Background : In recent years, completely smoke free workplaces have become popular because creation of smoke free environment is one of the most effective strategies for reducing health risk and productivity loss. However it is difficult to reach a consensus for completely smoke free workplace, as there are a lot of workers to disagree on it. Objective: We investigated the predictors of the worker's attitude on completely smoke free workplace. Method: Workers from company of energy in Japan were enrolled between October and November 2010. The total number of subjects who participated in this survey was 1964 (recovery rate 100%). Each subject was asked to fill out a self-administered questionnaire and 1926 subjects were analyzed. The questionnaire was constructed as follows, 1) personal date 2) smoking state (current smoker, ex-smoker, non-smoker) 3) the feeling of environmental tabacco smoke (ETS), the awareness of ETS, the awareness of productivity loss by smoking, the attitude whether they agree or disagree to completely smoke free workplace. Current smokers were further stratified as light (below 10 cigarettes per day), moderate (11-20 cigarettes per day), heavy (above 21 cigarettes per day). Those who used to smoke in the past were considered as ex-smokers. We conducted our date by univariate and multivariate logistic analysis. Result: Workers who disagree to completely smoke free workplace are youngers, smokers who smoke numbers of cigarettes. The more the number of cigarettes smoked, smokers are opposed to completely smoke free workplace. Especially it was remarkable in the heavy smokers. In addition, those who disagree to complete smoke free workplace are follows. The workers who don't feel uncomfortable by environmental tabacco smoke (ETS), the workers who aren't aware of ETS and the productivity loss by smoking. Conclusion: Whether people agree or disagree to the completely smoke free workplace or not is related to the factor that smoking state (heavy smoker or not), age (younger), the awareness on ETS or productivity loss by smoking. The education for youngers about health risk and productivity loss by smoking is useful for achieving completely smoke free workplace.

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With the increasing health consciousness in consumers, nutrients in honey such as glucose, added sugars, oligosaccharides, vitamins, minerals, and amino acids are gaining attention and its demand as a health food is increasing. In addition, it has also been used in treatment of wounds at several medical institutions. Honey is a transparent liquid when harvested, but often crystallizes, presumably due to super saturation of glucose or fructose. These sugars are thought to solidify through the growth of fine saccharides with the pollen in the honey as the crystal nuclei. No definitive reports have been published on this subject to date. In this study, we compared shifts in trace element components of liquid and crystal of honey after crystallization by measuring pollen and trace element contents in each portion as well as trace element contents in purified honey. These experiments showed that differences in pollen counts in liquid and crystal depend on the type of honey, although, in agreement with the accepted opinion that crystal contained larger quantities of pollen. Furthermore, differences in trace element contents were observed between liquid and crystal of honey, although liquid portions contained larger quantities of trace elements. Likewise, liquid portions in purified honey contained larger quantities of trace elements, which were concentrated in the liquid portion following crystallization. These data indicate that trace elements in honey not only originate from pollen, but also from the nectar.

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Aim: To promote comprehensive community care for elderly people with mental and cognitive impairments, the author provided certified caregivers with a care training program to reduce care difficulties and assess the effects and issues. Methods: The program consisted of a lecture about the features of mental and cognitive functions among elderly people and case studies for dealing with elderly people with mental and cognitive impairments. The author conducted self-rating questionnaires of about 24 items regarding care difficulties before and after the programs. The author used Friedman's test and Bonferroni multiple comparison of analyses for levels of difficulty, and the significance level was p<0.05. regarding care difficulties. Results: The scores of care difficulties before the training, the average scores were over 3.0 for 7 items and 2.5 for the other items experienced. After the training, the average scores of all of the items experienced were less than 2.0. The levels for the items "understanding mental symptoms and anxiety", "communication techniques" and "deal with refusals" decreased significantly. However, the levels of 4 items "deviating behaviors", "suicidal ideation", "phone calls many times" and "no sense of the value of money" did not decrease. The levels of the item "life disabilities" decreased and participants understood the need for the communication in offices and multidisciplinary collaboration from the case studies. Conclusion: These programs were effective for certified caregivers to understand mental symptoms and anxiety, to improve communication techniques and dealing with refusals. It is necessary to examine the effects of continuing the training program and the implementation system for the training.

