Leaf morphometric analysis and potential distribution modelling contribute to taxonomic differentiation in the Quercus microphylla complex.

Mexico is a major center of evolutionary radiation for the genus Quercus, with oak species occurring across different habitat types and showing a wide variation in morphology and growth form. Despite representing about 20% of Mexican species, scrub oaks have received little attention and even basic aspects of their taxonomy and geographic distribution remain unresolved. In this study, we analyzed the morphological and climatic niche differentiation of scrub oak populations forming a complex constituted by six named species, Quercus cordifolia, Quercus frutex, Quercus intricata, Quercus microphylla, Quercus repanda, Quercus striatula and a distinct morphotype of Q. striatula identified during field and herbarium work (hereafter named Q. striatula II). Samples were obtained from 35 sites covering the geographic distribution of the complex in northern and central Mexico. Morphological differentiation was analyzed through geometric morphometrics of leaf shape and quantification of trichome traits. Our results indicated the presence of two main morphological groups with geographic concordance. The first was formed by Q. frutex, Q. microphylla, Q. repanda and Q. striatula, distributed in the Trans-Mexican Volcanic Belt, the Sierra Madre Occidental and a little portion of the south of the Mexican Altiplano (MA). The second group consists of Q. cordifola, Q. intricata and Q. striatula II, found in the Sierra Madre Oriental and the MA. Therefore, our evidence supports the distinctness of the Q. striatula II morphotype, indicating the need for a taxonomic revision. Within the two groups, morphological differentiation among taxa varied from very clear to low or inexistent (i.e. Q. microphylla-Q. striatula and Q. cordifolia-Q. striatula II) but niche comparisons revealed significant niche differentiation in all pairwise comparisons, highlighting the relevance of integrative approaches for the taxonomic resolution of complicated groups such as the one studied here.

A School-Based Program for Problematic Internet Use for Adolescents in Japan.

Despite the serious influence of problematic Internet use on mental health among Japanese adolescents, no randomized clinical trials have investigated universal school-based interventions for this potential health challenge. Therefore, this study aimed to assess the efficacy of a school-based educational program. This two-armed, parallel, cluster-based randomized clinical trial included 5312 students from 13 high schools situated in a mid-sized Japanese city. The students in the intervention arm received 10 weekly standardized sessions, including a combination of information provision and interactive sessions by schoolteachers. The students in the control group followed a standard school curriculum. A generalized estimating equation model was applied to assess the primary (Korean Scale for Internet Addiction [K-scale] score) and secondary (behavioral change status according to changes in the transtheoretical model smartphone addiction score and Internet usage time) outcomes two months after intervention completion. The intention-to-treat analysis included 2597 (97.2%) and 2504 (94.9%) students in the intervention and control groups, respectively. Nevertheless, a significant discrepancy emerged regarding the behavioral change status. Therefore, this school-based program did not improve the Internet or smartphone addiction scores among Japanese adolescents. Further studies are needed to develop appropriate interventions for adolescents.

Self-Monitoring of Physical, Cognitive, and Social Activities and 2-Year Disability Onset in Community-Dwelling Older Adults.

