[Factors Associated with Breastfeeding at One Month Postpartum: Focus on Nursing Guidance and Mothers' Breastfeeding Behavior].

OBJECTIVES: In this study, we aimed to clarify the factors associated with breastfeeding at one month postpartum, with focusing on midwives' nursing guidance and mothers' breastfeeding behavior. METHODS: A total of 158 mothers who participated in a medical examination two weeks after delivery were followed up with a questionnaire at two weeks and one month postpartum. Furthermore, we conducted multiple logistic regression analyses with breastfeeding at the one-month health checkup as the dependent variable and breastfeeding guidance and mothers' breastfeeding behavior as independent variables adjusted for birth history and delivery method, which were the confounding factors. RESULTS: For nursing guidance, we examined 149 individuals without missing data. In total, 71 (47.7%) mothers were found to be breastfeeding at one month postpartum. Breastfeeding probabilities were significantly higher in mothers who received guidance regarding the meaning of their infants' crying, changes in breast tension, breast care, and mothers' milk production, which were measured, with odds ratios ranging from 2.47 to 3.68. Breastfeeding odds ratios were significantly higher in mothers who inserted the nipple deeply into the baby's mouth such that the baby's lips spread outward, as well as in those who breastfed until the breast felt light and those who breastfed eight times a day than in mothers who did not, with odds ratios ranging from 2.27 to 5.86. CONCLUSION: This study indicated that early postpartum support, including guidance regarding the meaning of infants' crying, changes in breast tension, breast care, lactation measurement, and proper breastfeeding methods, is crucial in establishing breastfeeding.

Positive and negative effects of finance-based social capital on incident functional disability and mortality: an 8-year prospective study of elderly Japanese.

BACKGROUND: Rotating savings and credit associations (ROSCAs) involve group financial self-help activities. These voluntary financial cooperative associations-mujin in Japanese-are found in some rural areas of Japan. Cross-sectional evidence suggests that active participation in mujin correlates with rich social capital and better functional capacities among older adults. However, the effect of mujin on subsequent health outcomes is unknown. METHODS: In 2003, we conducted a baseline interview survey of 583 functionally independent adults randomly selected from Yamanashi Prefecture residents aged 65 years or older. They were followed up until 2011. We used proportional hazards models, and factor analysis of 8 mujin-related questions identified 2 components: the "intensity and attitude" and "financing" aspects of mujin. RESULTS: The hazard ratios (HRs) for incident functional disability-identified by using the public long-term care insurance database-per 1-SD increase in factor scores were 0.82 (95% CI: 0.68-0.99) for the intensity and attitude score and 1.21 (1.07-1.38) for financing score. Adjustments for age, sex, marital status, household composition, physical health, education, income, and other factor scores only slightly attenuated these HRs. The results for mortality models were very similar to those for incident functional disability. CONCLUSIONS: ROSCA-type activities in Japan could have beneficial effects on the health of older adults if used primarily for the purpose of friendship. Mujin for aggressively financial purposes might be somewhat harmful, as such activities might reflect the "dark side" of social capital, ie, overly demanding expectations of group conformity.

Early impact of depression symptoms on the decline in activities of daily living among older Japanese: Y-HALE cohort study.

OBJECTIVE: It is well known that depression deteriorates basic activities of daily living (ADLs), such as eating and bathing, among the elderly, but little is known about the early impact of depression symptoms on the next higher level of functioning, namely higher-levels ADLs, such as instrumental self-maintenance, intellectual activities, and social roles. The objective of this study was to determine whether symptoms of depression are associated with a subsequent decline in higher-level ADLs within a 12-month period of time. METHODS: The study cohort consisted of a random sample of 587 non-institutionalized adults aged ≥ 65 years living in Yamanashi prefecture, Japan. The baseline survey was conducted in 2003. After 12 months, a mailed follow-up survey evaluated changes in higher-level ADLs (follow-up rate 98.6%). RESULTS: After adjusting for sociodemographic and behavioral confounders, logistic regression indicated that baseline severe depression symptoms were associated with a 3.2-fold (95% confidence interval 1.6-6.3) higher chance of a subsequent decline in higher-level ADLs compared to those without severe depression symptoms. The presence of severe depression symptoms was selected by stepwise logistic regression in all models, except for the model with intellectual activities as an outcome, while other lifestyle factors were not selected. CONCLUSIONS: Symptoms of severe depression may adversely affect higher-level ADLs even in a relatively short time-frame. In addition, the early effects of depression symptoms may be stronger than those of other traditional lifestyle risk factors. Monitoring a wide range of ADLs in elderly individuals showing signs of depression may be important to prevent a functional decline in health and the need for long-term care.

