The Effect of a Learning Partner Model-Based Program on Spreading Cancer Prevention Knowledge Using Community Health Volunteers in Japan.

OBJECTIVES: This study examines the implementation and short-term effects of a Learning Partner Model (LPM)-based educational program on cancer prevention and control information for community health volunteers in Japan. METHODS: The program was undertaken by 3 local governments in collaboration with a government initiative and offered a 90-min group workshop to community health volunteers. Community health volunteers (primary participants) recruited in turn friend or family members (secondary participants) with whom they were prepared to share the content of the workshop with the help of printed materials received in the workshop. We conducted self-administered paper and pencil questionnaire surveys before, immediately after, and 3 months after the workshop. The t-test, Fisher's exact test, paired t-test, and McNemar test were used to compare the 2 groups' demographic characteristics and healthy habits at pretest. Repeated measures ANOVA was used to compare cancer prevention knowledge between groups and over time. RESULTS: Of 142 participants, 107 pairs of learning partners (primary and corresponding secondary participant) completed all questionnaires. All primary participants and 37.4% of the secondary participants were women, and 57.9% of the learning partners were spouses. The results showed significantly higher correct answers on the cancer-prevention knowledge questions in the post-workshop and follow-up surveys compared to the pre-workshop survey (P < .001). The increase in knowledge was observed in all learning-partner groups in all 3 sites. CONCLUSION: The study demonstrates a promising strategy that can be adapted to the health needs of the community beyond cancer prevention and control, building on the efforts of local governments and government health initiatives.

Risk Factors for Urinary Incontinence in Japanese Elderly Women.

OBJECTIVES: The aim of this study is to clarify risk factors of urinary incontinence (UI) in elderly Japanese women. METHODS: We randomly selected 1600 women, aged between 65 and 74 years, from the resident registration of Sapporo City and we analyzed 746 women, who responded twice on surveys in 2010 and 2011. UI was defined as frequent UI when it occurred at least once a week in both 2010 and 2011. RESULTS: Multivariate logistic regression analysis revealed that the past maximum body weight, smoking index, past history of bladder disease or hemorrhoids, and the participant's mother's history of UI were significantly associated with an increased risk of UI. CONCLUSION: Lifestyle habits such as weight gain and smoking habits were associated with an increased risk of UI in Japanese women. Further study is needed, because modification of these risk factors may possibly result in reducing risk of UI.

A prospective study of factors associated with risk of turnover among care workers in group homes for elderly individuals with dementia.

OBJECTIVES: A prospective study was conducted to assess factors associated with risk of turnover among care workers in group homes (GHs) for elderly individuals with dementia. METHODS: In January, 2010, 51 out of 238 GHs in Sapporo City responded to our request for participation in a survey. During February and March of 2010, 438 out of 700 care workers (62.6%) in the GHs returned a completed questionnaire to us. They were followed up with until March of 2012, and 395 subjects (90.1%) responded to our survey, which was conducted twice. Over the course of 2 years, 91 subjects left their jobs. Cox's proportional hazards model was used for analysis, adjusting for gender and age. RESULTS: Less provision of social support by supervisors, colleagues, family or friends was significantly associated with increased risk of turnover. Financial aids for off-the-job training was marginally significantly associated with reduced risk of turnover. Longer duration of working for frail elderly care was significantly associated with decreased risk of turnover. Habitual smoking was significantly associated with increased risk of turnover. CONCLUSIONS: Social support in the workplace may be important to reduce the risk of turnover in care workers at GHs. Further prospective studies are required in other areas in Japan.

A cross-sectional study on association of work environment, coping style, and other risk factors with depression among caregivers in group homes in Japan.

A cross-sectional study was conducted to explore the potential association between work environment and/or stress coping ability, and depressive status among caregivers working for "group homes (GHs)" in Japan. In January 2010, 438 out of 700 caregivers working at GHs in Sapporo City returned completed questionnaires to us. The questionnaires consisted of the Center of Epidemiological Scales-Depression, items about worker's attributions, Ozeki's coping scale, and so on. An analysis using a logistic regression model was used to find the associations adjusting for gender and age. Subjects who were 45 yr or older, had a spouse, had job training, a standard workload and scored high in emotion-oriented coping were significantly associated with a decreased risk of depression. Subjects who were less proud of their job, less willing to continue care for the frail elderly and had fewer acceptances by their supervisors or colleagues for consultation were significantly associated with an increased risk of depression. This study supports our hypothesis that there can be possible variables among individual factors, work environment and/or coping style for stress which may modulate a risk on the depressive status of caregivers.

