Purpose The purpose of this study was to determine changes in functional status of Japanese community-dwelling elderly, and to identify physical, psychological, and social factors that predict functional change in a 1-year longitudinal study.
Methods A cohort of people 65 years of age and over living in two cities in Yamagata Prefecture were followed for one year. The employed degree of independent criteria developed by the Ministry of Health and Welfare had nine levels. Subjects were classified as independent (rank J) and homebound (rank A) and numbered 112 and 53, respectively. Data on demographic, physical, psychological, and social variables were collected in 1997 by mail and interview during house visits. Death and change in functional status were checked in 1998.
Results At follow-up, 1.0% of independent elders had died. Likewise, of the homebound elderly 7.7% had died. Change in functional status between the baseline and follow-up surveys were similar for both sexes and all age groups. According to nine levels criteria, rates for a good and a poor functional status of independent elderly were much the same at the baseline. Among homebound elders, 35.4% demonstrated improvement in the functional status and 14.6% deterioration. Among independent elderly, worsening of the functional status was significantly displayed, particularly with regard to hearing deficits, hospitalization within the past one year, loss of self-efficacy, fair or poor subjective health and poor functional ability. Among homebound elderly, worsening was significantly displayed in term of incontinence and poor self-efficacy.
Conclusions When functinal status at baseline was poor, deterioration was evident at follow-up survey, independent of the sex or age group. Transition in functional status can be dynamic, and improvement was more usual than worsening among homebound elderly. Our results show that increase in self-efficacy can be an effective target in programs for improvement of functional status and for prevention of functional deterioration among the independent and homebound elderly of both sexes.

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Objective To ascertain the meaning and the influence of daily physical activity on QOL among the elderly, we surveyed their lifestyle exercise habits, cross-sectionally and longitudinally.
Methods The subjects of this study were all residents living in a certain suburb of Nagoya-city, aged 63, 68, 73, 78, 83 years of age. They answered questionnaires regarding their exercise, physical activity, and QOL with six categories. The same questionnaire survey was conducted again 3 years later, and 958 people who answered both of them were examined in this study. The three-year-trend for physical activities, exercise habits and QOL scores, were analyzed and a comparison of QOL was made between the first and third year data based on the primary physical-activity-scores. In addition we applied logistic regression analysis to investigate the influence of physical activity changes (independent variable) on maintaining or improving of QOL scores (dependent variable).
Results Daily physical activities were well maintained, but the percentage of feasible activities decreased by 5-10% as the sample population aged. On the other hand, 20 to 30% of the subjects increased their physical activity. The more people moved, the higher the QOL scores they had in both cross-sectional and longitudinal analyses. According to the logistic regression analysis, baseline physical activity habits positively contributed to most QOL change, increase in exercise tending to maintain or improve the QOL scores.
Conclusions Daily physical activity was relatively well maintained among the sample population, and some increased their physical activity scores over the period studied. Those with high values had better physical conditions and a consistently high QOL. These results suggest that maintaining or increasing physical activity positively influences QOL in the elderly.

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Objective The puepose of the study was to examine the recovery of maternal bone mineral dendity (BMD) following pregnancy and lactation, including the effects of subsequent pregnancy and lactation.
Subjects and Methods Twenty-eight pregnant women were followed longitudinally from early pregnancy (baseline) to five years postpartum (maximum). BMD was measured by ultrasonic bone densitometry at early pregnancy, one week postpartum and at a six-month intervals thereafter. Stiffness calculated from the combined value of speed of sound and broadband ultrasound attenuation was used as an index of BMD. Changes in BMD were examined in 19 women without subsequent pregnancy, divided by the period of lactation, 0-1 month (control), 2-6 months and 8 months or longer. Then, the relationship of recovery of BMD to the interval before a subsequent pregnancy was examined.
Results and Conclusions
 1. BMD in women with 0-1 and 2-6 months lactation duration returned to baseline levels within 1 and 1.5 years postpartum, respectively. That in women with a lactation duration of 8-12 months returned to the baseline within 4 years pospartum, showing wide individual variation.
 2. BMD in women with subsequent delivery after an interval of more than 1 year following weaning showed recovery at subsequent delivery. In some, increase was observed after the period of lactation.
 3. BMD in women with subsequent delivery within 1 year after weaning showed an overall decrease at subsequent delivery.
 These results show that BMD lost during pregnancy and lactation returns to the baseline within four years postpartum, depending on the lactation period, and the length of time from weaning to the next delivery, rather than the lactation period, affect BMD recovery.

