Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic systemic inflammation causing progressive joint damage that can lead to lifelong disability. The pathogenesis of RA ...involves a complex network of various cytokines and cells that trigger synovial cell proliferation and cause damage to both cartilage and bone. Involvement of the cytokines tumor necrosis factor (TNF)-α and interleukin (IL)-6 is central to the pathogenesis of RA, but recent research has revealed that other cytokines such as IL-7, IL-17, IL-21, IL-23, granulocyte macrophage colony-stimulating factor (GM-CSF), IL-1β, IL-18, IL-33, and IL-2 also play a role. Clarification of RA pathology has led to the development of therapeutic agents such as biological disease-modifying anti-rheumatic drugs (DMARDs) and Janus kinase (JAK) inhibitors, and further details of the immunological background to RA are emerging. This review covers existing knowledge regarding the roles of cytokines, related immune cells and the immune system in RA, manipulation of which may offer the potential for even safer and more effective treatments in the future.
We examined the associations of informal (eg, family members and friends) and formal (eg, physician and visiting nurses) social support with caregiver's burden in long-term care and the relationship ...between the number of available sources of social support and caregiver burden.
We conducted a mail-in survey in 2003 and used data of 2998 main caregivers of frail older adults in Aichi, Japan. We used a validated scale to assess caregiver burden.
Multiple linear regression demonstrated that, after controlling for caregivers' sociodemographic and other characteristics, informal social support was significantly associated with lower caregiver burden (β = -1.59, P < 0.0001), while formal support was not (β = -0.30, P = 0.39). Evaluating the associations by specific sources of social support, informal social supports from the caregiver's family living together (β = -0.71, P < 0.0001) and from relatives (β = -0.61, P = 0.001) were associated with lower caregiver burden, whereas formal social support was associated with lower caregiver burden only if it was from family physicians (β = -0.56, P = 0.001). Compared to caregivers without informal support, those who had one support (β = -1.62, P < 0.0001) and two or more supports (β = -1.55, P < 0.0001) had significantly lower burden. This association was not observed for formal support.
Social support from intimate social relationships may positively affect caregivers' psychological wellbeing independent of the receipt of formal social support, resulting in less burden.
Growing socioeconomic disparity is a global concern, as it could affect population health. The author and colleagues have investigated the health impacts of socioeconomic disparities as well as the ...pathways that underlie those disparities. Our meta-analysis found that a large population has risks of mortality and poor self-rated health that are attributable to income inequality. The study results also suggested the existence of threshold effects (ie, a threshold of income inequality over which the adverse impacts on health increase), period effects (ie, the potential for larger impacts in later years, specifically after the 1990s), and lag effects between income inequality and health outcomes. Our other studies using Japanese national representative survey data and a large-scale cohort study of Japanese older adults (AGES cohort) support the relative deprivation hypothesis, namely, that invidious social comparisons arising from relative deprivation in an unequal society adversely affect health. A study with a natural experiment design found that the socioeconomic gradient in self-rated health might actually have become shallower after the 1997-98 economic crisis in Japan, due to smaller health improvements among middle-class white-collar workers and middle/upper-income workers. In conclusion, income inequality might have adverse impacts on individual health, and psychosocial stress due to relative deprivation may partially explain those impacts. Any study of the effects of macroeconomic fluctuations on health disparities should also consider multiple potential pathways, including expanding income inequality, changes in the labor market, and erosion of social capital. Further studies are needed to attain a better understanding of the social determinants of health in a rapidly changing society.
