Relationship between Illness Perception and the need for Professional Medical Interpretation for International Patients in Japan.

This study aimed to conduct a cross-sectional questionnaire survey of foreign patients to analyze the impact of patients' illness perceptions on their need for professional medical interpreters. From February 2022 to May 2023, an online questionnaire was distributed to 4,962 individuals aged 18 years or older who were non-native speakers of Japanese. These individuals were enrolled in organizations such as international exchange associations and Japanese language support classes and had utilized medical institutions in Japan due to their own illness or injury or that of their children. Among the 312 valid responses, international patients with a high score for illness perception were more likely to want to utilize professional medical interpreters than those with a low score for illness perception (odds ratio, 1.968; 95% confidence interval, 1.044-3.709; P = 0.036). Our findings suggest that hospitals should be better prepared to meet the potential language needs of international patients with a higher illness perception.

Longitudinal effects of disaster-related experiences on problem drinking among Fukushima nuclear plant workers.

BACKGROUND: In the Fukushima nuclear power plant disaster of March 11, 2011, plant workers were exposed to various traumatic events and reported a subsequent increase in alcohol use. To determine the relationship between disaster-related experiences and problem drinking, we conducted a three-year follow-up study. METHODS: Problem drinking among the nuclear plant workers was assessed annually from 2012-2014 using a modified version of the CAGE questionnaire that asked about current, rather than lifetime, drinking. A total of 1378 workers provided at least one CAGE response, and 2875 observations were used in the present analysis. Mixed-effects logistic regression models were used to analyze the relationship between disaster-related experiences and problem drinking over time. RESULTS: The prevalence of problem drinking (CAGE score ≥2) increased over time. At the baseline assessment in 2012, a year after the disaster, plant workers who had experienced life-threatening danger and discrimination had significantly more symptoms of problem drinking, which persisted over the following 2 years. Although at baseline, plant workers who had experienced major property loss or the death of a colleague showed no significant differences in problem drinking symptoms from those without such experiences, over the next 2 years their problem drinking increased significantly. CONCLUSIONS: Individuals who experienced life-threatening danger and discrimination during the Fukushima nuclear power plant disaster reported an increase in problem drinking. Although major property loss and the death of a colleague did not elevate problem drinking prevalence at baseline, it did so over the next 2 years. Different adverse effects of a natural disaster appear to differentially increase drinking behavior over time.

Mushroom intake and risk of incident disabling dementia: the Circulatory Risk in Communities Study (CIRCS).

It is uncertain whether dietary intake of mushrooms rich in dietary fibre and several antioxidants is associated with a lower risk of dementia. We sought to examine prospectively the association between mushroom intake and the risk of disabling dementia. We performed a prospective study involving 3750 people aged 40 to 64 years residing in three communities who participated in an annual cardiovascular risk survey from 1985 to 1999. Cases of incident disabling dementia were surveyed from 1999 to 2020. We calculated the hazard ratios (HR) and 95 % CI for incident total dementia according to mushroom intake among participants with or without a history of stroke. During a mean 16·0 years' follow-up in 3739 eligible participants, 670 people developed disabling dementia. For women, mushroom intake was inversely associated with the risk of total dementia and the association was confined to dementia without a history of stroke. The multivariable HR (95 % CI) for total dementia in women were 0·81 (0·62, 1·06) for mushroom intake of 0·1-14·9 g/d and 0·56 (0·42, 0·75) for mushroom intake above 15·0 g/d (Pfor trend = 0·003) compared with no intake. The corresponding HR (95 % CI) for dementia without a history of stroke were 0·66 (0·47, 0·93) and 0·55 (0·38, 0·79) (Pfor trend = 0·01). In men, no associations were observed between mushroom intake and the risk of disabling dementia. Among Japanese women, dietary mushroom intake was associated with a lower risk of disabling dementia.

Continuous positive airway pressure alleviates insomnia in workers sleeping near other workers with sleep apnea after the Fukushima Nuclear Power Plant disaster.

