[Current status of breast cancer undetected by mammography in population-based breast cancer screening and associated factors].

Objective　This study aimed to promote the application of mammography (MMG) screening without performing a clinical breast examination (CBE). It examined population-based screening data, including history taking findings, to elucidate the status of breast cancer cases, detected solely by CBE, and to reveal the factors associated with breast cancer. Through this, it explored alternative methods for evaluating breast cancer cases, undetected by MMG, when CBE is omitted.Methods　The linked anonymized data from women, who underwent breast cancer screening in 2014, 2016, or 2017, were prepared. The data were obtained from the Nishinomiya City database. Breast cancer, undetected by MMG, were defined as breast cancer cases diagnosed by close examination based on CBE only (MMG findings were category 2 or lower, with no abnormalities). To assess the quality of breast cancer screening, process indices were calculated for the overall population, and for patients indicated for close examination based on CBE but not MMG. The association of breast cancer with each factor was statistically analyzed (χ2 test, etc.).Results　In total, 13,504 women underwent breast cancer screening. Close examination was required in 1,247 women (9.2%). Breast cancer was diagnosed in 44 women (3.5%), including four, who had breast cancer undetected by MMG. All of the process indices satisfied the acceptable values. Three of the four women with breast cancer, undetected by MMG, noticed a lump. Breast cancer was significantly associated with "subjective symptoms". The presence of a "lump" and "nipple discharge" were significantly more common in breast cancer patients.Conclusion　Three of the four breast cancer cases, undetected by MMG screening, had a subjective symptom (lump). There was a significant association between subjective symptoms (lump and nipple discharge) and breast cancer. To avoid missing breast cancer, undetected by MMG alone, these symptoms should be especially evaluated in women to compensate for the omission of a CBE. This can be achieved by encouraging women experiencing symptoms to seek consult, performing a thorough history-taking and observation, engaging in multidisciplinary collaboration (communication from medical staff to physicians), and promoting breast awareness.

Effects of in-hospital exercise on sarcopenia in hepatoma patients who underwent transcatheter arterial chemoembolization.

BACKGROUND AND AIM: Sarcopenia is a prognostic factor in hepatocellular carcinoma (HCC) patients. HCC patients who underwent transcatheter arterial chemoembolization (TACE) are at a risk of muscle atrophy. We aimed to investigate the effects of in-hospital exercise on muscle mass and factors associated with muscle hypertrophy in HCC patients who underwent TACE. METHODS: We enrolled 209 HCC patients who underwent TACE. Patients were classified into either an exercise (n = 102) or control (n = 107) group. In the exercise group, patients were treated with in-hospital exercise (median 2.5 metabolic equivalents/20-40 min/day). The effects of exercise on muscle mass were evaluated by changes in skeletal muscle index (ΔSMI) between before and after TACE. Factors associated with an increase in SMI were analyzed by logistic regression and decision-tree analyses. RESULTS: There was no significant difference in serum albumin and bilirubin levels between the two groups. ΔSMI was significantly higher in the exercise group than in the control group (0.28 cm2 /m2 vs -1.11 cm2 /m2 , P = 0.0029). In the logistic regression analysis, exercise was an independent factor for an increase in SMI (hazard ratio 2.13; 95% confidence interval 1.215-3.846; P = 0.0085). Moreover, the decision-tree analysis showed that exercise was the initial divergence variable for an increase in SMI (the ratio of increased SMI: 53% in the exercise group vs 36% in the control group). CONCLUSIONS: In-hospital exercises increased muscle mass in HCC patients who underwent TACE. In addition, exercise was an independent factor for muscle hypertrophy. Thus, in-hospital exercise may prevent sarcopenia in HCC patients who underwent TACE.

Maternal subjective well-being and preventive health care system in Japan and Finland.

Background: Maternal well-being is an important issue not only for mothers but also for their offspring and whole families. This study aims to clarify differences in subjective well-being for mothers with infants and associated factors by comparing Japanese and Finnish mothers. Methods: In Finland, 101 mothers with infants who received health check-ups at child's age 4 months participated in the study. In Japan, 505 mothers with infants who should receive health check-ups at child's age 4 months and, whose age, age of the infant and number of children matched with the Finnish mothers were selected. The factors associated with maternal subjective well-being were explored by the linear regression analysis. All Finnish mothers had individual infant health check-ups by nurses in Child Health Clinics nearly monthly. The same nurse was responsible for following up the family throughout the years. All Japanese participants received group health check-up once at child's age 3 to 4 months, and a nurse did not cover same child and their mother. Results: Finnish mothers showed significantly better subjective well-being compared with Japanese mothers. Whereas 85% of Finnish mothers responded that they had obtained childcare information from public health nurses, significantly fewer Japanese mothers indicated the same response (8%). Linear regression analyses disclosed that mothers' subjective well-being was associated with country, mothers' stress and age. Conclusion: Finnish mothers had better subjective well-being than Japanese mothers. Our results may indicate that the Finnish health care system supports mothers better than the Japanese health care system does.

