世古 留美

OBJECTIVES: To compare the characteristic competencies of public health nurses working for the older adult's health and welfare in public administration ("PA") with those at community general support centers ("CGSC") in Japan. METHODS: We conducted a questionnaire survey by mail for PA and CGSC public health nurses. A competency list that was developed to compare three groups (PA, CGSC experts with ≥5 years of experience, and CGSC newcomers with ≤2 years of experience) was used. The following characteristics were examined: (1) competencies acquired early after arriving at the CGSC, (2) competencies acquired through a certain amount of CGSC experience, (3) common competencies, (4) competencies that even experts lacked, and (5) competencies that the newcomers lacked. RESULTS: We examined the responses of 171 PA nurses, 185 CGSC expert public health nurses, and 165 CGSC newcomer public health nurses. The results of comparison of the three groups showed that (1) had no applicable items; (2) had nine items for individual support associated with preventive care management; (3) had 14 items including teamwork among three professionals (social workers, senior care manager, public health nurse)/other professionals and self-improvement; (4) had three items for community development, (5) had two items for individual support and 16 items for community development. CONCLUSION: Initiatives for preventive care and coordination of care teams should be supported and suggested as characteristic competencies for CGSC public health nurses.

OBJECTIVES: Employment support for working age people with disease is important. We investigated the intention to work among outpatients with malignant neoplasms, ischemic heart disease, and cerebrovascular disease. METHODS: We used anonymous data from the 2007, 2010, and 2013 Comprehensive Survey of Living Conditions in Japan, a self-administered nationwide questionnaire survey. Data for 154,445 participants (76,059 men and 78,386 women) aged 20-64 years were analyzed using logistic regression models adjusted for covariates. RESULTS: The number of outpatients with malignant neoplasms, ischemic heart disease, and cerebrovascular disease was 851, 1,037, and 716, respectively. The adjusted odds ratio for not working in people with the intention to work was significantly higher among outpatients with the three diseases than among non-outpatients, for both men and women. The adjusted odds ratio for intention to seek permanent work in unemployed people with the intention to work was lower among outpatients with cerebrovascular disease than among non-outpatients for men (p=0.093), and was significantly higher among outpatients with malignant neoplasms than among non-outpatients for women (p=0.007). CONCLUSIONS: This study identified a high proportion of unemployed people with the intention to work among outpatients with these three diseases, and suggests that there are disease-associated differences in employment type sought.

<p> Taking action in response to health examination results is important to stay healthy. We aimed to investigate the associations between occupation, employment type and company size, and having a health examination and taking action in response to the results among Japanese employees. We focused on three particular actions by employees in response to health examination results: paying attention to one's health, receiving health guidance, and visiting a medical institution. We used anonymous data from the 2010 Comprehensive Survey of Living Conditions of Japan, a self-administered nationwide questionnaire survey. The data of 23,963 employees (12,938 male and 11,025 female) aged 20–64 yr were analyzed using logistic regression models adjusted by covariates. There were significant changes in odds ratios for receiving a health examination by occupation, employment type and company size. We found significant odds ratios for receiving health guidance by occupation and company size, but there was almost no significant association with paying attention to one's health and visiting a medical institution. These results confirmed that receiving a health examination was associated with occupational factors, and suggested that receiving health guidance after health examination results was associated with occupation and company size.</p>

<p>Objectives: The aim of this study was to investigate changes in health university students' attitudes toward community service before and after a community-oriented education program using team-based learning (TBL). </p><p>Methods: A community-oriented educational program using TBL was carried out with a total of 529 3rd- and 4th-year students in seven faculties of two departments at Fujita Health University, and a questionnaire survey was conducted before and after the program. There were eight questions on students' attitude toward community service.</p><p>Results: Responses with no missing information from 431 students were used in the analysis. There were significant increases in the number of positive responses to three questions after TBL. The item "I think there are things that university students can do as members of the community" increased from 81.9% before TBL to 86.5% after, "I can form specific images of activities that benefit the community" increased from 46.0% before to 70.3% after, and "In the future I want to participate in activities that benefit the community" increased from 74.7% before to 80.3% after.</p><p>Conclusion: The results suggest that this community-oriented educational program using TBL raised the motivation of university students in medical and health science programs to practice community health care.</p>