Background: There is little longitudinal evidence on the impact of specific living arrangements (ie, who individuals live with) on mental health among older adults, and no studies have examined the ...modifying effect of residential social cohesion level on this association. We aimed to examine the association between living arrangements and depressive symptoms and whether this association varies with residential neighborhood social cohesion level among 19,656 men and 22,513 women aged 65 years and older in Japan. Methods: We analyzed the association between baseline living arrangements in 2010 and depressive symptoms in 2013. We calculated gender-specific odds ratios (ORs) of living arrangements for depressive symptoms using a logistic regression and conducted subgroup analyses by neighborhood social cohesion level. Results: Among men (but not women), living alone (OR 1.43; 95% confidence intervals CI, 1.18–1.73) and living with spouse and parent (OR 1.47, 95% CI, 1.09–1.98) were associated with increased odds of depressive symptoms compared with living with a spouse only. Living with spouse and child was a risk for men in the young age group but a protective factor for women. We also identified that the negative impact of living arrangements on depressive symptoms was attenuated in neighborhoods with higher levels of social cohesion. Conclusions: Living arrangements are associated with risk of depressive symptoms among men and women; these associations differ by gender and neighborhood social cohesion level. Our results suggest the need to pay more attention to whether individuals live alone, as well as who individuals live with, to prevent depressive symptoms among older adults.
Recent evidence has suggested that in Japan, professionals and managers have a higher risk of poor health than other workers (e.g., clerks and manual laborers), and this effect may be stronger among ...women than men. Low organizational justice, which is known to be a potential risk factor for poor health among employees, may explain the gender-specific association.
We examined the associations between perceived organizational justice and psychological distress and stress-related behaviors (smoking and heavy drinking) in 2,216 female and 7,557 male employees aged 18 to 69 years from the Japanese Study of Health, Occupation, and Psychosocial Factors Related Equity. We measured both procedural and interactional justice, and compared managers and professionals with other employees.
After adjusting for demographic characteristics and occupational stress, low levels of perceived procedural and interactional justice were found to be associated with a high prevalence of psychological distress for both women and men, regardless of occupational status. Among female managers and professionals, perceived interactional justice (measured as the levels of supports by supervisors, etc.) was significantly associated with smoking, whereas no such association was observed among other workers. When interactional justice was perceived to be low, the prevalence of smoking was 6.5 percentage points higher among managers and professionals than among others. Neither procedural nor interactional justice was associated with risk of heavy drinking.
Female managers and professionals in a workplace with unsupportive supervisors may be more likely to engage in unhealthy coping behaviors to manage their stress. Creating supportive workplaces may be beneficial in increasing workers' health, especially for female managers and professionals.
Population ageing and stringent licensing policies will increase the number of older drivers who stop driving. Adverse health outcomes owing to driving cessation and their prevention are emerging ...concerns. Therefore, we longitudinally examined the impact of driving cessation and alternative transportation use after cessation on the risk of functional limitations in a cohort of community-dwelling people (65 years and older) in Japan.
Using cohort data of those who drove as of 2006/07, we compared the risk of functional limitations between 2,704 current drivers and 140 former drivers (who stopped driving by 2010). Of the former drivers, 77 did not use public transportation or bicycles after driving cessation (thus losing independent mobility). We calculated the hazard ratios (HRs) for the incidence of functional limitations with 95% confidence intervals (CIs) based on the Cox proportional hazards model with the covariates influencing the functional limitations.
From 2010 through 2016, 645 people had functional limitations, which included 38, 82, and 119 per 1,000 person-years among current drivers, former drivers who used public transportation or bicycles, and former drivers who were only driven by others, respectively (HR 1.69; 95% CI, 1.15-2.49 and HR 2.16; 95% CI, 1.51-3.10, relative to current drivers).
Driving cessation is associated with an increased risk of functional limitations among older adults, but this risk might be alleviated if they are able to maintain independent mobility using public transportation or bicycles after driving cessation.
This study aimed to examine the contextual effects of community-level social capital on the onset of depressive symptoms using a longitudinal study design.
We used questionnaire data from the 2010 ...and 2013 waves of the Japan Gerontological Evaluation Study that included 14,465 men and 14,600 women aged over 65 years from 295 communities. We also used data of a three-wave panel (2006-2010-2013) to test the robustness of the findings (n = 7,424). Using sex-stratified multilevel logistic regression, we investigated the lagged associations between three scales of baseline community social capital and the development of depressive symptoms.
