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Smoking cessation is an achievable behavioral change, which reduces the risks of cardiovascular diseases, cancers and tobacco-related diseases. There is a need for an effective smoking cessation service for low and middle income country settings where the smoking rate is generally very high whilst a cessation service is not usually accessible. This study devised a new smoking cessation service package and assessed its effectiveness in the primary health care setting of northern Thailand. This randomized controlled trial was centered at Maetha district hospital, Lampang province, Thailand, and its network of mobile non-communicable disease clinics at seven primary care units. A total of 319 eligible patients who consented to participate in the study, were randomly allocated to an intervention arm (160) and a control arm (159), applying block randomization. The multi-component intervention service consisted of: The control group received the routine service comprising of brief counseling and casual follow-up. Smoking cessation, confirmed by six months of abstinence and the piCo+ Smokerlyzer breath test, was compared between the two services after a year follow-up. The trial is registered as an international current control trial at the ISRCTN registry. ISRCTN89315117. The median age of the participants was 64 years, with females constituting 28.84%. Most of the participants smoke hand-rolled cigarettes (85%). The intervention arm participants achieved a significantly higher smoking cessation rate than the control arm 25.62% vs 11.32%, with an adjusted odd ratio of 2.95 and 95% confidence interval 1.55–5.61. In relation to accessing smoking cessation services within the primary health care setting, participants who received the evidence-based intervention package were about three times more likely to succeed in giving up smoking than those who received the routine service. Utilizing community resources as major intervention components, the evidence from this trial may provide a useful and scalable smoking cessation intervention for low and middle income countries. Current controlled trials ISRCTN89315117 . WHO international clinical trial identifier number: U1111–1145-6916; 3/2013.

Background Global sodium intake remains above the recommended levels to control blood pressure (BP). We aimed to evaluate the efficacy of a dietary intervention on BP through salt reduction among community‐dwelling participants with high risk of cardiovascular disorders (CVD). Methods This cluster randomized trial (February 2012 to January 2013) included cooking instruction using the pocket salt meter among patients with diabetes and/or hypertension who were treated at health center in Thailand. Based on health centers, 8 clusters of eligible participants were randomly allocated to the 4 intervention and 4 control groups. Dietary intervention was performed at baseline, 1 month, and 3 months in intervention group. In both groups, systolic and diastolic BPs, and estimated 24 hours salt intake based on overnight urine samples were measured at baseline, 6 months, and 12 months. Results A total of 753 participants were enrolled (374 in the intervention group and 379 in the control group). In the mixed‐effects model, there were significant difference in SBP and estimated salt intake after adjusting covariates at 6 months (adjusted differences between groups [95% CI]; −7.55 [−5.61 to −9.49] mm Hg P, Our cluster randomized trial data revealed the effectiveness of a dietary intervention combining cooking instruction with visualization of estimated salt intake in reducing salt intake. This type of dietary intervention targeting salt intake reduction may contribute to BP management.

This study aimed to explain factors affecting health-related quality of life among community-dwelling elderly individuals living in Japan. We conducted a questionnaire survey of 898 individuals at senior citizens clubs in a rural area near the Tokyo metropolitan area in 2015, and analyzed the responses of 715 who provided valid responses. The survey questions included basic attributes (e.g., age, economic affluence), state of health (e.g., whether s/he has heart disease or not), the Spirituality Rating Scale Related to Health in the Elderly (SP Health Scale, composed of, e.g., meaning and purpose of living, self-transcendence), the Abbreviated Lubben Social Network Scale, and the MOS 8-Item Short Form Health Survey (SF-8). Multiple regression analyses were performed using the physical component summary (PCS) and mental component summary (MCS) of the SF-8 as dependent variables and all others as independent variables. Factors associated with improved PCS were economic affluence and SP Health Scale (meaning and purpose of living), while the factors associated with reduced PCS were age and state of health (heart disease, gastrointestinal disease, osteoarthritis, lower back pain, knee pain, and eligible for long-term care). Meanwhile, factors associated with improved MCS were economic affluence, while those that were associated with reduced MCS were state of health (cancer and headache) and SP Health Scale (self-transcendence). These results suggest the need to understand spirituality in addition to the subjective economic situation, age, and medical condition of elderly individuals in order to improve their physical and mental health.

