The effectiveness of Modified Early Warning Score (MEWS) using individual-specific range in predicting pneumonia hospitalization among nursing home residents in Japan: Comparison with National Early Waring Score (NEWS)

Aim: The purpose of this study was to compare the usefulness between the National Early Warning Score (NEWS), which uses the absolute value range, and the Modified Early Warning Score (MEWS), which considers individual-specific ranges (evaluated by mean and standard deviation [SD], relative measures), in predicting pneumonia hospitalization among nursing home residents.Methods: The current study was a retrospective, observational study. The subjects were 235 nursing home residents (75 men and 160 women; pneumonia group, n=62; non-pneumonia group, n=173). The mean and SD of each vital sign (systolic blood pressure, heart rate, body temperature, and oxygen saturation) of each subject recorded over 28 days was calculated. In the pneumonia group, the points at the date of hospitalization were aggregated to derive the NEWS and MEWS. In the non-pneumonia group, the point at the 35th day from the start of the nursing home stay was aggregated to derive the NEWS and MEWS.Results: The area under the curve (AUC) for predicting pneumonia hospitalization was 0.80 (95% confidence interval [CI], 0.72- 0.88) for NEWS and 0.92 (95%CI, 0.87-0.97) for MEWS using individual-specific ranges. The AUC of MEWS using individualspecific ranges was significantly greater than that of NEWS (p<0.0001). When 3 was used as a cutoff value in MEWS, the Youden Index was the best value (0.75). Sensitivity, pecificity, positive predictive value, and negative predictive value were 0.77, 0.97, 0.91, and 0.92, respectively.Conclusion: Our MEWS system using individual-specific ranges showed good performance in predicting hospitalization for pneumonia among nursing home residents

Association of Physical Performance and Pain With Fear of Falling Among Community?Dwelling Japanese Women Aged 65 Years and Older

Our aim was to explore the association of physical performance and pain with fear of falling among community-dwelling Japanese women. The subjects were 278 women aged 65 years and over. We collected information on fear of falling, painful joints, comorbidities, falls in the previous year, and cataracts. Walking time (distance of 6 m), chair stand time (5 times), grip strength, the timed up and go test (TUG), and functional reach were measured. The prevalence of fear of falling was 36.3%, and it increased with age, but it was not significant (P=0.081). Multivariate logistic regression analysis showed that poor physical performance (longer walking time, longer chair stand time, weaker grip strength, and longer TUG) and pain (low back, and upper and lower extremity pain) were significantly associated with fear of falling after adjusting for age, body mass index, comorbidities, falls in the previous year, and cataracts. Maintaining physical functioning and managing pain may be important for elderly women with fear of falling

Plasma 25-Hydroxyvitamin D Is Independently Associated with Hemoglobin Concentration in Male Subjects with Type 2 Diabetes Mellitus

Introduction. It was reported that 25-hydroxyvitamin D level was independently associated with anemia in chronic kidney diseases, but the relation between vitamin D and anemia in diabetes mellitus is not still certain. We analyzed the relation between plasma 25-hydroxyvitamin D level and hemoglobin concentration. Materials and Methods. A cross-sectional study in male patients with type 2 diabetes was performed. Correlation coefficients and standardized partial regression coefficient for the hemoglobin concentration were evaluated. Results. Hemoglobin concentration was positively correlated with body mass index, HbA1c, estimated glomerular filtration rate, cholinesterase, and 25-hydroxyvitamin D level and negatively correlated with age, duration of diabetes mellitus, serum creatinine, and urinary albumin creatinine ratio. Multiple regression analysis revealed the independent relation of 25-hydroxyvitamin D to hemoglobin concentration. Conclusions. Plasma circulating form of vitamin D is significantly associated with hemoglobin concentration in diabetes mellitus independent of the clinical markers for kidney function or nutrition

Environmental radioactive contamination in settlements around the former Soviet Union’s Semipalatinsk nuclear test site: Sarzhal, Karaul and Kainar settlements, and some settlements located south of the Pavlodar Region

