Public health nurses fostering self-help health promotion groups for older people.

OBJECTIVE: Public health nurses foster self-help groups that are intended to solve health problems and improve the health of older people. This study aims to clarify how public health nurses foster such self-help groups. DESIGN: This is a qualitative study that utilizes one-to-one semi-structured interviews. SAMPLE: The participants comprised 11 full-time public health nurses who had experience in fostering self-help groups and had at least 5 years of experience as public health nurses. MEASUREMENTS: Interview transcripts were created, and a qualitative analysis was performed inductively. RESULTS: In total, 33 themes, 14 theme clusters, and four categories were extracted. The categories were as follows: coordinating with relevant occupations and residents to collect community information and solve health problems, organizing classes from health promotion to member-centered group activities, ensuring group development support and establishing a support system, and supporting leaders behind the scenes. CONCLUSIONS: Public health nurses begin by gathering information about a given community and sharing local health problems with public health authorities and residents. The nurses build trusting partnerships with members and assign appropriate roles to them to better address their problems. Additionally, the nurses provide indirect group support by encouraging leaders as needed.

Maternal and placental risk factors for light-for-gestational-age births.

AIM: We conducted a cross-sectional study to investigate risk factors for births of light-for-gestational-age (LGA) infants. METHODS: A survey was conducted at the Department of Obstetrics and Gynecology at Sapporo Medical University Hospital in Sapporo, Japan from 2013 to 2014. LGA and appropriate for gestational age (AGA) are defined as having a birthweight below the 10th percentile and between the 10th percentile and 90th percentile for gestational age at birth in the population standard of gestational age, sex, and parity, respectively. An odds ratio (OR) and its 95% confidence interval (95%CI) for LGA were calculated by analysis using the logistic regression model. RESULTS: In total, 307 inpatients (94.2%) participated in the study out of 326 consecutive post-partum inpatients. Among them, 37 infants and 237 infants were classified into the LGA and AGA groups, respectively. As a result of multivariable analysis, prevalence of gestational hypertension (OR = 8.96, 95%CI 1.81-44.35) and the presence of placental infarction (OR = 9.65, 95%CI 1.76-53.01) were significantly associated with an increased risk of LGA. Placentas weighing 510-603 g and ≥604 g were significantly associated with reduced risk of LGA (OR = 0.04, 95%CI 0.01-0.29 and OR = 0.03, 95%CI 0.01-0.32, respectively), and higher placental weights were significantly observed in the trend for reduced LGA risk (P for trend < 0.001). CONCLUSION: We found that the prevalence of gestational hypertension, lower placental weight, and the presence of placental infarctions were all independently associated with the risk of LGA. Placental abnormalities may be etiologically important for LGA risk, though further research is necessary.

Relationship between hepatocellular carcinoma and impaired glucose tolerance among Japanese.

BACKGROUND/AIMS: Both the incidence of diabetes mellitus (DM) and mortality from Hepatocellular carcinoma (HCC) are increasing in Japan. As the association of overall cancer and HCC with impaired glucose tolerance (IGT) has been studied rarely in the world including Japan, this study assessed their associations using cohort data of Hokkaido, Japan. METHODOLOGY: After getting ethical consent, this study included 908 men and 1,081 women aged 30-77 years during 1977-78 and collected detailed information using the baseline survey. The subjects were followed until 2002 and deaths were recorded using ICD-9. Classifying them into three groups of diabetes status namely DM, IGT, and normal, the relative risk (RR) of mortality was estimated by diabetes status using multivariate Cox model. RESULTS: This study revealed no association between overall cancer and diabetes status. However, the RR of mortality from HCC was about 11 times (HR= 10.8, 95%CI: 1.3-92.5) higher in IGT compared with normal group. DM group also showed higher risk of mortality than normal group. CONCLUSIONS: HCC mortality was significantly high among IGT group. However, as the results of the study were based on small data, further studies with large cohort are needed to address the association of IGT with overall cancer and HCC mortality in Japan.

