[Factors related to sarcopenia in community-dwelling elderly subjects in Japan].

OBJECTIVES: This study aimed at determining the factors associated with sarcopenia, defined as low muscle mass and strength and low physical performance, in community-dwelling elderly subjects in Japan. METHODS: The subjects included 1,074 elderly, community-dwelling Japanese people aged 65 years or older. We measured appendicular muscle mass (AMM) by bioelectrical impedance analysis, grip strength, and usual walking speed. A low muscle mass was defined by the AMM index (AMI, weight [kg]/height [m(2)] as >2 standard deviations below the mean AMI for normal young subjects. The lowest quartile for grip strength and usual walking speed were classified as low muscle strength and low physical performance, respectively. "Sarcopenia" was characterized by a low muscle mass, combined with either a low muscle strength or low physical performance. Subjects without low muscle mass or strength and low physical performance were classified as "normal." Subjects were classified as being "intermediate" if they were neither "sarcopenic" nor "normal." Items in the questionnaire included residential status, past medical history, admission during the past year, smoking and drinking habits, leisure-time physical activity, health status, depression, masticatory ability, and dietary variety score. RESULTS: Sarcopenia was identified in 13.7% of men and 15.5% of women. Among men, a large proportion of subjects with sarcopenia had poor masticatory ability and a low dietary variety score compared with normal or intermediate subjects. Among women, a large proportion of the subjects with sarcopenia lived alone, had poor exercise habits, considered themselves to be unhealthy, and had poor masticatory ability compared with normal or intermediate subjects. A multiple logistic regression analysis showed that age and dietary variety in men and age and masticatory ability in women were associated with sarcopenia. CONCLUSION: The present study carried out in Japan showed that sarcopenia, assessed by muscle mass, muscle strength, and physical performance, was associated with age, dietary variety score (in men), and masticatory ability (in women).

[Comparison of diagnostic criteria for the metabolic syndrome among Japanese university faculty].

OBJECTIVES: Diagnostic criteria for the metabolic syndrome (Mets) in Japan have been set by the Medical Committee of the Japanese Association of Medical Sciences (Med), the National Health and Nutrition Examination Survey (Nat), specific health checkups (Ckup), and second medical examination by Worker's Accident Compensation Insurance System (Wor). The purpose of this study was to compare classification of the metabolic syndrome by different organizational criteria and to investigate underlying differences. METHODS: All faculty members of a university in Osaka, Japan, underwent mandatory health checkups in September 2008. The demographic distribution included 769 males (mean age, 49 +/- 12 years) and 415 females (mean age, 43 +/- 10 years). Using the Med, Nat, Ckup and Wor criteria, individuals were assessed for the MetS and pre-metabolic syndrome (pre-Mets), strongly suspected metabolic syndrome (S-Mets) and assumed pre-metabolic syndrome (A-pre-Mets), as well as a positive support level (PSL) and a motivational support level (MSL). All faculty members were categorized into a morbid group (Mets, S-Mets, PSL, and FB) or a pre-morbid group (pre-Mets, A-pre-Mets, and MSL) based on medical data and smoking habits. The incidence of morbid and pre-morbid individuals was compared across the four criteria and analyzed based on gender and age (under 40 and 40 or over). RESULTS: Male incidences for the morbid and pre-morbid classifications were 17% and 20% with Med, 9% and 23% with Nat, 27% and 14% with Ckup, and 1.4% and 0% with Wor. There were significant differences across criteria sets in both the morbid and pre-morbid groups, with significantly greater numbers of males than females, and higher prevalences in those aged 40 or over than in their younger counterparts. Males aged under 40 classified into the pre-morbid group comprised 18% in Med, 16% in Nat, and 13% in Ckup. CONCLUSION: The different disease incidences found between Med and Ckup data in males aged 40 or over might be attributed to varying criteria for blood glucose levels, while Wor data may be influenced by the higher level of blood pressure set as a criterion with this approach. It will be important to continuously validate currently established criteria to identify the actual prevalence of MetS in Japan. Furthermore, incorporation of waist circumference and BMI for females, and a positive approach for young males, may be critical for future developments.

