Protective and high-risk social activities associated with homebound status among older adults in rural Japan.

Becoming homebound can be devastating for older adults in rural communities. This study aimed to identify protective or high-risk social activities associated with homebound status among the rural young old (ages 65-74) and the oldest old (ages ≥ 75). We used data from a survey of older adults in a rural community of Japan in 2014. Questions covered sociodemographic characteristics, homebound status (i.e., going out less than once a week), physical and psychological status, and social activities. Using survey data, we conducted logistic regression analysis to identify protective and high-risk social activities associated with homebound status. Of the 1,564 participants, 51.0 % were the oldest old, and the mean age was 75.2 (±7.0) years. The prevalence of homebound status was 10.5 % total: 5.2 % among the young old and 15.7 % among the oldest old and highest among the female oldest old (19.4 %). The main protective social activity for the young and the oldest old was visiting friends' houses (adjusted odds ratio [AOR] 5.38, 95 % confidence interval [CI] 1.64-17.64 and AOR 3.49, 95 % CI 1.07-11.42, respectively). For the young old, specific high-risk social activities were advising family and friends (AOR 0.07, 95 % CI 0.01-0.62) and activities to support older adults (AOR 0.17, 95 % CI 0.03-0.84). For the oldest old, a protective social activity was participating in long-term care prevention programs (AOR 28.94, 95 % CI 1.90-441.63). To prevent rural older adults from becoming homebound, support should be provided according to protective and high-risk social activities for age groups, with particular attention to safe socialization amid the threat of COVID-19.

Homecare protective and risk factors for early childhood caries in Japan.

BACKGROUND: Early childhood caries (ECC) affects children across Japan and throughout the world. Thus, it is important to identify dietary and dental care habits that either promote oral health or cause ECC. The objective of this study was to identify protective and risk factors associated with ECC in Japan. METHODS: In a typical rural Japanese community, we selected children born between 2004 and 2008 who had received checkups at their community health center including oral examinations conducted by dentists. We obtained data from children's records and from a questionnaire filled out by parents. We enrolled only children who at their checkup for 18-month-olds had no caries, and we obtained data about them at their checkup for 3-year-olds. We classified children as either having caries (treated or untreated) or being caries-free. We conducted bivariate analyses using data on child/family demographic characteristics, child's dietary habits, and child/parental oral health habits. We also conducted logistic regression analysis to control for variables and identify predictors of the presence/absence of caries. RESULTS: Five hundred sixty six children (278 boys, 288 girls) were enrolled and followed. After 2 years, 173 children (30.6%) presented with caries. Logistic regression analysis predicting caries at follow-up identified the interaction term "bottlefed overnight and brushed irregularly" at 18 months of age as a highly significant predictor of developing caries-adjusted odds ratio (AOR) of 14.27, 95% confidence interval (CI) 1.02-199.71. Two variables measured at follow-up were also significant predictors: having low levels of dental plaque (AOR 2.41, 95% CI 1.34-4.35) and having a mother who had untreated caries (AOR 1.84, 95% CI 1.09-3.12). CONCLUSION: Public health efforts should encourage parents to eliminate bottle feeding overnight and promote brushing twice daily as children's teeth begin to erupt. Greater efforts should be made to teach parents and daytime caregivers how to brush effectively to remove all plaque. Health professionals should pay close attention to mothers' oral health status. Mothers with caries should receive prompt treatment and be assisted in developing better dietary and oral health habits that will benefit themselves and their children. Policies and programs should focus more on family oral health rather than just child oral health.

Semantic Examination of a Japanese Center for Epidemiologic Studies Depression: A Cautionary Analysis Using Mixed Methods.

Background Cross-cultural research relies on the linguistic, conceptual, and semantic equivalence of instruments. Widely used translations of the Center for Epidemiologic Studies Depression (CESD) for cross-cultural samples should be analyzed to reaffirm conceptual and semantic equivalence. Purpose This methodological study aimed to discover and resolve problematic translations of a Japanese version of the CESD. Design Sequential explanatory mixed method design using spiraling integration. Methods Sample includes 34 first-generation Japanese women living in the US and 72 community-based women in Japan. Ethnographic analysis of the semantic meanings of items was followed by t tests to compare original and retranslated item means, as well as Cronbach's reliability and corrected item-total correlations analyses. Results Six problematic items were retranslated: bothered, failure, hope, restless sleep, happiness, and "getting going." Reliabilities for the CESD that included the new CESD item translations were the same; however, most item-scale correlations were higher for the revised translations across the two groups. Conclusions We conclude that both failure and "getting going" may be culturally bound items. Implications for cross-cultural and ethnographic nursing research include planning mini-ethnographic analysis when using translations to discover and reconcile cultural differences in connotations, motivations, and goals.

Development of a health literacy scale for women of reproductive age: an examination of reliability and validity in a study of female workers.

