BACKGROUND: No previous study reported an association between paternal involvement in childcare and housework and maternal physical punishment. METHODS: Using data from the Japanese Longitudinal Survey of Newborns in the 21st century (N = 38,554), we analyzed responses about fathers' involvement in childcare and housework at 6 months and mothers' spanking of children at 3.5 years. Fathers' involvement in childcare and housework was scored and categorized into quartiles. Spanking frequency was asked in the "often", "sometimes", or "not at all" categories. Multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the mothers' often spanking children were computed for the fathers' involvement in childcare and housework. We also stratified the association by fathers' working hours (40-49, 50-59, or ≥ 60 hours/week). RESULTS: Among the 16,373 respondents, the proportion of mothers who often spanked their children was 4.8%. Compared with the lowest quartile, a higher frequency of paternal involvement in housework was associated with a lower risk of spanking children (p trend = 0.001). Adjustment for covariates attenuated the association, but significant association was observed in the 3rd quartile of paternal involvement in housework [OR (95% CI): 0.77 (0.62-0.96)]. When the fathers worked fewer than 50 hours a week, a significant negative association was observed between the fathers' frequency of childcare and the likeliness of the mothers' spanking their children (p trend = 0.02). CONCLUSIONS: The fathers' active involvement in childcare and housework could reduce the mothers' physical punishment for their children.

BACKGROUND: Some studies conducted in the United Kingdom have shown long-term associations between paternal involvement in childcare and adolescents' mental health issues. However, findings were inconsistent, and similar epidemiologic studies have not been conducted in other countries in Europe or Asia. Thus, we aimed to examine this association using Japanese population-based cohort study data. METHODS: The Japanese Longitudinal Survey of Newborns in the 21st Century commenced in 2001. Data from 18,568 16-year-olds enrolled in the survey were analyzed. Poor psychological well-being was assessed using the WHO-5 Well-being Index. Paternal involvement in childcare-in tasks such as changing diapers-was assessed at the children's 6 months of age. We created four groups from least involvement to most active involvement based on the frequency of fathers' performing the tasks. RESULTS: The risk of poor psychological well-being was lower among more active involvement groups compared with the least involvement group, after adjusting for potential confounders (risk ratios = 0.90 [95 % confidence intervals: 0.85, 0.95] for the most active group). LIMITATIONS: Due to 16 years of follow-up, loss to follow-up may have caused a selection bias. CONCLUSIONS: Our study is the first in Asian countries to show that fathers' active involvement in childcare is associated with poor psychological well-being in adolescence. Encouraging fathers' involvement in childcare may ameliorate prevalent issues of school refusals and withdrawals in the long term in Japan.

BACKGROUND: Father's closeness and playful behavior influence a child's emotional and cognitive development. In this study, we aimed to assess the long-term association of paternal involvement in childcare at 1-3 years of life on subsequent behavioral outcomes at 8 years of age. METHODS: Data were obtained from the 2010 cohort of the Longitudinal Survey of Newborns in the 21st century in Japan. We used group-based trajectory modeling to predict the trajectory of total childcare scores in surveys 1, 2 and 3 to determine the overall involvement of fathers in childcare during early childhood. The level of fathers' involvement in childcare was categorized as "low", "medium" and "high". Responses from the eighth survey were used to assess child behavioral outcomes using five indicators when the child was 8 years old. Crude and adjusted logistic regression analysis was conducted to estimate the odds ratio (OR) separately for each of the behavioral outcomes of the child. RESULTS: Among the 17,027 father-child dyads included in this study, two-thirds of the fathers were of the age group 30-39 years. Compared to low involvement, children of fathers with high involvement in childcare during the early childhood years were less likely to not want to go to school even after adjusting for covariates (adjusted OR, 0.46; 95% CI: 0.32-0.66). CONCLUSIONS: Children benefit from their fathers' involvement in early childcare activities. To improve a child's well-being, fathers should be encouraged by providing them with a suitable working environment with flexible arrangements and the opportunity to involve in childcare.

OBJECTIVES: The demand on Japanese women to fulfill their dual roles as mothers and labor force participants leads to a subsequent reduction of their employment hours, switching of occupations, or quitting the labor force. This study aims to examine paternal factors associated with mothers' employment status 18 months after childbirth. METHODS: We used data from the 2010 cohort of the Longitudinal Survey of Newborns conducted in Japan. We restricted our analysis to 10 712 mothers who had full-time employment 1 year before childbirth. A logistic regression analysis was conducted to assess paternal factors associated with mothers' employment after childbirth. RESULTS: One-third of the mothers with full-time employment before childbirth were not working full-time 18 months after delivery. We found that high childcare involvement (score 13-18) of fathers (OR, 1.20; 95% CI, 1.01-1.43) and fathers with part-time employment (OR, 1.59; 95% CI, 1.12-2.26) were associated with higher odds of mothers' full-time employment. Fathers' weekly work of ≥60 h (OR, 0.79; 95% CI, 0.71-0.88) and higher annual income decreased the odds ratios by over 20%. CONCLUSIONS: Fathers' work arrangements and involvement in childcare play a key role in helping mothers resume employment postchildbirth.

