Objectives To investigate gender differences in the relationship between sleep and depression in the elderly.
Methods Residents of a village in Kumamoto Prefecture, Japan (563 people) aged≥65 years were given a self-administered questionnaire survey between June and July 2010. To evaluate levels of sleep and depression, the Pittsburgh Sleep Quality Index (PSQI) and the Geriatric Depression Scale—Short Form (GDS-SF) were used. Adjustment factors assessed age, income, residence status, social role, medical history, nursing situation, and cognitive function. As with previous studies, respondents were evaluated as having a disturbed sleep or depression if the sum of their PSQI and GDS-SF scores was 6 or more. We examined the relationship between sleep and depression using multiple logistic regression analysis, with presence of depression in each gender introduced as a dependent variable. Given that some degree of correlation was expected among adjustment factors in the model, we constructed a model that introduced the adjustment factors stepwise to confirm the robustness of the model and any effect of multicollinearity.
Results Overall (n=424), a significant relationship was found between disturbed sleep and depression in all models. The odds ratio was 1.92 (95% confidence interval: 1.11–3.32) in the final model, controlling all adjustment factors. In men (n=198), although the relationship between disturbed sleep and depression was significant before adjustment, no significance was observed after adjustment. In women (n=226), however, a significant relationship was observed between disturbed sleep and depression in both models. After the introduction of all variables as adjustment factors, the odds ratio was 2.28 (95% confidence interval: 1.11–4.69).
Conclusion Our findings suggest a significant relationship between disturbed sleep and depression in elderly women, but not in men. While the reasons for this gender difference are unclear at present, various factors, such as the endocrine system, are likely to be involved. Future studies should take this gender difference into account in order to enact more effective measures for preventing depression in the elderly.

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Objectives As the number of tuberculosis (TB) cases has decreased, early diagnosis of TB has become more difficult. Delayed diagnosis of TB may lead to worsening of the affected individual's condition and may spread the disease in the community. The purpose of this study was to find factors associated with patient delay in seeking treatment after developing symptoms of TB.
Methods Structured interviews were conducted with adult TB patients from 17 health centers registered under the national Japanese TB surveillance system from January 1, 2010 to November 30, 2010. The questionnaire used for the interview included items on symptoms, type of coping behavior from the time of onset of symptoms to the time of the first hospital visit, recognition of and experience with TB, priorities in terms of health behavior, and demographic characteristics of the patients.
Results Among the 60 patients interviewed, only 53 patients’ data were analyzed. Seven patients were excluded from analysis because they had no symptoms, were non-Japanese, had extrapulmonary tuberculosis, or were undergoing retreatment. The mean age of the patients was 60.2±19.2 (mean±SD) years. Twenty-two patients (41.5%) visited a hospital after a gap of more than two months from the time of onset of their symptoms (hereafter referred to as “patient delay”). Factors associated with patient delay were presence of sputum and hemoptysis, positive sputum smear, low priority given to health, lack of a family physician, lack of consultation, taking over-the-counter drugs, and disliking hospital visits.
Conclusion Factors associated with patients’ seeking medical treatment more than two months after developing symptoms of TB included taking over-the-counter drugs disliking hospital visits and not consulting health professionals or the people around them. In order to prevent patient delay, our findings suggest the following actions. Health care professionals need to provide information about symptoms of tuberculosis and the merits of early hospital visits to patients. It is also necessary for health care professionals in public health centers, etc., to communicate the need to have people available whom patients can consult regarding their symptoms and receive appropriate advices or secure appropriate treatment when they have symptoms of tuberculosis.

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Objectives The purpose of this study was to describe the content of interventions provided by mental health professionals working for local government in Japan to families of people with schizophrenia in need of treatment.
Methods The study was designed to be qualitative and descriptive. The subjects were ten local prefectural or municipal government professionals in the Kanto region who worked as psychiatric social workers or public health nurses and who had five or more years of experience in their professions. In semi-structured interviews, subjects were asked to choose one case from their experience of assisting both persons with schizophrenia and their families who contacted them for consultation, in which they believed that they were able to successfully assist the family in bringing the untreated person with schizophrenia or person who had discontinued treatment to hospital. Interview questions focused on the professionals’ assistance to the families. The interview data were transcribed, coded by type of assistance rendered, and categorized by commonalities for comparison.
Results Six major categories and nineteen subcategories were extracted through the data analysis process, which focused on support for the families of people with schizophrenia that helped the latter engage in treatment. The six major categories were “Make a tentative intervention plan,” “Establish relationship with family,” “Wait for the family members to make their decision to hospitalize the person,” “Stand by the family members and support their decision to persuade the person to receive treatment” “Make pre-hospitalization arrangements” and “Provide continual support for families and the patient after hospitalization.”
Conclusion The most important forms of support for families were assistance in persuading the person with schizophrenia to receive treatment and in making their own decision to bring the person to inpatient treatment. This support can lead to better patient-family relationships in the future and to better prognoses. The results of this study will contribute to improving the quality of professional support for families who are trying to make decisions regarding treatment of their relatives with schizophrenia.

