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The goal of the present study was to investigate the factors related to depression among childcare workers. From November 2015 to August 2016, 358 nurseries (17.9%) answered a questionnaire. Adjusted for nursery work experience totaling more than five years, work place, cooperation in the work place, quality of sleep, hospital visiting, factors related to work of more than five years (OR=0.55, 95%CIs=(0.34, 0.91)), ability to consult troubles with boss (OR=0.36, 5%CIs=(0.18, 0.73)), to be able to take paid holidays (OR=0.49, 95%CIs=(0.27, 0.88)), having a spouse (OR=0.55, 95%CIs=(0.32, 0.94)) were considered to decrease the risk of depression. The Japanese government should prompt to improve the reatment of nurseries.

Objective We tried to develop smoking cessation program for pregnant smokers at an obstetric clinic. Methods We asked 10 obstetric clinics to participate in this projects from July to August, 2018. Eventually, 4 clinics responded to our request for participation. We provided them a device for measuring respiratory carbon monoxide, manual for instruction of smoking cessation in a pregnant smoker conducted by health professionals, and right for health professionals to access the internet e-learning program of smoking cessation called J-STOP. A doctor and midwifes at each clinic conducted intervention of pregnant smoker for smoking cessation from September, 2018 to March, 2019, using the manual of smoking cessation for a pregnant smoker. Results 30 pregnant smokers had been involved in this program with written informed consent. Their average age (standard deviation or SD) was 29.2 years (5.4), and their average number of cigarettes per day was 8.5 pieces (5.6). Their average value of respiratory carbon monoxide (CO) concentration was 8.6ppm (6.3), and 28 subjects (93.3%) had at least a smoker in household, including 24 subjects of smoking partner. Among them, 4 subjects stopped smoking just before the survey, and residual 20 subjects stated that they would like to stop smoking in 6 months. Conclusions Because most of pregnant smokers desired to stop smoking, it is important to develop the way for their smoking cessation.

Objectives: The purpose of this study was to clarify factors influencing care workers' attitudes toward end-of-life (EOL) care characteristics at special nursing homes (SNHs). Methods: A questionnaire was initially sent to 630 care workers at 19 SNHs in October 2012. Written informed consent was obtained from 253 of these workers (40.2%), who then completed and returned the questionnaires. Participants were asked to reply to questions covering demographic data, work environment, depression status, experiences/education concerning EOL, communication skills, and attitudes toward EOL care. The Japanese version of the Frommelt Attitude Toward Care of the Dying Scale, Form B (FATCOD-B-J) assessment instrument was used in the analysis of the data received. Using the median value of the FATCOD-B-J score, 130 subjects were allocated to the high score (HS) group (FATCOD-B-J?23) and 123 to the low score (LS) group (FATCOD-B-J

There were no previous reports assessing the effect of tobacco smoke on blood lead levels (BLLs) simultaneously in children and adults in Japan. We investigated the association of passive and active smoking with BLLs in children and adults among the general population in Hokkaido, Japan. One hundred seventy-seven persons (78 males, 99 females) participated in the survey in May, 2014. Age groups of subjects younger than 18 years (age group A) and subjects older than or equal to 18 years (age group B) were designated. The median value of the BLLs was used for us to divide into two groups, such as high and low BLL groups. Age and sex adjusted odds ratios (OR) and 95% confidence levels (CLs) were estimated with analysis of the logistic regression model. BLLs in age group B were significantly higher than age group A (p=0.023). In age group A, the proportion of subjects living with habitual smokers other than parents in the household was significantly higher in the high BLL group than in the low BLL group (p=0.019). In age group B, currently habitual smoking was significantly associated with increased risk being in the high BLL group (OR=3.17, 95% CL, 1.28-7.86). A duration of smoking longer than or equal to 20 years was significantly associated with increased risk of being in the high BLL group (OR=2.73, 95% CL, 1.07-6.94), BLL is higher in older persons than in younger persons. Active and passive smoking may be associated with high BLLs in adults and children, respectively.

