Hideyasu Aoyama

The effects of frequently rotating shiftwork on sleep and the family life of hospital nurses.

The effects of three frequently rotating shifts in an irregular sequence on the daily activities of 239 Japanese female hospital nurses were studied by the time-budget method. The nurses recorded their daily activities for several consecutive days. The questionnaire was returned by 80.8% of the participants, and recordings of 1016 days were analysed. A two-way analysis of variance clarified that the shift combination influenced the daily activities. The most distinct result was that nurses spent significantly more time on free-time activities on the day when they worked the night shift followed by the evening shift than they did on the day when they worked any other shift combination. Nurses offset sleep deprivation either by sleeping during the day before and after working the night shift (82-100%) or by sleeping 2 to 4 h later in the morning after working the evening shift and on days off. There was a strong positive correlation between total sleep time (including day sleep) and the length of the interval between two consecutive shifts (r = 0.95, p < 0.001). This result suggests that more than 16 h between work shifts is required to allow more than 7 h of total sleep time. In an analysis by household status, nurses who had young children (average age, 2.8 years) slept less and spent less time on free-time activities than did other nurses.

Primary health care in Japan and the United States.

Japan has universal health insurance and its total health expenditure as a percentage of the gross domestic product is almost 50% less than that of the United States where 15% of persons under age 65 are uninsured. The health of the Japanese population as judged by neonatal, postnatal, and total infant mortality, percent of infants born with birth weights below 2500 g, and life expectancy at birth and ages 20 and 65 is superior to the health of Americans. Primary care, however, as an academic discipline and primary care training programs are absent in Japan. Physician training, incongruent with need, combined with government controlled low professional medical fees contribute to an extraordinarily high annual ambulatory patient contact rate (14 compared with 2.8 for Americans) and excessive use of diagnostic testing. Although primary care training is better developed in the U.S.A., interest in receiving, such training among medical school graduates is declining. Several factors that contribute to quality of care are examined. Comparisons between countries, however, must be viewed with caution because of the multitude of demographic, genetic, historical, economic and cultural variables that influence how health care is delivered and received. Both countries face major challenges. The projected rapid increase in the relative ratio of the elderly to total population in Japan will severely strain its ability to contain health care costs. Interest in primary care training in Japan dates back to 1978 but its implementation has been largely unsuccessful. The challenges in the U.S.A. are far more formidable.(ABSTRACT TRUNCATED AT 250 WORDS)

Training in evaluation of expressed emotion using the Japanese version of the Camberwell Family Interview

To evaluate the effect of training in rating expressed emotion (EE) using the Japanese version of the Camberwell Family Interview (CFI), interrater reliability between a certified rater and a trainee was examined. The material was 65 CFI interviews with the families of 46 schizophrenic patients. The two raters independently rated EE status, critical comments (CC), hostility (H), emotional overinvolvement (EOI), warmth (W) and positive remarks (PR). The interrater reliability was satisfactory with regard to EE status, CC, H, EOI and PR. In the category of W, however, the results were unsatisfactory, as there was no positive development of agreement over time. In fathers, the interrater reliability of W was lower than in other relationships. Use of interview transcripts could contribute to a more satisfactory interrater agreement in EOI, and this is recommended as a useful training tool in EE evaluation.

Development of eating behavior and its relation to physical growth in normal weight preschool children

In order to examine whether some characteristics of eating behavior are related to physical growth and weight increment in young children, a longitudinal prospective study was conducted. The eating behaviors of 11 age-matched normal-weight preschool children were observed at lunchtime on 18 consecutive days. The same set of observations was carried out three times when the children were 40, 52 and 59 months old, on average. MANOVA procedures for repeated measures design revealed that the eating behavior of the subjects changed considerably between the first and second observation stages, whereas it did not change significantly between the second and third stages. It was considered that eating behaviour developed mostly between the first and second observation stages and that the subjects were able to eat completely independently by the second observation stage. The increment in the childrens weight per month began to show individual variation at the age of 48 months between the first and second observation stages. Coincidentally, the relationship between eating behavior and physique first appeared at the second observation stage and a similar relationship was observed at the third stage. The partial correlation coefficients and the multivariate multiple regression of MANOVA were performed for this analysis. Meal duration was the factor most strongly related to weight and BMI, whereas in contrast, growth history and familial factors influenced the eating behavior at the first observation stage. The present results indicate that eating behavior was one of the factors related to the rapid increase in weight soon after or just at the time of initiation of complete self-feeding in normal-weight children.

