Concerning associations between the social support network and physical health of the elderly, longitudinal studies have been conducted using various measurement indexes. The studies indicated that the support network influences on physical function and life expectancy. In this study we compared research papers from Japan and elsewhere that appeared after 1980, from the viewpoint of 1) social support effects, and 2) social network effects, to examine potential problems in the future. The main knowledge obtained was that the receipt of emotional support, wide network size, and participation in social activities reduced the risk of early death and decrease in physical function of elderly people. Sex differences were indicated, and in many cases, the effects were more remarkable in men than women. In addition the positive influence of receiving help from a support network, a major subject of conventional research, the effects of offering help to others and negative findings were also examined. It has been indicated that participation in volunteer groups and offer of support to other people can prevent decrease in physical function or early death. As negative effects, improper instrumental support rather disturbs the mental and physical independence of elderly people. As future issues, it is necessary to focus on both positive/negative and receipt/offer effects of support network, and to clarify how to provide example which best match the life of elderly people by comparing sexes and regions. It is also important to actually apply the knowledge gained from observational studies to prevent the elderly from becoming a condition requiring care, and to develop intervention studies which can increase the social contacts of elderly people at the same time as conducting health education and medical treatment.

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Purpose The purpose of this survey was to study child-rearing problems and necessary community welfare and health services in the families with twins or triplets as compared with families with singleton children.
Methods The subjects were 205 mothers of twins or triplets aged less than 6 and 911 mothers of similarly aged singleton children.
Results 1. Concerning maternal feeling when informed of a pregnancy, a significant difference was observed between the mothers with twins or triplets and the mothers with singleton children: 1.3% of the mothers with singleton children were not delighted when informed of a pregnancy, while the rate for mothers with twins or triplets was 12.4%. Mothers of twins or triplets showed significantly greater anxiety when informed of a pregnancy, and also after delivery, greater anxiety for child-rearing.
 2. Mothers of twins or triplets were more likely to feel they could not get information regarding pregnancy and child-rearing.
 3. There were higher rates of child-rearing problems with regard to economic burden, attending a hospital when a child become ill, shortage of hands for medical examinations or preventive injections, going out with children, shortage of cooperators for child-rearing, lack of time and difficulty for feeding methods for twins or triplets.
 4. Community welfare and health services that mothers of twins or triplets wished for were an allowance for child-rearing in 77.0% of cases, helper or baby-sitter for medical examinations or preventive injections in 59.8%, and meeting for mothers of multiple children in 52.0%.
Conclusion This study indicated a tendency for mothers of twins or triplets to show greater anxiety during pregnancy, greater anxiety for child-rearing after delivery, and harder to get information regarding pregnancy and child-rearing as compared with those having singleton children. Mothers of twins or triplets had more child-rearing problems with regard to shortage of cooperators, economic burden and feeding methods for plural infants.

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Purpose The effects of improved BCG vaccination for babies in Seto-city, Aichi were evaluated.
Method The tuberculin test was performed counting the number of BCG needle traces on 3409 children in the first class of primary school in Seto-city from 2000 to 2002. The children in 2000 and 2001 received ordinary BCG vaccination as babies, while the children in 2002 received the improved BCG vaccination. Children who had not received any BCG vaccination were excluded.
Results Percentages of children with needle traces were 25.1% in 2000, 38.1% in 2001, and 70.5% in 2002. Values for those with a positive tuberculin test (PTT percentages) were 32.5% in 2000, 36.5% in 2001, and 63.7% in 2002. The differences were highly significant (P<0.001) between 2000, as well as 2001 and those in 2002 in the two categories.
 The PTT percentages with needle traces were 41.8% in 2000, 42.0% in 2001, and 66.9% in 2002, as compared with 29.4%, 33.1%, and 56.1%, respectively for no needle traces. The difference was highly significant between children with needle traces in 2000 and those with no needle traces in 2002 (P<0.001).
 The PTT percentages with one to nine needle traces were 40.2% in 2000, 34.0% in 2001, and 63.9% in 2002, and for 10 to 18 needle traces were 46.3%, 55.7%, and 70.7%, respectively.
 Percentages of children with reddening of the skin from 0 to 4.9 mm in diameter were 34.6% in 2000, 33.3% in 2001, and 16.3% in 2002, and for 5 to 9 mm were 32.8% in 2000, 30.2% in 2001, and 20.0% in 2002. Differences were highly significant between 2000 and 2002 in both categories (P<0.001）.
Conclusion These results suggest that improved BCG vaccination has significantly increased tuberculin-positive children, with or without needle traces. The number of needle traces seems to be a less important factor than the percentage of children with needle traces.