Objectives A prospective study was conducted to assess factors associated with risk of turnover among care workers in group homes (GHs) for elderly individuals with dementia. Methods In January, 2010, 51 out of 238 GHs in Sapporo City responded to our request for participation in a survey. During February and March of 2010, 438 out of 700 care workers (62.6%) in the GHs returned a completed questionnaire to us. They were followed up with until March of 2012, and 395 subjects (90.1%) responded to our survey, which was conducted twice. Over the course of 2 years, 91 subjects left their jobs. Cox's proportional hazards model was used for analysis, adjusting for gender and age. Results Less provision of social support by supervisors, colleagues, family or friends was significantly associated with increased risk of turnover. Financial aids for off-the-job training was marginally significantly associated with reduced risk of turnover. Longer duration of working for frail elderly care was significantly associated with decreased risk of turnover. Habitual smoking was significantly associated with increased risk of turnover. Conclusions Social support in the workplace may be important to reduce the risk of turnover in care workers at GHs. Further prospective studies are required in other areas in Japan.

Objectives The aim of this study is to clarify risk factors of urinary incontinence (UI) in elderly Japanese women. Methods We randomly selected 1600 women, aged between 65 and 74 years, from the resident registration of Sapporo City and we analyzed 746 women, who responded twice on surveys in 2010 and 2011. UI was defined as frequent UI when it occurred at least once a week in both 2010 and 2011. Results Multivariate logistic regression analysis revealed that the past maximum body weight, smoking index, past history of bladder disease or hemorrhoids, and the participant's mother's history of UI were significantly associated with an increased risk of UI. Conclusion Lifestyle habits such as weight gain and smoking habits were associated with an increased risk of UI in Japanese women. Further study is needed, because modification of these risk factors may possibly result in reducing risk of UI.

A cross-sectional study was conducted to explore the potential association between work environment and/or stress coping ability, and depressive status among caregivers working for "group homes (GHs)" in Japan. In January 2010, 438 out of 700 caregivers working at GHs in Sapporo City returned completed questionnaires to us. The questionnaires consisted of the Center of Epidemiological Scales-Depression, items about worker's attributions, Ozeki's coping scale, and so on. An analysis using a logistic regression model was used to find the associations adjusting for gender and age. Subjects who were 45 yr or older, had a spouse, had job training, a standard workload and scored high in emotion-oriented coping were significantly associated with a decreased risk of depression. Subjects who were less proud of their job, less willing to continue care for the frail elderly and had fewer acceptances by their supervisors or colleagues for consultation were significantly associated with an increased risk of depression. This study supports our hypothesis that there can be possible variables among individual factors, work environment and/or coping style for stress which may modulate a risk on the depressive status of caregivers.

Aim: Depression affecting caregivers is a risk factor for discontinuing at-home care. The present cross-sectional study was conducted to evaluate factors related to depression among family caregivers. Methods: A cross-sectional study was conducted to evaluate factors related to depression among family caregivers of the frail elderly. The study included caregivers whose relatives received periodic visits from a nurse from one of seven Sapporo-based home-visiting nursing service stations in October 2008 or from one of nine Kochi-based home-visiting nursing service stations between June 2009 and March 2010. Caregivers were asked to answer a self-administered questionnaire about various factors that might affect their depression and to complete a Center for Epidemiologic Studies Depression Scale evaluation. We analyzed 127 pairs of responses in total. Results: After we adjusted the results for the caregivers' gender and age, the factors that decreased the risk of depression in the Sapporo group related to relieving the stress that results from being a caregiver (OR = 0.12, 95%CI = [0.03, 0.42]) and the ability to independently pay more than ¥10 000 for part of care service costs (OR = 0.17, 95%CI = [0.05, 0.58]). In contrast, feeling ill was a factor that increased caregivers' risk of depression in the Kochi group (OR = 4.23, 95%CI = [1.29, 13.9]), but not in Sapporo group (OR = 2.53, 95%CI = [0.91, 7.08]). Caregivers in the Sapporo group were more likely to feel ill (P

