Aim: To investigate the association between decline of basic activities of daily living (ADL) in each dimension and change in caregiver burden in patients with mild-to-moderate Alzheimer's disease.Methods: This retrospective study included 117 outpatients with Alzheimer's disease who presented to the Memory Clinic at the National Center for Geriatrics and Gerontology in Japan between September 2010 and April 2014 (mean age 77.3 AE 6.4 years; 68.6% women). Patients and their caregivers completed comprehensive geriatric assessment at baseline and at the 3-year follow up. Caregiver burden was assessed using the Japanese version of the Zarit Burden Interview. ADL were assessed by the Barthel Index. Among patients with full points on each subitem of the Barthel Index at baseline, incident ADL decline was defined as a loss of at least 5 points at the 3-year follow up. Other confounding factors including demographic data, cognitive function, vitality, and behavioral and psychiatric symptoms of dementia were also assessed. The longitudinal relationship between incident ADL decline and changes in caregiver burden was evaluated by multivariate linear regression, adjusted for confounding variables.Results: In descending order, declines in ADL at 3 years were noted in bathing (25.4%), bowel control (25.4%), grooming (22.9%) and bladder control (22.9%). On multivariate analyses, ADL declines in feeding (b = 17.2, P < 0.01) and bathing (b = 11.0, P = 0.02) were significantly associated with increased caregiver burden.Conclusion: Incident ADL declines in feeding and bathing are significant risk factors for increased caregiver burden in patients with Alzheimer's disease.

Study Design. Retrospective study. Objective. To investigate the association between gestational weight gain (GWG) during pregnancy and persistent low back and pelvic pain (LBPP) after delivery. Summary of Background Data. Persistent LBPP after delivery is a risk factor for developing depression and chronic pain as well as incurring sick leave. Women experience weight gain during pregnancy. Excessive weight gain places a greater burden on the musculoskeletal system. However, little is known about how GWG is associated with LBPP after delivery. Methods. After Ethics Committee approval, we analyzed 330 women at 4 months after delivery who had LBPP during pregnancy. The exclusion criteria were as follows: specific low back pain, multiple birth, and incomplete data. Four months after delivery, LBPP was assessed using a self-report questionnaire. Persistent LBPP was defined as pain at 4 months after delivery with an onset during pregnancy or within 3 weeks after delivery. GWG was calculated as the difference between the pregnancy weight and the prepregnancy weight, which we categorized into three groups: <10, 10 to <15, and ≥15 kg. Other confounding factors including age, height, weight at 4 months after delivery, parity, gestational week, mode of delivery, weight of the fetus, and prepregnancy LBPP were assessed. We used logistic regression analysis to calculate LBPP odds ratios (ORs) according to GWG. Results. The prevalence of persistent LBPP was 34.1% (n = 113). Compared with women with a GWG of <10 kg, women with a GWG of ≥15 kg had a higher prevalence of persistent LBPP (OR = 2.77, 95% confidence interval (95% CI) = 1.28–5.96, adjusted OR = 2.35, 95% CI = 1.06–5.21); however, no significant difference was found for women with a GWG of 10 to <15 kg (OR = 1.18, 95% CI = 0.72–1.92, adjusted OR = 1.02, 95% CI = 0.61–1.72). Conclusions. Our study showed that excessive weight gain during pregnancy is one of the risk factors of persistent LBPP. Appropriate weight control during pregnancy could help prevent persistent LBPP after delivery. Level of Evidence: 3

Aim: To examine the association between public transportation use and loneliness in urban elderly who stop driving. Methods: In this cross-sectional study, we assessed 31 community-dwelling older adults who had stopped driving. Public transportation use was assessed by using frequency and divided into two groups. The users group was participants who used public transportation more than once a week and the nonusers group was participants who used public transportation less than once a week. Loneliness was measured using the Japanese version of the UCLA Loneliness Scale version 3 (UCLA.LS.ver3), with a higher score indicating greater loneliness. The independent t test was used to compare the UCLA.LS.ver3 scores between users and nonusers group. A multiple linear regression model was used with the UCLA.LS.ver3 score as the objective variable and public transportation use as the explanatory variable. Results: The UCLA.LS.ver3 score was significantly higher in the nonusers group than in the users group (nonusers group: 12.7 ± 1.9; users group: 10.1 ± 2.9, p = .017). After adjustments, public transportation use was significantly associated with lower loneliness (β = −2.55, p = .029). Conclusion: Public transportation use might have important role to prevent loneliness in older adults who stop driving.

This study clarified the prevalence of daytime sleepiness in fourth-, fifth-, and sixth-grade children and examined the association between physical activity (PA) and daytime sleepiness in children aged 9–12 years. This cross-sectional study included 314 children (mean age ± standard deviation: 10.5 ± 1.0 years; male: 52.9%) enrolled in two public elementary schools in Kobe, Japan. PA was assessed using the Physical Activity Questionnaire for Older Children. The outcome was self-reported daytime sleepiness. The prevalence of daytime sleepiness in fourth-, fifth-, and sixth-grade children were 10.8%, 25.2%, and 28.6%, respectively. In univariate analysis, subjects with reported daytime sleepiness had lower PA levels than those without daytime sleepiness (odds ratio (OR) = .67; 95% confidence interval (CI) = .47–.95). Multiple logistic regression analysis demonstrated that lower PA was significantly associated with daytime sleepiness after adjusting for multiple confounders (OR = .54; 95% CI = .37–.81). The prevalence of daytime sleepiness in fifth and sixth grades was higher than fourth grade. Furthermore, this study clarified the significant association between PA and daytime sleepiness and suggested that PA could be one of the factors to prevent daytime sleepiness in children aged 9–12 years.