Okayama City Research Articles

Validating weight optimization’s Impact on participants via Social Impact Bonds

Abstract Background To promote health for everyone, even the health-unconcerned, Okayama City has established the Social Impact Bond (SIB), which funds and executes social programs for defined outcomes, with third-party assessment. This study examined the normalization of participants’ physiques three years later to verify the effectiveness of SIB. Methods We conducted a study of a quasi-experimental design, non-randomized controlled trial. A total of 8,251 eligible people applied for the program. Of these, 1,599 were enrolled in the National Health Insurance System (NIH), and 731 of them were included in the intervention group in 2018. Among 705 non-participating matched members and randomly selected, 170 were used as the control group. Whether or not the standard physique in the endpoint (EP) FY2021, was used as the dependent variable, and the participation as the independent variable. Age, gender, and physique at baseline (BL) were used as covariates for logistic regression analysis. Results A total of 532 patients underwent health checkups for both BL and EP, and the follow-up rate was 60.5% in the intervention group and 52.9% in the control group. Examination of between-group differences in BL revealed that the mean age was 66.7 years significantly higher in the males’ intervention group and 60.6 years in the control group (p < 0.01). The crude odds ratio (OR) of maintaining or achieving standard BMI in the participating group was 0.90, and the adjusted OR was 1.23 and 1.31 after propensity score matching, both were not significant. On the other hand, when restricted to people with thinness, the pre-adjusted OR was 5.00 and the adjusted OR was 12.43. Conclusions Participation in the project contributed about 20% to 30% to weight optimization, and it could not be denied that it was brought about by chance. However, when limited to thin physiques, project participation was about twelve times higher, and the probability of having an appropriate physique was increased. Key messages • SIB might affect the BMI optimization for older people in improving thinness. • Efforts will be needed to encourage participation among younger age groups.

A Key Research Case for Promoting Education for Sustainable development: The Case of Okayama, Japan

This paper explores the productive efforts of Okayama City, Japan, in advancing education for sustainable development (ESD). Focusing on two significant initiatives, the Marine Conservation Education Program and RCE Okayama, the paper explores how these programs integrate formal, non-formal, and informal education to foster sustainable practices. The Marine Conservation Education Program, a collaboration between schools and local fishermen, involves experiential learning to instill marine conservation principles among students, yielding significant shifts in their attitudes towards ocean protection. RCE Okayama, recognized globally, collaborates with various organizations to promote ESD within the community, offering programs and training to enhance understanding and implementation of sustainable practices. The paper emphasizes the synergy of formal and non-formal education, highlighting the broader impacts of Okayama's ESD efforts on developing a sustainable society.

Examining the Content of Disaster-Related Information Disseminated to a Migrant Population

Many local governments, especially in Japan, disseminate multilingual disaster-related information to migrants as part of their disaster education programs to make their disaster risk reduction (DRR) policies more inclusive. However, little is known about the specific content of the information disseminated through such programs and how or why that content is selected. Using an example case of Okayama Prefecture in Japan and its principal city, Okayama City, the current study identifies the content of multilingual disaster-related information, as well as the assumptions behind its selection. To this end, the content of multilingual disaster-related information disseminated by these local governments was inductively analyzed, focusing on (1) what is and is not communicated, (2) how the government views the migrant population, and (3) their goals of information dissemination targeting migrants. As a result of conducting a qualitative content analysis on information disseminated by the Okayama local governments via information booklets and a YouTube video, it was found that the content was largely concerned with calling migrants to be proactive in taking preventive and harm reduction measures, as well as acquiring prerequisite knowledge (e.g., about disasters and their management). The underlying assumptions and expectations behind this content (e.g., how a behavioral change occurs and self-sufficiency as an expectation in disaster preparedness) are discussed, as well as issues associated with these assumptions.

Isolation of Vibrio cholerae and Vibrio vulnificus from Estuarine Waters, and Genotyping of V. vulnificus Isolates Using Loop-Mediated Isothermal Amplification.