[Assessing weight and other factors associated with the urinary incontinence of elderly women: a cross-sectional study].

OBJECTIVES: Urination diseases--particularly urinary incontinence (UI)--strongly affect individuals' quality of life (QOL). It is important to maintain overall QOL in societies with an increasing number of long-living elderly people, such as in Japan. Thus, this study aims to clarify the risk factors concerning UI in elderly women. METHODS: For this study, we obtained the approval of the Ethical Committee of Sapporo Medical University. In October 2010, we randomly selected 1,600 women, aged between 65 and 74 years, from the registry of Sapporo city residents and mailed out a self-administered questionnaire. Our questionnaire consisted of five subsections (24 items in total), including fundamental attributes, health condition, past history, present illness, and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The self-reported prevalence of UI was defined as frequent UI being at least once a week. A logistic regression analysis was used to assess the risk factors for UI. RESULTS: Among those who received the questionnaire, 802 women (response rate: 50.1%) returned a completed questionnaire with written informed consent. Their mean age (+/- standard deviation) was 69.8 +/- 2.6 years, and the prevalence of UI was found to be 29.7%. The mean scores (+/- standard deviation) of ICIQ-SF were 1.7 +/- 2.9 for all participating subjects, and 5.55 +/- 2.50 and 0.09 +/- 0.53 for the groups with or without UI, respectively. The results of the multiple logistic regression analysis were as follows: the odds ratio (95% confidence interval) was 1.94 (1.32, 2.85) for a past maximum weight heavier than or equal to 60 kg; 1.98 (1.18, 3.32) for a smoking index more than or equal to 300; 2.54 (1.47, 4.39) for a poor self-perceived health status; 1.62 (1.09, 2.40) for having a past history of bladder diseases; 1.72 (1.11, 2.69) for having a past history of hemorrhoidal disease; and 2.05 (1.36, 3.10) for a history of UI in one's mother. CONCLUSION: The self-reported prevalence rate of UI was 29.7% in women aged 65-74 years. In the future, we plan to conduct a follow-up survey to further clarify the risk factors of UI that have been implicated in this cross-sectional study.

Relationship of hobby activities with mortality and frailty among community-dwelling elderly adults: results of a follow-up study in Japan.

BACKGROUND: The proportion of Japanese adults aged 65 years or older is predicted to increase; thus, it is becoming more important to identify factors that influence health status among elderly adults in Japan. We conducted a follow-up study of community-dwelling elderly adults to assess the relationship of hobby activities with mortality and incident frailty. METHODS: We randomly selected 3583 individuals aged 65 to 84 years from the residential registries of 7 study areas in Hokkaido, Japan in August 2007. Among them, 1955 (54.6%) returned completed questionnaires with written informed consent by mail. The baseline assessment questionnaire comprised questions on current and past involvement in hobby activities, self-perceived health status, smoking and drinking habits, and body height and weight. Questions on hobby activities were from 4 categories: solitary physical, group physical, solitary cultural, and group cultural activities. We later conducted a follow-up survey of the participants to ascertain all-cause mortality and incident frailty. A Cox proportional hazards model was used for analysis of data from September 2007 to May 2010. RESULTS: After adjusting for potential confounders, the risk of incident frailty among respondents participating in solitary physical activities was significantly lower than in those who did not participate in such activities (hazard ratio = 0.57; 95% CI 0.33, 0.99). Furthermore, the risk of incident frailty among respondents taking part in group cultural activities was significantly lower than in those who did not participate in such activities (0.41; 0.19, 0.87). CONCLUSIONS: These findings may be important for programs that seek to promote good health among elderly adults.

What is a common factor in different areas?: The case of depression among caregivers of the frail elderly in Sapporo and Kochi, Japan.