[Objective assessment of walking in housebound elderly who are able to go out alone].

AIM: The aim of this study was to objectively assess the risk parameters associated with walking in housebound elderly. METHODS: The subjects were 622 community-dwelling elderly (210 men and 375 women: age 65-85) with independence in activities of daily living (ADL). We administered questionnaires pertaining to housebound factors and measured walking parameters, twice, in May 2008 and May 2009. Housebound status was defined as leaving the house no more than once a week, and non-housebound status as more than once every 2-3 days. We measured the following walking parameters: usual and maximum walking speed, timed up and go, obstacle-negotiating gait, stair-climbing, and number of daily steps. RESULTS: The overall prevalence of housebound status was 10.0% in men and 8.5% in women. No statistically significant differences were seen in the prevalence of housebound status between genders or age groups. In men, maximum walking speed, timed up and go, and daily steps were slower or less in housebound than in non-housebound subjects. In women, all walking parameters, except usual walking speed, were slower or less in housebound than in non-housebound subjects. Logistic regression analysis showed that obstacle-negotiating gait was a risk factor for men (odds ratio 2.49), and for women, all walking parameters, except walking at usual speed, were risk factors, with the highest odds ratio of 4.77 for obstacle-negotiating gait. A slower obstacle-negotiating gait was a risk factor for housebound status for both men and women. CONCLUSION: Compared with non-housebound subjects, housebound elderly with the ability to go out alone had a similar usual walking speed but a slower obstacle-negotiating gait.

[Aging changes in muscle mass of Japanese].

AIM: The purpose of this study is To examine the influence of age on muscle mass in a Japanese population for health promotion. METHODS: Subjects were 4,003 community-dwelling Japanese men and women. We employed four-frequency bioelectrical impedance analysis to estimate upper and lower limbs, trunk and whole body muscle mass. RESULTS: Men showed significantly more muscle mass in all parts of the body compared to women. There was a curvilinear relationship between age and muscle mass in both men and women. For all parts of the body, the slope of the regression line between age and muscle mass was greater in men than women. The changes in muscle mass with advancing age were different in each part of the body. In the upper limbs, there was little change with advancing age in both men and women. In the lower limbs, the decrease in muscle mass began after two decades, with the reduction in this muscle mass the greatest of all parts of the body with advancing age. In the trunk, the slope of the regression line increased from the second to the fifth decade, after which the slope decreased. CONCLUSIONS: These findings indicated that lower limb muscle mass was the first to begin to decrease and also showed the greatest decrease. For health promotion, it was seen as important to maintain muscle mass from at least middle age, with particular emphasis on the lower limbs.

[Utility of color-changeable chewing gum to evaluate masticatory ability in community-dwelling elderly persons].

PURPOSE: The masticatory ability of community-dwelling elderly persons is often evaluated using subjective questionnaires. However, an objective evaluation would clearly be beneficial so that problems can be adequately addressed. The purpose of this study was to determine the utility of color-changeable chewing gum to evaluate masticatory ability in community-dwelling elderly persons. METHODS: We analyzed the reliability of the chewing gum for assessment of masticatory ability in 5 individuals who were examined on 5 occasions at 2 hour intervals. We also analyzed the validity of color-change of the chewing gum for assessment of masticatory ability by means of a four-part examination of 210 community-dwelling elderly persons. The four parts were as follows: evaluation of masticatory ability with the gum, determination of the number of residual teeth, measurement of maximum bite force, and a questionnaire in which participants were asked to assess their own masticatory ability. Color changes in the gum after chewing were measured with a color-reader and quantified with the a* color space defined by the Commission Internationale de l'Eclairage. A higher a* value indicates a higher degree of mastication. RESULTS: With respect to reliability, the coefficient of variation for the a* of the color-changeable chewing gum was 2.15-3.75%. There were no significant a* value differences between men and women in any age group. Decrease with age was significantly only in women. With respect to validity, the a* value of the color-changeable chewing gum had a significant positive correlation with the number of residual teeth and maximum bite force in both men and women. In addition, men and women who reported good masticatory ability in response to the questionnaire had significantly high a* values. CONCLUSION: We found the use of color-changeable chewing gum to be a highly reliable and valid method for evaluating masticatory ability. Our results indicate that this method could be useful for monitoring masticatory ability in the community-dwelling elderly.