OBJECTIVES: To examine the efficacy of continuous positive airway pressure for improving the sleep of all individuals residing in a temporary shelter. METHODS: Workers at a nuclear power plant using a gymnasium as temporary shelter were divided into two groups: 15 workers with obstructive sleep apnea received continuous positive airway pressure treatment, and 107 workers without obstructive sleep apnea received no treatment. We assessed subjective sleepiness among the workers with obstructive sleep apnea before and after continuous positive airway pressure treatment, and evaluated insomnia in all workers before and after workers with obstructive sleep apnea were given continuous positive airway pressure treatment. RESULTS: Workers who received continuous positive airway pressure treatment reported significantly improved subjective sleepiness, but did not experience a significant change in insomnia symptoms. However, workers without obstructive sleep apnea reported significant improvements in their insomnia symptoms following the treatment of workers with obstructive sleep apnea. CONCLUSIONS: Using continuous positive airway pressure to treat workers with obstructive sleep apnea residing in temporary shelters may help prevent adverse health consequences from insomnia among other individuals sleeping nearby.

Serum folate and risk of disabling dementia: a community-based nested case-control study.

PURPOSE: The aim of this study was to examine associations between serum folate levels and risk of disabling dementia that required care under the national insurance (disabling dementia). METHODS: We performed a nested case-control study in a community-based cohort, the Circulatory Risk in Communities Study, involving 13,934 Japanese individuals aged 40-84 years at the baseline period of 1984-2005. Serum folate was measured in 578 cases of incident disabling dementia, and in 1,156 controls whose age (±1 years), sex, area of residence, and baseline year were matched with the cases. The diagnosis of disabling dementia was performed by attending physicians under the National Long-Term Care Insurance System in Japan. Conditional odds ratios of disabling dementia according to quintiles of serum folate were calculated using conditional logistic regression models. RESULTS: After a 20.8-year follow-up, serum folate was inversely associated with risk of disabling dementia. The respective multivariable odds ratios (95% CIs) were 0.71 (0.51-0.99), 0.76 (0.54-1.06), 0.70 (0.49-1.00), and 0.62 (0.43-0.90) for persons with the second, third, fourth, and highest quintiles of serum folate as compared with the lowest quintile (P for trend = 0.03). A similar association was observed for dementia with or without stroke. CONCLUSION: In this nested case-control study with a long follow-up, low serum folate levels were associated with an increased risk of disabling dementia among Japanese individuals.

Longitudinal Changes in Arterial Stiffness Associated with Physical Activity Intensity: The Toon Health Study.

AIMS: Several studies have revealed an association between moderate-to-vigorous physical activity (MVPA) and arterial stiffness, which is a known risk factor for cardiovascular disease. However, a few studies have considered the difference in the longitudinal effect of its intensity in a large general population. Therefore, we examined the effect of MVPA intensity on longitudinal changes in arterial stiffness. METHODS: We conducted a prospective cohort study involving 1,982 Japanese men and women. Arterial stiffness was measured using the cardio-ankle vascular index (CAVI) at baseline and 5-year follow-up. Physical activity was quantified using the Japan Arteriosclerosis Longitudinal Study Physical Activity Questionnaire and categorized into quartiles as MVPA levels. Linear mixed models were used to examine the differences at baseline and the rate of changes in CAVI associated with MVPA levels for over 5 years. RESULTS: The multivariable-adjusted mean differences in CAVI at baseline were significantly lower in the third (ß=-0.019 [95% confidence interval {CI}=-0.033 to -0.005]) and fourth (ß=-0.018 [95% CI=-0.035 to -0.001]) quartiles of the MVPA group compared with those in the lowest quartile of MVPA, and the significant effect persisted 5 years later. CONCLUSIONS: In summary, this study provides evidence to support the existence of a threshold for beneficial levels of MVPA in the prevention of arterial stiffness. Furthermore, this study suggests that exceeding this threshold may exert similar effects on arterial stiffness. These findings suggest that an optimal level of MVPA exists for preventing arterial stiffness, and exceeding this threshold may not engender additional benefits.

Relationship Between Patient-Provider Language Discordance and the Need for Professional Medical Interpretation for International Patients in Japan.