OBJECTIVES: We examined the associations of perceived psychosocial safety climate (PSC) with psychological distress and work engagement in Japanese employees. We also examined the mediation effects of job demands (i.e., psychological demands) and job resources (i.e., job control, worksite support, and extrinsic reward) in these associations. METHODS: A total of 2200 employees (1100 men and 1100 women) registered with a Japanese online survey company were surveyed using a self-administered web-based questionnaire containing the scales on PSC (12-item PSC scale), job demands and job resources (Job Content Questionnaire and Effort-Reward Imbalance Questionnaire), psychological distress (K6 scale), and work engagement (9-item Utrecht Work Engagement Scale), and items on demographic and occupational characteristics (i.e., age, sex, education, occupation, work form, and working hours per week). A multiple mediation analysis with a bootstrap method was conducted. RESULTS: After adjusting for demographic and occupational characteristics, significant negative and positive total effects of perceived PSC were observed on psychological distress and work engagement, respectively (c = -0.258 [95% confidence interval (CI): -0.298 to -0.219] and 0.383 [95% CI: 0.344-0.421], respectively). When we included job demands and job resources as mediators in the model, significant total mediation effects in these associations were observed (c - c' = -0.181 [95% CI: -0.221 to -0.143] and 0.269 [95% CI: 0.234-0.304], respectively). CONCLUSIONS: Our findings suggest that perceived PSC is negatively associated with psychological distress and positively associated with work engagement, and that these associations are partially mediated (or explained) by job demands and job resources.

OBJECTIVE: We examined the prospective association of low adaptation to management philosophy with refraining from seeking medical care (RSMC) among Japanese employees in a company with a management philosophy of "pursuing employees' well-being." METHODS: We surveyed 2791 employees (2059 men and 732 women) from two factories of a Japanese manufacturing company following the management philosophy of "pursuing employees' well-being." Using a self-administered questionnaire, we measured adaptation to management philosophy at baseline and RSMC at a one-year follow-up. We conducted robust Poisson regression analysis. RESULTS: Low adaptation to management philosophy was significantly associated with RSMC (incidence-rate ratio = 1.17 [95% confidence interval: 1.03-1.35]). CONCLUSIONS: Adaptation to management philosophy may be an important factor associated with the decision of employees working at a company following the "pursuing employees' well-being" management philosophy to seek medical care for their perceived health issues.

BACKGROUND: Pregnancy discrimination in the workplace is prevalent worldwide. However, few studies have examined the effects of pregnancy discrimination on mothers' perinatal mental health. We aimed to investigate the association between pregnancy discrimination and postpartum depressive symptoms, and the mediation effects of prenatal depressive symptoms on this association. METHODS: Our sample consisted of 285 Japanese women employed during pregnancy who completed a baseline online survey in May 2020 and a follow-up mail survey two months postpartum. Pregnancy discrimination was defined as exposure to any of 16 forms of disadvantageous treatment or harassment related to pregnancy, prohibited by national guidelines. Prenatal (assessed at baseline) and postpartum (assessed at follow-up) depressive symptoms were measured using the Edinburgh Postnatal Depression Scale. Multiple linear regression and mediation analyses were performed overall and stratified by regular (permanent) and non-regular (precarious) employees. RESULTS: Overall, 23.9% of participants experienced pregnancy discrimination during pregnancy. After adjusting for potential confounders, pregnancy discrimination was significantly associated with postpartum depressive symptoms (coefficient 1.76, 95% confidence interval [CI] 0.65-2.88). When stratified by employment type, these effects were observable among non-regular employees (coefficient 2.51, 95% CI 0.45-4.57) but not regular employees. Mediation analysis showed that prenatal depressive symptoms mediated 57.1% (95% CI 20.1-94.1%) of the association between pregnancy discrimination and postpartum depressive symptoms among all participants, with a greater effect among non-regular employees (64.1% [95% CI 18.5-109.8%]). CONCLUSIONS: Pregnancy discrimination has adverse effects on postpartum depressive symptoms, partially through prenatal depressive symptoms, especially among non-regular employees. To prevent perinatal depression in female workers, employers should comply with legislation and take preventive measures against pregnancy discrimination, while considering vulnerable employees.

