[Comparison and clarification of public health and public health nursing competencies: A report of the Committee on Public Health Nursing (2017-2018)].

Objectives　The Committee on Public Health Nursing (2017-2018) of the Japanese Society of Public Health aimed to elucidate the competencies of public health and public health nursing to provide basic materials for public health, public health nursing education, practice, and research.Methods　We studied the core competencies of public health professionals and public health nursing in the United States and examined similarities to and differences from those in Japan.Results　The United States and Japan shared similar public health and public health nursing competencies in that they targeted populations, identified health problems, and clarified health challenges for effective actions. However, differences were noted in the understanding of target groups, perspectives for identifying health problems and overcoming health challenges, and conceptualization of individuals in populations. In public health, the target population practiced clear boundaries, such as residing in certain geographical areas and ethnic groups, among others. In health challenges, the top-down approach was employed to resolve health problems in certain populations. The individual was recognized as a part of a population composed of a certain group. In public health nursing, target population (e.g., from individuals/families to groups/communities/social groups) were understood in a continuous and multilayered manner. Individual/family health problems were associated with the characteristics of groups, communities, and social groups that encompass the continuum. Moreover, health challenges were addressed in a manner oriented toward the transformation of social groups as a whole. Public health nursing competencies in both countries, which share many similarities, were developed to achieve the objectives of public health. In the United States, the competencies and skills considered necessary, such as analytical/assessment and cultural competency skills, were clearly expressed and constructed in line with the core competencies of public health professionals. However, in Japan, skills and abilities necessary as competencies in public health nursing mentioned above were not specified.Conclusion　Elucidating the core competencies of public health professionals in Japan is essential to develop human resources that can contribute to effective practices in public health and public health nursing. Toward this end, skills and abilities necessary as competencies in public health nursing in Japan, which were not previously verbalized, should be described in detail.

Supporting elder persons in rural Japanese communities through preventive home visits by nursing students: A qualitative descriptive analysis of students' reports.

This article describes the evaluation of an innovative nursing education curriculum project, preventive home visiting practice, which began full implementation in 2015, in terms of students' learning outcomes. For the purpose of learning how elder persons live in community, all the 327 undergraduate nursing students, from freshmen to seniors, provided monthly or bi-monthly visits to home-dwelling elderly persons aged 75 or above in their home over 1 year period, in order to provide support for their independent living and to learn from them. The students' reports submitted at the end of the first academic year were qualitatively analyzed to evaluate what they learned. They acquired multiple perspectives for understanding elder persons, including a variety of individual and environmental aspects of wellness, prevention, and community life. They also acknowledged the importance of team practice through working and collaborating with different grade levels and generations. Overall, the observed learning contents were useful for future nursing education with elder persons and facilitating critical changes in nursing education systems to address the problems of aged society.

[Vitalizing public health activities through community assessment: A report of the Committee on Public Health Nursing 2014-2017].

Objectives　This report aims to present the community assessment model developed by the Committee on Public Health Nursing (6th term) of the Japanese Association of Public Health. This new model was designed such that it could be applied to a broad range of public health activities. It aims at theorizing public health nurses' practice-based knowledge and sharing it among other public health professionals.Methods　The model was developed during seven committee meetings held from October 2014 to September 2017. In the first step, we brainstormed the definition and methods of community assessment and constructed a framework for a literature review. In the second step, information on theories, research, and practice relevant to community assessment was reviewed based on this framework. In the third step, the community assessment model was developed based on the results of the literature review and the practice experience of the committee members. In the last step, we examined the applicability of this model to the practice of occupational health and public health administration.Project activities　We defined community assessment as the "skills and methods based on applied science that drive Plan-Do-Check-Action (PDCA) cycles in every activity that aims at achieving a better quality of life (QOL)." We further classified community assessment into two types; comprehensive assessment and targeted assessment. The model underlined that community assessment was a continuous and developmental process that occurs throughout every stage of the PDCA cycle, and that it was oriented toward improving the QOL of community residents. This model also purported that the empirical and scientific intuition, and ethical sensitivity of assessors were among the key determinants of assessment quality.Conclusion　The model on community assessment developed in the present study based on the empirical knowledge of public health nurses could be applied to all types of public health activities in communities.