OBJECTIVES: Self-monitoring of physical, cognitive, and social activities may be a means of helping older adults to adopt or maintain an active lifestyle, but its effect on disability onset is unknown. This study aimed to examine the association between self-monitoring of the activities and disability onset in older adults. DESIGN: Longitudinal, observational study. SETTING AND PARTICIPANTS: General community setting. Participants were 1399 older adults aged ≥75 years (mean age: 79.3 ± 3.6 years; 48.1% female). METHODS: Participants conducted self-monitoring of physical, cognitive, and social activities using a specialized booklet and a pedometer. Level of engagement in self-monitoring was assessed based on the percentage of days in a year for which activities were recorded: no-engagement group (0% of days recorded; n = 438), midlevel-engagement group (0.1-89.9% of days recorded; n = 416), and high-engagement group (≥90% of days recorded; n = 545). Disability onset was determined by whether the participants were awarded a long-term care insurance certification over the 2 years after the explanation of the booklet and pedometer. RESULTS: Cox proportional hazard regression models showed that the high-engagement group, when compared to the no-engagement group, had a significantly reduced hazard ratio (HR) for disability onset, after adjustment for covariates (HR 0.54, 95% CI 0.34-0.86, P = .010). After propensity score adjustment through inverse probability of treatment weighting (IPTW) and propensity score matching (PSM), the high-engagement group's HR remained significantly lower (IPTW: HR 0.54, 95% CI 0.34-0.86, P = .010; PSM: HR 0.58, 95% CI 0.35-0.96, P = .032). CONCLUSIONS AND IMPLICATIONS: Self-monitoring of physical, cognitive, and social activities reduces the risk of 2-year disability onset in community-dwelling older adults. Further studies in other settings are needed to examine whether self-monitoring of activities can be a population approach for the primary prevention of disability in other settings.

[Survey results on the status of implementation of population approach projects for fathers across Japan by their municipalities].

Objectives　This study aimed to examine the status of implementation and details of population-based approach projects that primarily target fathers nationwide. It also seeked to discuss the possibility of providing childcare support to fathers in the community.Methods　This study analyzed the overall results of two surveys undertaken. The primary survey was conducted between December, 2020 and February, 2021 by administering a mail questionnaire within 1,741 municipalities across Japan. A secondary interview survey was then conducted from August to September, 2021, among the municipalities that responded that they are "implementing projects mainly for fathers," and those that obtained consent to participate in this survey.Results　The 837 municipalities (response rate = 48.1%) that responded to the primary survey were included in the analysis. Many municipalities provided paternal and family support in addition to childcare support for mothers, at the time of issuing maternal and child health handbooks and in parent classes. This support was inclusive of distributing leaflets and pamphlets for fathers (P=0.036), encouraging fathers to participate in parent classes (P<0.001), setting dates and times that are easy for fathers to participate in (P<0.001), and including content for fathers (P<0.001). There were significantly more responses from local governments of the municipalities with a total population of 70,000 or more. The number of municipalities that "implemented childcare support that primarily targeted fathers instead of mothers" was 54 or 6.5% of the total. However, about 70% of the municipalities that had not implemented such programs recognized the need for their implementation. In the 21 municipalities where the interviews were conducted, there were 10 projects implemented during pregnancy, 12 during the childcare period after delivery, and 1 implemented across both. The contents of the implemented programs varied widely, with each municipality devising its own programs based on regional characteristics, which had generally favorable evaluations from the participants. In contrast, many municipalities mentioned that the small number of participants was an issue.Conclusion　Although fathers are encouraged to participate in childcare and housework within households, it is rare for them to be given opportunities to gain the required knowledge and skills. Most projects provide support for fathers as supporters of mothers. Going forward, in addition to surveys targeting fathers, there is a need to present project models that can be implemented by the local governments.

Social frailty as social aspects of frailty: Research, practical activities, and prospects.

With the topical focus on the prevention of and countermeasures for frailty, scattered studies have subdivided its social elements and aspects as "social frailty." While the concepts and definition of "social frailty" are yet to be established, the purpose of using the term is to capture the attention of professionals using the social aspects of frailty to support older adults. The goal is to increase healthy life expectancy by recognizing that social factors are unlikely to pose a risk of functional decline in isolation, but may increase such a decline when combined with other factors. At feasible scopes of intervention, ways to address these factors should be pursued. Although social aspects are often expressed by frail people, or social factors with complex processes that can cause functional decline, there is no unified definition or indicator of social frailty. Further research and discussion are needed to clarify its academic significance and usefulness for disability prevention. Recognizing this, when the Japanese Socio-Gerontological Society's Study Committee on "Social Frailty" published its recommendations, it suggested that when using the term "social frailty" we should specify the significance of its use; consider the comprehensiveness of frailty; be mindful of the interrelationship of social activities and other social aspects; and consider environmental conditions such as a person's values, preferences and life course, social norms, systems, and government policies. High-risk individuals may need multidisciplinary approaches delivered by various professionals, including clinicians, in realizing a life in line with their unique values and preferences. In such cases, it is necessary to understand the background and process that led to frailty, from physical, psychological, and social perspectives, referring to the abovementioned four points. The introduction of social aspects as one of the assessment frameworks can significantly bridge the gap between medical care and the community. Geriatr Gerontol Int 2022; 22: 991-996.