OBJECTIVE: There is little evidence that workplace social support can relieve workers' mental health problems. Therefore, we examined whether social support from coworkers and supervisors was associated with reduced serious psychological distress among employees. METHODS: We used two-wave panel data from 13 Japanese companies. The baseline survey was conducted in 2011, and the follow-up survey 1 year later. From 9,889 respondents, we selected 759 who had psychological distress at baseline, defined as ≥13 on the Kessler Psychological Distress scale (K6). RESULTS: Increased coworker support was significantly associated with employees' reduced psychological distress [odds ratio (OR) 3.51, 95% CI 2.17-5.68]. The association between increased supervisor support and reduced psychological distress was nonsignificant [OR 1.32, 95% CI 0.85-2.04]. CONCLUSION: Encouraging coworker support may contribute to the secondary prevention of mental health problems among employees.

Objectives Recently, paternal involvement in childcare has been gaining public attention in Japan. However, studies on the influences of active paternal involvement remain scarce. This study aimed to review the findings on the influence of paternal involvement in childcare on mothers, children, and fathers themselves from studies conducted in Japan and published mainly after 2010. Additionally, we examined methodological issues that need to be addressed when researchers conduct studies on paternal involvement in the future.Methods We reviewed 26 journal articles (22 in Japanese and 4 in English) from four databases: "Igaku Chuo Zasshi Web (Japana Centra Revuo Medicina History and Activities)," JSTPlus, JMEDPlus, and PubMed with conditions such as studies conducted in Japan, families with young children, and questionnaire-based quantitative studies. We described respondents (mothers, fathers, or both) and assessed paternal involvement in childcare, outcomes, and findings.Results We reviewed studies on paternal involvement in childcare published in Japanese after 2010 and English after 2000 and observed two trends across the studies. The first was that if mothers acknowledge active paternal involvement in childcare, mothers' parenting stress seemed to be lower, and they seemed to be happier. Moreover, for children's health and development, active paternal involvement seemed to be associated with positive results, such as prevention of unintentional injuries and obesity. However, in the second trend, we observed that active paternal involvement, assessed by the fathers themselves, were often not associated with lower parenting stress among mothers. We also could not observe a consistent trend on the findings related to the influences on fathers, due to the limited number of studies. We observed that assessment of paternal involvement in childcare was inconsistent across studies included in this review.Conclusion With more social pressure for fathers to be actively involved in childcare, public interest for the influence would be heightened. For future studies, better ways of assessing the quantity and content of paternal involvement in childcare need to be discussed.

BACKGROUND: Even though fathers participate in childcare at a higher rate than before, there remains a lack of research on the factors that contribute to parenting stress among fathers. This study explored the socioeconomic and demographic factors associated with parenting stress among fathers of preschool children. METHODS: Our study included 17 645 fathers who participated in the 2016 Comprehensive Survey of Living Conditions in Japan. Parenting stress was assessed using a single question. Socioeconomic and demographic factors were predictors. Logistic regression analysis was conducted to estimate the odds ratio (OR) and 95% confidence interval (CI) for parenting stress. RESULTS: Overall, 6.6% fathers experienced parenting stress. Fathers with a youngest child aged 0-2 years were more likely to experience parenting stress than those with a youngest child aged 3-6 (OR: 1.45, 95% CI: 1.25-1.68). Compared with fathers who lived in two-parent households without grandparents, those who lived in single-father households (both with and without grandparents) were more likely to experience parenting stress (OR: 12.13, 95% CI: 5.60-26.29 and OR: 4.19, 95% CI: 2.04-8.60, respectively). Furthermore, there was a significant negative association between education and parenting stress. CONCLUSIONS: Having a child aged 0-2 years, single fatherhood, and higher education were associated with parenting stress among fathers of preschool children. Healthcare professionals need to be aware of these factors when supporting fathers in raising their children.

The 12-item psychosocial safety climate scale (PSC-12) has been used extensively in previous research, but its reliability and validity in a Japanese context are still unknown. We examined the psychometrics of the Japanese version of the PSC-12 (PSC-12J). The PSC-12J and scales on the relevant variables were administered to 2200 employees registered with an online survey company. A follow-up survey with 1400 of the respondents was conducted two weeks later. Internal consistency and test-retest reliability were examined via Cronbach's alpha and Cohen's weighted kappa coefficients, respectively. Structural, convergent, and known-group validities were examined using confirmatory factor analysis (CFA) and item response theory (IRT) analysis, correlation analysis, and Kruskal-Wallis test, respectively. Cronbach's alpha and Cohen's weighted kappa coefficients were 0.97 and 0.53, respectively. CFA based on the four-factor structure established in the previous literature showed an acceptable model fit. IRT analysis showed that each item was an adequate measure of the respondent's latent trait. Correlations of the PSC-12J with the relevant variables and distribution of scores by demographic characteristics were also observed in the theoretically expected directions, supporting the construct validity of the PSC-12J. Our findings establish the PSC-12J as a reliable and valid measure of the psychosocial safety climate construct in the Japanese context.

