤差を使ったロジスティック回帰分析を行い,集団レベルの環境要因の影響も加味して接種率の地域差を評価した。結果 肺炎球菌ワクチンの接種率は13.5%(男性14.5%,女性12.5%)で,男性の方が若干高い値であった。年代別では,男女とも前期高齢者では10%以下であり,80〜84歳では20%を超えていた。中学校区別の接種率では,5%以下の地域が4ヶ所ある一方で20%を超える地域も2ヶ所存在し,性別と年齢を調整した後においても有意(P&lt;0.01)な接種状況の地域差が認められた。ロジスティック回帰分析の結果,ワクチン接種を促進する要因として,高い年齢(P&lt;0.01),低い主観的健康感(P&lt;0.05),呼吸器疾患あり(P&lt;0.01)が認められた。相関分析で中学校区別の接種率と関連する要因は認めず,マルチレベル相関分析において個人レベルでのみ,高い年齢,低い主観的健康感,呼吸器疾患あり,短い教育年数が接種ありと有意に相関した(P&lt;0.01)。また,地域レベルの変数を説明変数に加えクラスタ標準誤差を使ったロジスティック回帰分析において,環境要因として中学校区別の教育年数や所得格差は有意ではなく,個人レベルの年齢,主観的健康感や呼吸器疾患の有無とは異なり,ワクチン接種に与える影響は認められなかった。結論 高齢で主観的健康感が優れず呼吸器疾患を持った住民が多い地域において,肺炎球菌ワクチンの接種率が高く,調査した範囲で接種の有無に環境要因の影響は認められなかった。また,健康リテラシーが高いと推定される教育年数が長い集団ほど接種率は低い傾向が認められたことから,ワクチンの有用性について広く啓発活動を実施し,現在の健康状態に過信することなくワクチン接種を推奨する取り組みが求められている。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER JAPAN KK  

Data of long-term efficacy and safety including bleeding risk associated with antithrombotic regimens after primary percutaneous coronary intervention (PCI) using first-generation drug-eluting stent (1st DES) are scarce. Consecutive 422 patients with ST-elevation myocardial infarction (STEMI) underwent primary PCI with DES (285 patients), bare metal stent (BMS, 58 patients) or balloon angioplasty (BA 79 patients). At a median follow-up of 44 months, major cardiovascular events were significantly lower for 1st DES compared with BMS and BA (11.9 vs. 25.9 vs. 16.5 %, p = 0.027). Cardiac death, recurrent myocardial infarction and target lesion revascularization (TLR), differed among the groups (DES 8.8 %; BMS 13.8 %; BA 17.7 %; p = 0.019), although the superiority of DES subsided beyond 1 year by increased late TLRs. Major bleedings were not higher in DES than in BMS and BA (4.6 vs. 6.9 vs. 1.5 %, p = 0.252). Multivariate logistic regression analysis revealed that both dual antiplatelet therapy (DAPT)[ 24 months and indefinite oral anticoagulation (OAC) were associated with a major bleeding. The risk was even greater with triple antithrombotic therapy (odds ratio 19.5; 95 % confidence interval 3.73-102.07; p < 0.0001). 1st DES showed favorable overall long-term clinical outcome in STEMI, with an inherent limitation of an increased risk of late TLR. Prolonged DAPT and OAC synergistically increase the risk of major bleeding after primary PCI.

DOI： 10.1007/s12928-014-0306-0

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：CAMBRIDGE UNIV PRESS  

We studied the spatial trend of norovirus (NoV) epidemics using sentinel gastroenteritis surveillance data for patients aged &lt; 15 years (n= 140) in the Tokyo area for the 2006-2007 to 2008-2009 seasons utilizing the kriging method of geographical information system (GIS). This is the first study of the spreading pattern of NoV epidemics using sentinel surveillance data. Correlations of sentinel cases between the seasons and with demographic data were examined to identify the trend and related factors. A similar pattern of diffusion was observed over the seasons, and its mean correlation between seasons was significantly high. A higher number of cases were found in the peripheral area, which surrounds the most populated central area, and showed a correlation with the ratio of the children population (r = 0.321, P &lt; 0.01) and the ratio of residents in larger families (r = 0.263, P &lt; 0.01). While NoV susceptibility remained, the results suggest a transmission route in the local community as a possible epidemic factor. Prevention with focus on the peripheral area is desirable.

DOI： 10.1017/S0950268814000697

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：TOHOKU UNIV MEDICAL PRESS  

Influenza vaccination is considered the single most important medical intervention for the prevention of influenza. The dose of trivalent influenza vaccine in children was increased almost double since 2011/12 season in Japan. We estimated the influenza vaccine effectiveness for children 1-11 years of age using rapid test kits in Isahaya City, involving 28,884 children-years, over two consecutive influenza seasons (2011/12 and 2012/13). Children were divided into two groups, vaccinated and unvaccinated, according to their vaccination record, which was obtained from an influenza registration program organized by the Isahaya Medical Association for all pediatric facilities in the city. There were 14,562 and 14,282 children aged from 1-11 years in the city in 2011 and 2012 respectively. In the 2011/12 season, the overall vaccine effectiveness in children from 1-11 years of age, against influenza A and B were 23% [95% confidence interval (Cl): 14%-31%] and 20% [95% CI: 8%-31%], respectively. In the 2012/13 season, vaccine effectiveness against influenza A and B was 13% (95% Cl: 4%-20%) and 9% (95% Cl: 4%-21%), respectively. The vaccine effectiveness was estimated using the rapid diagnosis test kits. Age-stratified estimation showed that vaccine effectiveness was superior in younger children over both seasons and for both virus types. In conclusion, the trivalent influenza vaccine has a significant protective effect for children 1-11 years of age against influenza A and B infection in the 2011/12 season and against influenza A infection in the 2012/13 season in a community in Japan.

DOI： 10.1620/tjem.232.97

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Influenza vaccination is considered the single most important medical intervention for the prevention of influenza. The dose of trivalent influenza vaccine in children was increased almost double since 2011/12 season in Japan. We estimated the influenza vaccine effectiveness for children 1-11 years of age using rapid test kits in Isahaya City, involving 28,884 children-years, over two consecutive influenza seasons (2011/12 and 2012/13). Children were divided into two groups, vaccinated and unvaccinated, according to their vaccination record, which was obtained from an influenza registration program organized by the Isahaya Medical Association for all pediatric facilities in the city. There were 14,562 and 14,282 children aged from 1-11 years in the city in 2011 and 2012 respectively. In the 2011/12 season, the overall vaccine effectiveness in children from 1-11 years of age, against influenza A and B were 23% [95% confidence interval (CI): 14%-31%] and 20% [95% CI: 8%-31%], respectively. In the 2012/13 season, vaccine effectiveness against influenza A and B was 13% (95% CI: 4%-20%) and 9% (95% CI: -4%-21%), respectively. The vaccine effectiveness was estimated using the rapid diagnosis test kits. Age-stratified estimation showed that vaccine effectiveness was superior in younger children over both seasons and for both virus types. In conclusion, the trivalent influenza vaccine has a significant protective effect for children 1-11 years of age against influenza A and B infection in the 2011/12 season and against influenza A infection in the 2012/13 season in a community in Japan.

DOI： 10.1620/tjem.232.97

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Two new influenza virus neuraminidase inhibitors (NAIs), peramivir and laninamivir, were approved in 2010 which resulted to four NAIs that were used during the 2010-2011 influenza season in Japan. This study aims to monitor the susceptibility of influenza virus isolates in 2009-2010 and 2010-2011 influenza seasons in Japan to the four NAIs using the fluorescence-based 50% inhibitory concentration (IC₅₀) method. Outliers were identified using box-and-whisker plot analysis and full NA gene sequencing was performed to determine the mutations that are associated with reduction of susceptibility to NAIs. A total of 117 influenza A(H1N1)pdm09, 59 A(H3N2), and 18 type B viruses were tested before NAI treatment and eight A(H1N1)pdm09 and 1 type B viruses were examined from patients after NAI treatment in the two seasons. NA inhibition assay showed type A influenza viruses were more susceptible to NAIs than type B viruses. The peramivir and laninamivir IC₅₀ values of both type A and B viruses were significantly lower than the oseltamivir and zanamivir IC₅₀ values. Among influenza A(H1N1)pdm09 viruses, the prevalence of H274Y viruses increased from 0% in the 2009-2010 season to 3% in the 2010-2011 season. These H274Y viruses were resistant to oseltamivir and peramivir with 200-300 fold increase in IC₅₀ values but remained sensitive to zanamivir and laninamivir. Other mutations in NA, such as I222T and M241I were identified among the outliers. Among influenza A(H3N2) viruses, two outliers were identified with D151G and T148I mutations, which exhibited a reduction in susceptibility to oseltamivir and zanamivir, respectively. Among type B viruses, no outliers were identified to the four NAIs. For paired samples that were collected before and after drug treatment, three (3/11; 27.3%) H274Y viruses were identified among A(H1N1)pdm09 viruses after oseltamivir treatment but no outliers were found in the laninamivir-treatment group (n=3). Despite widespread use of NAIs in Japan, the prevalence of NAI-resistant influenza viruses is still low.

