就業を希望する家族介護者における介護と就業の有無および就業時間との関連 : 国民生活基礎調査を用いて

学位の種別: 課程博士審査委員会委員 : （主査）東京大学教授 橋本 英樹, 東京大学教授 松山 裕, 東京大学准教授 永田 智子, 東京大学講師 長野 宏一朗, 東京大学准教授 島津 明人University of Tokyo(東京大学

Exercise or sports in midlife and healthy life expectancy: an ecological study in all prefectures in Japan

BackgroundWith the increase of overall life expectancy in Japan, effective and beneficial lifestyle approaches and practices are crucial for individuals to have a long, productive and healthy life. Although previous studies suggest that exercise or sports, especially when performed with others, from midlife level have a positive impact on enhancing healthy life expectancy, there is paucity of information regarding these contexts and possible associations. The present study intends to clarify the relationship between engagement in exercise or sports among middle-aged persons and healthy life expectancy through an ecological study in all prefectures in Japan.MethodsWe tabulated (1) the ratios of middle-aged individuals engaged in exercise or sports and (2) the different methods by which they are engaged in exercise or sports for each prefecture by using data from the 2005–2010 Longitudinal Survey of Middle-aged and Elderly Persons by the Ministry of Health, Labour and Welfare of Japan. Weighted multiple linear regression analyses were performed by sex, using healthy life expectancy in 2010 of each prefecture calculated by Hashimoto (2013) as a criterion variable; indices of (1) and (2) of each year as explanatory variables; and age, living conditions, employment, and chronic diseases as adjusted variables.ResultsFor middle-aged males, the ratio of those engaged in exercise or sports in each year from 2005 to 2010 was positively correlated with healthy life expectancy; this relationship was found in the ratio of middle-aged engaging in exercise or sports “with families or friends”. For females, such a relationship could only be found in the ratio of middle-aged females engaged in exercise or sports in 2008, and those engaging in exercise or sports “with families or friends” in 2006, 2008 and 2010.ConclusionPrefectures with a higher ratio of middle-aged individuals engaging in exercise or sports, especially when done with families or friends, have longer healthy life expectancies. This was particularly evident for males. Thus, exercise or sports with families or friends in midlife seems to be more effective in promoting healthy life expectancy for males than females in Japan

ジドウ ギャクタイ ヨボウ ニ ムケタ ボシ ホケン タントウ ホケンシ ト ヨウ ホゴ ジドウ タイサク チイキ キョウギカイ ノ レンケイ システム ニ カンスル ケンキュウ

目的：児童虐待の予防を図るため、母子保健担当保健師と要保護児童対策地域協議会（以下、要対協）の連携システムの構築を促進する要因を明らかにすることである。方法：連携の現状、連携する上で困っていることおよびうまくいっていること、より連携を図るために必要だと思うことについて、フォーカス・グループ・インタビュー調査を実施した。結果：母子保健担当保健師グループ６名、調整機関担当者グループ３名、母子保健担当保健師と調整機関担当者の混合グループ４名計13名からデータを得た。重要カテゴリーとして、「連携指針の整備」「組織化の推進」「人材管理」「政策への対応」「情報管理」「チーム力向上」の６領域を生成した。結論：母子保健と要対協が有機的連携に向けたビジョンを明確化することや、人材や情報を最大限に活用できる組織運営と環境づくりを図るための中長期計画策定の必要性が示された。そして、それぞれの特性を生かした役割分担や基本的な連携パターンを確立するための業務手順書やマニュアルの作成は、行政特有の定期人事異動の観点においても、業務継続性を担保するために重要とされた

Patterns of Movement Performance Among Japanese Children and Effects of Parenting Practices: Latent class analysis

Objectives: The study aimed to examine the long-term effects of parenting practice during preschool years on children’s movement performance in primary school. Methods: This study involved a three-year longitudinal study including 225 children aged 3–6 years old. Parents reported baseline parenting practice and evaluated children’s movement performance three years later. Latent class analysis was used to explore latent classes of movement performance. A post hoc test was used to identify the characteristics of different patterns. Finally, adjusted multinomial logistic regression models were used to test the influence of parenting practice on identified patterns of movement performance. Results: Children in this study were grouped into three movement performance pattens, labelled as ‘least difficulties’ (58.2%, n = 131), ‘low back pain’ (30.2%, n = 68), and ‘most difficulties’ (11.6%, n = 26). After controlling for age, gender, having siblings or not, family structure, BMI SDS, sleep condition and dietary habits, we found that if parents played games with children frequently, the children would have a 0.287 times lower probability of being in the ‘low back pain’ class, 95%CI [0.105, 0.783], and if parents take children to meet peers of a similar age frequently, the children would have a 0.339 times lower probability of being in ‘most difficulties’ class, 95%CI [0.139, 0.825]. Conclusions: Primary healthcare providers should pay careful attention to children with movement difficulties. The study provides longitudinal evidence to support the applicability of positive parenting practice in early childhood to prevent children’s movement difficulties. Keywords: Movement performance; Parenting practice; Latent class analysis; Child; Longitudinal study; Japan

Explaining the decline in coronary heart disease mortality rates in Japan: Contributions of changes in risk factors and evidence-based treatments between 1980 and 2012

