Motoyuki Yuasa

A randomized controlled trial of a Functioning Improvement Tool home‐visit program and its effect on cognitive function in older persons

The aim was to determine whether mini mental state examination (MMSE) scores improved in older participants of a Functioning Improvement Tool (FIT) home‐visit program.

Evidence-based new service package vs. routine service package for smoking cessation to prevent high risk patients from cardiovascular diseases (CVD): study protocol for randomized controlled trial

BackgroundSmoking cessation is a high-priority intervention to prevent CVD events and deaths in developing countries. While several interventions to stop smoking have been proved successful, the question of how to increase their effectiveness and practicality in developing countries remains. In this study, a newly devised evidence-based smoking cessation service package will be compared with the existing service in a randomized controlled trial within the community setting of Thailand.Method/DesignThis randomized control trial will recruit 440 current smokers at CVD risk because of being diabetic and/or hypertensive. Informed, consented participants will be randomly allocated into the new service-package arm and the routine service arm. The study will take place in the non-communicable disease clinics of the Maetha District Hospital, Lampang, northern Thailand. The new smoking-cessation service-package comprises (1) regular patient motivation and coaching from the same primary care nurse over a 3-month period; (2) monthly application of piCO + smokerlyzer to sustain motivation of smoker’s quitting attempt and provide positive feedback over a 3-month period; (3) assistance by an assigned family member; (4) nicotine replacement chewing gum to relieve withdrawal symptoms. This new service will be compared with the traditional routine service comprising the 5A approach in a 1-year follow-up. Participants who consent to participate in the study but refuse to attempt quitting smoking will be allocated to the non-randomized arm, where they will be just followed up and monitored. Primary outcome of the study is smoking cessation rate at 1-year follow-up proven by breath analysis measuring carbomonoxide in parts per million in expired air. Secondary outcomes are smoking cessation rate at the 6-month follow-up, blood pressure and heart rate, CVD risk according to the Framingham general cardiovascular risk score, CVD events and deaths at the 12-month follow-up, and the cost-effectiveness of the health service packages. Intention-to-treat analysis will be followed. Factors influencing smoking cessation will be analyzed by the structure equation model.DiscussionThis multicomponent intervention, accessible at primary healthcare clinics, and focusing on the individual as well as the family and social environment, is unique and expected to work effectively.Trial registrationCurrent Controlled Trials ISRCTN89315117

Reducing salt intake for prevention of cardiovascular diseases in high-risk patients by advanced health education intervention (RESIP-CVD study), Northern Thailand: study protocol for a cluster randomized trial

BackgroundDecreasing salt consumption can prevent cardiovascular diseases (CVD). Practically, it is difficult to promote people’s awareness of daily salt intake and to change their eating habits in terms of reducing salt intake for better cardiovascular health. Health education programs visualizing daily dietary salt content and intake may promote lifestyle changes in patients at high risk of cardiovascular diseases.Methods/DesignThis is a cluster randomized trial. A total of 800 high-CVD-risk patients attending diabetes and hypertension clinics at health centers in Muang District, Chiang Rai province, Thailand, will be studied with informed consent. A health center recruiting 100 participants is a cluster, the unit of randomization. Eight clusters will be randomized into intervention and control arms and followed up for 1 year. Within the intervention clusters the following will be undertaken: (1) salt content in the daily diet will be measured and shown to study participants; (2) 24-hour salt intake will be estimated in overnight-collected urine and the results shown to the participants; (3) a dietician will assist small group health education classes in cooking meals with less salt. The primary outcome is blood pressure change at the 1-year follow-up. Secondary outcomes at the 1-year follow-up are estimated 24-hoursalt intake, incidence of CVD events and CVD death. The intention-to-treat analysis will be followed.Blood pressure and estimated 24-hour salt intake will be compared between intervention and control groups at the cluster and individual level at the 1-year follow-up. Clinical CVD events and deaths will be analyzed by time-event analysis. Retinal blood vessel calibers of CVD-risk patients will be assessed cross-sectionally. Behavioral change to reduce salt intake and the influencing factors will be determined by structured equation model (SEM). Multilevel regression analyses will be applied. Finally, the cost effectiveness of the intervention will be analyzed.DiscussionThis study is unique as it will recruit the individuals most vulnerable to CVD morbidity and mortality by applying the general Framingham CVD risk scoring system. Dietary salt reduction will be applied as a prioritized, community level intervention for the prevention of CVD in a developing country.Trial registrationISRCTN39416277

