Purpose We examined spousal gender differences in change of caregiving experience over 2-years, focusing on care-recipient's physical and mental conditions, living arrangements, financial status, utilization of long-term care insurance (LTCI), availability of secondary caregivers, caregiver's coping strategies and psychological well-being. We also investigated causal associations between caregiving experiences and psychological well-being of the spousal caregivers.
Method We conducted a 2-wave survey, in Oct. 2003 and 2005. The subjects were a stratified random sample of 5,000 users of LTCI in Higashi-osaka city in Japan. Data were collected through mailed, anonymous self-report questionnaires. Totals of 212 wives and 356 husbands were longitudinally analyzed. A cross-lagged effect model by simultaneous analysis of multiple populations was made to analyze a causal association between caregiving experiences and caregivers' psychological well-being.
Results There were no significant changes in care-recipient's physical and mental conditions. Over the 2 years, husbands increased the amount of ADL assistance and availability as secondary caregivers, and wives increased utilization of LTCI services. We also found gender differences in the priority of coping strategies. Husbands' preferred coping strategy over 2 years was more on ‘willing commitment caregiver's role ‘while for wives’ it was ‘instrumental support seeking’. Wives demonstrated a significantly reduced positive appraisal of caregiving. Though the amount of ADL assistance and ‘instrumental support seeking’ reduced husband's depression, husband's positive appraisal of caregiving significantly increased strategies of ‘emotional support seeking’ and ‘willing commitment of care role’. Wives& depression decreased with ‘valuing own leisure and refreshing’ strategies. Furthermore, wives' positive caregiving appraisal increased both strategies of ‘keeping own pace of caregiving’ and willing acceptance of care role'.
Conclusion The husband's results support an interpretation of adaptation to the caregiving role over two years. Therefore husbands who do not experience increase in ADL assistance might be at risk of caregiver's depression. We should monitor their situation of caregiving continually. Though wives increased utilization of LTCI services, this service use did not improve their psychological well-being, and they exhibited decreased positive appraisal of caregiving.

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Objectives To compare medical expenses among regions in Japan, the “regional difference index” of National Health Insurance has been used. The index is formulated as a ratio of observed to expected numbers. However, it has large variability such as in the standardized mortality ratio (SMR) in small populations. To circumvent this problem, we propose an alternative index based on Bayesian methods.
Methods Regional medical expenses were assumed to have a log normal distribution and be derived from the conventional regional difference index as a statistical estimator. Under the assumed distribution, we then considered a full Bayes estimator for the index. The data for 2003-2005 were used for a comparison between the proposed Bayesian index and the conventional index.
Results Under the assumed lognormal model, we could define the conventional index as an estimator for the expenditure level in the region. We showed that it has a large variability for small populations. The proposed Bayes estimator could solve this problem.
Conclusions The proposed index based on Bayesian inference could stably estimate the level of regional medical expenses. We therefore suggest that a more appropriate discussion of regional differences could be given using this Bayesian index than with the conventional one.

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Purpose The purpose of this study was to develop “a professional identity scale for public health nurses (PISP)” and to discover factors related to professional identity for use in studies to improve public health nurse (PHN) activities.
Method Questionnaires including a tentative PISP together with “ego identity’ “self-esteem’, and “nurse identity’ scales were sent to PHNs working in the Kanto region. Out of 986 questionnaires sent, 739 were be collected, and the data were statistically analysed for reliability,validity, and identify-related factors.
Results 1) A tentative PISP consisting of 7 factors and 52 items was developed. Item analysis and exploratory factor analysis (Promax rotation) of the scale showed that 37 of the PISP items had a 5-factor structure. Theses factors were interpreted as “confidence in working as a public health nurse,” “identification of the profession with life,” “feedback from others and self-esteem,” “adaptation to and certainty about career,” and “integration of life and career.” 2) A significant, positive correlation was found between the total score of PISP and the “ego identity’ and “self-esteem’ scales. 3) A significant, positive correlation was found between the total score of PISP and the “nurse identity’ scale. 4) The Cronbach's alpha coefficient for the total PISP was 0.96. 5) Significant, positive correlations were also found between the total score of PISP and age and years of experience. 6) Significantly higher scores of PISP were found for those having a partner or housemate, living with a partner or children, and holding a higher position 7) Multiple regression analysis showed that the factors significantly related to the total PISP score were having faith in his or her duties, having high motivation, being of a higher age, and having a satisfying role as a PHN.
Conclusion The PISP developed in this research demonstrates considerably high reliability and validity. It also showed the necessity to improve the working environment and enhance the positive behavior and motivation of PHNs, for facilitating their development of a professional identity.

