Vital statistics for coronary heart disease (CHD) were dramatically influenced by the tenth revision of the International Classification of Diseases (ICD-10) in 1995. To better understand the accuracy of death certificate diagnosis of CHD and heart failure, validation studies in Japan were reviewed. Positive predictive values and sensitivity, calculated as validation measures, varied widely between studies, differing with regard to autopsy rates, amount of information on medical records, and period investigated. However, heart failure, which has been frequently assigned on death certificates in Japan, was validated in some studies. Half of these were evaluated to be sudden deaths, including coronary deaths. Because autopsy-based studies on sudden deaths indicated that 30-50% of these were accounted for by CHD deaths, deaths assigned to heart failure should be taken into consideration in order to determine the actual number of CHD deaths in Japan. Focusing on changes in vital statistics after the 1995 ICD revision, the Oita Cardiac Death Surveys (OCDS) allowed interpretation of its effects on CHD and heart failure. Much of the increase in CHD deaths on vital statistics reflects more false positive cases, particularly for out-of-hospital deaths. Considering the Japanese features of vital statistics for CHD, further epidemiological validation studies are needed in order to confirm the accuracy of CHD death certificate diagnoses and to monitor actual CHD trends in Japan.

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 Health education is an important profession. The certification of health education specialists (CHES) has evolved in the United States (U.S.) over the past 50 years. This article briefly focuses on the CHES system in the U.S. and research studies related to this topic, including coverage of the CHES responsibilities and competencies by professional school programs in the U.S., as well as other CHES issues. The CHES credentialing system in the U.S. was successfully developed over a long period of time, and its history in the U.S. is unique. Japan has now started to develop a similar certification process and is concerned about academic programs for training Japanese health educators. Awareness of the CHES system and the U.S. health education certification process and framework may help Japanese health educators and academics to tailor their health education certification processes more effectively.

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Objective To compare the accuracy and validity of three different methods (Proportional Disease Magnitude method [PDM] with two different magnitude estimations: arithmetic means with correction by the authors; Proportional Allotment Estimator [PAE] by Tango; Maximum Likelihood Estimator [MLE] also by Tango) for estimating disease-specific costs in health insurance claims.
Methods Application of the three methods to a computer-generated simulation dataset whose disease-specific costs were known and to actual outpatient claims whose disease-specific costs were unknown.
Outcome measures For simulation data, the accuracy was assessed by correlation between known disease-specific costs and estimated disease-specific costs by the three methods. For actual claims, concurrent validity was assessed by inter-method correlations between pairs of the two methods.
Results All three methods showed good agreement and accuracy with the simulation data but marked disagreement when they applied to actual claims. MLE yielded an aggregate total of disease-specific costs exceeding the actual total by 21.3% and showed negative disease-specific costs in 18 out of 154 categories. Inter-method correlations showed that PDM with PAE and MLE correlated most strongly (R²=0.9022) while the least correlation was observed for PDM with arithmetic means and MLE (R²=0.6861).
Conclusion MLE is not usable for claims analysis but PDM yielded good estimates with two different methods of magnitude estimation using actual claims.

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Objective Whether the benefit of a public health program surpasses the cost of providing the program is an important question for public service providers. This study aimed to evaluate one health checkup program provided by a municipal government by measuring the public's willingness to pay (WTP) for maintaining the program.
Methods A questionnaire-based study of a health checkup program targeting people joining the National Health Insurance system was conducted. The WTP was estimated from a demand curve for the program, which was constructed by a revealed preference method, that is, by the travel cost method.
Results The WTP was calculated as 5410 yen per person, an amount substantially below the cost to the government of providing the service. The aggregate WTP was also estimated to be lower than the current expense of the municipal government.
Conclusion The amount users are willing to pay for a health checkup program provided by the municipal government appears to be less than the actual cost of the program. The travel cost method might reflect short-term private benefit produced by the health checkup program but cannot take into account long-term private benefit or overall social benefits which ensues.

