Our previous study revealed that a 14-week indirect lifestyle intervention (LSI) implemented through wives had significant effects on weight loss among obese men. The purpose of the current study was to compare long-term maintenance of body weight after LSI between direct (DI) and indirect (II) intervention groups. Of participants in the previous intervention study, 15 men in the DI group and 24 married couples in the II group consented to a 2-year follow-up measurement session. Body weight, metabolic syndrome (MS) components, daily energy intake, and activity energy expenditure were measured pre- and post-LSI and at the follow-up. Participation rate in the 2-year follow-up tended to be higher in the II group (66.7%) than in the DI group (44.1%). Changes in body weight during the 2-year period in the DI and II groups were 1.4 ± 2.9 kg (P = 0.09) and 1.0 ± 3.4 kg (P = 0.15), respectively. There were no differences in the measurements or their changes between the two groups at the 2-year follow-up; however, we did find a significant correlation in the change in energy intake (r = 0.68, P < 0.01) between wives and husbands. While we found no significant difference in body weight maintenance between the DI and II groups, our study showed that many husbands in the II group succeeded in long-term maintenance of their weight loss, indicating that an indirect LSI through wives can affect the long-term maintenance of body weight among obese men.

Although the physical activity reference value for older adults (10 METs*hour/week) has been promoted by Japan Ministry of Health, Welfare, and Labour since 2013, little is known about how many steps/day cut-off values that optimally identify meeting the reference value according to the differences of age, sex, medical history, and joint pain. The purpose of this study were 1) to determine the steps/day that optimally identify meeting the reference value, and 2) to identify the differences by the effects of age, sex, medical history, and joint pain on cut-off values. This study included 583 community-dwelling older Japanese adults (aged 73.2 ± 5.4 years; 153 men, 430 women). A uniaxial accelerometer survey was conducted to estimate the total physical activity volume and steps/day. Receiver operating characteristic (ROC) analyses were used to detect steps/day cut-off values for meeting the reference value among all participants and stratified by age, sex, medical history, and joint pain. The optimal cut-off value (AUC (area under the ROC curve), sensitivity, and specificity) for the reference value was 4376 steps/day (0.99, 95.2%, and 97.2%) in all participants. Differences among the cut-off values according to age, sex, medical history, and joint pain ranged from 39 to 169 steps/day. These results suggest that step counts has satisfactory validity to represent the reference value in older adults, and the effects of age, sex, medical history, and joint pain on cut-off values were considerably small. Therefore, this step-count level may be a useful indicator for modifying the daily-life activities of older adults.

This study aimed to examine the association between body mass index (BMI) and muscle strength, and mobility limitation (ML). A cross-sectional analysis was conducted on data from 570 community-dwelling older Japanese women aged 65-91 years [mean age, 73.9 ± 5.8 (SD) years]. Muscle strength was assessed by hand-grip strength (HGS). ML was assessed using self-reported difficulty level in walking 400 m and ascending 10 steps without resting. BMI and muscle strength were divided into tertiles (high: BMI ≧ 25.1 kg/m², HGS ≧ 22.5 kg; middle: BMI 22.4-25.0 kg/m², HGS 18.8-22.4 kg; low: BMI ≦ 22.3 kg/m², HGS ≦ 18.7 kg) respectively, and logistic regression analysis was used to determine the association between BMI and muscle strength with ML. 256 participants (44.9%) were identified as having ML. Adjusted odds ratios of BMI for ML were 1.64 (95% confidence interval (CI): 1.00-2.68) in the middle group and 1.89 (95% CI: 1.15-3.12) in the high group when compared to the low group. Adjusted odds ratios of muscle strength for ML were 1.25 (95% CI: 0.77-2.04) in the middle group and 1.85 (95% CI: 1.11-3.09) in the low group when compared to the high group. Compared to the low BMI plus high muscle strength group, adjusted odds ratio for ML was significantly higher in the high BMI plus low muscle strength group (2.65, 95% CI: 1.02-6.87) and the high BMI plus middle muscle strength group (3.09, 95% CI: 1.25-7.61). Our findings indicate that the combination of overweight plus muscle weakness is more predictive for having ML than overweight or muscle weakness alone.

Borderline personality disorder (BPD) is often manifested by maladaptive behaviours such as self-injury. The interpersonal style characteristic of BPD makes it difficult to maintain stable therapeutic relationships, with the patient often discontinuing treatment. Although dialectical behavior therapy (DBT) has been reported to benefit patients with BPD, reports in Asian countries have been few. We herein describe a 22-year-old female with BPD and a history of attempted suicide and self-injury who underwent DBT at our hospital. Methods: Our 6-month DBT consists of 4 parts: weekly psychotherapy by a psychiatrist, weekly skills training by a clinical psychologist and nurse, emergency consultations, and supervision/consultation meetings. Individual psychotherapy and skills training sessions, respectively, were conducted for this patient 24 times. Results: After completing DBT, the number of self-injuries and frequency of suicidal ideation in our patient decreased. Conclusion: Although more costly than standard treatment for BPD, a trial of DBT might be worthwhile in Japanese patients.

OBJECTIVESTesticular toxicities of antimony compounds were evaluated in rats and mice. The slightly water-soluble antimony compound antimony trioxide (ATO) and the highly water-soluble antimony compound antimony potassium tartrate (APT) were examined.

METHODSDaily doses of the compounds were 27.4, 12.0 and 1,200 mg/kg body weight in the APT group, low-ATO group and high-ATO group, respectively. The corresponding daily doses of antimony were 10, 10 and 1,000 mg/kg body weight, in the APT group, low-ATO group and high-ATO group, respectively. Both compounds were administered by gavage: rats, 3 days per week for 4 weeks; mice, 5 days per week for 4 weeks.