Acupuncture and moxibustion, massage, bone-setting, manual therapy, and chiropractic treatments are representative components of orthopedic complementary and alternative medicine (OCAM) in Japan. However, the state of their utilization and characteristics are unclear, and have yet to be thoroughly surveyed. The objective of this study was to survey the utilization and characteristics of OCAM in the general public.In January 2011, we conducted a self-administered online questionnaire survey with 10,400 members of the general public, who were registered as consumer reviewers at the internet survey company. Survey topics were the use of OCAM within one month prior to the survey, the objective of using OCAM, and the presence or absence of consultation with and recommendation or referral by a physician. The subjects were divided into those who used and did not use OCAM as user and non-user groups, respectively, and the age, sex, and prevalence of past treatment for orthopedic diseases at medical institutions were compared between the groups. Data of 3,211 subjects (1,611 males and 1,600 females, mean age: 44.7 years old) were analyzed.Four hundred and thirty-eight subjects (13.6%) used OCAM within one month prior to the survey. The subjects in their forties used OCAM most frequently, followed by those in their twenties. The most frequent objective of OCAM usage was treatment, accounting for 63% (275 subjects) of the subjects. Fifty-three subjects (12.1%) consulted a physician, and 48 (11%) were recommended or referred by a physician. Upon logistic regression analysis, significant differences were detected in age, sex, and prevalence of treatment at a medical institution in the user group. A decreasing trend in the odds ratio correlated with subjects having received previous treatment at a medical institution, female subjects, and subjects of a younger age (p = 0.01; odds ratio = 4.33, 1.43, and 1.01, respectively), and these factors were independent.It was determined that 13.6% of the subjects had used OCAM, and many relatively young females (especially those in their forties or twenties) with a past medical history used it based on their own judgment.

In Japan, traditional gender roles of women, especially the role of motherhood, may cause early career resignations in female physicians and a shortage of female researchers. Besides this gender issue, a general physician shortage is affecting basic science fields. Our previous study suggested that female physicians could be good candidates for the basic sciences because such work offers good work-life balance. However, the attractiveness for female physicians of working in the basic sciences, including work-life balance, is not known. In a 2012 nationwide cross-sectional questionnaire survey, female physicians holding tenured positions in the basic sciences at Japan's medical schools were asked an open-ended question about positive aspects of basic sciences that clinical medicine lacks, and we analyzed 58 respondents' comments. Qualitative analysis using the Kawakita Jiro method revealed four positive aspects: research attractiveness, priority on research productivity, a healthy work-life balance, and exemption from clinical duties. The most consistent positive aspect was research attractiveness, which was heightened by medical knowledge and clinical experience. The other aspects were double-edged swords; for example, while the priority on research productivity resulted in less gender segregation, it sometimes created tough competition, and while exemption from clinical duties contributed to a healthy work-life balance, it sometimes lowered motivation as a physician and provided unstable income. Overall, if female physicians lack an intrinsic interest in research and seek good work-life balance, they may drop out of research fields. Respecting and cultivating students' research interest is critical to alleviating the physician shortage in the basic sciences.

Background In Japan, the field of Basic Sciences encompasses clinical, academic, and translational research, as well as the teaching of medical sciences, with both an MD and PhD typically required. In this study, it was hypothesized that the characteristics of a Basic Sciences career path could offer the professional advancement and personal fulfillment that many female medical doctors would find advantageous. Moreover, encouraging interest in Basic Sciences could help stem shortages that Japan is experiencing in medical fields, as noted in the three principal contributing factors: premature resignation of female clinicians, an imbalance of female physicians engaged in research, and a shortage of medical doctors in the Basic Sciences. This study examines the professional and personal fulfillment expressed by Japanese female medical doctors who hold positions in Basic Sciences. Topics include career advancement, interest in medical research, and greater flexibility for parenting. Methods A cross-sectional questionnaire survey was distributed at all 80 medical schools in Japan, directed to 228 female medical doctors whose academic rank was assistant professor or higher in departments of Basic Sciences in 2012. Chi-square tests and the binary logistic regression model were used to investigate the impact of parenthood on career satisfaction, academic rank, salary, etc. Results The survey response rate of female physicians in Basic Sciences was 54.0%. Regardless of parental status, one in three respondents cited research interest as their rationale for entering Basic Sciences, well over twice other motivations. A majority had clinical experience, with clinical duties maintained part-time by about half of respondents and particularly parents. Only one third expressed afterthoughts about relinquishing full-time clinical practice, with physicians who were parents expressing stronger regrets. Parental status had little effect on academic rank and income within the Basic Sciences, Conclusion Scientific curiosity and a desire to improve community health are hallmarks of those choosing a challenging career in medicine. Therefore, it is unsurprising that interest in research is the primary motivation for a female medical doctor to choose a career in Basic Sciences. Additionally, as with many young professionals with families, female doctors seek balance in professional and private lives. Although many expressed afterthoughts relinquishing a full-time clinical practice, mothers generally benefited from greater job flexibility, with little significant effect on career development and income as Basic Scientists. Electronic supplementary material The online version of this article (10.1186/s12960-017-0241-0) contains supplementary material, which is available to authorized users.