Barriers and catalysts of nutrition literacy among elderly Japanese people.

Improving skills for accessing and utilizing diet/nutrition information is important for preventing non-communicable diseases and frailty among elderly people. With the rapidly increasing number of elderly people in the world, promoting nutrition literacy among them is a pivotal health policy for maintaining and promoting health. This article describes the barriers and catalysts of nutrition literacy among elderly Japanese people (aged ≥75 years). A cross-sectional analysis of the responses to a questionnaire administered to 678 study participants (men = 347, women = 331) was conducted. Logistic regression analysis revealed that more men had limited nutrition literacy than did women. After stratification by gender, the limited nutrition literacy group was associated with cognitive difficulty in men and women, visual impairment in men and hearing impairment in women. Lower education level and economic status were associated with limited nutrition literacy among women. Adjusted odds ratios (ORs) controlling for age, education level and economic status, as well as cognitive, visual and hearing function, indicated that informational support [OR = 5.59, 95% confidence interval (95% CI) = 1.28-24.49] and diet/nutrition information obtained from friends of the participants (OR = 2.16, 95% CI = 1.11-4.20) were both associated with adequate nutrition literacy among men, whereas diet/nutrition information from health professionals (OR = 3.96, 95% CI = 1.97-7.95) had a significant relation with adequate nutrition literacy among women. Moreover, in the adequate nutrition literacy group, men were more likely to be overweight (OR = 2.17, 95% CI = 1.20-3.91). These findings suggested that cognitive and sensory functions should be taken into account when diet information is provided to older adults. Enhancement of social networks is also a key point in improving nutrition literacy. An effective intervention to improve nutrition literacy in elderly people, particular old men, warrants further investigation.

Depressive symptoms and past lifestyle among Japanese elderly people.

In order to develop an effective preventive intervention for depression, this cross-sectional study aimed to analyze the relationship between past lifestyle, social activity, and depressive symptoms among community-dwelling elderly people in Japan (n = 887). The Geriatric Depression Scale was used for assessing depressive symptoms. The lifestyle of middle-aged people was assessed using a recall report. The prevalence of depressive symptoms among the subjects was 12.9%. Logistic regression analyses showed that physical exercise, daily intake of well-balanced meals and milk products, and the presence of hobbies were related to the absence of depressive symptoms among both men and women. Among men, avoidance of excess salt and fat was related to the absence of depressive symptoms, while among women, moderate alcohol consumption and good relationships with neighbors were related. Physical exercise, dietary education, and promotion of social activities among middle-aged people were recommended for prevention of depressive symptoms.

Relation of Gamma-glutamyltransferase and alcohol drinking with incident diabetes: the HIPOP-OHP study.

AIM: Gamma-glutamyltransferase (GGT) is known to correlate well with alcohol consumption; however, the relation between GGT and diabetes and that between alcohol consumption and diabetes mellitus (DM) is inconsistent. Thus, several questions, such as whether light to moderate drinkers can be considered as low risk for diabetes incidence irrespective of their GGT level, is unresolved. In this study, we investigated the relation of GGT or alcohol drinking with DM incidence considering the body mass index (BMI) in healthy Japanese workers. METHODS: We followed 3095 men who did not have DM at baseline for 4 years. Incident diabetes was defined as a fasting (non-fasting) plasma glucose level of >or=7.0 (11.1) mmol/L, or treatment of diabetes. Multiple adjusted hazard ratios (HR) were calculated using Cox proportional models. RESULTS: Participants with higher GGT (GGT >or=27 IU/L) showed an increased risk of diabetes incidence even when their BMI level was low. Although a U-shaped relation between alcohol drinking and incident diabetes was observed, the risk to light to moderate drinkers (alcohol <23 g/day) was not low if they were either overweight (BMI >or=25 kg/m(2)) or had higher GGT (HR=2.60, p=0.08) or both overweight and higher GGT (HR=3.16, p=0.07) compared with never drinkers without higher GGT and overweight. CONCLUSIONS: Higher GGT was associated with a higher incidence of DM irrespective of drinking status or obesity. Although a U-shaped relation between alcohol drinking and incident diabetes was observed, the risk to light to moderate drinkers was not low if they were either overweight or had higher GGT.

