[Study of characteristics of experience in successful smoking cessation among middle-aged male workers in Japan].

OBJECTIVE: To clarify the characteristics of the experience leading to successful smoking cessation and to examine the nature of smoking cessation support to capture these characteristics. METHODS: Semi-structured interviews were conducted for 30-60 minutes with 14 middle-aged male workers, who smoked an average of five or more cigarettes per day, and had currently quit smoking for more than six months without any treatment. Questionnaire items included the reasons for attempting to quit smoking, the methods used, changes in feelings and situations during the smoking cessation effort, past experience of failure, and current notions. To extract labels, subcategories, categories, and core categories, a verbatim record was made and analyzed qualitatively and inductively. RESULTS: Overall, 683 labels, 117 subcategories, 32 categories, and 9 core categories were extracted. The core categories were indicated by 【 】 and the categories by ≪ ≫. The participants expressed 【hesitation about the challenge of quitting smoking】 and 【skepticism about remaining a smoker】 owing to changes in the society surrounding smokers, and were 【preparing to face a difficult challenge】. After commencing the challenge, the smokers were 【able to achieve success in quitting smoking】 as they continued to 【try and find ways to quit smoking that suited them】 and go through the 【battle against the urge to smoke using "my energy as a shield"】 in the midst of 【pain associated with withdrawal from cigarettes】. They were able to 【establish a way of life as a successful nonsmoker】 by continuing to quit smoking, while simultaneously experiencing 【the confusion encountered after smoking cessation】. Categories indicating relationships with others, such as 【avoiding negative images due to smoking】, 【 protecting one's pride against others】, and 【experiencing pleasure at being recognized by others】 were extracted. CONCLUSION: The results showed that 【skepticism about remaining a smoker】 was seen as a turning point in the challenge of quitting smoking. Taking an approach that leads to this feeling is important for smokers. After quitting smoking, continuous follow-up is believed to be necessary to reduce 【the confusion encountered after smoking cessation】 and continue to 【establish a way of life as a successful nonsmoker】. This study revealed that "public self-consciousness" leads to behavioral changes toward smoking cessation, suggesting the possibility of new findings.

Culturally sensitive disaster nursing by Public health nurses in Japan.

OBJECTIVE: To clarify culturally sensitive disaster nursing by public health nurses (PHNs) in Japan, an island nation located on the Pacific Rim, with regard to PHNs' intentions and comforting supports for affected people. DESIGN: Qualitative descriptive study. SAMPLE: Participants were 17 local PHNs and 13 affected people in nine disaster-affected municipalities throughout Japan. MEASUREMENTS: Semi-structured interviews were conducted between October 2018 and July 2019. Two types of categories were qualitatively created: categories for PHNs' culturally sensitive disaster nursing actions, including their intentions; and categories for comforting supports that PHNs provided for affected people through the four phases of disaster. The relationship between these two types of categories was determined. Cultural factors were extracted from the culturally sensitive disaster nursing actions of PHNs and categorized. RESULTS: Regarding intentions, in the acute phase, PHNs utilized culture. In the sub-acute phase, they utilized, acted based on, followed, thought of, and balanced cultural knowledge. In the mid-term-phase, they utilized, thought of, followed, and balanced with local culture. In the long-term phase, they merged, thought of, balanced, utilized, and followed local cultural practices. The actions associated with these intentions corresponded to comforting supports for affected people. Cultural factors, such as transportation style, were obtained in each phase. CONCLUSION: To enhance the resilience of a community affected by disaster, PHNs should focus on maximizing, preserving, and accommodating culture to maintain familiar life patterns when people's circumstances are totally disrupted by powerful forces of nature.

Function and practice of public health nursing in Japan: a trial to develop the Japanese Purpose-Focused Public Health Nursing Model.

AIM: To clarify the significance of public health nurses' practice, we introduced the activities of Japanese public health nurses and tried to develop a model based on the purpose of their work. BACKGROUND: Despite international efforts toward clarifying public health nurses' practice, earlier models based on the purpose of their activities were underdeveloped. METHOD: Japanese terms describing public health nurses' activities were gathered from the literature, nine researchers analysed and brainstormed the activities to develop a model. Seven municipality public health nurses and three researchers in both Japan and the USA validated the model. RESULTS: The model includes three categories: creating the basis for support; working with individuals, families to enhance their health; and enhancing the health of individuals, families, groups, communities/regions by working with the community. CONCLUSION: The Japanese Purpose-Focused Public Health Nursing Model was based on the purpose of public health nurses' practice which was considered significant for assisting public health nurses to explain the meaning of their work.