Background:Smoking cessation is most needed but, least accessible public health intervention in developing countries. Practicality of smoking cessation interventions determines their feasibility to implement in resource-limited setting.Objectives:This review aimed at identifying strategic mechanisms to launch accessible smoking cessation services within primary health care settings of developing countries.Methods:The efficacy of smoking cessation methods were reviewed in Cochrane reviews and clinical trials. Relevant research with an outcome of smoking cessation for six months and articles published after 2000 indexed in the PubMed database were reviewed. The practicality of each intervention was narratively appraised with further reviewing relevant effectiveness trials and observational studies.Finding and discussion:Contemporary evidence favours multi-components smoking cessation strategy combining more than one efficacy-proven methods such as brief advice, nicotine replacement therapy (NRT) and nursing intervention. Future trials to evaluate social and family influences on smoking behaviour in combination with above interventions are necessary. Moreover, training health care professionals in primary health care to implement smoking cessation intervention may overcome human resource insufficiency and ensure smokers’ access to cessation service within the community setting.

Objective To evaluate the efficacy and safety of the β3-adrenoceptor agonist mirabegron, in a Japanese population with overactive bladder (OAB). Patients and methods This randomised, double-blind, placebo-controlled phase III study enrolled adult patients experiencing OAB symptoms for ≥24 weeks. Patients with ≥ 8 micturitions/24 h and ≥1 urgency episode/24 h or ≥1 urgency incontinence episode/24 h were randomised to once-daily placebo, mirabegron 50 mg or tolterodine 4 mg (as an active comparator, without testing for non-inferiority of efficacy and safety) for 12 weeks. The primary endpoint was the change in the mean number of micturitions/24 h from baseline to final assessment. Secondary endpoints included micturition variables related to urgency and/or incontinence and quality-of-life domain scores on the King's Health Questionnaire. Safety assessments included adverse events (AEs), post-void residual urine volume, laboratory variables, vital signs and 12-lead electrocardiogram. Results A total of 1139 patients were randomised to receive placebo (n = 381), mirabegron 50 mg (n = 380) or tolterodine 4 mg (n = 378). Demographic and baseline characteristics were similar among the treatment groups. At final assessment, mirabegron was significantly superior to placebo in terms of mean [sd] change from baseline in number of micturitions/24 h (-1.67 [2.212] vs -0.86 [2.354]; P Conclusions Mirabegron 50 mg once daily is an effective treatment for OAB symptoms, with a low occurrence of side effects in a Japanese population.

1 Objectives To evaluate the efficacy and safety of the β3-adrenoceptor agonist, mirabegron, compared with placebo in Japanese patients with overactive bladder (OAB). 2 Methods Patients with OAB symptoms for ≥24 weeks, ≥8 micturitions/24 h on average, and ≥1 episode of urgency and/or urgency incontinence/24 h were randomized to mirabegron (25, 50 or 100 mg) or placebo for 12 weeks. The primary endpoint was change from baseline to end of study in the mean number of micturitions/24 h. Secondary endpoints included micturition variables related to urgency, incontinence, volume voided, and quality of life based on the King's Health Questionnaire (KHQ). Safety was evaluated based on adverse events (AEs), laboratory findings, vital signs, electrocardiogram, and post-void residual volume. 3 Results In total, 842 patients were randomized to placebo (n = 214), mirabegron 25 mg (n = 211), 50 mg (n = 208), or 100 mg (n = 209). The primary endpoint was significantly improved in each mirabegron group compared with placebo (P

This cross-sectional study (February 2012 to March 2013) was conducted to estimate daily salt intake and basic characteristics among 793 community-dwelling participants at high risk of cardiovascular disease (Framingham risk score15%), who had visited diabetes or hypertension clinics at health centres in the Muang district, Chiang Rai, Thailand. We performed descriptive analysis of baseline data and used an automated analyser to estimate the average of 24-hour salt intake estimated from 3 days overnight urine collection. Participants were divided into two groups based on median estimated daily salt intake. Mean age and proportion of males were 65.2 years and 37.6% in the higher salt intake group (=10.0 g/day, n=362), and 67.5 years and 42.7% in the lower salt intake group (10.0 g/day, n=431), respectively (p=0.01, p0.01). The higher salt intake group comprised more patients with a family history of hypertension, antihypertensive drug use, less ideal body mass index (18.5-24.9), higher exercise frequency (=2 times weekly) and lower awareness of high salt intake. Among higher salt intake participants, those with lower awareness of high salt intake were younger and more often had a family history of hypertension, relative to those with more awareness. Our data indicated that families often share lifestyles involving high salt intake, and discrepancies between actual salt intake and awareness of high salt intake may represent a need for salt reduction intervention aiming at family level. Awareness of actual salt intake should be improved for each family.此橫斷性研究（2012 年2 月至2013 年3 月）為評估居住在社區具高心血管疾病 風險（Framingham 危險分數15%）的793 名參與者的鹽攝取量及其基本特性， 他們曾因糖尿病或是高血壓至泰國清萊府Muang 區的健康中心就診。我們分析 參與者的基本特性，並使用自動化分析儀評估所收集的三天隔夜尿液，藉此推 估平均24 小時鹽攝取量。依照估算的每日鹽攝取量中位數將參與者分成高鹽 （=10.0 g/day，n=362）及低鹽（10.0 g/day，n=431）攝取量組，兩組對象的平均年齡及男 性比例分別為65.2 歲、67.5 歲及37.6%、42.7%（p=0.01, p0.01）。高鹽攝取組 有較多參與者有家族高血壓病史、使用抗高血壓藥、較少人介於理想身體質量 指數範圍（18.5-24.9）、較高的運動頻率（每週大於等於兩次）與較低的高鹽攝 取認知。在高鹽攝取組中，那些對高鹽攝取認知低者比起相對認知高者，較為 年輕且有較多人有家族高血壓病史。我們的資料顯示，家庭成員經常共有涉及 高鹽攝取的生活習慣。而實際鹽分攝取量與對高鹽攝取認知之間的差異可能代 表需要將減鹽介入的目標放在家庭層次。每個家庭之實際鹽分攝取量的認知應 該被改善。.