Effects of changes in obesity and exercise on the development of diabetes and return to normal fasting plasma glucose levels at one-year follow-up in middle-aged subjects with impaired fasting glucose.

ObjectivesBorderline diabetes, a precursory condition of diabetes, is an important issue in the prevention of diabetes. The aim of the present study was to clarify the effects of one-year changes in obesity and exercise on the development of diabetes or return to normal fasting plasma glucose (FPG) levels among middle-aged people with impaired fasting glucose (IFG) at baseline.MethodsAmong those who attended a basic health examination in 1997, we selected 1,620 subjects who showed impaired fasting glucose (FPG of 110 mg/dl or higher) and had complete data on height, weight and exercise. At the one-year follow-up (in 1998), 1,099 of those subjects attended a health examination; FPG, height, weight and exercise were evaluated for 731 subjects. Subjects were classified into the following three groups, on the basis of changes in FPG during the year between the two examinations: developing diabetes (DM), remaining IFG, and returning to normal (WNL).ResultsAmong those who were initially obese, there was a significant difference in the proportions of DM, IFG and WNL between those with and without improvement in obesity in the year preceding the follow-up (p<0.05). Those with improvement in obesity showed a significantly higher tendency to return to WNL than those without improvement in obesity. Multiple logistic regression analysis showed that those with improvement in obesity had a significantly higher odds ratio (2.17) to return to WNL (p=0.015). Among those who were initially not obese, there was no significant association between changes in obesity and developing DM or returning to WNL. No significant association was observed between changes in exercise and developing DM or returning to WNL.ConclusionThe present findings suggest that, among obese IFG subjects, improvement in obesity is associated with returning to normal plasma glucose. Weight control may be important for the normalization of borderline diabetes.

Relation between the IADL and Physical Fitness Tests Focusing on Uncertainty of Answering Questionnaire in Elderly Women

This paper examines the uncertainty of answering questionnaire in elderly women. We derive a membership function demonstrating a robustness of the knee-raising test and height related to decreased instrumental activities of daily living (lADL) for the uncertainty of answering questiormaire. This result could be maintained if the number of movement were within range from -10 to +5 persons.

Rough Set Based Knowledge Discovery of Interface for the Internet Usage among Japanese Elderly Women

The world currently faces the new wave of industrial civilization, that is regarded as the changes caused by the Revolution of Information Technology (IT). This study is conducted to clarify how a mobile phone (MP) and the Internet through personal computer (IPC) have been actually used. We also examine what kind of interface (input device) is preferred by the elderly, by using a questionnaire regarding the IT equipment. This study adopts not only the ?2 test but also the rough set analysis. As a result of the rough set analysis and ?2 test, those who were interested in a MP preferred, Japanese kana syllabary (JKS) the most. The rough set analysis also discovered the facts that those interested in the keyboard had a preference for the IPC and also that those interested in the JKS and the speech preferred a MP. We can conclude that the complementary use of the rough set analysis and ?2 test bring more powerful knowledge discovery.

PRESENT STATUS OF THE DISTRIBUTION OF IONIZING RADIATIONS AND THE HEALTH OF PARTICIPATING WORKERS IN OUR INDUSTRIAL CIRCLE (REPORT 1)

Three hundred and seventy four industrial enterprises listed in the Department of Labor as handling ionizing radiations were investigated by means of questionnaires. Answers were received from 229 radiation handling works, involving 1, 742 workers. Number of sources were 824, among which x-ray equipments for nondestructive inspection was ranking at the top and radioactive substances, industrial gamma ray apparata, x-ray diffraction apparata, accelerators, nuclear reactors were following in the given order. According to industrial classification, the order was transportation machine makers (mainly shipbuilding), electric equipment makers, chemical industry, steel and nonsteel metal industry. Characterisitics could be admitted to their radiation sources by the sorts of enterprises. Exposure doses were investigated in those participating in one kind of radiation sources. Calculating for a year, the doses were:below (and including) 10 mrem 53.5%, under 500 mrem 33.9%, under 1000 mrem 8.3%, under 5000 mrem 3.9% and above 5000 mrem 0.4%. The measurement was taken by way of film badge method. It seldom exceeded the exposure doses given by the recommendation of ICRP. Pocket dosimeter showed almost the same, only having a tendency to show a slightly higher amount of dose compared with film badge method. Exposure dose took the order of industrial x-ray, industrial gamma ray, medical x-ray and medical gamma ray. In the scale of enterprises, there was a tendency that the exposure dose was larger in small industries.