Factors associated with failure to undergo health check-ups in Nagasaki Prefecture, Japan.

Objective: Municipal National Health Insurance (NHI) in Nagasaki Prefecture in Japan struggles with poor attendance of health check-ups, which was only 39.6% in 2018. This study aimed to evaluate factors that encourage healthy behaviors, including opting for health check-ups, and the characteristics of middle-aged and older individuals who did not undergo health check-ups. Materials and Methods: This cross-sectional study, using a self-administered questionnaire, was conducted in August 2020 in three municipalities of Nagasaki Prefecture. In addition to questions regarding sociodemographic information, such as sex, age, educational status, self-rated economic status, and family structure, the questionnaire included questions on daily lifestyle habits such as alcohol intake and exercise, current medical treatment, self-rated health, and information related to health check-ups. Of the 18,710 questionnaires distributed in the three municipalities, 8,756 (46.8%) were collected by the end of December 2020, of which 7,840 were valid for analysis. The compliance rate for health check-ups was obtained from the Public Health and Welfare Bureau of Nagasaki Prefecture. Statistical analyses were performed according to two age groups: 40-59 and 60-74 years. Results: Among the respondents who did not undergo health check-ups in the year prior to this study, "lack of time" and being "too bothersome" were the most popular reasons for not attending health check-ups. "Living alone" and "low self-rated economic status" were negative factors for receiving health check-ups regardless of age group. Conclusions: Vulnerable middle-aged and older persons, such as those living alone and with low economic status, were less likely to undergo health check-ups. Emphasis on home visits by public health nurses may also be needed to increase awareness of individual health conditions, especially for people living alone and those who are socioeconomically disadvantaged.

Association between the dietary inflammatory index and disability in Japanese older people.

OBJECTIVES: To examine the demographic and lifestyle characteristics related to the dietary inflammatory index (DII™) score and to evaluate the association between DII score and disability among older people in Japan. DESIGN: Cross-sectional design. The DII score was calculated from nutrient intake information obtained from a FFQ. Disability was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence questionnaire. Overall disability and disability in each component of everyday competence, that is, instrumental activities of daily living (IADL), intellectual activities and social participation, were assessed. Those with a deficit in one or more activities were defined as disabled. SETTING: Five non-urban areas in Japan. PARTICIPANTS: A total of 1642 Japanese older people aged 65 years or older. RESULTS: Women, residents of Oga-shi, and those with a higher education and greater frequency of shopping followed a more anti-inflammatory diet, while those living alone and residents of Minamiawaji-shi had higher dietary inflammation. A pro-inflammatory diet was associated with higher odds of overall disability and disability in each component of competence: overall disability, OR (95 % CI) = 1·26 (1·16, 1·36); IADL disability, OR (95 % CI) = 1·16 (1·07, 1·26); disability in intellectual activities, OR (95 % CI): 1·30 (1·20, 1·40); and disability in social participation, OR (95 % CI) = 1·20 (1·11, 1·29). CONCLUSIONS: Sex, living alone, education, frequency of shopping and area of residence were shown to be determinants of DII score in Japanese older people. DII score was positively associated with disability.

Food store accessibility affects nutritional intake through shopping frequency and food intake in middle-aged to older adults in rural Nagasaki, Japan.

OBJECTIVES: The food environment is an important determinant of dietary and nutritional intake, but studies thus far have reported mixed results. We examined associations between food store accessibility and nutritional intake among middle-aged to older adults in rural Japan using data from a questionnaire survey of national health insurance enrollees. METHODS: The survey was conducted in Nagasaki, Japan, for individuals aged 40-74 years. Direct distances from home and food store density were estimated using a geographic information system (GIS). We focused on protein, vitamin D, and calcium intake for their preventive effects on frailty and sarcopenia. To examine the effects of food store accessibility on nutritional intake, we hypothesized a model with a chain of associations of food store accessibility, shopping frequency, food intake frequency, and nutritional intake. We performed a path analyses to explore the food items to be included in the models, associations between the variables, and fitness of the models. RESULTS: We obtained final models with satisfactory fit indices. The resultant models included significant associations between: 1) accessibility indicators and shopping frequency, 2) shopping frequency and intake frequency for two or four categories of food, and 3) intake frequency and nutritional intake. CONCLUSIONS: The results demonstrated that accessibility to food stores, assessed in terms of direct distance from home and food store density, can affect the intake of protein, vitamin D, and calcium through the effect on shopping frequency and intake frequency of some categories of food items, among middle-aged to older adults in Nagasaki, Japan.

