Rie Akamatsu

Internet Use for Health-Related Information via Personal Computers and Cell Phones in Japan: A Cross-Sectional Population-Based Survey

Background The Internet is known to be used for health purposes by the general public all over the world. However, little is known about the use of, attitudes toward, and activities regarding eHealth among the Japanese population. Objectives This study aimed to measure the prevalence of Internet use for health-related information compared with other sources, and to examine the effects on user knowledge, attitudes, and activities with regard to Internet use for health-related information in Japan. We examined the extent of use via personal computers and cell phones. Methods We conducted a cross-sectional survey of a quasi-representative sample (N = 1200) of the Japanese general population aged 15–79 years in September 2007. The main outcome measures were (1) self-reported rates of Internet use in the past year to acquire health-related information and to contact health professionals, family, friends, and peers specifically for health-related purposes, and (2) perceived effects of Internet use on health care. Results The prevalence of Internet use via personal computer for acquiring health-related information was 23.8% (286/1200) among those surveyed, whereas the prevalence via cell phone was 6% (77). Internet use via both personal computer and cell phone for communicating with health professionals, family, friends, or peers was not common. The Internet was used via personal computer for acquiring health-related information primarily by younger people, people with higher education levels, and people with higher household incomes. The majority of those who used the Internet for health care purposes responded that the Internet improved their knowledge or affected their lifestyle attitude, and that they felt confident in the health-related information they obtained from the Internet. However, less than one-quarter thought it improved their ability to manage their health or affected their health-related activities. Conclusions Japanese moderately used the Internet via personal computers for health purposes, and rarely used the Internet via cell phones. Older people, people with lower education levels, and people with lower household incomes were less likely to access the Internet via cell phone. The Internet moderately improved users’ health-related knowledge and attitudes but seldom changed their health-related abilities and activities. To encourage communication between health providers and consumers, it is important to improve eHealth literacy, especially in middle-aged people. It is also important to make adequate amendments to the reimbursement payment system and nationwide eHealth privacy and security framework, and to develop a collaborative relationship among industry, government, and academia.

Association of enjoyable childhood mealtimes with adult eating behaviors and subjective diet-related quality of life.

OBJECTIVE This study examined whether the experience of enjoyable mealtimes at home during childhood was related to eating behaviors and subjective diet-related quality of life in adulthood. METHODS The study used data (n = 2,936) obtained from a research program about Shokuiku (food and nutrition education) conducted by the Cabinet Office in Japan in November and December 2009. The study employed logistic regression adjusted for all predictor variables. RESULTS Enjoyable eating experiences in childhood were positively associated with a balanced diet (meals with 3 dishes; odds ratio [OR]: 1.78, 95% confidence interval [CI]: 1.45-2.19), eating vegetable dishes (OR: 1.71, 95% CI: 1.37-2.12), and subjective diet-related quality of life scores (OR: 3.84, 95% CI: 3.14-4.70) in adulthood. CONCLUSIONS AND IMPLICATIONS This study suggests that enjoyable eating experiences at home during childhood appear to promote healthy eating habits and the development of a positive diet-related quality of life in the future.

Overeating at dinner time among Japanese workers: Is overeating related to stress response and late dinner times?

There are several known risk factors for overeating, including negative feelings and hunger. It was hypothesized that overtime work is associated with stress responses and later dinner times, leading to longer periods of time without eating, and that this, in turn, leads to a strong experience of hunger and consequent overeating at dinner. The aim of this study was to examine relationships among overeating at dinner, stress responses (e.g., fatigue, anxiety, and depression), and dinner times in Japanese male workers. In December 2012, 255 Japanese male workers at a leasing company completed a self-report questionnaire about overeating at dinner, psychological stress responses, physical stress responses, and dinner times. Each worker was sent an email with a link to the questionnaire website, where his answers were collected. Relationships between overeating at dinner and lifestyle issues were investigated using multiple linear regression analysis treating overeating as a dependent variable. Factors related to overeating at dinner included psychological stress response (β = 0.251 p < 0.001) and dinner time (β = 0.220, p = 0.004). These cross-sectional data suggest that overeating at dinner is related to dinner time in men and to stress responses.