A Strategy for Further Wellness for All: A Population Approach to Prevent Cardiovascular Diseases in Japan.

A population approach may be effective in reducing cardiovascular disease (CVD) in the entire population. In Japan, the first public population approach is Health Japan 21 from 2000 to 2012. In 2013, it was revised as Health Japan 21 (the second term), which was promoting the health of all citizens until 2022. In the final assessment, although a significant decrease in age-adjusted CVD mortality was observed, it is unclear why these findings occurred. An assessment system for a population approach for CVD needs to be developed in Japan.

Creating a Healthy Food Environment as a Radical Population Approach and Japanese Initiatives.

Nutrition education is important to encourage people to promote a healthy diet; however, education alone exerts a limited effect. It is crucial to create a healthy food environment, including food systems that supply diversified, balanced, and healthy food options. Improving the food environment is a population approach. Radical population approaches necessitate removing the underlying impediments, such as high sodium products, sugar-sweetened beverages, and unhealthy ultra-processed foods. Negotiation and collaboration with the private sector is critical to tackle and solve these issues. In Japan, public-private-academic collaboration has been implemented since 2013 in the national health promotion action, termed Health Japan 21 (Second term). Recently, Japan has launched a novel initiative to create a healthy food environment.

The Kesennuma Study in Miyagi, Japan: Study Design and Baseline Profiles of Participants.

BACKGROUND: To clarify the association between psychosocial problems and frailty in the areas affected by the Great East Japan Earthquake, and to develop strategies for preventive long-term care in the community, we launched the Kesennuma Study in 2019. This report describes the study design and the participants' profiles at baseline. METHODS: The prospective study comprised 9,754 people (4,548 men and 5,206 women) randomly selected from community-dwelling independent adults aged 65 to 84 who were living in Kesennuma City, Miyagi. The baseline survey was conducted in October 2019. It included information on general health, socio-economic status, frailty, lifestyle, psychological factors (eg, personality, depressive moods), and social factors (eg, social isolation, social capital). A follow-up questionnaire survey is planned. Mortality, incident disability, and long-term care insurance certifications will also be collected. RESULTS: A total of 8,150 questionnaires were returned (83.6% response rate), and 7,845 were included in the analysis (80.4%; mean age 73.6 [standard deviation, 5.5] years; 44.7% male). About 23.5% were considered frail. Regarding psychological and social functions, 42.7% had depressive moods, 29.1% were socially isolated, and only 37.0% participated in social activities at least once a month. However, 82.5% trusted their neighbors. CONCLUSION: While local ties were strong, low social activity and poor mental health were revealed as issues in the affected area. Focusing on the association between psychological and social factors and frailty, we aim to delay the need for long-term care for as long as possible, through exercise, nutrition, social participation, and improvement of mental health.

Sodium/potassium ratio change was associated with blood pressure change: possibility of population approach for sodium/potassium ratio reduction in health checkup.

