Purpose This study was conducted with the aim of multi-faceted evaluation of a health education program, “Genki-jaya”, run at Fukushima City Health and Welfare Center.
Methods “Genki-jaya” is a health education program including indibivual health instructions combined with group education on exercises as well as diet. A total of 55 participants completed the program through December 1999 to March 2001. Twenty-six were under the medical care covered by national-health-insurance when the program started, and 19 of these, whose medical expenses for one month prior to the program were zero, were studied. The program was evaluated using the following:
 1. Results of questionnaire surveys to examine self-care ability and perceived health conducted at the end of the program and three months after it finished.
 2. Physical measurement items (blood pressure, weight, body fat rate, and BMI) and physical fitness items (maximum-oxygen-uptake, muscle-strength of legs, etc.) at the start of, and three months after the program.
 3. Change in the total medical expenses between one year prior to and after the program, and its relationship with physical measurements and satisfaction with the program. Comparison of the mean three-month medical expenses before, during, and after the program. Comparison of medical expenses three months before, at the beginning and end of, and three months after the program.
 4. Follow-up of continuous activities among graduates of the program.
Results 1. Regarding self-care ability, dietary habits, and exercise habits, these continued to improve after the program and all participants were satisfied. Regarding perceived health, subjective symptoms improved.
 2. Physical measurements improved through the program. Both mean diastolic pressure and body fat rate at the end of the program were significantly lower than at the beginning. Moreover, mean systolic and diastolic pressures significantly decreased from the end of the program through three months thereafter.
 3. The medical expenses before and after the program did not change significantly, and differences did not correlate with physical measurements and satisfaction with the program.
 4. Three self-supporting associations among the graduates had been organized to continue instructed exercises were active at the end of March 2001.
Conclusion Although Genki-jaya had no significant impact on medical expenses, improvement in self-care ability, perceived health, physical measurements and formation self-supporting associations was observed. Multi-faceted evaluation of the program will now be continued to examine larger numbers of newly enrolled trainees for a longer period of time.

View full abstract

Purpose The objectives of this study were to examine the degree of psychological distress during the first 6 months after diagnosis of gastric cancer and investigate the relation to psychological support from public health nurses and family members.
Methods One hundred and five patients with stomach, colorectal, or esophagus cancer were mailed a questionnaire. They were asked questions concerning the level of shock on the day of diagnosis, at 1-week after the diagnosis, and at 6 months post diagnosis. In addition, their physical and psychological status was assessed at the 6-month time point. They were also asked about perceived psychological support from public health nurses and family members. The relation between psychological distress and such psychological support was then assessed using multiple regression analyses.
Results The levels of shock on the day of diagnosis and after 1-week were both significantly related to the psychological support from public health nurses. Physical and psychological status at 6 months post diagnosis was significantly related to the level of psychological support from the patient's family members.
Conclusion The study revealed that psychological support from public health nurses improves the level of patient psychological distress during the first 1 week after the cancer diagnosis. Psychological support from family members facilitates the physical and psychological adjustment at 6 months post diagnosis. The results indicate that psychological support is important just after cancer diagnosis and for longer term adjustment, pointing to a major role of health care professionals alleviating problems associated with cancer diagnosis.

View full abstract

Objective The study was carried out to analyse and compare the number of examinees, cancer detection rate change in the age distribution of screened women with data from the periods 1974~1983 and 1984~1993.
Subjects and methods The target population of the study composed women participating in uterine cancer screening by automobile in Fukui prefecture over the twenty year from 1974 to 1993, divided equally into early and late periods. The examination method was smear sampling for cytology, performed by scraping the cervix with a cotton swab or wooden spatula. Patients with suspicious or positive smears underwent histological diagnosis by colposcopic biopsy.
Results 1) The number of examinees was increased over 160% during the late as compared to the early periods. 2) The dysplasia detection rate increased from 0.195 to 0.27%. 3) The carcinoma detection rate, in contrast, decreased from 0.2% to 0.1%. 4) The rate of smears categorized as class III or above increased with age in the early period but was steady across the age distribution in the late period. 5) Class (IIIa) dysplasia and class (IIIb) in situ carcinoma detection rates were higher in the late than the early period. 6) The carcinoma detection rates increased with age in early period, while in the late period, those for patients under the age of 29 and over 70 years old were higher and these for other ages were lower than in the early period. 7) The carcinoma detection rate for first examinees was higher than for repeated examinees. 8) The proportion of first examinees was 65.5% among women under the age of 29 and 46.8% among women aged 30~34. 9) Carcinoma detection rates for individual public health centers (PHCs) were Fukui PHC 0.13%, Kanazu PHC 0.11%, Okuetsu PHC 0.09%, Tannan PHC 0.11%, Reinan PHC 0.04%.
Conclusions The results showed the detection rate to be higher at the first visit. The detection rates for dysplasia and carcinoma were increased in young women in the late as compared to the early period. It is important to follow up the patients with dysplasia and encourage more frequent visit by young as well as aged women.