AIM: Depression affecting caregivers is a risk factor for discontinuing at-home care. The present cross-sectional study was conducted to evaluate factors related to depression among family caregivers. METHODS: A cross-sectional study was conducted to evaluate factors related to depression among family caregivers of the frail elderly. The study included caregivers whose relatives received periodic visits from a nurse from one of seven Sapporo-based home-visiting nursing service stations in October 2008 or from one of nine Kochi-based home-visiting nursing service stations between June 2009 and March 2010. Caregivers were asked to answer a self-administered questionnaire about various factors that might affect their depression and to complete a Center for Epidemiologic Studies Depression Scale evaluation. We analyzed 127 pairs of responses in total. RESULTS: After we adjusted the results for the caregivers' gender and age, the factors that decreased the risk of depression in the Sapporo group related to relieving the stress that results from being a caregiver (OR = 0.12, 95%CI = [0.03, 0.42]) and the ability to independently pay more than ¥10 000 for part of care service costs (OR = 0.17, 95%CI = [0.05, 0.58]). In contrast, feeling ill was a factor that increased caregivers' risk of depression in the Kochi group (OR = 4.23, 95%CI = [1.29, 13.9]), but not in Sapporo group (OR = 2.53, 95%CI = [0.91, 7.08]). Caregivers in the Sapporo group were more likely to feel ill (P < 0.01) than their counterparts in Kochi. CONCLUSION: The Japanese government should take measures to reduce caregivers' depression. Otherwise family members will increasingly discontinue to provide at-home care.

Dietary intake of six minerals in relation to the risk of chronic obstructive pulmonary disease.

To investigate the relationship between dietary intake of minerals and the risk of chronic obstructive pulmonary disease (COPD), a case-control study was conducted in central Japan. A total of 278 referred patients (244 men and 34 women) aged 50-75 years with COPD diagnosed within the past four years and 340 community-based controls undertook spirometric measurements of lung function. A structured questionnaire was administered face-to-face to obtain information on demographics and habitual food consumption. Dietary intakes of six major minerals were derived from the Japanese food composition tables. The COPD patients had lower habitual energy-adjusted intakes of calcium, phosphorus and iron than controls, but not sodium. A significant reduction in prevalence of COPD was observed for calcium, with adjusted odds ratio 0.65 (95% confidence interval: 0.37- 0.98) for the highest level versus lowest level of intake. A high iron intake was also inversely associated with the COPD risk. In conclusion, an inverse association was evident between dietary calcium intake and the risk of COPD for Japanese adults.

Ecological studies on influenza infection and the effect of vaccination: their advantages and limitations.

Ecological studies lack the ability to control for the effects of confounding factors. The findings of a linear relationship between average exposure and disease frequency in ecological studies do not imply that such a linear relationship will be present at the individual levels. This is known as the 'ecological fallacy'. Despite these limitations, ecological studies may be the best approach to studying exposures that are easier to measure at the group rather than the individual level because most ecological studies make use of routinely collected data. They are also useful for monitoring the effectiveness of population interventions such as vaccination programs, health education campaigns and mass screening programs. Thus, ecological studies are useful epidemiologic tools for public health surveillance if we know their limitations and interpret their results carefully. Ecological studies often help to generate hypotheses, although they rarely provide a strong test of a causal hypothesis.

Confounding in evaluating the effectiveness of influenza vaccine.

Confounding is a kind of bias which occurs in a research. Confounding is less frequent in randomized controlled trials (RCT) for evaluation of influenza vaccines. However, there are obstacles or difficulties in conducting RCT for evaluation of influenza vaccines, particularly, in the elderly people. Therefore, a retrospective or prospective cohort study has been primarily performed to evaluate effectiveness of influenza vaccine in elderly people. Confounding by indication or other confounding exist in most observational studies. Accordingly, at the stage of designing or analyzing a study, confounding should be controlled with a restriction, matching, stratified or multivariate analysis technique.

Comparison of the clinical features of Japanese patients with primary biliary cirrhosis in 1999 and 2004: utilization of clinical data when patients applied to receive public financial aid.