DOI： 10.1016/j.antiviral.2013.06.003

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE BV  

Two new influenza virus neuraminidase inhibitors (NAIs), peramivir and laninamivir, were approved in 2010 which resulted to four NAIs that were used during the 2010-2011 influenza season in Japan. This study aims to monitor the susceptibility of influenza virus isolates in 2009-2010 and 2010-2011 influenza seasons in Japan to the four NAIs using the fluorescence-based 50% inhibitory concentration (IC50) method. Outliers were identified using box-and-whisker plot analysis and full NA gene sequencing was performed to determine the mutations that are associated with reduction of susceptibility to NAIs. A total of 117 influenza A(H1N1)pdm09, 59 A(H3N2), and 18 type B viruses were tested before NAI treatment and eight A(H1N1)pdm09 and 1 type B viruses were examined from patients after NAI treatment in the two seasons. NA inhibition assay showed type A influenza viruses were more susceptible to NAIs than type B viruses. The peramivir and laninamivir IC50 values of both type A and B viruses were significantly lower than the oseltamivir and zanamivir IC50 values. Among influenza A(H1N1)pdm09 viruses, the prevalence of H274Y viruses increased from 0% in the 2009-2010 season to 3% in the 2010-2011 season. These H274Y viruses were resistant to oseltamivir and peramivir with 200-300 fold increase in IC50 values but remained sensitive to zanamivir and laninamivir. Other mutations in NA, such as I222T and M2411 were identified among the outliers. Among influenza A(H3N2) viruses, two outliers were identified with D151G and T1481 mutations, which exhibited a reduction in susceptibility to oseltamivir and zanamivir, respectively. Among type B viruses, no outliers were identified to the four NAIs. For paired samples that were collected before and after drug treatment, three (3111; 27.3%) H274Y viruses were identified among A(H1N1)pdm09 viruses after oseltamivir treatment but no outliers were found in the laninamivir-treatment group (n = 3). Despite widespread use of NAIs in Japan, the prevalence of NAI-resistant influenza viruses is still low. (C) 2013 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.antiviral.2013.06.003

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Background: Norovirus (NoV) is a major cause of gastroenteritis during the autumn and winter seasons in Japan as well as in other temperate climate regions. Most outbreaks are thought to occur by secondary attacks through person-to-person infection by fecal-oral route. Severe cases are found in young children or patients with chronic diseases. Clarifying the patterns of epidemic diffusion is important for considering effective monitoring and surveillance as well as possible prevention.Methods: We considered the predominant viral genotype from the laboratory result obtained from Infectious Agents Surveillance Report (IASR) of National Institute of Infectious Diseases (NIID). We investigated the increase of NoV cases nationwide for the 2006-07 to 2008-09 seasons using sentinel gastroenteritis data collected from about 3000 pediatric clinics on National Epidemiological Surveillance of Infectious Diseases (NESID) acquired from the kriging method in the geographic information system (GIS).Results: During these three seasons, the majority of the detected virus was GII.4, which ranged from 60.4 to 88.9%. The number of cases (per sentinel site) at the peak week was 22.81 in the 2006-07 season and it decreased in the following seasons. NoV cases began to increase earlier in the southern areas and gradually extended into the northern areas, similarly, over the seasons. The average period from when the increase of cases was detected in the southern area to when it reached the northern area was 12.7 weeks.Conclusion: The decrease of the number of sentinel cases at the peak week may suggest the development of herd immunity after a period of high prevalence. Although the NoV epidemic is thought to be associated with cold weather, its cases first increased in the southern area with relatively warm temperature, indicating there are other climate factors involved. Geographic study using the sentinel data could enhance the monitoring and surveillance of and preparedness against epidemics.

DOI： 10.1371/journal.pone.0071696

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The clinical effectiveness of the newly released neuraminidase inhibitors (NAIs) laninamivir and peramivir has not been sufficiently evaluated in influenza-infected patients in clinical and practical settings. In this study, we analyzed the clinical data of 211 patients infected with influenza A virus subtype H3N2 (A(H3N2)) and 45 patients infected with influenza A virus subtype H1N1pdm (A(H1N1)pdm09) who received the NAIs oseltamivir, zanamivir, laninamivir, or peramivir during the 2010-2011 influenza season. The duration of fever from the first dose of the NAI to fever alleviation to <37.5 °C was evaluated as an indicator of the clinical effectiveness of the NAIs in the influenza-infected patients. For the A(H3N2)-infected patients, Kaplan-Meier analysis showed the peramivir treatment group had the fastest time of fever alleviation to <37.5 °C (median 17.0 h, 95 % confidence interval [CI] 7.2-26.8 h) of the four treatment groups. No significant difference was found in the time to fever alleviation among the other antivirals, oseltamivir, zanamivir, and laninamivir. Results of multivariate analysis, using a Cox proportional-hazards model (hazard ratio 3.321) adjusted for the factors age, sex, body weight, vaccination status, time from onset to the clinic visit, and body temperature showed significantly faster fever alleviation in the peramivir treatment group compared with the oseltamivir treatment group. For the A(H1N1)pdm09-infected patients, only the oseltamivir and zanamivir treatment groups were compared, and no significant difference in time to alleviation of fever was observed between the two groups. Based on a cycling probe real-time polymerase chain reaction (PCR) assay, none of the A(H1N1)pdm09 strains in this study had the H275Y mutation conferring oseltamivir resistance. Further evaluation of the clinical effectiveness of the newly released NAIs for influenza-infected patients, including those infected with A(H1N1)pdm09, is needed.

DOI： 10.1007/s10156-012-0428-1

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE BV  

The clinical effectiveness of the newly released neuraminidase inhibitors (NAIs) laninamivir and peramivir has not been sufficiently evaluated in influenza-infected patients in clinical and practical settings. In this study, we analyzed the clinical data of 211 patients infected with influenza A virus subtype H3N2 (A(H3N2)) and 45 patients infected with influenza A virus subtype H1N1pdm (A(H1N1)pdm09) who received the NAIs oseltamivir, zanamivir, laninamivir, or peramivir during the 2010-2011 influenza season. The duration of fever from the first dose of the NAI to fever alleviation to <37.5 C was evaluated as an indicator of the clinical effectiveness of the NAIs in the influenza-infected patients. For the A(H3N2)-infected patients, Kaplan-Meier analysis showed the peramivir treatment group had the fastest time of fever alleviation to <37.5 C (median 17.0 h, 95 % confidence interval [CI] 7.2-26.8 h) of the four treatment groups. No significant difference was found in the time to fever alleviation among the other antivirals, oseltamivir, zanamivir, and laninamivir. Results of multivariate analysis, using a Cox proportional-hazards model (hazard ratio 3.321) adjusted for the factors age, sex, body weight, vaccination status, time from onset to the clinic visit, and body temperature showed significantly faster fever alleviation in the peramivir treatment group compared with the oseltamivir treatment group. For the A(H1N1)pdm09-infected patients, only the oseltamivir and zanamivir treatment groups were compared, and no significant difference in time to alleviation of fever was observed between the two groups. Based on a cycling probe real-time polymerase chain reaction (PCR) assay, none of the A(H1N1)pdm09 strains in this study had the H275Y mutation conferring oseltamivir resistance. Further evaluation of the clinical effectiveness of the newly released NAIs for influenza-infected patients, including those infected with A(H1N1)pdm09, is needed. © 2012 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases.

