Objectives The present cohort study investigated the relationship between participation in a secondary screening test for the frail elderly and the findings of this screening test, and the relationship between participation and new onset of the need for long-term care in the elderly.
Methods A primary screening survey was conducted on all 4,050 functionally independent elderly people aged≥65 years living in Ishikawa Town, Japan. We included 3,150 subjects for analysis, dividing them into the following 3 groups: 1) non-frail elderly, 2) possible frail elderly who participated in the secondary screening test, and 3) possible frail elderly who did not participate in the secondary screening test. We used Cox's proportional hazards model to calculate the hazard ratios of new onset of the need for long-term care by the participating and non-participating groups as compared to the non-frail group over 2 years.
Results The proportion of non-frail elderly and possible frail elderly was 72.7% (n=2,289) and 27.3% (n=861), respectively. The number of subjects who did not participate in the secondary screening test (n=582) were 2.1-fold greater than that of subjects who did (n=279). The prevalences of withdrawal and impaired instrumental activity of daily living were significantly higher in the non-participating group than in the participating group. During the 2-year follow-up period, 168 subjects developed the need for long-term care. The incidence of new onset of the need for long-term care for each group (/1,000 persons) was 24.0 in the non-frail group, 93.2 in the participating group, and 149.5 in the non-participating group. The hazard ratios of new onset of the need for long-term care were 2.55 (95% confidence interval, 1.59–4.10) for the participating group and 4.46 (3.15–6.32) for the non-participating group after adjustment for confounding factors, including sex, age, and type of household. The hazard ratios were 0.75 (0.41–1.37) for the participating group and 1.09 (0.65–1.82) for the non-participating group after additional adjustment for total points on the Kihon Checklist (a frailty checklist) for assessing the frail elderly.
Conclusion Compared to non-frail elderly, the possible frail elderly had an increased risk of developing the need for long-term care. Moreover, compared to the possible frail elderly who participated in the secondary screening test, the possible frail elderly who did not participate in the test had a further increased risk of developing the need for long-term care.

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Objectives Health insurers in Japan are required to provide health checkups specifically designed to detect signs of metabolic syndrome. Since National Health Insurance organizations have been increasing their numbers of low-income beneficiaries, this observational study was carried out to investigate the differences between persons with differing household income levels based on the factors associated with their participation in health checkups.
Methods The data source for this study was a database of scored answers in collected, unsigned questionnaires provided by the National Health Insurance of Sapporo City. The survey was conducted in 2009, approaching 3000 beneficiaries aged 40–74 years and sampling 4 groups divided by household income and participation in the 2008 health checkup. The survey included questions about demographics, awareness of the details of the health checkup, and knowledge of lifestyle-related diseases. Valid answers from 1656 respondents were analyzed using multiple logistic regression analysis.
Results After analyzing the level of awareness of health checkup details among subjects and its association with checkup participation, knowledge of the locations where the checkups were held showed the highest adjusted odds ratios. Multivariate logistic regression analysis showed that the following factors were associated with participation in checkups in both lower- and higher-income groups: previous and regular participation in health checkups, willingness to attend the next checkup, and status of family or friends regarding checkup participation. In addition, that a substantial out-of-pocket cost for the checkup was not levied had a significant relationship with checkup attendance in lower-income beneficiaries, while personal obligation to undergo regular health checkups regardless of the busyness of their schedules was found to have a significant relationship in higher-income beneficiaries.
  In addition, logistic models that excluded factors of previous and future health checkup participation indicated that participation in health checkups in the lower-income group was associated with an interest in health checkup test items, smoking habits, and the perception of the importance of undergoing health checkups even without specific symptoms, while an interest in healthy lifestyles was found to have a significant relationship with participation in health checkups in the higher-income group.
Conclusion The study showed that awareness of checkup locations and regular attendance at health checkups are strongly related to participation. Some differences in factors associated with health checkup participation were detected among individuals with differing income levels.

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Objectives This study aimed to identify the relationship between burnout, personal traits, work environment, and the stress coping skills of caregivers in group homes (GH) for elderly patients with dementia.
Methods An anonymous, self-administered questionnaire was distributed to 600 caregivers working in 47 GH in Fukuoka Prefecture. Three hundred and thirty-three responses were analyzed. The questionnaire gathered information on burnout, personal traits, work environment, and stress coping skills. The modified Japanese version of the Maslach Burnout Inventory (MBI) was applied.
Results The mean age of the subjects was 42.5 years. The 2 main employment statuses were full-time worker (75.4%) and temporary worker (22.8%). The annual income of 178 (53.5%) subjects was less than 2 million yen. Most of them (80%) harbored job insecurity with regard to the future. The mean scores for 3 MBI elements-emotional exhaustion, depersonalization, and reduced personal accomplishment-were 14.3, 11.2, and 16.1, respectively. After adjusting for personal traits and work environment, burnout was found to be significantly associated with the difficulties perceived by caregivers, and was composed of 4 factors: conflict with the GH residents, support system at the workplace, conflict among staff members, and a sense of being burdened. The elements of emotional exhaustion and depersonalization were also related to the subjects, while the element of reduced accomplishment was related to their active coping levels.
Conclusion The burnout status of caregivers in GH is associated with their perceived difficulties in daily care work. This finding suggests that these caregivers require individual support to cope with the difficulties involved in their daily care work as well as to improve their work environment.

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Objectives Leptospirosis is a zoonotic infection; water and soil are contaminated with Leptospira through the urine of rodents carrying the agent in the kidneys, and then the infection is established percutaneously or orally. In November 2009, the first notification of leptospirosis was submitted in Gunma Prefecture. It is important to clarify the current status of the leptospirosis epidemic in the prefecture and to enlighten residents and healthcare professionals. Hence, we examined the infection status of leptospirosis in residents living near the residence of the patient in this study.
Methods Subjects: Subjects were residents of Isesaki City, Gunma Prefecture, aged 40–64 years and who had undergone a specific health examination (mass health examination) for insured persons under Japan's National Health Insurance on April 23 and 26, 2010. Sample size: We randomly selected 100 subjects from residents who underwent the examination, and antibody titer against leptospirosis was measured. Testing method: Measurement of the antibody titer was commissioned to the National Institute of Infectious Diseases. Microscopic agglutination tests using 6 serotypes of living Leptospira that are widely distributed to the main islands of Japan were performed.
Results One hundred eighty subjects underwent the examination on the 2 days, and 174 of them consented to participate in the study. Serum antibody titer was measured in 100 patients, and the results were all negative.
Conclusion Leptospirosis is a treatable disease when it is diagnosed; therefore, early diagnosis and treatment is important. Mild cases may be missed. Awareness of leptospirosis is low among healthcare professionals in the prefecture. Although it is a rarely infectious disease, it is important to make leptospirosis known to medical associations in the prefecture and to conduct training workshops and similar activities.

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[in Japanese]

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