Structural analysis of the effects of dietary and lifestyle habits, socio-economic status, and three health-related factors on urban elderly in Japan

This study aimed to reveal the causal relationships of dietary and lifestyle habits with socio-economic status (SES) and three health-related factors (physical, mental and social health) in elderly urban dwellers in Japan. All the elderly urban dwellers aged 65 years or more in an urban area of Tokyo were surveyed using a self-administered questionnaire in September 2001. There were 13,195 respondents with a response rate of 80.2%. And then, two follow-up surveys were conducted in 2004 and 2007, respectively. Finally, 8162 respondents were included as analysis subjects. Data analysis was performed using factor analysis and structural equation modelling (SEM). As a result of an exploratory factor analysis, three latent variables (‘dietary and lifestyle habits in 2004’, ‘SES in 2001’ and ‘three health-related factors in 2001’) were defined and applied in the SEM. From the best-fit models, dietary and lifestyle habits in 2004 were well explained by SES and three health-related factors in 2001 (R2 = 0.44 for elderly men and R2 = 0.61 for elderly women). The results showed that dietary and lifestyle habits in 2004 were not only directly affected by SES and the three health-related factors in 2001, but also indirectly by SES via the three health-related factors. Moreover, the causal relationships between the three latent variables depended on sex and age. In conclusion, SES as a basic determinant – enough income, high education level and good physical, mental and social health – favoured both directly and indirectly the practice of healthy or desirable lifestyle habits of the elderly late in life. It will be necessary to construct a model with higher external validity in a future study.

Daily salt intake estimated by overnight urine collections indicates a high cardiovascular disease risk in Thailand.

This cross-sectional study (February 2012 to March 2013) was conducted to estimate daily salt intake and basic characteristics among 793 community-dwelling participants at high risk of cardiovascular disease (Framingham risk score >15%), who had visited diabetes or hypertension clinics at health centres in the Muang district, Chiang Rai, Thailand. We performed descriptive analysis of baseline data and used an automated analyser to estimate the average of 24-hour salt intake estimated from 3 days overnight urine collection. Participants were divided into two groups based on median estimated daily salt intake. Mean age and proportion of males were 65.2 years and 37.6% in the higher salt intake group (>=10.0 g/day, n=362), and 67.5 years and 42.7% in the lower salt intake group (<10.0 g/day, n=431), respectively (p=0.01, p<0.01). The higher salt intake group comprised more patients with a family history of hypertension, antihypertensive drug use, less ideal body mass index (18.5-24.9), higher exercise frequency (>=2 times weekly) and lower awareness of high salt intake. Among higher salt intake participants, those with lower awareness of high salt intake were younger and more often had a family history of hypertension, relative to those with more awareness. Our data indicated that families often share lifestyles involving high salt intake, and discrepancies between actual salt intake and awareness of high salt intake may represent a need for salt reduction intervention aiming at family level. Awareness of actual salt intake should be improved for each family.

Multilevel, cross-sectional study on social capital with psychogeriatric health among older Japanese people dwelling in rural areas

There has been increasing interest in the effect of social capital (SC) on health over the last decade both in Japan and internationally. This study elucidated whether components of SC are linked to the psychogeriatric health of older Japanese individuals.

Effect of exercise on bone status and body composition in Japanese students

PURPOSE We evaluated the effect of exercise on stiffness and fat-free mass (FFM), which consists of bone and muscle, in Japanese students. It is uncertain whether exercise or sports activities will help to accumulate overall peak bone mass in Japanese adolescents. METHODS A total of 710 Japanese students (age = 15-20 yr) were enrolled. Students who regularly engage in physical exercise were assigned to an exercise group; other students were assigned to a nonexercise group. Body composition, including height, weight, waist circumference, hip circumference, body mass index, and waist-to-hip ratio, were measured and calculated. Lung volume, body volume, and body fat percentage were evaluated by air displacement plethysmography. Fat mass and FFM were derived from body fat percentage and body weight. Bone status, such as speed of sounds, broadband ultrasound attenuation, and stiffness, which is defined as bone density, was assessed by quantitative ultrasound. RESULTS In both sexes, height, weight, body mass index, circumferences, waist-to-hip ratio, lung volume, and body volume between the exercise and nonexercise groups did not show any significant differences. FFM, speed of sounds, broadband ultrasound attenuation, and stiffness in the exercise group were statistically higher than those in the nonexercise group (P < 0.05). Although stiffness positively correlated with age with the exception of the nonexercise group in females (P < 0.01), stiffness correlated with FFM in the exercise and nonexercise groups in both sexes (P < 0.01). CONCLUSIONS Ours is the first analysis of a trend in peak bone mass, including the effect of exercise in Japanese students. For Japanese pubertal females who did not have a history of regular exercise, stiffness slowly decreased with age. Exercise habits in early childhood are important in the relationship between stiffness and FFM.