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Objective To clarify whether self efficacy for health promotion is associated with functional ability among elderly inhabitants of a rural community in Japan.
Methods The research was a longitudinal study of inhabitants aged 65 and over in a community in Nagano, Japan, who completed a questionnaire at the baseline in 1998 and at follow-up in 1999. The questionnaire included 1) Self Efficacy Scale for Health Promotion measuring the belief in task performance on health, 2) health behavior, 3) a functional ability scale consisting of instrumental activities of daily living, effectance, and social role (Tokyo Metropolitan Institute of Gerontology Index of Competence: TMIG Scale), and 4) demographic factors such as age and sex.
Results At the baseline, 477 subjects completed the questionnaire by themselves and achieved full marks on the TMIG Scale. Of these, 457 responded again 12 months later. Low self efficacy for health promotion at baseline was a significant correlate for functional decline during the 12-month period.
Conclusion Self efficacy for health promotion is a predictive factor for functional ability and can be important as an intervention target for elderly people.

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Objective In this study, we aimed to examine the factors that affect people's attitudes toward parental care. Previous qualitative studies present several factors that affect the decision of adult children of whether to take care of elderly parents or send them to a nursing home when they become fragile and need daily help. In the present study, we included affection, filial obligation, sekentei (i.e., wanting to keep an appearance of taking care), and other factors presented in previous studies.
Methods In May 2001, we mailed a questionnaire to females in their 30s who live in an agricultural area of K. City, Saitama Prefecture in Japan. We asked the respondents whether they would take care of their mothers or mothers-in-law, or send the mothers to a nursing home when the mothers need 24-hour care in the near future.
Results Logistic regression analysis revealed that filial obligation and sekentei affected attitude toward care in the case of a mother while affection did in the case of a mother-in-law.
Discussion These results suggest that women who do not have intimate feelings towards their mothers-in-law may choose not be a caregiver. On the other hand, women may take care of their mothers, whatever feelings they have because of the blood-relation. Also it may be that in such a small agricultural area, sekentei affects people's conduct, even if it is a private matter, such as caring an elderly mother.

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Objective The purposes of this research were to clarify three-year changes in functional capacity and to investigate related physical health, psychological/mental health, and social health factors in older adults living alone in a rural area of Japan.
Methods Home visit interviews were conducted in 2000 (the baseline survey: n=128) and in 2003 (the follow-up survey: n=101) with older adults living alone in a town in Ishikawa prefecture. Seventy nine subjects were analyzed using logistic regression analysis at the follow-up survey.
Results Of these 79 subjects, 40 persons had scores for functional capacity decreased by one or more points, the “Lowered” group (50.6%), while 27 persons were “Unchanged” (34.2%), and 12 persons were “Improved” (15.2%). Factors at the baseline survey were compared between the “Lowered” group and the “Unchanged/Improved” group. Significant factors that caused a decreased functional capacity were age (75 years old and over), no participation in social activities, and contact with friends/neighbors over the phone less than once a week.
Conclusion This research has shown that participation in social activities and contact with friends/neighbors maintain a higher functional capacity in older adults living alone.

