Community factors to promote parents' quality of child-nurturing life.

OBJECTIVES: The purpose of this study was to clarify the role of community factors in parents' quality of child-nurturing life (QCNL). METHODS: We developed a questionnaire to evaluate the degree of QCNL and determine the structural factors related to QCNL as community factors related to parents' QCNL derived from focus group interviews and the Delphi technique. The questionnaire also included the battery of the self-rating depression scale and Tsumori-Inage Infant's Developmental Test. Using the questionnaire, we then conducted a quantitative survey of parents whose children attended nursery schools in Kumamoto Prefecture. Factor analysis, calculation of the mean score and/or ratio to each item, Pearson's correlation coefficient, t test, multiple regression analysis, and covariance structure analysis were performed. RESULTS: The questionnaire we developed consisted of seven items with 75 elements, involving ten elements as community factors. Subjects included 699 parents (mean age 33.6 ± 5.4 years) and 965 children (age range 0-6 years). Factor analysis revealed that community factors consisted of five factors, such as "lifestyle rooted in the ground," "balance of housekeeping and work," "community network," "amenity," and "regeneration of life". These factors may be dominant in a rural area. Finally, we developed a structural model with "community factors," QCNL, QOL, and "child growth" by covariance structural analysis. The analysis revealed that community factors had a positive relation to parents' QCNL (r = 0.81, p < 0.001) and that parental SDS score had a negative relation to parents' QCNL (r = -0.59, p < 0.001). The analysis did show that community factors were positively related to the sound growth of children. CONCLUSION: The covariance structure analysis revealed that community factors were associated with parents' QCNL, SDS, and "child growth."

Incidence and Consequence of Falls among Stroke Rehabilitation Inpatients in Convalescent Rehabilitation Ward : Data Analysis of the Fall Situation in Multi-institutional Study / The Japanese Journal of Rehabilitation Medicine

We collected and analyzed large-scale data concerning the fall of stroke inpatients in convalescent rehabilitation wards. Three hundred seventy-four of 1,107 inpatients experienced one fall or more, and 16 factors associated with falls were clarified by the chi-square test. To extract the significant item from a multifactor, the logistic regression analysis of 16 factors was carried out, and we developed an assessment sheet for the risk degree of first fall prediction in stroke inpatients. We selected eight variables as the items on the assessment sheet : history of previous falls, central paralysis, visual impairment, sensory disturbance, urinary incontinence, use of psychotropic medicines, mode of locomotion, and cognitive impairment. The total score of the assessment sheet was ranged from 0 to 10 and the mean score of fallers (6.4±1.5) among subjects was significantly higher than that of non-fallers (5.1±1.9) (<i>p</i> <0.001). When the subjects were classified into three groups, a significant difference (<i>p</i><0.001) in the tendency of fall incidence in term of days after admission was found among the three groups on the basis of the Kaplan-Meier survival curve.

Description of environmental determinants of quality of life in children with intellectual disability in Japan using the Delphi technique

<p><b>OBJECTIVES</b>The present study aimed to define the framework of an environment conducive to the well-being of children with intellectually disability (CID).</p><p><b>METHODS</b>A questionnaire composed of 31 items was developed through literature review. Then a 2-round Delphi survey was conducted with 3 different panels: health professionals (HPs), parents of CID, and teachers. The participants were asked to rate each item, select and rank the 10 most important items, and suggest additional ones.</p><p><b>RESULTS</b>A total of 71 participants responded to the first round: 24 HPs, 22 parents, and 25 teachers. In the second round the overall response rate was 83%. At the end of the exercise, 12 items reached global consensus, i.e., in all groups. Only 5 items were ranked as most important by all groups: attitudes of family members at home; attitudes of HPs and teachers; support from family members at home; support at school (classmates and teachers); and government policies. Nevertheless, the panelists' views diverged on the remaining items. Several additional elements were suggested.</p><p><b>CONCLUSIONS</b>The views of HPs, teachers, and parents are complementary for the improvement of quality of life (QOL) of CID. The present findings will be used as a basis for the development of an instrument to assess the living environment of CID.</p>

