Purpose The number of municipalities that offer a pneumococcal pneumonia vaccine (PPV) to their aged inhabitants has been increasing. In this study, a complete count survey of the practice of municipality-organized PPV vaccination programs was carried out to explore co-payment/subsidy levels and uptake rates.
Method A questionnaire inquiring into the price charged to the vaccinee, the subsidy provided by the municipality, the size of the target population, and the numbers of individuals vaccinated from 2001 to 2007 was sent to 63 municipal authorities which had organized PPV vaccination programs. Annual changes of co-payment/subsidy and uptake rates are examined with analysis of variance (excluding the year with n≤2).
Results The number of municipalities that provided a subsidy was 1 in 2001, 2 in 2002, 18 in both 2003 and 2004, 24 in 2005, 41 in 2006, and 56 in 2007. Average levels of subsidy were ¥3233 in 2003, ¥3225 in 2004, ¥3168 in 2005, ¥3158 in 2006, and ¥3351 in 2007. Average levels of co-payment are ¥3899 in 2003, ¥3928 in 2004, ¥3979 in 2005, ¥3891 in 2006 and ¥3672 in 2007. No significant differences were found among average levels of subsidy/co-payment between consecutive years (F=0.195, p=0.964/F=0.271, p=0.949). Average uptake rates by number of years since the beginning of the program (response rate 68.1%, 109/160) were 17.7% for the 1^st-year, and 5.4%, 3.7%, 3.4%, 4.6% for the 2^nd- to 5^th-years, respectively. Statistically significant differences were observed between the 1^st- and each of the following years (Dunnett T3, p<0.001). Average uptake rates in the first year of the program (response rate 80.9%, 51/63) were 32.1% in 2003, 8.5% in 2005, 13.6% in 2006 and 16.5% in 2007. Significant differences were observed between 2003 and 2005 (Tukey's HSD, p=0.03), and 2003 and 2006 (Tukey's HSD, P=0.015).
Conclusion Our results revealed levels of co-payment/subsidy and uptake rates of municipality-organized PPV vaccination programs for the first time.

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Purpose The purpose of this study was to develop a Social Activities-Related Daily Life Satisfaction Scale specifically applicable to elderly people in communities and to evaluate its reliability and validity.
Methods Sixteen items were extracted from an initial pool and assessed for inclusion in the scale by correlation and exploratory factor analyses. To confirm validity, confirmatory factor analysis was conducted and correlation coefficients were calculated. In addition, t-tests were performed in order to generate scores of the subscale related to activity. To prove reliability, Cronbach's coefficient alpha values were calculated. Data for 755 older adults aged 65 to 84 years were obtained from a mail survey in Ichikawa City, Chiba Prefecture.
Results Exploratory factor analyses indicated that four factors, “satisfaction with learning” (four items), “satisfaction with usefulness to others and society” (four items), “satisfaction with health and physical strength” (three items), and “satisfaction with friends” (three items) should be extracted. Confirmatory factor analysis for assessing the 14-item four-factor model showed high goodness of fit indices (GFI=0.943, AGFI=0.915, RMSEA=0.068). Concurrent validity was established by comparing the score of the scale with five external variables (Activity and Daily Life Satisfaction Scale for the Elderly, Life Satisfaction Index K, etc). Student's t-tests revealed that each score of the subscale was positively associated with activity variable. The overall Cronbach's coefficient alpha for the scale was 0.919 and for its four subscales values ranged from 0.814 to 0.887.
Conclusion A Social Activities-Related Daily Life Satisfaction Scale was derived consisting of four subscales, “satisfaction with learning”, “satisfaction with usefulness to others and society”, “satisfaction with health and physical strength”, and “satisfaction with friends”. The results of the present study suggested that the Social Activities-Related Daily Life Satisfaction Scale has adequate reliability and validity.