The development of an Aftermath of Dietary Lapses Coping Questionnaire for weight control

Objective: This study was designed to develop the Aftermath of Dietary Lapses Coping Questionnaire (ADLCQ) for evaluating how people cope with the aftermath of dietary lapses during weight control. Method: Between June–July 2012, dieticians working in public health centres and city offices in Sizuoka, Japan, recruited 466 participants. They were asked to complete a 20-item self-report questionnaire pertaining to coping strategies in the aftermath of dietary lapses. The questionnaire included items regarding the stage (readiness) of weight control, the experience of weight loss and demographic characteristics. We examined the questionnaire’s construct validity by conducting confirmatory and exploratory factor analyses and investigated reliability by examining internal consistency and correlations of factors with readiness for weight control and the experience of weight loss. Results: Data from 411 participants were analysed. Five factors (i.e. self-reflective thoughts, compensation by healthy eating, compensation by exercising, self-monitoring and positive thoughts), collectively consisting of 17 items, reached nearly acceptable levels of validity (adjusted goodness-of-fit index [AGFI] = .919, goodness-of-fit index [GFI] = .943, comparative fit index [CFI] = .832, root mean square error of approximation [RMSEA] = .045). Cronbach’s alpha coefficients ranged from .61 to .87. Scores for coping differed with the readiness for weight control and the experience of weight loss. Conclusion: We developed the 17-item ADLCQ to evaluate coping with the aftermath of dietary lapses and confirmed the validity and the reliability of the questionnaire.

Japanese Children and Plate Waste: Contexts of Low Self-Efficacy.

Objective: Leaving a portion of meals uneaten, known as plate waste, is a serious problem among children in Japan. Although children’s confidence that they can completely finish meals is related to plate waste, the circumstances that influence this confidence are not known. This study examined situations in which low self-efficacy for finishing their meal occurs among elementary school children in Tokyo, Japan. Design: A survey using a cross-sectional self-reporting questionnaire was conducted in December 2009. This questionnaire included items about plate waste behaviour, self-efficacy for completely finishing meals in specific situations, sex, height and weight. Methods: A total of 2659 Japanese 5th-grade students completed the questionnaire. Univariate logistic regression and multivariate logistic regression analyses were performed with the plate waste behaviour item, the not-completely-eaten group and the completely-eaten group as dependent variables, and with the self-efficacy items as independent variables. Results: Significant correlations were found between plate waste and low self-efficacy for completely finishing meals ‘when portion size is too large’ (boys: Odds ratio (OR) = 3.94; 95% Confidence interval (CI) = 2.83, 5.49 and girls: OR = 2.68; 95% CI = 2.03, 3.54), ‘when food one dislikes is served’ (boys: OR = 3.74; 95% CI = 2.77, 5.04 and girls: OR = 2.89; 95% CI = 2.21, 3.76), and ‘when the time allowed to eat is too short’ (boys: OR = 1.57; 95% CI = 1.16, 2.14 and girls: OR = 1.49; 95% CI = 1.13, 1.97). Low self-efficacy ‘when a meal is not delicious’ (OR = 1.79; 95% CI = 1.32, 2.43) was a predictor of plate waste only among boys. Conclusions: The results suggest that in Japan environmental improvement and nutritional education are related to children’s plate waste.

Long-term weight gain is related to risk of metabolic syndrome even in the non-obese

OBJECTIVE To examine the relationship between long-term weight gain and risk of metabolic syndrome (MetS) in non-obese and obese subjects. METHODS Cross-sectional data from 3342 participants (1614 men, 1728 women) were obtained from a Specific Medical Checkup and a self-reported questionnaire survey conducted by a health insurance society between April 2009 and March 2010. Subjects were divided into four groups based on body mass index (BMI) and experience of weight gain since the age of 20 years using a self-reported questionnaire: non-obese/non-gain, non-obese/gain, obese/non-gain, and obese/gain. Relationships between weight gain and risk of MetS were investigated using logistic regression analysis, with the four groups as a dependent variable. RESULTS There were 2103 (62.9%) subjects in the non-obese/non-gain, 545 (16.3%) in the non-obese/gain, 125 (3.7%) in the obese/non-gain, and 569 (17.0%) in the obese/gain groups. The obese/gain group showed the highest risk of MetS in men (odds ratio [OR]: 37.45, 95% confidence interval [95% CI]: 25.32-55.40) and women (OR: 163.13, 95% CI: 56.22-473.32). Even the non-obese/gain group had an increased risk of MetS, in men (OR: 4.98, 95% CI: 3.47-7.15) and women (OR: 6.28, 95% CI: 1.53-25.83). CONCLUSION The data show that the obese/gain group had the highest risk of MetS, and that those who gained weight were at risk of MetS, even the non-obese.