Cognition of social capital in older Japanese men and women.

OBJECTIVE. This study explored factors related to cognition of social capital among Japanese older people. METHOD. Using a cross-sectional survey design, data were gathered from 940 people aged over 65 years. Cognition of social capital was compared by gender, and it was regressed on participation in community activities and health behaviors of middle age and current health status. RESULTS. Men had higher cognitive social capital than women (p = .004). Multiple regression analysis shows that men who rested for health during middle age had high cognition of social capital. Cognition of social capital was also related to self-rated health, depression, and cognitive difficulties for both men and women. Daily activity was included among women. DISCUSSION. Participation in community activities and health behaviors during middle age were associated factors for cognition of social capital among the older people, and encouraging cognition of social capital was important for active aging.

Is maternal smoking during early pregnancy a risk factor for all low birth weight infants?

BACKGROUND: Low birth weight (LBW) infants do not form a homogeneous group; LBW can be caused by prematurity or poor fetal growth manifesting as small for gestational age (SGA) infants or intrauterine growth retardation. We aimed to clarify the relationship of maternal smoking with both SGA and preterm LBW infants. METHODS: The study population comprised pregnant women who registered at the Koshu City between January 1, 1995, and December 31, 2000, and their children. We performed multivariate analyses using multiple logistic regression models to clarify the relationship of maternal smoking during pregnancy with the SGA outcome and preterm birth in LBW infants. RESULTS: In this study period, 1,329 pregnant women responded to questionnaires, and infant data were collected from 1,100 mothers (follow-up rate: 82.8%). The number of LBW infants was 81 (7.4%). In this cohort, maternal smoking during early pregnancy was associated with LBW and the SGA outcome. Maternal smoking during early pregnancy was a risk factor for LBW with SGA outcome and for LBW with full-term birth. However, it was not a risk factor for LBW with appropriate weight for gestational age (AGA) and LBW with preterm birth. CONCLUSION: These results suggested that LBW with AGA and LBW with preterm birth were associated with other risk factors that were not considered in this study, such as periodontal disease. For the prevention of LBW, not only abstinence from smoking during pregnancy but also other methods such as establishing a clinical setting should be adopted.

Maternal negative attitudes towards pregnancy as an independent risk factor for low birthweight.

AIM: Recently, Japan has witnessed an increase in the number of low-birthweight (LBW) infants. LBW children face a variety of social and medical risk factors. Thus, besides reducing infant mortality, preventing LBW would have many other important health benefits. Emotional status during pregnancy is stated as one of the important risk factors for LBW. This study aims to clarify the relationship between maternal emotions and low birthweight (LBW) after adjusting the effects of other well-known factors that influence LBW. METHODS: This community-based case-control study involved 145 newborns with LBW (cases) and 213 newborns with normal weight (controls). They were born in the municipalities that fall within the jurisdiction of the Yoshida public health center between 1st January 2003 and 30th September 2004. Participants' mothers were interviewed using a simple, structured questionnaire to collect general data on mother and infant, hazardous habits and maternal socioeconomic, occupational and psychological factors. The odds ratio with a 95% confidential interval of delivering LBW infants was calculated using logistic multivariable regression analysis based on maternal and infant factors. RESULTS: In the multivariable regression model, the second-born or subsequent infant was unlikely to be LBW. On the contrary, maternal smoking habit during pregnancy, mothers who kept house by themselves and maternal negative attitudes towards pregnancy during the early stages promoted LBW incidence. CONCLUSION: Maternal negative attitude towards pregnancy during the early stages was an independent LBW risk factor and our simple questionnaire can be used to estimate maternal psychological status in early pregnancy.

Engagement in a cohesive group and higher-level functional capacity in older adults in Japan: a case of the Mujin.

The Mujin is a traditional Japanese rotating saving and credit association (RoSCA) that provided financial aid for the lower-middle class in Japan until the postwar reconstruction period. The traditional Mujin has disappeared from most regions, and the surviving Mujin provides more of a social networking than a financial function for its members. We investigated the association between level of participation in the Mujin and the capacity for independent living in older adults. Baseline data of an ongoing cohort study of 581 self-sufficient older adults were analyzed. The Tokyo Metropolitan Institute of Gerontology Index of Competence was used to measure higher-level functional capacity, and the level of engagement in the Mujin was determined by a score derived by factor analysis. We found that a higher level of engagement in the Mujin was associated with greater functional capacity, especially social role performance, the highest-level function. We conclude that the Mujin provides a venue for community interaction that serves to increase the social capital of the community and may have psychosocial benefits for its members due to strong membership ties and mutual trust. Further investigation of the causal relationship between participation in the Mujin and functional capacity, and the psychosocial effects of similar financial mutual-aid systems in other social contexts is warranted.

