Bowel movement frequency, stool consistency, and risk of disabling dementia: a population-based cohort study in Japan

OBJECTIVES

This population-based study aimed to evaluate the association between bowel habits from midlife and dementia.

STUDY DESIGN

This was a cohort study using certification records for national long-term care insurance in Japan.

METHODS

Participants aged 50 to 79 years who reported bowel habits from eight districts within the Japan Public Health Center-based Prospective Study (JPHC Study) were followed from 2006 to 2016 for incident dementia. Hazard ratio (HR) and 95% confidence interval (CI) were estimated for men and women separately using Cox proportional hazards models accounting for various lifestyle factors and medical histories.

RESULTS

Among 19,396 men and 22,859 women, 1889 men and 2685 women were diagnosed with dementia. In men, the multivariable-adjusted HRs compared with bowel movement frequency (BMF) of once/day were 1.00 (95% CI: 0.87-1.14) for twice/day or more, 1.38 (1.16-1.65) for 5-6 times/week, 1.46 (1.18-1.80) for 3-4 times/week, and 1.79 (1.34-2.39) for <3 times/week (P for trend <0.001). In women, the corresponding HRs were 1.14 (0.998-1.31), 1.03 (0.91-1.17), 1.16 (1.01-1.33), and 1.29 (1.08-1.55) (P for trend = 0.043). Harder stool was associated with higher risk (P for trend: 0.0030 for men and 0.024 for women), with adjusted HRs compared to normal stool of 1.30 (1.08-1.57) for hard stool and 2.18 (1.23-3.85) for very hard stool in men, and 1.15 (1.002-1.32) and 1.84 (1.29-2.63) in women.

CONCLUSIONS

Lower BMF and harder stool were each associated with higher risk of dementia.

Effects of the order of exposure to antimicrobials on the incidence of multidrug-resistant Pseudomonas aeruginosa

Multidrug-resistant Pseudomonas aeruginosa (MDRP) is one of the most important pathogens in clinical practice. To clarify the mechanisms contributing to its emergence, we isolated MDRPs using the P. aeruginosa PAO1, the whole genome sequence of which has already been elucidated. Mutant strains resistant to carbapenems, aminoglycosides, and new quinolones, which are used to treat P. aeruginosa infections, were isolated; however, none met the criteria for MDRPs. Then, PAO1 strains were exposed to these antimicrobial agents in various orders and the appearance rate of MDRP varied depending on the order of exposure; MDRPs more frequently appeared when gentamicin was applied before ciprofloxacin, but were rarely isolated when ciprofloxacin was applied first. Exposure to ciprofloxacin followed by gentamicin increased the expression of MexCD-OprJ, an RND-type multidrug efflux pump, due to the NfxB mutation. In contrast, exposure to gentamicin followed by ciprofloxacin resulted in more mutations in DNA gyrase. These results suggest that the type of quinolone resistance mechanism is related to the frequency of MDRP and that the risk of MDRP incidence is highly dependent on the order of exposure to gentamicin and ciprofloxacin.

Strategies of Health Surveillance in the construction of a support network for breastfeeding women

In 2018 the Municipal Health Department of the city of Diadema, São Paulo, Brazil, started the implementation of strategies to promote, protect and support breastfeeding in health surveillance actions. Supervised compliance with the Brazilian Standards of Commercialization of Foods for Infants and Children of 1st Childhood, nipples, pacifiers and bottles and encouraged the installation of breast-feeding support rooms in public and private workplaces in the city, aiming to intervene in the infant mortality rates. According to the Global Strategy of the World Health Organization (WHO/UNICEF), for the Feeding of Infants and Children in the First Childhood, only 35% of children worldwide are breastfed exclusively during the first four months of life. What are the contributions of the surveillance area in encouraging the installation of breast-feeding facilities in the workplace? What are the responsibilities of the Health Surveillance to promote breastfeeding? The strategies implemented aimed to create a culture of respect and support for breastfeeding as a way to promote the health of the working woman and her baby, bringing direct benefits to society.The importance of women in promoting breastfeeding is evident, but it is essential to implement public policies. The surveillance began to integrate the municipal network of incentive to breastfeeding in search of the integrality of the attention aiming to contribute to increase the rates of breastfeeding in the city. Measures of a supervisory nature were implemented to comply with the rules that protect the practice of breastfeeding, in order to avoid early weaning and to reduce infant mortality. Intra and intersectoral strategies, permanent education and awareness-raising among professionals and the population were used. Isolated and fragmented initiatives do not contribute to structuring a breastfeeding support network in the workplace and many companies have not expressed an interest in promoting breastfeeding space.