Factors associated with self-rated health among mineworkers in Zambia: a cross-sectional study.

BACKGROUND: This study aims to examine miners' working conditions and self-rated health status in copper mines in Zambia and to identify the conditions and factors necessary to improve the safety and health of mineworkers. METHODS: A cross-sectional study using a self-administered questionnaire was conducted anonymously among copper mineworkers in Zambia in 2015 and 2016. Five targeted mining companies among 33 were introduced by the Mineworkers' Union of Zambia. Study participants were recruited at the waiting space for underground work, waiting rooms of company clinics/hospitals, and/or at training sessions, which were places permitted by the target companies to perform data collection via convenience sampling. Bivariate analyses (e.g., t tests, Kruskal-Wallis tests, chi-square tests, or Cochran-Armitage tests) and logistic regression analysis were used to analyze differences in demographic characteristics and to compare their working conditions, health conditions, safety management at the workplace, and training opportunities by employment status. RESULTS: In total, 338 responses were analyzed. Regular employees had better working conditions, including higher incomes (P = 0.001), more likely to be guaranteed sickness insurance by the company (P < 0.001), paid holidays (P = 0.094), and sick leave (P = 0.064), although the difference was not statistically significant. Mineworkers' decreased self-rated health was determined by job category (adjusted odds ratio [AOR], 0.41; 95% confidence interval [CI], 0.21, 0.82; P = 0.012). Having experienced violence from the boss/manager (AOR, 0.54; 95% CI, 0.32, 0.91; P = 0.020) was negatively associated with better self-rated health in the crude odds ratio. CONCLUSIONS: Among mineworkers in Zambia, nonunderground work and not having experienced violence from their boss/manager contributed to increased self-rated health. From the perspective of psychological safety and human security, the management of safety and the working environment, including human resource management and preventing harassment/violence, should be assured, especially for underground mineworkers.

Factors related to ikigai among older residents participating in hillside residential community-based activities in Nagasaki City, Japan.

Objective: The present study aims to investigate the factors related to self-rated ikigai (purpose in life) among older residents participating in hillside residential community-based activities in Nagasaki City. Methods: A self-administered anonymous questionnaire survey was carried out with older residents participating in two hillside residential community-based activities in Nagasaki City, Japan. The questionnaire included questions on sociodemographic information (age, sex, family structure, education, and self-rated economic satisfaction), self-rated health, mental health status measured using Geriatric Depression Scale-15 (GDS-15), and self-rated ikigai score that was estimated using a visual analog scale. Results: A total of 32 older residents (7 males, 25 females) participated in the questionnaire survey. Although self-rated ikigai score was not associated with sociodemographic factors, there were associations between the score, self-rated health (P=0.001), and mental health (GDS-15) (P=0.015). Statistically significant correlations between self-rated ikigai score and social participation (ρ=0.426, P=0.017), self-rated health (ρ=-0.485, P=0.007), and mental health (GDS-15) (ρ=-0.523, P=0.007) were observed. Conclusion: Increasing social participation may increase individual ikigai, preventing poor self-rated health and low mental health status in older people. Maintaining their social participation in the community might be effective for the health promotion of older residents in hillside residential areas of Nagasaki City.

Disaster preparedness of hillside residential area in Nagasaki city, Japan: evaluations regarding experiences related to a fire.

