Published papers

【背景】国民の身体活動実践を支援するツールとして，厚生労働省が2013年に策定した「健康づくりのための身体活動指針(アクティブガイド)」(現指針)があり，現在は新指針へ改訂作業中である．これらの指針の認知し，理解することは，身体活動の信念や行動意図を介して身体活動の促進に寄与できる可能性がある．ただしこの仮説は横断的検討に留まり，因果関係が明確でない．本研究では，指針の提示が知識，信念，行動意図，身体活動量に及ぼす影響を検証した．【方法】社会調査会社の登録モニターを無作為抽出し，適格基 準(20歳～64歳の男女，現指針の認知がなく身体活動制限のな い者)を満たす1333名を対象とした．介入前(T1)調査では，指針の知識，身体活動の信念，行動意図，身体活動量，ヘルスリテラシー，個人属性をオンライン上で調査した．その後，現指針提示群，新指針案提示群(厚労科研研究班案)，食事バランスガイド提示群(対照群)に無作為割付し，提示資料の熟読を求めた．介入直後(T2)と1週間後(T3)調査では，知識，信念，行動意図をオンライン上で再調査し，T3時点は身体活動量も調査した．統計解析は，知識，信念，行動意図，身体活動量をアウトカムとし，提示群，時点，提示群×時点の交互作用項，ならびに調整変数に個人属性を投入した線形混合モデルを実施した．さらに指針の提示が知識の変容を媒介して，信念，行動意図，身体活動量の変容に影響を及ぼすか共分散構造分析で検討した．【結果】現指針提示群は対照群よりT2時点の知識と行動意図， T3時点の知識と余暇身体活動時間が有意に高かった．加えて知識の変容は，信念，行動意図，身体活動の変容をもたらしたが，知識，信念の変容に及ぼす影響は，ヘルスリテラシーが低い群 で顕著であった．一方，新指針案提示群は対照群よりT2時点の知識が有意に高かったが，知識の変容と信念，行動意図，身体活動の変容との関係は明確でなかった．【結論】現指針の提示は，知識，信念，行動意図の変容を介し て身体活動の促進に寄与できる可能性がある．ただしヘルスリテラシーが知識，信念の変容に修飾作用を及ぼす可能性があり，指針を活用した身体活動介入ではこの点に留意が必要かもしれない．一方で新指針案の提示は，介入直後の知識の向上に寄与するに留まった．本研究で用いた新指針案は最終版ではないため，さらなる改良を経て行動変容の促進に寄与できる指針となることが期待される．【倫理的配慮】本研究は，神戸大学大学院人間発達環境学研究科倫理審査委員会の承認を得て実施した (承認番号：709)．インターネットによるアンケート調査の最初のページ (Web 画面)で，本研究の説明した画面を提示し，内容を十分理解した上で研究参加に同意が得られる場合のみ，次ページ以降のアンケート画面に進むよう教示した．

[目的]日本の中悪性度成人非ホジキンリンパ腫(NHL)サバイバーの身体活動量(PA)と健康関連QOL(HRQOL)との関連性を明らかにすることを目的とした。[対象と方法]都内1大学病院通院中のNHL患者(診断後6ヵ月-8年の者)100名(年齢中央値65.0歳)とした。自己記入式質問紙法により得られるPAとHRQOLの関連を重回帰分析にて解析した。[結果]PAは多いほど身体面のHRQOLも有意に高くなるが、精神面のHRQOLに対する寄与は示されなかった。[結語]身体活動の取組みのHRQOL促進に対する有用性が示唆される。(著者抄録)

To date, there has been no comprehensive study on the relationship of stress response, coping and lifestyle (e.g., diet, exercise habits, and sleeping habits) with premenstrual syndrome (PMS) for female athletes. This study aimed to examine this relationship. We used a web questionnaire to acquire the required data from Japanese female university athletes. Based on structural equation modeling, we used the PMS score as an outcome and examined its relationship to stress response, emotion-focused coping, dietary intake, amount of exercise in club activities surveyed by club unit, and sleeping time. Our study included 257 subjects (average age, 20 years). The results showed that the stress response was a direct factor in the PMS score (standardized coefficient:.63). Emotion-focused coping and dietary intake were associated with PMS scores through stress response (-.26 and -.27, respectively). Emotion-focused coping was also associated with the dietary intake (.19). Factors associated with emotion-focused coping were amount of exercise (.22) and sleeping time (.27). The amount of exercise was associated with sleeping time (-.26). These results suggest that avoiding stressors, enhancing emotion-focused coping, reducing the stress response by maintaining a balanced and sufficient diet, performing an appropriate amount of exercise, and improving sleep habits may be effective in managing PMS.