Background: Depression affecting caregivers is a risk factor for discontinuing at-home care. Objective: The present cross-sectional study was conducted to evaluate factors related to depression of family caregivers. Methods: A cross-sectional study was conducted in order to evaluate factors related to depression among family aregivers for the frail elderly with periodic nurse service in 2008, in 7 home-visiting nursing service stations in Sapporo, Japan. Caregivers were asked to answer a self-administered questionnaire about various factors that might affect their depression, and also to complete a Center for Epidemiologic Studies Depression Scale Evaluation (CES-D). We analyzed 71 pairs in total. Results: Factors related to poor health (OR=3.40, 95%CI: 1.13, 10.18) and a longer time spent physically caregiving (OR=3.08, 95%CI: 1.02, 9.35) were associated with being depressed. On the other hand, factors related to a good or fair economic position (OR=0.30, 95%CI: 0.10, 0.91), having a sister or brother who could help from the outside (OR=0.21, 95%CI: 0.05, 0.91), being able to relieve irritation caused by caregiving (OR=0.10, 95%CI: 0.03, 0.36), using the care service at home well (OR=0.24, 95%CI: 0.06, 0.98), and being able to pay more than 10,000 Japanese Yen by themselves as part of the total care service costs (OR=0.15, 95%CI: 0.04, 0.57) were associated with not being depressed. Conclusion: Caregivers should be supported not only informally but also by a new government funded system.

本研究では在宅要介護高齢者の入院・入所のリスク要因を検討した。追跡研究は札幌市内の7訪問看護ステーションで実施した。2008年10月に、86組からインフォームドコンセントが得られた。その内、15人の要介護高齢者は64歳以下であったので除外し、解析は71組で行った。2名が追跡期間中に死亡したが、在宅介護は成功したと考えて解析に含めた。追跡は6か月行い、郵送法で家族介護者から介護状況を確認した。女性介護者は男性介護者に比べ入院・入所のリスクは低かった（HR=0.17, 95%CI=(0.04, 0.80)）。本追跡研究は現在も継続しているので、将来の追跡結果も報告したい。

BACKGROUND: In Asia there are few reports considering time intervals in the examination of clinical features of primary biliary cirrhosis (PBC). Therefore, we tried to compare the characteristics of patients with PBC in two different years.METHODS: In two fiscal years (1999 and 2004), 9,761 and 13,142 patients with symptomatic PBC were registered to receive public financial aid from the Ministry of Health, Labour and Welfare of Japan, respectively. For the present study, clinical data from 2,127 patients in 1999 and 6,423 ones in 2004 were available. We compared the data in the two different years, including sex, age, major symptoms, and laboratory data.RESULTS: Male/female ratios were the same figure (0.13 for 1999 and 2004). The median age was significantly older in 2004 than in 1999 (59 years for 1999, 63 years for 2004, respectively, p

Confounding is a kind of bias which occurs in a research. Confounding is less frequent in randomized controlled trials (RCT) for evaluation of influenza vaccines. However, there are obstacles or difficulties in conducting RCT for evaluation of influenza vaccines, particularly, in the elderly people. Therefore, a retrospective or prospective cohort study has been primarily performed to evaluate effectiveness of influenza vaccine in elderly people. Confounding by indication or other confounding exist in most observational studies. Accordingly, at the stage of designing or analyzing a study, confounding should be controlled with a restriction, matching, stratified or multivariate analysis technique.

Ecological studies lack the ability to control for the effects of confounding factors. The findings of a linear relationship between average exposure and disease frequency in ecological studies do not imply that such a linear relationship will be present at the individual levels. This is known as the 'ecological fallacy'. Despite these limitations, ecological studies may be the best approach to studying exposures that are easier to measure at the group rather than the individual level because most ecological studies make use of routinely collected data. They are also useful for monitoring the effectiveness of population interventions such as vaccination programs, health education campaigns and mass screening programs. Thus, ecological studies are useful epidemiologic tools for public health surveillance if we know their limitations and interpret their results carefully. Ecological studies often help to generate hypotheses, although they rarely provide a strong test of a causal hypothesis.