Objectives: We examined whether selected factors were associated with activity limitation used to calculate the healthy life expectancy in accordance with the target of Health Japan 21 (the second term). <br>Methods: Data for 6251 subjects were obtained from the Comprehensive Survey of Living Conditions and the National Health and Nutrition Survey, both of which were conducted by the Ministry of Health, Labour and Welfare of Japan in 2010. The age-adjusted odds ratios (AOR) of limitation of activity for the assessed factors were estimated using a logistic model.<br>Results:, The percentage of persons with activity limitation was 12.1% of men and 15.6% of women. For men, low body mass index (BMI) (AOR: 2.02, p=0.008), high blood pressure (AOR: 1.53, p=0.021), high hemoglobin A1c (HbA1c) (AOR: 1.99, p=0.000), a small number of steps (AOR: 1.68, p=0.002), and high intake of salt (AOR: 0.69, p=0.010) were significantly associated with limitation of activity. For women, high BMI (AOR: 1.49, p=0.003), a small number of steps (AOR: 1.48, p=0.009), and high intake of salt (AOR: 0.77, p=0.017) were significantly associated with activity limitation. <br>Conclusion: We identified several factors that were associated with activity limitation. Our results from cross-sectional data require careful interpretation before concluding whether these relationships are causal

目的&emsp;健康日本21（第二次）の目標（平均寿命の増加分を上回る健康寿命の増加）を考慮して，健康寿命の将来予測を行った。<br/>方法&emsp;基礎資料として，国民生活基礎調査，介護給付費実態調査と簡易生命表を用いた。2011～2020年の将来の死亡率が「日本の将来推計人口（平成24年 1 月推計）」のそれと同じと仮定し，将来の不健康割合に 3 つのシナリオを設定した。この仮定とシナリオの下で，将来の健康寿命をサリバン法で算定した。<br/>結果&emsp;「日常生活に制限のない期間の平均」では，2010年観察値（男70.4年と女73.6年）に対する2020年予測値は将来の不健康割合が2010年現在と同じというシナリオで男71.2年と女74.3年，最近の推移を継続するというシナリオで男71.4年と女74.5年，一定率で低下して将来の不健康寿命の延伸がないというシナリオで男71.7年と女74.9年であった。最後のシナリオにおける不健康割合の2010～2020年の低下率は男0.95と女0.96と推定された。「自分が健康であると自覚している期間の平均」は2010年観察値（男69.9年と女73.3年）に対する2020年予測値が 3 つのシナリオで男69.5～71.2年と女72.9～74.6年であった。最後のシナリオにおける不健康割合の低下率は男0.96と女0.97と推定された。65歳の「日常生活動作が自立している期間の平均」は2010年観察値（男17.2年と女20.5年）に対する2020年予測値が男18.0～18.2年と女21.2～21.5年であった。最後のシナリオにおける不健康割合の低下率は男0.90と女0.91と推定された。<br/>結論&emsp;将来の不健康割合にシナリオを設定して，2011～2020年の健康寿命を予測した。健康日本21（第二次）の目標が達成されるための将来の不健康割合の低下率を見積もった。

本研究は脂肪肝(FL)発症の危険因子をロジスティック回帰分析より求め，FL発症確率を検討すると共に，減量によるFL消失確率を明らかにすることを目的とした．対象は611名，平均年齢50.6&plusmn;9歳．FLの危険因子の中からBMI, HDLコレステロール(HDL), 中性脂肪(TG), HbA₁c (A₁c), 尿酸(UA)を用いFL発症確率を検討すると，非FL群の危険因子平均値ではFL発症確率は男性15%, 女性1%と推定された．A₁c 6.5%まで上昇するとFL発症確率は男性75.5%, 女性22%, TG 200 mg/dlではFL発症確率は男性で，ほぼ100%, 女性は85%であった．また，多重リスク症候群を疑わせる状態からの減量効果ではBMI 26 kg/m², A₁c 5.8%, UA 7.0 mg/dl, TG 150 mg/dl, HDL 39 mg/dlでのFL発症確率は男性88%, 女性46%がBMI 1 kg/m²の減量でFL発症確率男性59%, 女性9.3%, BMI 2 kg/m²の減量で男性20%, 女性7.6%に激減するものと予測された．このことから男性は体重の約10%, 女性は約5%の減量で十分効果が認められると推定された．