Development of an assessment sheet for fall prediction in stroke inpatients in convalescent rehabilitation wards in Japan

<p><b>OBJECTIVE</b>We conducted a study to develop an assessment sheet for fall prediction in stroke inpatients that is handy and reliable to help ward staff to devise a fall prevention strategy for each inpatient immediately upon admission.</p><p><b>METHODS</b>The study consisted of three steps: (1) developing a data sampling form to record variables related to risk of falls in stroke inpatients and conducting a follow-up survey for stroke inpatients from their admission to discharge by using the form; (2) carrying out analyses of characteristics of the present subjects and selecting variables showing a high hazard ratio (HR) for falls using the Cox regression analysis; (3) developing an assessment sheet for fall prediction involving variables giving the integral coefficient for each variable in accordance with the HR determined in the second step.</p><p><b>RESULTS AND DISCUSSION</b>(1) Subjects of the present survey were 704 inpatients from 17 hospitals including 270 fallers. (2) We selected seven variables as predictors of the first fall: central paralysis, history of previous falls, use of psychotropic medicines, visual impairment, urinary incontinence, mode of locomotion and cognitive impairment. (3) We made 960 trial models in combination with possible coefficients for each variable, and among them we finally selected the most suitable model giving coefficient number 1 to each variable except mode of locomotion, which was given 1 or 2. The area under the ROC curve of the selected model was 0.73, and sensitivity and specificity were 0.70 and 0.69, respectively (4/5 at the cut-off point). Scores calculated from the assessment sheets of the present subjects by adding coefficients of each variable showed normal distribution and a significantly higher mean score in fallers (4.94 +/- 1.29) than in non-fallers (3.65 +/- 1.58) (P = 0.001). The value of the Barthel Index as the index of ADL of each subject was indicated to be in proportion to the assessment score of each subject.</p><p><b>CONCLUSION</b>We developed an assessment sheet for fall prediction in stroke inpatients that was shown to be available and valid to screen inpatients with risk of falls immediately upon admission.</p>

Effect of Estradiol on Heme Biosynthetic Pathway in Lead-Poisoned Rabbits

Objectives: To clarify the effect of the female hormone estradiol (Est) on heme biosynthesis in lead-poisoned rabbits, parameters indicating lead exposure, such as free erythrocyte protoporphyrin (FEP) level and δ-aminolevulinic acid dehydratase (ALA-D) activity, were determined. Methods: Twenty-six male Japanese white rabbits (body weight (BW), 3 kg) were divided into four groups: I (control), II (Est), III (Pb), IV (Est+Pb). About 3 weeks after castration, Est (3 mg/kg of BW) was injected intramuscularly, and 2 weeks thereafter, lead (1.2 mg/kg of BW) was injected intravenously. After the initial injection of each of these substances, the same dose of each of these substances was injected once a week until the 9th week. Results: In groups III and IV, FEP level increased and ALA-D activity in the erythrocytes, bone marrow and liver decreased with an increase in lead concentration in blood. FEP level decreased significantly (p<0.01) in the 8th and 10th weeks after Est injection in group IV compared to with that in group III and was not elevated in group II compared with that in group I. ALA-D activity in the erythrocytes, bone marrow and liver increased significantly in group II compared with that in group I, whereas Ht and Hb levels decreased in group II compared with those in group I, and decreased in group IV compared with those in group III. The level of iron in plasma (Fe-P) was within the normal range during experiment. Conclusions: In this study, Est did not increase FEP level. From the above results regarding FEP level and ALA-D activity, Est may prevent an increase in FEP level caused by lead. Ht and Hb levels, which are the parameters of anemia, decreased mainly as a result of Est exposure rather than lead exposure.