DOI： 10.1007/s10156-012-0428-1

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIOMED CENTRAL LTD  

Background: Annual influenza epidemics occur worldwide resulting in considerable morbidity and mortality. Spreading pattern of influenza is not well understood because it is often hampered by the quality of surveillance data that limits the reliability of analysis. In Japan, influenza is reported on a weekly basis from 5,000 hospitals and clinics nationwide under the scheme of the National Infectious Disease Surveillance. The collected data are available to the public as weekly reports which were summarized into number of patient visits per hospital or clinic in each of the 47 prefectures. From this surveillance data, we analyzed the spatial spreading patterns of influenza epidemics using weekly weighted standard distance (WSD) from the 1999/2000 through 2008/2009 influenza seasons in Japan. WSD is a single numerical value representing the spatial compactness of influenza outbreak, which is small in case of clustered distribution and large in case of dispersed distribution.Results: We demonstrated that the weekly WSD value or the measure of spatial compactness of the distribution of reported influenza cases, decreased to its lowest value before each epidemic peak in nine out of ten seasons analyzed. The duration between the lowest WSD week and the peak week of influenza cases ranged from minus one week to twenty weeks. The duration showed significant negative association with the proportion of influenza A/H3N2 cases in early phase of each outbreak (correlation coefficient was -0.75, P = 0.012) and significant positive association with the proportion of influenza B cases in the early phase (correlation coefficient was 0.64, P = 0.045), but positively correlated with the proportion of influenza A/H1N1 strain cases (statistically not significant). It is assumed that the lowest WSD values just before influenza peaks are due to local outbreak which results in small standard distance values. As influenza cases disperse nationwide and an epidemic reaches its peak, WSD value changed to be a progressively increasing.Conclusions: The spatial distribution of nationwide influenza outbreak was measured by using a novel WSD method. We showed that spreading rate varied by type and subtypes of influenza virus using WSD as a spatial indicator. This study is the first to show a relationship between influenza epidemic trend by type/subtype and spatial distribution of influenza nationwide in Japan. © 2012 Shobugawa et al.; licensee BioMed Central Ltd.

DOI： 10.1186/1476-072X-11-20

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIOMED CENTRAL LTD  

BACKGROUND: Annual influenza epidemics occur worldwide resulting in considerable morbidity and mortality. Spreading pattern of influenza is not well understood because it is often hampered by the quality of surveillance data that limits the reliability of analysis. In Japan, influenza is reported on a weekly basis from 5,000 hospitals and clinics nationwide under the scheme of the National Infectious Disease Surveillance. The collected data are available to the public as weekly reports which were summarized into number of patient visits per hospital or clinic in each of the 47 prefectures. From this surveillance data, we analyzed the spatial spreading patterns of influenza epidemics using weekly weighted standard distance (WSD) from the 1999/2000 through 2008/2009 influenza seasons in Japan. WSD is a single numerical value representing the spatial compactness of influenza outbreak, which is small in case of clustered distribution and large in case of dispersed distribution. RESULTS: We demonstrated that the weekly WSD value or the measure of spatial compactness of the distribution of reported influenza cases, decreased to its lowest value before each epidemic peak in nine out of ten seasons analyzed. The duration between the lowest WSD week and the peak week of influenza cases ranged from minus one week to twenty weeks. The duration showed significant negative association with the proportion of influenza A/H3N2 cases in early phase of each outbreak (correlation coefficient was -0.75, P = 0.012) and significant positive association with the proportion of influenza B cases in the early phase (correlation coefficient was 0.64, P = 0.045), but positively correlated with the proportion of influenza A/H1N1 strain cases (statistically not significant). It is assumed that the lowest WSD values just before influenza peaks are due to local outbreak which results in small standard distance values. As influenza cases disperse nationwide and an epidemic reaches its peak, WSD value changed to be a progressively increasing. CONCLUSIONS: The spatial distribution of nationwide influenza outbreak was measured by using a novel WSD method. We showed that spreading rate varied by type and subtypes of influenza virus using WSD as a spatial indicator. This study is the first to show a relationship between influenza epidemic trend by type/subtype and spatial distribution of influenza nationwide in Japan.

DOI： 10.1186/1476-072X-11-20

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Background: Pandemic influenza A(H1N1) 2009 virus was first detected in Japan in May 2009 and continued to circulate in the 2010-2011 season. This study aims to characterize human influenza viruses circulating in Japan in the pandemic and post-pandemic periods and to determine the prevalence of antiviral-resistant viruses.Methods: Respiratory specimens were collected from patients with influenza-like illness on their first visit at outpatient clinics during the 2009-2010 and 2010-2011 influenza seasons. Cycling probe real-time PCR assays were performed to screen for antiviral-resistant strains. Sequencing and phylogenetic analysis of the HA and NA genes were done to characterize circulating strains.Results and Conclusion: In the pandemic period (2009-2010), the pandemic influenza A(H1N1) 2009 virus was the only circulating strain isolated. None of the 601 A(H1N1) pdm09 virus isolates had the H275Y substitution in NA (oseltamivir resistance) while 599/601 isolates (99.7%) had the S31N substitution in M2 (amantadine resistance). In the post-pandemic period (2010-2011), cocirculation of different types and subtypes of influenza viruses was observed. Of the 1,278 samples analyzed, 414 (42.6%) were A(H1N1) pdm09, 525 (54.0%) were A(H3N2) and 33 (3.4%) were type-B viruses. Among A(H1N1) pdm09 isolates, 2 (0.5%) were oseltamivir-resistant and all were amantadine-resistant. Among A(H3N2) viruses, 520 (99.0%) were amantadine-resistant. Sequence and phylogenetic analyses of A(H1N1) pdm09 viruses from the post-pandemic period showed further evolution from the pandemic period viruses. For viruses that circulated in 2010-2011, strain predominance varied among prefectures. In Hokkaido, Niigata, Gunma and Nagasaki, A(H3N2) viruses (A/Perth/16/2009-like) were predominant whereas, in Kyoto, Hyogo and Osaka, A(H1N1) pdm09 viruses (A/New_York/10/2009-like) were predominant. Influenza B Victoria(HA)-Yamagata(NA) reassortant viruses (B/Brisbane/60/2008-like) were predominant while a small proportion was in Yamagata lineage. Genetic variants with mutations at antigenic sites were identified in A(H1N1) pdm09, A(H3N2) and type-B viruses in the 2010-2011 season but did not show a change in antigenicity when compared with respective vaccine strains.

DOI： 10.1371/journal.pone.0036455

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Publishing type：Research paper (international conference proceedings)   Publisher：IEEE  

DOI： 10.1109/GHTC.2012.18

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Other Link： https://dblp.uni-trier.de/db/conf/ghtc/ghtc2012.html#KawanoSSGSAOIYKTHSN12

Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER SOC MICROBIOLOGY  

In eight successive seasons (2001 to 2009), a total of 726 human respiratory syncytial virus (HRSV) infections from a total of 1,560 children with acute lower respiratory tract illness were identified. Molecular analysis of the attachment (G) protein gene confirmed that 52 (7.8%) children were infected more than once with any of the 3 genotypes of HRSV-A (genotypes GA5, NA1, and NA2) and/or 6 genotypes of HRSV-B (genotypes BA4, BA5, and BA7 to BA10). Repeated infections in 46 cases (82.1%) occurred in the next season, and only one case occurred in the same season (10-day interval). First infections were 33 (63.5%) HRSV-A cases and 19 (36.5%) HRSV-B cases, whereas second infections occurred in 35 (67.3%) HRSV-A cases and 17 (32.7%) HRSV-B cases. Third infections were attributed to 4 (100.0%) HRSV-A cases. Homologous subgroup reinfections were detected in 28 cases, 23 HRSV-A cases and 5 HRSV-B cases (P = 0.005), whereas homologous genotype reinfections were detected only for 5 HRSV-A cases (2GA5 and 3NA2) but not any HRSV-B case. Heterologous subgroup reinfections were detected in 28 cases, 12 cases from HRSV-A-to-HRSV-B reinfections and 16 cases from HRSV-B-to-HRSV-A reinfections. Genotypes NA1 and NA2 had higher numbers of heterologous genotype infections than did other genotypes. Our observations suggest that repeated infections occur more frequently in HRSV-A strains than in HRSV-B strains, and heterologous genotype reinfections occur more frequently than homologous genotype reinfections, especially in the case of the emerging genotypes NA1 and NA2 of HRSV-A strains that circulated in the community during our study period.

