保健師が多機関と行う研究体制構築のプロセスの特性

　本研究の目的は、保健師が多機関と行う研究体制の構築とプロセスの特性を明らかにすることである. 研究対象は、JMSコホート研究(The Jichi Medical School Cohort Study)の対象地区市町村に属する保健師5名とした. 対象条件としては、データベース調査, 追跡調査を担当し, 研究プロセスを12.8年間経験した保健師とした. 半構造的インタビュー調査にて多機関と行う研究における保健師の役割と課題を聴取し, 質的帰納法手法にて分析をした. その結果, 多機関との関わりを特徴とした研究体制構築プロセスの5つの局面は, 研究の動機付け], [研究の計画], [研究の実施], [研究の成果], [研究の発展]に分類された. [研究の発展]は, 地域活動への還元と保健師の専門性の発展に2つに分類された. 以上のことから, 多機関と行う地域の研究課題に対して, 多機関との関わりのプロセスの特性を踏むことにより, 研究の成果を地域活動に取り入れ, 保健師の技術を向上, 意識の変化をおこさせることができる. その結果, 普遍性のある地域活動の展開がされて, 更に多機関と行う研究課題と地域独自に行う研究課題に取り組めることができる特性を構造化した.The purpose of this research is to clarify characteristics of the process of research for public health nurses. The study method is select 5 public heath nurses who belonged to the district cities, towns and villages of The Jichi Medical School Cohort Study. As an object condition, public health nurses are in charge of investigation for database making. a follow-up survey, and it is experienced a study process the an average of 12.8 year. We then carried out formal interviews. In regard to the research process, we asked about the roles and drawbacks of public health nurses in research and analyzed it for qualitative inductivity. The results is the characteristics in the process of constructing a research program includes a five step process, including the following steps[the incentives of the study], [the plans of the study], [the enforcement of the study], [the results of the study], and for the overall[development of the study]. [development of the study] similar, was classified in the reduction of local action and the development of speciality public halth nurses. The results showed that, many constructing a local research program to carry out, by going through the characteristics of the process of the relation with many constructing, and a charge in the level of consciousness in the technology used by public health nurses. As a result, it followed that local action with universality was possible. and structured characteristics that could wrestle for research themes along with other faculties and areas to perform better originated more

Low Lipoprotein(a) Concentration Is Associated with Cancer and All-Cause Deaths: A Population-Based Cohort Study (The JMS Cohort Study)

Background: Experimental studies support the anti-neoplastic effect of apo(a), but several clinical studies have reported contradictory results. The purpose of this study was to determine whether a low lipoprotein(a) [Lp(a)] concentration is related to mortality from major causes of death, especially cancer. Methods The subjects were 10,413 participants (4,005 men and 6,408 women) from a multi-center population-based cohort study in Japan (The Jichi Medical School cohort study). The average age at registration was 55.0 years, and the median observation period was 4,559 days. As the estimated hazard ratio was high for both the low and very high Lp(a) levels, we defined two Lp(a) groups: a low Lp(a) group [Lp(a)<80 mg/L] and an intermediate-to-high Lp(a) group [Lp(a)≥80]. Participants who died from malignant neoplasms (n = 316), cardiovascular disease (202), or other causes (312) during the observation period were examined. Results: Cumulative incidence plots showed higher cumulative death rates for the low Lp(a) group than for the intermediate-to-high Lp(a) group for all-cause, cancer, and miscellaneous-cause deaths (p<0.001, p = 0.03, and p = 0.03, respectively). Cox proportional hazards analyses with the sex and age of the participants, body mass index, and smoking and drinking histories as covariates showed that a low Lp(a) level was a significant risk for all-cause, cancer, and miscellaneous-cause deaths (p<0.001, p = 0.003, and p = 0.01, respectively). The hazard ratio (95% CI) [1.48, 1.15–1.92] of a low Lp(a) level for cancer deaths was almost the same as that for a male sex (1.46, 1.00–2.13). Conclusions: This is the first report to describe the association between a low Lp(a) level and all-cause or cancer death, supporting the anti-neoplastic effect of Lp(a). Further epidemiological studies are needed to confirm the present results