Fathers' involvement in childcare has been increasing in recent years. However, very little is known about the health impact on fathers when they are caring for or living with a disabled child. This study aims to understand the psychological distress and subjective health outcomes among fathers living with a disabled child compared to fathers living without a disabled child. Data for this study were obtained from the Comprehensive Survey of the Living Conditions conducted by the Ministry of Health, Labour and Welfare in 2016. Multivariable logistic regression was used among 438 disabled-child and father dyads and 27,682 non-disabled-child and father dyads to analyse the association between a child's disability status with father's health outcomes. Fathers of disabled children had a higher prevalence of psychological distress (17% vs. 12%) and poor subjective health status (13% vs. 8%) than fathers of non-disabled children. A large proportion of disabled children were boys (70%) and had disability level 1 (47%). After adjusting for covariates, the odds ratio (OR) of having psychological distress (OR, 1.53; 95% CI, 1.19-1.97) and poor subjective health status (OR, 1.78; 95% CI, 1.34-2.36) among fathers of disabled children is significantly higher compared to fathers of non-disabled children. Unemployed fathers had a higher odds ratio of psychological distress (OR, 3.07; 95% CI, 2.49-3.79) and poor subjective health status (OR, 4.90; 95% CI, 3.95-6.09) compared to regular working fathers. Fathers of children with disabilities need greater physical and mental health and wellbeing support. They should be provided with additional support not just for their mental but also their subjective wellbeing.

BACKGROUND: In Japan, ten percent of single-parent households are led by fathers. Taking care of children as a single father is very stressful and could put a strain on their health. It is very important to prevent and identify psychological distress among fathers for both their own health and to avoid negative impacts on children. This study aims to determine the prevalence of, and factors associated with psychological distress among single fathers and understand how it is different from partnered fathers. METHODS: We used data from the Comprehensive Survey of Living Conditions 2016. Psychological distress, assessed using the K6 scale, was analysed among 868 single and 43,880 partnered fathers. Logistic regression analysis was performed to assess the risk factors for psychological distress such as employment type, sleep hours, smoking and drinking habits. RESULTS: Single fathers had a higher proportion (8.5%) of psychological distress compared to partnered fathers (5.0%). A large percentage of single fathers had a lower educational level and were non-regular workers, self-employed or unemployed, compared to partnered fathers. Among single fathers, the crude and adjusted odds ratio for employment type and sleep hours were significantly associated with psychological distress. CONCLUSION: As single parents who are self-employed or directors are likely to have significantly reduced psychological distress than those with regular jobs, measures are needed to improve the work-family balance for non-self-employed fathers. There is a need to provide assistance to improve the quality and amount of sleep of single fathers to ensure their and their children's good health.

OBJECTIVE: To investigate the association between individual adaptation of management philosophy and mission statement, and work engagement among employees in a single Japanese company. METHODS: We carried out a 1-year prospective cohort study on all workers aged 18 to 65 years in a Japanese electrical components manufacturer. Our cohort included 2044 men and 721 women. We used multiple regression analysis to examine associations between variables. RESULTS: Higher individual adaptation of management philosophy and mission statement at baseline was significantly associated with better work engagement at follow-up after adjusting for potential confounders and work engagement at baseline (β = 0.085, 95% confidence interval 0.054 to 0.117). CONCLUSIONS: There is a positive association between higher individual adaptation of management philosophy and mission statement with work engagement.

OBJECTIVE: We examined the association of organizational justice (i.e., procedural justice and interactional justice) with cognitive failures, and the mediation effect of psychological distress on this association in Japanese employees. METHODS: A total of 189 men and 35 women from two sites of a manufacturing company in Japan were surveyed using a self-administered web-based questionnaire. A multiple mediation analysis was conducted. RESULTS: A significant negative total effect of procedural justice on cognitive failures was observed (c = -0.180 [95% confidence interval: -0.315 to -0.044]). Furthermore, the mediation effect of psychological distress was significant (c-c' = - 0.213 [95% confidence interval: -0.323 to -0.115]). Similar patterns were observed for interactional justice. CONCLUSIONS: Employees may be more likely to experience cognitive failures in daily activities in work settings where organizational justice is lower, which seems to be explained by psychological distress.