DOI： 10.1128/JCM.02132-10

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMC  

Background: The spread of influenza viruses in a community are influenced by several factors, but no reports have focused on the relationship between the incidence of influenza and characteristics of small neighborhoods in a community. We aimed to clarify the relationship between the incidence of influenza and neighborhood characteristics using GIS and identified the type of small areas where influenza occurs frequently or infrequently.Methods: Of the 19,077 registered influenza cases, we analyzed 11,437 influenza A and 5,193 influenza B cases that were diagnosed by the rapid antigen test in 66-86 medical facilities in Isahaya City, Japan, from 2004 to 2008. We used the commercial geodemographics dataset, Mosaic Japan to categorize and classify each neighborhood. Furthermore, we calculated the index value of influenza in crude and age adjusted rates to evaluate the incidence of influenza by Mosaic segmentation. Additional age structure analysis was performed to geodemographics segmentation to explore the relationship between influenza and family structure.Results: The observed number of influenza A and B patients in the neighborhoods where young couples with small children lived was approximately 10-40% higher than the expected number (p < 0.01) during all seasons. On the contrary, the number of patients in the neighborhoods of the aging society in a rural area was 20-50% lower than the expected number (p < 0.01) during all seasons. This tendency was consistent after age adjustment except in the case of influenza B, which lost significance in higher incidence areas, but the overall results indicated high transmission of influenza in areas where young families with children lived.Conclusions: Our analysis indicated that the incidence of influenza A and B in neighborhood groups is related to the family structure, especially the presence of children in households. Simple statistical analysis of geodemographics data is an effective method to understand the differences in the incidence of influenza among neighborhood groups, and it provides a valuable basis for community strategies to control influenza. © 2011 Kimura et al; licensee BioMed Central Ltd.

DOI： 10.1186/1471-2334-11-36

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Phylogenetic analysis of respiratory syncytial virus (RSV) group B genotype BA strains from the 2002-2003 to 2009-2010 seasons collected in Niigata, Japan, revealed four distinct clusters, designated new BA genotypes BA7, BA8, BA9, and BA10. These new genotypes were not associated with large outbreaks in the community.

DOI： 10.1128/JCM.00646-10

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Human respiratory syncytial virus (HRSV) is a common etiological agent of acute lower respiratory tract disease in infants. We report the molecular epidemiology of HRSV in Niigata, Japan, over six successive seasons (from 2001 to 2007) and the emerging genotypes of HRSV subgroup A (HRSV-A) strains. A total of 488 HRSV samples were obtained from 1,103 screened cases in a pediatric clinic in Niigata. According to the phylogenetic analysis, among the PCR-positive samples, 338 HRSV-A strains clustered into the previously reported genotypes GA5 and GA7 and two novel genotypes, NA1 and NA2, which were genetically close to GA2 strains. One hundred fifty HRSV-B strains clustered into three genotypes, namely, GB3, SAB3, and BA, which has a 60-nucleotide insertion in the second hypervariable region of the G protein. The NA1 strains emerged first, in the 2004-2005 season, and subsequently, the NA2 strain emerged in the 2005-2006 season. Both strains caused large epidemics in the 2005-2006 and 2006-2007 seasons. The average age of children who were infected with NA2 strains was significantly higher than that of those infected with GA5 and the frequency of reinfection by NA2 was the highest among all genotypes, suggesting that this genotype possessed new antigenicity for evading past host immunity. This is the first paper to show a possible correlation between an emerging genotype, NA2, and large outbreaks of HRSV in Japan. Continuing studies to follow up the genetic changes and to clarify the mechanism of reinfection in HRSV are important steps to understand HRSV infections. Copyright © 2009, American Society for Microbiology. All Rights Reserved.

DOI： 10.1128/JCM.00115-09

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：TOHOKU UNIV MEDICAL PRESS  

In recent years, a dramatic increase of amantadine-resistant influenza A has occurred globally, but limited data have been available on the clinical course of patients developed amantadine-resistant viruses. We compared fever reduction between patients who developed resistance or remained sensitive in a pediatric clinic in Niigata, Japan, from 2000 to 2006. A total of 2,802 clinical samples were collected from patients who visited the pediatric outpatient clinic with influenza like illness during the seven influenza epidemic seasons. Patients were divided into 4 groups and analyzed for the fever reduction after amantadine treatment: emerged amantadine-resistant (n = 15); amantadine-sensitive (n = 35); patients administered no antiviral drugs (n = 42); and oseltamivir-treated patients (n = 320), which served as references. All 4 groups showed alleviation of fever up to day 3. The amantadine-resistant group had a significant recurrence of fever on day 4 and/or 5, and as a consequence, the course of illness was prolonged. Considering the pattern of fever, recurrent and persistent patterns were found significantly at higher rates in children with emerged resistant virus compared to other groups, and the age tended to be younger in amantadine-resistant compared to amantadine-sensitive group (3.9 ± 3.0 v 6.7 2+ 4.1 years old, n.s.). Therefore, we concluded that younger children were prone to develop amantadine-resistance after treatment and showed a significant recurrence of fever on day 4 and/or 5, and the course of illness was consequently prolonged. © 2008 Tohoku University Medical Press.

DOI： 10.1620/tjem.214.129

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Influenza A virus has the ability to overcome immunity from previous infections through the acquisition of genetic changes. Thus, understanding the evolution of the viruses in humans is important for the surveillance and the selection of vaccine strains. A total of 30 influenza A/H3N2 viruses and 35 influenza A/H1N1 viruses that were collected in Vietnam from 2001 to 2006 were used to analyze the evolution of the hemagglutinin (HA), neuraminidase (NA), and matrix protein (M) genes. Phylogenetic analysis of individual gene segments revealed that the HA and the NA genes of the influenza A viruses evolved in a sequential way. However, the evolutionary pattern of the M gene proved to be nonlinear and was not linked with that of the HA and NA genes. Genetic drift in HA1 segments, especially in the antigenic sites of A/H3N2 viruses, occurred more frequently in A/H3N2 viruses than it did in A/H1N1 viruses. Two reassortants, one influenza A/H3N2 strain and one A/H1N1 strain, were found on the basis of the phylogenetic analysis of the three genes. While both genetic mutation and reassortment contributed to their evolution, the frequency of genetic changes and reassortment events differs between the two subtypes. As influenza viruses circulate throughout the year, we emphasize the importance of surveillance in tropical and subtropical zones, where the emergence of new strains may be detected earlier than it is in temperate zones.

DOI： 10.1128/JCM.01549-07

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Oseltamivir has been used for treatment of influenza A and B infections, but recent reports documented that it was less active against the latter. We compared the effectiveness of oseltamivir in children between laboratory confirmed influenza A and B over 4 influenza seasons from 2001 to 2005 in a pediatric clinic in Japan. Among 1,848 patients screened, 299 influenza A and 209 influenza B patients were administered oseltamivir (treated groups), and 28 influenza A and 66 influenza B patients were assigned as non-treated groups. The duration of fever, defined as period when patients had the maximum temperature higher than 37.5 degrees C in three-time measurements in a day after the clinic visit, was evaluated among the four groups. In uni-variate analysis, the duration of fever was shorter for treated group than non-treated for influenza A (1.8 +/- 0.9 days vs 2.6 +/- 1.3 days, p < 0.01), but it was not significant for influenza B (2.4 +/- 1.3 days vs 2.8 +/- 1.2 days, p = 0.9). The fever duration was longer in treated influenza B than A patients (p < 0.01). Multi-variate analysis indicated younger age (< 6 years old) and higher body temperature at the clinic visit prolonged the duration of fever. Adjusted average duration of fever indicated that oseltatmivir was effective for both types, but more effective on influenza A, and the benefit increased for younger children. Our data provide evidence that oseltamivir is beneficial for influenza infections, but the effectiveness is differed by type and age.