Characteristics of stepfamilies and maternal mental health compared with non-stepfamilies in Japan.

BACKGROUND: Stepfamilies remain poorly understood in Japanese society, and the support needs of stepfamily mothers are unclear. This study aimed to identify characteristics of stepfamilies and maternal mental health as compared with non-stepfamilies in Japan to utilize as a primary resource for providing effective support through community-based health care for stepfamilies. METHODS: From December 2011 to July 2012, we conducted this questionnaire survey with mothers at 3- and 4-month checkups for infants. The response rate was 75.1%. The sample for analysis included responses of 2246 mothers, excluding single mothers. RESULTS: Respondents comprised 47 (2.1%) stepfamilies and 2199 (97.9%) non-stepfamilies. There were significantly higher rates of parents with not more than a high school education and ≥3 children among stepfamilies compared with non-stepfamilies. Stepfamily mothers had significantly higher rates of feeling a lack of economic resources, absence of participation in childbirth education classes, smoking during pregnancy, and unplanned pregnancy. Furthermore, they also had significantly higher rates of depression and a lack of confidence in the parent role. Maternal depression was associated with factors such as maternal age, self-perceived health, stress level, confidence in breastfeeding, confidence in the parent role, and number of children. CONCLUSIONS: These findings suggest that stepfamilies exhibit many characteristics related to social disadvantage and problems with community-based health care in Japan. Healthcare providers should be aware of stepfamily mothers' support needs and should put in place a support system for stepfamilies. Moreover, compared with non-stepfamily mothers, stepfamily mothers have a significantly higher prevalence of depression. However, stepfamily composition does not necessarily increase the risk of maternal depression. Therefore, healthcare providers should put in place a system for obtaining more thorough information about stepfamilies and conduct an early assessment to identify their support needs.

Erratum to: Characteristics of stepfamilies and maternal mental health compared with non-stepfamilies in Japan.

[This corrects the article DOI: 10.1186/s12199-017-0658-z.].

An association between dietary habits and traffic accidents in patients with chronic liver disease: A data-mining analysis.

The incidence of traffic accidents in patients with chronic liver disease (CLD) is high in the USA. However, the characteristics of patients, including dietary habits, differ between Japan and the USA. The present study investigated the incidence of traffic accidents in CLD patients and the clinical profiles associated with traffic accidents in Japan using a data-mining analysis. A cross-sectional study was performed and 256 subjects [148 CLD patients (CLD group) and 106 patients with other digestive diseases (disease control group)] were enrolled; 2 patients were excluded. The incidence of traffic accidents was compared between the two groups. Independent factors for traffic accidents were analyzed using logistic regression and decision-tree analyses. The incidence of traffic accidents did not differ between the CLD and disease control groups (8.8 vs. 11.3%). The results of the logistic regression analysis showed that yoghurt consumption was the only independent risk factor for traffic accidents (odds ratio, 0.37; 95% confidence interval, 0.16-0.85; P=0.0197). Similarly, the results of the decision-tree analysis showed that yoghurt consumption was the initial divergence variable. In patients who consumed yoghurt habitually, the incidence of traffic accidents was 6.6%, while that in patients who did not consume yoghurt was 16.0%. CLD was not identified as an independent factor in the logistic regression and decision-tree analyses. In conclusion, the difference in the incidence of traffic accidents in Japan between the CLD and disease control groups was insignificant. Furthermore, yoghurt consumption was an independent negative risk factor for traffic accidents in patients with digestive diseases, including CLD.

Child Maltreatment Among Singletons and Multiple Births in Japan: A Population-Based Study.