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Objective To clarify correlated factors with activities of health related crisis management (HRCM) by prefectural public health centers (PPHCs) and municipalities.
Methods A cross-sectional study of 460 PPHCs and 3,173 municipalities was performed with questionnaires mailed directly to the institutions. Activities of HRCM, which included 24 hour shifts according to the magnitude of the crisis, health services for sufferers, sanitary improvement of shelters, information services for the public, and simulation to cope with health related crises, were evaluated. Items other than simulation were assessed with four grade scales and simulation by whether it was carried out. Correlated factors, which included the size of population, whether a health related crisis had happened in the last 5 years and whether there were facilities that could be a cause of such crises.
Results The response rates of PPHCs and municipalities were 72.8% and 61.7% respectively. More than 60% of PPHCs had good activity for 24 hour shifts for crises of great magnitude. However less than 50% of PPHCs and municipalities performed well with health services for sufferers, sanitary improvement of shelters and information services for the public. Moreover less than 20% of PPHCs and municipalities implemented simulations. Population correlated with health services for sufferers in both municipalities and PPHCs and with sanitary improvement in PPHCs, although the coefficients were small. Municipalities in which a health related crisis had occurred in the past and those in which there were facilities that could be a cause of health related crises performed better activities than others. This was not the case for PPHCs.
Conclusion The study indicated that neither PPHCs nor municipalities performed activities of HRCM sufficiently. It is suggested that PPHCs need to support municipalities, which have no experience of public health emergencies and which have an environment with no obvious danger.

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Purposes Physicians, dentists and pharmacists are required to report to the Ministry of Health, Labour and Welfare every two years by law in Japan and the Survey of Physicians, Dentists and Pharmacists (SPDP) is carried out based on the information provided. Because report omissions are known to occur with the SPDP, we estimated the actual report rates.
Methods The report rate is usually estimated by dividing the number of persons reporting by the number of total registrants in each registration year, but the survival rate is not considered in this method. We therefore estimated the report rates of registrants after 1955, using data from the SPDP between the years 1982 and 2000, without considering the survival rate, and then estimated the report rates of registrants after 1955, using data from the 2000 SPDP, this time considering the survival rate. We also compared the report rates among physicians, dentists and pharmacists.
Results In the year 2000 SPDP, the report rates (physicians, dentists and pharmacists) without considering the survival rate were 87.08%, 84.98% and 71.58%, respectively. The respective values considering the survival rate were 90.30%, 87.15% and 72.98%, respectively. The improvement in the report rate for pharmacists was less than those for physicians or dentists. With physicians and dentists, when the survival rates were taken into consideration, rates were more than 90% between 1965 and 2000, except for a temporary decline around 1990. With pharmacists, however, lower rates were observed in the earlier years of registration.
The reasons for the differences in report rates for physicians, dentists and pharmacists were thought to be as follows:
 1) There are more women pharmacists than physicians or dentists.
 2) The survival rate of pharmacists is higher than for physicians or dentists.
 3) The mean registration age of pharmacists is younger than that of physicians or dentists.
Conclusions Differences exist with report rates of physicians, dentists and pharmacists, and these appear due to variation in the gender ratio and age distribution.

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