DOI： 10.1620/tjem.214.113

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Language：English   Publisher：OXFORD UNIV PRESS INC  

DOI： 10.1086/525055

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Substantial increase in amantadine-resistant influenza A (H3N2) was reported in Asia and North America in 2005. In this study the frequency and genetic characteristics of amantadine-resistant influenza A, circulated in Japan in 2005-2006 season, were investigated. Isolates were tested by amantadine susceptibility test (TCID50/0.2 ml method), and sequencing of the M2 gene to identify mutations that confer resistance. Additionally, the hemagglutinin (HA) and neuraminicase (NA) genes of the viruses were examined. In total, 415 influenza A isolates from six prefectures were screened, and 231 (65.3%) of 354 influenza A (H3N2) were amantadine-resistant, with a serine to asparagine (S31N) change in the M2 gene. However, none of 61 A (HIN11) isolates were resistant. In addition, genetic analyses of the HA gene showed all amantadine-resistant viruses clustered in one (named clade N), possessing specific double mutations at 193, serine to phenylalanine (S193F), and at 225, asparatic acid to asparagine (D225N), and sensitive viruses belonged to another group (clade S). The clinical presentations at the clinical visit did not differ between patients shedding clacle N virus and those shedding clacle S virus. None of the patients had received previous treatment with amantadine. The results indicate an unusually high prevalence and wide circulation of the amantadine-resistance influenza A (H3N2) in Japan in the 2005-2006 season. These strains had the characteristic double mutations in the HA, in addition to the M2 mutation responsive for resistance. Antiviral resistance monitoring should be intensified and maintained for rapid feedback into treatment strategies, and selection of alternative therapeutic agents.

DOI： 10.1002/jmv.20946

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO LTD  

Objectives: Due to high vaccine coverage in Niigata, we had no outbreaks of measles from 1997 to 2003 but an opportunity to study the rote of sporting events in the propagation of an epidemic was experienced in the spring of the tatter year.Methods: Mandatory measles case reports were requested from all. high schools in Niigata, which covered a school year, date of onset, club activity, vaccination status, and hospitalization.Results: With national marathon and kendo (Japanese fencing) meetings for high school students, measles outbreaks occurred at 27 high schools with 192 patients (186 students and 6 teachers) in Niigata. Of 64 unvaccinated patients, 14 (21.9%) were hospitalized and 6 (6.2%) of 97 vaccinated patients. Mostly single cases were encountered at high schools in which index cases had a vaccination history, whereas at a high school in which index cases had no vaccination history, the total number of cases per school increased, mostly within more than 3 cases (p < 0.05).Conclusion: We conclude that sporting events, even if outdoors, might be a risk factor for measles infections. Appropriate actions to control outbreaks should be performed promptly in collaboration with related personnel and institutions. (c) 2007 Published by Elsevier Ltd on behalf of The British Infection Society.

DOI： 10.1016/j.jinf.2007.04.004

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Objective: The aim of this study was to clarify the epidemiology of laboratory-confirmed influenza in Hanoi, Vietnam.Methods: Influenza was detected by virus isolation from nasopharyngeal swabs of influenza-like-illness (ILI) patients who reported to outpatient clinics in Hanoi, Vietnam between 2001 and 2003, before the start of avian influenza A/H5N1 outbreaks. Influenza isolates were characterized by hemagglutinin inhibition test.Results: A total of 4708 nasopharyngeal swabs were collected from patients with ILI. Influenza was positive in 119 (2.5%) samples by virus isolation. Influenza circulated throughout the year, with possible two peaks in summer and winter. Influenza B viruses and A/H3N2 predominated in 2001 and 2002, respectively, and mixed circulation of A/H1N1, A/H3N2 and B were observed in 2003. The seasonality of influenza roughly matched with clinical case reports in the North Region by National Communicable Disease Surveillance in Vietnam.Conclusions: The findings of year-round and biannual peak circulation of influenza in a subtropical. area were in accordance with the results of previous studies in tropical and subtropical regions. Our observations indicated that establishment of Laboratory- based surveillance in tropical and sub-tropicat countries is important for taking actions for pandernic strategies, and links to the WHO global influenza network. (c) 2006 The British Infection Society. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jinf.2006.12.001

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER SOC MICROBIOLOGY  

To study the molecular epidemiology of respiratory syncytial virus (RSV) in a community, children with acute respiratory symptoms at a pediatric outpatient clinic in Niigata, Japan, were analyzed over three seasons from November 2001 to July 2004. Of 499 nasopharyngeal aspirate specimens, 185 (37.1%) were RSV positive, and only 8 (4.5%) of 177 patients were shown by the reverse transcription (RT)-PCR method to be reinfected. RSV infection occurred beginning in the early winter, and the rates declined in the spring. The predominant subgroup changed from A to B and returned to A over the three seasons. Phylogenetic analysis also revealed that multiple genotypes cocirculated each year, with genotype GA5 of subgroup A predominating in the 2001-2002 and the 2003-2004 seasons. A new genotype of subgroup B (named BA, according to the nomenclature for viruses) with a 60-nucleotide insertion in the second variable region of the attachment glycoportein protein was predominant as an emerging strain in the 2002-2003 season, but this was not associated with new epidemiological or clinical features, unlike the cases of disease caused by other genotypes in the other seasons. In conclusion, our molecular analysis of RSV confirms that multiple genotypes cocirculate each year and that the genotype predominating may shift with the season. Support for determination of the genotype by RT-PCR as an effective tool for characterization of RSV circulation patterns in the community is provided.

DOI： 10.1128/JCM.43.1.36-40.2005

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Language：Japanese   Publisher：(株)メディカルレビュー社  

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：日本小児呼吸器学会  

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近年、本邦ではRSウイルスの流行開始が早まっている。これまで秋から冬にかけて流行するのが通常であったが、特に2017年からは8〜9月に流行のピークが観察され、大きな流行時期の変化があった。一般的に、RSウイルスの流行は気温や相対湿度といった気象条件と関連があり、温帯地域では秋から冬に流行し、熱帯や亜熱帯では年中流行がある。流行時期が変化した理由はいくつか考えられる。一部の地域では、温暖化や異常気象により気候条件が亜熱帯に近くなり流行が起きたかもしれない。グローバリゼーションにより特にアジアからの訪日外国人が急激に増える中、熱帯や亜熱帯からの人の流れが不規則なRSウイルスの流行を引き起こしている可能性もある。ウイルス側の要因としてウイルスの型や遺伝子型が大きく変化したという報告は今のところない。今後も流行時期が前後する可能性を念頭に診療にあたる必要がある。(著者抄録)

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Background: We estimated influenza vaccine effectiveness (VE) in 2015-2016 season against medically attended, laboratory-confirmed influenza, when quadrivalent inactivated vaccine (IIV4) was first introduced in Japan, using test-negative case-control design. Influenza A(H1N1)pdm09 cocirculated with B/Yamagata and B/Victoria during the study period in Japan. Method: We based our case definition on two laboratory tests, real-time reverse transcription polymerase chain reaction (RT PCR), and virus isolation and compared VEs based on these tests. In addition, VE was evaluated by rapid diagnostic test (RDT). Nasopharyngeal swabs were collected from outpatients who visited clinics with influenza-like illness (ILIs) in Hokkaido, Niigata, Gunma and Nagasaki prefectures. Results: Among 713 children and adults enrolled in this study, 578 were influenza positive by RT PCR including, 392 influenza A and 186 influenza B, while 135 were tested negative controls. The adjusted VE by RT PCR for all ages against any influenza was low protection of 36.0% (95% confidence interval [CI], 3.1% to 58.6%), for influenza A was 30.0% (95% CI: -10.0% to 55.5%), and influenza B was moderate 50.2% (95% CI: 13.3% to 71.4%). Adjusted VE for virus isolation for A(H1N1)pdm09 was 37.1% (95% CI: 1.7% to 59.7%), Yamagata lineage 51.3% (95% CI: 6.4% to 74.7%) and Victoria lineage 21.3% (95% CI: -50.0% to 58.9%). VE was highest and protective in 0-5 years old group against any influenza and influenza A and B/Yamagata, but the protective effect was not observed for other age groups and B/Victoria. RDT demonstrated concordant results with RT PCR and virus isolation. Sequencing of hemagglutinin gene showed that all A(H1N1)pdm09 belong to clade 6B including 31 strains (88.6%), which belong to clade 6B.1 possessing S162N mutations that may alter antigenicity and affect VE for A(H1N1)pdm09. Conclusions: IIV4 influenza vaccine during 2015-2016 was effective against A(H1N1)pdm09 and the two lineages of type B. Younger children was more protected than older children and adults by vaccination.

