Development of the Parenting Behavior Checklist to Promote Preschoolers' Sleep (PCPP).

OBJECTIVES: To develop the Parenting Behavior Checklist to Promote Preschoolers' sleep (PCPP), quantify sleep-promoting parenting behaviors for children, and examine the scale's reliability and validity. METHODS: The PCPP was developed based on the recommendations of the ABCs of SLEEPING for children's sleep, which is strongly supported by research evidence. Its validity and reliability were evaluated using data from 140 participants. Structural validity was estimated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and internal consistency was evaluated by Cronbach's α. Hypothesis testing was evaluated by analyzing the correlations between each factor of the Japanese Sleep Questionnaire for Preschoolers (JSQ-P) and the PCPP. RESULTS: Regarding structural validity, EFA was conducted because CFA showed a poor model fit. The PCPP comprised one factor and six items. The JSQ-P subfactors of insomnia or circadian rhythm sleep-wake disorders, undesirable morning symptoms and behaviors, and insufficient sleep were moderately negatively correlated with the PCPP; the subfactor of undesirable daytime behaviors related to sleep problems was weakly negatively correlated with the PCPP. Thus, the sleep-promoting parenting behaviors listed in the PCPP were associated with better sleep in children. CONCLUSIONS: The PCPP showed sufficient reliability and validity. Future studies should use the scale to examine more effective interventions regarding sleep-promoting parental behaviors for children.

Rice OsHAK5 is a major potassium transporter that functions in potassium uptake with high specificity but contributes less to cesium uptake.

Cesium (Cs) in the environment is primarily absorbed by a potassium (K) transporter. OsHAK5 is a KT/HAK/KUP family K-transporter showing a high affinity for K. We created cultured rice cells whose OsHAK5 was knocked down by RNAi (named KD). In the medium containing 1.0 m m and less K, the growth of KD was significantly suppressed, suggesting that OsHAK5 greatly contributed to K absorption under limited K conditions. Although Cs suppressed the growth of KD and WT, stronger inhibition was observed on KD. Both KD and WT accumulated similar amounts of Cs when they were cultured in a medium containing Cs, whereas lower amounts of K were detected in KD. These results suggest that OsHAK5 was less involved in the absorption of Cs, although it was essential to K absorption under limited K conditions. In contrast, this means that another transporter may contribute to cesium uptake in rice.

The Quaternary Kurobegawa Granite: an example of a deeply dissected resurgent pluton.

The Quaternary Kurobegawa Granite, central Japan, is not only the youngest known granitic pluton exposed on the Earth's surface, it is one of few localities where both Quaternary volcanics and related plutons are well exposed. Here, we present new zircon U-Pb ages together with whole rock and mineral geochemical data, revealing that the Kurobegawa Granite is a resurgent pluton that was emplaced following the caldera-forming eruption of the Jiigatake Volcanics at 1.55 ± 0.09 Ma. Following the eruption, the remnant magma chamber progressively cooled forming the voluminous Kurobegawa pluton in the upper crust (~ 6 km depth) until ~ 0.7 Ma when resurgence caused rapid uplift and erosion in the region. This is the first study to document the detailed spatiotemporal evolution of resurgent pluton for a Quaternary caldera system. Our new findings may contribute significantly to understanding the fate of active caldera systems that can produce supereruptions.

Is 4-month-old infants' night waking affected by mothers' responses to them? A cross-sectional survey in Japan.

OBJECTIVE: To investigate the association between night waking frequency in 3- to 4-month-old infants and mothers' response to them. DESIGN: Cross-sectional survey. SAMPLE: We examined 663 mothers of infants aged 3-5 months who attended regular health checks for 4 months at 7 public health centres in Japan between September 2006 and March 2007. MEASUREMENTS: Mother-reported questionnaires were used, measuring the frequency of infants' night waking and four types of responses by mothers. Using multiple regression, the association between number of wakings and each response was evaluated adjusting for covariates, that is mother's (e.g. feelings of worry and bed-sharing) and infant's (e.g. age and sex) demographic variables. RESULTS: The number of wakings was related to "immediately feeding and/or checking diapers" (ß = 0.16, p = .002).This response to infants' night waking may be associated with night waking frequency. CONCLUSION: Modifying caregiver responses to infants' night waking by reducing immediate feeding or diaper checks could improve infants' night waking frequency.

