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Background: Food access is an important aspect of health promotion for the elderly. The aim of this study was to investigate the relationship between distance to the nearest food store and diet variety in rural community-dwelling elderly Japanese.Methods: This cross-sectional study analyzed data from 1,103 elderly participants surveyed by mail in rural areas of Japan. Diversity of food intake was assessed using the diet variety score (DVS). Street network distance from home to food store was calculated and categorized by quartile using a geographic information system and analyzed in relation to diet using multivariable regression with the primary outcome as low DVS. Sub-analysis of the association with DVS was conducted for each food store category (convenience store, supermarket, and small food store). The association between intake frequency of each food group and distance was also analyzed.Results: Participants in the fourth quartile of distance to food store had significantly higher prevalence ratio (1.15; 95% CI, 1.01–1.32) for low DVS than those in the first quartile. There was a significant tendency between greater distance to food store and lower DVS (P for trend = 0.033). Supermarkets and convenience stores, in particular, showed significant associations. Greater distance was significantly associated with lower frequency of meat and fruit intake.Conclusion: There was significant association between distance to nearest food store and diet variety in rural Japanese elderly. These findings suggest the importance of interventions for areas at high risk of low diet variety, such as places far away from food stores.

Background Appropriate help-seeking behavior (HSB) that involves lay and professional care may moderate the usage of medical resources and promote good health, especially among the rural elderly. However, there is little evidence regarding the rural elderly’s HSB choices for mild symptoms. Therefore, this study attempts to bridge this gap. Methods The participants were patients living in rural areas and over the age of 65, who attended Japanese clinics and general hospitals. In Phase 1, monthly diaries and one-on-one interviews about their mild symptoms and HSB were used to establish HSB items and assess its content validity. Content analysis helped determine the items. In Phase 2, participants were asked to complete the list to measure HSB. The answers to the list and HSB mentioned in the diaries were compared to evaluate concurrent validity. Retests were conducted to examine the content’s reliability and test-retest reliability. Results Phase 1 included 267 participants (average age = 75.1 years, standard deviation [SD] = 4.3; 50.1% male). The diary collection rate was 97.6%. Of the participants, 70.4% used lay care and 25.4% used professional care. Content analysis identified eight types of lay care and four types of professional care. Phase 2 included 315 participants (average age = 77.7 years, SD = 8.27; 46.0% male). In terms of validity, the results of the list and the diaries were correlated (Spearman r 0.704; p  < 0.001). The most common behavior with mild symptoms was consulting with primary care physicians, followed by self-care and using home medicine. The test-retest reliability for mild symptoms found kappa values of 0.836 for lay care and 0.808 for professional care. Conclusions The choices of HSB for mild symptoms clarified identified in this study have high validity and reliability. Therefore, it can be used to assess the relationships between HSB and health conditions and the effectiveness of health promotion on rural older people’s HSB.

Background: The Foods with Function Claim was introduced in Japan in April 2015 to make more products available that are labeled with health functions. A product’s functionality of function claims must be explained by the scientific evidence presented in clinical trials (CTs) or systematic reviews, but the quality of recent CTs is unclear. The purpose of this study was to evaluate the risk of bias (RoB) using “a revised tool to assess risk (RoB 2)” published in 2018 for notifications based on all recent CTs published on the Consumer Affairs Agency website. Methods: A total of 38 submitted papers based on CTs that were published on the Consumer Affairs Agency website during the period from 1 January 2023 to 30 June 2024 were eligible. The RoB 2 tool provides a framework for considering the risk of bias in the findings of any type of randomized trial. This tool with five domains was used to evaluate the quality of research methods. Results: Eligible CTs were assessed as “low risk” (11%, n = 4), “medium risk” (13%, n = 5), and “high risk” (76%, n = 29). A number of highly biased papers were published. Bias occurred in all five domains, especially “bias in selection of the reported result (Domain 5)”, which was the most serious (“high risk”; 75%). For elements correlated with RoB, there was no significant difference (p = 0.785) in the RoB 2 score between for-profit and academic research in the author’s affiliated organization. There was no significant difference (p = 0.498) in the RoB score between the published year categories of 2000–2019 and 2020–2024, and no significant difference (p = 0.643) in the RoB score between English and Japanese language publications. Conclusion: Overall, the quality of the latest CTs submitted after 2023 was very low, occurring in all five domains, and was most serious for “bias in selection of the reported result (Domain 5)”.