Recently, the sodium (Na)/potassium (K) ratio was reported to be associated with blood pressure (BP). A Na/K ratio self-monitoring device using spot urine was established recently. Here, we assessed whether the urinary Na/K ratio change measured using the Na/K device was associated with BP change in a health checkup setting. We targeted 12,890 participants who attended the health checkup in Tome City, Miyagi between 2017 and 2018. Tome City introduced urinary Na/K ratio measurements during health checkups since 2017. For each year, we compared the baseline characteristics according to the urinary Na/K ratio and BP level. We assessed the relationship between change in urinary Na/K ratio and BP change using multiple regression analyses adjusted for age, sex, and change in body mass index (BMI) and alcohol intake. The average urinary Na/K ratio was significantly lower in 2018 than in 2017 (5.4 ± 3.0 to 4.9 ± 2.2, P < 0.01). The systolic BP of the participants in 2018 (130.9 ± 17.4 mmHg) was lower than that in 2017 (132.1 ± 17.9 mmHg). Moreover, the change in systolic BP and diastolic BP was positively associated with the change in urinary Na/K ratio. In conclusion, the association of the change in urinary Na/K ratio with hypertension and changes in systolic and diastolic BP can be explained by a change in alcohol intake, BMI, and urinary Na/K ratio. Therefore, measuring the urinary Na/K ratio in community settings is a potential population approach for counteracting hypertension.

The Association of Daily Physical Activity Behaviors with Visceral Fat.

The association between health benefits and physical activity has received increasing attention among researchers working on the prevention of noncommunicable disease. However, the number of studies on the association between daytime activities and visceral fat is limited. In this study, we evaluated how daily physical activity behaviors impact the visceral adipose tissue (VAT) and body mass index (BMI). A total of 3543 participants (1240 men, 2303 women) were included in this cross-sectional study. The duration of daily physical activities (sedentary time, standing time, and walking time) was classified into the six categories. Multiple regression analysis was carried out to compare continuous variables. VAT and BMI were used as dependent variables, and the daily physical activities were used as independent variables. All results were expressed after adjusting for confounders, including sex, age, Brinkman index, daily alcohol consumption, sleeping time, and medication for hypertension, dyslipidemia, and diabetes. The multiple regression analysis showed that sedentary time was significantly associated with VAT (beta = 1.145, p value = 0.002), whereas standing time was negatively associated with VAT (beta = -0.763, p value = 0.043). Walking time was negatively and robustly associated with all depending variables as follows: BMI (beta = -0.172, p value = 0.001) and VAT (beta = -2.023, p value <0.001). This study showed that a daily behavior time affects the accumulation of VAT and BMI. A shift from sedentary time to standing or walking time might be a key population approach to prevent cardiometabolic diseases.

Majority of New Onset of Dental Caries Occurred from Caries-Free Students: A Longitudinal Study in Primary School Students.

We examined Rose's axiom that a large number of people exposed to a small risk may generate more cases than a small number exposed to a high risk, using data on caries incidence. This longitudinal study was based on the records of annual dental checks conducted in primary schools in Okinawa, Japan. Participants were students aged 6-11 years at baseline in 2014, and a follow-up survey was conducted after one-year. The outcome variable was the increased number of decayed, missing, and filled teeth (DMFT). The predictor variable was the baseline DMFT score. Gender, grade, and affiliated school variables were adjusted. A negative binomial regression model was used to obtain the estimated increase of DMFT score. Among 1542 students, 1138 (73.8%) were caries-free at baseline. A total of 317 (20.6%) developed new caries during the follow-up. The predicted number of new carious teeth in a caries-free students and students with DMFT = 1 at baseline were 0.26 (95% CI, 0.22-0.31) and 0.45 teeth (95% CI, 0.33-0.56), respectively. However, among the total of 502 newly onset of carious teeth, 300 teeth (59.7%) occurred from the caries-free students at baseline. Hence, prevention strategies should target the low-risk group because they comprise the majority of the population.

Longitudinal effects of a nationwide lifestyle intervention program on cardiometabolic outcomes in Japan: An observational cohort study.