BACKGROUND: The occurrence of multiple births has been recognized as a risk factor for child maltreatment. However, few population-based studies have examined the relationship between multiple births and child maltreatment. This study aimed to evaluate the degree of risk of child maltreatment among singletons and multiple births in Japan and to identify factors associated with increased risk. METHODS: Using population-based data, we analyzed the database of records on child maltreatment and medical checkups for infants aged 1.5 years filed at Nishinomiya City Public Health Center between April 2007 and March 2011. To protect personal information, the data were transferred to anonymized electronic files for analysis. RESULTS: After adjusting by logistic regression for each associated factor and gestation number, multiples themselves were not associated with the risk of child maltreatment. However, compared with singletons, multiples had a significantly higher rate of risk factors for child maltreatment, including low birth weight and neural abnormality. Moreover, compared with mothers of singleton, mothers of twins had a significantly higher rate of poor health, which is a risk factor of child maltreatment. CONCLUSION: Multiples were not associated with the risk of child maltreatment. However, compared with singletons, multiples and their mothers had a significantly higher rate of risk factors of child maltreatment.

Lactobacillus plajomi sp. nov. and Lactobacillus modestisalitolerans sp. nov., isolated from traditional fermented foods.

Three Lactobacillus-like strains, NB53T, NB446T and NB702, were isolated from traditional fermented food in Thailand. Comparative 16S rRNA gene sequence analysis indicated that these strains belong to the Lactobacillus plantarum group. Phylogenetic analysis based on the dnaK, rpoA, pheS and recA gene sequences indicated that these three strains were distantly related to known species present in the L. plantarum group. DNA-DNA hybridization with closely related strains demonstrated that these strains represented two novel species; the novel strains could be differentiated based on chemotaxonomic and phenotypic characteristics. Therefore, two novel species of the genus Lactobacillus, Lactobacillus plajomi sp. nov. (NB53T) and Lactobacillus modestisalitolerans sp. nov. (NB446T and NB702), are proposed with the type strains NB53T ( = NBRC 107333T = BCC 38054T) and NB446T ( = NBRC 107235T = BCC 38191T), respectively.

Height growth of triplets from birth to 12 years of age in Japan.

We analyzed the characteristics associated with the growth in height of Japanese triplets from birth to 12 years of age. The study included 376 mothers and their 1,128 triplet children, who were born between 1978 and 2006. Data were collected through a mailed questionnaire sent to the mothers asking for information recorded in medical records. For these births, data on triplets' length and height growth, gestational age, sex, parity, maternal age at delivery, and maternal height were obtained from records in the Maternal and Child Health Handbooks and records in the school which children receive health check-ups. The height deficit of the triplets compared to the general population of Japan remained between 2% and 5% until 12 years of age. Moreover, at 12 years of age, the differences of height between the general population and triplets were approximately -3.6 cm for male and -4.4 cm for female. Maternal height showed the strongest contribution to height of triplets from 6 to 12 years of age. In conclusion, triplets remain shorter than singletons until 12 years of age.

Genetics of head circumference in infancy: a longitudinal study of Japanese twins.

OBJECTIVES: Previous studies have shown strong genetic influence to head circumference (HC), but still little is known on the development of genetic etiology of HC in infancy, especially in non-Caucasian populations. Thus, we decided to analyze the genetics of HC growth in Japanese infants. METHODS: Longitudinal measures of HC were available from birth to 13 months of age in 206 monozygotic and 156 dizygotic complete twin pairs. Genetic modeling for twin data was used. RESULTS: We found only little evidence for sex-specific differences in the genetics of HC and thus analyzed boys and girls together. After 5 months of age the heritability of HC was high, but before that age also a substantial common environmental component was present. Not only strong genetic persistence for HC was found but also a new genetic variation emerged. New environmental variation shared by co-twins affecting HC was found until 3 months of age, and this effect was further transmitted until 1 year of age. CONCLUSIONS: HC and its growth are strongly genetically regulated. Largely, the same genetic factors affect the variation of HC at different ages, and new genetic variation emerged during the first year of life. Knowledge on the genetic component in the variation of HC may help to design tools for defining abnormal growth of HC in population-based screenings for related disorders.

[Factors associated with the recognition of child maltreatment by mothers rearing children from infancy to primary school age].

