[The number of deaths by suicide after the Great East Japan Earthquake based on demographic statistics in the coastal and non-coastal areas of Iwate, Miyagi, and Fukushima prefectures].

Objective　The number of deaths by suicide after the Great East Japan Earthquake was surveyed based on demographic statistics. In particular, this study examined whether or not there were excessive deaths due to suicide (excluding people who were injured in the earthquake) after the Great East Japan Earthquake disaster. This examination surveyed municipalities in coastal and non-coastal areas of Iwate, Miyagi, and Fukushima prefectures (referred to below as the "three prefectures").Methods　The demographic statistics questionnaire survey information supplied by Article 33 of the Statistics Act (Ministry of Health, Labour and Welfare's published statistics Vol. 0925 No.4, September 25th, 2014) were used as the basic data with particular reference to the information on the deaths from January 1st, 2010 to March 31st, 2013. The information obtained included the date of death, the municipality where the address of the deceased was registered, the gender of the deceased, age at the time of death, and cause of death codes (International Classification of Disease Codes 10th revision: ICD-10). Additionally, information was gathered about the population based on the resident register from 2009 to 2013 and the 2010 National Census; the number of deaths by suicide was then totalled by period and area. The areas were classified as municipalities within three prefectures and those located elsewhere using the municipality where the address of the deceased was registered.Results　The SMR for suicides did not show a tendency to increase for coastal or non-coastal areas throughout the two-year period after the earthquake disaster (from March 2011 to February 2013).　The SMR for the three prefectures 0-1 years after the disaster compared with the year before the disaster was 0.92 and for 1-2 years after the disaster was 0.93. Both these values were significantly low. Looking at both the non-coastal and coastal areas from each of the three prefectures, the SMR for suicides for 0-1 and 1-2 years after the disaster compared with the year before the disaster ranged from 0.73 to 1.07. None were significantly high.Conclusion　The above results indicate that there was no increase in deaths by suicide in these three prefectures in the two years following the earthquake disaster.

Vision and hearing impairments, cognitive impairment and mortality among long-term care recipients: a population-based cohort study.

BACKGROUND: Vision and hearing impairments among elders are common, and cognitive impairment is a concern. This study assessed the association of vision and hearing impairments with cognitive impairment and mortality among long-term care recipients. METHODS: Data of 1754 adults aged 65 or older were included in analysis from the Gujo City Long-Term Care Insurance Database in Japan for a mean follow-up period of 4.7 years. Trained and certified investigators assessed sensory impairments and cognitive impairment using a national assessment tool. Five-level scales were used to measure vision and hearing impairments. Cognitive performance was assessed on two dimensions, namely communication/cognition and problem behaviors. We performed logistic regression analysis to estimate odd ratios (ORs) and 95 % confidence intervals (CIs) for the association of vision and hearing impairments with cognitive impairment. Using Cox proportional hazard regression models, we obtained hazard ratios (HRs) for mortality. RESULTS: Of 1754 elders, 773 (44.0 %) had normal sensory function, 252 (14.4 %) vision impairment, 409 (23.3 %) hearing impairment, and 320 (18.2 %) dual sensory impairment. After adjusting for potential cofounders, ORs of cognitive impairment were 1.46 (95 % CI 1.07-1.98) in individuals with vision impairment, 1.47 (95 % CI 1.13-1.92) in those with hearing impairment, and 1.97 (95 % CI 1.46-2.65) in those with dual sensory impairment compared to individuals with normal sensory function. The adjusted HR of overall mortality was 1.29 (95 % CI 1.01-1.65) in individuals with dual sensory impairment and cognitive impairment relative to normal sensory and cognitive functions. CONCLUSIONS: Cognitive impairment was most common in individuals with dual sensory impairment, and those with dual sensory impairment and cognitive impairment had increased mortality.

Initiatives for community building in an urban semi-marginal village: Progress of the Ajinadai Lively Project and future challenges.

Objectives We launched and engaged in the "Ajinadai Lively Project" to examine the ideal state of community building in an urban semi-marginal village. In addition to discussing its progress and describing the activities, we examine future challenges.Methods (1) We gathered existing resources, conducted a district survey and focus group interview, and investigated the community's health issues. (2) We conducted a workshop with local residents and formulated an action plan. (3) We conducted a health volunteer training class to foster community leaders. (4) Local residents interacted with students through nursing school practice and student volunteer activities.Results The health issues in the community were as follows: (1) Few connections existed between residents across generations, and no framework for mutual assistance was established. (2) Many solitary elderly people and elderly households existed, and we found many instances of elderly-to-elderly care and social withdrawal of elderly people. (3) Many slopes and staircases existed, which made mobility difficult for elderly people. Based on these results, we encouraged the state to pursue quality of life as "A community where people connect and help one another across generations" as well as "A healthy community where people greet one another." We also established health, behavioral, and environmental goals. The health volunteer training class became an impetus for residents to realize the necessity of not only protecting their own health, but also encouraging others and the whole community to get involved.Conclusion While the health volunteer training class did not initiate autonomous activity, it increased the motivation of residents themselves for community building. Performing continuous evaluations and offering support for autonomous activity is important in the future.