The Japanese government launched a nationwide health screening and lifestyle intervention program in 2008 to prevent and reduce metabolic syndrome in at-risk individuals. This study examined the longitudinal effects of the program's lifestyle interventions on metabolic outcomes using health insurance data from one prefecture. The study population comprised 16,317 individuals aged 40-74 years who met the recommendation criteria for the interventions between 2009 and 2015. Participants were categorized into an overall intervention group (comprising a single-session motivational intervention group and a multi-session intensive intervention group) and a non-intervention group. We evaluated the interventions' effects on the initiation of medications for metabolic disorders (hyperlipidemia, hypertension, and hyperglycemia) and metabolic syndrome incidence for 6 years using discrete hazard models that adjusted for sex, age, health screening measurements, and smoking habit. The longitudinal effects on health screening measurements were also evaluated using regression models for repeated measures. The adjusted hazard ratios (aHRs) (95% confidence interval [CI]) for initiation of medications were 0.83 (0.77-0.90), 0.77 (0.71-0.84), and 0.66 (0.57-0.77) for overall, motivational, and intensive interventions, respectively. The aHRs (95%CI) for metabolic syndrome incidence were 0.84 (0.75-0.94), 0.80 (0.71-0.91), and 0.67 (0.51-0.89) for overall, motivational, and intensive interventions, respectively. The interventions reduced body mass index and waist circumference, but had modest effects on blood lipids, blood glucose, and hemoglobin A1c levels; blood pressure was unaffected. These interventions represent an effective strategy to prevent the progression of preclinical metabolic syndrome, but further studies are needed to evaluate their long-term preventive effects on cardiovascular disease and diabetes.

Gains in life expectancy in the Australian population due to reductions in smoking: comparisons between interventions targeting the population versus interventions in a specific high risk group.

BACKGROUND: Four decades of population-based tobacco control strategies have contributed to substantial reduction in smoking prevalence in Australia. However, smoking prevalence is still double in socially disadvantaged groups compared to those that are not. But not all tobacco control strategies successfully used in the general population is effective in specific high-risk population groups. Hence, an effective way to reduce smoking in high risk population groups may include targeting them specifically to identify and support smokers to quit. In this backdrop, we examined whether tobacco control interventions at the population-level are more effective in increasing life expectancy among Australians compared to interventions targeting a high risk group or a combination of the two when smoking prevalence is reduced to 10 and 0% respectively. METHODS: Using the risk percentiles approach, analyses were performed separately for men and women using data from various sources such as the 2014-15 National Health Survey linked to death registry, simulated data for high risk groups, and the Australian population and deaths data from the census. Indigenous status was simulated by preferentially assigning those who are indigenous to lower SES quintiles. The age-sex distribution of mental disorder status was simulated using its distribution from 2016 National Drug Strategy Household Survey with 25.9% of mentally ill being assigned to current smoking category and the rest to non-smoking category. The age-sex distribution of prisoners was simulated based on 2014 ABS Prisoners Australia survey with 74% of prisoners being assigned to current smoker category and the rest to non-smoker category. Homelessness status was simulated according to age, sex and indigenous status for 2011 census with all homeless being allocated to the lowest SES category. The age-sex distribution of total cholesterol level was simulated based on 2011-13 Australian Health Survey. RESULTS: The results showed that the combined approach for reducing smoking is most effective for improving life expectancy of Australians particularly for the socially disadvantaged and mentally ill groups both of which have high fraction of smokers in the population. For those who were mentally ill the gain in ALE due to reduction of smoking to 10% was 0.53 years for males and 0.36 years for females which were around 51 and 42% respectively of the maximal gains in ALE that could be achieved through complete cessation. CONCLUSIONS: Targeting high-risk population groups having substantial fraction of smokers in the population can strongly complement the existing population-based smoking reduction strategies. As population and high risk approaches are both important, the national prevention policies should make judicious use of both to maximize health gain.

Modeling return of the epidemic: Impact of population structure, asymptomatic infection, case importation and personal contacts.