OBJECTIVES: This study aimed to develop a Health Literacy Scale for women of reproductive age by creating an original scale based on a concept analysis of health literacy. METHODS: A 30-item scale was created through an examination of their content validity and face validity based on attributes derived from concept analysis conducted in previous research. The main survey consisted of a self-administered questionnaire distributed to 1,030 female workers between the ages of 20 and 39 residing in the Kinki and Tokai regions of Japan. An additional survey was administered to 424 participants, from whom written informed consent was obtained. The reliability of the scale was examined using Cronbach's alpha and by assessing the significance of the correlation coefficient with the additional survey. Validity was examined through a comparison with the Japanese version of the Health Promoting Lifestyle Profile (JLV-HPLP II) and by examining correlations with subscale scores of the Social Skills Self-Rating Scale for adults as well as scale scores for cervical cancer screening behaviors. RESULTS: For the main survey, 632 out of 1,030 (61.4%) responded, of which 622 (98.4%) were valid responses. For the additional survey, 86 out of 424 (20.3%) responded, of which 86 (100%) were valid responses. The original 30 items were reduced to 21 across four factors through item and factor analysis using the principal extraction method and promax rotation. The coefficient of determination was 0.537. These four factors were labeled: "Women's choice for adopting health information and practice," "Self-care during menstruation," "Knowledge of the female body," and "Sexual discussion with partner." Cronbach's alpha for each factor ranged from 0.72 to 0.83, and the overall value was 0.88. For the additional survey, the correlation on the overall scale was significant (r=0.85, P<0.01). Moreover, the new scale was significantly correlated with the JLV-HPLP II and the Social Skills Self-Rating Scale for adults (ps<0.01). The correlation with scale scores for cervical cancer screening behaviors was highly significant among those who had been screened (P<0.001). CONCLUSION: The reliability and validity of this particular Health Literacy Scale were largely confirmed. The significant relationship observed between cervical cancer screening behaviors and the various scale scores suggests the practical applicability of health literacy education aimed at the prevention, early detection, and treatment of female-specific diseases.

[Healthcare and daily needs of expectant Brazilian women residing in Japan. Analysis of fieldwork conducted during prenatal examinations and home visits].

OBJECTIVES: To investigate the everyday lives and public healthcare needs of Brazilian nursing mothers and pregnant women residing in Japan, during the pregnancy and postpartum period, and the difficulties experienced in using or accessing the Japanese public healthcare system. METHODS: The participants included 10 Brazilian expectant mothers who were residing in Prefecture A, but did not understand Japanese well, and those who were delivering for the first time in Japan. From August 2007 to July 2009, the researcher and interpreter conducted fieldwork by accompanying participants to medical examinations and making home visits. Analysis of the findings of this field study was carried out by labeling the relevant field note descriptions of each participant's thoughts and feelings concerning pregnancy and childbirth, the state of their everyday lives, and any additional public health-related difficulties encountered during this time. Additionally, individuals with common occurrences were again grouped and categorized for performing the analysis. RESULTS: Among the 10 participants, 8 were in their twenties and 2 were in their thirties; 8 participants had lived in Japan for less than 3 years and 2 of them for less than 10 years. Eight participants had had no prior experience with childbirth, whereas 2 had experienced childbirth. All 10 had resigned from work before entering into the late pregnancy stage, rendering their economic conditions solely dependent upon their husbands' income. In fact, many participants were in a difficult financial state. 6 women lived with their husbands, 2 others lived with husbands and had children, and 2 others were living with their husbands and parents in the same house. Six participants had families nearby that could provide support. However, none of the 10 participants maintained interactions with friends after having resigned from work. Participants were organized into the following 4 major categories based on the state of their everyday lives and the difficulties experienced in terms of public health: (I) women who had strong support from immediate families, but very little everyday interaction with friends and neighbors; (II) women who were forced to lead irregular lifestyles due to demanding workload, which consequently exerted more burden on their bodies; (III) women who did not have sufficient information regarding childbirth in Japan and who were anxious due to lack of information and comprehension; and (IV) women who were confused due to the system and customs that were different from their country of origin. CONCLUSION: The everyday lives of Brazilian pregnant women living in Japan tend to be isolated, and these women have a tendency to maintain irregular living conditions. With respect to the available facilities in the Japanese public healthcare system, these Brazilian women lacked sufficient information concerning pregnancy and childbirth in Japan, and were often perplexed by the different maternity health standards between Japan and Brazil, such as those regarding weight gain. It is important to understand the living conditions of such women residing in Japan, to form stable relationships with them from the beginning of their pregnancies, to formulate a plan to prevent them from being isolated after childbirth, and to create responses that consider information found in their native country Brazil. Furthermore, municipalities, public health centers, obstetric and pediatric medical facilities, international associations, private support organizations, and employers should cooperate with each other to establish a support system that includes the dissemination of side-by-side translation charts and manuals for intercultural understanding of public health regarding pregnancy; in addition, seminars and consultation sessions should be conducted.

Grassroots efforts of Japanese women to promote services for abused women.

The purpose of this study was to identify and describe the personal experiences of six Japanese female volunteers who formed a support group to provide services for abused women. The interpretation of the women's stories also increased understanding about the process of forming and developing a grassroots organization to take needed action. The interpretive phenomenological approach guided the study. The findings illustrate that a group of community volunteers can identify and effectively address a significant social issue on their own initiative.

Chieko's story: giving voice to survivors of wife abuse.

Chieko's story relates in narrative form the childhood and early adult experiences of a Japanese woman who is learning to heal and rebuild her life after growing up in a violent home and ending an abusive marriage. This exemplar illustrates major processes and themes that emerged from a cross-cultural qualitative study of family violence. It also portrays universal aspects of this significant and pervasive health and social issue. This in-depth analysis and commentary on one woman's story that could have occurred almost anywhere uncovers hidden aspects contributing to the recidivism of this phenomenon. This story conveys hope for the many women and children who have no voice and for the clinicians who work with them.

Nationwide study of environmental assessment for people with schizophrenia in Japan.

The purpose of the present study was to develop an environmental assessment tool related to the living of the mentally disabled and to examine the health care professionals' perception of the current situations and its importance. The relationships between the current and ideal environmental situations were analyzed. The survey was conducted at 3310 municipalities nationwide by mailing self-report questionnaires, which consisted of 52 items developed by specialists for the mentally disabled and their families. The 52-item questionnaire was rated with a five-point scale for both current and important environmental situations. The main findings included statistically significant differences between the mean scores of the current and important environmental situations, items perceived as important at a similar degree, and those suggesting the largest gap between the current and important situations related to learning opportunities. These results could be useful for implementation in community health nursing.