[The relationship between sleep and subjective mental health at one month postpartum in Japanese women].

Objectives　This study aimed to separately ascertain and examine the association between sleep and mental health among primiparas and multiparas at one month postpartum.Methods　The subjects were 234 primiparas and 223 multiparas (a total of 457) at one month postpartum who agreed to participate in the questionnaire survey during a health check-up at a maternity hospital. According to the delivery records, they had no history of mental diseases. The survey items of the questionnaire concerned living environment, sleep status, subjective mental health (depressive mood, anxiety, low motivation, irritability) and sleep-related lifestyle. At first, we compared these items between primiparas and multiparas. Next, multiple regression analysis by a general linear model was used to investigate the association between sleep status and mental health. The dependent variables were sleep satisfaction, total sleep time, the existence of sleep problems (difficulty initiating sleep, difficulty maintaining sleep, waking up too early), irregularity of bedtime, and five kinds of sleep-related lifestyle. The independent variables were the four mental health indices according to a visual analog scale.Results　In primiparas, total sleep time was shorter, bedtime and sleeping time were later, two kinds of sleep-related lifestyle were worse, and the symptoms of tinnitus and tired feeling were higher than in multiparas. In multiparas, sleep onset latency was longer, the number of times of night awakening was higher, irritability was stronger, and the prevalence of headache was higher than in primiparas. Sleep satisfaction was related to all four indices of mental health for both primiparas and multiparas. In primiparas, the existence of sleep problems was related to depressive mood and anxiety, and the irregularity of bedtime was related to anxiety. "Getting up immediately after awakening" was related to irritability, as well as low motivation, in multiparas. "A nap shorter than 30 minutes before 3 PM" was related to anxiety and low motivation in primiparas. The irregularity of bedtime was negatively related to anxiety, low motivation, and irritability in multiparas.Conclusion　It is suggested that sleep problems, which tend to be overlooked, are related to subjective mental health at one month postpartum. Thus, we conclude that sleep education during pregnancy and sleep evaluations at postpartum check-ups are necessary for postpartum women's mental health.

The Relationship between Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 Ligands Containing Apolipoprotein B and the Cardio-Ankle Vascular Index in Healthy Community Inhabitants: The KOBE Study.

AIMS: Lectin-like oxidized low-density lipoprotein (LDL) receptor-1 ligands containing apolipoprotein B (LAB) and lectin-like oxidized LDL receptor-1 (LOX-1) are known as LOX-1-related modified LDL indicators. These indicators play an important role in the early phase atherosclerosis, but the relationship between these indicators and subclinical atherosclerosis, as represented by the cardio-ankle vascular index (CAVI), has not been assessed. We herein investigated the association of LOX-1- related modified LDL indicators and the CAVI in healthy, Japanese urban community inhabitants who were considered to be at low risk for cardiovascular disease (CVD). METHODS: The participants were 515 healthy Japanese (310 men and 205 women) without a history of CVD, cancer or the use of medication for hypertension, diabetes or dyslipidaemia. To estimate the association between LOX-1-related modified LDL indicators (LAB, soluble form of LOX-1 (sLOX-1)) and the CAVI, we performed multivariable linear regression analyses with possible confounders such as the serum LDL cholesterol level. RESULTS: The plasma LAB showed a positive association with the CAVI in men (standardized coefficient: 0.11, p = 0.04). This relationship was not observed in women. On the other hand, no clear association was observed between the CAVI and the plasma sLOX-1 level in either sex. CONCLUSIONS: The plasma LAB levels may represent a useful marker for detecting potential atherosclerosis in healthy individuals considered to be at low risk for atherosclerosis and CVD. Further studies are needed to confirm the present findings.