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Objective Life-space is a spatial measure of mobility defined by the distance a person routinely travels to perform activities over a specific time period. Life-space assessment (LSA) has been widely applied, but measurement properties have not been investigated in a Japanese population. The purpose of this cross-sectional study was to describe distributions of maximal life-space and to clarify the validity of composite scores of an LSA scale among community-dwelling older adults using preventive health care services in Japan.
Methods Surveys were conducted between November 2007 and February 2008 with a specially prepared Japanese LSA version. The sample was composed of 2,147 participants using preventive health care services provided by the Japanese long-term care insurance system, all being aged 65 and over, with adequate cognitive functions and living at home in the community (29.5% men, mean age +/−[SD] 79.4+/−6.9 years). First, the levels of life-space, based on how far a person had travelled on leaving his or her place of residence during the month preceding the assessment, were investigated. Second, LSA scores were calculated considering the degree of independence as well as frequencies for individuals at each level, then descriptive statistics were checked. Finally, it was tested whether the scores could be related to external criteria and functional or socio-psychological variables stated in previous studies.
Results Sixty-four percent of individuals attained the highest level of life-space (i.e. outside town). The average of the composite scores was 51.4+/−25.2 points and the distribution was almost normal. The dispersion of the scores tended to be large. Values correlated with the hierarchical mobility level classification as an external criterion (0.539). As hypothesized, the scores were correlated with age (−0.296), functional mobility (time up and go test) (−0.387), and instrumental activities of daily living (0.533), and were discriminated by sex, depressive mood, and perceived health status, in the expected directions.
Conclusions The present study described the extent of life-space in older adults using preventive health care services in Japan, and provided preliminary support for criterion-related (concurrent) and construct validity of scores with the LSA Japanese version. The LSA composite scoring method may have advantages for detecting differences in life-space among individuals, as compared to simply using the maximal level attained.

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Objective The purpose of this study was to examine the relationship between depressive status and subsequent certification of long-term care insurance use, and to investigate sex differences in this relationship in an elderly Japanese population.
Methods The Tsurugaya Project was a comprehensive geriatric assessment conducted for community-dwelling elderly persons aged 70 years or older in the Tsurugaya area, Sendai, Japan (N=2,925). Of those who participated (N=958), the 841 who gave informed consent and were not qualified for certification of long-term care insurance use at the baseline survey were analyzed. Depression was assessed using the 30-item Geriatric Depression Scale (GDS). We classified the subjects into three categories: normal (GDS less than 10), mild depression (GDS between 10 and 13), and moderate to severe depression (GDS more than 13 and/or taking antidepressive medication). The hazard ratio of incident certification of long-term care insurance use by depressive status was calculated using the Cox proportional hazards model.
Results During 4 years of follow-up, a total of 151 subjects were certificated for long-term care insurance and 46 subjects died. Particularly in men, the depressive status was related to subsequent incident certification of long-term care insurance use. In men, the age-adjusted hazard ratios (HRs) were 1.77 (95% confidence interval (CI): 0.91-3.48) for mild depression, and 2.26 (1.11-4.64) for moderate to severe depression (P for trend=0.023). The relationship between depressive status and subsequent certification of long-term care insurance use in men was significant even after adjustment for age, comorbid conditions, social factors and lifestyle (multivariate-adjusted HR: 1.31 (95% CI: 0.65-2.65); mild depression 2.19 (1.06-4.54); moderate to severe depression: P for trend=0.034). In women, there was no significant association between depressive status and certification of long-term care insurance use. In both sexes, there was no significant association between depressive status and death.
Conclusion The relationship between depressive status and subsequent certification of long-term care insurance use was significant only in men. In men, the relationship was significant even after adjustment for age, comorbid conditions, social factors and lifestyle. These results suggest a sex difference in the relationship between depressive status and subsequent certification of long-term care insurance use in elderly Japanese.

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Objective This study sought to clarify psychosocial and psychiatric differences of suicide-completers dependent on their employment situation.
Methods Since December 2007, we have been conducting a Japan-wide study on suicide-completers using a psychological autopsy method, a semi-structured interview by a psychiatrist and a mental health professional including a public health nurse with the closest bereaved. Items questioned included family environment, suicide situation, life history f, labor situation, economic problems, and psychiatric diagnosis according to DSM-IV criteria at the time of death. As of July 2009, we had collected psychosocial and psychiatric information for 46 Japanese suicide cases.
Results More than half of 31 suicide-completers with a job at the time of their death were married men aged 40~59 (mean age 48.1±12.6). Many had socialdifficulties such as alcohol-related problems or debt (38.7% and 41.9%, respectively). More than sixty percent of the 15 unemployed suicide-completers were unmarried and aged 20~39 (mean age 43.4±19.9). The percentage of women in the unemployed suicide-completers was significantly higher than that for women with a job. Although social problems were not confirmed in the unemployed, the prevalence of alcohol use disorders was significantly higher in suicide-completers with a job than in those who were unemployed. However, the prevalence of schizophrenia was significantly higher in the unemployed.
Conclusions Our findings suggest that to prevent suicide of those with a job, enhanced mental health support in the workplace and a better understanding of the association between alcohol use disorders and suicide are required. To prevent suicide of those who are unemployed, mental health support for the younger generation, particularly in cases with schizophrenia, is recommended.

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[in Japanese]

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[in Japanese]

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