More than 450 nuclear atomic explosions including atmospheric, aboveground and underground nuclear tests had been conducted by the former Soviet Union (USSR) at the Semipalatinsk Nuclear Test Site (SNTS) over the past 40 years. Since 1994, we have concentrated our energies on assessing the human health and environmental impacts of nuclear testing. Especially, residual long-lived radionuclides such as 137Cs and Pu isotopes have been measured for soil samples from various areas. The studies focused on the evaluation of radioactive contamination in the settlements where the Semipalatinsk historical cohort resided. In October 2005, detailed soil sampling was carried out around Dolon settlement to estimate the width and position of center-axis of the fallout plume associated with the first USSR atomic bomb on 29 August 1949, and provided useful information on the efforts to estimate radiation dose in Dolon settlement as reliably as possible. Such studies were, next, devoted more time and attention to the Sarzhal and Karaul settlements located in the southeastern direction from the SNTS. The local fallout from the fist thermonuclear event on 12 August 1953 (30 m in height, 400 kt in scale) heavily affected those settlements. Here, laying stress on Sarzhal and Karaul settlements, the accumulated levels and spatial distribution of soil contamination by 137Cs and 239,240Pu have been excessively investigated since 2007. Besides, the radionuclides 236U and 237Np derived from bomb materials themselves were also measured together with the induced radionuclides, 152Eu and 60Co, in some soil samples. Based on those data obtained, radiation doses in air in two settlements were first reconstructed. As a result, adsorbed doses in air in case of the evacuation (non-evacuation) for inhabitants in Sarzhal and Karaul settlements were evaluated to be 20〜100 mGy (210〜530 mGy) and 10〜75 mGy (120〜380 mGy), respectively, as our tentative estimate for 1-year cumulative external doses mainly due to the local fallout from the first USSR hydrogen bomb test in August 1953. Apart from the above researches, in the Kainar village, one of the villages where the historical cohort resides, located south of the SNTS, and in the Pavlodar District located in the adjust north direction of the SNTS in which data were very limited, accumulated levels of 137Cs and Pu isotopes in soils have been measured for evaluating 137Cs and Pu inventories and their spatial distributions. The inventories of 137Cs found out both inside and outside of the Kainar village were in a wide range of 130〜7,500 Bq/m2. A clear shape similar to a Gaussian function along the center-axis of the radioactive plume, which has been found in Dolon, Sarzhal and Karaul settlements, was not observed in their spatial distributions, indicating a wider and uniformly close contamination of this region. On the other hand, in Pavlodar District, the 137Cs inventories ranged from 1,000 to 3,000 Bq/m2 for soil samples. As a whole, Pavlodar areas that the surveys have been conducted were found not to be contaminated so highly, compared with the northeastern areas including Dolon settlement contaminated heavily by the first nuclear atomic explosion in August 1949. The obtained data were also compared with all the data from other areas where we have surveyed until now. The obtained data will be useful for future residents' exposure dose assessmentAbstract… 1 Ⅰ．はじめに… 2 Ⅱ．サルジャール及びカラウル集落… 3 Ⅲ．カイナル集落及びパブロダール州南部の集落…16 Ⅳ．これまでに調査したセミパラチンスク全地域の137Cs及び239,240Pu蓄積量と 　　239,240Pu/137Cs及び238Pu/239,240Pu放射能比の比較… 24 Ⅴ．全体のまとめ…24 参考文献…26 Appendix…29本研究は、長期に渡る文部省の科学研究費助成金（基盤研究（A,B）: 海外、代表者 : 星 正治、山本政儀、川野徳幸） No.22404004、19404005、23406002、20406002、26257501、24310044、23310183、15H03137の助成を受けて行われた

Vitamin K deficiency, evaluated with higher serum ucOC, was correlated with poor bone status in women