Healthcare costs for the elderly in Japan: Analysis of medical care and long-term care claim records.

BACKGROUND: The population is aging rapidly in many developed countries. Such countries need to respond to the growing demand and expanding costs of healthcare (HC) for the elderly. Therefore, it is important to investigate the factors correlating such HC costs. In Japan, HC is composed of two sections, namely medical care (MC) and long-term care (LTC). While many studies have examined MC and LTC costs on their own, few studies have conducted comprehensive investigations of HC costs. The aim of this study is to examine the risk factors that influence HC costs for the elderly who enroll in the LTC insurance system in Japan. METHODS: The inclusion criteria in the present study are as follows: being 65 years of age, or older; certified eligibility for, and use of services offered by the LTC insurance system at home or in an institutional setting in December 2009; and being covered by the National Health Insurance (NHI) system. MC and LTC insurance data were obtained from claim records for the elderly in July and December of 2007, 2008, and 2009 (i.e., a total of six survey points). Panel data, per subject, were constructed using MC and LTC claim records. The sample included 810 subjects and 4029 observations. RESULTS: We estimated a regression equation with a censored dependent variable using a Tobit model. Significant associations between MC or LTC costs and interaction terms (household composition × seasonal effects) were investigated. MC costs significantly decreased and LTC costs significantly increased among subjects living alone during winter. Income level was also a positive determinant of MC costs, while eligibility level was a positive determinant of LTC costs. CONCLUSIONS: We recommend that the health policy for the elderly focus more on seasonal effects, household composition, and income level, as well as on eligibility level.

The Importance of the Maternal/Self-Role Satisfaction for Reducing Anxiety: A Cross-Sectional Survey of Japanese Mothers.

Women who rear children have two types of roles: the maternal role and the self-role. Previous studies have suggested that maternal role satisfaction is related to anxiety, but the importance of self-role satisfaction in promoting the health of mothers has received less attention. The changing roles of women in society, especially in urban areas, have altered mothers' views of child-rearing. Our primary focus was on the relationship between maternal/self-role satisfaction and anxiety in mothers. To examine this, we conducted a cross-sectional survey using self-administered questionnaires that were distributed in 2011 to 2,342 mothers attending the 18-month health checkup of their children, in 7 cities of the Tokyo metropolitan area. A total of 881 responded (effective response rate = 38.0%). Multiple regression analysis revealed that maternal role satisfaction and self-role satisfaction were both significantly and negatively associated with anxiety. Thus, self-role satisfaction should be considered alongside maternal role satisfaction in evaluating and reducing anxiety. Health care professionals in community settings should conduct comprehensive assessments of maternal role satisfaction and self-role satisfaction.

Relationship between patient group participation and self-care agency among patients with a history of cardiac surgery: A cross-sectional study.

BACKGROUND: Little is known regarding the influence of participation in patient groups on self-care in patients with a cardiac surgery history. OBJECTIVES: To investigate the relationship between patient group participation and self-care among patients with a cardiac surgery history. METHODS: Participants were 956 patients with cardiac surgery history from a patient group. Information on self-care agency, patient group participation, and health status was collected through a self-administered questionnaire. RESULTS: There were 566 valid responses. Participants were mostly male (76.4%), and the mean age was 70.6 years. A high social support level from a patient group was associated with each subscale of the self-care agency as follows: self-care operations (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.04-1.12), adjusting one's condition (OR 1.04, 95% CI 1.01-1.07), and attention to self-care (OR 1.05, 95% CI 1.02-1.07). CONCLUSIONS: Patient group participation may promote self-care performance in patients with a cardiac surgery history.