OBJECTIVE: This research was conducted to determine the prevalence of recognition of child maltreatment among mothers with children aged 12 or under, and to identify associated factors in order to prevent child maltreatment. METHODS: The subjects of this study were 3,000 women extracted by systematic random sampling of mothers of 6,790 children who had had four-month health check-ups in Nishinomiya city. The response rate was 57.5%. After excluding mothers with children aged 13 years and over, the study sample included 1,471 mothers with children aged 12 or under. A questionnaire survey was conducted by mail. Recognition of child maltreatment by mothers was assessed with a question that asked the mother if she was sometimes aware that she had potentially abused her child, and, if yes, what kind of acts had she performed. RESULTS: There were 333 mothers (22.6%) who answered "yes" to the question "Are you sometimes aware that you have potentially abused your child?" These mothers reported emotional or physical aggression toward their children. Results of logistic regression showed that recognition of child maltreatment was associated with existence of a child whom the mother felt difficulty in cherishing, number of children, maternal poor health, higher scores of STAI trait anxiety and disabled children. Mothers reported difficulties in child-rearing for more than one child as the main reason behind existence of a child whom the mother felt difficulty in cherishing. CONCLUSION: These findings suggested that mothers with more than one child need more support in order to prevent child maltreatment.

Motor development of triplets: a Japanese prospective cohort study.

We analyzed whether motor development in early life is different between singletons and triplets in Japan. The motor development was reported by mothers by postal questionnaire for 1,121 triplet children and in regular health check-ups for 13,906 singleton children. Children who were suspected of having neurological abnormality or disability were excluded from the analysis. The ages of milestone achievements were significantly higher in triplets for each outcome compared to singletons. Further, after adjustment for gestational age, birthweight, and birth length, the differences were significant for maintaining head, sitting alone and standing holding on. In children with birthweight of 2 kg or more, the ages of milestone achievements were significantly higher in triplets for each outcome compared to singletons, except walking holding on. Moreover, after adjustment for the confounding factors, the differences were significant for sitting alone and walking independently. On the contrary, singletons attained motor development facilitating crawling, walking holding on, and walking independently slower than triplets among those children with birthweight of 2 kg or less after adjustment for gestational age. In conclusion, triplets are overall at higher risk for the delay of gross motor milestones as compared to singletons independently of birth-related factors. In contrast, among children with a birthweight of less than 2 kg, singletons showed slower motor development than triplets after adjusting for gestational age. There is an obvious need to apply developmental standards that consider at least both multiple birth status (singleton, twin or triplet) and birthweight.

[Buffering effect of social support in the workplace on job strain and depressive symptoms].

OBJECTIVE: The present study examined the buffering effect of social support in the workplace on job strain and depressive symptoms by conducting a cross-sectional survey using a self-report. METHODS: The subjects were 712 employees (male, over 40 yr old) who worked at a precision machine factory. The questionnaire determined the subjects, ages, types of occupation, scores of depressive symptoms, job strain (job demand and job control), and social support (supervisor support and coworker support). Job strain and social support were evaluated by the Job Content Questionnaire (JCQ). The Center for Epidemiologic Studies Depression Scale (CES-D) score was measured and depressive symptoms were defined as a CES-D score > or = 16 point. Job strain and social support were calculated and divided into low-score groups (LG) and high-score groups (HG), respectively, by the median value. The mean values of CES-D in the LG and HG of job strain or social support were compared by the t-test. The hierarchical multiple regression was analyzed with the CES-D score as the dependent variable and by the characteristics of the participants, job strain and social support, and the cross-product interaction term of job strain and social support as independent variables. The effect of the degree of social support in the LG and HG of job strain on the CES-D score was evaluated by analysis of covariance adjusted for age. RESULTS: The results showed that 23.2% of the workers had depressive symptoms, and that, the CES-D scores in the job demand group were significantly higher in HG than in LG. The CES-D scores in the job control, supervisor support, and coworker support groups were significantly higher in LG than in HG. The hierarchical multiple regression analysis showed that job demand, job control, supervisor support, and coworker support had significant main effects on the CES-D score. Furthermore, it was shown that there was a significant interaction in the CES-D score between job control and supervisor support, and that, the CES-D score in the supervisor support group was significantly higher in LG than that in HG only when job control was low. CONCLUSIONS: These results suggest that supervisor support may have the effect of buffering depressive symptoms related to low job control.

Growth charts of length and height from birth to six years of age in Japanese triplets.