Objective: This study examined Japanese mothers’ satisfaction with food-safety education in primary schools, compared the characteristics of mothers who were not satisfied, and identified topics that should be included in food-safety education, according to mothers. Design: An online survey was conducted in March 2011 in Japan. The questionnaire included topics related to food-safety education and satisfaction regarding food-safety education. Setting: Japanese mothers with children attending primary school were asked to complete an online questionnaire. Method: A total of 1,300 mothers completed questionnaires. The sample was divided into two groups according to median scores for satisfaction with food-safety education, and chi-square tests were used to compare data related to other questions. The numbers of mothers who selected each topic for inclusion in food-safety education were calculated. Results: Participants were divided into two groups; high satisfaction ( n = 796, 61.2%) and low satisfaction ( n = 504, 38.8%). The low-satisfaction group consisted of mothers who described government action related to the food-safety problem as ‘inadequate’ ( n = 305, 60.5%) and who disagreed with the notion that food items can be 100% safe ( n = 146, 29.0%). More than half of the mothers endorsed ‘judging freshness’, ‘reading food labels’, and ‘food additives’ as important topics to include in food-safety education. Conclusion: Japanese mothers who were not satisfied with food-safety education were more likely to consider government actions inadequate and to disagree with the notion that food items can be 100% safe. Mothers wanted schools to teach not only the prevention of food-borne illnesses but also other topics related to food safety.

PURPOSE The BCG immunization has long been performed in Japan. Although the BCG immunization service is the responsibility of the municipality, the manner in which the BCG immunization is delivered differs from municipality to municipality. The purpose of this study was to clarify how the different manner of the BCG immunization delivery systems influenced the BCG immunization coverage. METHODS The study of BCG immunization coverage was conducted in the Tama area located in the western suburbs of Tokyo in 2004. The birth data and the immunization history by the age of 3 years were collected in the three-year-old health check-up from a total of 2,341 children residing in the Tama area. Based on the age at immunization for each child, the BCG immunization coverage was calculated according to the types of the BCG immunization delivery system. The immunization types were defined as follows; the BCG immunization given on the occasion of the mass health check-up (Group 1); the exclusive mass BCG immunization in a monthly service (Group 2); the exclusive mass BCG immunization in a bimonthly service (Group 3); the exclusive mass BCG immunization in services of fewer than every two months (Group 4); and the immunization given on an individual basis by a general practitioner (Group 5). A univariate analysis was performed to examine the relationship between the BCG immunization coverage by the age of 6 months and the difference among the BCG immunization delivery systems, followed by a multivariate regression analysis to adjust for the factors related to the demography, health care services and the socio-economic status of the municipalities. RESULTS Unadjusted odds ratios and adjusted odds ratios for BCG unimmunized children under the age of 6 months by the BCG immunization delivery manner groups were OR 1 reference, adj. OR 1 reference in Group 1; OR 1.42 CI 0.87-2.29, adj. OR 4.01 CI 2.24-7.11 in Group 2; OR 4.96 CI 3.66-6.82, adj. OR 15.59 CI 10.10-24.49 in Group 3;OR 18.60 CI 13.77-25.49, adj. OR 48.17 CI 29.62-79.75 in Group 4; and OR 4.24 CI 2.86-6.31, adj. OR 15.61 CI 9.05-27.26 in Group 5. The univariate analysis and multivariate regression analysis revealed an influence of the BCG immunization delivery manner on the BCG immunization coverage. CONCLUSION The choice of BCG immunization delivery manner is very important to raise the BCG immunization coverage. The BCG immunization given on the occasion of the mass health check-up and the high-frequent immunization service are thought to improve the BCG immunization coverage.