[Burden among caregivers of the frail elderly and its correlation with the introduction of a long-term care insurance system for the elderly in fourth year].

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.

[Burden on family caregivers of frail elderly persons one year after the introduction of public long-term care insurance service in the Onga District, Fukuoka Prefecture: evaluation with a Japanese version of the Zarit caregiver burden interview].

The present study was conducted to investigate the factors related to the feeling of psychological stress, called heavy burden, in caregivers who took care of frail elderly persons 1 year after the introduction of the public long-term care insurance system (i.e., kaigo hoken) in the northern part of Fukuoka Prefecture, Kyushu, Japan. Forty-seven caregivers answered a self-administered questionnaire involving the Japanese version of the Zarit Caregiver Burden Interview (ZBI) and thus described their own caregiving situation. Compared to caregivers with a light burden, heavily burdened caregivers were less likely to have time to go out without their frail elderly, but tended to spend a longer time with them in providing for their physical care. Compared with less burdened caregivers, heavily burdened caregivers tended to be concerned with what others thought or said and more likely to use a short-stay service (i.e., temporary nursing home assistance). More social services should be provided to let caregivers have their own time without caring for their patients. In addition, local governments and caremanagers should help caregivers to understand the benefits of services available for the elderly and their caregivers.

What is a common factor in different areas?: The case of depression among caregivers of the frail elderly in Sapporo and Kochi, Japan.

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 < 0.01) than their counterparts in Kochi. CONCLUSION: The Japanese government should take measures to reduce caregivers' depression. Otherwise family members will increasingly discontinue to provide at-home care.

Factors associated with the professional competencies of public health nurses employed by local government agencies in Japan.

OBJECTIVE: This paper aims to clarify some of the factors associated with the professional competencies of public health nurses (PHNs) employed by local government agencies in Japan. DESIGN: A cross-sectional study. SAMPLE: PHNs (N=1,614) working in local government agencies in Japan. MEASUREMENTS: Based on self-reported questionnaires, the nurses were grouped according to experience. Statistical differences between the groups were analyzed using analysis of variance. Multiple regression analyses were used to determine associated factors. RESULTS: Variables contributing to high self-evaluation of interpersonal health support competencies were length of experience as a PHN, an awareness of the role expectations of community health support and administration, marital status, and participation in off-the-job training programs. The same variables contributed to high self-evaluation of community health support and administration competencies. In addition, experience of job transfer or rotation was found to be a variable. CONCLUSIONS: These results show the importance of off-the-job training programs designed to foster exposure to a wide variety of personal and professional experiences. They also illustrate the importance of planned on-the-job training programs that promote an understanding of the nature of the field, as well as developing planning and administrative competency in career development.

A Review of Cohort Studies on the Association Between History of Diabetes Mellitus and Occurrence of Cancer.

We conducted a review of previous cohort studies on the association between a history of diabetes mellitus (DM) and the occurrence of cancer. We limited the papers to those concerning cohort studies on 9 cancer sites, i.e. the kidney, liver, biliary tract, pancreas, colon or rectum, prostate, breast, endometrium, and ovary, in addition to all cancers. With regard to kidney, liver, biliary tract, pancreatic, colorectal, breast, and endometrial cancers, the risk of cancer development has been consistently reported to be positively associated with DM by two or more cohort studies. In contrast, DM was shown to relate negatively to the risk of prostate cancer by two cohort studies. However, there were no cohort studies which showed an either significantly positive or negative association of DM with ovarian cancer. Elevated levels of insulin or IGFs among DM patients have been proposed as a causal mechanism of increased risk for most of the reviewed cancers. In addition, increased estrogen levels in DM patients have been suggested to explain the casual mechanism of increased risk for kidney, breast and endometrial cancers, and decreased risk for prostate cancer. On the other hand, the possibility of detection bias has been suggested in the association of DM with the risk of most of these cancers. Obesity and heavy consumption of alcohol have been indicated as confounding factors in the relationship of DM to the risk for some of them. Thus, further studies are necessary for firm conclusions regarding the association of DM with cancer risk.