Association between Municipal Health Promotion Volunteers' Health Literacy and Their Level of Outreach Activities in Japan.

OBJECTIVES: To explore the association between health literacy and levels of three types of core activities among health promotion volunteers (developing a healthy lifestyle, outreach to family, and outreach to community members). STUDY DESIGN: A cross-sectional, anonymous, self-administered postal survey of registered health promotion volunteers in the Konan area in Shiga Prefecture in Japan, conducted in January 2010. The study sample was 575 registered health promotion volunteers. METHODS: The survey collected data on health literacy, gender, age, education, self-rated health, perceptions about the volunteer organization, and perceptions of recognition in the community. The level of engagement in health promotion activities was measured by the extent to which the participants engaged in seven healthy behaviors and promoted them to family members and the community. The authors compared the health literacy level and other characteristics of the participants by core health promotion activities, using a chi-squared test, to examine the associations between demographic and other variables and the three core activities (healthy lifestyle, outreach to family, and outreach to community).Logistic regression analysis was conducted to examine the association between the degree to which the volunteers engaged in core activities ("healthy lifestyle," "outreach to family," "outreach to community") and the levels of health literacy (low, medium, high) among health promotion volunteers, controlling for the effects of age, gender, health condition, education which may also have an impact on volunteers' outreach activities. RESULTS: Four hundred and fifty-four questionnaires were returned, a 79.0% response rate. Excluding 16 cases with missing values on health literacy or the degree of health promotion activities, 438 research subjects were included in the analysis (valid response rate: 76.2%). Health literacy and a few demographic and other characteristics of the volunteers were associated with the three core health promotion activities. In bivariate analyses, active participation in the core activities was more prevalent among older volunteers (p<0.001 for all three activities). Self-rated health condition was associated with both outreach to family (p = 0.018) and community (p = 0.046). Years of experience as volunteer and perception of being recognized in the community also had statistically significant association with outreach to the community (p<0.001). In multiple logistic regression, those with higher level of health literacy were more likely than others to actively engage in outreach to family (OR = 1.70, 95% CI 1.03 to 2.80; OR = 1.76, 95%CI 1.04 to 3.00 for medium and high, respectively) and outreach to community (OR = 2.26, 95%CI 1.34 to 3.83; OR = 2.61 95%CI 1.49 to 4.58 for medium and high, respectively). Perception of being recognized in the community also had a statistically significant and positive impact on outreach to the community (OR = 1.52, 95%CI 1.17 to 1.99). CONCLUSIONS: Volunteers with higher health literacy were more likely to actively engage in outreach to family and outreach to community. Providing educational programs to improve volunteers' health literacy may facilitate their work.

Conformity to the neighborhood modifies the association between recreational walking and social norms among middle-aged Japanese people.

AIM: Recreational walking benefits the health of the middle-aged population. Social norms might generate an intention-behavior gap, the state of people forming adequate intentions but failing to translate these intentions into action. People living in a community where the neighbors conform to the average behaviors of those who live in the neighborhood might restrict behaviors that stray from the neighborhood's social norms. This cross-sectional study was conducted in order to examine whether the degree of conformity to the neighbors modified the association between social norms and recreational walking among middle-aged adults in Japan. METHODS: Using a questionnaire, data were collected from 730 participants in Japan. Among those who intended to recreationally walk, a multiple logistic regression was carried out separately for the participants with a high or low degree of conformity to the neighborhood social norms. RESULTS: Of the total number of respondents, 511 (70%) reported recreational walking intentions. The descriptive norm was significantly associated with recreational walking only among the participants with a high degree of conformity. In contrast, there was no such association among the participants with a low degree of conformity. CONCLUSION: The results confirmed that people who live in a community where people tend to conform translated walking intentions into action when they saw their neighbors walk recreationally. Public health nurses should evaluate the degree of conformity in neighborhoods and neighbors' descriptive norms when promoting walking.