Bacteria in the genus Vibrio are ubiquitous in estuarine and coastal waters. Some species (including Vibrio cholerae and Vibrio vulnificus) are known human pathogens causing ailments like cholera, diarrhea, or septicemia. Notably, V. vulnificus can also cause a severe systemic infection (known as vibriosis) in eels raised in aquaculture facilities. Water samples were periodically collected from the estuary of the Asahi River, located in the southern part of Okayama City, Japan. These samples were directly plated onto CHROMagar Vibrio plates, and colonies displaying turquoise-blue coloration were selected. Thereafter, polymerase chain reaction was used to identify V. cholerae and V. vulnificus. A total of 30 V. cholerae strains and 194 V. vulnificus strains were isolated during the warm season when the water temperature (WT) was higher than 20 °C. Concurrently, an increase in coliforms was observed during this period. Notably, V. vulnificus has two genotypes, designated as genotype 1 and genotype 2. Genotype 1 is pathogenic to humans, while genotype 2 is pathogenic to both humans and eels. The loop-mediated isothermal amplification method was developed to rapidly determine genotypes at a low cost. Of the 194 strains isolated, 80 (41.2%) were identified as genotype 1 strains. Among the 41 strains isolated when the WTs were higher than 28 °C, 25 strains (61.0%) belonged to genotype 1. In contrast, of the 32 strains isolated when the WTs were lower than 24 °C, 27 strains (84.4%) belonged to genotype 2. These results suggest that the distribution of the two genotypes was influenced by WT.

Fine Particulate Matter and Diabetes Prevalence in Okayama, Japan.

Many studies have shown an association between long-term exposure to particulate matter having an aerodynamic diameter of 2.5 μm or less (PM2.5) and diabetes mellitus (DM), but few studies have focused on Asian subjects. We thus examined the association between long-term exposure to PM2.5 and DM prevalence in Okayama City, Japan. We included 76,591 participants who had received basic health checkups in 2006 and 2007. We assigned the census-level modeled PM2.5 data from 2006 and 2007 to each participant and defined DM using treatment status and the blood testing. PM2.5 was associated with DM prevalence, and the prevalence ratio (95% confidence interval) was 1.10 (1.00-1.20) following each interquartile range increase (2.1 μg/m3) in PM2.5. This finding is consistent with previous results and suggests that long-term exposure to PM2.5 is associated with an increased prevalence of DM in Okayama City, Japan, where the PM2.5 level is lower than in other cities in Asian countries.

Sound map of urban areas recorded by smart devices: case study at Okayama and Kurashiki

This paper presents a sound map to visualize environmental sounds collected using a cloud sensing approach, i.e. participatory sensing and opportunistic sensing. Our sound map have two major extra functions than a simple noise map which visualized sound levels. The first one is introduction of visualization of sound-type icons on the noise map to enrich information. The second one is animating a transition of sound levels on noise map to visible the change according to the time in a day as a simulation. To demonstrate our sound map and develop the functions, we carried out several experiments. First, we developed a sound collection system to simultaneously collect physical sounds, their statistics, and their subjective impression. Then, we conducted sound collection experiments using the developed system in Okayama city and Kurashiki city. We analyze the data to focus on the difference between the cities and the differences between the usual and the unusual days. Furthermore, the collected data included subjective impressions by participants. We try to predict bustle situations in sightseeing areas by two approaches; the first is using Gaussian Mixture Models, and the second is using i-vector, which is well-known approach in the speaker identification tasks.

COVID-19 pandemic and language development in children at 18 months: a repeated cross-sectional study over a 6-year period in Japan

ObjectiveTo evaluate the impact of the COVID-19 pandemic experience on language development among children, we compared language development at 18 months of age, before and during the pandemic in Japan,...

The Relationship between the Evaluation of Public Transport Services and Travel-Based CO2 Emissions from Private Transport Modes in Regional and Metropolitan Areas in Japan

Promoting public transport use is expected to contribute to reducing CO2 emissions in the transport sector. Using Okayama City and Central Tokyo as representative case studies of regional and metropolitan areas in Japan, this study examines the impact of the evaluation of the ‘hard’ and ‘soft’ attributes of rail and bus services on the overall evaluation. This study then explores the relationship between the overall evaluation and usage frequency of rail and bus services, as well as the relationship between the usage frequency and travel-based CO2 emissions from private transport modes. Furthermore, this study investigates whether the emissions cause differences in the evaluation of the ‘hard’ and ‘soft’ attributes of public transport services. The findings suggest prioritising an improvement in ‘hard’ rather than ‘soft’ attributes in order to reduce emissions through the use of public transport in regional areas. However, in metropolitan areas, no relationship was found between the evaluation of public transport services and emissions, presumably because of the lower ownership rate of private cars that residents can use freely and the markedly higher level of rail and bus services. This study provides a methodological reference for analysing the potential to reduce travel-based emissions from private transport modes by enhancing public transport service contents.

