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Iizuka G, Tsuji T, Ide K, Kondo K. Relationship between participation in projects of incentives to promote walking and healthy aging among the older population: A four-year longitudinal study. Prev Med 2024; 187:108125. [PMID: 39232992 DOI: 10.1016/j.ypmed.2024.108125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 08/30/2024] [Accepted: 08/31/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE This study aimed to evaluate the association between the Yokohama Walking Point Program, which promotes walking through feedback on step counts and incentives, and the extension of healthy life expectancy. METHODS A total of 4298 individuals aged over 65 years who responded to the 2013 and 2016 surveys and who were not certified as needing long-term care in 2016 were included in this study. The participants were categorized into "non-participation," "participation without uploading," and "participation with uploading" groups based on their involvement and uploading of pedometer data. The objective variable was the occurrence of long-term care certification and deaths over the subsequent four years. A modified Poisson regression model was applied, adjusting for 15 variables before project initiation. RESULTS A total of 440 participants (10.2 %) were included in the "participation with uploading" group and 206 (4.8 %) in the "participation without uploading" group. Compared with "non-participation," the risk ratio was 0.77 (95 % confidence interval (CI): 0.59-0.99) for "participation with uploading" and 1.02 (95 % CI: 0.75-1.38) for "participation without uploading". In the sensitivity analysis censoring death as an inapplicable outcome and considering functional decline, participation with uploading showed a risk ratio of 0.79 (95 % CI: 0.60-1.04) for the likelihood of functional decline. CONCLUSIONS The use of pedometers and health point programs based on walking activity is associated with enhancing the health of older individuals participating in the program, representing a population-centric strategy targeting all citizens.
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Affiliation(s)
- Gemmei Iizuka
- Center for Preventive Medical Sciences, Chiba University, 1-33, Yayoicho, Inage-ku, Chiba-shi, Chiba 263-8522, Japan; Tama Family Clinic, 337, Noboritoshinmachi, Tama-ku, Kawasaki-shi, Kanagawa 214-0013, Japan.
| | - Taishi Tsuji
- Center for Preventive Medical Sciences, Chiba University, 1-33, Yayoicho, Inage-ku, Chiba-shi, Chiba 263-8522, Japan; Institute of Health and Sport Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan.
| | - Kazushige Ide
- Center for Preventive Medical Sciences, Chiba University, 1-33, Yayoicho, Inage-ku, Chiba-shi, Chiba 263-8522, Japan.
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, 1-33, Yayoicho, Inage-ku, Chiba-shi, Chiba 263-8522, Japan; Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu-shi, Aichi 474-8511, Japan.
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Li J, Liao Y, Zhang SY, Jin L, Congdon N, Fan Z, Zeng Y, Zheng Y, Liu Z, Liu Y, Liang L. Effect of laughter exercise versus 0.1% sodium hyaluronic acid on ocular surface discomfort in dry eye disease: non-inferiority randomised controlled trial. BMJ 2024; 386:e080474. [PMID: 39260878 DOI: 10.1136/bmj-2024-080474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
OBJECTIVE To assess efficacy and safety of laughter exercise in patients with symptomatic dry eye disease. DESIGN Non-inferiority randomised controlled trial. SETTING Recruitment was from clinics and community and the trial took place at Zhongshan Ophthalmic Center, Sun Yat-sen University, the largest ophthalmic centre in China, between 18 June 2020 to 8 January 2021. PARTICIPANTS People with symptomatic dry eye disease aged 18-45 years with ocular surface disease index scores ranging from 18 to 80 and tear film break-up time of eight seconds or less. INTERVENTIONS Participants were randomised 1:1 to receive laughter exercise or artificial tears (0.1% sodium hyaluronic acid eyedrop, control group) four times daily for eight weeks. The laughter exercise group viewed an instructional video and participants were requested to vocalise the phrases "Hee hee hee, hah hah hah, cheese cheese cheese, cheek cheek cheek, hah hah hah hah hah hah" 30 times per five minute session. Investigators assessing study outcomes were masked to group assignment but participants were unmasked for practical reasons. MAIN OUTCOME MEASURES The primary outcome was the mean change in the ocular surface disease index (0-100, higher scores indicating worse ocular surface discomfort) from baseline to eight weeks in the per protocol population. The non-inferiority margin was 6 points of this index score. Main secondary outcomes included the proportion of patients with a decrease from baseline in ocular surface disease index score of at least 10 points and changes in dry eye disease signs, for example, non-invasive tear break up time at eight weeks. RESULTS 299 participants (mean age 28.9 years; 74% female) were randomly assigned to receive laughter exercise (n=149) or 0.1% sodium hyaluronic acid (n=150). 283 (95%) completed the trial. The mean change in ocular surface disease index score at eight weeks was -10.5 points (95% confidence interval (CI) -13.1 to -7.82) in the laughter exercise group and -8.83 (-11.7 to -6.02) in the control group. The upper boundary of the CI for difference in change between groups was lower than the non-inferiority margin (mean difference -1.45 points (95% CI -5.08 to 2.19); P=0.43), supporting non-inferiority. Among secondary outcomes, the laughter exercise was better in improving non-invasive tear break up time (mean difference 2.30 seconds (95% CI 1.30 to 3.30), P<0.001); other secondary outcomes showed no significant difference. No adverse events were noted in either study group. CONCLUSIONS The laughter exercise was non-inferior to 0.1% sodium hyaluronic acid in relieving subjective symptoms in patients with dry eye disease with limited corneal staining over eight weeks intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT04421300.