Objective: An accidental fire that occurred in a hillside residential area in the city of Nagasaki was evaluated to assess the challenges faced by communities located on sloped terrains and to develop community-based support systems applicable to such hillside residential areas. Methods: Community observations and key-informant interviews were performed in the area affected by the fire. A self-administered questionnaire survey was also conducted among residents of the affected area. Information obtained through community observations of the fire-struck area and key-informant interviews was analyzed and assessed using a two-dimensional (2D) framework. Results: According to community observations and key-informant interviews, initial firefighting efforts were delayed due to lack of preparedness, in addition to geographic factors such as narrow roads and outdoor staircases, which allowed the fire to spread. The livelihood and health support measures for elderly residents requiring evacuation assistance were also insufficient. A hospital neighboring the area affected by the fire accident voluntarily provided some services to evacuees, but support from other nearby organizations/institutions was either not available or not offered. According to the questionnaire answers, elderly residents had little knowledge of the location and proper use of fire hydrants in their area. In addition, 65% of the respondents had never participated in disaster training exercises. From these results, the following three points could be determined: 1) The geographic features of the hillside residential area enhanced the spread of the fire. 2) The multi-sector support systems for evacuees were inadequate, collaboration among the existing systems was insufficient, and the roles of those systems were not fully clarified in advance. 3) Elderly residents in the hillside residential area did not have sufficient the knowledge and/or ability to engage in fire prevention activities and had inadequate firefighting skills. Conclusions: It is important to improve disaster preparedness knowledge and training for local residents on ordinary times. Additionally, cross-sector collaborative disaster response, harmonious management, and support systems must be ensured and sustained before, during, and after disasters.

Contribution of social relationships to self-rated health among Japanese community-dwelling elderly.

Objective: Participation in social activities is associated with physical and psychological health in the community-dwelling elderly population. We examined the two factors of social relations and community health resources, associated with higher self-rated health levels in the community-dwelling elderly. Methods: A total of 145 community-dwelling elderly people ≥ 65 years old from two neighborhood associations in Nagasaki City were recruited for this study, representing 85% of the officially registered ≥ 65-year-old population in the target area. Face-to-face interviews using a structured questionnaire were conducted by trained interviewers in August 2009, with questions related to sociodemographic characteristics, social relationships, and self-rated health (SRH). Community health resources (type and walking distance from home) were evaluated by one of the authors as a community assessment. Results: Seventy-eight community-dwelling elderly people (25 men and 53 women) participated in the study. Elderly people who reported going out every day were more likely to show higher SRH scores (excellent/good) than those going out less often (OR: 3.7; 95% confidence interval [CI]: 1.0, 14.2; P = 0.056). The numbers of interactions with friends in higher and lower SRH groups were 6.5 ± 8.4 (mean ± standard deviation) and 2.4 ± 1.1 (P = 0.01, Mann-Whitney U test), respectively. The numbers of relatives talking on the phone in higher and lower SRH groups were 2.9 ± 1.3 and 2.2 ± 1.2 (P = 0.031, Mann-Whitney U test), respectively. Meeting scores with friends in higher and lower SRH groups were 7.8 ± 5.8 and 4.5 ± 3.6 (P = 0.068), respectively. The scores of community health resources among higher and lower SRH groups were 21.2 ± 1.5 and 20.9 ± 1.4 (P = 0.547), respectively. The scores of community association/activities in higher and lower SRH groups were 3.9 ± 1.0 and 3.6 ± 0.9 (P = 0.227), respectively. Conclusion: This study indicated the importance of interaction with friends and relatives for maintaining higher SRH among community-dwelling elderly people.

Feasibility of the Pharmacy DOTS System in Nagasaki Prefecture.