Obesity, overweight, and severe prognosis in COVID-19 patients in Japan

IntroductionObesity (i.e., body mass index [BMI] of 30 kg/m2 or more) is one of the risk factors for severe COVID-19, but the findings may not be directly applicable to Asians, who have a different cutoff point for defining obesity. We thus examined the association between obesity/overweight (BMI of 25 kg/m2 or more and less than 30 kg/m2) and the risk of COVID-19 severity. MethodsThe study population included COVID-19 patients who had been enrolled in the registry of the Okayama City Public Health Center in Okayama, Japan, between March 2020 and June 2022. We included 27 820 patients who had information on BMI and prognosis, and we conducted Poisson regression analysis with robust error variance to estimate risk ratios (RRs) with 95% confidence intervals (CIs) for severe outcomes. ResultsObesity and overweight were associated with the increased risk of severe COVID-19 in all age categories. The RRs (95% CI) for COVID-19 induced respiratory failure compared to the normal weight category were 1.57 (1.31–1.88) for overweight and 2.45 (1.90–3.15) for obesity. ConclusionsBoth obesity and overweight were associated with increased risk of severe COVID-19. This study suggests the importance of the overweight category to predict the risk of severe COVID-19 in Asians.

Predictive Factors for Recovery from Alcoholic Liver Failure.

Alcoholic liver disease is a risk factor for non-virus-related hepatocellular carcinoma (HCC), which is increasing in prevalence. This study aimed to identify the factors for recovery from alcoholic liver failure. Sixty-two consecutive patients hospitalized for alcoholic liver failure at Okayama City Hospital were enrolled. The characteristics of patients who survived to the 1-month follow-up and whose liver function improved to Child-Pugh A at 3 months (CPA3) and 12 months (CPA12) were compared with the rest of the patients. The survivors at 1 month (50 patients) were significantly younger than the deceased patients and had better liver and renal function with higher levels of γ-glutamyl transferase (GGT). The same factors, except renal function, were correlated with achieving CPA3. High AST, ALT, and GGT levels as well as short spleen length, total abstinence, and good Child-Pugh scores at admission were identified as factors for achieving CPA12. The extent of alcohol intake before admission was not identified as a risk factor in any analysis. In conclusion, baseline liver function is crucial for survival and achieving CPA3, whereas high transaminase and γ-GTP levels, the absence of splenomegaly, and total abstinence are significant factors for achieving CPA12.

The Effect of Medical Cooperation in the CKD Patients: 10-Year Multicenter Cohort Study.

While chronic kidney disease (CKD) is one of the most important contributors to mortality from non-communicable diseases, the number of nephrologists is limited worldwide. Medical cooperation is a system of cooperation between primary care physicians and nephrological institutions, consisting of nephrologists and multidisciplinary care teams. Although it has been reported that multidisciplinary care teams contribute to the prevention of worsening renal functions and cardiovascular events, there are few studies on the effect of a medical cooperation system. We aimed to evaluate the effect of medical cooperation on all-cause mortality and renal prognosis in patients with CKD. One hundred and sixty-eight patients who visited the one hundred and sixty-three clinics and seven general hospitals of Okayama city were recruited between December 2009 and September 2016, and one hundred twenty-three patients were classified into a medical cooperation group. The outcome was defined as the incidence of all-cause mortality, or renal composite outcome (end-stage renal disease or 50% eGFR decline). We evaluated the effects on renal composite outcome and pre-ESRD mortality while incorporating the competing risk for the alternate outcome into a Fine-Gray subdistribution hazard model. The medical cooperation group had more patients with glomerulonephritis (35.0% vs. 2.2%) and less nephrosclerosis (35.0% vs. 64.5%) than the primary care group. Throughout the follow-up period of 5.59 ± 2.78 years, 23 participants (13.7%) died, 41 participants (24.4%) reached 50% decline in eGFR, and 37 participants (22.0%) developed end-stage renal disease (ESRD). All-cause mortality was significantly reduced by medical cooperation (sHR 0.297, 95% CI 0.105-0.835, p = 0.021). However, there was a significant association between medical cooperation and CKD progression (sHR 3.069, 95% CI 1.225-7.687, p = 0.017). We evaluated mortality and ESRD using a CKD cohort with a long-term observation period and concluded that medical cooperation might be expected to influence the quality of medical care in the patients with CKD.