Urination diseases--particularly urinary incontinence (UI)--strongly affect individuals' quality of life (QOL). It is important to maintain overall QOL in societies with an increasing number of long-living elderly people, such as in Japan. Thus, this study aims to clarify the risk factors concerning UI in elderly women.For this study, we obtained the approval of the Ethical Committee of Sapporo Medical University. In October 2010, we randomly selected 1,600 women, aged between 65 and 74 years, from the registry of Sapporo city residents and mailed out a self-administered questionnaire. Our questionnaire consisted of five subsections (24 items in total), including fundamental attributes, health condition, past history, present illness, and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The self-reported prevalence of UI was defined as frequent UI being at least once a week. A logistic regression analysis was used to assess the risk factors for UI.Among those who received the questionnaire, 802 women (response rate: 50.1%) returned a completed questionnaire with written informed consent. Their mean age (+/- standard deviation) was 69.8 +/- 2.6 years, and the prevalence of UI was found to be 29.7%. The mean scores (+/- standard deviation) of ICIQ-SF were 1.7 +/- 2.9 for all participating subjects, and 5.55 +/- 2.50 and 0.09 +/- 0.53 for the groups with or without UI, respectively. The results of the multiple logistic regression analysis were as follows: the odds ratio (95% confidence interval) was 1.94 (1.32, 2.85) for a past maximum weight heavier than or equal to 60 kg; 1.98 (1.18, 3.32) for a smoking index more than or equal to 300; 2.54 (1.47, 4.39) for a poor self-perceived health status; 1.62 (1.09, 2.40) for having a past history of bladder diseases; 1.72 (1.11, 2.69) for having a past history of hemorrhoidal disease; and 2.05 (1.36, 3.10) for a history of UI in one's mother.The self-reported prevalence rate of UI was 29.7% in women aged 65-74 years. In the future, we plan to conduct a follow-up survey to further clarify the risk factors of UI that have been implicated in this cross-sectional study.

The aim of this study is to clarify risk factors of urinary incontinence (UI) in elderly Japanese women.We randomly selected 1600 women, aged between 65 and 74 years, from the resident registration of Sapporo City and we analyzed 746 women, who responded twice on surveys in 2010 and 2011. UI was defined as frequent UI when it occurred at least once a week in both 2010 and 2011.Multivariate logistic regression analysis revealed that the past maximum body weight, smoking index, past history of bladder disease or hemorrhoids, and the participant's mother's history of UI were significantly associated with an increased risk of UI.Lifestyle habits such as weight gain and smoking habits were associated with an increased risk of UI in Japanese women. Further study is needed, because modification of these risk factors may possibly result in reducing risk of UI.

Background: The proportion of Japanese adults aged 65 years or older is predicted to increase; thus, it is becoming more important to identify factors that influence health status among elderly adults in Japan. We conducted a follow-up study of community-dwelling elderly adults to assess the relationship of hobby activities with mortality and incident frailty.Methods: We randomly selected 3583 individuals aged 65 to 84 years from the residential registries of 7 study areas in Hokkaido, Japan in August 2007. Among them, 1955 (54.6%) returned completed questionnaires with written informed consent by mail. The baseline assessment questionnaire comprised questions on current and past involvement in hobby activities, self-perceived health status, smoking and drinking habits, and body height and weight. Questions on hobby activities were from 4 categories: solitary physical, group physical, solitary cultural, and group cultural activities. We later conducted a follow-up survey of the participants to ascertain all-cause mortality and incident frailty. A Cox proportional hazards model was used for analysis of data from September 2007 to May 2010.Results: After adjusting for potential confounders, the risk of incident frailty among respondents participating in solitary physical activities was significantly lower than in those who did not participate in such activities (hazard ratio = 0.57; 95% CI 0.33, 0.99). Furthermore, the risk of incident frailty among respondents taking part in group cultural activities was significantly lower than in those who did not participate in such activities (0.41; 0.19, 0.87).Conclusions: These findings may be important for programs that seek to promote good health among elderly adults. Language: en

Depression affecting caregivers is a risk factor for discontinuing at-home care. The present cross-sectional study was conducted to evaluate factors related to depression among family caregivers.A cross-sectional study was conducted to evaluate factors related to depression among family caregivers of the frail elderly. The study included caregivers whose relatives received periodic visits from a nurse from one of seven Sapporo-based home-visiting nursing service stations in October 2008 or from one of nine Kochi-based home-visiting nursing service stations between June 2009 and March 2010. Caregivers were asked to answer a self-administered questionnaire about various factors that might affect their depression and to complete a Center for Epidemiologic Studies Depression Scale evaluation. We analyzed 127 pairs of responses in total.After we adjusted the results for the caregivers' gender and age, the factors that decreased the risk of depression in the Sapporo group related to relieving the stress that results from being a caregiver (OR = 0.12, 95%CI = [0.03, 0.42]) and the ability to independently pay more than ¥10 000 for part of care service costs (OR = 0.17, 95%CI = [0.05, 0.58]). In contrast, feeling ill was a factor that increased caregivers' risk of depression in the Kochi group (OR = 4.23, 95%CI = [1.29, 13.9]), but not in Sapporo group (OR = 2.53, 95%CI = [0.91, 7.08]). Caregivers in the Sapporo group were more likely to feel ill (P0.01) than their counterparts in Kochi.The Japanese government should take measures to reduce caregivers' depression. Otherwise family members will increasingly discontinue to provide at-home care.