BACKGROUND: Language barriers between patients and healthcare providers pose significant challenges in medical care in Japanese hospitals. Inadequate patient understanding of discussions with healthcare providers because of patient-provider language discordance has been reported in previous studies. There are growing expectations of professional medical interpreters to address these challenges. A previous study reported that patients with patient-provider language discordance were more likely to need interpreter assistance compared with patients with patient-provider language concordance. OBJECTIVE: We conducted a cross-sectional study utilizing a questionnaire survey of foreign patients to analyze the impact of the degree of patient-provider language discordance on the degree of patient comprehension of patient-provider communication, as well as patients' need for professional medical interpreters in Japanese hospitals. METHOD: From February 2022 to May 2023, an online questionnaire was distributed to 4,962 individuals aged 18 years or older who were non-native speakers of Japanese and who had attended medical institutions in Japan because of illness or injury experienced by themselves or by their children. A chi-square test and residual analysis were used to analyze the relationship between patient-provider language discordance and patient comprehension of patient-provider language concordance. Logistic regression analysis was performed to analyze the relationship between patient-provider language discordance and the necessity of professional medical interpretation. RESULTS: Among 4,962 study subjects who received the online survey, the total number of responses was 363 (7.3%). The rate of low-level patient comprehension was significantly higher in the patient-provider language discordance group compared with other groups. In a logistic regression model that accounted for sociodemographic factors, both the partial and complete patient-provider language discordance groups were more likely to want to use professional medical interpreters compared with the patient-provider language concordance group (OR: 4.16; 95% CI, 1.55-11.16; P=0.005; OR: 4.73; 95% CI, 1.70-13.18; P=0.003, respectively). CONCLUSION: The current findings suggest that hospitals should be better prepared to meet the potential language needs of international patients with no or limited use of Japanese in daily conversation.

Perceived Level of Life Enjoyment and Risk of Developing Disabling Dementia: The Japan Public Health Center-Based Study.

OBJECTIVES: Life enjoyment, linked to the ability to engage pleasurably with one's environment, may be related to the risk of developing dementia. This prospective cohort study examined the association between level of life enjoyment and disabling dementia incidence among Japanese community residents. METHODS: The participants were Japanese, aged 45-74 years old at 5-years follow-up, in the Japan Public Health Center-based Study (N = 38,660). Psychological conditions and other confounding variables were identified through self-administered questionnaires. Incident disabling dementia registered based on the Japan's Long-Term Care Insurance system from 2006 to 2016. Hazard ratios [95% confidence intervals] were assessed using Cox proportional hazards models. RESULTS: Over a median follow-up period of 9.4 years, a total of 4,642 cases of disabling dementia developed. Level of life enjoyment was inversely associated with the risk of disabling dementia: the multivariable hazard ratios were 0.75 [0.67-0.84] (p < .001) and 0.68 [0.59-0.78] (p < .001) with medium and high life enjoyment, respectively, compared to low life enjoyment. Furthermore, the association between greater life enjoyment and low risk for disabling dementia was strongest in the subgroup with low-medium mental stress. In the high mental stress group, this association was evident for poststroke disabling dementia, but not for disabling dementia without a history of stroke. DISCUSSION: A higher level of life enjoyment was associated with a lower risk of disabling dementia, particularly in the low-medium mental stress group. This finding suggests the importance of having life enjoyment by managing mental stress for reducing risk of disabling dementia.

Dietary behaviours and related lifestyles according to the presence or absence of skipping breakfast in Japanese adults: the JPHC-NEXT study.

OBJECTIVE: To assess dietary behaviours and related lifestyles according to the presence or absence of skipping breakfast. DESIGN: We analysed the cross-sectional data from a baseline survey of a large-scale population-based cohort study in Japan conducted in 2011-2016. Participants provided information on dietary behaviours and lifestyles through a self-administered questionnaire. Skipping breakfast was defined as not eating breakfast at least once a week and was classified according to the frequency of skipping breakfast as 1-2, 3-4 or ≥5 times/week. SETTING: Sixteen municipalities in seven prefectural areas across Japan under the Japan Public Health Centre-based prospective study for the Next Generation. PARTICIPANTS: 112 785 residents (51 952 males and 60 833 females) aged 40-74 years. RESULTS: After adjustment for age, socio-demographic status, drinking status and smoking status, individuals who skipped breakfast at least once a week, compared with those who ate breakfast every day, were more likely to have adverse dietary behaviours such as frequent eating out (multivariable OR = 2·08, 95 % CI (1·96, 2·21) in males and 2·15, 95 % CI (1·99, 2·33) in females), frequent eating instant foods (1·89, 95 % CI (1·77, 2·01) in males and 1·72, 95 % CI (1·56, 1·89) in females). They had late bedtime (1·85, 95 % CI (1·75, 1·95) in males and 1·98, 95 % CI (1·86, 2·11) in females) and living alone (2·37, 95 % CI (2·17, 2·58) in males and 2·02, 95 % CI (1·83, 2·21) in females), using the logistic regression model. CONCLUSIONS: Both adult males and females who skipped breakfast were likely to eat out, to have a dietary habit of eating instant foods and have lifestyles such as late bedtime and living alone than those who ate breakfast.