BACKGROUND: Proactive interventions have halted the pandemic of coronavirus infected disease in some regions. However, without reaching herd immunity, the return of epidemic is possible. We investigate the impact of population structure, case importation, asymptomatic cases, and the number of contacts on a possible second wave of epidemic through mathematical modeling. METHODS: we built a modified Susceptible-exposed-Infectious-Removed (SEIR) model with parameters mirroring those of the COVID-19 pandemic and reported simulated characteristics of epidemics for incidence, hospitalizations and deaths under different scenarios. RESULTS: A larger percent of elderly people leads to higher number of hospitalizations, while a large percent of prior infection will effectively curb the epidemic. The number of imported cases and the speed of importation have small impact on the epidemic progression. However, a higher percent of asymptomatic cases slows the epidemic down and reduces the number of hospitalizations and deaths at the epidemic peak. Finally, reducing the number of contacts among young people alone has moderate effects on themselves, but little effects on the elderly population. However, reducing the number of contacts among elderly people alone can mitigate the epidemic significantly in both age groups, even though young people remain active within themselves. CONCLUSION: Reducing the number of contacts among high risk populations alone can mitigate the burden of epidemic in the whole society. Interventions targeting high risk groups may be more effective in containing or mitigating the epidemic.

Population analysis to assess the influence of age and body weight on pharmacokinetics and pharmacodynamics of dexmedetomidine in New Zealand White rabbits.

The purpose of this work was i) to develop a population pharmacokinetic (PK) and pharmacodynamic (PD) model of dexmedetomidine (DEX) in New Zealand White rabbits, ii) to investigate the influence of the age and weight of the animals on the model parameters, and iii) to assess the linearity of DEX PKs in the examined dose range. This was a prospective, crossover study, using a total of 18 New Zealand White rabbits. DEX was administered as a single intravenous bolus injection in the doses from 25 to 300 µg kg-1 . Each New Zealand White rabbit was given the same dose of drug in its three developmental stages. To determine the DEX PK, seven blood samples were taken from each animal. The pedal withdrawal reflex was the PD response used to assess the degree of sedation. Nonlinear mixed effects modelling was used for the population PK/PD analysis. The typical value of elimination clearance was 0.061 L min-1 and was 35% higher in younger New Zealand White rabbits compared with older animals. The PK of DEX was linear in the examined concentration range. Age-related changes in sensitivity to DEX were not detected. The results suggest that due to the pharmacokinetics, younger animals will have lower DEX concentrations and a shorter duration of sedation than older animals given the same doses of DEX per kg of body weight.

Comparison of Alternative Population Modeling Approaches for Implementing a Level A IVIVC and for Assessing the Time-Scaling Factor Using Deconvolution and Convolution-Based Methods.

Different approaches based on deconvolution and convolution analyses have been proposed to establish IVIVC. A new implementation of the convolution-based model was used to evaluate the time-scaled IVIVC using the convolution (method 1) and the deconvolution-based (method 2) approaches. With the deconvolution-based approach, time-scaling was detected and estimated using Levy's plots while with the convolution-based approach, time-scaling was directly determined by a time-scaling sub-model of the convolution integral model by nonlinear regression. The objectives of this study were (i) to show how time-scaled deconvolution and convolution-based approaches can be implemented using population modeling approach using standard nonlinear mixed-effect modeling software such as NONMEM and R, and (ii) to compare the performances of the two methods for assessing IVIVC using complex in vivo drug release process. The impact of different PK scenarios (linear and nonlinear PK disposition models, and increasing levels of inter-individual variability (IIV) on in vivo drug release process) was considered. The performances of the methods were assessed by computing the prediction error (%PE) on Cmax, AUC, and partial AUC values. The mean %PE values estimated with the two methods were compliant with the IVIVC validation criteria. However, different from convolution-based, deconvolution-based approach showed that (i) the increase of IIV on in vivo drug release significantly affects the maximal %PE values of Cmax leading to failure of IVIVC validation, and (ii) larger %PE values for Cmax were associated to complex nonlinear PK disposition models. These results suggest that convolution-based approach could be considered at preferred approach for assessing time-scaled IVIVC.

