Objective The purposes of this study were to estimate the prevalence of past solvent abuse among junior high school students in Saitama prefecture and to investigate smoking and drinking as “gateway drugs” for solvent abuse.
Methods The survey was conducted from Dec 2002 to Jan 2003, in 3 junior high schools in Saitama, using anonymous self-reporting to preserve privacy. A total of 2, 049(93.2%) students responded to our questionnaire. Two groups were categorized and analyzed according to history of solvent abuse in the past. To investigate “gateway effects” of smoking and drinking, we analyzed their relationship with solvent abuse, order of precedence of usage and confounding factors.
Results The prevalence of history of solvent abuse was 1.1% of the total. There were notable differences depending on sex and grade. 1.9% of male students had some experience as compared to only 0.3% of female students. An increase was evident according to grade (grade 1-0.6%, grade 2-0.8%, grade 3-2.1%) and there was a strong association between smoking, drinking and solvent abuse. The order of precedence of solvent abuse could not be established because some users had first experienced smoking, drinking and solvent abuse in the same grade and there was also a high recall bias among the subjects. A number of respondents also reported the reverse order, of experiencing solvent abuse before smoking and drinking. The user group was habitual smokers were recommended to smoke by their parents, spent longer periods in solitude, witnessed solvent abuse and had a friend who abused solvents. After adjusting for confounding factors using multiple logistic regression analysis, a relationship between smoking and solvent abuse remained but not the relationship with drinking.
Conclusion The study conformed that there is solvent abuse among junior high school students, even in the lowest grade. Health education must focus on this fact and the finding that the user group reflects peer pressure and is faced with poor communication and advice from their families. Therefore health education focused on life skills and social support considering family ties must be emphasized. It could not be established which was first experienced, but a strong relationship between smoking and solvent abuse was observed even after multivariable analysis. On the other hand, the results suggested that habitual drinking is not a “gateway drug” to solvent abuse.

View full abstract

Objectives The purpose of this study was to examine the efficacy of an increased calcium (Ca) diet for preventing bone mineral loss in long-term lactating women, considering bone metabolism, and recovery of bone loss caused by long-term lactation with low dietary Ca intake.
Subjects and Methods Two groups of long-term (>12 mon.) lactating women…one with an enhanced Ca intake (Group M, n=22) and the other with diet feeding no cow's milk and no milk products (Group N, n=16)…and a control group of 21 non-lactating postpartum women (Group C) were studied. Bone mineral density (BMD) was measured by ultrasonic bone densitometry. Stiffness calculated from the combined value of speed of sound and broadband ultrasound attenuation was used as an index of BMD. BMD and bone metabolic markers in urine and serum (only M and C groups) were assessed from 1~12 weeks postpartum (initial) at six-month intervals for a maximum of two years and changes were compared among the groups.
Results 1. The mean (±SD) dietary Ca intake was 1032(209)mg/day in the M group.
 2. After lactating for one year, the N group demonstrated significant decrease in BMD, with both 1 and 2 babies, whereas the M group had no significant change.
 3. The BMD in the N group returned to initial levels at 0.5~1 year post-weaning,
 4. In the N group, compared with the M group, the urinary Hydroxyproline/creatinine ratio was significantly higher at the initial measurement and half a year thereafter, while urinary Ca/creatinine ratio was significantly lower after a year. However, there were no significant differences between the M and C groups.
 5. Serum bone alkaline phosphatase was significantly higher in the M group compared with the C group.
Conclusions Bone loss during long-term lactation can be prevented with adequate dietary Ca intake. Once lost, recovery to initial levels occurs 0.5~1 year post-weaning.