[Evaluation of the best indicator of muscle mass in community-dwelling elderly persons].

AIM: The purpose of this study was to determine the best way to indicate muscle mass of community-dwelling elderly men and women. METHODS: We recruited 398 elderly men and women (age range, 61-96, years) who use a community center and live in a metropolitan suburb. We measured appendicular and whole body muscle mass by using bioelectrical impedance analysis and analyzed our results in relation to indicators of physical function. We assessed muscle mass with no adjustment, adjustment by body mass, and adjustment by body height. RESULTS: In men, appendicular muscle mass adjusted by body mass correlated significantly with 10-m obstacle walking time, and whole body muscle mass adjusted by body mass correlated significantly with all indicators physical function except five chair stands and maximum walking speed. In women, appendicular and whole body muscle mass adjusted by body mass correlated significantly with all indicators of physical function. However, appendicular and whole body muscle mass adjusted by body height were unrelated to indicators of physical function. CONCLUSIONS: Only whole body muscle mass adjusted by body mass was related to physical function in both men and women. This finding suggests that whole body muscle mass adjusted by body mass is the best indicator of muscle mass in community-dwelling elderly persons.

[A cross-sectional study on the relationship between the Trail Making Test and mobility-related functions in community-dwelling elderly].

AIM: The Trail Making Test (TMT) has been studied in western countries as an indicator of executive function, but there are few data on the TMT in Japan. This study was conducted to assess the characteristics of TMT and to explore the effect of TMT on physical function among community-dwelling elderly Japanese to promote health in the aged. METHODS: Subjects were 175 individuals aged>or=65 years (57 men and 118 women). The TMT test which consists of two parts (part A and part B)was performed. 8 physical function items such as indicators of functional decline (usual walking speed, timed up-and-go (TUG), one-leg standing balance, and handgrip strength), and indicators of mobility (maximum walking speed, TUG with cup, stair-climbing, obstacle-negotiating gait) were measured. For this analysis, we used a difference score defined as TMT calculated as the difference between times (part B-part A=TMT). Data were analyzed by sex respectively. RESULTS: The median TMT value was 58.61 seconds in men and 65.67 seconds in women. TMT value increased with age and there was no difference between men and women in absolute values. multinomial logistic regression analysis showed that poor TMT was related to low tertiles of TUG, handgrip strength, MWS, TUG with cup, stair-climbing and obstacle-negotiating gait, and to intermediate tertile of MWS with adjustment for age and sex. CONCLUSION: TMT was significantly associated with mobility-related functions, suggesting that TMT, as the indicator of executive function, should be considered to be included in the test batteries for evaluating older people.

Factors associated with good self-rated health of non-disabled elderly living alone in Japan: a cross-sectional study.

BACKGROUND: Self-rated health (SRH) is reported as a reliable predictor of disability and mortality in the aged population and has been studied worldwide to enhance the quality of life of the elderly. Nowadays, the elderly living alone, a particular population at great risk of suffering physical and mental health problems, is increasing rapidly in Japan and could potentially make up the majority of the aged population. However, few data are available pertaining to SRH of this population. Given the fact that sufficient healthcare is provided to the disabled elderly whereas there is little support for non-disabled elderly, we designed this population-based survey to investigate SRH of non-disabled elderly living alone and to identify the factors associated with good SRH with the purpose of aiding health promotion for the elderly. METHODS: A cross-sectional study was conducted in a metropolitan suburb in Japan. Questionnaires pertaining to SRH and physical conditions, lifestyle factors, psychological status, and social activities, were distributed in October 2005 to individuals aged > or = 65 years and living alone. Response rate was 75.1%. Among these respondents, a total of 600 male and 2587 female respondents were identified as non-disabled elderly living alone and became our subjects. Multivariate logistic regression was used to identify the factors associated with good SRH and sex-specific effect was tested by stepwise logistic regression. RESULTS: Good SRH was reported by 69.8% of men and 73.8% of women. Multivariate logistic regression analysis showed that good SRH correlated with, in odds ratio sequence, "can go out alone to distant places", no depression, no weight loss, absence of self-rated chronic disease, good chewing ability, and good visual ability in men; whereas with "can go out alone to distant places", absence of self-rated chronic disease, no weight loss, no depression, no risk of falling, independent IADL, good chewing ability, good visual ability, and social integration (attend) in women. CONCLUSION: For the non-disabled elderly living alone, sex-appropriate support should be considered by health promotion systems from the view point of SRH. Overall, the ability to go out alone to distant places is crucial to SRH of both men and women.