Background We aimed to quantify contributions of changes in risks and uptake of evidence-based treatment to coronary heart disease (CHD) mortality trends in Japan between 1980 and 2012. Methods We conducted a modelling study for the general population of Japan aged 35 to 84 years using the validated IMPACT model incorporating data sources like Vital Statistics. The main outcome was difference in the number of observed and expected CHD deaths in 2012. Results From 1980 to 2012, age-adjusted CHD mortality rates in Japan fell by 61%, resulting in 75,700 fewer CHD deaths in 2012 than if the age and sex-specific mortality rates had remained unchanged. Approximately 56% (95% uncertainty interval [UI]: 54–59%) of the CHD mortality decrease, corresponding to 42,300 (40,900–44,700) fewer CHD deaths, was attributable to medical and surgical treatments. Approximately 35% (28–41%) of the mortality fall corresponding to 26,300 (21,200–31,000) fewer CHD deaths, was attributable to risk factor changes in the population, 24% (20–29%) corresponding to 18,400 (15,100–21,900) fewer and 11% (8–14%) corresponding to 8400 (60,500–10,600) fewer from decreased systolic blood pressure (8.87 mm Hg) and smoking prevalence (14.0%). However, increased levels of cholesterol (0.28 mmol/L), body mass index (BMI) (0.68 kg/m2), and diabetes prevalence (1.6%) attenuated the decrease in mortality by 2% (1–3%), 3% (2–3%), and 4% (1–6%), respectively. Conclusions Japan should continue their control policies for blood pressure and tobacco, and build a strategy to control BMI, diabetes, and cholesterol levels to prevent further CHD deaths

Interaction Rating Scale (IRS) as an Evidence-Based Practical Index of Children’s Social Skills and Parenting

Background: The purpose of this paper is to describe the features of the Interaction Rating Scale (IRS) as an evidence-based practical index of children’s social skills and parenting.Methods: The participants in our study, which was conducted as part of a Japan Science and Technology Agency (JST) project, were 370 dyads of children (aged 18, 30, and 42 month) and 81 dyads of 7-year-old children with their caregivers. The participants completed the five minute interaction session and were observed using the IRS.Results: The results indicated that the IRS can measure children’s social skill development and parenting with high validity. Along with the discriminate validity for pervasive development disorder (PDD), attention-deficit/hyperactivity disorder (ADHD), abuse and maltreatment, a high correlation with the SDQ (Strength and Difficulties Questionnaire), and high reliability, the IRS is effective in describing features of social skill development.Conclusions: The IRS provides further evidence of the fact that in order to study children’s social skill development, it is important to evaluate various features of the caregiver-child interaction as a predictor of social skills

Detection of the Onset of Ischemia and Carcinogenesis by Hypoxia-Inducible Transcription Factor-Based In Vivo Bioluminescence Imaging

An animal model for the early detection of common fatal diseases such as ischemic diseases and cancer is desirable for the development of new drugs and treatment strategies. Hypoxia-inducible factor 1 (HIF-1) is a transcription factor that regulates oxygen homeostasis and plays key roles in a number of diseases, including cancer. Here, we established transgenic (Tg) mice that carry HRE/ODD-luciferase (HOL) gene, which generates bioluminescence in an HIF-1-dependent manner and was successfully used in this study to monitor HIF-1 activity in ischemic tissues. To monitor carcinogenesis in vivo, we mated HOL mice with rasH2 Tg mice, which are highly sensitive to carcinogens and are used for short-term carcinogenicity assessments. After rasH2-HOL Tg mice were treated with N-methyl-N-nitrosourea, bioluminescence was detected noninvasively as early as 9 weeks in tissues that contained papillomas and malignant lesions. These results suggest that the Tg mouse lines we established hold significant potential for monitoring the early onset of both ischemia and carcinogenesis and that these lines will be useful for screening chemicals for carcinogenic potential

The relationship between the development of social competence and sleep in infants: a longitudinal study

BackgroundMany reports argue that sleep is important for children’s health, learning, and academic performance. The purpose of this longitudinal study was to examine the association between sleep and the development of social competence in infants.MethodsThis study was conducted as part of a Japan Science and Technology Agency (JST) project. Caregivers responded to the Japan Children’s Study Sleep Questionnaire when children were 18 months old. The interactions of caregivers and children were observed when children were 18, 30, and 42 months old, and rated with the Interaction Rating Scale, which is a measure of social competence.ResultsNocturnal sleep duration of more than 10 h and an earlier bed time than 22:00 were significantly correlated with two trajectory groups (low point and high point transition groups) of children’s social competence at 18, 30, and 42 months. Further, total sleep duration of more than 12.25 h and an earlier bed time than 22:00 were significantly correlated with the trajectory of children’s social competence at 18, 30, and 42 months.ConclusionsSleep duration and sleep onset time are important factors in children’s development of social competence

Development of a Japanese version of the BREAST-Q and the traditional psychometric test of the mastectomy module for the assessment of HRQOL and patient satisfaction following breast surgery

BACKGROUND:　 An understanding of health-related quality of life (HRQOL) is of utmost importance in both oncological and esthetic breast surgery. The BREAST-Q is a patient-reported outcome (PRO) measure that investigates HRQOL and patient satisfaction before and after breast surgery. The aim of this study was to develop a Japanese version of the BREAST-Q including the mastectomy module, the reconstruction module, the augmentation module and the reduction/mastopexy module, and to assess the psychometric properties of the mastectomy module among Japanese women.　 METHODS:　 The Japanese version of the BREAST-Q was developed through forward translation, backward translation and patient testing. Traditional psychometric testing of the mastectomy module was administered to 45 post-mastectomy patients.　 RESULTS:　 The mastectomy, reconstruction, augmentation and reduction/mastopexy modules were formally developed into Japanese. Despite cultural difference between Japanese women and original target population, the contents were considered to be valid among Japanese woman. With the exception of the sexual well-being subscale, good reliability and validity were evident for the mastectomy module (Test-retest reliability 0.76-0.95, Chronbach's alpha coefficient 0.77-0.98).　 CONCLUSIONS:　 The BREAST-Q Japanese version is a useful PRO measure for investigating the impact of breast surgery on HRQOL and patient satisfaction. Further validation in younger Japanese women is needed to determine the usefulness of the sexual well-being subscale