The evaluation of QOL (Quality of Life) in the medical field has revolved around the development of self-measurement scales comprising two or more questions based on psychometric theory. QOL research in the field of child health progressed in the latter half of the 80s in the United States, and aspects of ambiguity and adaptation to the environment of children were recognized. Objective health and subjective health differ significantly among children and are strongly influenced by environmental factors. In addition, QOL in early life anticipates the later health status in adolescence and youth. For these reasons, QOL research in the field of child health is very important.
 More than 20 scales, exemplified by CHQ, PedsQL, TACQOL/TAPQOL, and COOP charts, exist as standard generic QOL indices for children. Disease-specific scales cover epilepsy, asthma, and allergic disease, as discussed in a number of early studies. Diabetes, skin disease, and cancer are also major research subjects. Self-evaluation is one of the principles of QOL research; it is stated that children in the age group of 5-6 years are already capable of expressing pain and their physical condition and that the competency to describe abstract concepts such as pride and happiness matures around the age of 9-10 years. Sources of information such as the computer have developed and spread remarkably in recent years. The use of such technology facilitates the evaluation of young children with a high level of accuracy.
 The problems currently faced are the low reliability of responses of children, difficulties in cross-cultural comparison, and transformation of the sense of values according to growth. In conclusion, the development of QOL research in the field of child health should allow realization of an improved health situation in which children's points of view are included in the decision-making process for required treatments and health care policy. Further, health administration can be expected to thereby become more effective and balanced.

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 Contingent valuation method (CVM) can be applied to measure benefits of healthcare services. It is a technique for estimating subjects' willingness to pay (WTP) for a service under the scenario describing a virtual market with a questionnaire. In the present research, we outlined foreign studies and reviewed domestic studies on healthcare contingent valuation. A total of 14 papers from domestic literature (five English and nine Japanese articles) identified with mechanical search engines were verified for the following eight items: the method of the questionnaire; the information included in the virtual scenario; the question form for the willingness to pay; bias problems specific to CVM; validity/reliability, ex post/ex ante valuation, altruistic WTP, and non-health value. The following conclusions were drawn from the domestic studies: (1) several studies were short of sufficient information regarding the virtual scenario; (2) no research proved the existence of bias and the ways of coping with it; (3) tests for reliability were not carried out, although some kind of validity was verified; (4) all involved ex post user based evaluation; (5) neither altruistic WTP nor non-health value was examined.
 Taken the advantages of CVM into consideration, it should become a useful tool, complementing other economic evaluation techniques. Since its application has just begun in Japan, more emphasis needs to be given to practical issues so that healthcare workers will utilize CVM in a way that domestic studies in health economics will be activated.

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Objective Parenting anxiety has been highlighted recently because it tends to be a problem of mother-child relationships and a factor in child maltreatment. Compared to mothers of singletons, it is reported that mothers of twins experience a greater physical and mental burden of parenting. This study aims to investigate whether mothers of twins have more parenting anxiety than those of singletons and whether parenting anxiety affects child's mental development in both twin and singleton groups.
Methods 218 mothers of 0 to 2-year-old twins were recruited at seventeen organizations for twin rearing in Kinki area, western Japan, from March to May 2005. Questionnaires were mailed or handed out to the mothers. In all, 124 mothers of twins (56.9%) returned the questionnaires. 5 data sets were excluded because of twins' cerebral paralysis or other reasons and 119 data sets (96.0%) were analyzed. A total of 348 mothers of singletons were collected at four preschools and two public health centers in the same area from March 2005 to March 2006. Questionnaires were mailed or handed out and were returned by 101 mothers (28.1%). 4 data sets were excluded because of the presence of twins or over age children and 97 data sets (96.0%) were analyzed. The core questionnaires included the JCFRI Child Rearing Support Questionnaire for measurement of parenting anxiety and the Tsumori-Inage Infant Developmental Scale.
Results 1. Compared to their counterparts with singletons, mothers of twins showed significantly higher scores for parenting anxiety, including general confusion of parenting and negative feelings toward their children.
 2. On multiple logistic regression analysis, high parenting anxiety in mothers of 2-year-old twins, especially negative feelings were related to delay in the children's mental development. However, there was no significant relationship with twins aged 0 or 1 year and with singletons of 0 to 2 years of age.
Conclusions The results suggest that negative feelings toward children influence mother-child interactions and complicate relationships. Parenting anxiety is a severe problem in mothers of twins not only because it causes mental problems in mothers but also because it has an impact on child mental development.

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Purpose The purpose of the present study was to explore structural relationships among health behavior and health consciousness and to delineate latent factors underlying them.
Methods Data used in this study were obtained from a mail survey conducted by Toshima City Government, Tokyo, in 2002. The subjects were 3,000 community residents, living in the city, ranging in age from 20 to 79 years. The response rate was 54.3%. The data for 1,301 respondents without missing observations were analyzed. A second-order factor model utilizing 23 items of health behavior and health consciousness as observed indicators was developed for the analysis.
Results Covariance structure analysis showed that a model consisting of 23 observed indicators, 9 latent first-order factors, and one second-order factor fitted well and explained the structure of health behavior and health consciousness: the 23 items of health behavior and health consciousness were indicatives of the latent second-order factor named Health-oriented Attitude. The second-order factor score was significantly higher in respondents willing to participate in programs of public health agencies than in those not willing.
Conclusion The results imply that reinforcement of the health-oriented attitude may bring about improved health consciousness and practice of health behavior. They also suggest the necessity to reconsider traditional programs of public health agencies because persons with a weak health-oriented attitude are less likely to participate.

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[in Japanese]

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[in Japanese]

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