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Purpose Many female adolescents suffer menstrual pain and their daily activities are often adversely affected. It is, therefore, necessary to clarify what factors are associated with menstrual pain in order to assist in improving their quality of life (QOL). The purpose of the present study was to examine if adolescents' physique, which reflects their diet and physical activities, has any influence on the frequency of menstrual pain. Especial attention was concentrated on the Body Mass Index (BMI).
Subjects and Methods Using a cross-sectional sample of 2,718 college women aged 18 to 21, both a measurement of body weight and height and a survey with a self-administered questionnaire were carried out in April 2000. The data for the 2,282 college women who properly answered questions were analyzed to study the association of the frequency of menstrual pain with age, physique, exercising habits and factors associated with menstruation such as menarcheal age, menstrual cycle, menstrual duration and menstrual flow.
Results Of the 2,282 college women studied, 34.1% regularly experienced menstrual pain, 48.7% sometimes and 17.2% seldom. When the college women studied were divided into three groups according to an old definition of obesity by Nippon Himan Gakkai, 34.8% of them belonged to the underweight group (BMI<19.8), 53.8% to the normal group (19.8≦BMI<24.2) and 11.4% were overweight (BMI≧24.2). Logistic analysis showed the odds ratio (OR) for the underweight group regularly experienced menstrual pain to be 1.3 (95% confidence intervals (CI): 1.1-1.6) while that for the overweight group was 1.1 (95% CI: 0.8-1.5), taking the normal group as the reference. Early menarche and heavy menstrual flow increased the risk of experiencing menstrual pain while irregular menstrual cycle was associated with decrease.
Conclusion The prevalence of menstrual pain among the college women studied was very high, 82.8%, the frequency being greatest in the underweight group (BMI<19.8). Given the current trend for young women to wish to be thin and the fact that nearly half of Japanese females aged 15 to 24 are already lean, this study suggests that it is very important to take measures to counteract young women's enthusiasm for excessive dieting or other approaches to weight loss since this will help reduce their menstrual pain and improve their QOL.

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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 waling (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.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Objectives We investigated the German system for managing patients with viral hemorrhagic fever (VHF) in comparing with the current Japanese system.
Methods In Germany, we visited the Robert Koch Institute and the isolation centers in Berlin and Leipzig. In Japan, we visited the isolation wards in the Narita Red Cross Hospital and the Rinku General Medical Center in Izumi-Sano, Osaka, to allow determination of differences in the systems. In terms of the “WHO program on emerging virus diseases, 1994”, we then evaluated the two countries' systems.
Results In Germany, the finding of a suspected case with VHF is promptly reported to the competent authorities at the local level. Public health physicians on 24-hour duty declare a quarantine alert and the case is transferred to one of five isolation centers not by plane but by ambulance car. The isolation rooms in Berlin, constructed some 20 years ago, are enclosed with plastic film and kept under negative pressure and this hinders it difficult to perform intensive care in the small space available. In contrast, intensive care and routine clinical tests can be readily conducted in the isolation facilities in Leipzig installed in 2000, since the rooms are spacious and kept under negative pressure. It is also noteworthy that the same ward is utilized for patients with drugresistant infectious diseases to train medical staff.
 With 3 of the 4 goals in the WHO program, establishing efficient surveillance of infectious diseases, provision of a qualified national laboratory and performance on practical research on infectious diseases, there are no large differences, between the two countries, in continuous efforts in line with recently-modified infectious disease laws. However, we found differences with regard to an effective strategy to circumvent VHF, 1) local government has a main role against VHF and control team is promptly designated in Germany, 2) only 10 beds are equipped to deal with VHF in Germany, 3) management of air-droplet infection seems insufficient in Japan, 4) highly-equipped isolation rooms are not utilized for patients other than those with VHF in Japan.
Conclusions These findings require urgent discussion among Japanese experts concerning; 1) operation of BSL4 facilities in national laboratories; 2) collaboration among quarantine stations, local government and national reference laboratories; 3) the appropriate number of isolation wards; 4) practical procedures to run of isolation wards efficiently; 5) the possibility of utilizing isolation wards for non-VHF.

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