Background: Although moderate-to-vigorous physical activity (MVPA) has multiple health benefits, current participation in recommended MVPA level and its determinants among Japanese children and adolescents remain unclear. Therefore, this cross-sectional study investigated the prevalence of meeting recommended MVPA level and its correlates among Japanese children and adolescents. Methods: Using the Japanese version of the World Health Organization (WHO) Health Behaviour in School-aged Children survey questionnaire, we confirmed the prevalence of meeting recommended MVPA level in all primary schools (PS) and junior high schools (JHS) in Unnan City, Japan. We evaluated its association with school grade, gender, body weight status, screen time, consumption of breakfast, physical activity (PA) preference, and population density using Poisson regression. Results: We found that 20.1% of the 1,794 students (9–15 years old) met the WHO recommendation. Meeting recommended MVPA level was significantly associated with being in the sixth grade of PS (prevalence ratio [PR] 0.57; 95% confidence interval [CI], 0.39–0.84) and first (PR 1.52; 95% CI, 1.16–1.99), second (PR 1.45; 95% CI, 1.10–1.90), and third grade of JHS (PR 0.40; 95% CI, 0.26–0.62) (vs fourth grade of PS); being a boy (PR 1.33; 95% CI, 1.12–1.59) (vs girl); liking PA (PR 3.72; 95% CI, 2.22–6.22) (vs dislike); and belonging to a medium-population-density (PR 0.73; 95% CI, 0.61–0.88) or low-population-density area (PR 0.67; 95% CI, 0.48–0.94) (vs high-population-density area). Conclusions: About 20% of Japanese children and adolescents engaged in the recommended MVPA level. MVPA was associated with grade, gender, preference for PA, and population density.

The objectives of this review were to summarize the evidence from randomized controlled trials (RCTs) on the effects of animal-assisted therapy (AAT). Studies were eligible if they were RCTs. Studies included one treatment group in which AAT was applied. We searched the following databases from 1990 up to October 31, 2012: MEDLINE via PubMed, CINAHL, Web of Science, Ichushi Web, GHL, WPRIM, and PsycINFO. We also searched all Cochrane Database up to October 31, 2012. Eleven RCTs were identified, and seven studies were about “Mental and behavioral disorders”. Types of animal intervention were dog, cat, dolphin, bird, cow, rabbit, ferret, and guinea pig. The RCTs conducted have been of relatively low quality. We could not perform meta-analysis because of heterogeneity. In a study environment limited to the people who like animals, AAT may be an effective treatment for mental and behavioral disorders such as depression, schizophrenia, and alcohol/drug addictions, and is based on a holistic approach through interaction with animals in nature. To most effectively assess the potential benefits for AAT, it will be important for further research to utilize and describe (1) RCT methodology when appropriate, (2) reasons for non-participation, (3) intervention dose, (4) adverse effects and withdrawals, and (5) cost.

Background Intervention trials that have demonstrated significant effects may not always replicate those effects when scaled up. This study aimed to test whether scaling-up a successful cluster randomized trial (the COMMUNICATE study, 9 intervention communities), which promoted population-level physical activity (PA), could promote PA in a broader citywide setting (29 communities) after two years, as a mid-term evaluation of the six-year scaled-up trial. Methods This is a single-arm, pre-post comparison of a multi-strategic community-wide intervention covering the entire Unnan City, Japan. The intervention for middle-aged and older people consisted of three components: information delivery, education, and support delivery. The intervention method followed the COMMUNICATE study but adapted and introduced new initiatives tailored to local resources. A baseline survey ( n  = 3,718) among randomly selected residents aged 40–79 years in 2016 and a follow-up survey with the same respondents two years later were conducted. The primary outcome was the change in the percentage of people who practiced the recommended levels of PA, analyzed with a generalized linear mixed model to account for clusters at individual and community levels. Additionally, we examined the dose–response relation of the effect based on the intervention doses in each community. The RE-AIM framework assessed intervention dissemination and implementation. Results The two-year intervention was implemented in all communities, reaching and involving various groups. The rate of people engaged in PA significantly increased in two years (adjusted change: + 8.0 percentage points [95% confidence interval: 6.1, 10.0]). Based on the type of PA, only muscle-strengthening activity showed a significant increase (+ 11.5% points [9.6, 13.5]), whereas walking (-1.8% points [-3.6, 0.1]) and flexibility activities (+ 0.3% points [-1.5, 2.0]) did not. The increase in PA in higher-dose areas was not significantly different but slightly larger than that in lower-dose areas (+ 8.4% points vs. + 7.6% points, adjusted difference in change: 0.8% points [-3.8, 5.5]). Conclusion The scaled-up citywide intervention promoted PA, especially muscle-strengthening activity. Collaboration with diverse organizations in different settings is crucial for multi-faceted interventions and requires balancing uncertainty in its implementation quality and quantity owing to collaborative decision-making. Trial registration UMIN-CTR, UMIN000024682. Registered 02 November 2016, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000028377