Factors Affecting Professional Autonomy of Japanese Nurses Caring for Culturally and Linguistically Diverse Patients in a Hospital Setting in Japan.

PURPOSE: The study aimed to analyze the professional autonomy of Japanese nurses when caring for non-Japanese patients and to identify its contributing factors. METHOD: A descriptive cross-sectional design was used. Participants included 238 clinical nurses working at 27 hospitals in Japan. The Intercultural Sensitivity Scale (Chen and Starosta), and the Scale for Professional Autonomy in Nursing (Kikuchi and Harada) were used to measure intercultural sensitivity and professional autonomy. Stepwise multiple regression analysis was used to identify the most significant factors affecting professional autonomy. RESULTS: Professional autonomy of Japanese nurses caring for non-Japanese patients was significantly lower than when caring for Japanese patients (142.84 vs. 172.85; p < .001). Contributing factors were intercultural sensitivity (p < .001), length of nurse experience (p < .05), and availability of interpretation service (p < .05). CONCLUSION: Incorporating transcultural nursing content into training programs in schools and hospitals could enhance professional autonomy of Japanese nurses by promoting intercultural sensitivity.

Effectiveness of community-based health services by nurse practitioners: protocol for a systematic review and meta-analysis.

INTRODUCTION: To realise universal health coverage in an ageing society, adequate provision of appropriately trained human resources is essential. The nurse practitioner (NP) is an autonomous and independent, advanced practice nurse capable of providing treatment and care that can be substituted for some aspects of a medical doctor's (MD's) role, especially in a community setting. Previous systematic reviews found higher levels of patient satisfaction with services provided by NPs than those provided by MDs. As non-communicable diseases become a major health burden requiring long-term healthcare in community settings, this systematic review aims to assess the equivalence of NP services to standard care provided by MDs, and to determine whether their practice is an effective alternative to that of MDs in community settings. METHODS AND ANALYSIS: Relevant randomised controlled trials (RCTs) and cluster RCTs will be searched in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and the British Nursing Index. We will assess patient and health system utilisation outcomes of interventions comparing treatment and care provided by NPs in community settings with that provided by MDs. Two authors will independently screen studies for inclusion, consulting with a third author where necessary to resolve discrepancies. The risk of bias of included studies will be assessed using the Cochrane Collaboration risk of bias tool, and quality of evidence using the GRADE approach. Meta-analysis of included studies will be conducted using fixed-effect or random-effects models depending on the degree of between-study heterogeneity. Results will be presented using risk ratios with 95% CI for dichotomous outcomes and standardised mean differences with 95% CI for continuous outcomes. ETHICS AND DISSEMINATION: This systematic review and meta-analysis protocol does not require ethical approval. We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER: PROSPEROCRD42014009627.

Identifying Residents' Health Issues Six Weeks after the Great East Japan Earthquake.

OBJECTIVE: The aim of this study was to identify the characteristics and health issues of residents in need of assistance in a town affected by the Great East Japan Earthquake, six weeks after the disaster, through an outreach initiative. DESIGN AND SAMPLE: A cross-sectional qualitative design was used. Public health nurses conducted comprehensive semi-structured interviews during home visits with residents. A total of 5,082 residents from the affected town. MEASURES: These included demographic information, public records of the extent of the damages, and qualitative interview data to determine the urgency of the necessary interventions. RESULTS: A total of 281 residents needed some kind of assistance and were identified as "requiring early intervention (within two weeks)" or "requiring assistance (within 12 weeks)." The most common health issue requiring early intervention was "interruption of treatment" (25.0%), followed by "need for mental care." The most frequent health issue requiring assistance within 12 weeks was the "need for mental health care" (39.7%), followed by "interruption of treatment," and "need for nursing care." CONCLUSIONS: During a disaster, it is imperative to identify cases requiring early intervention. Home-visit interviews were necessary to identify existing health concerns to prevent the development of more serious health problems.