Adolescent Loneliness in 70 Countries Across Africa, America, and Asia: A Comparison of Prevalence and Correlates.

PURPOSE: Emerging studies address adolescent loneliness a public health problem due to its negative associations with adverse health. However, evidence concerning adolescent loneliness and its correlation in nonwestern, low- and middle-income countries is scarce. This study examined the prevalence of loneliness and its correlates (i.e., sex, bullying victimization, and peer support) across 70 countries from five WHO regions. METHODS: Data were collected from the Global School-based Student Health Survey of children aged 13-17 (2003-2018) years. Loneliness was defined as feeling lonely most of the time or always in the past 12 months based on self-reports. The prevalence of loneliness was estimated, and multivariable logistic regression ascertained prevalence ratios of correlates by country. Meta-analysis was used to examine regional and overall pooled estimates. RESULTS: Among the 248,017 students included in the study, the overall prevalence of loneliness was 11.7% (95% confidence interval (CI): 10.6-12.7), with significant variations across countries. Girls (vs. boys prevalence ratio (PR = 1.4 95% CI: 1.3-1.4), students who experienced bullying victimization (PR = 2.2, 95% CI: 2.1-2.3), and students who reported a lack of close friends (PR = 1.8, 95% CI: 1.7-1.9) were at increased risk of experiencing loneliness. There was significant heterogeneity between countries for sex and lack of close friends but not for bullying victimization. DISCUSSION: Adolescent loneliness is prevalent globally, especially in Africa and the Eastern Mediterranean. The considerable heterogeneity in its prevalence and correlates suggest that tailoring to the country context may benefit policy initiatives. Bullying may be a common intervention target in all countries.

Trends in stroke, cardiovascular disease, and medical expenditure under a community-based long-term stroke prevention program.

BACKGROUND: Evidence on the effects of preventive measures for noncommunicable disease is urgently needed for low-income and middle-income countries suffering from stroke epidemics along with population aging. OBJECTIVES: We sought to examine the impact of a community-based stroke prevention program on incidences of stroke and ischemic heart disease, mortality from cardiovascular disease, and medical expenditure. METHODS: Trends in the incidences of stroke and ischemic heart disease were documented in a Japanese rural community, Kyowa, from 1981 through 2015. Trends in mortality from cardiovascular disease and in medical expenditures were compared between Kyowa and its surrounding municipalities from 1981 through 2004. RESULTS: In Kyowa, the age-and-sex-adjusted incidences of stroke and of ischemic heart disease decreased by half (from 4.1 to 1.9 and from 1.5 to 0.7 per year/1000 persons, respectively) over the past 35 years. A similar decreasing trend was observed for the age-and-sex-adjusted mortality from cardiovascular disease, and this decreasing trend occurred earlier than that in the surrounding municipalities. The medical expenditures for cardiovascular disease became lower in Kyowa than in the surrounding municipalities over time. CONCLUSION: Our study's findings suggest that a community-based stroke prevention program augmented the decline in the incidences of stroke and ischemic heart disease, mortality from cardiovascular disease, and attenuated the increase in medical expenditures for cardiovascular disease.

Nocturnal Intermittent Hypoxia and the Risk of Cardiovascular Disease among Japanese Populations: The Circulatory Risk in Communities Study (CIRCS).

AIMS: Information is limited about the influence of obstructive sleep apnea (OSA) on developing cardiovascular disease (CVD) among Asian community-dwelling populations. We examined the association between nocturnal intermittent hypoxia as a surrogate marker of OSA and the risk of CVD in a Japanese community-based cohort study. METHODS: We used baseline surveys from 2000 to 2008 to study the cohort data of 5,313 residents from three Japanese communities who were between the ages of 40 and 74 years and initially free from ischemic heart disease and stroke. We assessed the number of 3% oxygen desaturation index (ODI) as the indicator of nocturnal intermittent hypoxia. We divided individuals into two groups depending on 3% ODI (3% ODI ≥ 5 or 3% ODI ＜5). Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD according to 3% ODI. Age, sex, body mass index, alcohol, and smoking were adjusted in the multivariable models. RESULTS: During 12.8 years of the median follow-up with 66,796 person-years, 185 cases with CVD (115 stroke and 70 coronary heart disease [CHD]) were recorded. The multivariable HRs (95% CIs) were 1.49 (1.09-2.03), 2.13 (1.08-4.22), and 1.93 (1.16-3.19) for the 3% ODI ≥ 5 group versus the 3% ODI ＜5 group of developing CVD, lacunar infarction, and CHD, respectively. CONCLUSIONS: Nocturnal intermittent hypoxia may increase the risk of developing lacunar infarction and CHD among community-dwelling Japanese populations. However, we could not find a significant risk of developing total stroke or stroke subtypes such as intraparenchymal hemorrhage, subarachnoid hemorrhage, and total ischemic stroke.