Job stressors and job stress among teachers engaged in nursing activity.

Teachers and staff members engaged in nursing activity experience more stress than other workers. However, it is unknown whether teachers engaged in nursing activity in schools for handicapped children experience even greater stress. This study evaluated job stressors and job stress among such teachers using a cross-sectional study design. The subjects were all 1,461 teachers from all 19 prefectural schools for handicapped children in Shizuoka Prefecture, Japan. We used a brief job stress questionnaire for the survey and 831 teachers completed the questionnaire. Job stressors among teachers engaged in nursing activity were compared with those among teachers not engaged in nursing activity. Job stress among such teachers was estimated by the score for total health risk, and was compared with the score in the Japanese general population. Male and female teachers engaged in nursing activity had a significantly higher level of job stressors for physical work load and job control compared with those not engaged in nursing activity. The scores for total health risk among male and female teachers engaged in nursing activity were 102 points and 98 points, respectively. These scores were not markedly above 100 points which is the mean score in the Japanese general population.

Five-hour sleep restriction for 7 days increases subjective sleepiness.

We investigated the effects of a 5-h sleep restriction for 7 d on subjective sleepiness in an ambulatory condition by comparing them with baseline conditions consisting of an 8-h sleep for 7 consecutive days. Subjects were 13 healthy male students (mean age 21.1 yr). Each subject was required to get 8 h of sleep (baseline, from 2300 to 0700) for 7 d, and 5 h of sleep (sleep restriction, from 0100 to 0600) for 7 d in an ambulatory condition. The order of the two sleep schedules was randomly assigned. Subjective sleepiness was assessed by a Visual Analog Scale (VAS) every 3 h at 0900, 1200, 1500, 1800, and 2100 for 7 successive days during each sleep schedule. The VAS score during sleep restriction gradually increased up to the 5th day and then reached a plateau. The patterns of time-course changes in the VAS score were similar to those at baseline. The VAS scores showed a peak at 0900, taking a dip at 1200, and then gradually increasing toward 2100. The mean VAS score of the last three days of the 5-h sleep restriction was significantly higher than that at baseline (p<0.001). A 5-h sleep restriction for 7 d in an ambulatory condition increased subjective sleepiness up to the 5th day and then reached a plateau. The patterns of the time-course changes in sleepiness of 5-h sleep restriction per day did not differ from that at baseline.

[Predictors of houseboundedness among elderly persons living autonomously in a rural community].

AIM: The housebound state is a risk factor for disability. This prospective study aimed to determine factors predictive of houseboundedness in the elderly, with an ultimate goal of preventing this condition. METHODS: A self-report questionnaire pertaining to mental, physical and social status was administered to 732 community-dwelling elderly persons (313 men, 419 women; age range, 65-85 years) in October 2000. All subjects independently performed both basic and instrumental activities of daily living, went out alone for long distances, and did not use long-term care insurance. They were followed up until March 2003. "Housebound" was defined as leaving the house once a week or less. A stepwise multiple logistic regression model, adjusted for age, was used to identity factors predictive of houseboundedness. Data were analyzed on the basis of gender. RESULTS: By the end of the follow-up period, 14.4% of men and 26.0% of women had become housebound. Stepwise multiple logistic regression analysis showed that predictive factors for men were lack of frequent contact with friends, neighbors and relatives; symptoms of lower limb pain; and self-assessed weight or muscle loss; and predictive factors for women were lack of frequent contact with friends, neighbors and relatives; lower limb pain; and self-assessed deterioration in health. Limited social contact and the presence of lower limb pain were common predictive factors for houseboundedness in both men and women. CONCLUSION: The findings from this study show that, among autonomous elderly persons, those who are socially isolated or who have physical pain are more likely to become housebound.