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In Japan, the rate of women receiving cervical cancer screenings is low. The reason for this is women's lack of knowledge regarding cervical cancer. It has been suggested that there is a need for an outreach program to provide women with accurate information concerning cervical cancer and to promote screenings. The purpose of this research was to exam the effects of an intervention program aimed at raising adult women's understanding of cervical cancer and to change behavior in regards to cervical cancer screenings. 48 women participated in the study: 19 intervention subjects who participated in the intervention program which consisted of cervical cancer seminars using the peer-learning method, and, 29 control subjects who received a pamphlet with information on cervical cancer. To evaluate the intervention group a preliminary survey was compared against a follow-up survey six months after the intervention. The surveys contained a score of the Self-Efficacy Scale for Cervical Cancer, the Health Belief Model Scale for Cervical Cancer, as well as, cervical cancer screenings and attitudes towards screenings. Results showed the Self-Efficacy Scale score for the intervention group to rise from 56.7±17.7 (preliminary survey) to 69.7±21.7 (post-survey) a significantly higher increase (P=0.001). There were negligible changes in the Health Belief Model Scale for Cervical Cancer and in behavior towards cervical cancer screenings. It is suggested that the intervention program, which adopted a peer-learning model approach to cervical cancer screening outreach, improved self-efficacy of cervical cancer screenings. It is recommended that future outreach programs adopt a peer-learning model approach when educating women about cervical cancer and the benefits of screenings.

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We investigated the influence of continuous dietary guidance on clinical indices in dialysis outpatients at a facility performing continuous dietary guidance (our facility) and a facility non-continuously performing such guidance (other facility), and analyzed how to construct an optimal nutritional assessment system for continuous dietary guidance and nutritional management. The 15-year survival rate was compared between patients of our (our facility group) and the other (other facility group) facility. The cumulative survival rate decreased after about 5 years in the other facility group, whereas it decreased after 10 years in our facility group, clarifying that the survival rate after the introduction of dialysis was higher in our than in the other facility, and the factor influencing the outcome of dialysis was the rate of weight gain between dialysis treatments. Blood urea nitrogen significantly decreased after intervention in both our and the other facility group (p<0.05), suggesting a decrease in food intake. The rate of weight gain between dialysis treatments significantly increased only in the other facility group (p<0.05), suggesting the aggravation of water control. We also investigated factors influencing the outcome of dialysis with regard to clinical indices related to dietary guidance and nutritional management using COX regression analysis. The survival time prolonged as the duration of dialysis treatment shortened, and it was longer in our facility group. Serum albumin decreased to a level lower than the target in both groups. The rate of weight gain between dialysis treatments was within the target range, but it tended to be high in the other facility group. Based on these findings, to perform nutritional management of elderly long-term dialysis patients, it is important to enrich patient education and guidance at the time of introducing dialysis, periodically observe the serum albumin level and weight gain rate, and perform nutritional management corresponding to the conditions of patients undergoing dialysis.

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In order to evaluate role of public health centers following the implementation of the Services and Supports for Persons with Disabilities Act, a survey was carried out among 518 public health centers within Japan, with replies received from 238 centers (a response rate of 45.9%). Ongoing services provided by public health centers following the implementation of the Act included "consultations", "coordination with mental health and welfare groups" and "review meetings of difficult cases". Issues the centers are consulted on included "resolving difficult cases" as well as "dealing with hospitalization". Regarding regional conferences to support independence, 60% of replies indicated that they were either "being held" or "will be in the near future". The most prominent examples of difficult and problematic cases encountered by the health centers were those involving schizophrenics in the prime of life, with numerous consultations. It is imperative that consultation support be enhanced, as it coordinates services and improves and develops public resources. The results of the present study revealed that regional conferences to support independence play a central role in this, and therefore also need to be improved further.

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In order to shift from medical care centered on hospitalization to care centered on living within the community, public health centers have issues they need to consider based on their current approach, and also to investigate their future role. A survey was carried out among 518 public health centers throughout Japan, with replies received from 238 centers (a response rate of 45.9%). As an approach to shifting toward allowing the mentally disabled to live within the community, public health centers have so far continually coordinated with related organizations. However, only about 30% of cases actually resulted in approaching patients in long-term hospitalization and attempting to encourage hospital discharge. Fully grasping the situation of the local regions is predicted to be complex for public health centers, but by utilizing experience gleaned from past activities, they need to expand their activities in joint efforts with local municipalities. Moreover, in order to support living within the community, it was noted that public health centers would need to educate local residents, maintain housing and offer support both consultations and providing work. It is evident that further investigation is necessary to determine what role the public health centers will play in fulfilling these issues.

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The purpose of the study was to examine the lives of mothers and children and status of health activities, as viewed by physicians and public health nurses in areas with limited medical resources, to identify their health problems. Interprofessional groups consisting of one doctor and six public health nurses conducted focus-group interviews twice, in which mothers and children expressed their opinions on their living environments and the status of health care services. Verbatim records were created based on the obtained data, and they were categorized using a content analysis method: [feelings and behaviors of mothers as viewed by health professionals], [status of parenting environments in the community], [being influenced by regional characteristics], [being influenced by physical environments], [being influenced by a lack of social resources], and [views based on experience of maternal and child health activities]. Health professionals considered that they are required to gain the trust of children and their mothers to allow them to continuously utilize limited medical resources, and that people raising children live in varying forms of family environment and often rely on their parents living together with them. Health professionals also recognized that families who raise children with health problems are also in need of financial support for expenses other than medical fees because they need to attend preschools or receive treatment at hospitals far from their homes.

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