Longitudinal Trends in Blood Pressure Associated with The Changes in Living Environment Caused by the Great East Japan Earthquake: The Fukushima Health Management Survey.

The Great East Japan Earthquake occurred on 11 March 2011, forcing Fukushima Prefecture residents to change their living environment. Such sudden changes possibly have long-term effects on cardiovascular-related diseases. We therefore sought to identify temporal relationships between living environment changes and blood pressure levels over three years following the earthquake. Participants included 14,941 men and 21,533 women aged 16 years or older who answered self-administered questionnaires, including questions on living environment changes at baseline (2012). Blood pressure levels were measured each year from 2012 to 2015. Linear mixed-effects models were used to analyze associations between living environment changes and blood pressure levels. Men with changes in living environment (i.e., those living in shelters or in temporary housing, rental apartments, relatives' houses, or others) showed significantly higher diastolic blood pressure levels than those who lived in their home at baseline (77.3 mmHg vs. 77.8 mmHg; p < 0.001). The time-dependent effect of diastolic blood pressure levels associated with living environment was not statistically significant, indicating a sustained difference in diastolic blood pressure associated with living environment changes at baseline after three years. The effect of living environment changes on diastolic blood pressure increment was also evident in men without antihypertensive medication use during the study period and in men who were current drinkers at baseline. There were no associations between living environment changes and diastolic blood pressure levels among women. Sudden changes in living environment due to the disaster had an impact on the long-term effects of higher diastolic blood pressure among middle-aged men.

Dietary fiber intake and risk of incident disabling dementia: the Circulatory Risk in Communities Study.

OBJECTIVES: It has been hypothesized that dietary fiber intake has a beneficial impact on prevention of dementia, but the epidemiological evidence is scant. We sought to examine whether dietary fiber intake is inversely associated with risk of dementia requiring care under the national insurance (disabling dementia). METHODS: The study setting was the Circulatory Risk in Communities Study, involving 3739 Japanese individuals aged 40-64 years at the dietary surveys (1985-99). Dietary fiber intake was estimated using the 24-hour dietary recall method. Incident disabling dementia was followed up from 1999 through 2020. Disabling dementia was further classified into that with or without a history of stroke. Hazard ratios of disabling dementia according to quartiles of total, soluble, and insoluble fiber intake were calculated using the Cox proportional hazards model. RESULTS: During a median 19.7-year follow-up, a total of 670 cases of disabling dementia developed. Dietary fiber intake was inversely associated with risk of dementia: the multivariate hazards ratios (95% confidence intervals) were 0.83 (0.67-1.04), 0.81 (0.65-1.02), and 0.74 (0.57-0.96) for individuals with the second, third, and highest quartiles of dietary fiber intake, respectively, as compared with the lowest quartile (P for trend = 0.03). The inverse association was more evident for soluble fiber intake and was confined to dementia without a history of stroke. As for fiber-containing foods, potatoes, but not vegetables or fruits, showed a similar association. CONCLUSIONS: Dietary fiber intake, especially soluble fiber, was inversely associated with risk of disabling dementia in a general Japanese population.

Hobby Engagement and Risk of Disabling Dementia.