We analyzed the characteristics associated with the growth in length and height of Japanese triplets from birth to 6 years of age and present the growth charts for them. The study included 354 mothers and their 1,061 triplet children, who were born between 1978 and 2006. Data were collected through a mailed questionnaire sent to the mothers asking for information recorded in medical records. For these births, data on triplets' length and height growth, gestational age, sex, parity, and maternal age at delivery were obtained from records in the Maternal and Child Health Handbooks, which is provided by the authorities after a report of pregnancy. Birth length showed the strongest contribution to height of triplets from 1 to 6 years of age. In addition, birthweight was also a significant contributing factor to height from 1 to 3 years of age. Compared to the 50th percentile of the growth standard for the general population of Japan, the length and height deficit of the triplets was approximately 15% at birth (male, -7.0 cm; female, -7.0 cm), decreased within the first year of age, and fluctuated between 2 and 5% until 6 years of age (male, -3.7 cm; female, -3.3 cm). In conclusion, triplets have lower birth length and subsequent height than singletons. In spite of the catch-up growth during the first year of life, they are behind singletons even in mid-childhood. This study provides height growth curves for triplets.

Weight growth charts from birth to 6 years of age in Japanese triplets.

We analyzed the characteristics of weight growth and present the weight growth charts from birth to 6 years of age in Japanese triplets. The study included 366 mothers and their 1098 triplet children, who were born between 1978 and 2006. Data were collected through a mailed questionnaire sent to the mothers asking for information recorded in medical records. For these births, data on triplets' weight growth, gestational age, sex, parity, and maternal age at delivery were obtained from records in the Maternal and Child Health Handbooks, which is provided by the authorities after a report of pregnancy. Birthweight proved to be the strongest contribution on weight of triplets from 1 to 6 years of age. In addition, gestational age was also a significant contributing factor to weight from birth to 6 years of age. Moreover, males had a higher weight from birth to 6 years of age than females. Compared to the 50th percentile of the growth standard for the general population of Japan, the weight deficit of the triplets was more than 40% at birth (male, -1.28 kg; female, -1.28 kg), decreased within the first 1 year of age, and fluctuated between 4% and 9% until 6 years of age (male, -1.82 kg; female, -1.78 kg). In conclusion, triplets have lower birth weight than singletons and in spite of the rapid catch-up growth during first year of life they are behind singletons even in mid-childhood. This study provides growth curves for use in triplets.

[Anxiety and associated factors in mothers of twins or triplets as compared with mothers of singleton children].

PURPOSE: The purpose of this survey was to study anxiety and associated factors in the mothers of twins or triplets as compared with the mothers of singleton children. METHODS: The subjects were 130 mothers of twins or triplets aged 3 or under and 860 mothers of similarly aged singleton children. The Japanese version of State-Trait Anxiety Inventory (STAI) was used to evaluate their anxiety states. RESULTS: 1. Mothers of twins or triplets showed significantly higher STAI state anxiety scores than those of singleton children. However, there was no significant difference in STAI trait anxiety between mothers with twins or triplets and those with singleton children. 2. Mothers of twins or triplets showed greater anxiety during pregnancy than those of singleton children. There were also higher rates of cases where stress could not be alleviated in mothers of twins or triplets than in those with singleton children. STAI state anxiety of mothers was associated with anxiety during pregnancy, anxiety for future child-rearing, problems with stress alleviation, maternal health conditions, poor sleeping conditions and having siblings. CONCLUSION: This study indicated a tendency for mothers of twins or triplets to show greater anxiety as compared with those having singleton children. It is important to improve the child-rearing environment to reduce anxiety felt by mothers of twins or triplets.

Comparison of motor development between twins and singletons in Japan: a population-based study.

This study was performed using population-based data to analyze whether motor development in early life is different between singletons and twins in Japan. For better comparison and investigation, we divided the 2 groups into a group with a birthweight of 2.5 kg or greater (subgroup A) and a group with a birthweight of less than 2.5 kg (subgroup B), respectively. We analyzed the database of medical check-ups for children aged 3 years between April 2001 and July 2004. They received medical checkups at 4 months, 1.5, and 3 years of age. Children who were suspected of having neurological abnormality or disability were referred to specialists and excluded from the database. The data of 14,132 children were analyzed. Among these, 13,040 (92.3%) children were singletons in subgroup A, 75 (0.5%) were twins in subgroup A, 866 (6.1%) were singletons in subgroup B and 151 (1.1%) were twins in subgroup B. The mean age at achieving milestones was slower in twins of subgroup A for each developmental outcome than singletons of subgroup A, and the difference between twins and singletons was significant after adjustment for rolling over. On the contrary, after adjusting for a confounding factor (gestational age), singletons of subgroup B attained motor development facilitating walking independently slower than twins of subgroup B. There were different tendencies in the results regarding the motor development of subjects of subgroup A and that of subjects of subgroup B.

Breastfeeding rates among singletons, twins and triplets in Japan: A population-based study.