Impact of alcohol consumption upon medical care utilization and costs in men: 4-year observation of National Health Insurance beneficiaries in Japan.

AIMS: The purpose of the present study was to examine the association between alcohol consumption and in-patient and out-patient care utilization and its costs, respectively. DESIGN AND PARTICIPANTS: The present data were derived from a 4-year prospective observation of National Health Insurance beneficiaries in rural Japan. A total of 17 497 men aged 40-79 years were analysed, after excluding subjects who at the baseline reported having had at least one of four chronic diseases: stroke, myocardial infarction, liver disease and cancer. Alcohol intake was classified into five groups, not including ex-drinkers: life-long abstainers and ethanol intakes of 1-149 g/week, 150-299 g/week, 300-449 g/week, and > or = 450 g/week. FINDINGS: The hospital days and in-patient care cost showed a U-shaped relationship with alcohol consumption. In-patient cost was highest for those consuming more than 450 g/week [ pound 74.96, 95% confidence interval (CI): 54.39, 95.52] and for life-long abstainers ( pound 69.16, 95% CI: 62.08, 77.83), and lowest for those consuming 150-299 g/week ( pound 51.69, 95% CI: 45.33, 58.04). In-patient use by age specific analysis also showed a U-shape at all ages, and was lowest for those consuming 1-149 g/week in youngest age group. In contrast, the number of physician visits and out-patient cost showed an inverse linear relationships with alcohol consumption. CONCLUSIONS: This study suggests that in-patient use shows a U-shaped curve and out-patient use shows an inverse linear relationship to alcohol consumption.

Impact of walking upon medical care expenditure in Japan: the Ohsaki Cohort Study.

BACKGROUND: Physical activity is expected to reduce medical costs by lowering the risk for a variety of chronic diseases. However, little is known about the actual magnitude of medical cost saved by physical activity. We attempted to quantify the association between time spent walking and medical care costs, based on a 4-year prospective observation of National Health Insurance (NHI) beneficiaries in rural Japan. METHODS: In 27 431 Japanese men and women, aged 40-79 years, who had no functional limitation or conditions interfering with physical activity at the baseline survey in 1994, we ascertained all hospitalizations, outpatient visits, and the costs through computerized linkage with NHI claims history files between January 1995 and December 1998. RESULTS: Medical costs significantly reduced with longer time spent walking. Per capita medical cost was pound 111.80 per month (95% CI: 109.3, 114.2) in those who walked for < or =30 minutes/day, pound 108.10 (95% CI: 105.7, 110.5) in those who walked for 30 minutes-1 hour, and pound 97.30 (95% CI: 95.5, 99.0) in those who walked for > or =1 hour, after multivariate adjustment of potential confounders. CONCLUSIONS: This prospective study in Japan indicated that time spent walking was significantly associated with lower medical costs.

Effects of exercise training on physical activity in older people: a randomized controlled trial.

BACKGROUND: Recent randomized controlled trials indicated that exercise training for elderly significantly increased their physical fitness. However, very few studies have examined changes in physical activity after exercise training. The purpose of this study was to investigate whether six-month exercise training for older adults can increase and maintain their physical activity in daily life. METHODS: Sixty-two men and women aged 60 to 81 years (mean age 67.1 years), living in communities, were randomly allocated into an exercise group (n = 32) or a control group (n = 33). The intervention started in April 1998 and lasted for 25 weeks. The exercise regimen consisted of endurance training and resistance exercises in a two-hour class conducted at least twice a week. The subjects completed a physical activity diary at each pre-intervention (March 1998), post-intervention (September 1998) and follow-up (April 1999) measurement of physical activity. Physical activity, expressed as total daily energy expenditure, was calculated by multiplying the amount of time spent in each activity and the corresponding METs. RESULTS: Total daily energy expenditure significantly increased from 40.8 kcal/kg/day to 43.5 kcal/kg/day in the exercise group (p = 0.03), but did not change in the control group. At the follow-up measurement, the mean total daily energy expenditure in the exercise group remained significantly higher, by 1.7 kcal/kg/day, than that at the pre-intervention (p = 0.05). CONCLUSIONS: This randomized controlled trial indicated that exercise training for elderly was effective in increasing physical activity in daily life.