Objective To identify whether university students who have both food-safety knowledge and beliefs perform risk-reduction behaviors. Design Cross-sectional research using a questionnaire that included food-safety knowledge, perceptions, risk-reduction behavior, stages for the selection of safer food based on the Transtheoretical Model, and demographic characteristics. Setting Four universities in eastern Japan and 2 universities in western Japan. Participants University students (n = 799). Main Outcome Measures Food-safety knowledge, beliefs, and risk-reduction behaviors. Analysis Answers on measures assessing risk perception and food-safety knowledge were combined to form 4 groups of participants. Relationships among demographic characteristics, the 4 groups, risk-reduction behaviors, stage of change, and severity and susceptibility were assessed. Results The proportion of students who had more knowledge of food safety and a belief that “there are no 100% safe food items” was high in the group that frequently performed risk-reduction behaviors, as it was in the group who had taken a basic class about food or health care and who had, or were working toward, a food or nutrition qualification. Conclusions and Implications University students who thought that there were no 100% safe food items and who had more knowledge about food safety were more likely to confirm food-safety information when selecting food.

Background: Undue parental fear of fever in children was termed “fever phobia” by Schmitt following a survey in the USA in 1980. In 2000, Crocetti et al. conducted the same survey and concluded that fever phobia existed even 20 years later. In this study, we explore differences in fever phobia between these two US populations and a Japanese sample, and determine whether parents of a single child or those whose child was previously hospitalized or had a febrile seizure report greater anxiety about fever. Methods: A questionnaire was distributed to parents of children who visited a pediatric outpatient clinic in Juntendo University Nerima Hospital between 19 and 30 November 2007. Results: Data was obtained from 211 parents who agreed to participate in the study. Compared with much smaller proportions reported in the two previous studies, 62% of caregivers considered a temperature below 37.8°C to be a fever, although less than half of parents reported that they were “very worried” about fever. Over 90% identified doctors and nurses as their primary information source. In contrast to 7% of parents in the US studies, almost no parents reported that temperatures could rise to or above 43.3°C if fever was left untreated; however, 63% of parents stated that they would visit a hospital. Conclusions: Fever phobia exists on both sides of the border, and while caregivers in Japan appear to have a more accurate understanding of fever, they are more likely to rely on health-care professionals to manage the condition.

Objectives The purpose of this study was to determine which zoonoses should the general population be more aware of. Methods We conducted qualitative research (Delphi method) on thirty veterinarians who were selected from the whole country. Results Twenty-four diseases were selected. The reasons for their selection were classified into three categories: "Amount of knowledge, attitude and behavior", "Clinicoepidemiologic characteristics" and "Social characteristics". More than half of the top ten zoonoses are those that are not transmitted from humans to humans, with rabies in the first place, avian influenza (with its high pathogenicity) in the second place and psittacosis in the third place. Conclusions From the top ten diseases, it is considered that the prevention of animal-to-human transmission should be emphasized. In addition, from the reasons for the selection, it is suggested that it is necessary to review social characteristics, such as the inadequacy of quarantine and the insufficiencies of legal systems. As for the zoonoses that are transmitted from humans to humans, it will be indispensable in the future to widely spread information on zoonoses and enlighten the general population about them. It is thought that this survey can be a basis for selecting a zoonosis that should be given priority in enlightening the general population.

Study design Prospective, randomized, controlled trial. Objective To investigate the effectiveness of home-based exercise on pain, dysfunction, and quality of life (QOL) in Japanese individuals with chronic low back pain (CLBP). Summary of background data Exercise therapy is a widely used treatment for CLBP in many countries. The studies on its effectiveness have been performed only in Western industrialized countries. The existence of cross-cultural differences and heterogeneity of patients in each country may influence the outcome of interventions for CLBP. Data that would enable researchers to compare the effectiveness of interventions between widely different societies is lacking. Methods A total of 201 patients with nonspecific CLBP were randomly assigned to either the control or exercise therapy group: 89 men and 112 women with a mean age of 42.2 years. The control group was treated with nonsteroidal anti-inflammatory drugs (NSAIDs), and the exercise group performed trunk muscle strengthening and stretching exercises. The primary outcome measures were pain intensity (visual analogue scale) and dysfunction level (Japan Low back pain Evaluation Questionnaire [JLEQ] and Roland-Morris Disability Questionnaire [RDQ]) over 12 months. The secondary outcome measure was FFD (Finger-floor distance). Statistical analysis was performed using Wilcoxon signed-ranks and Mann-Whitney U tests, and estimation of the median with 95% CI was calculated. Results In both groups, significant improvement was found at all points of follow-up assessment. However, JLEQ and RDQ were significantly more improved in the exercise group compared to the control group (P = 0.021 in JLEQ, P = 0.023 in RDQ). The 95% CI for the difference of medians of the change ratio between exercise and NSAID groups, [Exercise] - [NSAID], was -0.25 to -0.02 in JLEQ, -0.33 to 0.00 in RDQ, and -0.20 to 0.06 in visual analogue scale. Conclusion The home-based exercise prescribed and monitored by board-certified orthopedic surgeons was more effective than NSAIDs for Japanese patients with CLBP.