Sedentary Time is Associated with Cardiometabolic Diseases in A Large Japanese Population: A Cross-Sectional Study.

AIM: Accumulating evidence reveals that sedentary behavior is associated with mortality and cardiometabolic disease; however, there are potential age and sex differences in sedentary behavior and health outcomes that have not been adequately addressed. This study aimed to determine the association of sedentary behavior with cardiometabolic diseases such as hypertension, dyslipidemia, diabetes mellitus, and its risk factors in a large Japanese population according to age and sex. METHODS: Using data from the Japan Multi-Institutional Collaborative Cohort Study obtained from baseline surveys, data of 62,754 participants (27,930 males, 34,824 females) were analyzed. This study uses a cross-sectional design and self-administered questionnaires to evaluate sedentary time and anamnesis. For the logistic regression analysis, sedentary time ＜5 h/day was used as the reference and then adjusted for age, research areas, leisure-time metabolic equivalents, and alcohol and smoking status. From the analysis of anthropometric and blood examinations, 35,973 participants (17,109 males, 18,864 females) were analyzed. RESULTS: For hypertension and diabetes, sedentary time was associated with a significantly higher proportion of male participants. Both sexes were associated with a significantly higher proportion of participants with dyslipidemia. Participants who had longer sedentary time tended to have increased levels of blood pressure, triglycerides, and non-high-density lipoprotein cholesterol (HDL-C), and decreased levels of HDL-C, especially in the 60-69 years group. CONCLUSIONS: Independent of leisure-time physical activity, sedentary time was associated with cardiometabolic diseases in a large Japanese population classified by age and sex. Our findings indicate that regularly interrupting and replacing sedentary time may contribute to better physical health-related quality of life.

Health advocacy for reducing smoking rates in Hamamatsu, Japan.

Efforts to reduce smoking at the Olympics that will be hosted in Tokyo in 2020 are spreading across the country, but they are not enough. In general, it is said that (1) smoke prevention education for minors, (2) smoking cessation support for smokers, and (3) smoking restriction in the social environment are necessary to reduce the smoking rate. Healthy Japan 21 called for achieving a numerical target for the reduction of youth smoking by 2010. The author is a principal school doctor at Hamamatsu Municipal Yuto Elementary School and has been teaching antismoking classes to elementary school students since 1999. In this area (Yuto District, Hamamatsu City in Shizuoka Prefecture, Japan), there is the Oki-jinja Shrine, which was built in 705, and a large event (Oki-jinja grand festival) is held there each autumn, attracting 2500 people. Since many people gather there, it is worthwhile to provide information about passive smoking prevention on shrine grounds. Since 1999, smoking prevention classes have been held at elementary schools, and in 2008, smoking was prohibited in the grounds of the Oki-jinja Shrine, making the festival there totally nonsmoking within the shrine grounds, among additional measures taken against smoking. In addition, measures against smoking at large events in Shizuoka Prefecture and Hamamatsu City have also been effective, and the smoking rate among Hamamatsu citizens has dropped to 10.2% (From Health Promotion Division, Hamamatsu City, 2016), which is expected to extend their healthy life expectancy. To reduce the smoking rate, it is important not only to provide administrative support but also to engage in steady civic activities.

Pharmacokinetic/Pharmacodynamic Evaluation of Hydrocortisone Therapy in Pediatric Patients with Congenital Adrenal Hyperplasia.