Background: Physical activity (PA) guidelines for early childhood have been established worldwide, and adherence to PA guidelines has been utilized to assess the effectiveness of policies regarding PA promotion. Although there is a Japanese PA guideline for preschoolers, little is known about adherence to this recommendation. This study examined and compared proportions of meeting the Japanese PA guideline among preschoolers. Methods: Participants comprised 821 children aged 3–6 years from all 21 preschools and childcare facilities (hereafter collectively “preschools”) within Unnan City, Shimane Prefecture, Japan. Data on PA levels were collected through a parent-report questionnaire in accordance with the Japanese PA guideline. This guideline recommends that preschoolers perform PA for at least 60 minutes every day. Analyses included descriptive statistics, chi-squared, and Mann–Whitney’s tests to compare adherence to the PA guideline. Results: Data of 441 participants from 20 preschools were analyzed. Of these, 292 (66.2%) preschoolers met the PA guideline. Boys (70.2%) showed a significantly higher proportion of meeting the PA guideline than girls (61.2%; P = 0.048). Proportions of meeting the PA guideline among preschool grades were not statistically different. Prevalence rates of meeting the PA guideline among 20 preschools considerably varied from 14.3% to 100% (P = 0.007). Conclusions: Two-thirds of preschoolers met the Japanese PA guideline, while adherence to PA recommendations differed between genders. Moreover, there were distinct variations of adherence to PA guideline among preschools. Possible determinants that cause the differences in adherence to the PA guideline at the individual and preschool-levels should be further evaluated.

Maintaining people’s health based on their help-seeking behavior (HSB) regarding mild symptoms is essential. An effective HSB, especially self-management, can facilitate the attainment of appropriate healthcare resources and affect health outcomes such as quality of life (QOL). However, clear evidence regarding the relationship between self-management, mild symptoms, and QOL is unavailable. Therefore, this cross-sectional study investigated this association in a rural elderly population. The participants, aged over 65 years, were living in rural communities. The primary outcome of QOL was examined using the EuroQol 5-Dimension 5-Level (EQ-5D-5L). After adjusting for propensity score matching, 298 participants in the self-management usage group were matched with 298 in the group not using self-management. The most frequent HSB trend was consulting with primary care physicians, followed by self-care, consulting with families, utilizing home medicines, and buying medicines. The EQ-5D-5L scores were statistically higher in the self-management usage group than in the other group. The HSBs with a trend of using self-management were related to a high QOL. Self-management of symptoms along with other HSBs can improve elderly HSBs in rural contexts. Educational interventions and system development for HSBs in rural contexts could be effective in enhancing the QOL of rural elderly populations.

In this mixed-methods study, we hypothesized that social cognitive theory (SCT)-based educational interventions for healthcare participation can improve the self-efficacy of older rural citizens in participating in their health management without any difficulties. Quasi-experimental study before and after SCT-based educational interventions and semi-structured interviews were conducted. Participants were Japanese elderly (>65 years) from rural communities. Propensity score matching was performed to estimate the effectiveness of educational interventions on participants’ perception (intervention: n = 156; control: n = 121). Interview contents were transcribed verbatim and analyzed based on thematic analysis. The intervention group scored significantly higher than the control group for participation in planning and managing self-care. Interviews revealed three themes: ability to manage health conditions, relationship with medical professionals, and relationship among citizens. Participants reported difficulties in judging symptoms and communicating with medical professionals. Hierarchy and low motivation to participate in healthcare hindered collaboration. The findings suggest that SCT-based educational interventions can positively impact rural citizens’ self-efficacy in healthcare participation.

The objective of this review was to summarize evidence for the effectiveness of music therapy (MT) and to assess the quality of systematic reviews (SRs) based on randomized controlled trials (RCTs). An SR of SRs based on RCTs. Studies were eligible if they were RCTs. Studies included were those with at least one treatment group in which MT was applied. We searched the following databases from 1995 to October 1, 2012: MEDLINE via PubMed, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Web of Science, Global Health Library, and Ichushi-Web. We also searched all Cochrane Database and Campbell Systematic Reviews up to October 1, 2012. Based on the International Classification of Diseases, 10th revision, we identified a disease targeted for each article. Twenty-one studies met all inclusion criteria. This study included 16 Cochrane reviews. As a whole, the quality of the articles was very good. Eight studies were about \"Mental and behavioural disorders (F00-99)\"; there were two studies on \"Diseases of the nervous system (G00-99)\" and \"Diseases of the respiratory system (J00-99)\"; and there was one study each for \"Endocrine, nutritional and metabolic diseases (E00-90)\", \"Diseases of the circulatory system (I00-99)\", and \"Pregnancy, childbirth and the puerperium (O60)\". MT treatment improved the following: global and social functioning in schizophrenia and/or serious mental disorders, gait and related activities in Parkinson's disease, depressive symptoms, and sleep quality. THIS COMPREHENSIVE SUMMARY OF SRS DEMONSTRATED THAT MT TREATMENT IMPROVED THE FOLLOWING: global and social functioning in schizophrenia and/or serious mental disorders, gait and related activities in Parkinson's disease, depressive symptoms, and sleep quality. MT may have the potential for improving other diseases, but there is not enough evidence at present. Most importantly, no specific adverse effect or harmful phenomenon occurred in any of the studies, and MT was well tolerated by almost all patients.