BACKGROUND: In Asia there are few reports considering time intervals in the examination of clinical features of primary biliary cirrhosis (PBC). Therefore, we tried to compare the characteristics of patients with PBC in two different years. METHODS: In two fiscal years (1999 and 2004), 9,761 and 13,142 patients with symptomatic PBC were registered to receive public financial aid from the Ministry of Health, Labour and Welfare of Japan, respectively. For the present study, clinical data from 2,127 patients in 1999 and 6,423 ones in 2004 were available. We compared the data in the two different years, including sex, age, major symptoms, and laboratory data. RESULTS: Male/female ratios were the same figure (0.13 for 1999 and 2004). The median age was significantly older in 2004 than in 1999 (59 years for 1999, 63 years for 2004, respectively, p<0.01). Jaundice and esophageal varices were found significantly less frequent in 2004 than in 1999 (p<0.01 for each item). Levels of total bilirubin,gamma-glutamyl transpeptidase (gamma-GTP), total cholesterol, and immunoglobulin M were significantly lower in 2004 than in 1999 (p< 0.02 for total bilirubin, and p<0.01 for other each item). The positive rate of antimitochondrial antibodies was significantly higher in 1999 than in 2004 (87.0% for 1999, 83.5% for 2004, respectively, p<0.01)). Complicated autoimmune diseases such as Sjögren's syndrome, rheumatoid arthritis, and chronic thyroiditis were found significantly more frequent in 2004 than in 1999 (p<0.01 for each item). CONCLUSIONS: Among the patients with PBC in 2004, an increase in median age, and lower levels of laboratory data such as gamma-GTP have been found compared to 1999. These results may show an accumulation of patients with better prognosis and the recent medical progress in controlling patients with PBC.J Epidemiol 2007; 17: 210-214.

Smoking, drinking, sleeping habits, and other lifestyle factors and the risk of systemic lupus erythematosus in Japanese females: findings from the KYSS study.

Many risk factors have been proposed for systemic lupus erythematosus (SLE). However, there is little information about the relationship between lifestyles and SLE in Japan. Two case control studies were conducted in Kyushu, southern Japan, and in Hokkaido, northern Japan, to examine the relationship between lifestyles and development of SLE in females. The participants were 78 patients and 329 controls in Kyushu and 35 patients and 188 controls in Hokkaido. Smoking was associated with an increased risk of SLE after adjusting for age in both regions. However, in Hokkaido, this association between smoking and SLE did not reach statistical significance after adjusting for alcohol drinking. The present study suggests that smoking may increase the risk of SLE among Japanese females.

Factors related to institutionalization among the frail elderly with home-visiting nursing service in Japan.

A dramatic increase in the number of elderly people in Japan has led to a concurrent increase in the number of frail elderly in need of care. It is estimated that the number of frail elderly will reach 3.9 million by the year 2010. Family members are often both physically and mentally burdened with caring for the frail elderly. The present study was conducted to identify the risk factors for institutionalization among the frail elderly receiving in-home care in Japan.

[Burden among caregivers of the frail elderly and its correlation with the introduction of a long-term care insurance system for the elderly in fourth year].

The present study was conducted in October 2003 to investigate the factors related to psychological stress and the heavy burden of caregivers taking care of frail elderly persons in the northern part of the Onga district, Fukuoka Prefecture, Kyushu, Japan. A total of 40 caregivers were assessed using a self-administered questionnaire involving the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI) and thus described their own caregiving situation. J-ZBI research had been done on a yearly basis for the previous 5 years and the results of each investigation regarding Center for Epidemiologic Studies Depression Scale (CES-D), and incidence of depression, ADL and dementia were compared prior to and after initiation of public long term care insurance for the elderly (LTCI). Compared to caregivers with a middle or light burden, heavily burdened caregivers were more likely to have a higher J-ZBI, and CES-D. Compared to caregivers with a light burden, heavily burdened caregivers were more likely to 1) be in poor condition, 2) complain of their economical situation, 3) spend a longer time with care talker. Compared to caregivers with a middle burden, heavily burdened caregivers more frequently used short-stay services (i.e., temporary nursing home assistance). J-ZBI and ADL were compared to before LTCI, and 4 years after LTCI had been started. Scores for both were lower after 4 years. Compared to before LTCI, day-care and day service were used less frequently 3 and 4 years after LTCI. After LTCI, caregivers showed a lower J-ZBI score, but the incidence of depression among caregivers was higher, compared to the general public. It is suggested that a government agency should be created to support not only the frail elderly but also their caregivers.