Does high-sensitivity C-reactive protein or low-density lipoprotein cholesterol show a stronger relationship with the cardio-ankle vascular index in healthy community dwellers?: the KOBE study.

AIM: High-sensitivity C-reactive protein (hs-CRP) identifies individuals at risk for cardiovascular disease (CVD) without an increased level of low-density lipoprotein cholesterol (LDL-C). The present study was performed to compare hs-CRP and LDL-C in association with the cardio-ankle vascular index (CAVI) in Japanese community dwellers considered to be at low risk for atherosclerosis from their level of traditional CVD risk factors. METHODS: A community-based study involving 386 healthy Japanese (261 men and 125 women) without a history of CVD and medications for hypertension, diabetes, and dyslipidemia was performed. Multiple adjustments were performed with linear regression models to estimate the association between CAVI and hs-CRP or LDL-C levels. The participants were divided into four groups on the basis of whether they were above or below the median hs-CRP and LDL-C values, and CAVI was compared among the four groups by analysis of covariance after adjusting for confounders. RESULTS: In multiple linear regression models, hs-CRP showed a significant positive association with CAVI; however, no clear association was observed between CAVI and LDL-C. These results were similar in the analyses among the participants with LDL-C <140 mg/dL or hs-CRP <1.0 mg/L. CAVI was higher in the groups with high hs-CRP than in those with low hs-CRP, irrespective of LDL-C; however, CAVI was highest in the group with high LDL-C and high hs-CRP. CONCLUSIONS: The present study suggests that hs-CRP could be a better risk factor assessor for atherosclerosis than LDL-C in individuals considered to be at low risk for atherosclerosis assessed by their traditional CVD risk factors.

[Factors and prosesses associated with weight loss in male workers in a specific health guidance program. A qualitative analysis of in-depth interviews].

OBJECTIVES: A qualitative analysis was conducted to identify factors important for weight loss through a specific health guidance program and to understand the processes that were crucial in achieving success. METHODS: Twenty-six male workers aged 41-59 years from five corporate health insurance societies in four prefectures who had lost > or = 4% weight by attending the six-month specific health guidance program were invited to participate in the in-depth interviews. Data were collected between October and December 2009. We audio taped the 30-minute interviews and performed qualitative analysis on the transcripts using a grounded theory. The discussion by the expert panel strengthened the validity of the analysis. RESULTS: The mean age was 49.9 +/- 5.6 years, and the average weight loss was 6.8 +/- 2.5%. All subjects were somewhat concerned about their health status and body shape before the first appointment, but two major prosesses, "critical feeling" and "sense of obligation," were identified after the first appointment. We also identified innovative efforts in all subjects during the process. Those who reported a "sense of obligation" at the beginning and those who had a negative perception during the program were found to have higher risks of weight rebound after the program was over. We considered personality, values, attitudes toward the program, and support from both family and workplace as the intervening conditions for behavior modification. CONCLUSION: Since everyone aged 40-74 years with a certain risk of metabolic syndromes is obligated by law to participate in the specific health guidance program, weight loss is challenging for those who are not motivated enough to change their behaviors. Therefore, the initial assessment of one's motivations, followed by interventions taken in consideration of one's lifestyle and social background, are crucial for the success of a weight loss program, as is the use of a client-centered approach.

[Non-face-to-face sleep improvement program in a workplace: bibliotherapy with and without behavioral self-control procedure].