DOI： 10.1016/j.jvacx.2019.100011

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RSウイルスはこれまで11〜1月の初冬に流行するウイルス感染症であったが、ここ数年夏や秋にはやり、2017、2018年には9月にピークがあった。これらの変化には、ウイルスの変異や、気候の温暖化、人の移動などが影響している可能性がある。(著者抄録)

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1年間に新潟県内で発生した大腿骨近位部骨折患者を対象とした。総骨折数は3214骨折であった。平均年齢は男性81.4歳、女性84.9歳、男女比は1:4であった。年齢階級別発生率ではほぼ全世代で発生率の減少を認め、特に高年齢帯で著明であった。全骨折者に占める85歳以上の割合は56.6%であった。全骨折者の82.5%に何らかの内科的既存合併症を有し、高血圧が最も多く(50%)、神経・脳血管疾患、心疾患と続いた。重度認知機能障害(MMSE&lt;9)を評価された患者が全体の1/4程度を占めた。脊椎X線で椎体骨折を評価すると79%に椎体骨折を認めた。最も多く使用されていた薬剤は活性型ビタミンD3製剤で、ビスホスホネート製剤は5.2%であった。

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1年間に新潟県内で発生した大腿骨近位部骨折患者を対象とした。総骨折数は3214骨折であった。平均年齢は男性81.4歳、女性84.9歳、男女比は1:4であった。年齢階級別発生率ではほぼ全世代で発生率の減少を認め、特に高年齢帯で著明であった。全骨折者に占める85歳以上の割合は56.6%であった。全骨折者の82.5%に何らかの内科的既存合併症を有し、高血圧が最も多く(50%)、神経・脳血管疾患、心疾患と続いた。重度認知機能障害(MMSE&lt;9)を評価された患者が全体の1/4程度を占めた。脊椎X線で椎体骨折を評価すると79%に椎体骨折を認めた。最も多く使用されていた薬剤は活性型ビタミンD3製剤で、ビスホスホネート製剤は5.2%であった。

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DOI： 10.18888/sh.0000000395

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Language：Japanese   Publisher：金原出版  

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＜文献概要＞RSウイルスの流行は,従来,日本を含む温帯地域では秋から流行が始まり冬にピークを迎えるとされてきたが,昨今では夏頃より始まり秋に入ると報告数が急増するパターンが続いている.本稿ではRSウイルスが流行する気象条件について概説し,本邦の過去7シーズンのサーベイランスデータから夏季の流行の気象条件に絞って分析した結果を詳しく述べた.夏季のRSウイルスの流行が高温かつ多湿の条件で起きていることと,気候区分に分類した分析により夏季の流行が日常的に起きている可能性がある地域を示した.RSウイルスの夏季の流行はハイリスクの小児に対して予防を目的とした抗体医薬であるパリビズマブの投与のタイミングに影響を及ぼすと考えられる.

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Language：Japanese   Publisher：日本臨床ウイルス学会  

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Language：Japanese   Publisher：グローバルヘルス合同大会事務局  

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目的 高齢者における残存歯の実態と背景にある要因を明らかにすることを目的として、個人の所得や暮らしのゆとりといった経済的な状況で説明されるかどうか、それらを考慮しても高齢者の残存歯数がジニ係数により評価した居住地の所得の不平等と関連するか検討した。方法 介護認定を受けていない65歳以上の高齢者を対象として2013年に全国で約20万人を対象に行われた健康と暮らしの調査(JAGES2013、回収率71.1%)において、新潟市データを分析対象とした。自記式調査票を用いて新潟市に住民票がある8,000人に郵送調査を実施し、4,983人(62.3%)より回答を得て、年齢と性別に欠損が無かった3,980人(49.8%)の有効回答を使用した。中学校区別の所得格差(ジニ係数)と残存歯数の地域相関を求め、ジニ係数別の残存歯数を比較した。次に、目的変数を残存歯数、説明変数を個人レベルの変数として、性別、年齢以外に、教育歴、等価所得、暮らしのゆとり、世帯人数、糖尿病治療の有無、喫煙状況を用い、地域レベルの変数として、中学校区ごとの平均等価所得とジニ係数とした順序ロジスティック回帰モデルによるマルチレベル分析を行った。結果 57中学校区別のジニ係数と残存歯数の地域相関は、相関係数-0.44(P&lt;0.01)の弱い負の相関を認め、ジニ係数が0.35以上の所得格差が大きい地域は他の地域と比較して有意(P&lt;0.001)に残存歯数が少なかった。残存歯数を目的変数とした順序ロジスティック回帰モデルにおいて、性別と年齢を調整後、個人レベルでは教育歴、等価所得、暮らしのゆとり、喫煙状況、地域レベルではジニ係数、平均等価所得が有意な変数であった。一方で、すべての変数を投入したモデルでは、個人レベルの教育歴と地域レベルの平均等価所得において有意な結果は得られなかった。結論 所得格差が比較的小さいと考えられる日本の地方都市においても、個人レベルの要因を調整後に地域レベルの所得格差と残存歯数の間に関連が認められた。高齢者の残存歯数は永久歯への生え変わり以降、長い時間をかけて形成されたものであり、機序は明らかではないが、所得分配の不平等が住民の健康状態を決めるとする相対所得仮説は、今回対象となった高齢者の残存歯数において支持される結果であった。(著者抄録)

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© Cambridge University Press 2016. In temperate zones, human respiratory syncytial virus (HRSV) outbreaks typically occur in cold weather, i.e. in late autumn and winter. However, recent outbreaks in Japan have tended to start during summer and autumn. This study examined associations of meteorological conditions with the numbers of HRSV cases reported in summer in Japan. Using data from the HRSV national surveillance system and national meteorological data for summer during the period 2007-2014, we utilized negative binomial logistic regression analysis to identify associations between meteorological conditions and reported cases of HRSV. HRSV cases increased when summer temperatures rose and when relative humidity increased. Consideration of the interaction term temperature × relative humidity enabled us to show synergistic effects of high temperature with HRSV occurrence. In particular, HRSV cases synergistically increased when relative humidity increased while the temperature was ≥28·2 °C. Seasonal-trend decomposition analysis using the HRSV national surveillance data divided by 11 climate divisions showed that summer HRSV cases occurred in South Japan (Okinawa Island), Kyushu, and Nankai climate divisions, which are located in southwest Japan. Higher temperature and higher relative humidity were necessary conditions for HRSV occurrence in summer in Japan. Paediatricians in temperate zones should be mindful of possible HRSV cases in summer, when suitable conditions are present.

DOI： 10.1017/S095026881600220X

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Aim: The present study examined whether social support, informal socializing and social participation are associated with glycemic control in older people. Methods: Data for this population-based cross-sectional study was obtained from the Japan Gerontological Evaluation Study (JAGES) 2010 linked to the annual health check-up data in Japan. We analyzed 9,554 individuals aged ≥65 years without the certification of needed long-term care. Multivariate logistic regression models were used to assess the effect of social support, informal socializing and social participations on glycemic control. The outcome measure was HbA1c ≥8.4%. Results: 1.3% of the participants had a level of HbA1c over 8.4%. Better glycemic control was significantly associated with meeting with friends one to four times per month (odds ratio [OR] 0.51, 95% confidence interval [CI]0.30-0.89, compared to meeting with friends a few times per year or less) and participation in sports groups (OR 0.50, 95% CI 0.26-0.97) even after adjusting for other variables. Meeting with friends more than twice per week, receiving social support, and being married were not associated with better control of diabetes. Conclusions: Meeting with friends occasionally is associated with better glycemic control among older people.

DOI： 10.1371/journal.pone.0169904

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Language：Japanese   Publisher：(一社)日本感染症学会  

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Norovirus (NoV) epidemics normally peak in December in Japan; however, the peak in the 2009-2010 season was delayed until the fourth week of January 2010. We suspected intensive hand hygiene that was conducted for a previous pandemic influenza in 2009 as the cause of this delay. We analysed the NoV epidemic trend, based on national surveillance data, and its associations with monthly output data for hand hygiene products, including alcohol-based skin antiseptics and hand soap. The delayed peak in the NoV incidence in the 2009-2010 season had the lowest number of recorded cases of the five seasons studied (2006-2007 to 2010-2011). GII.4 was the most commonly occurring genotype. The monthly relative risk of NoV and monthly output of both alcohol-based skin antiseptics and hand soap were significantly and negatively correlated. Our findings suggest an association between hand hygiene using these products and prevention of NoV transmission.