OBJECTIVES: Patients with congenital adrenal hyperplasia (CAH) require lifelong replacement therapy with glucocorticoids. Optimizing hydrocortisone therapy is challenging, since there are no established cortisol concentration targets other than the cortisol circadian rhythm profile. 17-hydroxyprogesterone (17-OHP) concentrations are elevated in these patients and commonly used to monitor therapy. This study aimed to characterize the pharmacokinetics/pharmacodynamics (PK/PD) of cortisol using 17-OHP as a biomarker in pediatric patients with CAH and to assess different hydrocortisone dosing regimens. METHODS: Cortisol and 17-OHP concentrations from 30 CAH patients (7-17 years of age) receiving standard hydrocortisone replacement therapy (5-20 mg) twice (n = 17) or 3 times (n = 13) daily were used to develop a PK/PD model. Sequentially, simulated cortisol concentrations for clinically relevant 3- and 4-times daily dosing regimens were compared with cortisol and 17-OHP target ranges and to concentrations in healthy children. RESULTS: Cortisol concentration-time profiles were accurately described by a 2-compartment model with first-order absorption and expected high bioavailability (82.6%). A time-delayed model with cortisol-mediated inhibition of 17-OHP synthesis accurately described 17-OHP concentrations. The cortisol concentration inhibiting 50% of 17-OHP synthesis was 48.6 nmol/L. A 4-times-daily dosing better attained the target ranges and mimicked the cortisol concentrations throughout the 24-hour period than 3-times-daily. CONCLUSIONS: A PK/PD model following hydrocortisone administration has been established. An improved dosing regimen of 38% at 06:00, 22% at 12:00, 17% at 18:00, and 22% at 24:00 of the daily hydrocortisone dose was suggested. The 4-times-daily dosing regimen was superior, avoiding subtherapeutic cortisol concentrations and better resembling the circadian rhythm of cortisol.

[Current status and issues around the process of health promotion program implementation by the municipal office of health and welfare: Survey results of all municipalities of six prefectures].

Objectives We aimed to investigate the progress of health promotion program implementation. This included an examination of the current status of and issues around planning, implementation, and evaluation of health and welfare services at the municipal level; further progress through focus on the population approach emphasized in Health Japan 21 (2nd) was also discussed.Methods A questionnaire survey on health promotion and welfare services was conducted among municipal offices in charge of health promotion. The status of health promotion program implementation was classified by types and fields. For focused health and welfare services, respondents were asked to answer a self-administered questionnaire about the process of planning, implementation, and evaluation. The details of services were confirmed by browsing reference materials or website information. We distributed the questionnaires to all 260 municipalities of 6 prefectures (Miyagi, Saitama, Shizuoka, Aichi, Osaka, and Wakayama); of which, 238 municipalities responded (response rate: 91.5%).Results Health promotion programs on nutrition and diet, physical activity, dental and oral health, prevention of lifestyle-related diseases, and promotion of regular health checkups were implemented with a high rate. Among the 238 municipalities, 85.2% responded that they focused on educational activities targeting the general population; of which 27.4% were considering using incentives to promote greater health awareness. Our survey indicated that 14.8% of municipalities focused on health education and classroom-style programs. While planning programs, 52.1% of municipalities used "materials from other municipalities where such programs were already implemented" and 89.1% of municipalities used them in incentive-related programs. Although 70% of municipalities were aware of health discrepancies among the local population, approximately 90% did not consider discrepancies between different economic, living environment, and occupation groups when planning programs. Although 87.3% of municipalities used number of participants as the main indicator in evaluating the programs, approximately 30% of municipalities used coverage rate and before-and-after assessments of health conditions as the main indicators.Conclusion Findings from this study suggest that improvements in the process of health promotion program planning and implementation, reference materials, and the perspective of health discrepancies are needed, along with an evaluation in programs focusing both on educational activities targeting the general population and incentive-related programs. It is also recommended that the central government and prefectures should not only introduce precedents, but also provide information. Using this, municipalities can demonstrate applied skills, such as the rationale and preparation status of the program, and propose evaluations based on the plan-do-check-act cycle.