Objective Stool reflect our dietary and nutritional status as well as the characteristics of gut microbiota; thus, stool can be a convenient, noninvasive index for the evaluation of physical health and nutritional intake. However, there are few studies on appropriate tools for comprehensive and easy-to-perform objective assessments of stool. Therefore, there is a need for an effective questionnaire to accurately ascertain daily bowel movement patterns (“usual evacuation”) and stool characteristics. Herein, we have created an assessment tool to determine stool characteristics (volume, color, form, etc.). To investigate the validity of this tool, we compared the results with evacuation diary data wherein the participants were asked to record the number of evacuations and stool characteristics.
Methods This study included 35 adult men and women, aged 22-78 years (45.2±17.1years). A questionnaire was administered to the subjects on usual stool characteristics for the most recent month, including the average number of evacuations, stool volume per evacuation, stool color and form, stool float, and abdominal bloating. To confirm the reproducibility of each item of this questionnaire, the survey was performed twice. Thereafter, an evacuation diary was used, wherein the subjects recorded the daily number of evacuations and stool characteristics for one week. Using the evacuation diary as the valid criterion for the number of evacuations and stool characteristics, we compared responses between the diary and the usual stool questionnaire. Additionally, the questionnaire had two types of responses for the number of evacuations, namely, multiple choice for categories indicating the number of evacuations and open answers using numerical values.
Results Assessment of the reproducibility of the questionnaire on usual stool by Spearman rank correlation coefficients showed a significant correlation (ρ=0.431-0.911) for all items. The weighted κ coefficient also showed high coincidence (weighted κ=0.348-0.841). Validity was assessed by comparing the number of evacuations per one-week period between the evacuation diary and the usual stool questionnaire. A higher correlation (ρ=0.855) was observed in the open responses for the number of evacuations per one-week period. Assessment of the correlations between median values for responses to stool characteristics in the one-week evacuation diary and the usual stool questionnaire showed significant correlation (ρ=0.429-0.800) for all items except for “stool float”.
Conclusion We confirmed the high reproducibility and validity of the questionnaire created in this study for the assessment of usual bowel movement patterns and stool characteristics.
Objective Obesity associated with an increased consumption of ultra-processed foods (UPF) has been reported by studies abroad using the NOVA food classification system, an international framework for classifying food according to the degree of processing. However, no such study has been conducted in Japan. In this study, we evaluated the association between UPF consumption, nutrient intake, and obesity using the NOVA system.
Method In September 2017, we conducted a survey using a questionnaire of patients who had attended routine health checkups in Manazuru Town, Kanagawa Prefecture and collected their three-day dietary records as well as medical examination results. The final analysis included 169 patients (66 men, 103 women). Food consumed by the respondents were classified into four groups of NOVA systems. The dietary share of UPF (UPF energy ratio) was compared to total energy intake (except alcoholic beverages and eating out). Nutrient intake and obesity risk were compared across the UPF energy ratio tertile (low, middle, and high intake). Covariance and logistic regression analysis were conducted and adjusted based on age, sex, household structure, education, income, and total energy intake (except energy-providing nutrients, macronutrients, and protein intake per body weight) to analyze the association between UPF consumption and nutrient intake. Finally, for obesity, we adjusted for physical activity and smoking status using a similar analysis of the relationship between UPF consumption and energy providing nutrients and macronutrients.
Result Approximately 75% of patients investigated were older than 65 years. The average (standard deviation) UPF energy ratio was 29.7% (15.0). There were no significant differences in socioeconomic status among groups according to the UPF energy ratio. The high-UPF group had a significantly greater total energy intake. However, the protein energy ratio, protein intake per body weight, dietary fiber, and vitamins A, E, K, B1, B6, C, niacin, folic acid, potassium, magnesium, and iron intake were significantly lower in the high-UPF group. Moreover, the high-UPF group had a significantly higher BMI. The odds ratio for obesity was higher (4.51[1.50-13.57]) in the high-UPF group than in the low-UPF group (1.00).
Conclusion Those who consumed more UPF had lower protein intake and suffered from multiple vitamin and mineral deficiencies. Furthermore, their energy intake was greater, and the odds ratio for obesity was significantly higher. It has been suggested that excessive UPF consumption warrants further attention.
Objective To explore the factors associated with mental health service utilization by individuals with mental distress in the general population.
Methods Using the anonymous data of 97,345 individuals from the 2013 Comprehensive Survey of Living Conditions (Health and Household Cards), we considered from the working age population 17,077 (7,735 male, 9,342 female) between the ages of 15 and 65 years and having a score of 5 or more on the Kessler Psychological Distress Scale (K6)—an indicator of mental distress. We selected variables potentially associated with psychiatric visits (exposure factors), such as the K6 total score (5-24 points), age, sex, drinking and smoking status, number of households, average household spending per month, education and working status, and hospital visits for other diseases. We performed multivariate logistic regression analysis to estimate the adjusted odds ratio and 95% confidence interval of each exposure for consultation for “depression and other mental illnesses” at a medical institution.
Results Among the 17,077 participants, 914 (5.4%) reported that they were currently consulting a medical institution for mental health disorders. The higher the individuals’ K6 total score, the higher was their likelihood of consulting a doctor for mental health disorders. Among those who reported consulting a doctor for mental illnesses, 58.3% were female, which was significantly higher than the female proportion in those who reported not consulting a doctor. The results of multivariate analysis showed drinking alcohol, living with a family of three or more people, and work, to be factors preventing mental illness service utilization, while being enrolled in high school or higher education, smoking, and consultations for other diseases were shown to be associated with a tendency to promote mental health care utilization.
Conclusions Using anonymous data from the 2013 Comprehensive Survey of Living Conditions, this study examined several background factors associated with mental health service utilization among a group with suspected mood and anxiety disorders. There is a necessity to create a social system that would allow the working population to consult a doctor for mental health disorders when needed, as well as receive information about mental illnesses.
Objectives The purpose of this study was to understand the experience of grown-up children with parents suffering from mental illness during their elementary, junior high, and high school years, and the consultation situations at their schools.
Methods A web-based questionnaire survey was conducted on 240 grown-up children who had participated in groups for children with parents suffering from mental illness. The analysis was a simple tabulation and compared the consultation history inside and outside the school environment, according to the respondent's age. Free-response descriptions were categorized according to the content.
Results A total of 120 respondents answered, ranging in age from 20 to over 50 years, with the majority being women (85.8%). Their mothers were the most likely parent to suffer from a mental illness (67.5%), and their estimated age at illness onset was before entering elementary school (73.1%).
During their elementary, junior high, and high school years, 57.8-61.5% of the respondents provided emotional care, and 29.7-32.1% did household chores. When they were in elementary school, most recognized adult fights (62.4%) and experienced attacks by parents (51.4%). Signs that others could have noticed included the fact that parents did not visit the school or talk to teachers, being bullied, forgetfulness, absenteeism, arriving late for school, and academic deterioration. Nearly half of the respondents (43.2-55.0%) hid their challenges during their elementary, junior high, and high school years. They were aware of teachers’ prejudice towards mental illness, discriminatory behavior, and lack of consideration for privacy. At the same time, many respondents wanted teachers to be concerned about their circumstances and listen to their stories.
More than half of the respondents (62.7-80.7%) did not approach school staff, who did not notice their problems. When they were high school students, they had an inadequate consultation environment or were unprepared to consult. The easiest person to approach was the teacher in charge.
Conclusion Children with parents suffering from a mental illness were those most in need of support, while being the least connected to sources of support. Schools need to support children to become aware of their problems at home, and teachers need to pay more attention to their students, and listen to them carefully, including to what they may not say.