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Affiliation(s)
- Jing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yinglin Liao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Shi-Yao Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
- Centre for Public Health, Queen's University Belfast, Belfast, Belfast, UK
- Orbis International, New York, NY, USA
| | - Zixin Fan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yangfa Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Zuguo Liu
- Xiamen University affiliated with Xiamen Eye Center, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Fujian Engineering and Research Center of Eye Regenerative Medicine, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Department of Ophthalmology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Lingyi Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
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Tamada Y, Takeuchi K, Kusama T, Saito M, Ohira T, Shirai K, Yamaguchi C, Kondo K, Aida J, Osaka K. Reduced number of teeth with and without dental prostheses and low frequency of laughter in older adults: Mediation by poor oral function. J Prosthodont Res 2024; 68:441-448. [PMID: 37793820 DOI: 10.2186/jpr.jpr_d_23_00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
PURPOSE Laughter is expected to have health-protective effects, but the potential link between tooth loss and laughter remains unclear. Therefore, this study aimed to examine the association between tooth loss and a low frequency of laughter among older adults in Japan, to elucidate whether this association could be mitigated by dental prostheses, and to evaluate the magnitude of the association mediated by poor oral function. METHODS We used cross-sectional data from 157,708 functionally independent participants aged ≥65 years (46.3% male) from the Japan Gerontological Evaluation Study. A modified Poisson regression model was applied to examine the association between the number of remaining teeth (≥20/10-19/0-9), dental prostheses use, and infrequent laughter (i.e., laughing never or almost never). Causal mediation analysis was performed to assess whether the association was mediated by difficulties in eating hard foods, choking, or dry mouth. RESULTS Among the participants, 9,129 reported infrequent laughter. Participants with ≤9 and 10-19 teeth who did not use dental prostheses had a 1.29 and 1.14 times higher likelihood of infrequent laughter than those with ≥20 teeth, respectively. Furthermore, difficulty eating hard foods, choking, and dry mouth mediated 22.8%, 0.4%, and 4.3% of the association between fewer remaining teeth and infrequent laughter, respectively. Meanwhile, we did not find evidence for the differences in infrequent laughter between participants with ≤19 teeth using dental prostheses and those with ≥20 teeth. CONCLUSIONS Tooth loss among individuals without dental prostheses was associated with infrequent laughter, and this association was mediated by poor oral function.
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Affiliation(s)
- Yudai Tamada
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Takeuchi
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Taro Kusama
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Masashige Saito
- Faculty of Social Welfare, Nihon Fukushi University, Mihama, Japan
- Center for Well-being and Society, Nihon Fukushi University, Mihama, Japan
| | - Tetsuya Ohira
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
- Radiation Medical Science Center for Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Kokoro Shirai
- Department of Social Medicine, Public Health, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Chikae Yamaguchi
- Department of Nursing, Faculty of Nursing, Kinjo Gakuin University, Nagoya, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
- Department of Gerontological Evaluation, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
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Watanabe T, Tamiya N. Utilization of Japanese long-term care-related data including Kaigo-DB: An analysis of current trends and future directions. Glob Health Med 2024; 6:63-69. [PMID: 38450118 PMCID: PMC10912809 DOI: 10.35772/ghm.2023.01135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 03/08/2024]
Abstract
Despite high expectations from the government and researchers regarding data utilization, comprehensive analysis of long-term care (LTC)-related data use has been limited. This study reviewed the use of LTC-related data, including Kaigo-DB, in Japan after 2020. There was an increase in studies using LTC-related data in Japan between 2020 and 2021, followed by a stabilization period. The national government provided 13.5% of this data (6.5% from Kaigo-DB), while prefectures and municipalities contributed 85.2%, and facilities provided 1.3%. The linked data used in 90.4% of the studies primarily consisted of original questionnaire or interview surveys (34.6%) and medical claims (34.0%). None of the studies based on Kaigo-DB utilized linked data. In terms of study design, cohort studies were the most common (84.6%), followed by descriptive (5.1%), cross-sectional (3.2%), and case-control studies (1.3%). Among the 138 individual-based analytical descriptive studies, the most frequently used LTC-related data as an exposure was LTC services (26.8%), and the most common data used as an outcome was LTC certification or care need level (43.5%), followed by the independence degree of daily living for the older adults with dementia (18.1%). To enhance the use of LTC-related data, especially the valuable national Kaigo-DB, insights can be gleaned from how researchers effectively utilize municipal and prefectural data. Streamlining access to Kaigo-DB and enabling its linkage with other datasets are promising for future research in this field.
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Affiliation(s)
- Taeko Watanabe
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
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Hosokawa R, Ojima T, Myojin T, Aida J, Kondo K, Kondo N. Estimating Health Expectancy in Japanese Communities Using Mortality Rate and Disability Prevalence. JMA J 2024; 7:21-29. [PMID: 38314416 PMCID: PMC10834173 DOI: 10.31662/jmaj.2023-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/18/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Although mortality and disability are known to be associated with health expectancy (LE), few studies have assessed the extent to which a reduction in their prevalence can extend a person's LE. Moreover, differences in this relationship based on gender have not been established. Thus, in this study, we constructed a regression model using the rate of mortality and prevalence of disability to predict LE in older adults (≥65 years) and assess the relationships between LE, mortality rate, and disability prevalence based on gender. Methods Data were collected from Japan's population registry and long-term insurance records (N = 344). Multiple linear regression was used to analyze the relationship between LE, mortality rate, and disability prevalence, stratified by gender. Results Age-adjusted mortality rate and disability prevalence significantly predicted LE and were significantly correlated with the measured LE index for both genders. For every 1% annual decrease in age-adjusted mortality, LE increased by 1.54 years for men and 2.15 years for women. Similarly, a 1% annual decrease in age-adjusted disability prevalence increased LE by 0.22 years for men and 0.32 years for women. The regression model coefficients indicated that the strength of the association between LE, mortality rate, and disability prevalence differed between genders. Our model accurately predicted LE (men: adjusted R2 = 0.968, women: adjusted R2 = 0.994). Conclusions Health promotion policies that are geared toward increasing health expectancy can be evaluated using mortality rate and disability prevalence as prognostic indicators. The strength of the association between LE, mortality, and disability differed between genders, suggesting the need for gender-specific policy planning to increase LE for both genders.