To investigate the relationship between dietary intake of minerals and the risk of chronic obstructive pulmonary disease (COPD), a case-control study was conducted in central Japan. A total of 278 referred patients (244 men and 34 women) aged 50-75 years with COPD diagnosed within the past four years and 340 community-based controls undertook spirometric measurements of lung function. A structured questionnaire was administered face-to-face to obtain information on demographics and habitual food consumption. Dietary intakes of six major minerals were derived from the Japanese food composition tables. The COPD patients had lower habitual energy-adjusted intakes of calcium, phosphorus and iron than controls, but not sodium. A significant reduction in prevalence of COPD was observed for calcium, with adjusted odds ratio 0.65 (95% confidence interval: 0.37- 0.98) for the highest level versus lowest level of intake. A high iron intake was also inversely associated with the COPD risk. In conclusion, an inverse association was evident between dietary calcium intake and the risk of COPD for Japanese adults.

Cross sectional studies were conducted in five towns in Japan before and after the introduction of the Long-term Care Insurance System (LTCIS), in order to evaluate the factors relating to depression among family caregivers for the frail elderly. Depressive caregivers were more likely to consult with their doctors, to be in poor health, to care for demented elderly with behavioral disturbances than the non-depressive caregivers both before and after the LTCIS. Before LTCIS, depressive caregivers were more likely to attend to the elderly for more than 16 hours per day than their counterparts. After the LTCIS, depressive caregivers were more likely to be a spouse, to care for a frail elderly male, and less likely to be able to go out without accompanying the elderly than their counterparts. Even after the introduction of LTCIS, half of the caregivers were depressive. It is suggested that a government agency should be created to support not only the frail elderly but also their caregivers.

Many risk factors have been proposed for systemic lupus erythematosus (SLE). However, there is little information about the relationship between lifestyles and SLE in Japan. Two case control studies were conducted in Kyushu, southern Japan, and in Hokkaido, northern Japan, to examine the relationship between lifestyles and development of SLE in females. The participants were 78 patients and 329 controls in Kyushu and 35 patients and 188 controls in Hokkaido. Smoking was associated with an increased risk of SLE after adjusting for age in both regions. However, in Hokkaido, this association between smoking and SLE did not reach statistical significance after adjusting for alcohol drinking. The present study suggests that smoking may increase the risk of SLE among Japanese females.

The present study was conducted in October 2003 to investigate the factors related to psychological stress and the heavy burden of caregivers taking care of frail elderly persons in the northern part of the Onga district, Fukuoka Prefecture, Kyushu, Japan. A total of 40 caregivers were assessed using a self-administered questionnaire involving the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI) and thus described their own caregiving situation. J-ZBI research had been done on a yearly basis for the previous 5 years and the results of each investigation regarding Center for Epidemiologic Studies Depression Scale (CES-D), and incidence of depression, ADL and dementia were compared prior to and after initiation of public long term care insurance for the elderly (LTCI). Compared to caregivers with a middle or light burden, heavily burdened caregivers were more likely to have a higher J-ZBI, and CES-D. Compared to caregivers with a light burden, heavily burdened caregivers were more likely to 1) be in poor condition, 2) complain of their economical situation, 3) spend a longer time with care talker. Compared to caregivers with a middle burden, heavily burdened caregivers more frequently used short-stay services (i.e., temporary nursing home assistance). J-ZBI and ADL were compared to before LTCI, and 4 years after LTCI had been started. Scores for both were lower after 4 years. Compared to before LTCI, day-care and day service were used less frequently 3 and 4 years after LTCI. After LTCI, caregivers showed a lower J-ZBI score, but the incidence of depression among caregivers was higher, compared to the general public. It is suggested that a government agency should be created to support not only the frail elderly but also their caregivers.

A dramatic increase in the number of elderly people in Japan has led to a concurrent increase in the number of frail elderly in need of care. It is estimated that the number of frail elderly will reach 3.9 million by the year 2010. Family members are often both physically and mentally burdened with caring for the frail elderly. The present study was conducted to identify the risk factors for institutionalization among the frail elderly receiving in-home care in Japan.