BACKGROUND: Sleep hygiene education has been important health issue in the health promotion and the prevention of lifestyle-related diseases. A feasible and effective method is necessary for population approach. OBJECTIVE: To evaluate the effects of a non-face-to-face brief behavioral program for a sleep improvement in workplaces. METHODS: Research design was a cluster control trial. Three hundred and thirty participants were allocated to the bibliotherapy group (BTG; n=130) or self-control group (SCG; n=200). Two groups were recruited from separated local sections of a Japanese company each other. There was no eligibility criteria and the intervention was open to every worker in the workplaces. All participants received a self-help booklet and information on recent topics of insomnia-related health problems. SCG participants set several behaviors for habit improvement and monitored those behaviors for 4 wk additionally. The replies to the questionnaire showed that almost all of them had any sleep disturbances. RESULTS: A total of 158 participants in SCG (79%) and a total of 106 participants in BTG (82%) responded to the post questionnaire. Sleep parameters of pre and post questionnaires were compared between SCG and BTG. Overall, sleep onset latency was reduced and sleep efficiency was improved. The significant changes were found in only SCG. Re-analysis of pre and post 3-days' sleep diaries showed that the subjects in both group improved significantly in the main variables (total sleep time, number of awakenings, time spent awake, sleep efficiency). Sleep onset latency, wake after sleep onset, and daytime sleepiness improved significantly in only SCG. CONCLUSION: These results suggest that an additional target setting and self-monitoring could promote the effectiveness for sleep improvement of a bibliotherapy.

[Effects of a non-face-to-face behavioral intervention on poor sleepers and factors affecting improvement of sleep].

OBJECTIVE: The purposes of this study were 1) to re-examine effects obtained from previous research of a non-face-to-face behavioral intervention in poorer sleepers and 2) to examine the factors impacting on improvement of sleep. METHODS: The subjects were 178 poor sleepers who participated in an intervention for sleep improvement. The educational procedures comprised a minimal behavioral self-help package for one month that featured self- learning and self- monitoring of practical target habits for change. It was non face-to-face program conducted by only one member of staff. Subjects were asked to answer a questionnaire before and after the intervention. To reexamine the effects of this program found in our previous research, 9 sleep indices, sleep quality, and sleep-related behaviors were compared between before and after intervention. The sleep indices were total sleep time, sleep onset latency, sleep efficiency etc. Subjects were divided into an improvement group (n = 63) and a non-improvement group (n = 115) using a cutoff value for average change in sleep onset latency and sleep efficiency. After comparison of sleep and behavior between the two groups, logistic regression analysis was conducted to select parameters affecting improvement with this program. RESULTS: Total sleep time was significantly increased from 5.7 h to 6.1 h, sleep onset time decreased 18 minutes, and sleep efficiency improved 5.6 points. With 8 of 9 sleep-related behaviors, the proportion of subjects having an undesirable habit significantly decreased. The mean total number of desirable habit' changes was 2.63 in the improvement group and significantly higher than the 2.06 in the non-improvement group. Logistic regression analysis demonstrated that large sleep onset latency at baseline and beginning of regular exercise significantly affected the improvement of sleep in the subjects, after adjusting for all other parameters. CONCLUSION: The effects revealed by our previous research were reconfirmed. It is suggested that this program is more useful for persons having severe sleep onset difficulties, and regular exercise is particularly important in improvement of sleep. It is possible that even simple behavioral intervention is feasible with many subjects to improve sleep and related habits in poor sleepers.

Effects of a non-face-to-face behavioral weight-control program among Japanese overweight males: a randomized controlled trial.

BACKGROUND: Weight control has been major health issue in the prevention of lifestyle-related diseases especially among middle-aged working males in Japan. The computerized behavioral program is expected as an effective and feasible intervention tool. PURPOSE: The purpose of this study is to examine two hypotheses. The first was that first month weight loss effect is obtained by a behavioral program assisted by computer-tailored advices (Kenkou-tatsujin [KTP]) among overweight males and maintained for 7 months; the second was that the effects in the full KTP is superior to the booklet only. METHOD: Fifty-one males (body mass index [BMI] = 26.2) were randomly allocated to the KTP group (KTPG) or control group (CG). The KTPG (n = 23) read a booklet, set target behaviors, received advises, and self-monitored their weight and the targeted behaviors for 7 months. The CG (n = 28) read the same booklet. Weight, BMI, biological indices, and daily behaviors were compared at baseline, first, third, and seventh month. The subanalysis among 36 obese subjects was added. RESULTS: In KTPG, weight loss was larger at the first month (-1.1 vs. -0.3 kg), walking steps increased for the seventh month, and several biological indices tended to improve more at the third month than CG. However, the difference of weight loss was not significant at the seventh month. Among the obese subjects, weight loss in KTPG was larger than CG at the third month (-3.0 vs. -1.4 kg). CONCLUSION: Weight loss effects of KTP were significant at 1 month, walking steps increase was maintained for 7 months.