BACKGROUND: The association between hobby engagement and risk of dementia reported from a short-term follow-up study for individuals aged ≥65 years may be susceptible to reverse causation. We examined the association between hobby engagement in age of 40-69 years and risk of dementia in a long-term follow-up study among Japanese, including individuals in mid-life, when the majority of individuals have normal cognitive function. METHODS: A total of 22,377 individuals aged 40-69 years completed a self-administered questionnaire in 1993-1994. The participants answered whether they had hobbies according to the three following responses: having no hobbies, having a hobby, and having many hobbies. Follow-up for incident disabling dementia was conducted with long-term care insurance data from 2006 to 2016. RESULTS: During a median of 11.0 years of follow-up, 3,095 participants developed disabling dementia. Adjusting for the demographic, behavioral, and psychosocial factors, the multivariable hazard ratios of incident disabling dementia compared with "having no hobbies" were 0.82 (95% confidence interval [CI], 0.75-0.89) for "having a hobby" and 0.78 (95% CI, 0.67-0.91) for "having many hobbies". The inverse association was similarly observed in both middle (40-64 years) and older ages (65-69 years). For disabling dementia subtypes, hobby engagement was inversely associated with the risk of dementia without a history of stroke (probably non-vascular type dementia), but not with that of post-stroke dementia (probably vascular type dementia). CONCLUSION: Hobby engagement in both mid-life and late life was associated with a lower risk of disabling dementia without a history of stroke.

Decreased psychomotor vigilance is a risk factor for motor vehicle crashes irrespective of subjective daytime sleepiness: the Toon Health Study.

STUDY OBJECTIVES: Although excessive daytime sleepiness (EDS) has a crucial impact on motor vehicle crashes (MVCs), the assessment of subjective sleepiness as a screening tool for MVC has limitations. Objective daytime sleepiness may be a better predictor of MVCs rather than subjective daytime sleepiness. Therefore, we aimed to examine the association of psychomotor vigilance as a surrogate marker of objective sleepiness and subjective sleepiness with MVCs in a prospective cohort study of the general population. METHODS: The study participants were 903 community-dwelling Japanese followed up 5 years after baseline and ascertained history of MVC over the study period. Psychomotor vigilance was measured by the psychomotor vigilance test and categorized into quartiles by the reciprocal of the mean reaction time (mean1/RT). Subjective EDS was defined using the Japanese version of the Epworth Sleepiness Scale. Multivariable logistic regression analysis was used to examine the association between mean1/RT and MVC after stratification by subjective EDS. RESULTS: The multivariable-adjusted odds ratio (95% confidence interval) for MVC among the highest quartile group of mean1/RT was 0.31 (0.17-0.57), compared with the lowest group (P for trend < .01). After stratification by subjective EDS, the significant association was found only among the nonsubjective EDS group (P for trend < .01) and not among the subjective EDS group (P for trend = .16). CONCLUSIONS: Decreased psychomotor vigilance measured by the psychomotor vigilance test was associated with a higher risk of MVCs, and the association was more evident among the nonsubjective EDS group. The psychomotor vigilance test may be useful to prevent sleep-related MVCs in the general population, particularly for individuals without subjective EDS. CITATION: Matsuo R, Tanigawa T, Oshima A, et al. Decreased psychomotor vigilance is a risk factor for motor vehicle crashes irrespective of subjective daytime sleepiness: the Toon Health Study. J Clin Sleep Med. 2023;19(2):319-325.

An association between cancer type and delirium incidence in Japanese elderly patients: A retrospective longitudinal study.

OBJECTIVE: There is not a known elevated prevalence of delirium in older adult cancer patients. However, it is unknown if the incidence of delirium varies by cancer type among older adult patients. Therefore, this study aimed to examine the association between the incidence of delirium and cancer type among older adult patients using a Japanese hospital-based administrative claims database. METHODS: A total of 76,868 patients over 65 years of age or older, first diagnosed with cancer on an initial date of hospitalization between April 2008 and December 2019, were included in this retrospective longitudinal study. Delirium was defined by the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes or antipsychotic medication use. Cox proportional hazard models were performed to estimate the risk of delirium incidence according to 22 cancer types during the one-year hospitalization period. RESULTS: The incidence rates of delirium were 17.1% for men and 15.3% for women. Compared to gastric cancer, the risk of delirium was significantly higher for pancreatic cancer (HR: 1.26, 95% CI: 1.11-1.42 for men; HR: 1.27, 95% CI: 1.11-1.45 for women), leukemia (HR: 1.24, 95% CI: 1.09-1.41 for men; HR: 1.20, 95% CI: 1.03-1.41 for women), and oropharyngeal cancer (HR: 1.30, 95% CI: 1.10-1.54 for men; HR: 1.32; 95% CI: 1.02-1.72 for women) after adjusting for age, initial hospitalization year, antipsychotic medications, and surgery. CONCLUSIONS: As compared to gastric cancer, patients with pancreatic cancer, leukemia, oropharyngeal cancer were found to have a higher risk of developing delirium. Our study findings suggested that the risk of delirium incidence may vary by cancer type.

