Kazuo Hayakawa

The Role of Public Health Nurses in Japanese Long-term Care Prevention Projects in the Community

As the frontrunner of ageing countries, we would like to introduce the role of public health nurses in Japanese long-term care prevention projects in the community and our research on healthy longevity in this review article. Previous studies in Japan reported that lack of participation in social activities was significantly related to an increased risk to suffer from disability and subsequently requiring the application of Japanese long-term care insurance. As for primary/secondary prevention for old populations, public health nurses are expected to develop and utilize the social capital in health promotion interventions at individual and community levels in Japan. Since 2006, long-term care insurance was revised focusing on preventive care by detecting people aged 65 years and older who are at high risk of needing future care or support. There will be increasing demand for health care professionals to promote a communitys overall health status in cost-effective ways, and public health nurses should play an important role to make it.

The relationship between body mass index and uric acid: a study on Japanese adult twins.

ObjectivesThe present study aimed to investigate the association between body mass index (BMI) and uric acid (UA) using the twin study methodology to adjust for genetic factors.MethodsThe association between BMI and UA was investigated in a cross-sectional study using data from both monozygotic and dizygotic twins registered at the Osaka University Center for Twin Research and the Osaka University Graduate School of Medicine. From January 2011 to March 2014, 422 individuals participated in the health examination. We measured height, weight, age, BMI, lifestyle habits (Breslow’s Health Practice Index), serum UA, and serum creatinine. To investigate the association between UA and BMI with adjustment for the clustering of a twin within a pair, individual-level analyses were performed using generalized linear mixed models (GLMMs). To investigate an association with adjustment for genetic and family environmental factors, twin-pair difference values analyses were performed.ResultsIn all analysis, BMI was associated with UA in men and women. Using the GLMMs, standardized regression coefficients were 0.194 (95xa0% confidence interval: 0.016–0.373) in men and 0.186 (95xa0% confidence interval: 0.071–0.302) in women. Considering twin-pair difference value analyses, standardized regression coefficients were 0.333 (95xa0% confidence interval: 0.072–0.594) in men and 0.314 (95xa0% confidence interval: 0.151–0.477) in women.ConclusionsThe present study shows that BMI was significantly associated with UA, after adjusting for both genetic and familial environment factors in both men and women.

Investigation of mental health in Indonesian health workers immigrating to Japan under the Economic Partnership Agreement.

The aim of this study was to assess the mental health status of Indonesian nurses and care workers who immigrated to Japan after the Economic Partnership Agreement was signed by the governments of Japan and Indonesia in 2008. From November 2012 to March 2013, questionnaires were mailed to 206 workers in 87 medical and caregiving facilities that openly accept Indonesian EPA immigrant workers. Responses were received from 71 workers in 35 facilities. Responses from 22.5% of workers suggested that they were at risk of developing mental health problems, and gender and acquisition state of national qualifications were the main factors influencing their mental health status. The results suggest that support after obtaining national qualifications is inadequate and that mid and long-term support systems that focus on the needs of immigrant healthcare workers after passing national examinations are necessary.

Language-related cerebral oscillatory changes are influenced equally by genetic and environmental factors

Twin studies have suggested that there are genetic influences on inter-individual variation in terms of verbal abilities, and candidate genes have been identified by genome-wide association studies. However, the brain activities under genetic influence during linguistic processing remain unclear. In this study, we investigated neuromagnetic activities during a language task in a group of 28 monozygotic (MZ) and 12 dizygotic (DZ) adult twin pairs. We examined the spatio-temporal distribution of the event-related desynchronizations (ERDs) in the low gamma band (25-50Hz) using beamformer analyses and time-frequency analyses. Heritability was evaluated by comparing the respective MZ and DZ correlations. The genetic and environmental contributions were then estimated by structural equation modeling (SEM). We found that the peaks of the low gamma ERDs were localized to the left frontal area. The power of low gamma ERDs in this area exhibited higher similarity between MZ twins than that between DZ twins. SEM estimated the genetic contribution as approximately 50%. In addition, these powers were negatively correlated with the behavioral verbal scores. These results improve our understanding of how genetic and environmental factors influence cerebral activities during linguistic processes.

Associations between Depressive State and Impaired Higher-Level Functional Capacity in the Elderly with Long-Term Care Requirements.

Depressive state has been reported to be significantly associated with higher-level functional capacity among community-dwelling elderly. However, few studies have investigated the associations among people with long-term care requirements. We aimed to investigate the associations between depressive state and higher-level functional capacity and obtain marginal odds ratios using propensity score analyses in people with long-term care requirements. We conducted a cross-sectional study based on participants aged ≥65 years (n = 545) who were community dwelling and used outpatient care services for long-term preventive care. We measured higher-level functional capacity, depressive state, and possible confounders. Then, we estimated the marginal odds ratios (i.e., the change in odds of impaired higher-level functional capacity if all versus no participants were exposed to depressive state) by logistic models using generalized linear models with the inverse probability of treatment weighting (IPTW) for propensity score and design-based standard errors. Depressive state was used as the exposure variable and higher-level functional capacity as the outcome variable. The all absolute standardized differences after the IPTW using the propensity scores were <10% which indicated negligible differences in the mean or prevalence of the covariates between non-depressive state and depressive state. The marginal odds ratios were estimated by the logistic models with IPTW using the propensity scores. The marginal odds ratios were 2.17 (95%CI: 1.13–4.19) for men and 2.57 (95%CI: 1.26–5.26) for women. Prevention of depressive state may contribute to not only depressive state but also higher-level functional capacity.