RESULTSNeither compound reduced the weights of reproductive organs or accessory sex organs nor affected sperm parameters. Few marked histopathologic changes were found in the testes of the treated animals. Even at 1,200 mg/kg body weight, which is greater than the LD(50) of APT, ATO produced no effects.

CONCLUSIONSIn this study, it was found that ATO and APT are not toxic to testes in rodents.

The purpose of this study was to examine the association between the hierarchy of higher-level functional capacity (instrumental self-competence, intellectual activity, social role) and the quantity of physical activity in older women (n = 175, 72.1 ± 5.8 years). Physical activity was estimated with a uniaxial accelerometer that calculated light-intensity physical activity (LPA), and moderate-to vigorous-intensity physical activity (MVPA). Higher-level functional capacity was assessed with the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence. According to the three subscales (instrumental self-competence, intellectual activity, and social role) of the TMIG index, participants who reported a score of 1 or more below the respective full marks were categorized as a group with reduced status. Logistic regression analysis was conducted to examine association between the hierarchy of higher-level functional capacity and the quantity of physical activity divided by intensity of activity, adjusted by covariance. Only low MVPA showed a significantly lower odds ratio than high MVPA in reduced status of instrumental self-competence. Since instrumental self-competence was significantly related with only the quantity of MVPA, it may be more important to focus on “quantity” of physical activity to prevent reductions in higher-level functional capacity in advanced stages of declining functional capacity.

The purposes of this study were (i) to determine the characteristics of physical function for frail older adults, compared with those for the independent and the dependent, (ii) to examine validity of the “health check-up questionnaire” (Kihon Check-list: CL) for finding frail older adults. Five hundred thirty-nine older Japanese people (75.5 ± 7.0 years) were assigned to each one of the three categories: the independent, the frail and the dependent according to the classification criteria of long-term care insurance system. Physical function score (PFS) was estimated by principal components analysis. Logistic regression analysis was conducted to assess validity of the CL and to examine the screening tool for detecting frail older adults who have a higher risk for becoming the dependent. Significant differences were observed among the three groups in PFS (the independent, 0.580 ± 0.467; the frail, -0.309 ± 0.733; the dependent -1.347 ± 0.949). The Odds ratio (OR) of the dependent for older adults to whom the CL was applied was 2.4 (95% confidence interval (CI): 1.3 - 4.5), and the OR for those to whom both the CL and the hand-grip strength test were applied was 5.4 (2.6 - 11.5). These data suggest that the comprehensive status of physical function of frail older adults, which varied widely, was intermediate between the independent and the dependent. It is useful to add the hand-grip strength test to the CL as a screening tool to subdivide frail older adults.

Habitual moderate- to vigorous-intensity physical activity positively impacts lower extremely performance in older adults. However, little is known whether habitual sedentary behaviour time independently impacts lower extremity performance. The purpose of this cross-sectional study was to identify whether sedentary behaviour time is associated with lower extremity performance independent of moderate- to vigorous-intensity physical activity time in older adults. Eight-hundred-and-two community-dwelling older Japanese adults (72.5 ± 5.9 years) participated in this study. Sedentary behavioir time and moderate- to vigorous-intensity physical activity time were assessed using a uniaxial accelerometer. Lower extremity performance was assessed by repeated chair stand, single leg stance, and timed up and go tests. Jonckheere terpstra trend test and Spearman rank correlation coefficient were used to identify the single relation between sedentary behaviour time and lower extremity performance. A hierarchical multiple regression analysis was used to identify whether sedentary behaviour time is associated with lower extremity performance independent of moderate- to vigorous-intensity physical activity time. Results of single relation analysis showed there were negative associations between sedentary behaviour time and all lower extremity performance tests. Multivariable analysis indicated that sedentary behaviour time was not significantly associated with any lower extremity performances but moderate- to vigorous-intensity physical activity time was positively associated with all lower extremity performance tests. In conclusion, sedentary behaviour time would be less useful than moderate- to vigorous-intensity physical activity time as an indicator for modifying habitual behavior to maintain good lower extremity performance in community-dwelling older adults.

  A 4–year trial of an undergraduate medical care education program for smoking cessation with the participation of simulated patients is described. Simulated medical care with the participation of simulated patients is thought to motivate medical students to learn clinical skills for smoking cessation. However, simulated medical care for smoking cessation is difficult to plan when both the medical students and the simulated patients are nonsmokers.

The purpose of this study was to retrospectively examine the association of habitual exercise with “single fall (= 1)”, “multiple falls (≥ 2)”, and “injurious falls (≥ 1)” among community-dwelling older adults. A total of 1,683 community-dwelling older adults, aged 60-97 years (72.6 +/- 6.6 yr, 512 men and 1,171 women) were included in this study. Habitual exercises continued one year or longer (6.4 +/- 9.5 yr) were classified into twelve types. Exercise components (time, quantity, period of continuity, and number of exercises) were divided with median or tertiles. To assess the association between habitual exercises and fall status, multivariable logistic regression analyses with stepwise selection method, were applied. The multivariable logistic regression analyses showed that dance (odds ratio (OR): 0.30, 95% confidence interval (CI): 0.09-0.96) was negatively associated with “single fall”. Bicycling (OR: 3.72, 95% CI: 1.32-10.77) was positively associated with “multiple falls”, and the period of continuity (OR: 0.74, 95% CI: 0.60-0.91) was negatively associated with “multiple falls”. None of the exercise components were selected with regard to “injurious falls”. Results indicate that dance may be an effective type of exercise for fall prevention among community-dwelling older adults. However, caution about falling is warranted toward bicycling as an exercise. Moreover, a longer period of continuity (≥ 4 years) appears to be a positive factor of habitual exercise for fall prevention.