Malnutrition risk predicts recovery of full oral intake among older adult stroke patients undergoing enteral nutrition: Secondary analysis of a multicentre survey (the APPLE study).

BACKGROUND & AIMS: Whether malnutrition risk correlates with recovery of swallowing function of convalescent stroke patients is unknown. This study was conducted to clarify whether malnutrition risks predict achievement of full oral intake in convalescent stroke patients undergoing enteral nutrition. METHODS: We conducted a secondary analysis of 466 convalescent stroke patients, aged 65 years or over, who were undergoing enteral nutrition. Patients were extracted from the "Algorithm for Post-stroke Patients to improve oral intake Level; APPLE" study database compiled at the Kaifukuki (convalescent) rehabilitation wards. Malnutrition risk was determined by the Geriatric Nutritional Risk Index as follows: severe (<82), moderate (82 to <92), mild (92 to <98), and no malnutrition risks (≥98). Swallowing function was assessed by Fujishima's swallowing grade (FSG) on admission and discharge. The primary outcome was achievement of full oral intake, indicated by FSG ≥ 7. Binary logistic regression analysis was performed to identify predictive factors, including malnutrition risk, for achieving full oral intake. Estimated hazard risk was computed by Cox's hazard model. RESULTS: Of the 466 individuals, 264 were ultimately included in this study. Participants with severe malnutrition risk showed a significantly lower proportion of achievement of full oral intake than lower severity groups (P = 0.001). After adjusting for potential confounders, binary logistic regression analysis showed that patients with severe malnutrition risk were less likely to achieve full oral intake (adjusted odds ratio: 0.232, 95% confidence interval [95% CI]: 0.047-1.141). Cox's proportional hazard model revealed that severe malnutrition risk was an independent predictor of full oral intake (adjusted hazard ratio: 0.374, 95% CI: 0.166-0.842). Compared to patients who did not achieve full oral intake, patients who achieved full oral intake had significantly higher energy intake, but there was no difference in protein intake and weight change. CONCLUSION: Severe malnutrition risk independently predicts the achievement of full oral intake in convalescent stroke patients undergoing enteral nutrition.

Survey of strontium in mineral waters sold in Japan: relations of strontium to other minerals and evaluation of mineral water as a possible dietary source of strontium.

The concentrations of strontium, calcium, and magnesium in 33 brands of natural mineral waters commercially available in Japan were determined by inductively coupled plasma-atomic emission spectrometry. The geometric mean values were 94.4 microg/L for strontium, 19.1 mg/L for calcium, and 2.82 mg/L for magnesium. Wide confidence intervals of 1.96-4539 microg/L for strontium, 0.865-421 mg/L for calcium, and 0.064-123 mg/L for magnesium were observed. The significant linear relationships among the three elements over a wide distribution range suggest that the synchronized variations of these elements are regulated by the natural ecosystem and not from accidental contamination from human activities or exceptionally high natural sources. Using the results of multiple linear regression analysis, the strontium concentration can be predicted by that of calcium with the appropriate power function. The results of this study suggest that mineral water can be an important nutritional source of strontium. As trace elements imbalance is often found in older patients with chronic renal failure, we propose that close attention of trace elements intake from trendy foods or beverages is necessary to prevent this hidden problem of a rapidly aging society.

Prevalence of and risk factors for low back pain among staffs in schools for physically and mentally handicapped children.