本研究では，管理栄養士・栄養士が，消費者に必要と考える食の安全の知識を調査することを目的とした。全国の管理栄養士・栄養士30名に協力を依頼し，22名（73.3％）から同意が得られた。質的調査法であるデルファイ法を用いて，3回にわたる質問紙調査を実施した。調査対象者は，食の安全に関する様々な項目について，優先順位をつけた。3回の調査の回収率は，第1回調査から順に100％（22人），95.5％（21人），95.5％（21人）であった。3回の調査を経て，最終的には35項目が得点し，上位10項目のうち第1，4，10位は「残留農薬」に関する項目であった。上位10項目の選出理由では「消費者」の「内面」および「行動」を中心にして，「社会の抱える課題」「周囲の人」「専門家」「生産者」との関連がみられた。管理栄養士・栄養士は，消費者の感情や行動に影響を及ぼす事項が食の安全教育に必要だと考えている。またその理由には，消費者自身の内面や行動，および社会の課題が関係していることが示唆された。今後は，専門家あるいは消費者を対象としたさらなる調査を行い，消費者にとって必要な食の安全に関する知識を確認することが必要である。（オンラインのみ掲載）

Parasitic infections are widespread in developing countries. Enterobiasis, caused by the Enterobius vermicularis nematode, is probably the most common helminth infecting the humanrace. We studied fecal specimens from Japanese residents in developing countries to determine the prevalence of E. vermicularis infection in this population. Individual specimens were collected using the cellophane tape method from Japanese residents in Asia, the Middle East, East Europe, Africa, and Central and South America in 2004. The specimens were examined in Japan. Subjects surveyed numbered 2247. The E. vermicularis infection rate was 0.62%. The most children infected with E. vermicularis ranged between 5 and 8 years of age. The prevalence of infection among Japanese children living in developing countries was 1.82%, higher than that in those living in Japan. Our results underscore the need to continue preventive measures such as health education to eradicate E. vermicularis infection in this group.

Both theoretical and empirical studies have documented the protective effect of religiosity and spirituality on general health in older adults in community and hospital settings; however, no study has documented the relationship between spirituality and depression among older adults living alone in communities in Korea. We tested two hypotheses: Hypothesis 1: Korean older adults living alone would be more depressed and less healthy than older adults living with family, and Hypothesis 2: Individuals who are more religious and spiritual would report a lower level of depression and a higher level of general health even when other demographic and living status variables are controlled. A descriptive, comparative, and correlational design with a convenience sampling method was conducted among community-dwelling Korean older adults in Chounbook Providence, South Korea. This study included 152 men and women older than 65 years old. Hypothesis 1 was supported as Korean older adults living alone were significantly more depressed than were older adults living with family (P.01). However, for Hypotheses 2, only spirituality activities and Spirituality Index of Well-Being scores were significantly associated with general health and/or depression (P.01), but there were no relationships between the variables of attendance and importance of religion with general health and depression.

Aim: To clarify the health-related conditions of Japanese expatriate children in Thailand. Methods: Records of Japanese children who consulted outpatient clinics at Bangkok Hospital in 2005 and 2006 (n = 2141) were analysed, and then compared with data from the patient survey conducted by the Ministry of Health, Labour and Welfare of Japan in 2005 (n = 575 400). Results: ‘diseases of the respiratory system’, categorized as chapter X under ICD-10 was the most frequent category in both Thailand and Japan. Although ‘certain infectious and parasitic diseases’ (chapter I) was the second most frequent category in Thailand, it was infrequent in Japan. In the subcategories of ‘diseases of the respiratory system’, ‘acute upper respiratory infections’ was frequent and asthma was infrequent in Thailand. Conversely, ‘acute upper respiratory infections’ showed a low percentage and asthma was the most frequently observed disease in Japan. Conclusion: This study examined Japanese children having the same genetic background but divided into two groups according to different living environments. Results demonstrate that children living in Japan contract asthma more frequently than infectious diseases, whereas those living in Thailand show the opposite trend, which supports the hygiene hypothesis that infections may protect against the development of allergic diseases, such as asthma.

Objective To identify specific infectious diseases about which the Japanese public should be informed. Materials and methods A Delphi survey was conducted, recruiting 26 physicians who are engaged in clinical practice of infectious diseases and working at designated medical institutions of infectious diseases in Japan. Results Following HIV/AIDS (first ranked), tuberculosis (second) and influenza (third), 24 diseases in total were identified based on "knowledge, awareness and behavior of inhabitants" or "social and clinico-epidemiological circumstances". Scores for the top three ranked diseases were more than two-folds of those for following diseases. Among the top 10 ranked diseases, 9 were in common with the previous survey result among public health physicians and veterinarians working for governmental agencies. Discussion Our findings of scores for specific diseases most likely reflect an importance of performing preventions and early diagnoses of severe diseases and promoting prophylaxis for travelers' diseases which tend to be factors for prioritizing infectious diseases among clinicians. The top-scored diseases among clinicians were consistent with those among public health officers, indicating the critical need to inform the public about these diseases. Nevertheless, both clinicians and public health experts have already attempted to promote preventions and/or treatment for these diseases in the previous time, and thus, the previous experience must be critically reviewed and reconsidered for improvements. In future, the similar surveys to ours should target specific subjects of experts and investigate more specific types of infectious diseases. Following such an expert survey, concrete action plans to inform the public about prioritized diseases are also called for.