View full abstract

[in Japanese]

View full abstract

Objective The aims of this study were to describe job characteristics for daytime and shift workers in home care services for the elderly and to clarify health care in the work setting, social support, and job satisfaction and possibilities.
Methods A self-reported questionnaire was given to 433 home care workers, both full time and part time (more than 15 hours), at 35 institutions that provide home care services to residents of Sapporo (return rate; 80.2%). The following issues were investigated: job content (physical care, assistance with housework, and advice), specialty, job satisfaction, possibilities, job training, health care and social support. The results were compared among employed types: full-time and part-time daytime and shift workers using the t-test or the Fisher's test.
Results The participants demonstrated high dissatisfaction with wages, physical uneasiness themselves and limited social support from their supervisors. Especially full-time workers were dissatisfied with the payment, whereas part-time workers complained about insufficient attention to the prevention of lumbago. It was found that part-time daytime workers were given insufficient on-job-training and education for prevention of infection, and that full-time shift workers greatly wished to leave the employment. However, the home care workers were satisfied with their job itself and expected to continue their work. Furthermore, half of the part-time workers hoped to work full time.
Conclusions Health management and educational training for part-time workers may be necessary to improve the quality of care services and protection of health. Promotion of full time employment and reconsideration of working condition might be necessary to provide sufficient home care services.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

Purpose The number of pet dogs moving with their owners to Honshu, the main island of Japan, from Hokkaido, and the number of dogs imported from overseas were examined, and the possibility of invasion of Echinococcus multilocularis and E. granulosus with these dogs was discussed.
Methods The number of pet dogs moving to Honshu-island from Hokkaido was examined with the movement notifications based on the Rabies Prevention Act in 29 prefectures during the period from 1996 to 2001. The number of pets was also examined by questionaire targeting 3 aviation and 3 ferry companies. The number of dogs imported from overseas was examined with the Annual Reports of the Animal Quarantine Service of Japan, The sanitary conditions of hotels for pet owners were also examined with a questionnaire.
Results Approximately 140 pet dogs were found to have officially moved annually from Hokkaido to Honshu during the study period. However, the actual number might be two to three times this estimate, because many dogs moved without notification. Nearly ten thousand pet dogs were transported a year to and from Honshu and Hokkaido by planes and ferries. A value of three thousand would be expected if people from Hokkaido were accompanying their pets at the rate of the registered dogs per population, one animal per 23 Hokkaido residents. Up to 30 pet dogs infested with E. multilocularis would probably be included per year, according to the infestation rate of 1% in Hokkaido. The number of imported dogs from overseas was assessed at approximately 15 thousand a year, but these dogs were not obligated to receive animal quarantine with respect to echinococcal infestation in Japan. Hotels for pet owners were considered to be managed rather sanitarily, though certain administrative guidance is necessary to prevent hydatid disease infection of travelers and hotel workers. The authors consider that dogs from Hokkaido and also from echinococcosis endemic countries should undergo fecal examination for parasite eggs to prevent invasion of the parasite into Honshu.
Conclusion The authors propose the fecal examination of the dogs from Hokkaido and also from overseas for preventing invasion of E. multilocularis and E. granulosus into Honshu, Japan.

View full abstract

Objective In accordance with the partial amendment of the Law on Mental Health and Welfare for People with Mental Disorders, some mental health and welfare work is now under the jurisdiction of cities, towns and villages instead of prefecture. What is the role of prefectural health centres in realizing the change? To assess the smoothness of the transfer of the work from prefectures to the municipalities, we investigated the situation in the latter and the actual support provided by health centres.
Methods A total of 103 health centres in the administrative divisions were recruited. A questionnaire survey was carried out to study the mental health and welfare work, the department in charge and other data for cities, towns, and villages in the administrative division of each prefectural health centre. The actions of health centres were also investigated and analyzed. In addition, Japan was divided into 6 blocks of health centres, and comparisons among the 6 blocks were made based on the answers to survey questions.
Results A total of 83 health centres responded to the questionnaire (the response rate was 80.6%), with 683 cities, towns and villages included in their territories about 60% of the municipalities had designated a person in chatge of the transferred mental health and welfare services, the tesponsible department was decided in less than 40% of cases. There were differences among the 6 blocks in Japan in the rates of actions on mental health and welfare, and in the designation of the department in charge in municipalities. Over 95% of the health centres provided educational courses related this transfer of work for municipalities. About 80% of the health centres evaluated the merit of the partial amendment for promotion of mental health and welfare, and 60% were anxious about retrogressive policies for people with mental disorders.
Conclusions Educational courses supported the smooth transfer of services. The department in charge of the transfer of service in the cities, towns and villages was designated in less than 60% of municipalities.

View full abstract