A brief parental education for shaping sleep habits in 4-month-old infants.

OBJECTIVE: To examine the effectiveness of a simple behavioral intervention with an educational booklet on the modification of parenting behaviors and the prevention of sleep disturbance in 4-month-old infants. DESIGN: A prospective cohort design with cluster sampling controls in a primary care setting. PARTICIPANTS: A total of 136 mothers with 4-month-old infants who visited a local health check-up clinic and responded to the 3-month follow-up survey. METHODS: At the health check-up, an intervention group was provided with 10 minutes of group guidance and a simple educational booklet designed to encourage parents to promote favorable sleep patterns in their infants. A control group was provided with standard education alone. The two groups were questioned 3 months later through a survey sent by mail. Main measurements were parenting behaviors of parents and night waking of infants. RESULTS: Two undesirable maternal behaviors that reinforce night waking in infants exhibited a significantly greater improvement in the intervention group than in the control group. "Feed or check diaper promptly" behavior and "hold and soothe immediately" behavior after "night waking" in the infant were significantly decreased in the intervention group. CONCLUSIONS: Our findings suggest that increased night waking in infants was prevented in the intervention group. Our results indicate that the proportion of infant night waking was significantly higher in the control group, and there was also a tendency toward an increase in the proportion of infants who woke frequently and cried. These infant behaviors were not changed in the intervention group at the 3-month follow-up stage.

[Impact of parenting behavior relevant to infant's sleep on maternal sleep and health].

BACKGROUND: Maternal health is affected by infant's sleep problems like night awakening or bedtime difficulties. Previous studies indicated that infant's sleep problems are affected by particular parenting behaviour (hereinafter referred to as parenting). However, the relation between maternal sleep and infant's sleep has been unclear and there is only limited information on the interaction between parenting, infant's sleep, maternal sleep, and maternal health. The purpose of this study was: 1. to examine the relationship between infant's sleep problems and maternal sleep and health; and 2. to investigate comprehensive relations of four parameters; maternal sleep, maternal health, infant's sleep, and parenting. METHODS: The subjects were 194 mothers who attended health checkup for 4month old infants. The questionnaire consisted of 3 components: 1) infant's and mother's sleep habits and sleep problems; 2) maternal health; 3) parenting. There were 15 items for parenting, divided into desirable and undesirable behavior. Subjects were classified into Problem Group (n = 40) or Control Group (n = 142) according to the infants' sleep problems. Maternal sleep, maternal health, parenting were compared between two groups. In addition, we examined relationships among the four parameters using path analysis. RESULTS: Over 60% of mothers experienced some sleep problems and about 30% were suspected of being at high risk of insomnia. The most common mother's sleep problem was "poor sleep quality". Over 80% of mothers had some health problems, that most frequently observed being "Shoulder stiffness". Desirable parenting like "Feed fully and checking the diaper before bedtime" was observed in 80% of mothers, while undesirable parenting like "Feeding or checking a diaper immediately" was seen in 71% of mothers. Maternal sleep problems, maternal health problems, and undesirable parenting were more frequent in the Problem Group than the Control Group. As a result of path analysis, the following relations were found: undesirable parenting affected infant's sleep problems, infant's sleep problems influenced maternal sleep, and mother's sleep influenced maternal health. CONCLUSIONS: Thirty percent of mothers were suspected of having sleep disorder and more than half practiced undesirable parenting. Undesirable parenting affected infant's sleep problems which in turn directly affected mothers' sleep and indirectly affected mother's health.

[Preparation and effect of a behavioral science-based education program for sleep improvement among medical students].