Objective This study aimed to investigate the preparedness of pharmacies to provide DOTS in Nagasaki Prefecture, Japan, and to analyze the feasibility of this system with a view toward providing a basis for future administrative studies to consider its adoption.Methods A self-administered mail questionnaire survey was conducted, involving the owners (mostly pharmacists) of 533 pharmacies belonging to designated medical institutions for tuberculosis treatment in Nagasaki Prefecture, seeking information on the following: 1) respondent attributes, 2) pharmacy-related information, 3) experience of participating in tuberculosis-related academic meetings, 4) recognition of DOTS and desire to cooperate with the pharmacy DOTS system and participate in related workshops, and 5) challenges and requirements of the provision of DOTS at pharmacies. Responses were analyzed using the chi-square test, focusing on factors related to the respondents' desire to cooperate with the pharmacy DOTS system and participate in related workshops. The significance level was set at P<0.05.Results On analyzing 212 valid responses (valid response rate: 39.8%), "participating in academic meetings or related workshops", "supporting patients with tuberculosis", "recognizing DOTS", "recognizing the pharmacy DOTS system", "calculating additional medical fees for standard dispensing", and "establishing community liaison systems" were significantly correlated with "wishing to cooperate with the pharmacy DOTS system". Furthermore, age under 50, in addition to "participating in academic meetings or related workshops", "supporting patients with tuberculosis", "recognizing DOTS", "recognizing the pharmacy DOTS system", "calculating additional medical fees for standard dispensing", and "establishing community liaison systems" were significantly correlated with "wishing to participate in related workshops". More than 60% and 50% of the respondents mentioned "tuberculosis-related knowledge and information" and "pharmacy manpower", respectively, as requirements for the provision of DOTS at pharmacies.Conclusion Pharmacies interested in "calculating additional medical fees for standard dispensing" and "establishing community liaison systems", as well as pharmacy owners younger than 50 who actively participate in tuberculosis-related academic meetings or similar activities are likely to cooperate with the pharmacy DOTS system in the future. It was also suggested that sufficient preparation for the adoption of this system, such as promoting collaboration between administrative offices and medical institutions and holding workshops on tuberculosis and the system, would contribute to its feasibility in Nagasaki Prefecture.

Community trial on heat related-illness prevention behaviors and knowledge for the elderly.

This study aims to explore whether broadcasting heat health warnings (HHWs), to every household and whether the additional home delivery of bottled water labeled with messages will be effective in improving the behaviors and knowledge of elderly people to prevent heat-related illness. A community trial on heat-related-illness-prevention behaviors and knowledge for people aged between 65 and 84 years was conducted in Nagasaki, Japan. Five hundred eight subjects were selected randomly from three groups: heat health warning (HHW), HHW and water delivery (HHW+W), and control groups. Baseline and follow-up questionnaires were conducted in June and September 2012, respectively. Of the 1524 selected subjects, the 1072 that completed both questionnaires were analyzed. The HHW+W group showed improvements in nighttime AC use (p=0.047), water intake (p=0.003), cooling body (p=0.002) and reduced activities in heat (p=0.047) compared with the control, while the HHW group improved hat or parasol use (p=0.008). An additional effect of household water delivery was observed in water intake (p=0.067) and cooling body (p=0.095) behaviors. HHW and household bottled water delivery improved heat-related-illness-prevention behaviors. The results indicate that home water delivery in addition to a HHW may be needed to raise awareness of the elderly.

Utilization of bar and izakaya-pub establishments among middle-aged and elderly Japanese men to mitigate stress.

Japanese suicide rate is one of the highest among industrialized nations, especially following the economic crisis of the 1990s, with more than 30000 suicides every year since 1998. Previous studies have pointed out to relationships between overwork and/or job stress, and death and other health risks, and suggested several possible avenues for releasing stress and emotional burden, including suicidal ideation, through talking with intimate friends, family, and specialists, such as counselors and physicians. The present study was performed to explore the potential role of owners and managers of bars and izakaya-pub establishments in mitigating stress of middle-aged and elderly Japanese men by having informal conversations with them. A self-administered questionnaire was posted to all bars and izakaya-pubs registered in Ohmura-city, Nagasaki prefecture, in December 2009. Among 260 bars and izakaya-pubs, a total of 103 owners and managers completed the questionnaire. More than half of the respondents experienced engaging in conversations with their customers regarding customers' various personal and private issues. The most frequently talked about problem was that regarding work (56.3%). Regardless of sex and age of the respondents, those with longer working experience in bar and izakaya-pub establishments were more likely to have had customers confiding in them financial problems including debts/loans (adjusted odds ratio: 5.48, p = 0.033). Owners and managers of bars and izakaya-pubs may be in a position to act as "listeners", to whom middle-aged and elderly men can talk about their personal problems casually and without having to worry about conflict of interests, and direct those in need to professional counseling.