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Affiliation(s)
- Rikuya Hosokawa
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Nara, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
- Center for Well-being and Society, Nihon Fukushi University, Aichi, Japan
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Naoki Kondo
- Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
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Suzuki M, Kojima T, Terabe K, Ohashi Y, Sato R, Kosugiyama H, Hasegawa J, Ohno Y, Nagai K, Ohnishi C, Sugiura H, Fujita H, Nagayoshi M, Kojima M, Asai S, Imagama S. Association between laughter, frailty, and depression in rheumatoid arthritis patients. Int J Rheum Dis 2024; 27:e15034. [PMID: 38287545 DOI: 10.1111/1756-185x.15034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/27/2023] [Accepted: 12/26/2023] [Indexed: 01/31/2024]
Abstract
OBJECTIVE This study aimed to determine whether there are associations between laughter, disease activity, frailty, and depression in rheumatoid arthritis (RA) patients. METHODS A total of 240 patients were included in this prospective cohort study on frailty in RA patients between March 2021 and June 2022. Patients were divided into the following four groups according to the frequency of laughter: "almost every day," "1-5 days per week," "1-3 days per month," and "never or almost never." Patient characteristics were compared among the four groups by analysis of variance. Factors associated with laughter were identified by multivariable logistic analysis. RESULTS The mean 28-joint Disease Activity Score using CRP was 1.91, with 70.7% of patients in remission and 12.6% in low disease activity. For the "almost every day" (42.5% of patients), "1-5 days per week" (40.0%), "1-3 days per month" (11.3%), and "never or almost never" (6.3%) groups, scores of the Kihon Checklist (KCL) for assessing frailty status were 3.5, 4.6, 7.3, and 8.1 (p < .001), respectively, and scores of the Beck Depression Inventory (BDI-II) were 8.4, 10.7, 15.1, and 16.5 (p < .001), respectively. Multivariable analysis revealed that KCL (OR: 0.81, 95% CI: 0.73-0.90) and BDI-II (OR: 0.91, 95% CI: 0.86-0.95) scores were independently associated with the frequency of laughter. CONCLUSION Frailty and depression were associated with laughter in RA patients with controlled disease activity. Interventions aimed at not only disease activity control but also frailty prevention may lead to a life filled with laughter.
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Affiliation(s)
- Mochihito Suzuki
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Orthopedic Surgery, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Kenya Terabe
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshifumi Ohashi
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryo Sato
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hironobu Kosugiyama
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Junya Hasegawa
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Ohno
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Chinami Ohnishi
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideshi Sugiura
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitomi Fujita
- Faculty of Health Sciences, Department of Rehabilitation, Nihon Fukushi University, Handa, Japan
| | - Mako Nagayoshi
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masayo Kojima
- Department of Frailty Research, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
- Nagoya City University, Graduate School of Medicine, Nagoya, Japan
| | - Shuji Asai
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Kiuchi S, Takeuchi K, Kusama T, Cooray U, Tamada Y, Osaka K, Tabuchi T. Does online communication mitigate the association between a decrease in face-to-face communication and laughter during the COVID-19 pandemic? A cross-sectional study from JACSIS study. Prev Med Rep 2023; 36:102432. [PMID: 37781106 PMCID: PMC10534252 DOI: 10.1016/j.pmedr.2023.102432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023] Open
Abstract
Laughter has a protective effect on human health. The spread of coronavirus disease 2019 (COVID-19) has changed opportunities for face-to-face communication and might decrease opportunities for laughter. This cross-sectional study aimed to investigate whether the decrease in face-to-face communication during the COVID-19 pandemic is associated with a decrease in laughter. Additionally, we investigated whether an increase in online communication mitigates this association. Data from the "Japan COVID-19 and Society Internet Survey (JACSIS)," conducted between August and September 2020, were used. Participants aged 15-79 years were included in this study. The outcome was a decrease in laughter before the onset of the COVID-19 pandemic. The explanatory variables were decreased face-to-face communication with friends and increased online communication (text message, telephone, and video contact). Causal mediation analysis was used to calculate prevalence ratios (PRs) and 95 % confidence intervals (CIs) of the controlled direct effects of increased online communication. Furthermore, the proportions eliminated (PEs) by an increase in online communication were calculated. Among the 25,482 participants, 40.4 % had decreased face-to-face communication and 21.4 % had a decreased frequency of laughter. After adjusting for confounders, a decrease in face-to-face communication was significantly associated with a decrease in laughter (PR = 1.62, 95 %CI = 1.55-1.70). PEs for decrease in laughter were 27.2 % (95 %CI = -2.0 to 56.4) for text-based communication, 36.1 % (95 %CI = 12.3-59.8) for telephone-based communication, and 28.6 % (95 %CI = 0.6-56.6) for video-based communication. Although a decrease in face-to-face communication was associated with a decrease in laughter during the COVID-19 pandemic, online communication, particularly telephone-based communication, mitigated this association.
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Affiliation(s)
- Sakura Kiuchi
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Aoba-ku, Sendai, Japan
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Japan
| | - Kenji Takeuchi
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Japan
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Japan
| | - Taro Kusama
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Japan
- Division of Statistics and Data Science, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Japan
| | - Upul Cooray
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Japan
| | - Yudai Tamada
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Japan
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Aoba-ku, Sendai, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
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Hayashi F, Shirai Y, Ohira T, Shirai K, Kondo N, Kondo K. Subjective Happiness, Frequency of Laughter, and Hypertension: A Cross-Sectional Study Based on the Japan Gerontological Evaluation Study (JAGES). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095713. [PMID: 37174231 PMCID: PMC10178400 DOI: 10.3390/ijerph20095713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
In recent years, positive psychological factors, such as subjective happiness and laughter, have been reported to be associated with cardiovascular disease. In this study, we examined the relationship of hypertension with subjective happiness and frequency of laughter using the data from the Japan Gerontological Evaluation Study (JAGES). Of the 138,294 respondents, 26,368 responded to a version of the self-administered questionnaire that included a question about the frequency of laughter in the JAGES 2013. In total, 22,503 (10,571 men and 11,932 women) were included in the analysis after excluding those with missing responses regarding a history of hypertension, frequency of laughter, and subjective happiness. The prevalence of hypertension in this study was 10,364 (46.1%). Multivariate logistic regression analysis showed that age, female sex, obesity, infrequent chewing, former and current drinker, seeing three to five friends, and the absence of hobbies were positively associated with hypertension. However, infrequent laughter/high level of subjective happiness, frequent laughter/high level of subjective happiness, being underweight, and current smoker were negatively associated with hypertension. As per the findings of this study, it was determined that subjective happiness was negatively associated with hypertension. Therefore, this study suggests that having more opportunities to feel happiness may be important in preventing hypertension.