Quality of nursing doctoral education in seven countries: survey of faculty and students/graduates.

AIMS: This study aimed to compare the findings of the quality of nursing doctoral education survey across seven countries and discuss the strategic directions for improving quality. BACKGROUND: No comparative evaluation of global quality of nursing doctoral education has been reported to date despite the rapid increase in the number of nursing doctoral programmes. DESIGN: A descriptive, cross-country, comparative design was employed. METHODS: Data were collected from 2007-2010 from nursing schools in seven countries: Australia, Japan, Korea, South Africa, Thailand, UK and USA. An online questionnaire was used to evaluate quality of nursing doctoral education except for Japan, where a paper version was used. Korea and South Africa used e-mails quality of nursing doctoral education was evaluated using four domains: Programme, Faculty (referring to academic staff), Resource and Evaluation. Descriptive statistics, correlational and ordinal logistic regression were employed. RESULTS: A total of 105 deans/schools, 414 faculty and 1149 students/graduates participated. The perceptions of faculty and students/graduates about the quality of nursing doctoral education across the seven countries were mostly favourable on all four domains. The faculty domain score had the largest estimated coefficient for relative importance. As the overall quality level of doctoral education rose from fair to good, the resource domain showed an increased effect. CONCLUSIONS: Both faculty and students/graduates groups rated the overall quality of nursing doctoral education favourably. The faculty domain had the greatest importance for quality, followed by the programme domain. However, the importance of the resource domain gained significance as the overall quality of nursing doctoral education increased, indicating the needs for more attention to resources if the quality of nursing doctoral education is to improve.

The effect of skill mix in non-nursing assistants on work engagements among home visiting nurses in Japan.

AIM: This study evaluated the effect of a skill-mix programme intervention on work engagement in home visiting nurses. BACKGROUND: A skill-mix programme in which home visiting nurses are assisted by non-nursing workers is assumed to foster home visiting nurses' work engagement. METHOD: Pre- and post-intervention evaluations of work engagement were conducted using self-administered questionnaires. A skill-mix programme was introduced in the intervention group of home visiting nurses. After 6 months, their pre- and post-intervention work engagement ratings were compared with those of a control group. RESULT: Baseline questionnaires were returned by 174 home visiting nurses (44 in the intervention group, 130 in the control group). Post-intervention questionnaires were returned by 38 and 97 home visiting nurses from each group. The intervention group's average work engagement scores were 2.2 at baseline and 2.3 at post-intervention; the control group's were 3.3 and 2.6. Generalised linear regression showed significant between-group differences in score changes. CONCLUSION: The skill-mix programme might foster home visiting nurses' work engagement by improving the quality of care for each client. Future research is needed to explain the exact mechanisms that underlie its effectiveness. IMPLICATIONS FOR NURSING MANAGEMENT: In order to improve the efficiency of services provided by home visiting nurses and foster their work engagement, skill-mix programmes might be beneficial.

Effects of lifestyle factors on urinary oxidative stress and serum antioxidant markers in pregnant Japanese women: A cohort study.