[Creating a "Health Promotion Checklist for Residents" Attempt to promote healthy activities].

OBJECTIVE: To create a "Health Promotion Checklist for Residents" to help promote healthy habits among local residents. METHODS: First, we investigated items for a health promotion checklist in the Health Japan 21 (2(nd) edition) and other references. Next, we conducted a questionnaire survey including these checklist items in August 2012. The study subjects were randomly selected Hatsukaichi city residents aged ≥20 years. Anonymous survey forms explaining this study were mailed to the investigated subjects and recovered in return envelopes. Data were compared by sex and age group. RESULTS: We created a checklist comprising a 23-item health promotion evaluation index with established scoring. There were 33 questions regarding health checkups; cancer screenings; dental checkups, blood pressure; glycated hemoglobin or blood glucose; dyslipidemia; body mass index; number of remaining teeth; breakfast, vegetable, fruit, and salt intake; nutrient balance; exercise; smoking; drinking; sleep; stress; and mental state. There were also questions on outings, community involvement, activities to improve health, and community connections. The questions were classified into six categories: health management, physical health, dietary and exercise habits, indulgences, mental health, and social activities. Of the 4,002 distributed survey forms, 1,719 valid responses were returned (recovery rate, 43.0%). The mean score by category was 1.69 (N=1,343) for health management, 6.52 (N=1,444) for physical health, 12.97 (N=1,511) for dietary and exercise habits, and 2.29 (N=1,518) for indulgences, all of which were higher for women, and 5.81 (N=1,469) for mental health, which was higher for men. The health management scores were higher among subjects in their 40s and 50s. The physical health score increased gradually with age from the 70 s and older to the 20 s, whereas the dietary and exercise habits increased gradually from the 20 s to the 70 s and older. The 20 s had high scores for indulgences, while mental health was low for the 20 s and 30 s and gradually increased from the 40 s to the 70 s and older. The social activities score (1.93; N=1,539) tended to be higher in the 40 s and older. CONCLUSION: Here we created and attempted to validate a checklist that promotes healthy habits nd found that subjects were able to use it to examine their living habits.

[Development of the role scale for municipal supervising public health nurses].

OBJECTIVES: As public health nurses are becoming increasingly decentralized in municipalities, recommendations for allocating supervising public health nurses are being made. This study aimed to develop a scale for measuring the implementation of role of municipal supervising public health nurses and to test its reliability and validity. METHODS: Scale items were developed using results of a qualitative inductive analysis of interview data, and the items were then revised following an examination of content validity by experts, resulting in a provisional scale of 17 items. A self-administered, written questionnaire was then completed by supervising public health nurses or public health nurses holding the most senior positions in all municipalities nationwide, with the exception of three prefectures in the Tohoku region (total 1,621 locations). RESULTS: In total, 1,036 responses were received, and 931 were used for analysis (valid response rate = 57.4%). Of these, 406 were completed by supervising public health nurses. After deleting one item as a result of item analysis and conducting principal component analysis, factor analysis was conducted using the major factor method and Promax rotation. One item with high loading on multiple factors was deleted, resulting in a scale comprising 15 items and 3 factors. The cumulative contribution ratio was 56.10%. The three factors were labeled "Promotion of health activities across the whole locality," "Coordination as a PHN role leader," and "Development of the skills of public health nurses". The reliability coefficient of the RMSP (Role Scale for Municipal Supervising Public Health Nurses) as a whole was 0.84 using the split-half method (Spearman-Brown formula) and 0.91 using Cronbach's alpha, confirming internal consistency. In terms of validity, an examination was conducted of the correlation of two RMSP scale scores (strength of awareness of role as a supervising public health nurse and confidence as a supervising public health nurse) and scores on existing scales assessing management abilities, and a significant correlation (P < 0.01) was obtained. Additionally, a comparison of the RMSP scores of decentralized local public health nurses according to rank and years of service in areas where there were no supervising public health nurses with the RMSP scores of supervising public health nurses showed that the scores of supervising public health nurses were higher. CONCLUSION: The developed scale was found to be reliable and valid for measuring the implementation of supervising public health nurses' role.

Factors for drop-out psychiatric treatment in patients with substance-related disorders.

We studied 199 inpatients and outpatients at a public psychiatric hospital to clarify the factors related to outcome following psychiatric care for substance-related disorder (SRD), and we discuss approaches for more effective community care in the future. The percentage of patients who discontinued treatment was 33.7%, suggesting that creation of a follow-up system for continuing outpatient care is an urgent task. Women were 35% more likely higher to discontinue treatment than men. Those with solvent dependence were 12% and 7.32 times more likely, respectively, to discontinue treatment than those with alcohol dependence. Those without complications were 2.24 times more likely than those with complications to discontinue treatment. Divorced patients were 18% and 6.35 times more likely, respectively, to discontinue treatment than married patients. There is insufficient support for patients with solvent dependence, and we observed that patients tended to have little motivation to stop using drugs or alcohol until physical complications occurred. Among the many divorced patients, desire for treatment was weak following breakdown of the family. The present findings suggest the importance of comprehensive efforts to treat substance use disorder at specialist medical institutions.