Key messages

Dissemination of the pro-breastfeeding culture in which the workplace is a mainstay for a network of support for working women. Surveillance Area acted in the Network of Women’s and Children’s Health Care contributing to the reduction of maternal and infant mortality and healthy infant development.

Protection of the rights of people in situations of violence

The Municipal Health Department of the city of Diadema, São Paulo, Brazil, has the Health Promotion and Violence Prevention Center focused on prevention, reception and protection of the rights of people in situations of violence. Articulation of the epidemiological, health and health surveillance actions of the worker with the psychosocial care network (in the field of mental health). What is the role of the Health Surveillance in the network of attention and protection for people in situations of violence? What is the health status of the places that shelter people in mental distress? How to intervene in situations of psychological violence at work? Violence is an important public health problem, considering the impact it has on the lives of people, families and communities. Violence is a complex, multifactorial phenomenon that can leave deep marks. From the users-guide were produced new arrangements in the production of care involving the surveillance teams, in intra and intersectoral interlocution, analyzing the situations, unfolding in the construction of other work processes and qualified interventions.

In Diadema, the three health surveillance departments (Epidemiology, Reference Center in Occupational Health and the Health Surveillance department) developed strategies aimed at the qualification of comprehensive attention to people and integrating the Network of Psychosocial Care (RAPSI).

The users in violence were treated with priority by the health services and the intervention was immediate. We observed that health services are more sensitive to dealing with cases of violence. The intervention requires the establishment of a network of attention and care for people in situations of violence. The interventions contributed to the prevention of violence and the promotion of health and the exchange of comprehensive care practices for people living in situations of violence and population segments at risk.

Key messages

The articulation of a network of protection for people in situations of violence exposes institutional violence and social vulnerabilities in order to intervene in the determinants. The compulsory notification of situations of interpersonal and self-harm inflicted violence is the basis for the action of care, prevention of violence and promotion of health.

EVALUATION OF PATIENT EXPOSURE IN FAST kVp SWITCHING DUAL ENERGY COMPUTED TOMOGRAPHY: PHANTOM STUDY

The aim of this study was to evaluate the suitability of size specific dose estimates (SSDE) to estimate patient dose in Fast kVp switching dual energy CT. An anthropomorphic phantom (RAN-110) was repeatedly scanned (chest, abdomen and the pelvis) using a 64 detector row MDCT (Discovery CT750 HD, GE Healthcare, Milwaukee, WI, USA) with various CT parameters, including Fast kVp switching. Dosimetry was performed using thermo-luminescent dosimeters, positioned both superficially and within the phantom. SSDE was calculated for all slices of the anthropomorphic phantom using both the localiser and axial images. In Fast kVp switching, SSDE underestimated the measured absorbed dose for the chest/abdomen region ~35% at the maximum, but were in closer agreement for the pelvic region about within 10%. In single energy techniques, SSDE could not be applied in the estimation of organ doses, but in Fast kVp switching dual energy techniques, SSDE could be applied for anatomical regions with larger thicknesses.