BACKGROUND: An increase in serum undercarboxylated osteocalcin concentrations suggests vitamin K deficiency. Clinical intervention studies suggested that the vitamin K supplementation might contribute to preventing bone loss in postmenopausal women. Evidence on the relationship between serum undercarboxylated osteocalcin (ucOC) levels and bone parameters of quantitative ultrasound (QUS) is limited. We examined the correlation between serum ucOC concentrations and bone status as measured by QUS among middle-aged and older Japanese men and women. METHODS: The subjects were community-dwelling men (n = 358) and women (n = 503) aged ? 40?years in Japan. Heel QUS parameters, including the stiffness index, speed of sound, and broadband ultrasound attenuation, were measured. Serum ucOC concentrations were measured by electrochemiluminescence immunoassay. Grip strength was measured in the dominant hand. Information on alcohol drinking, current smoking, exercise, and menopause in women was collected. RESULTS: Serum ucOC concentrations were significantly associated with age in both sexes. Serum ucOC concentrations in men were higher at ? 80?years than those in the age groups of 40-49, 50-59, and 60-69?years. Serum ucOC concentrations in women were higher in the age groups of 50-59 and 60-69?years than those at 40-49?years. Partial correlation analysis adjusting for covariates (age, body mass index, grip strength, alcohol drinking, current smoking, and exercise in men; age, body mass index, grip strength, alcohol drinking, current smoking, exercise, and menopause in women) showed that serum ucOC concentrations were negatively significantly correlated with all QUS parameters in women. Serum ucOC concentrations were not correlated with them in men. CONCLUSIONS: Vitamin K deficiency, evaluated with higher serum ucOC, was correlated with poor bone status in women

Association between mental health and bone mass among community-dwelling adults: Nagasaki Islands Study on bone health

Osteoporosis and its related fractures are important public health issues. This study examined the association between the Kessler Psychological Distress Scale (K6) and low bone mass in middle-aged community-dwelling men and women. A crosssectional study was nested in a prospective observational study of 1,101 participants (median age: 57 [49-62] years in men and 58 [50-62] years in women) residing in a rural city in western Japan. Participants were recruited during medical check-ups in 2016 and 2017 from the community-dwelling population. The bone mass of the calcaneus was evaluated using quantitative ultrasound. Of the participants, 56 men (14.9%) and 144 women (19.9%) had a bone mass of less than 70% of the mean of young adults. Univariate analysis revealed that there was a trend toward lower body mass index (BMI) and higher prevalence of low bone mass with an increase in K6 scores in men but not in women. Logistic regression analysis, adjusting for possible confounders(age, BMI, smoking, drinking habits, exercise habits, diabetes, hyperlipidemia, and hypertension), showed significant associations between the K6 scores and low bone mass (odds ratio (OR) = 2.66 for the men with 5 to 12 points of K6, OR = 7.51 for men with ≥ 13 of K6, not for women). We showed an association between psychological distress and low bone mass independent of cofounders among community-dwelling middle-aged men but not women. This suggests that healthy mental health in middle-aged men may be a possible target for the prevention of consequent osteoporosis or fragile bone fractures

Association of FTO genotype with obesity and bone health among communitydwelling adults ; Goto Island study on bone health

Bone mass is tuned by various factors, including aging, menopause, low body weight, and genetic variations. Here, we showed an independent association between a genotype on the fat mass- and obesity-associated FTO gene (#610966 on OMIM) and bone loss after adjusting for age and body mass index (BMI). A cross-sectional study was nested in a prospective observational study of 1,828 participants (median age: 69 [62-76] years in men and 68 [61-75] years in women) residing in a rural city in western Japan (Goto Island study). Participants were recruited during medical checkups in 2014 and 2016 from the community-dwelling population. The bone mass of the calcaneus was evaluated using quantitative ultrasound. The single nucleotide polymorphism (SNP) rs1421085 was genotyped using a hydrolysis probe. The chi-squared test was used to determine whether the variants were in equilibrium in this population. There were differences in medians of BMI among the genotypes (24.3 in CC, 23.0 in CT, and 22.6 in TT, P = 0.01), but not in those of bone mass. There was a significant association between the minor allele (C) and being overweight in a gene dosage-dependent manner (BMI > 25, OR per allele =1.52, 95% CI = 1.07-2.14, P = 0.02 in men, OR = 1.48, 95% CI = 1.16-1.95, P = 0.01 in women). Logistic regression analysis showed a significant protective association in male carriers of the minor allele against low bone mass (QUS T-score less than -2.0) after adjusting for age and BMI in men aged 65-75 years (OR = 0.50, 95% CI = 0.27-0.96, P = 0.036), with no significant association in women.Our study indicated an association between the genetic polymorphism of FTO and bone mass among community-dwelling men aged 65-75 years. The polymorphism may play a role in bone health with higher BMI and other beneficial functions