Objectives: No public consensus exists yet on handling Biosafety Level 4 agents and no laboratory is operational at BSL4 in Japan. A discussion that includes neighboring residents and experts should be initiated to communicate risks. In this article, we present the current situation and prioritize problems we presently face. Methods: A three-stage Delphi survey was conducted. The subjects were twenty-two persons with extensive experience and knowledge of infectious diseases. Seven projections and issues were made with regard to the problems arising from the lack of an operational BSL4 laboratory. These were tabulated by the KJ method. The top seven projections were scored, such that the top received 7 points and the last received 1 point. Results: A total of 51 projections were obtained for the first part of the survey, 39 for the second, and 29 for the last. The projection with the highest score was that it is impossible to cope with newly emerging infectious diseases. The second was that complete diagnoses are impossible without a BSL4 laboratory. All projections and issues were divided into the following four main groups: issues for researchers and laboratory staff, clinical practice and research on BSL4 agents, domestic and global security, and Japan’s international position. Conclusion: We clarified possible problem arising from not having BSL4 laboratories in Japan. The identification of projections by the Delphi survey in this study should be considered as one of many attempts to develop effective risk communication strategies.

Objectives: The objective of this study is to gather statistical references on food safety education that encourages competence of food choice from the view-point of food safety. A survey on the involvement of the risk communication program on food safety in municipal governments and the attitude of local dietetics professionals towards the program was conducted. Methods: In November, 2006, self-reported questionnaires were mailed to 1990 local dietetics professionals who worked in municipal governments in Japan. Descriptive statistics and cross tables were used for data analysis. Results: 1162 questionnaires were mailed and 1130 available surveys were returned. Among the respondents, 41.5% answered that they inform the community about food safety, but 49.9% answered that they did not get information from the community. Most of the respondents answered that risk communication of food safety was important; 21.8% answered “extremely agree” and 62.3% answered “rather agree” on a scale of four from “extremely agree” to “do not agree”. More than one-half of the dietetics professionals answered that their confidence in conducting risk communication was low; 20.5% answered “no confidence” and 52.5% answered “hardly have confidence” on a scale of four from “without confidence” to “with confidence”. More than 80% of the respondents answered that they needed “professional knowledge” and “support from professional agencies”. Conclusion: This study suggests that educating local dietetics professionals about professional knowledge on food safety, and obtaining support from special agencies will be essential in the upgrade of risk communication program on food safety in a community.

The characteristics were studied of risk communication regarding food safety (i.e., two-way, one-way, or not in practice) by local public agencies. The staff in charge of nutrition at public agencies in Japan were surveyed in November 2006 by means of a questionnaire answered anonymously. Answers concerning risk communication practices with residents were classified into three groups: ‘two-way,’ ‘one-way,’ and ‘not in practice.’ A cross-sectional analysis and chi-square test were used to assess each characteristic and differences between the groups for the other questions.Responses on risk communication practices with residents showed 144 (12.4%) responses as ‘two-way,’ 371 (31.9%) as ‘one-way,’ and 613 (52.8%) as ‘not in practice.’ The percentage of the ‘two-way’ group was significantly (p

To examine the effect of home-based exercise on knee osteoarthritis among Japanese in comparison with that of nonsteroidal antiinflammatory drugs (NSAIDs).An open-labeled, randomized, controlled, multiclinic trial compared home-based quadriceps exercise with NSAIDs. Treatments were basically evaluated after 8 wks and compared with the baseline scores. Outcomes were evaluated with a set of psychometric measurements including the Western Ontario and McMaster Universities Arthritis Index (WOMAC), 36-Item Short-Form Health Survey (SF-36), Japanese Knee Osteoarthritis Measure (JKOM), and pain with the visual analog scale.A total of 142 patients entered this trial to provide the baseline data. After 21 cases withdrew, the final number analyzed was 121 cases: 63 for the exercise group and 58 for the NSAIDs group. Between these two groups, there was no significant difference in gender, age, body height and weight, body mass index, or each score at baseline. The subjects in both groups showed improvements in all scores at the end of intervention. The difference in improvement rate of each score between the two groups was not statistically significant, though the mean rank score measured with JKOM in the exercise was slightly better than that of the NSAIDs.Home-based exercise using quadriceps strengthening improves knee osteoarthritis no less than NSAIDs.