Heat Exposure Following the Rainy Season Is Associated With an Increased Risk of Cardiovascular Emergency Among the Elderly in Japan.

Background Despite the impact of heat exposure caused by global warming, few studies have investigated the hourly effects of heat exposure and the risk of cardiovascular disease (CVD) in the elderly. We examined the associations between short-term heat exposure and the risk of CVD in the elderly in Japan and evaluated possible effect-measure modifications by rainy seasons that occur in East Asia. Methods and Results We conducted a time-stratified case-crossover study. The study included 6527 residents in Okayama City, Japan, aged ≥65 years who were transported to emergency hospitals between 2012 and 2019 for the onset of CVD during and a few months after the rainy seasons. We examined the linear associations between temperature and CVD-related emergency calls for each year and for hourly preceding intervals before the emergency call during the most relevant months. Heat exposure during 1 month after the end of the rainy season was associated with CVD risk; the odds ratio (OR)for a 1° C increase in temperature was 1.34 (95% CI, 1.29-1.40). When we further explored thenonlinear association by using the natural cubic spline model, we found a J-shaped relationship. Exposures 0 to 6 hours before the case event (preceding intervals 0-6 hours) were associated with CVD risk, particularly for thepreceding interval 0 to 1 hour (OR, 1.33 [95% CI, 1.28-1.39]). For longer periods, the highest risk was at preceding intervals 0 to 23 hours (OR, 1.40 [95% CI, 1.34-1.46]). Conclusions Elderly individuals may be more susceptible to CVD after heat exposure during the month after the rainy season. As shown by finer temporal resolution analyses, short-term exposure to increasing temperature can trigger CVD onset.

Differential Associations of Frailty with the Incidence of Mild and Severe Disabilities in Older Adults: A 3-Year Cohort Study.

Frailty is associated with the incidence of disability in older adults; however, few studies have investigated differences in the association of frailty with mild and severe disabilities according to Japanese long-term care insurance certification. This study separately investigated the associations between frailty and the incidence of mild and severe disabilities. This 3-year retrospective cohort study included community-dwelling adults in Okayama City aged ≥65 years. We assessed frailty status using the Kihon Checklist and defined the outcomes as mild and severe disabilities according to long-term care insurance certifications. We applied multinomial logistic regression analysis to investigate the association between frailty and the incidence of mild and severe disabilities. The analysis included a total of 36,043 participants. For mild disability, the odds ratios (ORs) comparing frail to robust and prefrail to robust were 3.85 (95% confidence interval [CI], 3.36-4.42) and 1.82 (95% CI, 1.58-2.10), respectively. Similarly, the corresponding ORs for severe disability were 4.35 (95% CI, 3.55-5.34) and 1.78 (95% CI, 1.43-2.21), respectively. In the age-stratified analysis of mild disability, the pre-old group (aged 65-74 years) with frail showed a higher association than the old-age group (aged ≥75 years) with frail. Regarding severe disability, the older group with frailty showed a higher association than the pre-old group with frailty. The results showed that both prefrail and frail were associated with the incidence of mild and severe disabilities, with different patterns of association between the pre-old and old age groups.