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Affiliation(s)
- Fumikazu Hayashi
- Department of Epidemiology, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima 960-1295, Japan
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikariga-oka, Fukushima 960-1295, Japan
| | - Yuka Shirai
- Department of Epidemiology, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima 960-1295, Japan
| | - Tetsuya Ohira
- Department of Epidemiology, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima 960-1295, Japan
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, 1 Hikariga-oka, Fukushima 960-1295, Japan
| | - Kokoro Shirai
- Department of Public Health, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba 263-8522, Japan
- Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Ohbu 474-8511, Japan
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9
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Hirosaki M, Ohira T, Wu Y, Eguchi E, Shirai K, Imano H, Funakubo N, Nishizawa H, Katakami N, Shimomura I, Iso H. Laughter yoga as an enjoyable therapeutic approach for glycemic control in individuals with type 2 diabetes: A randomized controlled trial. Front Endocrinol (Lausanne) 2023; 14:1148468. [PMID: 37065750 PMCID: PMC10102335 DOI: 10.3389/fendo.2023.1148468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Laughter has been reported to have various health benefits. However, data on the long-term effects of laughter interventions on diabetes are limited. This study aimed to investigate whether laughter yoga can improve glycemic control among individuals with type 2 diabetes. METHODS In a single-center, randomized controlled trial, 42 participants with type 2 diabetes were randomly assigned to either the intervention or the control group. The intervention consisted of a 12-week laughter yoga program. Hemoglobin A1c (HbA1c), body weight, waist circumference, psychological factors, and sleep duration were evaluated at baseline and week 12. RESULTS Intention-to-treat analysis showed that participants in the laughter yoga group experienced significant improvements in HbA1c levels (between-group difference: -0.31%; 95% CI -0.54, -0.09) and positive affect scores (between-group difference: 0.62 points; 95% CI 0.003, 1.23). Sleep duration tended to increase in the laughter yoga group with a between-group difference of 0.4 hours (95% CI -0.05, 0.86; P = 0.080). The mean attendance rate for laughter yoga program was high (92.9%). CONCLUSIONS A 12-week laughter yoga program is feasible for individuals with type 2 diabetes and improves glycemic control. These findings suggest that having fun could be a self-care intervention. Further studies with larger numbers of participants are warranted to better evaluate the effects of laughter yoga. CLINICAL TRIAL REGISTRATION http://www.chinadrugtrials.org.cn, identifier UMIN000047164.
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Affiliation(s)
- Mayumi Hirosaki
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
- *Correspondence: Mayumi Hirosaki, ; Tetsuya Ohira,
| | - Tetsuya Ohira
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
- *Correspondence: Mayumi Hirosaki, ; Tetsuya Ohira,
| | - Yawei Wu
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Eri Eguchi
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kokoro Shirai
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hironori Imano
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Narumi Funakubo
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hitoshi Nishizawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Naoto Katakami
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
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10
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Takashima N, Nakamura Y, Miyagawa N, Kadota A, Saito Y, Matsui K, Miura K, Ueshima H, Kita Y. Association between C-Reactive Protein Levels and Functional Disability in the General Older-Population: The Takashima Study. J Atheroscler Thromb 2023; 30:56-65. [PMID: 35264478 PMCID: PMC9899706 DOI: 10.5551/jat.63323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
AIMS High-sensitivity C-reactive protein (hsCRP) associates with atherosclerotic diseases such as stroke. However, previous results on the association between hsCRP levels and functional disability were controversial. METHODS We analyzed 2,610 men and women who did not exhibit functional disability or death within the first 3 years of the baseline survey and those aged 65 years or older at the end of follow-up. The levels of hsCRP were assessed using latex agglutination assay at baseline survey from 2006 to 2014. Functional disability was followed up using the long-term care insurance (LTCI) program until November 1, 2019. Functional disability was defined as a new LTCI program certification. Cox proportional hazards model with competing risk analysis for death was used to evaluate the association between hsCRP levels and future functional disability. RESULTS During a 9-year follow-up period, we observed 328 cases of functional disability and 67 deaths without prior functional disability incidence. The multivariable-adjusted hazard ratio (HR, 95% confidence interval [CI]) of functional disability in log-transferred hsCRP levels was 1.43 (1.22-1.67) in men and 0.97 (0.81-1.15) in women. When hsCRP level was analyzed as a categorical variable, low hsCRP levels (<1.0 mg/l) as the reference, the multivariable-adjusted HR (95% CI) of functional disability in high hsCRP levels (≥ 3.0 mg/l) was 2.37 (1.56-3.62). Similar results were observed when stratified by sex, but it was not significant in women. CONCLUSIONS This study demonstrates that low-grade systemic inflammation to assess hsCRP might predict the future incidence of functional disability, especially in men.
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Affiliation(s)
- Naoyuki Takashima
- Department of Public Health, Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan,Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yasuyuki Nakamura
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan,Yamashina Racto Clinic and Medical Examination Center, Kyoto, Japan
| | - Naoko Miyagawa
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan,Department of Preventive Medicine and Public Health, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan,NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshino Saito
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan,Faculty of Health Sciences, Department of Nursing, Aino University, Ibaraki, Japan
| | - Kenji Matsui
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan,Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan,NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan,NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshikuni Kita
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan,Faculty of Nursing Science, Tsuruga Nursing University, Tsuruga, Fukui, Japan
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11
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Kusama T, Takeuchi K, Kiuchi S, Aida J, Kondo K, Osaka K. Weight Loss Mediated the Relationship between Tooth Loss and Mortality Risk. J Dent Res 2023; 102:45-52. [PMID: 36068707 DOI: 10.1177/00220345221120642] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tooth loss is a risk factor for increased mortality; however, the underlying mechanism remains unclear. This study aimed to evaluate the mediating effect of weight change on the relationship between tooth loss and mortality risk. This was a 10-y follow-up prospective cohort study using the data from the Japan Gerontological Evaluation Study (JAGES). The participants were independent older adults aged ≥65 y at baseline and were followed up from 2010 to 2020. The incidence of death in 2013 and 2020, incidence of >5% weight loss/gain in 2010 and 2013, and the number of remaining teeth in 2010 were used as the outcome, mediator, and explanatory variables, respectively. We conducted causal mediation analysis by fitting the Cox proportional hazard model, including possible confounders. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) of the total effect (TE), natural indirect effect (NIE), and proportion mediated (PM) were estimated. Among the 34,510 participants, the mean age was 72.6 (SD = 5.4) y, and 47.6% were men. From 2013 to 2020, 14.0% of the participants (n = 4,825) died, 60.5% (n = 20,871) had 0 to 19 remaining teeth, and 17.2% (n = 5,927) and 8.4% (n = 2,907) experienced >5% weight loss and gain, respectively. The mortality rate was 0.016 per person-year among those with ≥20 remaining teeth and 0.027 per person-year among those with 0 to 19 remaining teeth. Weight loss of >5% significantly mediated the association between tooth loss and higher mortality risk (TE: HR, 1.28 [95% CI, 1.16 to 1.40]; NIE: HR, 1.03 [95% CI, 1.02 to 1.04]; PM, 13.1%); however, we observed a slight mediating effect for >5% weight gain (NIE: HR, 1.003 [95%CI, 1.0001 to 1.01]; PM, 1.3%). The present study suggests that a clinically meaningful level of weight loss mediated the association between tooth loss and increased risk of mortality among independent older adults.