Oxidative stress plays a major pathological role in pregnancy-related complications. Although oxidative stress is induced by exogenous toxins in association with a poor lifestyle in normal subjects, there is little information on the factors altering oxidative stress and antioxidant levels during pregnancy. The purpose of this study was to determine the relationship between lifestyle factors and oxidative stress/antioxidant levels during each trimester and 1-month postpartum. This prospective cohort study followed 54 healthy women through pregnancy; first, second, and third trimester and 1-month postpartum. Participants were administered a questionnaire on characteristics and lifestyle factors. Morning blood and urine samples were obtained to measure urinary biopyrrins and serum coenzyme Q10 (CoQ10) levels. The levels of urinary biopyrrins and serum CoQ10 increased significantly throughout pregnancy, with peak values registered during the third trimester. Higher biopyrrin levels were significantly associated with non-consumption of morning meal during the first trimester, smoking during the third trimester and 1-month postpartum, alcohol consumption during the third trimester, high food-based polyunsaturated fatty acid intake during the third trimester, and poor mental health scores during the first and third trimesters. Higher CoQ10 levels were significantly associated with no smoking during pregnancy and at 1-month postpartum, and with a high frequency of exercise during the third trimester and 1-month postpartum. Thus, pregnancy represents a state of oxidative stress, which can be counterbalanced by increased levels of antioxidants, such as CoQ10. We speculate that certain lifestyle choices such as avoiding smoking can reduce oxidative stress and increase antioxidant levels during pregnancy.

The tsunami's impact on mortality in a town severely damaged by the 2011 Great East Japan Earthquake.

This study identifies the relationship between tsunami damage and mortality through a demographic pyramid of a town severely damaged by the tsunami following the Great East Japan Earthquake of 11 March 2011. It uses cross-sectional data collection. Volunteers visited all households, including shelters, and asked residents about the whereabouts of family members and neighbours. The information was collated with lists of evacuees and the dead to confirm the whereabouts of all residents about 50 days after the disaster. Demographic pyramids for the whole population based on pre- and post-disaster data were drawn. In all, 1,412 (8.8 per cent) were dead or missing, 60.2 per cent of whom were aged 65 and over and 37.5 per cent aged 75 and over, suggesting that the very old should be located beyond the reach of tsunamis. The mortality rate of children was lower than that in other studies, which may indicate the efficacy of disaster evacuation drills.

Identification of the need for home visiting nurse: development of a new assessment tool.

OBJECTIVE: To develop a Home Visiting Nursing Service Need Assessment Form (HVNS-NAF) to standardize the decision about the need for home visiting nursing service. METHODS: The sample consisted of older adults who had received coordinated services by care managers. We defined the need for home visiting nursing service by elderly individuals as the decision of the need by a care manager so that the elderly can continue to live independently. Explanatory variables included demographic factors, medical procedure, severity of illness, and caregiver variables. Multiple logistic regression was carried out after univariate analyses to decide the variables to include and the weight of each variable in the HVNS-NAF. We then calculated the sensitivity and specificity of each cutoff value, and defined the score with the highest sensitivity and specificity as the cutoff value. RESULTS: Nineteen items were included in the final HVNS-NAF. When the cutoff value was 2 points, the sensitivity was 77.0%, specificity 68.5%, and positive predictive value 56.8%. CONCLUSIONS: HVNS-NAF is the first validated standard based on characteristics of elderly clients who required home visiting nursing service. Using the HVNS-NAF may result in reducing the unmet need for home visiting nursing service and preventing hospitalization.

[Mothers' difficulty in childrearing classified in terms of their children's behavioral characteristics].