Frailty and all-cause and cause-specific mortality in Japan

BackgroundIn aging societies, there is an increasing focus on the concept of frailty. However, there is no consistent means to assess this concept. We assessed frailty using the Kihon Checklist (KCL), which is widely used in Japan, and examined the association between frailty and all-cause and cause-specific mortality in Japan, the most aged society in the world. MethodsThis was a retrospective cohort study, and we analyzed 43,312 participants aged ≥ 65 years who were enrolled in basic health checkups in Okayama City, Japan. We defined the frailty status of the participants using the KCL. To assess the association of frailty status with all-cause and cause-specific mortality, we used cause-specific Cox proportional hazard models to estimate hazard ratios (HRs), adjusting for individual potential confounders. Mean follow-up time was 9.3 years. ResultsThe fully adjusted HR for all-cause mortality was 1.34 (95% confidence interval [CI]: 1.27-1.41) for the prefrail group and 2.22 (95% CI: 2.11-2.33) for the frail group. A similar pattern was observed for cardiovascular disease, respiratory disease, and cancer mortality. Younger people (65–74 years) and women tended to have higher effect estimates than older people (≥ 75 years) and men. ConclusionPrefrailty and frailty can increase the risk of both all-cause and cause-specific mortality. Our study suggests that to support frail patients, it could be effective to focus on the prevention and management of cardiovascular and respiratory disease, and that the KCL may be useful as a method of screening for frailty.

A descriptive analysis for the comparison of the symptoms and severity of coronavirus disease 2019 (COVID-19) in each epidemic period in Okayama City

Japan experienced four major epidemic periods (i.e., the 3rd-6th waves) of COVID-19 from January 2020 to March 2022. A different strain predominated in each period: the wild-type strain, an Alpha variant, a Delta variant, and an Omicron variant were predominant in waves 3, 4, 5, and 6, respectively. In this study, we conducted a descriptive analysis to investigate the differences in symptoms and severity during each epidemic period. We analyzed a total of 31,037 patients with COVID-19 who were reported to the Okayama City Public Health Center between February 1, 2020 and March 31, 2022. We described and compared the proportion of symptoms, the number and proportion of severe COVID-19 cases, and the number and proportion of deaths for each epidemic period. We also compared the proportion of severe COVID-19 cases depending on the number of vaccinations for the 5th and 6th waves. Differences in symptoms and severity were observed in each epidemic period. In the 5th and 6th waves, the results suggested that vaccination had a preventive effect against severe COVID-19.

Analysis of Questionnaire Survey about the Recovery after Flooding in 2018 in Mabi District of Okayama City

Analysis of Questionnaire Survey about the Recovery after Flooding in 2018 in Mabi District of Okayama City

Backwater Effect of Clogging of Aquatic Plants at Fine-Particle Screens on Inland Flooding in Okayama

In low-lying Okayama city, Japan, the heavy rainfall frequency and intensity have recently increased, subjecting the city to inland flooding. Another factor increasing the inland flooding risk is fine-particle screen clogging by aquatic plants at drainage pump stations, which obstructs drainage and causes backwater. In this study, water level simulations were conducted in drainage pump station channels to clarify the inland flooding risks with and without aquatic plant clogging-induced backwater at fine-particle screens. In the Urayasu West Drainage Pump Station channels, without backwater, no inland flooding occurred under an initial water level of 70% of the channel depth and a 40 m3/s discharge. However, when backwater deeper than 0.2 m occurred under the same conditions, inland flooding occurred, indicating an increased inland flooding risk associated with backwater. Additionally, we conducted an aquatic plant distribution survey in the main Okayama city channels and proposed six priority control sections based on sections with thriving aquatic plants. Although no previous inland flooding studies have considered aquatic plant clogging-induced backwater at fine-particle screens, aquatic plants cause clogging problems and drainage obstructions at water control facilities worldwide. Therefore, this study reveals the importance of conducting water level simulations and distribution surveys in areas other than Okayama city.

Quintuple Helix Lens for Transformation: An Okayama Model of Education for Sustainable Development