DOI： 10.1017/S0950268816000984

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2009/10、2011/12の各インフルエンザシーズン終了後に佐渡市内の全園児・学童を対象にインフルエンザの発症状況、予防行動の実施状況等に関する調査を実施した。その結果、回収率は2009/10シーズンが91%、2011/12シーズンが94%であった。多変量解析では2シーズンともに「ワクチン接種」「こまめな手洗い」が有意な発症リスク低下であることが判明した。しかし、「こまめな手洗い」の実践率は2009/10シーズンでも実践(ほぼ毎回やった)は23%と低く、2011/12シーズンは更に低下していた。このことから、有効性について繰り返し周知するとともに実践率向上に向けた園や学校、家庭への働きかけが必要と考えられた。

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Language：Japanese   Publisher：(一財)厚生労働統計協会  

目的 高齢者における中学校区別の肺炎球菌ワクチン接種率に関する調査を行い,接種率の背景要因について個人要因と環境要因の双方から実態を明らかにし,定期接種化された後に接種率の向上に必要な取り組みについて検討した。方法 N市在住の65歳以上の住民を対象として,要支援・要介護認定を受けていない8,000名の高齢者に郵送法で無記名自記式アンケート調査を実施した。57中学校区別に接種率を求め,住民構成を調整した後の地域差を分析した。接種の有無に関連する個人要因についてロジスティック回帰分析に加え,中学校区別の相関分析,個人と校区別集団の2つのレベルでマルチレベル相関分析を実施し,さらに,クラスタ標準誤差を使ったロジスティック回帰分析を行い,集団レベルの環境要因の影響も加味して接種率の地域差を評価した。結果 肺炎球菌ワクチンの接種率は13.5%(男性14.5%,女性12.5%)で,男性の方が若干高い値であった。年代別では,男女とも前期高齢者では10%以下であり,80〜84歳では20%を超えていた。中学校区別の接種率では,5%以下の地域が4ヶ所ある一方で20%を超える地域も2ヶ所存在し,性別と年齢を調整した後においても有意(P&lt;0.01)な接種状況の地域差が認められた。ロジスティック回帰分析の結果,ワクチン接種を促進する要因として,高い年齢(P&lt;0.01),低い主観的健康感(P&lt;0.05),呼吸器疾患あり(P&lt;0.01)が認められた。相関分析で中学校区別の接種率と関連する要因は認めず,マルチレベル相関分析において個人レベルでのみ,高い年齢,低い主観的健康感,呼吸器疾患あり,短い教育年数が接種ありと有意に相関した(P&lt;0.01)。また,地域レベルの変数を説明変数に加えクラスタ標準誤差を使ったロジスティック回帰分析において,環境要因として中学校区別の教育年数や所得格差は有意ではなく,個人レベルの年齢,主観的健康感や呼吸器疾患の有無とは異なり,ワクチン接種に与える影響は認められなかった。結論 高齢で主観的健康感が優れず呼吸器疾患を持った住民が多い地域において,肺炎球菌ワクチンの接種率が高く,調査した範囲で接種の有無に環境要因の影響は認められなかった。また,健康リテラシーが高いと推定される教育年数が長い集団ほど接種率は低い傾向が認められたことから,ワクチンの有用性について広く啓発活動を実施し,現在の健康状態に過信することなくワクチン接種を推奨する取り組みが求められている。(著者抄録)

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Language：English   Publisher：WHO EASTERN MEDITERRANEAN REGIONAL OFFICE  

Despite the significant burden of influenza outbreaks, active disease monitoring has been largely absent in the Middle East, including Lebanon. In this study we characterized influenza virus in 440 nasopharyngeal swabs collected from patients with acute respiratory infections during two influenza seasons in Lebanon. Influenza A(H3N2) was dominant in the 2013/14 season while the A(H1N1)pdm09 and B/Yamagata strains were most prevalent in the 2014/15 season. All tested isolates were susceptible to 4 neuraminidase inhibitors (oseltamivir, zanamivir, peramivir and laninamivir). Genetic analysis of the haemagglutinin gene revealed multiple introductions of influenza viruses into Lebanon from different geographic sources during each season. Additionally, large data gaps were identified in the Middle East region, as indicated by the lack of current influenza sequences in the database from many countries in the region.

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：新潟医学会  

健康格差の縮小は今後の保健施策を立てる上で重要な課題である。世界的にはすでに健康の社会的決定要因を評価し、健康格差を縮める試みが始まっている。日本では、2013年に施行された健康日本21(第二次)に&quot;健康格差の縮小&quot;が初めて明記された。我々は、新潟市高齢者のアンケート調査に基づき、GIS(地理情報システム)を用いて健康格差を見える化した。新潟市における健康格差の要因を探り、格差縮小の具体的対策を立てる取り組みを今後も継続していきたい。(著者抄録)

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Other Link： http://hdl.handle.net/10191/44196

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Language：Japanese   Publisher：(株)最新医学社  

新潟大学では,ミャンマーにてヒトインフルエンザの調査を10年以上にわたり行ってきた.これまで,ヤンゴン,ネピドー,ピンウールインの3つの都市に研究拠点を形成し,約2,000件のインフルエンザウイルスを分離し,ミャンマーでは雨季にインフルエンザが流行することが判明した.我々は若手の人材育成にも力を入れており,受け入れ研修や,現地に出向いて技術研修を行い,ミャンマーにおけるインフルエンザ研究のレベルアップを図ってきた.(著者抄録)

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Language：Japanese   Publisher：(公社)日本化学療法学会  

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Language：Japanese   Publisher：(一社)日本口腔ケア学会  

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Language：Japanese   Publisher：新潟人間生活学会  

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Language：Japanese   Publisher：(一社)日本感染症学会  

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Language：English   Publisher：CAMBRIDGE UNIV PRESS  

We studied the spatial trend of norovirus (NoV) epidemics using sentinel gastroenteritis surveillance data for patients aged &lt; 15 years (n= 140) in the Tokyo area for the 2006-2007 to 2008-2009 seasons utilizing the kriging method of geographical information system (GIS). This is the first study of the spreading pattern of NoV epidemics using sentinel surveillance data. Correlations of sentinel cases between the seasons and with demographic data were examined to identify the trend and related factors. A similar pattern of diffusion was observed over the seasons, and its mean correlation between seasons was significantly high. A higher number of cases were found in the peripheral area, which surrounds the most populated central area, and showed a correlation with the ratio of the children population (r = 0.321, P &lt; 0.01) and the ratio of residents in larger families (r = 0.263, P &lt; 0.01). While NoV susceptibility remained, the results suggest a transmission route in the local community as a possible epidemic factor. Prevention with focus on the peripheral area is desirable.