This study was performed to determine the rates of breastfeeding among singletons, twins and triplets in Japan, and identify factors associated with the decision to breastfeed or bottle-feed. We analyzed a database of medical check-up of infants aged 3 to 6 months between April 2001 and July 2004 in Nishinomiya City in Japan. This medical check-up is given to almost 100% of infants in Japan and the data of 15,262 infants were analyzed. Among these, 14,963 (98.0%) were singletons, 290 (1.9%) were twins and 9 (0.1%) were triplets. Exclusive breast-feeding was chosen by 6680 (43.8%) mothers, mixed-feeding by 4645 (30.4%) mothers, and bottle-feeding with formula milk only by 3900 (25.6%) mothers. The rate of exclusive breastfeeding among twins or triplets was significantly lower than among singleton babies: 4.1% among twins or triplets, and 44.7% among singletons. Moreover, twins and triplets were independently associated with a higher rate of bottle-feeding: the odds ratio indicated that mothers who had twins or triplets were 2.44 times more likely to choose bottle-feeding with formula milk only than those who had singletons. Sucking ability at birth was associated with a higher rate of bottle-feeding: the odds ratio indicated that mothers who had infants with poor sucking ability at birth were 1.56 times more likely to choose bottle-feeding as those who had infants with normal sucking ability.

Analysis of factors affecting birthweight, birth length and head circumference: study of Japanese triplets.

The aims of this study were to identify factors associated with birthweight, birth length and head circumference for triplets, and analyze these body size parameters at birth, especially head circumference, according to gestational age. The subjects of this study were 370 mothers and their 1109 triplet children (excluding one stillborn infant) who were born between 1978 and 2002. The gestational age proved to be the strongest contributing factor to birthweight, birth length and head circumference of the triplets. Moreover, sex was a significant factor affecting birthweight, birth length and head circumference. Male neonates had a higher birthweight, longer birth length and greater head circumference than female neonates. Birth order in triplets also had a significant effect on birthweight and head circumference. Lower birth-order neonates had a higher birthweight and greater head circumference. An effect of maternal pregravid body mass index (BMI) on both birthweight and birth length was observed. The birthweights of triplets born to women whose pregravid BMIs were more than 26.0 kg/m2 weighed an average of 150 g more than those of triplets born to women whose pregravid BMIs were less than 19.8 kg/m2, and the birth length of triplets born to women whose pregravid BMIs were more than 26.0 kg/m2 averaged 1.5 cm longer than those of triplets born to women whose pregravid BMIs were less than 19.8 kg/m2. Concerning head circumference, the median head circumference of male neonates was approximately 0.5 cm longer than female neonates. Compared to singleton neonates, the median head circumference of triplets was almost the same.

[Comparison of child-rearing problems and necessary community welfare and health services between mothers with twins or triplets of mothers with singleton children].

PURPOSE: The purpose of this survey was to study child-rearing problems and necessary community welfare and health services in the families with twins or triplets as compared with families with singleton children. METHODS: The subjects were 205 mothers of twins or triplets aged less than 6 and 911 mothers of similarly aged singleton children. RESULTS: 1. Concerning maternal feeling when informed of a pregnancy, a significant difference was observed between the mothers with twins or triplets and the mothers with singleton children: 1.3% of the mothers with singleton children were not delighted when informed of a pregnancy, while the rate for mothers with twins or triplets was 12.4%. Mothers of twins or triplets showed significantly greater anxiety when informed of a pregnancy, and also after delivery, greater anxiety for child-rearing. 2. Mothers of twins or triplets were more likely to feel they could not get information regarding pregnancy and child-rearing. 3. There were higher rates of child-rearing problems with regard to economic burden, attending a hospital when a child become ill, shortage of hands for medical examinations or preventive injections, going out with children, shortage of cooperators for child-rearing, lack of time and difficulty for feeding methods for twins or triplets. 4. Community welfare and health services that mothers of twins or triplets wished for were an allowance for child-rearing in 77.0% of cases, helper or baby-sitter for medical examinations or preventive injections in 59.8%, and meeting for mothers of multiple children in 52.0%. CONCLUSION: This study indicated a tendency for mothers of twins or triplets to show greater anxiety during pregnancy, greater anxiety for child-rearing after delivery, and harder to get information regarding pregnancy and child-rearing as compared with those having singleton children. Mothers of twins or triplets had more child-rearing problems with regard to shortage of cooperators, economic burden and feeding methods for plural infants.