The aim of this paper was to clarify the concept of quality of life (QOL) and to identify appropriate goals for future studies on the QOL of patients with schizophrenia, by historically review of the literature.
 First, the concept of QOL was discussed. With the recent move to attach more importance to outcomes in health services, more attention has been paid to QOL as an indicator of patients' perceived outcomes, and many studies on QOL have been published since 1990. Although definitions of QOL differ from researcher to researcher, four fundamental characteristics are identified: 1) QOL is based on the response from the patient himself/herself, 2) it is the subjective experience of the patient, 3) its index is multifactorial, and 4) scores for QOL change with time.
 Next, the QOL models of Bigelow, Lehman, and Skantze and Malm were reviewed as models of the QOL of patients with schizophrenia, and seven QOL scales were also discussed.
 Last, studies on the QOL of community residents with schizophrenia retrieved from the Medline and Japana Centra Revuo Medicina databases for 1992 to 2002 were examined. The strategy used for the search was “Quality of Life, psychiatric”. As a result, patients with schizophrenia had lower total QOL scores compared to non-disabled persons and patients with depression. Factors associated with their QOL were personal characteristics, lifestyle, negative symptoms, mental symptoms, adjustment (to relations with family, friends and others), social support, self-esteem, autonomy.
 Results indicated that a longitudinal study is needed to clarify the relationship between these factors and QOL affected by psychological variables of the patient and develop effective psychosocial intervention necessary in the care of patients with schizophrenia.

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Purpose The purpose of this survey was to investigate the efficacy and safety of influenza HA vaccine for children between 1 and 6 years of age in Mie Prefecture during the 1999/2000 prevalent season.
Methods We surveyed clinical data for children aged between 1 to 6 who visited five clinics in Mie Prefecture. Dividing them into vaccinated and non-vaccinated groups, we surveyed their basic properties, disease histories and manifestation of symptoms. The survey was performed with the consent of parents who were informed of the purpose. We also surveyed the adverse effects within 48 hours after vaccination. The serum HI titers of the vaccinated children were sampled three times: before the first vaccination and after the first and second vaccinations. The data were analysed with the chi-squared test and a multiple logistic model.
Results The frequency of febrile episodes above 38℃ was significantly lower in the vaccinated than the non-vaccinated group. While the relative risk for the entire survey period was 0.79, it declined to 0.62 during the peak period of the epidemic. Furthermore, the odds ratio was 0.42 by the multiple logistic model. Among the vaccinated group, the pattern in the increase of HI titer after vaccination varied depending on the species of vaccine antigen. In addition, the frequency of febrile episodes above 38℃ was significantly lower in the group which had an HItiter to A/Sydney antigen of 1:40 or more than in these with values below 1:40.
Conclusion The relative risk of febrile episodes above 38℃ during the influenza prevalent season was 0.62 or below, and vaccine efficacy was 38 percent or above. Considering the significant difference in the frequency of febrile episodes between the groups with HI titers above and below 1:40, it is necessary to study strategies for those with a low response.

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Objective To investigate the “secondary medical regions” where mentally disordered people receive out-patient and in-patient medical care in Fukuoka prefecture, and examine factors related receiving care in medical facilities outside of their secondary medical region of residence.
Methods 16129 out-patients on June 30, 2001 using “the public assistance system of outpatients' medical expenses” in line with the Law on Mental Health and Welfare for People with Mental Disorders were analyzed. 7513 in-patients with mental disorders in hospitals were also analyzed utilizing data from the “Patient Survey” by the Ministry of Health and Welfare in 1999. Whether they received out-patient care and in-patient medical care in their own region of residence or not was clarified for all of 13 secondary medical regions. Univariate and multivariate analyses with the multiple logistic regression model were employed to evaluate the relationship between the medical care outside their residential region and characteristics, such as the secondary medical region, gender, age, diagnosis, medical care insurance and so on.
Results With out-patient care, patients in secondary medical regions with a small population size tended to receive care outside of their residential region. Other characteristics associated with a significantly an increased proportion receiving care outside of their region included; young age, receiving care in clinics, and medical care insurance as “public corporation staff mutual aid association” and “employees' insurance or government's managed health insurance”. For in-patients care, patients in secondary medical regions with a small number of psychiatric beds per population showed a marked tendency to receive care outside of their residential region. A slight correlation was observed between population ant the proportion receiving care outside of their region. Young and diagnoses such as of “mental and behavioural disorders due to use of alcohol”, “other mental or behavioural disorders” “neurotic, stress-related and somatoform disorders” or “mood [affective] disorders”, were other characteristics associated with an increased proportion receiving care outside of their region.
Conclusions With the societal prejudice against mental disorders and regional differences in psychiatric medical facilities, it is of interest that this study indicated that mental disordered people receive medical care in a wide and relatively close area beyond their secondary medical region of residence.