What transforms society? Using the quintuple helix model (QHM) of social innovation, this study examines how the Okayama Education for Sustainable Development (ESD) project has transformed the local community and its people, and how this has led to global recognition. Okayama is known as a world leader in ESD and their unique approach is called the Okayama Model of ESD. This study further looks at the institutional configuration on the elements contributed to knowledge co-creation and how the key actors interacted to contribute to societal transformation through knowledge, social innovation, and institutional setting. The goal of this study is to outline the Okayama Model of ESD using the QHM lens constituted of five helices; education, politics, society, economy, and the natural environment. This study applies a qualitative research method, in which key actors who contribute most to the development of the Okayama Model of ESD are identified by content analysis and semi-structured interviews that are conducted using the life history method. The result shows that the firm ground of the political subsystem facilitates the interaction among the stakeholders in the three subsystems–education, social, and natural environment, which ultimately contributes to the joining of the economic subsystem and the initiation of the knowledge circulation process. Transformation necessitates a city-wide approach involving a network of multiple actors to collaborate for knowledge co-creation and circulation, and the establishment of a new social values system. The study revealed several key points of local action that accelerated the transformation process by helping in value creation, knowledge convergence, and system interaction, which was instilled early through all forms of education—multiple actors' interaction that shapes through the ESD project that stimulates the triangulation of mind, hearts, and hands. This way, the city of Okayama functions as a living laboratory for the Okayama Model of ESD. This situation naturally promotes Mode 3 of the knowledge co-creation system, and the principles of civic collaboration and citizen engagement developed through the Okayama Model of ESD have been elaborated in the prefecture-wide vision statement.

Impact of different medical direction policies on prehospital advanced airway management for out-of hospital cardiac arrest patients: A retrospective cohort study

BackgroundAlthough optimal prehospital airway management after out-of-hospital cardiac arrest (OHCA) remains undetermined, no studies have compared different advanced airway management (AAM) policies adopted by two hospitals in charge of online medical direction by emergency physicians. We examined the impact of two different AAM policies on OHCA patient survival. MethodsThis observational cohort study included adult OHCA patients treated in Okayama City from 2013 to 2016. Patients were divided into two groups: the O group - those treated on odd days when a hospital with a policy favoring laryngeal tube ventilation (LT) supervised, and the E group - those treated on even days when the other hospital with a policy favoring endotracheal intubation (ETI) supervised. Multiple logistic regression analysis was performed to assess airway device effects. The primary outcome measure was seven-day survival. ResultsOf 2,406 eligible patients, 50.1% were in the O group and 49.9% were in the E group. O group patients received less ETI (1.0% vs. 12.0%) and more LT (53.3% vs. 43.0%) compared with E group patients. In univariate analysis, no differences were observed in seven-day survival (9.4% vs 10.1%). Multiple regression analysis revealed neither LT nor ETI had a significant independent effect on seven-day survival, considering bag-valve mask ventilation as a reference (OR, 0.78; 95% CI, 0.54 to 1.13, OR, 0.79; 95% CI, 0.36 to 1.72, respectively). ConclusionDespite different advanced airway medical direction policies in a single city, there were no substantial impact on outcomes for OHCA patients.

Emotional work stress reactions of emergency medical technicians involved in transporting out-of-hospital cardiac arrest patients with “do not attempt resuscitation” orders

BackgroundEmergency medical technicians (EMTs) may be subjected to emotional stress during patient treatment/transport. In Japan, dispatched EMTs must attempt resuscitation in all cases of out-of-hospital cardiac arrest (OHCA), including patients with “do not attempt resuscitation” (DNAR) orders and patients whose families do not support resuscitation. We described the characteristics, prevalence, and outcomes of OHCA/DNAR patients, and aimed to identify factors associated with EMT stress when treating them. MethodsWe included OHCA patients transported by EMTs in the city of Okayama from 2015 to 2019. We identified patients with DNAR orders based on emergency medical service (EMS) records, then EMTs completed questionnaires regarding the management of those patients and EMTs’ emotions. ResultsAmong 3079 eligible OHCA patients, 122 patients (4%) had DNAR orders (DNAR group), and 2957 (96%) patients had no DNAR orders (no DNAR group). Based on responses from 243 EMT participants involved in OHCA/DNAR transports, we divided EMTs into high stress (73/243, 30%) and low stress (170/243, 70%) groups. EMTs experienced emotional stress from treating patients with family physician orders to transport (AOR: 4.74, 95% CI: 2.35–9.56) and those for whom prehospital defibrillation was performed (AOR: 20.7, 95% CI: 3.10–137.9). ConclusionsApproximately 30% of EMTs providing resuscitation to OHCA/DNAR patients experienced high levels of stress. Establishment of a prehospital emergency system incorporating physician medical direction and updated guidelines for treating patients with DNAR orders may reduce the psychosocial stress of EMTs.