Objective　Recently, in Japan, the compulsory vaccinations administered during early childhood have been becoming increasingly varied. As a result, the vaccination schedule has become complicated. In this study, we aimed to identify the association of time-appropriate vaccination during early childhood (dependent variable) with individual-level factors including socioeconomic status and having a family doctor. We also studied the association of time-appropriate vaccination with community-level factors including the number of pediatricians in a community.

Methods　Multilevel logistic regression models were used for analysis. Time-appropriate BCG, DPT, and measles vaccinations were the dependent variables. Individual-level data were obtained through a survey of parents of 18-month-old children as part of the final evaluation of “Healthy Parents and Children 21”; community-level data were obtained through a survey of municipalities as part of the aforementioned final evaluation as well as through a national survey. There were 23,583 parents in 430 municipalities who were eligible for analysis.

Results　Time-appropriate vaccination of infants was carried out by 88.3% of parents. The results of the multilevel logistic regression showed that time-appropriate vaccination was significantly lower for those who did not have a family doctor (adjusted odds ratio [AOR], 0.45; 95% confidence interval [CI], 0.36-0.55), the fourth or later birth order (0.23; 0.19-0.28), mothers aged less than 19 years at childbirth (0.17; 0.13-0.24), full-time working mothers (0.52; 0.47-0.58), and those under very difficult economic conditions (0.66; 0.57-0.77). Among community-level factors, only use of vaccination data by a municipality had a significantly negative association with the dependent variable.

Conclusion　Not having a family doctor, the mother's young age, late birth order, poor economic status, and full-time working mothers were risk factors associated with delayed vaccinations. It is necessary to improve environments that promote infants having a family doctor as well as to promote special approaches toward families at risk for delayed vaccinations.

Objectives　To examine how parents of children with mental illness prepare for their children's lives in the community after their own death.

Methods　Twenty-two parents living in the Kanto region, who have children with mental illness, were interviewed from December 2016 to February 2017. Through qualitative inductive analysis, codes were identified from the narrative data that showed the preparation of parents and compared their similarities and differences. Similar codes were collected and subcategories and categories were created with increasing abstraction levels. Each category was considered with respect to the purpose and the reason why each preparation was done.

Results　Participants were 9 fathers (40.9%) and 13 mothers (59.1%). Their ages were as follows: in their sixties (n=9; 40.9%), seventies (n=10; 45.5%), and eighties (n=3; 13.6%).

　Ten categories emerged regarding parental preparation for their children's life after their death: 1) Forecasting their own death and recognizing the limitations of support; 2) Trying to share with their children about their own death; 3) With consideration of after their own death, organizing the necessary information for their children and their own belongings; 4) Consulting with their relatives about the lives of their children and inheritance, and considering the use of the social resources; 5) Trying to secure a residence and living expenses for their children; 6) Connecting with social resources, searching for recovery methods for their children, and their own health maintenance; 7) Stabilizing and recovering disease conditions of their children, supporting to take medication and outpatient visits; 8) Assessing the ability of their children to live considering their independent life; 9) Developing their abilities to live and sociality, and making reliable supporters other than parents; 10) Encouraging to have fun in their children's lives and considering their employment. Parents were preparing to hope their child would cope with difficulties in their lives after their own death, and maintain a stable life in the community by him/herself.

Conclusions　The results suggested that parents should recognize the need of an independent life for their children in the community, to promote concrete preparations toward their children living in the community after their own death.

Objectives　In forthcoming preventive care, it is important to perceive that the health of the elderly is multifaceted. The purpose of the research is to analyze the difference in positive thinking between the elderly with long-term care risk and the healthy elderly, to clarify the relationship between long-term care risk and positive thinking.

Methods　A postal mail survey, based on a self-administered questionnaire, was conducted in City A. The subject were elderly people who were turning 75 years old in 2016, 593 people. There were 319 valid responses included in the analysis, of which 141 responses were from the previous survey (a factual survey performed in City A from August 2015 to January 2016) and 178 responses were from the late survey (in July 2016). The subjects included in the analysis were divided into the long-term care risk and the healthy group, and the component scores on positive thinking were compared to determine the relationship between positive thinking and long-term care risk. For the comparison of two groups, we used a t-test for normally distributed scales, the Mann-Whitney U test for deviated scales, and the χ² test for the comparison of dispersed variants. Discriminant analysis was performed to evaluate the degree of each component of positive thinking in long-term care risk. The significance levels of all tests were set at less than 5%.

Results　The components of positive thinking that demonstrated significant differences in the comparison between two groups were: Life Satisfaction Index K, PGC Morale Scale, Lubben Social Network Scale, social participation (Japan Science and Technology Agency Index of Competence to Assess Functional Capacity), self-negative beliefs (Japanese version of the Brief Core Schema Scale), and State Self-esteem Scale. Based on the discriminant analysis, variables mainly related to long-term care risk were self-negative beliefs, life satisfaction level, and self-preservation (Identity Scale). In addition, all components of positive thinking, excluding negative beliefs about others, were related to “depressive tendencies.”

Conclusion　Elderly people with long-term care risk tended to perceive themselves negatively; they lacked social relationships, and had low life satisfaction levels, morale, as well as self-esteem. It was suggested that “negative beliefs about the self” and “Life Satisfaction Index K” were important factors. It is necessary to reconsider the components of positive thinking and clarify its relationship with long-term care risk.