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Affiliation(s)
- T Kusama
- Division for Regional Community Development, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan.,Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - K Takeuchi
- Division for Regional Community Development, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan.,Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - S Kiuchi
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - J Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - K Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Chiba, Japan.,Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - K Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
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12
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Paran M, Sover A, Dudkiewicz M, Hochman O, Goltsman G, Chen Y, Zilber K, Merin O, Aranovich D, Kessel B. Comparison of Sense of Humor and Burnout in Surgeons and Internal Medicine Physicians. South Med J 2022; 115:849-853. [PMID: 36318953 DOI: 10.14423/smj.0000000000001470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
OBJECTIVES We aimed to evaluate humor styles in surgeons and internists and investigate the association between humor and burnout. METHODS A cross-sectional survey of physicians in surgical and medicine departments was conducted, assessing sense of humor and burnout using the Humor Styles Questionnaire and the Emotional Exhaustion subscale of the Maslach Burnout Inventory-Human Services Survey for Medical Personnel. RESULTS For 131 surgeons and 72 internists, no differences in humor styles were found. A sense of personal accomplishment was more common among surgeons (P = 0.03) and rates of burnout were lower for surgeons (P = 0.02). Physicians with a higher-than-average score in affiliative and self-enhancing humor were less likely to suffer from burnout (P < 0.0001 and P = 0.03, respectively). CONCLUSIONS Surgeons and internists have similar styles of humor. Surgeons suffer less from burnout. Affiliative and self-enhancing humor styles are associated with reduced burnout.
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Affiliation(s)
- Maya Paran
- From the Division of General Surgery and Trauma, Hospital Administration, and the Internal Medicine Department, Hillel Yaffe Medical Center, Hadera, Israel, The Open University of Israel, Ra'anana, Bnei Zion Hospital, Haifa, Israel, Shamir Medical Center, Zriffin, Israel, the Internal Medicine Division, Meir Medical Center, Kfar Saba, Israel, and Shaarei Zedek Hospital, Jerusalem, Israel
| | - Arie Sover
- From the Division of General Surgery and Trauma, Hospital Administration, and the Internal Medicine Department, Hillel Yaffe Medical Center, Hadera, Israel, The Open University of Israel, Ra'anana, Bnei Zion Hospital, Haifa, Israel, Shamir Medical Center, Zriffin, Israel, the Internal Medicine Division, Meir Medical Center, Kfar Saba, Israel, and Shaarei Zedek Hospital, Jerusalem, Israel
| | - Mickey Dudkiewicz
- From the Division of General Surgery and Trauma, Hospital Administration, and the Internal Medicine Department, Hillel Yaffe Medical Center, Hadera, Israel, The Open University of Israel, Ra'anana, Bnei Zion Hospital, Haifa, Israel, Shamir Medical Center, Zriffin, Israel, the Internal Medicine Division, Meir Medical Center, Kfar Saba, Israel, and Shaarei Zedek Hospital, Jerusalem, Israel
| | - Ohad Hochman
- From the Division of General Surgery and Trauma, Hospital Administration, and the Internal Medicine Department, Hillel Yaffe Medical Center, Hadera, Israel, The Open University of Israel, Ra'anana, Bnei Zion Hospital, Haifa, Israel, Shamir Medical Center, Zriffin, Israel, the Internal Medicine Division, Meir Medical Center, Kfar Saba, Israel, and Shaarei Zedek Hospital, Jerusalem, Israel
| | - Galina Goltsman
- From the Division of General Surgery and Trauma, Hospital Administration, and the Internal Medicine Department, Hillel Yaffe Medical Center, Hadera, Israel, The Open University of Israel, Ra'anana, Bnei Zion Hospital, Haifa, Israel, Shamir Medical Center, Zriffin, Israel, the Internal Medicine Division, Meir Medical Center, Kfar Saba, Israel, and Shaarei Zedek Hospital, Jerusalem, Israel
| | - Yaakov Chen
- From the Division of General Surgery and Trauma, Hospital Administration, and the Internal Medicine Department, Hillel Yaffe Medical Center, Hadera, Israel, The Open University of Israel, Ra'anana, Bnei Zion Hospital, Haifa, Israel, Shamir Medical Center, Zriffin, Israel, the Internal Medicine Division, Meir Medical Center, Kfar Saba, Israel, and Shaarei Zedek Hospital, Jerusalem, Israel
| | - Karina Zilber
- From the Division of General Surgery and Trauma, Hospital Administration, and the Internal Medicine Department, Hillel Yaffe Medical Center, Hadera, Israel, The Open University of Israel, Ra'anana, Bnei Zion Hospital, Haifa, Israel, Shamir Medical Center, Zriffin, Israel, the Internal Medicine Division, Meir Medical Center, Kfar Saba, Israel, and Shaarei Zedek Hospital, Jerusalem, Israel
| | - Offer Merin
- From the Division of General Surgery and Trauma, Hospital Administration, and the Internal Medicine Department, Hillel Yaffe Medical Center, Hadera, Israel, The Open University of Israel, Ra'anana, Bnei Zion Hospital, Haifa, Israel, Shamir Medical Center, Zriffin, Israel, the Internal Medicine Division, Meir Medical Center, Kfar Saba, Israel, and Shaarei Zedek Hospital, Jerusalem, Israel
| | - David Aranovich
- From the Division of General Surgery and Trauma, Hospital Administration, and the Internal Medicine Department, Hillel Yaffe Medical Center, Hadera, Israel, The Open University of Israel, Ra'anana, Bnei Zion Hospital, Haifa, Israel, Shamir Medical Center, Zriffin, Israel, the Internal Medicine Division, Meir Medical Center, Kfar Saba, Israel, and Shaarei Zedek Hospital, Jerusalem, Israel
| | - Boris Kessel
- From the Division of General Surgery and Trauma, Hospital Administration, and the Internal Medicine Department, Hillel Yaffe Medical Center, Hadera, Israel, The Open University of Israel, Ra'anana, Bnei Zion Hospital, Haifa, Israel, Shamir Medical Center, Zriffin, Israel, the Internal Medicine Division, Meir Medical Center, Kfar Saba, Israel, and Shaarei Zedek Hospital, Jerusalem, Israel