Improving ability of married women to prevent reproductive tract infections in rural western China

<p><b>OBJECTIVES</b>The purposes of this study are to investigate and analyze the status of reproductive tract infections (RTIs) in married women in rural western China, and to develop effective strategies for improving the ability of married women to prevent RTIs in this region.</p><p><b>METHODS</b>We conducted in-depth interviews of 142 married women from four villages in three townships. Two questionnaires were used to gather data on married women's health care status, family income, knowledge about RTIs, relevant behaviors, and attitudes toward RTIs. Descriptive, parallel, and logistic regression analyses and the Chi-square test were applied to analyze the relationships between basic conditions and several influential factors.</p><p><b>RESULTS</b>Over 80% of the respondents were of limited income and had with poor knowledge of and a lack of experience in preventing RTIs. Some 83.3% of the married women had experienced menstrual irregularities; 70.3% of those interviewed had experienced malodorous vaginal discharge with or without perineal itching. It was found that 80.7% of the interviewees did not have good personal hygiene habits in daily living regarding RTIs. It was found that the prevalence of RTIs was lower in women who had accurate information about RTIs. Most married women lacked basic knowledge of ways to prevent RTIs, and this, together with the limited support of the health care system and the absence of medical insurance schemes, was responsible for the observed high prevalence of RTIs.</p><p><b>CONCLUSIONS</b>There is an urgent need to improve the capability of married women in rural China to prevent RTIs, and it is important to find effective ways to prevent these diseases. Three health promotion strategies are presently being implemented to prevent RTIs and to build capacity for disease prevention among married women in rural western China.</p>

Effect of estradiol on heme biosynthetic pathway in lead-poisoned rabbits

<p><b>OBJECTIVES</b>To clarify the effect of the female hormone estradiol (Est) on heme biosynthesis in lead-poisoned rabbits, parameters indicating lead exposure, such as free erythrocyte protoporphyrin (FEP) level and δ-aminolevulinic acid dehydratase (ALA-D) activity, were determined.</p><p><b>METHODS</b>Twenty-six male Japanese white rabbits (body weight (BW), 3kg) were divided into four groups: I (control), II (Est), III (Pb), IV (Est+Pb). About 3 weeks after castration, Est (3 mg/kg of BW) was injected intramuscularly, and 2 weeks thereafter, lead (1.2 mg/kg of BW) was injected intravenously. After the initial injection of each of these substances, the same dose of each of these substances was injected once a week until the 9th week.</p><p><b>RESULTS</b>In groups III and IV, FEP level increased and ALA-D activity in the erythrocytes, bone marrow and liver decreased with an increase in lead concentration in blood. FEP level decreased significantly (p<0.01) in the 8th and 10th weeks after Est injection in group IV compared to with that in group III and was not elevated in group II compared with that in group I. ALA-D activity in the erythrocytes, bone marrow and liver increased significantly in group II compared with that in group I, whereas Ht and Hb levels decreased in group II compared with those in group I, and decreased in group IV compared with those in group III. The level of iron in plasma (Fe-P) was within the normal range during experiment.</p><p><b>CONCLUSIONS</b>In this study, Est did not increase FEP level. From the above results regarding FEP level and ALA-D activity, Est may prevent an increase in FEP level caused by lead. Ht and Hb levels, which are the parameters of anemia, decreased mainly as a result of Est exposure rather than lead exposure.</p>

Behavior and Lifestyle Factors Related to Quality of Life in Junior High School Students