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Objective This study was performed to determine the rates of breast-feeding and/or bottle-feeding in mothers of twins, triplets and higher order multiple births compared to those in mothers of singletons, and identify factors associated with decision as to breast-feed or bottle-feed.
Methods The subjects were 1,529 mothers of twins aged 6 months-6 years and 258 mothers of triplets and higher order multiple births (higher multiples) aged 6 months-6 years (234 mothers of triplets, 20 mothers of quadruplets, 4 mothers of quintuplets). Also, 1,300 subjects were recruited as a control group from mothers of singletons aged 6 months-6 years. Information regarding feeding methods, including exclusive breast-feeding, mixed-feeding and bottle-feeding with formula milk only, and duration of breast-feeding (in months) was collected.
Results There were significantly higher rates of bottle-feeding in mothers of twins and higher multiples than in mothers of singletons. Duration of breast-feeding in mothers who chose exclusive breast-feeding or mixed-feeding for twins and higher multiples was significantly shorter than those for the singletons. The feeding methods for the twins or higher multiples were not associated with prematurity or low birth weight. However, after adjusting for each associated factor using logistic regression analysis, the decision to bottle-feed was significantly associated with non-cooperation of the husband in childrearing and degree of anxiety that mothers felt when informed of a multiple pregnancy. The odds ratio indicated that mothers who received no cooperation from the husband for childrearing were 1.83 times more likely to choose bottle-feeding as those who received cooperation. Further, the odds ratio indicated that mothers who felt greater anxiety when informed of a multiple pregnancy were 1.73 times more likely to choose bottle-feeding as those who did not feel much anxiety.
Conclusion This study found that establishment and continuation of breast-feeding for twins, triplets and higher order multiple births are much more difficult than for singletons. Further, cooperation of the husband in childrearing and the degree of maternal anxiety when informed of a multiple pregnancy are significant factors affecting the decision to breast-feed or bottle-feed for twins, triplets or higher order multiple births.

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Objective Although education for smoking cessation is being conducted in Asian countries, the prevalence of smoking is still high. The present study was designed to clarify differences in the socio-cultural background in Japan and Thailand.
Methods Cross-sectional study. The Japan survey was conducted in Kanagawa and the Thailand survey in Suphanburi. Questionnaires written in English were translated into each language. The subjects were out-patients of community hospitals (331 males and 353 females in Japan and 293 males and 288 females in Thailand).
Results The prevalence of smoking was found to be higher in Thailand than in Japan for males but almost the same for females. A higher percentage of the subjects quit smoking in Japan than in Thailand. The motive for quitting smoking was “awareness of the harmful effects of smoking” in both countries, but “told by others to quit smoking” was also often encountered in Thailand. The method of quitting was most frequently “suppress the urge to smoke by will power” in both countries. Nicotine replacement therapy is not well known yet in either country.
Conclusion Smoking behavior was different although the difficulty of quitting smoking was common to both countries. The prevalence of smoking in younger males and females was established to be higher in Japan, and social and environmental regulations for quitting smoking were effective in Thailand. It suggests that such regulations should be made stricter in Japan. Enlightenment by providing knowledge may be particularly useful in Thailand.

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Objective Possible relationships were explored between socioeconomic status (SES) and intestinal parasitic infections among residents of Prek Russey, a commune in a rural area near Phnom Penh.
Methods An epidemiological study was conducted in Prek Russey Commune, consisting of the following three villages: Kroppeu Ha (KH), Prek Russey (PR), and Prek AngChanh (PA), with respective populations of 3,401, 1,350, and 1,044. Examinations of intestinal parasitic infections and the interview survey were performed.
Results Among the residents of KH, PR, and PA, respectively, the prevalence rates of three major species of parasites were as follows: 17%, 27%, and 34% had hookworm; 14%, 17%, and 19% had Ascaris lumbricoides; and 13%, 17%, and 18% had Strongyloides stercoralis. The prevalence of each parasitic group tended to increase in the order of KH, PR, and PA. The greatest differences between the villages were in the prevalence of hookworm infection. Our epidemiological survey revealed three SES-related factors whose proportions increased or decreased in the order of KH, PR, and PA. First, the percentages of households purchasing relatively safe drinking water were 96%, 63%, and 2%, respectively. Second, whereas 82% and 78% of houses in KH and PR were equipped with a latrine, only 41% of houses in PA were so equipped. Third, the proportion of households whose main income was from farming increased in the order of KH, PR, and PA.
Conclusion The present study thus suggests that greater latrine use and less dependence on farming activity are related to a lower prevalence of intestinal parasitic infections, although the results are not conclusive due to the ecological nature of the study.

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