OBJECTIVE: The present study aimed to investigate a simple education program that is effective for sleep improvement among medical students who will be medical doctors in the future. The education program applied in the present study was developed for sleep improvement based on behavioral science and changes in knowledge and sleeping habits were observed. METHODS: Subjects were 6th-year medical students of 2002 and 2003. Students of 2002 attended a program including a 90-minute lecture and a 2-week practice learning session, and students of 2003 attended only the lecture. In the lecture, behavior therapy for chronic insomnia was explained using a booklet. In the practice learning session, students set a target behavior for improvement and conducted self-monitoring of their sleep and the targeted behavior. Changes in knowledge about sleep, attitude toward the therapy, sleep, and sleep-related habits were observed and compared between the 2 groups of subjects immediately and 2-weeks after the lecture. RESULTS: It was found that after both programs subjects had more knowledge about sleep than before. In the program including practice learning session, subjects' attitude for managing patients changed from before the lecture to after the lecture, and after the practice learning session. It was found that more than half of the students thought that they could provide sleep guidance based on the behavior therapy. Regarding the subjects' sleep, significant improvements were observed for "having nightmares upon falling asleep," "sleepiness during daytime," "sense of getting a sound sleep," and "mood upon waking up." Regarding sleep-related habits, significant improvements were observed for "taking a nap," "dozing off," and "eating breakfast." On the other hand, only the lecture subjects improved irregularity of bedtime and sleeping time. Although an increase in knowledge and improvement of sleep were observed among students who attended only the lecture, a further increase in knowledge and improvement of sleeping habits were observed among students who also attended the practice learning session. CONCLUSION: The results described herein suggest developing and providing a simple and convenient education program for sleep improvement was effective for increasing students' knowledge about sleep, developing improved coping methods regarding sleep, and improving sleep. It is also suggested that behavioral scientific instructive methods, including practice learning, are effective for medical education.

[Sleep of 4-month-old infants: bedtime, night waking and sleep problems].

BACKGROUND AND OBJECTIVES: Recently, Japanese infant's bedtime has become late and it is reported that this might have a bad influence on infant's growth. The purpose of the present study was to investigate the actual situation and interrelationships between night waking and other sleep problems in Japanese 4-month -old infant. METHODS: The subjects were 194 mothers and infants who participated in health checkups at four months after delivery in Fukuoka City. The questionnaire consisted of 3 components: 1) infant's and mother's sleep practices and sleep problems; 2) coping behavior for infant's sleep; 3) perceptions of child-care and maternal health. Their responses were linked to health checkup's results. The subjects were divided into two groups; Waking Group (n = 111) who was wakening one or more times from 0-6 a.m. and Sleeping Group (n = 83) who was sleeping throughout the night. The proportion of Waking Group was constituted 57.2% in all infants. Infant's growth, sleep, and sleep problems were compared between two groups. RESULTS: The mean infant's bedtime was 10:28 p.m., and the proportion of infants reported to go to bed at 10 p.m. or later was 69.4%. The proportion of infants with irregular bedtimes was 16.5%. Twenty-eight point six percent of infants had sleep problems like difficulty settling, severe night waking and were suspected to be high risk of sleep disorders. Infants in the Waking Group were found to have more numbers of sleep problems than in the Sleeping Group. The proportion with difficulty settling was higher in the Waking Group. Additionally, the proportion with irregular bedtimes was higher in the Waking Group. However, infant's height and weight did not significantly differ between two groups. CONCLUSIONS: Late bedtime and high proportion of night waking in 4-month-old infants were found to be characteristic in Fukuoka city. There is a possibility that night waking reflects delayed development of circadian rhythms.

A randomized controlled trial on the long-term effects of a 1-month behavioral weight control program assisted by computer tailored advice.