Objectives: To analyze actual conditions of the quality of life (QOL) in junior high school students, we developed a questionnaire based on the PRECEDE-PROCEED model, and we conducted a survey by using this questionnaire. Methods: We conducted a workshop organized with 29 specialists on school health and community health to develop the questionnaire. The QOL outcome was assessed by the QOL Profile-Adolescent Version (QOLPAV). The subjects of the questionnaire surveys were 1600 general students in four junior high schools. To investigate a correlation between QOLPAV, behaviors and three enhancing factors, two different multiple regression models were constructed. Results: The question battery for QOLPAV was found to be a high value of Chronbach’s α. Among present subjects, 16.5% were categorized as “problematic” or “very problematic” classified by QOLPAV scores. In the first multiple regression model, significantly high odds ratios were obtained between the QOLPAV and 4 questions for behaviors, such as “studying with high motivation” (OR 1.64), “getting along well with my friends” (2.72), “having things I am interested in” (1.70), and “making my own decisions” (1.80). In the second model, significantly high odds ratios were obtained commonly between the above 4 questions about behaviors and 2 questions on enabling factors, such as “easy to understand lessons” (1.32-1.71) and “speaking to friends easily” (1.30-3.22). Conclusions: 1) We developed a questionnaire to analyze the actual condition of QOL in junior high school students with sufficient validity and availability. 2) Among the present subjects, 16.5% were found to be problematic QOLPAV. 3) Among the factors of behaviors, those representing positive willing and high coping ability with the elements of each school life contributed significantly to the QOLPAV. And among enhancing factors, “enabling factors” and “reinforcing factors” were stronger contributors to the behaviors strongly related to the QOLPAV than that of “predisposing factors”.

Behavior and lifestyle factors related to quality of life in junior high school students

<p><b>OBJECTIVES</b>To analyze actual conditions of the quality of life (QOL) in junior high school students, we developed a questionnaire based on the PRECEDE-PROCEED model, and we conducted a survey by using this questionnaire.</p><p><b>METHODS</b>We conducted a workshop organized with 29 specialists on school health and community health to develop the questionnaire. The QOL outcome was assessed by the QOL Profile-Adolescent Version (QOLPAV). The subjects of the questionnaire surveys were 1600 general students in four junior high schools. To investigate a correlation between QOLPAV, behaviors and three enhancing factors, two different multiple regression models were constructed.</p><p><b>RESULTS</b>The question battery for QOLPAV was found to be a high value of Chronbach's α. Among present subjects, 16.5% were categorized as "problematic" or "very problematic" classified by QOLPAV scores. In the first multiple regression model, significantly high odds ratios were obtained between the QOLPAV and 4 questions for behaviors, such as "studying with high motivation" (OR 1.64), "getting along well with my friends" (2.72), "having things I am interested in" (1.70), and "making my own decisions" (1.80). In the second model, significantly high odds ratios were obtained commonly between the above 4 questions about behaviors and 2 questions on enabling factors, such as "easy to understand lessons" (1.32-1.71) and "speaking to friends easily" (1.30-3.22).</p><p><b>CONCLUSIONS</b>1) We developed a questionnaire to analyze the actual condition of QOL in junior high school students with sufficient validity and availability. 2) Among the present subjects, 16.5% were found to be problematic QOLPAV, 3) Among the factors of behaviors, those representing positive willing and high coping ability with the elements of each school life contributed significantly to the QOLPAV. And among enhancing factors, "enabling factors" and "reinforcing factors" were stronger contributors to the behaviors strongly related to the QOLPAV than that of "predisposing factors".</p>

Quantification of α-methylene-λ-butyrolactone extracted from different parts ofAlstroemeria wilhelmina and evaluation of it's antigenicity using the guinea-pig maximization test

To detect the type of contact dermatitis caused due to the handling ofAlstroemeria wilhelmina, 1% α-methylene-λ-butyrolactone (α-MBL) dissolved in physiological alien and a five-fold diluted saline solution of original extracts of flowers, leaves and stems of the flower were applied to guinea-pigs for extracts were applied to the animals as the challenge treatment in compliance with the guinea-pig maximization test (GMT). As a consequence, not only primary irritant dermatitis was observed, but also delayed type allergic contact dermatitis due toAlstroemeria wilhelmina was observed. α-MBL determined in the extracts using high-performance liquid chromatography (HPLC) was found to be the biochemical material cause of the contact dermatitis. the flower region contained α-MBL in the highest concentrations compared with those of the leaves and stems. Therefore, the quantification of α-MBL in the extracts was concluded as being a useful evaluating method for contact dermatitis due to the handling ofAlstroemeria.