Concomitant assessment of DNA oxidation and bone resorption over a rapid body mass reduction period in female judokas

The purpose of this study was to concomitantly determine oxidative DNAdamage and bone resorption following a rapid body mass reduction in association with energy restriction and exercise training, considering 17β-estradiol level, in female collegiate judokas. Eighteen nationally ranked university female judokas were enrolled as participants in this study. All participants continuously managed to reduce their body mass 8 days just before a competition. To detect cumulative effects of oxidative DNA damage and bone resorption, urinary samples were collected in the morning on three different days (Day 1= the beginning of body mass reduction; Day 4=mid-term of body mass reduction; Day 7=the day before the competition) for the later analysis of 8-hydroxy-2’- deoxyguanosine (8-OHdG) as well as cross-linked N-terminal telopeptides of Type I collagen (NTx). Urinary 8-OHdG and NTx levels were determined with high performance liquid chromatography and enzyme-linked immunosorbent assay, respectively. No significant alterations were observed in urinary 8-OHdG or NTx levels over a rapid body mass reduction period. The findings of the present study indicate that female judokas appear to have relatively less oxidative DNA damage determined by quantification of 8-OHdG and bone resorption over a rapid body mass reduction period, potentially due to the enhanced endogenous defense responses (training adaptation). These data can provide athletes and coaches with valuable information in considering an optimal body mass management program to avoid detrimental physiological and biological conditions.

Causes and Radiological Consequences of the Chernobyl and Fukushima Nuclear Accidents

In this paper, the causes and the radiological consequences of the explosion of the Chernobyl reactor occurred at 1:23 a.m. (local time) on Apr. 26, 1986, and of the Fukushima Daiichi nuclear disaster following the huge Tsunami caused by the Great East Japan earthquake at 2.46 p.m. (local time) on Mar. 11, 2011 are discussed. The need for better severe accident management (SAM), and severe accident management guidelines (SAMGs), are essential in order to increase the safety of the existing and future operating nuclear power plants (NPPs). In addition to that, stress tests should, on a regular basis, be performed to assess whether the NPPs can withstand the effects of natural disasters and man-made failures and actions. The differences in safety preparations at the Chernobyl and Fukushima Daiichi will therefore be presented, as well as recommendations concerning improvements of safety culture, decontamination, and disaster planning. The need for a high-level national emergency response system in case of nuclear accidents will be discussed. The emergency response system should include fast alarms, communication between nuclear power plants, nuclear power authorities and the public people, as well as well-prepared and well-established evacuation plans and evacuation zones. The experiences of disaster planning and the development of a new improved emergency response system in Japan will also be presented together with the training and education program, which have been established to ensure that professional rescue workers, including medical staff, fire fighters, and police, as well as the normal populations including patients, have sufficient knowledge about ionizing radiation and are informed about the meaning of radiation risks and safety.

The host galaxy of a fast radio burst

In recent years, millisecond-duration radio signals originating in distant galaxies appear to have been discovered in the so-called fast radio bursts. These signals are dispersed according to a precise physical law and this dispersion is a key observable quantity, which, in tandem with a redshift measurement, can be used for fundamental physical investigations. Every fast radio burst has a dispersion measurement, but none before now have had a redshift measurement, because of the difficulty in pinpointing their celestial coordinates. Here we report the discovery of a fast radio burst and the identification of a fading radio transient lasting ~6 days after the event, which we use to identify the host galaxy; we measure the galaxy's redshift to be z = 0.492 ± 0.008. The dispersion measure and redshift, in combination, provide a direct measurement of the cosmic density of ionized baryons in the intergalactic medium of ΩIGM = 4.9 ± 1.3 per cent, in agreement with the expectation from the Wilkinson Microwave Anisotropy Probe, and including all of the so-called 'missing baryons'. The ~6-day radio transient is largely consistent with the radio afterglow of a short γ-ray burst, and its existence and timescale do not support progenitor models such as giant pulses from pulsars, and supernovae. This contrasts with the interpretation of another recently discovered fast radio burst, suggesting that there are at least two classes of bursts.

Use of a Latent Topic Model for Characteristic Extraction from Health Checkup Questionnaire Data

OBJECTIVES

When patients complete questionnaires during health checkups, many of their responses are subjective, making topic extraction difficult. Therefore, the purpose of this study was to develop a model capable of extracting appropriate topics from subjective data in questionnaires conducted during health checkups.