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Background Mt. Oyama on Miyakejima Island erupted in June 2000 and all Miyake village citizens were forced to evacuate the island in the September, due to continuous eruptions and emission of unsafe amounts of volcanic gas, mainly sulfur dioxide (SO₂). Beginning in February 2005, residents returned to live on the island despite the fact that volcanic gas was still being emitted.
Objective To examine changes in the respiratory systems of included children from February 2006 to November 2006.
Methods The study population was 141 children who participated in health checkups in November 2006, including 33 SO₂ hypersusceptible children who had a current or past history of asthma, obstructive lung function, current symptoms of whistling and wheezing, and/or deterioration of respiratory symptoms. Respiratory effects were evaluated by a questionnaire for respiratory symptoms and by spirometry. SO₂ was monitored at 7 sampling points within inhabited areas, and the mean SO₂ concentration from February 2005 to November 2006 was 0.031 ppm. The area was categorized into four areas by average SO₂ concentration, namely, areas L, H-1, H-2, and H-3, where the average SO₂ levels were 0.019, 0.026, 0.032, and 0.045 ppm, respectively.
Results Compared to children in area L, the frequencies of “phlegm” and “irritation of the nose” were significantly greater in the children in areas H-2 and H-3. %FVC and %FEV1 in hypersusceptible children were significantly reduced in November 2006 as compared to February 2006 (P=0.047, 0.027), though no reduction observed in normosusceptible children.
Conclusion Respiratory functions in hypersusceptible Miyakejima children may be affected by SO₂ exposure, and further follow-up observation is necessary.

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Purpose This article aims to predict the future course of city administration and public health centers through clarifying the actual state and local residents’ expectations of new public health centers on becoming a “Core City.”
Method Online questionnaire surveys targeting Kurume City residents were conducted in March 2008 (before becoming a Core City) and in October 2008, six months after becoming a Core City. Questions involved awareness of the Core City concept and the expectations for administration of the Core City and its new public health centers.
Result The recognition rate for the Core City concept was 62.6% in the first questionnaire survey and 78.9% in the second survey, demonstrating a significant increase (P<0.001). The expectations for the Core City centered on “Vitalization of the city” in both surveys. However, in the second survey results, “Nothing in particular” accounted for 81.2% of the responses for what the residents felt as a change after becoming a Core City. On the other hand, “Vitalization of the city” recorded 5.5% for the same question, showing a low rate. “Health promotion, Cancer check-ups, and Vaccination” were the most commonly chosen responses regarding expectations of the new public health centers in both surveys, accounting for approximately 30%. Nonetheless, the response to a question asking about actual utilization of the public health centers revealed a high rate of 83.4% for “Nothing in particular” in the second survey result. The recognition rate for the “Health Promotional Members” system implemented by the Kurume City public health centers from 2007 was a low 6.5%. Furthermore, the responses to the “District-Assigned Public Health Service” system to be introduced from 2009 were: In favor 52.6%, Opposed 3.0%, and Neither 44.3%.
Conclusion Although residents’ expectations of public health centers are high, the surveys revealed that the health promotional activities provided by the public health centers were not fully utilized. In the future, the recognition rate of the “District-Assigned Public Health Service” starting in 2009 should be improved as quickly as possible to enhance the support system to accommodate individual health needs.

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