Community civic participation was inversely associated with the onset of depressive symptoms (men: adjusted odds ratio AOR 0.93; 95% confidence interval CI, 0.88-0.99 and women: AOR 0.94; 95% CI, 0.88-0.997 per 1 standard deviation unit change in the score), while no such association was found in relation to the other two scales on social cohesion and reciprocity. This association was attenuated by the adjustment of individual responses to the civic participation component. Individual-level scores corresponding to all three community social capital components were significantly associated with lower risks for depressive symptoms. The results using the three-wave data set showed statistically less clear but similar associations.
Promoting environment and services enhancing to community group participation might help mitigate the impact of late-life depression in an aging society.
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•In Japan, the carbon footprint of health care accounted for 4.6% of total national emissions in 2011.•By 2015, the annual carbon footprint had increased to 72.0 MtCO2e owing to the ...growth of medical expenditures.•The carbon footprint per patient with or without hospitalization was 12 and 2.1 tCO2e/y, respectively.•Avoiding generation of unused medicines can potentially reduce emissions by 1.24 MtCO2e/y.•To safeguard planetary health, more options for health promotion and carbon emission mitigation need to be provided.
The carbon footprint of Japanese health care services, i.e. the domestic greenhouse gas (GHG) emissions caused by health care expenditures, including the associated fixed capital, were calculated using input-output analysis. In 2011 the total carbon footprint of these services was 62.5 × 106 metric tons of CO2 equivalent (MtCO2e), which is 4.6% of total domestic GHG emissions. Medical services involving hospitalization accounted for the greatest share, at 15.7 MtCO2e. The second highest category, Medical services without hospitalization, accounted for only slightly less: 14.2 MtCO2e. However, the difference in emissions per patient between these two categories was considerable. On average, emissions per patient for Medical services (hospitalization) were 12 tCO2e/patient, whereas for Medical services (non-hospitalization) they were only 2.1 tCO2e/patient, or 5.4 times less. In terms of type of medical condition, the greatest annual emissions were associated with cardiovascular disease (6.2 MtCO2e) and neoplasm (4.0 MtCO2e). In terms of age, emissions attributed to patients aged 65 and over accounted for more than half of total health care emissions. By 2015, the total carbon footprint had increased to 72.0 MtCO2e, a rise of over 15% in four years. Although medical care and pharmaceuticals are the main factors responsible for this increase, emissions associated with nursing services have also risen, suggesting that demographic aging may be having a significant impact on GHG emissions. As a countermeasure, the potential annual GHG mitigation achievable through avoidance of unused prescribed medicines resulting in waste was estimated at 1.24 MtCO2e, comparable with the total carbon footprint of home medicines. To safeguard planetary health, in addition to implementing technological improvements to the supply chains of health care services, it will be necessary to provide citizens further options for achieving health promotion and GHG mitigation simultaneously.
Abstract The impact of social participation on older adults
'
health may differ by individual socioeconomic status (SES). Consequently, we examined SES effect modification on the associations between ...types of social activity participation and incident functional disability. Cohort data from the 2003 Japan Gerontological Evaluation Study (
J
AGES
) was utilized. This included individuals who were aged 65 or older and functionally independent at baseline. Analysis was carried out on 12,991 respondents after acquisition of information about their long-term care (LTC) status in Japan. Incident functional disability was defined based on medical certification and LTC information was obtained from municipal insurance databases. Cox proportional hazard regression was conducted for analysis. Results indicated that participants in a sport (hazard ratio HR: 0.66; 95% confidence interval CI: 0.51,
0.85) or hobby group (HR: 0.69; 95% CI: 0.55,
0.87), or who had a group facilitator role (HR: 0.82; 95% CI: 0.66,
1.02) were less likely to be disabled. While men with 13 or more years of education were less likely to become disabled if they held facilitator roles, this association was weak among men with 0–5 years of education (HR of interaction term between 0
and
5 years of education and facilitator role dummy variable = 3.95; 95% CI: 1.30,
12.05). In conclusion, the association between group participation and smaller risk of the functional disability was stronger among highly educated older adults. Intervention programs promoting social participation should consider participants
'
socioeconomic backgrounds.
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