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13
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Wang Y, Shirai K, Ohira T, Hirosaki M, Kondo N, Takeuchi K, Yamaguchi C, Tamada Y, Kondo K, Cadar D, Iso H. Occasions for laughter and dementia risk: Findings from a six-year cohort study. Geriatr Gerontol Int 2022; 22:392-398. [PMID: 35289045 DOI: 10.1111/ggi.14371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/10/2022] [Accepted: 02/19/2022] [Indexed: 11/28/2022]
Abstract
AIM Currently, there is little evidence on the relationship between laughter and the risk of dementia, and since laughter is mainly a social behavior, we aimed to examine the association between various occasions for laughter and the risk of dementia in Japanese older adults. METHODS We draw upon 6-year follow-up data from the Japan Gerontological Evaluation Study, including 12 165 independent older adults aged 65 years or over. Occasions for laughter were assessed using a questionnaire, while dementia was diagnosed using the standardized dementia scale of the long-term care insurance system in Japan. Cox proportional hazards models were estimated, yielding hazard ratios and 95% confidence intervals (CIs). RESULTS The multivariable hazard ratio of dementia incidence for all participants in the groups for high versus low variety of occasions for laughter was 0.84 (95% CI: 0.72-0.98, P for trend <0.001). A greater variety of occasions for laughter was associated with a lower risk of dementia 0.78 (95% CI: 0.63-0.96, P for trend <0.001) among women, but was less pronounced for men, with significant associations only for the medium group. Laughing during conversations with friends, communicating with children or grandchildren, and listening to the radio were primarily associated with decreased risk. CONCLUSION A greater variety of laughter occasions in individual and social settings was associated with a reduced risk of dementia. Geriatr Gerontol Int 2022; 22: 392-398.
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Affiliation(s)
- Yu Wang
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kokoro Shirai
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tetsuya Ohira
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mayumi Hirosaki
- Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Kenji Takeuchi
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan.,Division of Regional Community Development, Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Chikae Yamaguchi
- Department of Community Health Nursing, Nagoya City University Graduate School of Nursing, Nagoya, Japan
| | - Yudai Tamada
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.,Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Dorina Cadar
- Department of Behavioural Science and Health, University College London, London, UK.,Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
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14
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Funakubo N, Eguchi E, Hayashi R, Hirosaki M, Shirai K, Okazaki K, Nakano H, Hayashi F, Omata J, Imano H, Iso H, Ohira T. Effects of a laughter program on body weight and mental health among Japanese people with metabolic syndrome risk factors: a randomized controlled trial. BMC Geriatr 2022; 22:361. [PMID: 35461239 PMCID: PMC9035242 DOI: 10.1186/s12877-022-03038-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 04/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background While there have been several intervention studies on the psychological effects of laughter, few have examined both the psychological and physical effects. This study investigates the effects of a laughter program on body weight, body mass index (BMI), subjective stress, depression, and health-related quality of life (HRQOL) among Japanese community-dwelling individuals using a randomized controlled trial with a waitlist. Methods Overall, 235 participants (37 men and 198 women) aged 43–79 years (mean 66.9, median 67.0) were randomized into laughter intervention and control groups (n = 117 and n = 118, respectively) to participate in a 12-week laughter program. Body weight, subjective stress, subjective well-being, and HRQOL were measured at the baseline, with a 12-week follow-up. The laughter program intervention’s effects on these factors were analyzed using an analysis of covariance adjusted by age, sex, risk factors, medication, and area. Furthermore, Pearson’s correlation and a general linear model analyzed the relationship between participants’ BMI and psychological index changes. Results The comprehensive laughter program significantly improved the mean body weight (p = 0.008), BMI (p = 0.006), subjective stress (p = 0.004), subjective well-being (p = 0.002), optimism (p = 0.03), and physical component summary (PCS) scores of HRQOL (p = 0.04). A similar tendency occurred for the mean changes in BMI and subjective stress score by area, sex, and age. Moreover, there was a significant and negative correlation between the change in BMI and PCS change (p = 0.04). Conclusion The comprehensive 12-week laughter intervention program, mainly comprising laughter yoga, significantly improved physical and psychological functions such as body weight, BMI, subjective stress, subjective well-being, and HRQOL among predominantly elderly Japanese community-dwelling individuals with metabolic syndrome risk factors. Moreover, PCS improved among participants who reduced BMI after the intervention. These results suggest that the laughter program may help reduce body weight in participants with metabolic syndrome risk factors by reducing stress and improving HRQOL and mental health factors, such as subjective well-being and optimism. Trial registration Registered with the University Hospital Medical Information Network Clinical Trials Registry UMIN-CTR000027145 on 27/04/2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03038-y.