OBJECTIVES: Mothers who experience difficulty in childrearing are becoming increasingly more prevalent in Japan. This study described and classified mothers' childrearing difficulty in terms of their children's behavioral characteristics and related factors. METHODS: Self-administered questionnaires were distributed to 818 mothers at their children's 3-year-old health checkup in eight suburban cities in Japan. The questionnaire consisted of items assessing the mother's experience of difficulty in childrearing for the child undergoing the checkup. The subjects were classified into four groups according to their children's behavioral characteristics: "low needs," "internalizing behavior," "externalizing behavior," and "comorbid internalizing-externalizing behavior." Multiple regression analysis was performed to examine the relationships between mothers' difficulty in childrearing and related factors. RESULTS: A total of 775 respondents were divided as follows: 332 mothers had children with low needs, 104 had those with internalizing behavior, 230 had those with externalizing behavior, and 109 had those with comorbid internalizing-externalizing behavior. Mothers in the low needs group showed less childrearing difficulty than did mothers in the other groups. Childrearing difficulty increased by group in the following order: internalizing, externalizing, and comorbid internalizing-externalizing. In all four groups, mothers with low self-efficacy and less appraisal support from their family encountered greater childrearing difficulty. In the low needs group, experiencing childrearing difficulty with another child was related experiencing childrearing difficulty with the child undergoing the checkup. In the internalizing behavior group, mothers who had experienced greater difficulty in childrearing were more likely to be housewives and of younger age, and were more likely to have had boys as the child undergoing the checkup. In the externalizing behavior group, mothers with more difficulty in childrearing were more likely to be younger and less healthy, have less appraisal support from their friends, and live in apartments. In the comorbid internalizing-externalizing group, if the mothers were housewives, they were more likely to have difficulty in caring for their other children, receive less appraisal support from their friends, and experience more difficulty in childrearing. CONCLUSION: The results showed that mothers' difficulty in childrearing and the factors related to this difficulty differed according to their children's behavioral characteristics. Public health nurses could provide more effective care and support to mothers by considering children's behavioral characteristics.

Adapting the Pregnancy Physical Activity Questionnaire for Japanese pregnant women.

OBJECTIVE: To assess the psychometric properties of the Pregnancy Physical Activity Questionnaire (PPAQ) for women who read and speak Japanese. DESIGN: This longitudinal study used a self-report questionnaire and quantitative biometric and instrumental measurements (actigraph) to assess the reliability and criterion validity. SETTING: A university hospital in Tokyo, Japan. PARTICIPANTS: Sixty-nine pregnant women living in Tokyo and its suburbs were recruited. METHODS: The test-retest reliability of the Japanese version of the Pregnancy Physical Activity Questionnaire (PPAQ-J) was evaluated through intraclass correlation coefficients (ICCs) between PPAQ-J results administered three times (at recruitment, 7 and 14 days later). Criterion validity was assessed by comparing results to actigraph measures using Spearman's correlation coefficients. Participants wore the actigraph over the 2-week research period. Data from 58 participants were analyzed for test-retest reliability. The data of 54 participants were used to analyze criterion validity. RESULTS: The ICCs for the first and second and for the first and third PPAQ-J questionnaires were ≥0.56 for total activity and activities broken down by intensity and type (in metabolic equivalents [METs] × hours/day). To evaluate criterion validity, Spearman's correlation coefficients were calculated between the first measurement of the PPAQ-J and three published cut-points used to classify actigraph data (minutes/day); correlations ranged from .02 to .35 for total activity, -.21 to -.25 for vigorous activity, -.09 to .38 for moderate activity, and .01 to .28 for light activity. CONCLUSION: The PPAQ-J is a psychometrically sound and comprehensive measure of physical activity in pregnant Japanese women.

Relationship between plasma total homocysteine level and dietary caffeine and vitamin B6 intakes in pregnant women.

A high total homocysteine (tHcy) level during pregnancy is a risk factor for adverse perinatal outcomes, such as fetal growth restriction and preeclampsia. Caffeine is assumed to increase tHcy levels by acting as a vitamin B6 antagonist. The objective of this study was to examine a relationship between circulating tHcy levels and dietary caffeine and vitamin B6 intakes in pregnant Japanese women. A total of 321 healthy women with singleton pregnancies were recruited in metropolitan Tokyo, from June to December 2008, resulting in the final number included in the study as 254. Dietary caffeine intakes did not correlate with plasma tHcy levels. When we analyzed the data according to caffeinated beverages, caffeinated tea consumption was positively associated with plasma tHcy levels only among the women with a high intake of vitamin B6 , after controlling for confounding factors (P = 0.029). No correlation between coffee consumption and plasma tHcy levels was found. Pregnant Japanese women might need to cut down the consumption of caffeinated tea as well as take sufficient vitamin B6 in order to prevent the tHcy levels from increasing.