The purpose of this study was to examine the mental health effects of Tai chi on regular practitioners by investigating the relationships between flow experience, IKIGAI (Japanese: "Life worth living"), and sense of coherence. The results indicated that flow experience may influence IKIGAI and IKIGAI may influence sense of coherence; this suggests that IKIGAI may act as an intermediary between flow experience and sense of coherence. The results also indicated that the longer the Tai chi experience, the higher was the flow experience.

This cross-sectional study investigated the associations of business type with the prevalence of metabolic syndrome (MetS) and lifestyle characteristics among workers in small- and medium-sized enterprises. In total, data from 167,736 workers (114,746 men and 52,990 women) who participated in health checkups in 2013 were analyzed using multilevel logistic regression models. The odds ratios (ORs) of having MetS, defined based on the criteria of the joint interim statement, were significantly higher in employees of transportation businesses (reference OR =1) than in other business types among men (OR: 0.67-0.85) and similar result was observed among women (OR: 0.70-0.88). The prevalence of a smoking habit was significantly higher in transportation workers than in employees of other businesses for both men and women. Furthermore, male transportation workers were more likely to skip breakfast, engage in <1 h/day of walking, walk at a slower speed, and eat dinner just before going to bed. Female transportation workers were more likely to have gained 10 kg since the age of 20 years. In conclusion, the prevalence of MetS was higher in transportation workers than in workers from other businesses; the associated risk factors may also vary by sex. To effectively promote public health, the labor environment, such as the business type, should be considered.

Background: Extracellular vesicles (EV) released from neurons into the blood can reflect the state of nervous tissue. Measurement of neuron derived EV (NDE) may serve as an indicator of brain injury. Methods: A sandwich immunoassay was established to measure plasma NDE using anti-neuron CD171 and anti-EV CD9 ([CD171 + CD9+]). Plasma samples were obtained from commercial sources, cross-country (n = 9), football (n = 22), soccer (n = 19), and rugby (n = 18) athletes over time. Plasma was also collected from patients undergoing total aortic arch replacement (TAR) with selective cerebral perfusion during cardiopulmonary bypass before and after surgery (n = 36). Results: The specificity, linearity, and reproducibility of NDE assay (measurement of [CD171 + CD9+]) were confirmed. By scanning electron microscopy and nanoparticle tracking, spherical vesicles ranging in size from 150 to 300 nm were confirmed. Plasma levels of NDE were widely spread over 2 to 3 logs in different individuals with a significant age-dependent decrease. However, NDE were very stable in each individual within a ± 50% change over time (cross-country, football, soccer), whereas rugby players were more variable over 4 years. In patients undergoing TAR, NDE increased rapidly in days post-surgery and were significantly (P =.0004) higher in those developing postoperative delirium (POD) (n = 13) than non-delirium patients (n = 23). Conclusions: The blood test to determine plasma levels of NDE was established by a sandwich immunoassay using 2 antibodies against neuron (CD171) and exosomes (CD9). NDE levels varied widely in different individuals and decreased with age, indicating that NDE levels should be considered as a normalizer of NDE biomarker studies. However, NDE levels were stable over time in each individual, and increased rapidly after TAR with greater increases associated with patients developing POD. This assay may serve as a surrogate for evaluating and monitoring brain injuries.

全国の運動施設における運動開始前の健康チェック、特に運動負荷試験の実施や利用者の健康リスクの層別化の実態を把握し、各施設での運動中における主要心血管イベント(MACE)発生の経験とその関連性について検討した。全国の運動を提供している団体等にアンケート調査を依頼し、有効回答494件を分析した。健康リスクの層別化をしている運動施設のMACE発生の経験は17/139施設(12.2%)、層別化をしていない運動施設では41/355施設(11.5%)であった。運動負荷試験の実施率は全体で7.3%であったが、医療母体の運動施設では29.6%と高かった。運動開始前の情報確認や健康チェック等のリスク管理を行っている施設はハイリスク者の利用が予想されるが、リスク層別化をしていない施設はMACE等の有害事象の促進因子になり、一方でリスク層別化をしている施設では、施設基準の取得が抑制因子になり得る可能性が示された。