OBJECTIVES: To examine the long-term effects of a new behavioral weight control program (Kenkou-tatsujin, KT program). The program consisted of twice-interactive letter communications including computer-tailored personal advice on treatment needs and behavioral modification. DESIGN: A randomized controlled trial comparing Group KM: KT program with 6-month weight and targeted behavior's self-monitoring, Group K: KT program only, Group BM: an untailored self-help booklet with 7-month self-monitoring of weight and walking, and Group B: the self-help booklet only. PARTICIPANTS: Two hundreds and five overweight Japanese females were recruited via a local newspaper. MEASUREMENTS: Weight loss (body weight, BMI, reduction quotient, etc.) and behavioral changes (daily eating, exercise and sleeping habits). FINDINGS: A significant weight loss was observed in all groups. At 1 month, Groups KM and K were superior, but at 7 months, the mean weight loss was significantly more in Group KM than the other 3 groups. At 7 months, 8 dietary habits and 4 physical activities were improved in all subjects. Habitual improvement was related to the weight loss in Groups KM and K at 1 month.

[Behavioral treatment for chronic insomnia].

The efficacy of non-pharmacological intervention for chronic insomnia has been proven by several meta-analytic reviews, an NIH report, an American Academy of Sleep Medicine review, and numerous clinical trials. Behavior therapy for chronic insomnia consists of relaxation, stimulus control, sleep restriction, cognitive restructuring and sleep hygiene education, which has produced reliable and durable changes in total sleep time, sleep onset latency, number and duration of awakening. These studies also showed that the post-treatment effect of behavior therapy is equal to that of hypnotic therapy, and that these effects were maintained for 6 months on follow-up assessment. Elderly insomniac patients would gain considerable benefit from behavioral treatments because there are no adverse physical effects as there are from pharmacological therapy. The authors present the basic theory, techniques of behavior therapy for insomnia, and the results of two important key meta-analytic reviews. Any behavioral approach such as convenient education, self-care enhancement by bibliotherapy, and individual face-to-face counseling, seem to be fruitful not only for American but also Japanese insomnia patients. Nonetheless, there are no currently actual intervention studies using behavior therapy in Japan. We have discussed the methodology of intervention study and published a behavioral self-help manual for people with sleep problems. Development of a behavioral approach to chronic insomnia seemed to be very beneficial and a useful contribution to mental health services.

[A correspondence behavioral approach for 6 lifestyle's improvements in a workplace].

OBJECTIVE: The purpose of this research was to examine the effect of a mediated minimal behavioral intervention aimed at lifestyle improvement in with reference to physical activity, healthy diet, appropriate alcohol consumption, quitting or decreasing smoking, dental care, and relaxation, coping with stress. Behavioral strategies used in this program were self-checks for these 6 daily habits, with goal setting for behavioral changes, and self-monitoring. The program ran for one month and support was provided for the participants to master behavioral techniques of self-control by explanation in the application format and rewards which were presented post intervention. METHODS: The participants were 435 office workers, 255 males (mean age: 46.6 years) and 180 females (mean age: 34.4 years). One healthcare provider managed the total intervention for all participants. Each selected optionally one of the 6 habits and 3 target behaviors from 10-12 realistic examples of behavior change on an application form. They received a monitoring sheet and a brief educational pamphlet for their selected habits. Next, they monitored and recorded their target behavior every day for one month. The primary outcome measures were behavior changes at the end of the intervention period and at 6 months thereafter. RESULTS: The results showed high compliance of application rates (7.8%) and record's performance ratios (80%). All habits improved significantly for a total of 18 concrete behavior traits: for example daily walking (P < .01), using stairs (P < .01), vegetable intake (P < .01), eating speed (P < .05), alcohol drinking frequency (P < .01), drinking frequency except at home (P < .05), cigarettes per day (P < .01), breathing cigarette smoke by the lungs (P < .01), teeth brushing frequency (P < .01), gum brushing frequency (P < .01), overall sleep time (P < .01), and taking a bath comfortably (P < .01). Two hundred and 72 (62.5%) subjects completed questionnaires after 6 months. Comparing pre, post, follow-up questionnaire, results 17 concrete behavior traits improved over the period studied. CONCLUSION: The intervention appeared to prompt and reinforce starting and practicing improved behavior because of the attractive application format, letter and rewards. Therefore, it was concluded that correspondence behavioral intervention is cost-effective and useful for lifestyle modification in the general population.