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Background Debate has been continuing whether endocrine disrupting chemicals (EDC) in the environment affect human reproduction. We are planning to use time to pregnancy (TTP) as a measure of human fecundity to relate EDC exposure in a future research. TTP is expressed as the number of non-contracepting menstrual cycles or months required for a couple to conceive. An extended TTP might be considered to reflect an injury to reproductive processes. Since this parameter has never been measured in Japan. the present preliminary study aimed at establishing a Japanese version of the TTP questionnaire and determining if TTP could be reliably measured in Japan.
Methods We prepared a self-administered questionnaire that consisted of questions on TTP, sexual life and dietary habits. Women who visited a gynecology clinic in Tokyo for confirmation of pregnancy during the period October 2000 to March 2001 were the subjects asked to fill in the questionnaire. The results were statistically analyzed by chi-square test, t-test and binominal logistic model after classifying the subjects into two groups: (a) Group I (TTP≦6months; n=53) (b) Group II (TTP>6months; n=16)
Results Of the 92 women approached, 69 (75.0%) could report TTP. The distribution of TTP, the mode being around 1-2 months with a positive skew toward longer value, was similar to those reported so far in Western countries. There were statistically significantly more smokers in Group II (smoker 62.5%) than in I (15.6%). Logistic regression analysis indicated prior gravidity and fish and milk consumption, in addition to cigarette smoking, to be related to TTP.
Conclusions The present preliminary study indicated that TTP surveys are feasible with Japanese based on the high response rate and plausible distribution of reported value. It also indicated that TTP was related to cigarette smoking, gravidity and dietary habits, again consistent with previous studies.

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[in Japanese]

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Purpose The purpose of this study was to understand the relation between daily life habits and subjective symptoms and to gather basic data about improvement of the quality of life and its influence on a person's health.
Method The subjects were middle-aged (including all residents, males and female, all between the ages of 20 and 59. n=2,520) in an agricultural village near a large urban center on the main island of Japan. A total of 1,834 villagers who responded to the survey in 1995 could be followed until 1998. The contents of the questionnaire covered age, sex, past history, daily life habits, mental condition, and activities of daily living. Using the method χ² verification and multiplex logistic analysis the village residents daily life hebits their relation with subjective symptoms after 3 years were investigated.
Results According to the analysis focusing on factors which had effects on subjective symptoms, the odds ratio were as follow:
⋅people who often skip breakfast-shortness of breath: 3.37
⋅people who often eat between meals-toothache: 2.06
⋅smokers-headache: 0.39, nausea: 18.89, urination problem: 0.03
⋅people with insufficient sleep-eye fatigue: 1.76, diarrhea: 4.07
⋅people with a BMI value less then 18.5-dizziness: 1.82
The results showed a significant relationship between people's daily life habits and their health condition. (all P<0.05)
Conclusion From the results of this study, we can clearly see the tendency to minimize the subjective symptoms by desirable daily habits and that there is a possibility to prevent some of the through even slight improvement of hebits.
 The study also indicates that it is necessary to stimulation a more diverse life style to maintain good health.

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Objective To clarify exercise habits, self-rated functional fitness, activities of daily living (ADL) and fear of falling in community-dwelling elderly who are classified as frail by the eligibility decision process of the Japanese long-term care insurance system.
Methods Subjects aged 75 years and older were classified into a frail elderly group (n=126; male=29, female=97) and a healthy elderly group (n=262; male=114, female=148). We had carried out an interview survey using questionnaire asking about exercise habits, self-rated functional fitness, ADL, fear of falling and activity curtailment. The survey was carried out by door-to-door method and data were collected from November to December 2000.
Results Respondents who answered no practice of exercise were more likely to be in the frail elderly group. Among the self-rated functional fitness items, endurance, muscular strength and flexibility were comparatively low in the frail elderly group. The rates of basic ADL dependence were higher for bathing (males=34.5%, females=15.5%) and walking (males=27.6%, females=20.6%), for both sexes of the frail elderly group. Also, the rate of instrumental ADL dependence was much higher in the frail elderly group than in the healthy elderly group. Among frail elderly, 93.1% of males and 93.8% of females had fear of falling. Of those who were afraid, 66.7% of males and 60.4% of females curtailed going out due to this fear.
Conclusions Our findings suggest that intervention programs are needed to improve bathing and walking ability as well as to provide social support for the frail elderly. Self-rated fear of falling is significantly associated with activity curtailment in this population.

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Objectives The physical and mental condition of elderly people changes every day and we hypothesized that this influences food intake and swallowing functions. The present study was undertaken to clarify relationships between daily living conditions and swallowing function.
Methods The subjects were users (105 males and 219 females) of 6 day-service centers. We performed a survey of IADL (Instrumental Activities of Daily Living), mobility, eating and swallowing behavior, and general health. In addition, we used RSST (Repetitive Saliva Swallowing Test) as a screen for functional dysphasia.
Results Women who had normal food ingestion and swallowing functions were capable of doing shopping, houswork and taking care of money independently. Males and females who were capable of moving around from place to place had nomal food ingestion and swallowing functions. With regard to daily eating habits and health condition, males and females who had normal food ingestion and swallowing functions were able to consume ordinary food, able to eat without any help, and often laugh.
Conclusion It was concluded that a normal swallowing condition in the elderly is related to laughing often, being independent in daily life, moving around and eating ordinary meals without any help.

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