Quantification of $\alpha$-Methylene-$\gamma$-butyrolactone Extracted from Different Parts of \it{Alstroemeria wilhelmina} and Evaluation of it's Antigenicity Using the Guinea-Pig Maximization Test

To detect the type of contact dermatitis caused due to the handling of Alstroemeria wilhelmina, 1% α-methylene-γ-butyrolactone (α-MBL) dissolved in physiological saline and a five-fold diluted saline solution of original extracts of flowers, leaves and stems of the flower were applied to guinea-pigs for induction treatment, and 0.1% α-MBL physiological saline and a ten-fold diluted solution of the original extracts were applied to the animals as the challenge treatment in compliance with the guinea-pig maximization test (GMT). As a consequence, not only primary irritant dermatitis was observed, but also delayed type allergic contact dermatitis due to Alstroemeria wilhelmina was observed. α-MBL determined in the extracts using high-performance liquid chromatography (HPLC) was found to be the biochemical material cause of the contact dermatitis. The flower region contained α-MBL in the highest concentrations compared with those of the leaves and stems. Therefore, the quantification of α-MBL in the extracts was concluded as being a useful evaluating method for contact dermatitis due to the handling of Alstroemeria.

Community-based Analysis of the Factorial Structures of the Recent Increase in Low Birthweight Infants

This study was conducted to determine whether the regional factors were related to the increase in the percentage of low birthweight(LBW: <2, 500g) infants in Kumamoto Pref., and to establish a tentative structure model for predicting low birthweight infants. Analyses for frequency of LBW infants between 1974 and 1997, and a multiple regression model and covariance structure model were conducted using data from the vital statistics between 1992 and 1997 and regional indicators concerned with LBW infants from official registered statistical data between 1992 and 1997. The 72 regional factors were clustered into four groups linked with agricultural areas such as Urban, Flat, Hilly and Mountainous areas. The recent increase in the incidence of LBW infants resulted from the increase in moderate−LBW(MLBW: 2, 000−2, 500g) infants of full term−LBW infants. There was a steady annual increase in the Urban agricultural area LBW infants since 1992. The two structure analyses revealed that the Urban area had a marked effect on the increase in LBW infants, whereas, farm villages in Hilly or Moutainous areas had less effect on the increase in LBW infants. These findings suggest that the regional factors relating to the mothers’ life−style or regional environments play a key role in the etiology and prevention of LBW, and will be a useful in the analyses using official registered material.

Determinants of Life satisfaction among Japanese Agricultural Workers

The purpose of this study was to investigate the factorial structure of life satisfaction in agricultural workers. One hundred and sixty−five (87 males and 78 females) agricultural workers mainly engaged in plastic greenhouse cultivation in southern Japan, ranging in age from 19 to 72 years (mean = 44.3 years), completed a questionnaire. Scores of life satisfaction showed a higher tendency in males than in females, and those in elders were higher than in younger people. Conversely, females showed higher stress scores than males, and younger people’s score were higher than the elders. Multiple regression analysis was performed to analyze the factorial structure of satisfaction. It is suggested that the level of life satisfaction is positively related to social support, and is negatively related to the impact of stressful life events, globally perceived stress and subjective symptoms of ill health. Stress levels depended on factors concerning the psychological demands of work, work posture, work hours and work environment. Different factorial structures were observed between female and male workers. Findings from this study suggest that a strong social support network may assist in enhancing life satisfaction. Furthermore, the ill health and stress experienced in agricultural work were associated with a reduced life satisfaction.