Objective The present study aimed to investigate a simple education program that is effective for sleep improvement among medical students who will be medical doctors in the future. The education program applied in the present study was developed for sleep improvement based on behavioral science and changes in knowledge and sleeping habits were observed.
Methods Subjects were 6th-year medical students of 2002 and 2003. Students of 2002 attended a program including a 90-minute lecture and a 2-week practice learning session, and students of 2003 attended only the lecture. In the lecture, behavior therapy for chronic insomnia was explained using a booklet. In the practice learning session, students set a target behavior for improvement and conducted self-monitoring of their sleep and the targeted behavior. Changes in knowledge about sleep, attitude toward the therapy, sleep, and sleep-related habits were observed and compared between the 2 groups of subjects immediately and 2-weeks after the lecture.
Results It was found that after both programs subjects had more knowledge about sleep than before. In the program including practice learning session, subjects' attitude for managing patients changed from before the lecture to after the lecture, and after the practice learning session. It was found that more than half of the students thought that they could provide sleep guidance based on the behavior therapy. Regarding the subjects' sleep, significant improvements were observed for “having nightmares upon falling asleep,” “sleepiness during daytime,” “sense of getting a sound sleep,” and “mood upon waking up.” Regarding sleep-related habits, significant improvements were observed for “taking a nap,” “dozing off,” and “eating breakfast.”
 On the other hand, only the lecture subjects improved irregularity of bedtime and sleeping time.
 Although an increase in knowledge and improvement of sleep were observed among students who attended only the lecture, a further increase in knowledge and improvement of sleeping habits were observed among students who also attended the practice learning session.
Conclusion The results described herein suggest developing and providing a simple and convenient education program for sleep improvement was effective for increasing students' knowledge about sleep, developing improved coping methods regarding sleep, and improving sleep. It is also suggested that behavioral scientific instructive methods, including practice learning, are effective for medical education.

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[in Japanese]

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Purpose In 2001, Japan launched a nationwide subsidy program for influenza immunization of the elderly, whose implementation was devolved to municipalities. Rapid appraisal of the financial impact and utilisation are helpful for evaluating public programs. The government appraised uptake rate with a resource-consuming complete survey. In the present study, the authors carried out a simple and easy sample survey, with a simple random sampling method, to estimate averages of co-payment, subsidy, and total price for one vaccination. The utility of a simple random sampling method for a nationwide survey is also discussed.
Method A total of 300 individuals were randomly selected from about 22 million senior citizens in the 2001/2 season. A questionnaire is sent to their municipal authorities, inquiring about the price of vaccination, the target population size, and the numbers of vaccinated seniors from 2001/2 to 2004/5. Annual changes and the differences between urban and rural areas were examined with analysis of variance and regression analysis.
Results The response rate is 94.0%. Nationwide average prices of vaccination in terms of co-payment, subsidy, and total price changes from 2001/2 to 2004/5 were as follows: the co-payments were ¥1134, ¥1136, ¥1139, ¥1129 and ¥1148; the subsidies were ¥2972, ¥2955, ¥2966, ¥2954 and ¥2941; and the total prices are ¥4194, ¥4169, ¥4178, ¥4156 and ¥4142. No statistically significant differences were found in the annual rates. Vaccine uptake rates from 2001/2 to 2003/4 were 29.9%, 37.8%, 46.1%, 49.6%, showing a statistically significant increase.
Conclusion These are the first estimates of price and uptake rates of influenza vaccination for the elderly in Japan by a sample survey method. The results demonstrate that the co-payment, subsidies, and the total price have not changed significantly since the program started, but that uptake has improved. The results also suggest that simple random sampling methods are useful for rapid appraisal of the nationwide trends with public programs devolved to municipalities.

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Objective The aim of this study was to investigate relationships between smoking and eating habits or behavior in male students.
Methods We performed a questionnaire regarding smoking, eating habits, eating behavior, and the frequency of food intake for 277 male students. We also measured bone mass by a quantitative ultrasound device, along with height, weight, body fat, and gripping power.
Results The percentage of students who had a smoking habit was 22.4%. No significant differences in physical factors between the smoker and non-smoker groups were observed. However, there was significant variation for having meals regularly, and for the habit of assessing their own eating behavior (both P<0.05,). The percentage of students who wanted to obtain nutritional support for maintaining their health, or desiring nutritional support in order to keep a good body style was significantly lower in the smoker group compared to the non-smoker group (P<0.05, respectively). Moreover, the percentage of students who had a habit of drinking alcohol or skipping meals was significantly higher in the smoker group (P=0.002). In addition, the percentage of smoking students who had a habit of exercise was significantly lower (P<0.001).
Conclusion In this study, we obtained useful data regarding relationships between smoking and eating habits in male students. These results suggested that appropriate nutritional education is important in the smoker group of male students for promotion of their health.

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Purpose This study was performed to examine factors related to the use of municipal institutions with the focus on ‘Accessibility’.
Method The data used in this analysis were from the AGES (Aichi Gerontological Evaluation Study) Project, conducted by Nihon Fukushi University located in Aichi Prefecture, Japan. A self-administrated questionnaires was mailed to 5,759 persons aged 65 years and older who were not disabled in 2006, and 2,795 persons responded.
 A dependent variable in the analysis was the use of municipal institutions (a Public Health Center, Welfare Center for the elderly and City Hall). Independent variables were age, disease, employment status, IADL(instrumental activities of daily living), depression (GDS: geriatric depression scale), self-rated feeling of health and ’Accessibility’ (transportation mode and distance from municipal institutions).
 Multivariate logistic analysis was used to provide adjusted relative risk estimates for the associations between use of municipal institutions and related factors.
Results In multivariate logistic analysis, ‘Accessibility’ showed a significant relative risk for the use of municipal institutions after controlling for other related factors. Compared with the elderly whose places of residence was located less than 250 meters from the municipal institutions, the relative risk for the elderly who resided more than 1,500 meters from the municipal institutions was around 0.4 (male: RR=0.358; female: RR=0.378).
Conclusion ‘Accessibility’ is significantly related to the use of municipal institutions. To promote use of the municipal institutions, improving elderly access may well be effective.

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