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15
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Inoue A, Hiratsuka Y, Takesue A, Aida J, Kondo K, Murakami A. Association between visual status and the frequency of laughter in older Japanese individuals: the JAGES cross-sectional study. BMJ Open Ophthalmol 2022; 7:e000908. [PMID: 35415267 PMCID: PMC8948375 DOI: 10.1136/bmjophth-2021-000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 03/11/2022] [Indexed: 11/04/2022] Open
Abstract
Objective Although the beneficial effects of laughter are abundantly reported, the physical function that is required as a premise for laughter has not been studied. The aim of this study is to investigate the association between visual status and frequency of laughter in a population-based sample of older adults. Methods and analysis We analysed cross-sectional data of community-dwelling independent individuals aged ≥65 years (n=19 452) in Japan. The outcomes were frequency of laughter and number of opportunities to laugh. We used multivariable logistic regression analysis with multiple imputations to investigate the association between visual status and laughter. Results The number of participants who laughed almost every day was 8197 (42.1%). After adjusting for individual covariates in the multivariable logistic regression analysis with multiple imputations, visual status was found to be significantly associated with the frequency of laugher and the number of opportunities to laugh (p for trend <0.01). Compare to 'normal vision', while excellent/very good vision was associated with increased frequency and number of opportunities to laugh (ORs: 1.72 and 1.25, respectively), poor vision decreased the frequency and number of opportunities to laugh (ORs: 0.86 and 0.87, respectively). Conclusions There is a link between visual impairment and laughter, with poor vision having a negative impact while good vision has a positive effect. Improving vision may lead to laughter promotion.
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Affiliation(s)
- Akira Inoue
- Department of Ophthalmology, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yoshimune Hiratsuka
- Department of Ophthalmology, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Atsuhide Takesue
- Department of Ophthalmology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Bunkyo-ku, Tokyo, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan,Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu-city, Aichi, Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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16
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Does laughing with others lower the risk of functional disability among older Japanese adults? The JAGES prospective cohort study. Prev Med 2022; 155:106945. [PMID: 34973283 DOI: 10.1016/j.ypmed.2021.106945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/26/2021] [Accepted: 12/25/2021] [Indexed: 11/22/2022]
Abstract
While laughter is evoked mainly in social contexts, the potential link between laughter in daily life and health benefits is unclear. This study aimed to examine the association between laughter in daily life and the onset of functional disability among older adults in Japan. Data were obtained from a 6-year follow-up cohort of 12,571 participants (46.1% male) in the Japan Gerontological Evaluation Study, aged ≥65 years, who could independently perform daily activities. We evaluated their laughter in daily life from three perspectives: the types of situations in which people laugh, the number of situations in which people laugh with others, and the persons with whom people laugh. Using the Cox proportional hazards model, the risk of functional disability was estimated. A total of 1420 functional disabilities were observed during follow-up. After adjusting for potential confounders, participants who laughed with others (e.g., during conversations with friends) were at a reduced risk of functional disability (hazard ratio, 0.77; 95% confidence interval, 0.65-0.92) than those who laughed alone (e.g., during watching television). Similarly, the number of situations to laugh with others was inversely associated with the risk of functional disability (Ptrend < 0.001). Laughing in a conversation with friends reduced the risk of functional disability by approximately 30% compared to laughing alone. Overall, laughing with others was associated with a reduced risk of functional disability. Having more situations to laugh with others or at least the situation to laugh with friends might contribute to reducing the risk of functional disability later in life.
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17
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Chen JJ, Liu LF, Lin CI, Lin HC. Multidimensional Determinants of Well-Being Among Community-Dwelling Older Adults During the Early Stage of the COVID-19 Pandemic in Taiwan. Gerontol Geriatr Med 2022; 8:23337214221111227. [PMID: 35898611 PMCID: PMC9309775 DOI: 10.1177/23337214221111227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/23/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Due to the insufficient and inadequate policies on the psychological well-being of the aged population, we aimed to examine the multidimensional determinants of well-being during the early stage of the COVID-19 pandemic. Method: Data were collected from face-to-face interviews with1,232 participants aged 50 and older living in Southern Taiwan. We used multivariate logistic regression to examine the associations between demographics, the physical health, mental health, social ties domains, and well-being. Results: We found that (i) in physical health, no dental problems and exercise were related to better well-being; (ii) in mental health, stress and depression decreased well-being, but laughing every day, and a positive attitude toward aging had adverse effects; and (iii) in social ties, subjective social status, family support, and place attachment to the community were positively associated with well-being. Discussion: Our findings highlight the multidimensional needs at the individual and community levels for the Chinese population.
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18
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Laughter therapy: A humor-induced hormonal intervention to reduce stress and anxiety. Curr Res Physiol 2021; 4:135-138. [PMID: 34642668 PMCID: PMC8496883 DOI: 10.1016/j.crphys.2021.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 12/20/2022] Open
Abstract
Prolonged pharmacological interventions have detrimental health consequences by developing drug tolerance or drug resistance, in addition to adverse drug events. The ongoing COVID-19 pandemic-related stress has adversely affected the emotional and mental health aspects around the globe. Consequently, depression is growing during the COVID-19 pandemic. Besides specific pharmacological interventions, which if prolonged have detrimental health consequences, non-pharmacological interventions are needed to minimize the emotional burden related to the COVID-19 pandemic. Laughter therapy is a universal non-pharmacologic approach to reduce stress and anxiety. Therapeutic laughter is a non-invasive, cost-effective, and easily implementable intervention that can be used during this pandemic as a useful supplementary therapy to reduce the mental health burden. Laughter therapy can physiologically lessen the pro-stress factors and increase the mood-elevating anti-stress factors to reduce anxiety and depression. In this ongoing stressful period of the COVID-19 pandemic, keeping necessary social distancing, it is important to create a cheerful environment that will facilitate laughter among the family, neighbor, and community to cope with the stresses of the COVID-19 pandemic. Prolonged pharmacological interventions have detrimental health consequences. Laughter therapy is a universal non-pharmacologic approach to reduce stress and anxiety. Therapeutic laughter is a non-invasive, cost-effective, and easily implementable intervention. Laughter therapy can be used during COVID-19 pandemic as a useful supplementary therapy to reduce the mental health burden.