Secular changes in growth among Japanese children over 100 years (1900-2000).

Human growth is associated with complex interactions between genetic and environmental factors. While research has reported increased body size and body mass index (BMI) of Japanese children, few studies have compared the magnitude of increments in growth before and after World War II (WW II) and also considered other social and economical events that may have influenced the growth of children. The current study assessed the secular change in growth in Japanese children and adolescents aged between 6 and 17 years using data from the School Health Statistics Survey conducted between 1900 and 2000 with consideration of key social changes during the 20th Century. Over the 100-year period, Japanese boys had height and weight increments of 1.0-2.0 cm per decade and 0.4-1.7 kg per decade whereas girls had rates of 1.1-1.9 cm and 0.4-1.5 kg per decade, respectively. The rates of height increment were significantly (p<0.05) different between pre-, during and post-WW II periods. While Japanese children were considerably larger in 2000 compared to 1900, increments between 1950 and 1960 reflected catch-up growth to restore physical size seen in children prior to WW II. The increments in body size continued after 1960 with greatest changes seen across the pubertal years. While increments in BMI were evident in most age groups, the BMI of 17-year-old girls was consistent over the 100 years. Results clarified secular changes in growth in Japanese school children across the 20th Century and possible factors contributing to these changes.

Knowledge, experience, and potential risks of dating violence among Japanese university students: a cross-sectional study.

BACKGROUND: The Domestic Violence Prevention Act came into effect in Japan in 2001, but covers only marriage partner violence and post-divorce partner violence, and does not recognize intimate partner violence (IPV). The present study was performed to determine the experience of harassment, both toward and from an intimate partner, and recognition of harassment as IPV among Japanese university students. METHODS: A self-administered questionnaire survey regarding the experience of harassment involving an intimate partner was conducted as a cross-sectional study among freshman students in a prefectural capital city in Japan. RESULTS: A total of 274 students participated in the present study. About half of the subjects (both male and female students) had experience of at least one episode of harassment toward or had been the recipient of harassment from an intimate partner. However, the study participants did not recognize verbal harassment, controlling activities of an intimate partner, and unprotected sexual intercourse as violence. Experience of attending a lecture/seminar about domestic violence and dating violence did not contribute to appropriate help-seeking behavior. CONCLUSIONS: An educational program regarding harassment and violence prevention and appropriate help-seeking behavior should be provided in early adolescence to avoid IPV among youth.

Fat-free mass and excess post-exercise oxygen consumption in the 40 minutes after short-duration exhaustive exercise in young male Japanese athletes.

The relationship between fat-free mass (FFM) and excess post-exercise oxygen consumption (EPOC) has not been well researched because of the relatively small number of subjects studied. This study investigated the effects of FFM on EPOC and EPOC/maximum oxygen consumption. 250 Japanese male athletes between 16 and 21 years old from Nagasaki prefecture had their EPOC measured up to 40 minutes after short-duration exhaustive exercise. The value was named as EPOC40 min. The proportions of EPOC up to 1, 3, 6, 10, and 25 minutes to EPOC40 min were calculated and named as P1, P3, P6, P10, and P25, respectively. Body size and composition, VO2max and resting metabolic rate (RMR) were also measured. Mean EPOC40 min was 9.04 L or 158 ml/kg FFM. EPOC40 min was related to FFM (r=0.55, p<0.001) and VO2max (r=0.37, p<0.001). The ratio of EPOC40 min to VO2max was related to FFM (r=0.28, p<0.001). P1, P3, P6, P10, and P25 were negatively related to EPOC40 min/FFM, EPOC40 min/VO2max, and FFM. Athletes who had larger FFM had larger EPOC40 40 min and EPOC40 40 min/VO2max, and smaller P1, P3, P10, and P25.