Frequency-specific genetic influence on inferior parietal lobule activation commonly observed during action observation and execution

Brain activity relating to recognition of action varies among subjects. These differences have been hypothesised to originate from genetic and environmental factors although the extent of their effect remains unclear. Effects of these factors on brain activity during action recognition were evaluated by comparing magnetoencephalography (MEG) signals in twins. MEG signals of 20 pairs of elderly monozygotic twins and 11 pairs of elderly dizygotic twins were recorded while they observed finger movements and copied them. Beamformer and group statistical analyses were performed to evaluate spatiotemporal differences in cortical activities. Significant event-related desynchronisation (ERD) of the β band (13–25u2009Hz) at the left inferior parietal lobule (IPL) was observed for both action observation and execution. Moreover, β-band ERD at the left IPL during action observation was significantly better correlated among monozygotic twins compared to unrelated pairs (Z-test, pu2009=u20090.027). β-band ERD heritability at the left IPL was 67% in an ACE model. These results demonstrate that β-band ERD at the IPL, which is commonly observed during action recognition and execution, is affected by genetic rather than environmental factors. The effect of genetic factors on the cortical activity of action recognition may depend on anatomical location and frequency characteristics.

Association between salivary flow rate and depressive symptoms with adjustment for genetic and family environmental factors in Japanese twin study

ObjectivesThe association between salivary flow rate (SFR) and depressive symptoms have been inconclusive. The present study aimed to investigate the association between SFR and depressive symptoms with and without adjustment for genetic and family environmental factors.Materials and methodsWe conducted a cross-sectional study using twins and measured SFR and depressive symptoms as the outcome and explanatory variables, respectively. We also performed three-step regression analyses by first analysing the association between SFR and depressive symptoms without adjustment for genetic and family environmental factors (individual-level analyses). We then performed between–within analyses using monozygotic (MZ) and same-sex dizygotic (DZ) twin pairs, and finally using only MZ twin pairs. These between–within analyses estimated the coefficients adjusted for genetic and family environmental factors. Furthermore, differences in the associations between individual-level and between–within suggest confounding by genetic and family environmental factors.ResultsWe conducted 448 twins aged ≥20xa0years. In individual-level analyses in males and between–within analyses using MZ and same-sex DZ male twin pairs, SFR associated with depressive symptoms. In between–within analyses using only MZ male twin pairs, SFR did not associate with depressive symptoms. In females, SFR did not associate with depressive symptoms in both individual-level and between–within analyses.ConclusionsThe present study revealed that the association between SFR and depressive symptoms was affected by common genetic factors in males.Clinical relevanceUnderstanding this association between SFR and depressive symptoms with adjustment for genetic and family environmental factors could lead to an important consideration for the prevention and treatment of hyposalivation.

Association between subjective memory complaints and depressive symptoms after adjustment for genetic and family environmental factors in a Japanese twin study.

AbstractObjectivesThe aim of this study was to investigate the association between subjective memory complaints (SMCs) and depressive symptoms, with and without adjustment for genetic and family environmental factors.nMethodsWe conducted a cross-sectional study using twins and measured SMCs and depressive symptoms as outcomes and explanatory variables, respectively. First, we performed regression analyses using generalized estimating equations to investigate the associations between SMCs and depressive symptoms without adjustment for genetic and family environmental factors (individual-level analyses). We then performed regression analyses for within-pair differences using monozygotic (MZ) and dizygotic (DZ) twin pairs and MZ twin pairs to investigate these associations with adjustment for genetic and family environmental factors by subtracting the values of one twin from those of co-twin variables (within-pair level analyses). Therefore, differences between the associations at individual- and within-pair level analyses suggested confounding by genetic factors.ResultsWe included 556 twins aged ≥20xa0years. In the individual-level analyses, SMCs were significantly associated with depressive symptoms in both males and females [standardized coefficients: males, 0.23 (95xa0% CI 0.08–0.38); females, 0.35 (95xa0% CI 0.23–0.46)]. In the within-pair level analyses using MZ and same-sex DZ twin pairs, SMCs were significantly associated with depressive symptoms. In the within-pair level analyses using the MZ twin pairs, SMCs were significantly associated with depressive symptoms [standardized coefficients: males, 0.32 (95xa0% CI 0.08–0.56); females, 0.24 (95xa0% CI 0.13–0.42)].nConclusionsThis study suggested that SMCs were significantly associated with depressive symptoms after adjustment for genetic and family environmental factors.n

Cost-benefit analysis of the rubella vaccination in Japan to prevent congenital rubella syndrome: analyses from three perspectives

In Japan, the number of reports of rubella has increased since 2012, with 14,344 cases being reported in 2013. Rubella infection in a first-trimester pregnant woman could result in congenital rubella syndrome (CRS), which causes serious complications. Many municipalities across the country have implemented programs to control the spread, such as offering a subsidy for the vaccination. The aim of this study is to evaluate the vaccination program for a couple planning pregnancy. We defined two different vaccination models-one for couples and one for females only-in order to compare cases of the program. Economic evaluation was conducted by calculating the benefit-cost ratio (BCR) and net present value (NPV), analyzing from three perspectives: of the society, of the payer for healthcare service, and of the healthcare service recipient. For the base case analysis, rubella cases in 5,564 men and 1,727 women and 34 CRS cases were estimated to have been averted. The BCRs of the couples’ program for society was 0.27, and the NPV estimates were approximately -6,111 million yen. The BCRs of the females-only program for society was 0.37. If the price difference between vaccine cost and subsidy is 1,189 yen, there is no effective cost value for the couples’ program from the recipient’s perspective. Incidence, vaccination costs, and subsidy were relatively sensitive parameters. Overall, the female program was preferable to the couples’ program. Correspondence to: Tomoya Itatani, Division of Nursing, Faculty of Health Science Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan; E-mail: itatani@mhs.mp.kanazawa-u.ac.jp