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Takashima N, Nakamura Y, Miyagawa N, Kadota A, Tanaka-Mizuno S, Matsui K, Miura K, Ueshima H, Kita Y. Association between Stress-Coping Strategy and Functional Disability in the General Older Adult Population: The Takashima Study. Gerontology 2021; 68:699-706. [PMID: 34592746 DOI: 10.1159/000519194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Both physical and psychological factors have been associated with functional disability. However, the associations between stress-coping strategies and future functional disability remain unclear. METHODS We analyzed 2,924 participants who did not have incidence of functional disability or death within the first 3 years of the baseline survey and were aged 65 years or more at the end of follow-up. Stress-coping strategies were assessed via a self-administered questionnaire (emotional expression, emotional support seeking, positive thought, problem-solving, and disengagement) in a baseline survey from 2006 to 2014. Levels of coping strategies were classified as low, middle, and high based of frequency. Functional disability decline was followed up using the long-term-care insurance program until November 1, 2019. Functional disability decline was defined as a new long-term-care insurance program certification. Cox proportional hazards model with competing risk analysis for death was used to evaluate associations between coping strategy levels and functional disability. RESULTS During the follow-up period, we observed 341 cases of functional disability and 73 deaths without previous incidence of functional disability. A significant inverse association between "positive thought" and "problem-solving" and future functional disability was observed. Multivariable adjusted hazard ratios (95% confidence interval) for functional disability were 0.68 (0.51-0.92) for high levels of "positive thought" and 0.73 (0.55-0.95) for high levels of "problem-solving," compared with low levels of the coping strategies. The inverse association was stronger in men. CONCLUSIONS Some subcomponents of stress-coping strategies might be associated with future incidence of functional disability among older adults.
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Affiliation(s)
- Naoyuki Takashima
- Department of Public Health, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.,Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Yasuyuki Nakamura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Yamashina Racto Clinic and Medical Examination Center, Kyoto, Japan
| | - Naoko Miyagawa
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Department of Preventive Medicine and Public Health, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Sachiko Tanaka-Mizuno
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Matsui
- Center for Public Health Sciences, National Cancer Center Japan, Chuo-ku, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Yoshikuni Kita
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Faculty of Nursing Science, Tsuruga Nursing University, Tsuruga, Japan
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Ishii M, Nakagawa K, Yoshimi K, Okumura T, Hasegawa S, Yamaguchi K, Nakane A, Tamai T, Nagasawa Y, Yoshizawa A, Tohara H. Higher Activity and Quality of Life Correlates with Swallowing Function in Older Adults with Low Activities of Daily Living. Gerontology 2021; 68:673-681. [PMID: 34818215 DOI: 10.1159/000518495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/14/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The aim of this study was to clarify the relationship among swallowing function, activity, and quality of life (QOL) in older adults with low activities of daily living (ADL). MATERIALS AND METHODS We conducted a cross-sectional study. In total, 271 Japanese adults aged over 65 years who underwent medical intervention at their residence (male: n = 107; female: n = 164; mean age = 84.6 ± 8.3 years) participated. We collected data regarding age, sex, body mass index (BMI), residence (their house/nursing home), activity status, consciousness level (eye response), history of aspiration pneumonia, other medical history, number of medication types, frequency of going out, and time spent away from bed. We judged consciousness level (eye response) using the Glasgow Coma Scale (GCS), calculated the Charlson comorbidity index, measured QOL using the short version of the Quality of Life Questionnaire for Dementia (short QOL-D), and assessed swallowing function using the Functional Oral Intake Scale (FOIS). To examine the relationship between scores for the FOIS and the other variables, we used the Spearman rank correlation coefficient and ordinal logistic regression analysis. RESULTS The FOIS was strongly correlated with BMI (ρ = 0.47), activity status (ρ = -0.60), GCS (ρ = -0.41), time spent away from bed (ρ = 0.56), scores for the short QOL-D (ρ = 0.40), weakly correlated with history of aspiration pneumonia (ρ = -0.27), and frequency of going out (ρ = 0.39). Results for the ordinal logistic regression analysis showed that the FOIS was associated with activity status, frequency of going out, time spent away from bed, and scores for the short QOL-D. CONCLUSION The swallowing function of older adults with low ADL was related to their QOL and activities, such as time spent away from bed and home. Thus, in rehabilitation programs for swallowing function in older adults, not only functional but also psychological approaches may prove effective.
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Affiliation(s)
- Miki Ishii
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kazuharu Nakagawa
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kanako Yoshimi
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takuma Okumura
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shohei Hasegawa
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kohei Yamaguchi
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Ayako Nakane
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tomoe Tamai
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yuki Nagasawa
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Akira Yoshizawa
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Haruka Tohara
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Hirosaki M, Ohira T, Shirai K, Kondo N, Aida J, Yamamoto T, Takeuchi K, Kondo K. Association between frequency of laughter and oral health among community-dwelling older adults: a population-based cross-sectional study in Japan. Qual Life Res 2021; 30:1561-1569. [PMID: 33432445 DOI: 10.1007/s11136-020-02752-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Oral health has been reported to have an impact on the activities of daily life such as chewing, eating, and laughing, while psychological factors such as depression and loneliness have been reported to affect oral health. Little is known, however, about the association between laughter and oral health in older adults. This study examined the bidirectional association between the frequency of daily laughter and oral health in community-dwelling older Japanese adults. METHODS Our cross-sectional study employed data from the 2013 Japan Gerontological Evaluation Study's self-reported survey, which included 11,239 male and 12,799 female community-dwelling independent individuals aged 65 years or older. We defined the oral health status by the number of remaining teeth. The association between the self-reported frequency of laughter (almost every day, 1-5 days per week, 1-3 days per month, or almost never) and oral health was examined using logistic regression analysis. RESULTS The participants with 10 or more teeth were significantly more likely to laugh compared with the edentulous participants, after adjusting for all covariates. Compared with those who almost never laughed, those who laughed 1-5 days per week were significantly less likely to be edentulous. After stratifying by sex, similar results were found only in the men for both analyses. CONCLUSION There was a significant bidirectional association between frequency of laughter and oral health that was independent of socioeconomic and lifestyle factors among older adults.
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Affiliation(s)
- Mayumi Hirosaki
- Department of Epidemiology, School of Medicine, Fukushima Medical University, Fukushima, Japan. .,Center for Southeast Asian Studies, Kyoto University, Kyoto, Japan.
| | - Tetsuya Ohira
- Department of Epidemiology, School of Medicine, Fukushima Medical University, Fukushima, Japan.,Department of Public Health, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kokoro Shirai
- Department of Public Health, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Naoki Kondo
- School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Division for Regional Community Development, Liaison Center for Innovative Dentistry, Graduate School of Dentistry, Tohoku University, Miyagi, Japan
| | - Tatsuo Yamamoto
- Department of Disaster Medicine and Dental Sociology, Graduate School of Dentistry, Kanagawa Dental University, Kanagawa, Japan
| | - Kenji Takeuchi
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.,Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
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