View full abstract

Purpose The purpose of this study was to clarify, using the Delphi technique and by the consensus of Experts, the expected competencies of Public Health Nurses (PHNs) working in government organizations according to their number of years' experience.
Methods Experts were nurses who had a PHN license in academic, administration and service areas. The criteria for selecting are as follows:
 Academic: professors of community nursing department, in nursing college.
 Administration: chief PHNs working in prefectural government organization, with the role of supervising and controlling PHNs.
 Service: recommended by each administration Expert and fulfilling all the following 3 points; (1) PHN experience of 10 years or more in a government organization, (2) a supervisory position over at least one junior PHN, and (3) an effective practical record as a PHN.
 209 Experts who were chosen by the specified criteria were approached for their participation.
 At Round 1, Experts were asked to list competencies important for PHN under 3 headings: knowledge, skills and attitudes. From the response in Round 1, competency items were categorized. A list was obtained and used in Round 2, when Experts were asked to select and rate the importance of competencies for 4 ranges of PHN years of experience. At Round 2, these competencies were analyzed on the basis of importance. At Round 3, Experts were asked whether they agree or not with the results of Round 2. The criterion for consensus was set as an agreement rate of 90%.
Results Of the total, 63 agreed to participate; 14 in the academic, 23 in the administration and 26 in the service area. Response were turned 63 from all at Round 1, 52 at Round 2 and 44 at Round 3.
 The result clarified the expected competencies into 47 items and 7 categories related to their importance in the experience year ranges. The 7 categories were: Conducting nursing processes; Conducting community health activities; Providing health care; Management; Information application; Human relations; and Personal characteristics. The very important competencies PHNs should have were regarded as follows: (1) At 1-3 years' experience, PHNs should have 2 categories (2) At 4-10 years, they should have the 5 categories (3) At 11-20 years they should have all 7 categories (4) At 21 or more years they should have at least 6 categories. At all levels PHNs were required to have the 2 categories of Providing health care and Personal characteristics.
Conclusions It was expected as PHNs gain experience they should obtain wider and more faranding competencies stepwise, from basic nursing care to community care, and on to administration.

View full abstract

Objective Health conditions are changing rapidly in aging societies and an essential health service by municipal governments is to promote the utilization of health notebooks in support of the health of individuals. The objective of this study was to clarify the relationship between utilization of health notebooks and rates for elderly among Japanese municipal governments.
Subjects and methods Questionnaires on the utilization of health notebooks were mailed to all 3,255 municipal governments in Japan. The 2,445 that filled in all items on the questionnaire were enrolled in this study. Questions concerned opportunities for utilizing health notebooks when residents received health education/guidance, health examinations, home visits, or welfare service. If they answered “Frequent use” for these opportunities, one point was given. Furthermore, if they answered that they filled in the results of residents’ health examination into health notebooks, one point was given. If a municipal government got 4 points or more, this municipality was classified as “health notebooks frequently used”.
Results The percentage of municipalities defined as “health notebooks frequently used” was higher among municipal governments with a high rate of elderly residents than with a lower rate. The odds ratio for being classified as “health notebooks frequently used” was higher among municipal government with high rates for the elderly and public health nurses per elderly person than with low rates.
Conclusion With increase in the percentage of elderly residents, municipal governments need to promote their health services in support of residents’ health. To improve the utilization of health notebooks, municipalities should increase the number of public health nurses.

View full abstract

Objectives To clarify factors associated with effective information tranges among staff of welfare facilities for the elderly, and to propose measures for an appropriate information flow system in welfare facilities and public health centers, communication channels and methods, and encouraging factors and barriers were investigated in terms of a printed medium on the control and management of scabies infections.
Methods A self-administered questionnaire survey and an interview survey were conducted with the staff of welfare facilities for the elderly where “Control and management manual of scabies infection” had been distributed by the Tama-Tachikawa Public Health Center in Tokyo.
 A self-administered questionnaire was sent to managers and chief practitioners of 66 facilities. Respondents were obtained from 66 managers and chief practitioners (response rate: 84.8%), and 831 practitioners (response rate: 53.1%). The questionnaire consisted of 20 items for managers and 18 items for chief practitioners, including experience of scabies epidemics in facilities, training experience for the use of “Control and management manual of scabies infection,” measures for information gathering, and current information flow within the facility.
 A semi-structured interview survey was conducted with the manager and/or chief practitioner and practitioners in five facilities. The number of respondents was 10. The interview questions included job description, scabies control measures, dissemination of the manual to the staff, use of the manual, flows of health-related information, and factors associated with information flows. Summarized codes were extracted from the transcriptions from tape recording and were categorized repeatedly according to similarity.
Results In the questionnaire survey, differences of information flow by types of facilities and professional backgrounds were found. Variation was detected in measures for information gathering and focuses in information management between managers/chief practitioners and practitioners. Practitioners wanted opportunities for information exchange while managers/chief practitioners mainly focused on prioritization of information collected. In addition, many respondents felt that information networks outside the facilities were poorly organized.
 From the interview survey, three major categories were extracted, that is, ’Information flow system,’ ’Personal qualification,’ and ’Factors related to the information flow system.’ As factors related to the information flow system, the following 7 subcategories were extracted. 1.Interest in information; 2. Working style and workload; 3. Information networks outside the facility; 4. Information management in the facility; 5. Environment for information sharing; 6. Budget for the information system; and 7. Interpersonal communication.
Conclusions For an effective information system, welfare facilities for the elderly should work on staff training, building their own information flow systems and improving the environment for information sharing and networking with specialized agencies, such as public health centers. At the same time, public health centers should support networking, interpersonal two-way communication and training of welfare-facility workers.

View full abstract