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Objectives To examine the applicability of data on polio virus detection in stool by the Pathogen Surveillance System of Japan (PSSJ) for the evaluation of polio virus retention status in a regional community after oral polio vaccination (OPV).
Methods 1. Data for the city of Kobe (part of the PSSJ data): Cases of polio virus detection in stool reported to Kobe City Public Health Center from January 1, 2000 to June 30, 2010 were examined regarding time duration from vaccination to detection as well as age and gender.
  2. PSSJ data: Cases of polio virus detection in stool reported to PSSJ from January 1, 2000 to December 31, 2010 were examined regarding the serological types of the virus as well as age and gender. A logistic regression analysis was used to derive odds ratios for the relationship between age and serological type of polio virus in stool.
Results Thirty-one cases (33 stool samples) were identified in the Kobe city data. Of these, 96.8% were in children two years old or younger and 54.8% were girls. The time duration between vaccination and detection of all the cases was within two months from vaccination. From the PSSJ data, 852 cases were identified. Of these, 97.3% were two years old or younger and 54.6% were girls. The proportion of serological types was different by age group: for those under one year old, the type 1 virus accounted for 33.2%; type 2, 44.8%; and type 3, 22.0%. In the one year old or older age group, these types accounted for 22.8%, 27.6% and 49.6%, respectively. Notably, the type 3 virus was detected more for the older age group. (odds ratio 3.4, 95% confidence interval 2.5–4.6).
Conclusion The duration before detection and the serological types of polio virus in stool from the PSSJ and Kobe City data are consistent with the results of the prior studies that have evaluated the shedding of polio virus in stool after the administration of OPV. Since the PSSJ data are collected from a relatively wide range of samples, we conclude that the PSSJ data accurately represent polio virus retention status in a regional community after OPV. The current situation of polio virus shedding in stool cannot be ignored, and further consideration needs to be given to improving the accuracy of the PSSJ data, because Japan is to switch over to inactive polio vaccines in the near future.

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Objectives We aimed to clarify the relationships of the different stages of behavior change in dietary habits followed by the mothers of school-age children with the actual breakfast intake of these children and the health-associated behavior of the family.
Methods We carried out a questionnaire-based survey of 1949 children at 18 elementary schools and of 881 families with children attending seven elementary schools in Kagoshima prefecture. We were supplied with information about children's breakfast intake and content on the day they took the survey and information about mothers’ breakfast intake and the stage of behavior change in dietary habits to which they belonged, for which five stages were defined using the stage-of-change model.
Results The collection rates were 83.3% and 83.1% among children and mothers respectively. Of the children, 83.1% ate breakfast every day, while 15.1% were not in the habit of having breakfast. Furthermore, 98.6% children had eaten breakfast on the day of the survey, but 15.1% had eaten only staple foods such as rice or bread; only 34.0% children combined staple foods, a main dish, and vegetables/fruits in their breakfast. Regarding dietary stage, 28.1% of the mothers belonged to the “maintenance” stage; 24.0%, the “action” stage; 6.9%, the “preparation” stage; 9.8%, the “contemplation” stage; and 5.7%, the “precontemplation” stage. Mothers belonging to the first two stages constituted the “action group,” because they were already taking care of their dietary habits, and mothers belonging to the latter three stages constituted the “no-action group,” because they were not taking care of their dietary habits. The mothers who could provide no answers to the question constituted the “no-answer group” (25.5%). A comparison of the three groups revealed that mothers belonging to the no-answer group had more children who went without breakfast than the action group (P=0.000). The children of mothers belonging to the no-action group (P=0.003) and the no-answer group (P=0.036) were not in general eating vegetables/fruits in their breakfast, in contrast with the action group. Furthermore, in the case of families with mothers belonging to the no-action and no-answer groups, the families did not often talk about diet, and the incidence of smokers among the fathers was high.
Conclusion In this study, the breakfast habits of children and the health behavior of families differed by stage of dietary behavior change to which the mother belonged.

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