Development of the Child Mealtime Feeding Behavior Questionnaire

It has been suggested that parents’ feeding behaviors are associated with the eating behaviors of their children. The objective of this study was to develop the Child Mealtime Feeding Behavior Ques...

Overeating, late dinner, and perceived stress in Japanese workers.

OBJECTIVES This study examined relationships among overeating at dinner, dinner time, perceived stress, and strategies for coping with stress among Japanese workers. METHODS In December 2012, 255 male Japanese workers at a leasing company completed a questionnaire about overeating (score range: 5-20), dinner time, perceived stress, and strategies for coping with stress. Each worker was sent an email with a link to a website, where their answers were collected. Relationships among overeating, dinner time, perceived stress, and stress-related coping strategies were investigated using two-way analysis of variance. RESULTS The analyses of cross-sectional data revealed no differences in the overeating scores among those who ate dinner before 21:00 according to their level of perceived stress. However, those who ate dinner after 21:00 and reported feeling stressed tended to overeat at dinner (F(1, 237)=5.62, p=0.019). Additionally, those with perceived stress engaged in emotional expression involving others, and those without perceived stress tended to seek help to solve their problems and change their mood. We found no significant interactions involving the items related to strategies for coping with stress. CONCLUSION This study found that overeating at dinner was related to dinner time and perceived stress. Additionally, the combination of a late dinner time and perceived stress reinforced overeating at dinner. The results of this study do not identify a coping strategy to prevent overeating.

Relationship between weight gain and metabolic syndrome in non-obese Japanese adults.

AIMS To examine the effects of weight gain (in kg) on the parameters of metabolic syndrome (MetS) in non-obese Japanese adults over a period of 1 year. METHOD We analyzed data on 1653 workers in a financial corporation (698 males and 955 females) who may have gained weight during 1 year but nevertheless remained non-obese. Data were collected twice: baseline data were collected between April 2010 and March 2011, and follow-up data were collected the next year. We calculated weight gains over the year and assigned all subjects into one of four groups according to the amount of weight gained: 0-0.99kg weight gain (reference), 1.00-1.99kg, 2.00-2.99kg, and more than 3.00kg. We compared changes in MetS parameters between the reference and other groups using Analysis of covariance (ANCOVA). RESULTS Significant between-group differences were evident among males in terms of abdominal circumference (AC), blood pressure, and triglyceride (TG) levels. More weight gain was associated with worse results with regard to these MetS parameters. The AC changes were 0.60, 1.55, 2.86, and 4.42cm in the reference group, those who gained 1.00-1.99kg, those who gained 2.00-2.99kg, and those who gained over 3.00kg, respectively; the differences between the reference group and all other groups were significant (all p values <0.001). CONCLUSIONS Weight gain (in kg) is a useful index of weight change and influences several parameters of MetS even over the course of 1 year.

New concepts of non-adherence among patients undergoing hemodialysis - a qualitative study exploring specific types of adherence/nonadherence

Rationale, aims and objectives: To determine more effective intervention, this qualitative study explores the specific behaviors of adult patients undergoing hemodialysis with regard to dietary and fluid restrictions. Additionally, to understand their characteristics, identified behaviors were categorized as being either intentional or unintentional. Methods: This study employed a descriptive exploratory design comprising individual semi-structured interviews. It was conducted from July to September 2014 in one private dialysis facility treating 73 outpatients in Tokyo, Japan. Forty-three patients receiving hemodialysis treatment consented to participate. Behaviors identified in the interviews were categorized by considering “the motivation behind them (intentional/unintentional)” and their “adequacy (if the behavior seems to lead adherence or not).” Results: This study identified 32 categories of “intentional behaviors” and 14 categories of “unintentional behaviors”. Intentional behaviors included general behaviors of “making adjustments in diet” and non-adherence behaviors of “taking halfway measures” and “abandonment”. Unintentional behaviors comprised general behaviors practiced after the initiation of HD therapy, in addition to non-adherence behaviors due to “habituation” and “dietary environments”. Conclusions: A total of 46 categories of specific behaviors regarding dietary and fluid restrictions in patients receiving HD were identified. Categories were then divided into two different types: intentional and unintentional. Though certain characteristics were similar to other adherence behaviors such as those toward medication, the current study also proposes some unique aspects of dietary behaviors with respect to diversity and habitual strength. Understanding the characteristics of different types of non-adherence behaviors, such as whether they are intentional or unintentional, could be a potentially important contribution to interventions.