Randomised controlled pilot study in Japan comparing a home visit program using a Functioning Improvement Tool with a home visit with conversation alone

Aim:  This study aimed to determine the effect of a home visit program using a Functioning Improvement Tool (FIT) compared with a home visit using conversation alone.

Association of prenatal exposure to PCDD/Fs and PCBs with maternal and infant thyroid hormones: The Hokkaido Study on Environment and Children's Health☆

Polychlorinated dibenzo-p-dioxins (PCDDs), dibenzofurans (PCDFs) and biphenyls (PCBs) are persistent organic pollutants that are universally detected. Some congeners of PCDDs, PCDFs or PCBs have dioxin-like toxicity, whereas non-dioxin-like PCBs are considered to have different toxicity. Reports of the relationships between prenatal exposure to PCDDs, PCDFs or PCBs and thyroid homeostasis in pregnant women and infants have been inconsistent. The aim of this study was to investigate the effect of maternal serum PCDD/F or PCB levels on maternal and neonatal thyroid hormone (TH) levels in a prospective cohort. Of the 514 subjects in the prospective cohort, 386 mothers and 410 infants were included for analysis. Fifteen dioxins and seventy PCBs in maternal blood collected between 23 and 41weeks of gestation were measured using high-resolution gas chromatography and high-resolution mass spectrometry. Blood samples to measure thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels were obtained from mothers at an early gestational stage (median ten weeks), and from infants between four and seven days of age, respectively. Multiple linear regression analysis was conducted. Median concentration of total PCBs, PCB 153 were 104,700, and 20,500pg/g lipid, respectively. Median total dioxin-TEQ was 13.8pg/g lipid. Total dioxin-TEQ, coplanar PCBs were positively associated with neonatal FT4 (beta=0.224, 0.206, respectively). The association was stronger in boys (beta=0.299, 0.282, respectively). Several PCDD/F and PCB isomers were also positively associated with neonatal FT4. Total PCBs or non-dioxin-like PCBs were not associated with any maternal or neonatal THs. No DLC grouping or congeners were associated with neonatal TSH. Non-ortho PCBs were positively associated with maternal FT4. Three PCB congeners had significant positive association(s) with maternal THs. In conclusion, the results of our study suggest that perinatal exposure to background-level DLCs increases neonatal FT4, especially in boys.

Cross-sectional analysis of self-efficacy and social capital in a community-based healthy village project in Santa Cruz, Bolivia

BackgroundAn assessment of self-efficacy and social capital may have the potential to detect an effect of dynamic, complex and comprehensive collective actions in community-based health promotion. In 2003, a healthy village project was launched in Santa Cruz, Bolivia with technical assistance from the Japan International Cooperation Agency (JICA). The originally developed FORSA (Fortalecimiento de Redes de Salud) model accounted for participatory processes in which people could improve their health and well-being through individual behavioral changes and family/community-driven activities. This study aimed to examine the extent of self-efficacy and social capital obtained via project activities by a cross-sectional analysis.MethodsWe randomly selected 340 subjects from the healthy village project site and 113 subjects from a control area. Both groups were interviewed using the same structured questionnaire. Self-efficacy was assessed with a General Self-Efficacy Scale (GSES), while social capital was measured as the frequency of formal group participation in community meetings during the past three months, perceived social solidarity, and general trust.ResultsThe study results showed that the participants in the project site had higher self-efficacy and social capital compared to those in the control site. The number of times a subject participated in the health committee activities was positively associated with the self-efficacy scale. Regarding social capital, females and lower-educated people were more likely to have had more frequent participation in formal groups; males and higher-educated participants showed less formal group participation, but more generosity to contribute money for the community. The main perceived benefit of participation in formal group activities varied among individuals.ConclusionThe findings suggest that people in the healthy village project site have higher self-efficacy, especially those with active participation in the health committee activities. To recruit more participants in future healthy village projects, we should consider the gender and level of education, and match the perceived benefits of participants accordingly.