There are gender differences in attitudes toward surrogacy when information on this technique is provided.

OBJECTIVE: We analyzed the data of a nationwide opinion survey reported in a previous study and clarified the importance of socioeconomic status and individual belief on people's opinion regarding the pros and cons of gestational surrogacy. In this study, we analyzed the data of this nationwide opinion survey to identify the effect of providing information about assisted reproductive technology (ART) on the people's attitude towards not only gestational surrogacy but also other ART procedures. STUDY DESIGN: This was a cross-sectional study. A nationwide opinion survey on ART was conducted in 2003. The participants included 3647 people (1564 people received only the questionnaire and 2083 people received the questionnaire and a brochure containing information about ART). Multivariate-adjusted odds ratio and 95% confidence interval were obtained using logistic regression models for understanding the manner in which the knowledge about ART affects the attitude of the general population towards ART, which uses donor gametes and surrogacy. RESULTS: With regard to gestational surrogacy, men in the brochure group could not clearly express their opinions when compared with those in the no-brochure group (odds ratio (OR): 0.69; 95% confidence interval (CI): 0.53-0.89). In contrast, with regard to donor insemination, women in the brochure group could clearly express their opinions when compared with those in the no-brochure group (OR, 1.24; CI, 1.02-1.52). Information about ART, especially in men, promoted disapproval of partial surrogacy (OR, 0.59; CI, 0.44-0.78) and gestational surrogacy (OR, 0.64; CI, 0.48-0.86). On the other hand, for other ART procedures, we found no significant association between receiving information via the brochure and people's attitude towards the technology. CONCLUSION: There were gender differences in attitude toward surrogacy that was affected by providing information about ART. Moreover, determining community attitudes, we observed that a good understanding of the information provided facilitates the expression of a clear opinion, thereby assisting respondents in deciding whether or not they approve of a certain technology.

Analysis of national representative opinion surveys concerning gestational surrogacy in Japan.

OBJECTIVE: Although gestational surrogacy offers several advantages, this procedure has given rise to some ethical and legal issues. We aimed to clarify the factors affecting the attitude of the Japanese toward gestational surrogacy. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Nationwide opinion surveys concerning assisted reproductive technologies (ART) were carried out in 1999 and 2003. Participants included 2568 and 3647 people from the general public surveyed in 1999 and 2003, respectively (1564 people received only the questionnaire, and 2083 people received a questionnaire and brochure about ART). MAIN OUTCOME MEASURE: Multivariate-adjusted odds ratio and 95% confidence interval from logistic regression models for factors affecting the attitude toward gestational surrogacy. RESULTS: In both surveys, approximately half of respondents approved of gestational surrogacy; 20-30% disapproved of the procedure. People with high socioeconomic status clearly expressed their opinion on this issue. A liberal attitude toward gender role promoted approval of gestational surrogacy; a liberal attitude toward family had the opposite effect. CONCLUSION: Our findings suggest that socioeconomic status affects people's expression of their opinion regarding this issue, while attitudes toward this procedure were influenced by individual belief. Considering socioeconomic status and diversity of individual belief is required for further discussion on this topic.

Factors explaining disability-free life expectancy in Japan: the proportion of older workers, self-reported health status, and the number of public health nurses.

BACKGROUND: Disability-free life expectancy (DFLE) data for 47 prefectures in Japan were reported in 1999; however, few studies have identified the factors associated with the length of the DFLE. The objective of this study was to elucidate the primary factors that explain differences in DFLEs in Japan. METHODS: In our ecological study, 47 prefectures in Japan were used as units of analysis. The DFLEs for men and women at 65 years of age (DFLE65), calculated by Hashimoto et al using Sullivan's method, were set as dependent variables. From various national surveys, 181 factors associated with demographics, socioeconomic status, health status and health behaviors, medical environment, social relationships, climate, and other areas were gathered as independent variables. Pearson's or Spearman's correlation coefficients were calculated to screen independent variables potentially associated with the DFLE65s. Then, multivariate linear regression analyses were conducted for the selected 24 independent variables after adjusting for the proportion of older people (65 years or more) and population density. RESULTS: Multivariate linear regression analyses revealed that the large number of public health nurses per 100,000 population, a good self-reported health status, and a high proportion of older workers were significantly associated with long DFLE65s for both genders. CONCLUSIONS: These three factors could potentially explain the differences in DFLE of the older population in Japan.