Dietary intake of beans and risk of disabling dementia: The Circulatory Risk in Communities Study (CIRCS).

OBJECTIVE: To examine whether bean intake (including soybeans) among Japanese adults is associated with risk of disabling dementia severe enough to require care under the national insurance system. METHODS: This cohort study involved 3739 individuals aged 40 to 64 years. The participants were categorized into five groups based on their dietary bean intake estimated by a 24h dietary recall. Hazard ratios and 95% confidence intervals of disabling dementia were estimated using Cox proportional hazard models adjusted for potential confounding factors (smoking, drinking, and intakes of energy and fish). RESULTS: During the 59,681 person-year follow-up, 670 cases of disabling dementia were observed. A weak inverse association between bean intake and risk of disabling dementia was found; the multivariable hazard ratios (95% CIs) were 0.79 (0.62-1.00), 0.80 (0.63-1.01), 0.84 (0.67-1.06), and 0.78 (0.62-0.99) for the four groups with higher bean intake, respectively, compared with the lowest group (P for trend = 0.21). A significant inverse association was observed for dementia without a history of stroke; for the four groups with higher bean intake the multivariable hazard ratios were 0.81 (0.61-1.08), 0.70 (0.52-0.95), 0.71 (0.52-0.95), and 0.69 (0.51-0.92), respectively, (P for trend = 0.03). No such association was observed for dementia with history of stroke. The group with increased natto intake were inversely associated with risk of disabling dementia (P for trend = 0.003), but tofu intake was not (P for trend = 0.19). CONCLUSIONS: Bean intake was inversely associated with risk of disabling dementia in those without a history of stroke.

Illness Perception Accorded by Language Assistance in Non-Japanese-Speaking Patients.

Background and objective While over half of foreign residents in Japan need language assistance during medical consultations, no extant studies have clarified illness perception accorded by language assistance in non-Japanese-speaking patients. This cross-sectional study conducted an online questionnaire survey to investigate the illness perception of non-Japanese-speaking patients and analyze the factors related to illness perception. Methodology The survey was conducted twice, from February to May 2022 and from February to April 2023, targeting non-Japanese-speaking individuals. In total, 293 valid responses were obtained. The Brief Illness Perception Questionnaire (Brief IPQ) scores were compared between the groups receiving language assistance and those without assistance, and a logistic regression analysis was performed to examine the factors related to illness perception accorded by the status of the language assistance group. Results The total score for illness perception was significantly lower in the language assistance group than in the non-assistance group (P = 0.04). Moreover, in the language assistance group, age (odds ratio [OR] = 0.91, 95% confidence interval [CI] = 0.84-0.99) and comprehension of medical consultations (OR = 0.31, 95% CI = 0.11-0.83) were significantly associated with low illness perception among participants. However, these associations were not observed in the non-assistance group. Conclusions These findings underscore the crucial role of ensuring effective communication and promoting a better understanding of illness perception during medical consultations.

Oral administration of sodium bicarbonate can enhance the therapeutic outcome of Doxil® via neutralizing the acidic tumor microenvironment.

The pH of the tumor microenvironment in solid tumors is reported to be more acidic than that of normal tissues. The pH is controlled by over-expression of several transporters that are associated with the progression, angiogenesis, and metastasis of solid tumors. Antitumor effects of weak-base anticancer agents, such as doxorubicin (DXR), could be reduced in an acidic environment because of increases in the ionized form of the drug under these conditions, reducing its membrane penetrability. In our previous studies, we demonstrated that oral administration of sodium bicarbonate (NaHCO3) can neutralize the acidic tumor microenvironment and enhance the effects of small molecule anticancer drugs. However, it is not known whether or not increasing the tumor pH by oral administration of NaHCO3 leads to enhanced antitumor effects of lipidic nanoparticle formulations of weak-base anticancer drugs, such as Doxil®. In this study, we investigated the antitumor efficacy of Doxil® in combination with oral administration of NaHCO3 in a Colon26 tumor-bearing mouse model. NaHCO3 clearly enhanced the tumor-growth inhibitory effect of Doxil® without exacerbating any systemic side effects. In vitro studies indicated that high levels of DXR were internalized into cells at neutral pH. These studies demonstrate that the neutralization of acidic tumor microenvironment by an oral administration of NaHCO3 could be a promising approach to enhance the therapeutic outcomes of Doxil®.