Impact of occupational stress on stroke across occupational classes and genders

The aims of the present study were to analyze the association between incident stroke, occupational class and stress and to examine whether the association is found in both men and women in a prospective study of Japanese male and female workers. A total of 3190 male and 3363 female Japanese community-dwelling workers aged 65 or under with no history of cardiovascular disease were followed. Occupational stress was evaluated using a demand-control questionnaire. The impact on stroke was examined in stratified analyses of occupational classes. We identified 147 incident strokes (91 in men and 56 in women) during the 11-year follow-up period. Men with high strain jobs (combination of high job demand and low job control) were nearly three times more likely to suffer from a stroke than men with low strain jobs (combination of low job demand and high job control). Among male workers in low occupational classes (blue-collar and non-managerial work), job strain was associated with a higher risk of stroke. In contrast, there was no association between job strain and incident stroke among male workers in high occupational classes (white-collar and managerial work). No statistically significant differences were found for stroke incidence among the job characteristic categories in all the female participants. However, significant, over five-fold excess risks were found among white-collar and managerial female workers exposed to high job strain, compared with their counterparts with low strain jobs. Our study of Japanese workers provided supportive evidence for vulnerability to occupational stress among lower occupational class workers in males but not in females.Japan Epidemiology Gender Occupations Psychological stress Socioeconomic factors Gender

Psychosocial job characteristics and risk of mortality in a Japanese community-based working population: The Jichi Medical School Cohort Study

We prospectively investigated the association between psychosocial job characteristics according to the job demand-control model and the risk of mortality in a Japanese community-based working population. A baseline examination conducted from 1992 to 1995 determined the socioeconomic, behavioural, and biological risks in addition to the psychosocial job characteristics of 3178 male and 3331 female workers aged 65 and under and free from cancer and cardiovascular diseases. During the 9-year follow-up study, 157 men and 64 women died. In the follow-up, the results of Cox proportional hazards regression analysis revealed that men with concurrent high job demands and high job control (an active job) had the lowest risk of mortality from all causes. Compared with the low demand and high control job category, the multivariate relative risk of an active job was 0.53 (95% confidence interval: 0.31, 0.89). This finding appeared largely attributable to a reduction in cancer mortality. Job characteristics were not associated with cardiovascular diseases or external causes of mortality. For women, no significant associations were observed. The findings suggest that an active job has a beneficial effect on the health of Japanese male workers. Investigating of the effect of psychosocial job characteristics on cancer might therefore provide valuable insights into the health of workers.Cardiovascular diseases Cohort studies Mortality Neoplasms Stress Psychological Workplace Japan

Implementation of a Smoke-Free Policy on School Premises and Tobacco Control as a Priority Among Municipal Health Promotion Activities: Nationwide Survey in Japan

We conducted a nationwide survey to evaluate the effect of implementing a smoke-free policy in municipalities that forbid teachers to smoke on school premises. Questionnaires were mailed to 3207 municipalities throughout Japan. After we adjusted for population size and the standardized mortality ratio for male lung cancer, we found that assigning a high priority to tobacco control in municipal health promotion activities was significantly associated with implementation of school tobacco-control policies (odds ratio = 1.50, 95% confidence interval=1.24, 1.81)

Metabolic syndrome is a risk factor for cancer mortality in the general Japanese population: the Jichi Medical School Cohort Study

Abstract Background Metabolic syndrome (MetS) and cancer are major public health problems worldwide. The relationship between MetS and cancer death is of great interest. We examined the predictive value of MetS for cancer mortality in Japan. Methods Study participants included 4495 men and 7028 women aged 18–90 years who were registered between 1992 and 1995 as part of the Jichi Medical School Cohort Study. We used a definition of MetS modified for the Japanese population. The primary outcome was cancer mortality. Additionally, the relationship between MetS and cancer-type specific mortality was examined. Analyses were conducted with Cox’s regression models adjusted for age, smoking status, alcohol drinking status, marital status, educational attainment, physical activity, occupational category, and menopausal status (only in women). Results During a mean follow-up of 18.5 years, 473 men and 297 women died from cancer. MetS was positively associated with cancer mortality in women (hazard ratio [HR], 1.69; 95% confidence interval [CI] 1.21–2.36), but not in men (HR, 1.21; 95% CI 0.90–1.62). Additionally, MetS was associated with a high risk of colorectal (HR, 3.48; 95% CI 1.68–7.22) and breast (HR, 11.90; 95% CI 2.25–62.84) cancer deaths in women. Conclusion MetS was a significant predictor of cancer mortality in women