Stages of change for salt intake and urinary salt excretion: baseline results from the High-Risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) study.

We investigate the relationship of urinary salt excretion to the stage of change to decrease salt intake in the Japanese diet. The data reported here were obtained from a baseline survey of the High-Risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) study that was conducted as a non-randomized control trial at 12 worksites in Japan. A total of 6,816 subjects (5,410 male, 1,406 female) were used in 1999 and 2000 for the analysis. We used three categories of stage of change: precontemplation or contemplation (P/C), preparation (P), and action or maintenance (A/M). Urinary salt excretion was estimated from the sodium and creatinine concentrations in spot urine samples. Multivariate analysis indicated that urinary salt excretion among males was 0.3 g/day greater in the P/C stage than in the A/M stage (p < 0.05). For non-obese females, urinary salt excretion in the P/C stage was 0.6 g/day greater than in the A/M stage (p < 0.05). Multivariate analysis showed that diastolic blood pressure in males not taking antihypertensive agents was 1.3 mmHg lower in the P/C stage than in the A/M stage (p < 0.05). A similar but statistically insignificant tendency was observed among non-obese females. A significant association was demonstrated between stage of change for dietary salt intake and urinary salt excretion for both males and non-obese females. There may be a potential application of the stage of change model for reducing dietary salt intake in a health promotion program.

Applicability of the stages of change model for analyzing fruit and vegetable intake in relation to urinary potassium excretion: baseline results from the High-Risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) Study.

The Stages of Change model evaluates and conceptualizes attempts to alter particular behavior patterns. To investigate the validity of this model for assessing fruit and vegetable intake, we examined the association between the stage of change in fruit and vegetable intake and urinary potassium excretion. The data were from baseline surveys taken in 1999 and 2000 from the High-Risk and Population Strategy for Occupational Health Promotion (HIPOP-OHP) study in Japan. This was a non-randomized control trial at 12 worksites in Japan and aimed to decrease cardiovascular risk factors. Cross-sectional analysis was performed using data from 6,774 participants (5,364 men and 1,410 women). We used three categories of the model: precontemplation or contemplation (P/C), indicating no commitment to change; preparation (P), indicating readiness to change behavior but not actually doing so; and action or maintenance (A/M), indicating an actual change in behavior. Urinary potassium excretion was estimated from the potassium and creatinine concentrations in spot urine samples. Multivariate analysis indicated that urinary potassium excretion in the A/M stage was 1.65 mmol/day more than in the P stage, and 1.44 mmol/day more than in the P/C stage for men (p <0.05, respectively). For women, urinary potassium excretion in the A/M stage was 1.26 mmol/day more than in the P/C stage (p <0.05) and 1.04 mmol/day more than in the P stage, although the latter result lacked statistical significance (p =0.08). This study supports the potential value of the Stages of Change model for increasing fruit and vegetable intake in the design of dietary intervention programs.

Musculoskeletal disorders among female nurses in a rural Japanese hospital.

The present research investigated the prevalence of musculoskeletal disorders (MSD) among a previously understudied group of Asian nursing professionals in a rural setting. A total of 305 female nurses (84% response rate) were recruited from a university teaching hospital in Yamanashi prefecture, central Japan. Data were gathered by means of a self-reporting questionnaire. Lower back pain (LBP) was the most commonly reported MSD, affecting 59% of all nurses. This was followed by MSD of the shoulder (46.6%), neck (27.9%), knees (16.4%) and upper leg (11.8%). Working in the surgical department was shown to increase the risk of any MSD 2.7 times when compared to nurses in the other departments (odds ratio 2.7, 95% confidence interval 1.2-6.7, P = 0.0202). Overall, our study shows that MSD are reasonably common among registered nurses in a rural Japanese hospital. These staff may also be at greater risk of suffering MSD than their city-based nursing counterparts and foreign colleagues, particularly with respect to LBP.