METHODS

We employed a latent topic model to group the lifestyle habits of the study participants and represented their responses to items on health checkup questionnaires as a probability model. For the probability model, we used latent Dirichlet allocation to extract 30 topics from the questionnaires. According to the model parameters, a total of 4381 study participants were then divided into groups based on these topics. Results from laboratory tests, including blood glucose level, triglycerides, and estimated glomerular filtration rate, were compared between each group, and these results were then compared with those obtained by hierarchical clustering.

RESULTS

If a significant (p < 0.05) difference was observed in any of the laboratory measurements between groups, it was considered to indicate a questionnaire response pattern corresponding to the value of the test result. A comparison between the latent topic model and hierarchical clustering grouping revealed that, in the latent topic model method, a small group of participants who reported having subjective signs of urinary disorder were allocated to a single group.

CONCLUSIONS

The latent topic model is useful for extracting characteristics from a small number of groups from questionnaires with a large number of items. These results show that, in addition to chief complaints and history of past illness, questionnaire data obtained during medical checkups can serve as useful judgment criteria for assessing the conditions of patients.

Note: Application of CR-39 plastic nuclear track detectors for quality assurance of mixed oxide fuel pellets

A CR-39 plastic nuclear track detector was used for quality assurance of mixed oxide fuel pellets for next-generation nuclear power plants. Plutonium (Pu) spot sizes and concentrations in the pellets are significant parameters for safe use in the plants. We developed an automatic Pu detection system based on dense α-radiation tracks in the CR-39 detectors. This system would greatly improve image processing time and measurement accuracy, and will be a powerful tool for rapid pellet quality assurance screening.

Isolation, Purification, and Characterization of a New Enzyme fromPseudomonassp. M-27, Carboxypeptidase G3

A new type of carboxypeptidase was found in a strain of Pseudomonas sp. M-27 isolated from soil. The cell-free extract, solubilized by colistin sulfate, was purified to homogeneity. This enzyme had a single peak with a molecular weight of 60,000 on a calibrated Superdex column and consisted of four subunits of identical molecular weights (M(r): 15,000). The enzyme hydrolyzed predominantly acidic peptides and N-acyl amino acids with Glu or Asp in the C-termini. This enzyme was not strongly affected by thiol enzyme inhibitors (PCMB, iodoacetic acid) or serine protease inhibitors (DFP, PMSF), but was inhibited by metal chelators. The enzyme resembles carboxypeptidase G1 or G2 in its glutamate-releasing activity. However, it acts not only on the L-form but also on the D-form of acidic amino acids and shows affinity for the long-chain fatty acyl group but not the benzoyl group. Thus, as this enzyme differs from carboxypeptidase G1 or G2, it was named carboxypeptidase G3.

Expression of NOS and VEGF in feline mammary tumours and their correlation with angiogenesis

In order to define the role of nitric oxide (NO) in feline mammary tumours, the expression of endothelial or inducible nitric oxide synthase (e/iNOS) and vascular endothelial growth factor (VEGF), and their relationship with angiogenesis, was investigated in 23 feline mammary tumours (two hyperplastic, 19 adenocarcinoma, one osteosarcoma and one squamous cell carcinoma) by immunohistochemistry. Tumour angiogenesis was assessed by CD31 immunostaining and was expressed as microvessel density (MVD). In general, iNOS immunoreactivity was localised in tumour cells and occasionally in stromal myofibroblasts, whereas eNOS and VEGF were localised in the cytoplasm of tumour epithelial cells and endothelium. In malignancy, expression of iNOS increased from well- to less-differentiated phenotypes (Grades 1-3) and was significantly higher in G3 and G2 when compared with G1 cases. However, increasing eNOS expression was limited only in hyperplastic lesions and showed no significant changes among the grades. In addition, expression of iNOS was positively correlated with VEGF and MVD in feline mammary tumours and both measures were significantly greater in less differentiated phenotypes (P<0.05). In conclusion, the expression of NOS isoforms in feline mammary tumours depended on tumour grade, and the positive correlations between iNOS and angiogenic markers suggests that iNOS synthesised by tumour cells promotes tumour growth. Thus, iNOS can be used as an important immunohistochemical marker to determine the degree of malignancy and prognosis of feline mammary carcinoma.