[States and predictors of postpartum smoking relapse: a population based longitudinal study].

Objectives　Although more than half of women who smoke attempt to stop smoking after conception, many relapse after delivery. We conducted a population-based longitudinal study to identify the predictors of postpartum smoking relapse.Methods　Participants were expectant mothers living in Nagoya city, Japan, who notified Health Centers of their pregnancy from April 2014 to March 2015. A self-administered questionnaire was given to the expectant mothers that includes individual factors in the pregnancy: expectant mother's smoking status, age, marital status, experience of parturition, (mother's and father's) occupations, infertility treatment reception, feelings when pregnancy was confirmed, plans to return to parents' house for delivery, accessibility to help with childcare, household member(s) smoking in the same room, alcohol consumption, and depressive symptoms continuing more than 2 weeks.　We followed their smoking status at their children's "3-month-old health check-up" (3 months) and "1-year-and-6-months-old health check-up" (18 months) held in Health Centers until March 2017.　The data were analyzed using a combination of Chi-square or Fisher's exact test and logistic regression modeling. The analyses were conducted separately in primiparas and multiparas in addition to all expectant mothers.Results　Participants were 24,413 mothers; 18,041 were followed up at 3 months and 14,163 at 18 months.　Of the 18,041 mothers at 3 months, 1,031 primiparas and 695 multiparas stopped smoking when they confirmed pregnancy; 89 (8.6%) primiparas and 107 (15.4%) multiparas relapsed at 3 months. Of the 14,163 mothers at 18 months, 789 primiparas and 568 multiparas stopped smoking when they confirmed pregnancy; 155 (19.6%) primiparas and 174 (30.6%) multiparas relapsed smoking at 18 months.　As a result of logistic regression modeling, "multiparas," "younger (<25 years old)," "not married (only in multiparas)," "no plan to return to mother's parent's house for delivery," "household member(s) smoking in the same room (only in primiparas)," and "depressive symptoms (only in all mothers and primiparas)" were the predictors of postpartum smoking relapse at 3 months. "Multiparas," "not married (only in all mothers)," "no help with childcare (only in all mothers)," and "household member(s) smoking in the same room" were the predictors of postpartum smoking relapse at 18 months.Conclusion　More mothers relapsed with smoking after 3 months than before 3 months. The predictors of postpartum smoking relapse differed between 3 and 18 months. Support to continue smoking cessation was needed for each mother at an appropriate time not only in pregnancy but also after delivery.

Change in activities of daily living, functional capacity, and life satisfaction in Japanese patients with subacute myelo-optico-neuropathy.

BACKGROUND: There have been few reports on longitudinal change in activities of daily living (ADL), functional capacity, and life satisfaction in patients with subacute myelo-optico-neuropathy (SMON). METHODS: A total of 1309 SMON patients 40 to 79 years of age underwent a medical examination conducted by the SMON Research Committee during the period from 1993 through 1995 (baseline) in Japan; 666 (51%) were followed-up after 12 years and were thus eligible for analysis. We calculated scores for ADL, functional capacity, and life satisfaction at baseline, and at 3, 6, 9, and 12 years after baseline, using data from medical examinations conducted in 1993 through 2007. The Barthel Index, the Tokyo Metropolitan Institute of Gerontology Index of Competence, and the patient's response to the question "Are you satisfied with life?" were used to assess ADL, functional capacity, and life satisfaction, respectively. RESULTS: As compared with baseline, the mean scores for ADL, functional capacity, and life satisfaction were all significantly lower after 12 years in men and women, with the exception of life satisfaction in women. The change in scores for functional capacity from baseline to year 12 was significantly associated with change in life satisfaction; however, the changes in ADL and age at baseline were not. CONCLUSIONS: We observed decreases in ADL, functional capacity, and life satisfaction among SMON patients. Our results suggest that a decrease in life satisfaction can be prevented by maintaining or improving functional capacity.

Activities of daily living, functional capacity, and life satisfaction of subacute myelo-optico-neuropathy patients in Japan.

BACKGROUND: Patients with subacute myelo-optico-neuropathy (SMON) suffer from a number of serious neurological symptoms that adversely affect their activities of daily living (ADL). However, the effects of these neurological symptoms on functional capacity and life satisfaction have not been reported. METHODS: We analyzed data from 1,300 SMON patients aged 55-94 years that was obtained at medical check-ups carried out by the SMON Research Committee in 2004-2006 in Japan. The neurological symptoms investigated were visual impairment, dysbasia, symptoms of the lower extremities, and sensory symptoms. Neurological symptoms were classified by severity. The Barthel Index, the Tokyo Metropolitan Institute of Gerontology Index of Competence, and the participant's response to the question "Are you satisfied with life?" were used to evaluate ADL, functional capacity, and life satisfaction, respectively. Data were analyzed using a proportional odds model with the scores for these items as ordinal dependent variables. RESULTS: For most neurological symptoms, scores for ADL, functional capacity, and life satisfaction were significantly lower in participants with severe or moderate neurological symptoms than in those with nearly normal results upon examination. The odds ratio for life satisfaction due to superior functional capacity was significant after adjustment for sex, age, and ADL score. CONCLUSION: The presence of neurological symptoms in SMON patients was associated with low functional capacity, life satisfaction, and ADL. Our results suggest that the life satisfaction of SMON patients can be increased by improving their functional capacity.

Clinical analysis of longstanding subacute myelo-optico-neuropathy: sequelae of clioquinol at 32 years after its ban.

One thousand and thirty-one longstanding patients with subacute myelo-optico-neuropathy (SMON; 275 males, 756 females; mean age +/- S.D., 72.9 +/- 9.6 years; age at onset 37.6 +/- 9.8 years; duration of illness 35.3 +/- 4.0 years) were examined in 2002, 32 years after banning of clioquinol. At onset, 66.7% of patients were unable to walk, and 4.7% complete blindness. At present time, about 41% of patients were still difficult to walk independently, including 15.8% of completely loss of locomotion. One point six percent of patients were in complete blindness and 5.8% had severe visual impairment. The majority (95.6 - 97.7%) of patients exhibited sensory disturbances including superficial and vibratory sensations and dysesthesia. Dysautonomia was observed as leg hypothermia in 79.8%, urinary incontinence in 60.7%, and bowel disturbance in 95.3%. As complication, high incidence was revealed with cataract (56.2%), hypertension (40.2%), vertebral disease (35.5%), and limb articular disease (31.5%). These results indicate the serious sequelae of clioquinol intoxication, SMON.