Objectives: We studied 1365 male workers at a Japanese computer worksite in 2004 to determine the relationship between employees' time management factor of visual display terminal (VDT) work and General Health Questionnaire (GHQ) score.Methods: We developed questionnaires concerning age, management factor of VDT work time (total daily VDT work time, duration of continuous work), other work-related conditions (commuting time, job rank, type of job, hours of monthly overtime), lifestyle (smoking, alcohol consumption, exercise, having breakfast, sleeping hours), and the Japanese version of 28-item General Health Questionnaire (GHQ). Multivariate logistic regression analyses were performed to estimate the odds ratios (ORs) of the high-GHQ groups (>6.0) associated with age and the time management factor of VDT work.Results: Multivariate logistic regression analyses indicated lower ORs for certain groups: workers older than 50 years old had significantly a lower OR than those younger than 30 years old; workers sleeping less than 6 h showed a lower OR than those sleeping more than 6 h. In contrast, significantly higher ORs were shown for workers with continuous work durations of more than 3 h compared with those with less than 1 h, those with more than 25 h/mo overtime compared with those with less, those doing VDT work of more than 7.5 h/day compared with those doing less than 4.5 h/day, and those with more than 25 h/mo of overtime compared with those with less.Conclusion: Male Japanese computer workers' GHQ scores are significantly associated with time management factors of VDT work.

Background : The male-to-female ratio of infection for HIV/AIDS has rarely been reported since the 1990s. We previously calculated the country-specific male-to-female ratio of people living with HIV/AIDS, in 1999, 2001, and 2003. Methods : The data of people living with HIV/AIDS and the HIV adult rate were obtained from the table of country-specific HIV/AIDS estimates in the Report on the global HIV/AIDS epidemic, UNAIDS. Results : The male-to-female ratios of the countries in Africa region were reported to be below 1.00 in 1999, 2001, and 2003. The ratios of the countries in other regions were all over 1.00, except for the Bahamas in 2001, Haiti in 2001 and 2003, Jamaica in 2001, Guyana in 2001 and 2003, and Honduras in 2001 and 2003. The male-to-female ratios significantly decreased in Africa and Latin America region between 1999 and 2003 according to the Wilcoxon signed rank test (p< 0.0005). The countries with a high HIV adult rate tended to have lower male-to-female ratios and vice versa in 1999, 2001, and 2003 according to the Wilcoxon rank sum test (p< 0.005). In the 1980s homosexual or bisexual transmission and transmission through drug-injecting behavior were the major modes of spreading HIV in North America, Australia, and Europe where the male-to-female ratios were 10-15. In contrast, heterosexual transmission predominated in Africa, the Caribbean and Latin America where the male-to-female ratios were 1-5. Conclusions : These results indicate that the ratios have therefore been declining in most countries recently, and even within the four-year period between 1999 and 2003, a decreasing tendency was observed in Africa and Latin America.

In early 1946, immediately after World War II, there was a smallpox epidemic in Japan. In this paper we investigated trends in the occurrence of smallpox by week and region using official documents of the General Headquarters, Supreme Commander for the Allied Powers (GHQ/SCAP), which are stored in the National Diet Library Modern Japanese Political History Materials Room, and summarized the measures taken against this epidemic. The following two points were clarified: 1) The 1946 smallpox epidemic peaked in Week 13 (March 24-30; 1,405 new patients), and the highest morbidity during this epidemic was seen in Hyogo Prefecture, followed by Osaka Prefecture, Aichi Prefecture, Tokyo Prefecture, and Hokkaido Prefecture. 2) Measures taken against this epidemic were classified into the following three stages: 1. "Vaccine shortage/Manufacture acceleration stage," 2. "Vaccine sufficiency/Smallpox vaccination program implementation stage," and 3. "Detection of defects in vaccination technique/Reimplementation of the smallpox vaccination program stage".

Objectives : This study investigated the effect of the helmet act for motorcyclists on increasing helmet use and reducing motorcycle-related deaths and severe injuries in Thailand. Methods : Data were derived from a trauma registry at the Khon Kaen Regional Hospital in the northeast Thailand. Helmet use and outcome in motorcycle crashes were compared 2 years before (1994–1995) and after (1996–1997) enforcement of the helmet act. During the study period, there were 12,002 injured motorcyclists including 129 death cases in the municipality of Khon Kaen Province who were brought to the regional hospital. Results : After enforcement of the helmet act, helmet-wearers increased five-fold while head injuries decreased by 41.4% and deaths by 20.8%. Those who had head or neck injuries or died were less likely wearing a helmet. Compliance of helmet use was lower at night. Fatality of injured motorcyclists did not significantly decrease in the post-act period and among helmet-wearers. Conclusion : Enforcement of the helmet act increased helmet-wearers among motorcyclists but helmet use did not significantly reduce deaths among injured motorcyclists. Motorcyclists should be instructed to properly and consistently wear a helmet for their safety.