DOI： 10.1017/S0950268814000697

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Language：Japanese   Publisher：新潟人間生活学会  

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Language：Japanese   Publisher：新潟大学災害・復興科学研究所  

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Language：Japanese   Publisher：(株)医薬ジャーナル社  

わが国では抗インフルエンザ薬として、M2阻害薬、ノイラミニダーゼ(NA)阻害薬、RNAポリメラーゼ阻害薬が認可されている。M2阻害薬、NA阻害薬はともに1〜2日間の有熱期間の短縮効果があるが、耐性株の出現が問題となっている。現在、ヒトに感染する、A/H1N1pdm09、A/H3N2、A/H7N9はすべてM2阻害薬に耐性である。NA阻害薬については、A/H1N1でNAタンパク275位の変異による耐性株が出現しやすい。わが国では2013-2014年シーズンに札幌を中心にA/H1N1pdm09耐性株の地域流行がみられ、注目を集めている。2014年、世界に先駆け、RNAポリメラーゼ阻害薬のファビピラビル(アビガン)が条件付きで承認となった。今後も新規薬剤の開発が進むものと考えられる。(著者抄録)

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Language：Japanese   Publisher：新潟県医師会  

Respiratory Syncytial Virus(RSV)の流行状況について、国立感染症研究所の6シーズン分の感染症発生動向調査結果を用い、気象条件との関連について検討した。2007〜08シーズンから2010〜11シーズンまでは、どの地域でも流行は10月頃から始まり12月にピークを迎えていたが、2011〜12シーズン以降は、九州や南海では8月より始まり、11月頃には全国的にピークとなった。南日本(沖縄)では5月末〜7月に流行が大きかった。気候区分ごとの毎週のRSV定点あたり報告数と週平均気温の関係は、沖縄以外では負の相関を、沖縄では正の相関を示した。RSV報告数と週平均相対湿度の関係は、沖縄では正の相関を示し、他の地域では相関がなかった。RSV報告数を目的変数、平均気温および相対湿度を説明変数とした線形回帰モデルを地域ごとに作成したところ、沖縄では気温、湿度とも正の関連、沖縄以外ではそれぞれ負、正の関連があった。

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DOI： 10.20837/12014102451

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Language：Japanese   Publisher：日本公衆衛生学会  

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Language：Japanese   Publisher：(株)医薬ジャーナル社  

インフルエンザウイルスのノイラミニダーゼ(NA)阻害剤への耐性は、ウイルスのNA蛋白の1アミノ酸変異により生じる。薬剤耐性ウイルスの検出には、感受性検査と、遺伝子型検査の二通りがある。最近、世界保健機関(WHO)により耐性の定義が統一され、基準株に対する50%阻止濃度(IC50)の上昇度により耐性を判定することとなった。薬剤投与後に留まらず、近年、A型H1N1亜型の市中株でNA阻害剤の耐性株が流行し、大きな問題となっている。2007〜2008年にA型H1N1ソ連型の耐性株(H275Y変異株)の世界的な流行が起こり、2011年にはオーストラリアで、そして2013〜2014年シーズンには、日本においてH1N1pdm09のH275Y耐性株の流行が起こった。今後も耐性株のサーベイランスを続けるとともに、新しい機序の薬剤の開発が望まれている。(著者抄録)

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Language：Japanese   Publisher：(一社)医療の質・安全学会  

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DOI： 10.11477/mf.1664102444

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Language：Japanese   Publisher：新潟県医師会  

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Language：Japanese   Publisher：(株)医学書院  

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Language：English   Publisher：PUBLIC LIBRARY SCIENCE  

Background: We examined the relationship between incident functional disability and social participation from the perspective of number of types of organizations participated in and type of social participation in a prospective cohort study.
Method: The study was based on the Aichi Gerontological Evaluation Study (AGES) Cohort Study data. We followed 13,310 individuals aged 65 years or older for 4 years. Analysis was carried out on 12,951 subjects, excluding 359 people whose information on age or sex was missing. Social participation was categorized into 8 types.
Results: Compared to those that did not participate in any organizations, the hazard ratio (HR) was 0.83 (95% CI: 0.73-0.95) for participation in one, 0.72 (0.61-0.85) for participation in two, and 0.57 (0.46-0.70) for participation in three or more different types of organizations. In multivariable adjusted models, participation in the following types of organization was protective for incident disability: local community organizations (HR = 0.85, 95% CI: 0.76-0.96), hobby organizations (HR = 0.75, 95% CI: 0.64-0.87), and sports organizations (HR = 0.64, 95% CI: 0.54-0.81).
Conclusion: Social participation may decrease the risk of incident functional disability in older people in Japan. This effect may be strengthened by participation in a variety of different types of organizations. Participating in a local community, hobby, or sports group or organization may be especially effective for decreasing the risk of disability.

DOI： 10.1371/journal.pone.0099638

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Language：Japanese   Publisher：日本小児感染症学会  

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Language：Japanese   Publisher：(一社)日本循環器病予防学会  

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Language：Japanese   Publisher：日本小児感染症学会  

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Language：Japanese   Publisher：(株)医薬ジャーナル社  

RSウイルス(respiratory syncytial virus:RSV)は3歳以下の小児における下気道細気管支炎および肺炎の原因ウイルスとして世界的にもっとも多くみられる。RSV感染症は、早産児または気管支肺異形成症、先天性心疾患をもつ2歳以下の児等のハイリスクグループではしばしば致命的となる。また、RSV感染症は喘息との関連が示唆されており、臨床的なコホート研究および動物モデルを用いた研究が行われている。RSVに対する承認済みのワクチンはなく、唯一のウイルス特異的薬剤である抗体医薬パリビズマブは予防的投与によりRSV感染症による入院率を低下させる。発展途上国では重症急性下気道感染により死亡する幼児が毎年、数多く発生していることから、安価なワクチンまたは抗ウイルス薬の開発がRSV感染症対策の大きな課題である。(著者抄録)

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Language：Japanese   Publisher：日本小児感染症学会  

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佐渡島南部地域では2010〜2011年にかけて侵襲性・非侵襲性インフルエンザ菌b型(Hib)感染症が8例続発したが、クラスター解析にて同地域のHib発症に関するRelative Riskは島内他地域と比べ24.74倍であることが判明した。今回、著者らは同地域における深刻な健康被害を食い止めるため調査・介入を行った。まず、同地域のA保育園の全園児を対象に上咽頭培養検査を行ったところ、Hib保菌率は9.1%(5/55)と佐渡島全体の保菌率の約11倍であることが明らかとなった。その後、Hib保菌者に対してリファンピシン内服による除菌を行い、更にHibワクチン未接種園児に対してワクチン接種を推奨した結果、3ヵ月後の上咽頭培養検査ではHib保菌者が0名となり、暫定的ではあるがHib流行終息宣言を出すに至った。尚、今回の調査・介入からは、1)Hibワクチン接種者であってもHibを保菌しており、リザーバーとして他者にHibを伝播していた危険性があること、2)今回のような緊急事態でも5歳以上小児のHibワクチン接種は自費接種で、副反応補償に関しても制限があること、の2つの問題点が明らかとなった。

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After the cataclysmic explosion in the Fukushima Daiichi Nuclear Power Station triggered by the Great East Japan Earthquake of March 2011, more than 100,000 citizens living within 20km of the nuclear power station were evacuated. These residents were not allowed to return home for more than a year, until April 2012, when the Japanese government began to lift the evacuation order for some areas. As local governments contemplate strategies to revive these communities, a lingering question remains: how safe is it to live here? Answering this question is difficult for a number of reasons. Our project aims to provide data to allow individuals and communities to make their own assessments. The Radioisotope Center (RC) in Niigata University has built a vehicle-mounted radiation monitoring system consisting of a real-time GPS receiver, a dosimeter, and a laptop. This tool allows government officials in the affected municipalities to continuously measure airborne radiation levels. RC has partnered with the Institute for Digital Research and Education (IDRE) from the University of California, Los Angeles (UCLA) to develop a public web-based interface to this data to inform citizens about radiation levels in their communities. Both of these tools enable gathering and making data available to the general public more easily, and allow the public to make informed decisions about the safety of the decontaminated zones in the absence of widely-accepted standards. © 2012 IEEE.

DOI： 10.1109/GHTC.2012.18

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季節外でインフルエンザA型との情報から、新型インフルエンザの集団発生の可能性が高いと判断し、これらのグループの患者が受診した際に、可能な範囲でトリアージ法を導入した。大学部活合宿中のグループ37例中、27例が発熱、咳、咽頭痛、鼻汁・鼻閉などのインフルエンザ様症状を呈する集団感染があった。問診票からの臨床症状は、37℃以上の発熱27例、咳22例、頭痛19例、咽頭痛18例、関節痛12例筋肉痛10例、悪寒8例、鼻汁・鼻閉6例、食欲低下10例、吐き気・嘔吐3例、下痢1例であった。インフルエンザ迅速診断キットの結果は陽性8例、陰性19例であった。治療は全例に抗ウイルス薬、解熱鎮痛薬を処方した。重症例はなく、全員帰宅可能と判断した。

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2005年以降、A型インフルエンザのアマンタジン耐性株がアジアを中心に急増し、2005/2006年は本邦でA/H3N2の耐性株増加が確認された。さらに2006/2007年はA/H3N2の耐性が持続しているばかりでなく、A/H1N1でもアマンタジン耐性株の増加がみられた。(著者抄録)

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