The objective of this study is to clarify the prevalence of and risk factors for low back pain (LBP) in schools for physically and mentally handicapped children. This study design is a cross-sectional study. The subjects included were 1,869 staff members from 19 prefectural schools for children in Shizuoka Prefecture, Japan, which included schools for the blind, deaf-mutes, physically handicapped, and mentally retarded children. A total of 975 subjects completed two postal questionnaires which included morbidity, demographic factors, nursing activity, and psychosocial factors. The answer rate was 52%. The one-month prevalence of LBP was 45%. According to the classification of nursing activity, assistance in movement 1.67 (95% CI 1.27-2.14), excretory function 1.45 (1.11-1.88), and feeding 1.44 (1.10-1.90) showed significant increases in the odds ratio. The adjusted odds ratio significantly increased by 2.35 (1.78-3.11) in the group with depression symptoms as well as in the group with job stressors such as quantitative, qualitative, and physical work loads, job control, utilization of technique, interpersonal conflicts, and degree of satisfaction with their work/home life.

[Incidence of disability in housebound elderly people living in a rural community].

This study aimed to explore whether being housebound is a risk factor for disabilities and whether low social communication increases incidence of disability in elderly people. A self-reported questionnaire regarding demographic characteristics was administered to 2,046 community-dwelling elderly people (aged 65 and older) in October 2000, and subjects were followed up until March 2003. All subjects were independent in activities of daily living. In this study, being housebound was defined on frequency of going out, with those who left the house once or less per week being classified as housebound. We further classified the housebound into four groups: I, going out alone is difficult but social communication occurs; II going out alone is difficult and no social communication occurs; III, going out alone is possible but not undertaken often, and some social communication occurs; and IV, going out alone is possible but seldom undertaken and no social communication occurs. In this population, overall prevalence of being housebound was 8.5%, and about half of those who were housebound fit the third classification. At the end of the follow-up period, 12.7% of subjects reported disabilities. The incidence of disability was higher in the housebound compared with the non-housebound. The incidence of disability by age was higher in housebound groups than in the non-housebound in elderly individuals aged under 85, but no significant differences were recognized in those aged over 85. In terms of housebound status, all housebound groups had higher levels of disability than the non-housebound. However, the groups without social communication (H and IV) exhibited higher incidence of disability than those with social communication (I and II). From the results obtained, we conclude that being housebound is a risk factor for disability in elderly individuals aged 65 to 85 years who are living independently, and that lower social communication also represents a risk factor for disability. This study appears to indicate that a frequency of going out of once or less a week is a valid guide for determination of housebound status.

Quality of life (QOL) of the community-dwelling elderly and associated factors: a population-based study in urban areas of China.

OBJECTIVE: China has the most elderly people. Maintaining and improving the QOL of the elderly has emerged as a particularly important issue. This population-based study aimed to examine the QOL of the urban elderly and to clarify the associated factors. METHODS: A cross-sectional study was performed in Liaoning Province. The elderly people without senile dementia composed our study population and were interviewed from March to November, 2012 with questionnaires pertaining to QOL (SF-36), cognitive ability, demographic characteristics, health status, behavioral factors, and social-psychological factors. 4067 effective responses were received (effective response rate: 86.0%). After further cognitive screening, 3714 participants were included as the subjects. RESULTS: The mean scores of physical component summary (PCS) and mental component summary (MCS) were 53.7±21.5 (mean±SD) and 58.9±18.9, respectively. With adjustment for age and sex, general linear model analysis showed that, in standardized estimate (ß) sequence, PCS was significantly associated with chronic disease, taking a walk, visual ability, sleeping quality, marital status, alcohol consumption, hearing ability, smoking, neighborhood relationships, filial piety, ethnicity, and regular diet, and MCS was associated with chronic disease, sleeping quality, taking a walk, visual ability, marital status, ethnicity, filial piety, regular diet, alcohol consumption, smoking, and hearing ability. CONCLUSIONS: The community-dwelling elderly in urban areas had a low level of QOL. To improve QOL, the maintenance of health conditions was crucial. Efforts to encourage the elderly to perform feasible exercise and develop good lifestyles should be focused on. Also, children's filial duty to their parents should be enhanced.

The current situation of voluntary vaccination and the factors influencing its coverage among children in Takatsuki, Japan: focus on Hib and pneumococcal vaccines.

This study aimed to understand the current scenario of voluntary vaccination and the factors influencing its coverage among 18-month-old children of Takatsuki City, Japan. Based on 1167 parents responses, we found that voluntary vaccination coverage rates were low when compared with routine vaccination rates. The children who were not the first born of the family and who had young and poorly educated parents were less likely to receive voluntary vaccination. Japanese government-supported vaccines, such as Haemophilus influenzae type b and pneumococcal vaccine, had a higher coverage than the vaccines for which parents had to bear the entire vaccination cost. Furthermore, it was found that mass communication media and family pediatricians were effective means to disseminate voluntary vaccination-related information. We envisage that an active participation of medical professionals, easy access to vaccinations, and mass awareness programs will increase voluntary vaccination coverage in Takatsuki.

Psychosocial factors related to low back pain among school personnel in Nagoya, Japan.

Related factors of low back pain (LBP) among school personnel were investigated. We designed a cross-sectional study employing questionnaires, which included a Japanese version of the Job Content Questionnaire. Subjects consisted of 3306 male and 3184 female school personnel in all public schools and kindergartens operated by Nagoya City, Japan. Prevalence of LBP in each work category was compared to that in general teachers of each gender after adjusting for age. Male teachers at schools for the handicapped and in classrooms for the handicapped showed significantly higher LBP prevalence. Among female participants, teachers at schools for the handicapped, physical education teachers, kindergarten personnel and school nurses displayed higher LBP prevalence. In work categories which demonstrated high LBP prevalence, low social support and low job satisfaction were related to LBP of school nurses despite low physical loads. High job demand and physical loads correlated to LBP in kindergarten personnel.

Effects of changing shift schedules from a full-day to a half-day shift before a night shift on physical activities and sleep patterns of single nurses and married nurses with children.

To clarify the effects of changing shift schedules from a full-day to a half-day before a night shift, 12 single nurses and 18 married nurses with children that engaged in night shift work in a Japanese hospital were investigated. Subjects worked 2 different shift patterns consisting of a night shift after a half-day shift (HF-N) and a night shift after a day shift (D-N). Physical activity levels were recorded with a physical activity volume meter to measure sleep/wake time more precisely without restricting subjects' activities. The duration of sleep before a night shift of married nurses was significantly shorter than that of single nurses for both shift schedules. Changing shift from the D-N to the HF-N increased the duration of sleep before a night shift for both groups, and made wake-up time earlier for single nurses only. Repeated ANCOVA of the series of physical activities showed significant differences with shift (p < 0.01) and marriage (p < 0.01) for variances, and age (p < 0.05) for a covariance. The paired t-test to compare the effects of changing shift patterns in each subject group and ANCOVA for examining the hourly activity differences between single and married nurses showed that the effects of a change in shift schedules seemed to have less effect on married nurses than single nurses. These differences might due to the differences of their family/home responsibilities.

[Structural analysis of users' needs from a community pharmacy related to home care in a suburban area].

OBJECTIVES: To clarify the needs of home care service users needs from a community pharmacy and the functions related to home care in a suburban area. METHODS: A questionnaire on pharmacy services and functions was submitted to 472 home care service users in a suburban area. Gender, age, family status, presence of carers, health condition, home care services being used, prescription and pharmacy utilization status, presence of family pharmacy, and recognition of the need for drug management guidance by home visiting pharmacists were surveyed as well as the users' needs from a community pharmacy and its functions. Using these results, principal component analysis was performed. RESULTS: It was found that the users had a great need for the following services and functions: adequate medication instruction, listening attentively to users, and a good attitude from pharmacists and clerks. Meanwhile, the users' need for home care related services was relatively low, i.e. counseling about home care and welfare services, provision of a home visiting service, and provision of home care supplies. Also, principal component analysis indicated that users' needs consisted of five components, viz, medical services, material supply, convenience, readiness of service provision, and consideration of privacy. Regarding home care related services, counseling about home care and welfare services was related to the medical services; provision of home care supplies was related to the material supply; provision of a home visiting service was related to convenience. CONCLUSIONS: It was shown that users did not clearly recognize a service need for home care services as a new function of community pharmacies. Rather, users recognized the need for home care services connected to these already provided by community pharmacies. Therefore, information provision and education are necessary so that users can clearly understand the details and merits of the home care services which community pharmacies provide.