BACKGROUND: Many wage earners in developed countries have irregular shift patterns and work evenings, nights, and weekends. Some studies have demonstrated that the nonstandard work schedules of parents have adverse effects on their children's weight, specifically leading to or worsening obesity. However, no such study has been conducted in adolescents of high school age. This study examined the association between mothers' nonstandard work schedules and adolescent obesity. METHODS: A cross-sectional study of adolescents aged 16-17 years (n = 1743) used paired matches of self-administered questionnaires for adolescents and their mothers from Tokyo, Japan. Obesity was defined by International Obesity Task Force cut-offs. Nonstandard work schedules were defined as working early mornings, nights, overnights, or weekends. Chi-square tests were conducted to examine the association between the mothers' work schedules and their adolescent children's poor lifestyles, overall and stratified by income levels. Then, logistic regression analyses were conducted to examine the association between mothers' work schedules and obesity of their adolescent children, overall and stratified by income levels. RESULTS: Overall, 6.5% of adolescents had obesity. The prevalence of obesity was higher among adolescents from low-middle income groups (8.2%) than that among those from high-income groups (5.9%). No clear patterns were found between mothers' work schedules and adolescents' poor lifestyles when stratified by income levels. Mothers' nonstandard work schedules were significantly associated with adolescent obesity (odds ratio [OR]: 1.56, 95% confidence interval [CI]: 1.02-2.40). However, this association was not significant after adjustment for confounders. After stratification by income levels, mothers' nonstandard work schedules significantly associated with their children's obesity (OR: 2.93, 95% CI: 1.45-5.92) only in high-income groups. This association remained after adjustment of the adolescents' lifestyles and their mothers' working hours. CONCLUSIONS: Our results suggest that mothers' nonstandard work schedules have adverse effects on adolescent obesity only in high-income families. Low-middle income families experienced higher levels of adolescent obesity, regardless of the mothers' work schedules. Policy makers should consider mothers' work schedules as a factor in preventing adolescent obesity.

OBJECTIVES: Maternity harassment, known in English as pregnancy discrimination, remains prevalent in developed countries. However, research examining the mental health effects of maternity harassment is lacking. We aimed to examine the association between maternity harassment and depression during pregnancy in Japan. METHODS: A cross-sectional Internet survey was conducted on 359 pregnant employees (including women who were working at the time their pregnancy was confirmed) from May 22 to May 31, 2020, during which time a COVID-19 state of emergency was declared. Maternity harassment was defined as being subjected to any of the 16 adverse treatments prohibited by national guidelines. Depression was defined as a score of ≥9 on the Edinburgh Postnatal Depression Scale (Japanese version). Logistic regression analysis was performed. RESULTS: Overall, 24.8% of the pregnant employees had experienced maternity harassment by supervisors and/or colleagues. After adjusting for demographics, pregnancy status, work status, and fear of COVID-19, pregnant employees who experienced maternity harassment were more likely to have depression than those who did not (odds ratio 2.48, 95% confidential interval 1.34-4.60). This association was not influenced by whether they were teleworking or not as a COVID-19 measure. CONCLUSIONS: One quarter of pregnant employees experienced maternity harassment and had a higher prevalence of depression than those who did not. Being physically away from the office through teleworking may not reduce the effect of maternal harassment on depression. To protect the mental health and employment of pregnant women, employers should comply with the laws and take measures to prevent maternity harassment.

OBJECTIVE: We carried out a prospective study to investigate the association between work engagement and work performance in a group of Japanese workers. METHODS: Our cohort included 1632 men and 192 women aged 65 years or younger who worked at a manufacturing company in Japan. Multiple regression analysis was conducted. RESULTS: Higher work engagement at baseline was significantly associated with better work performance at follow-up (β = 0.159, P < 0.001). A sex-stratified analysis showed that the impact of work engagement at baseline on work performance at follow-up was stronger among women than among men (β = 0.242, P < 0.001 and β = 0.153, P < 0.001, respectively). CONCLUSIONS: Higher work engagement may have beneficial effects on work performance. The impact of work engagement on work performance may be greater among women than among men.

OBJECTIVES: We examined the association of workplace social capital (WSC), including structural and cognitive dimensions, with refraining from seeking medical care (RSMC) among Japanese employees. DESIGN: One-year prospective cohort study. SETTING AND PARTICIPANTS: We surveyed 8770 employees (6881 men and 1889 women) aged 18-70 years from 12 firms in Japan using a self-administered questionnaire comprising the WSC scale and the items on potential confounders (ie, age, educational attainment and equivalent annual household income) at baseline (from April 2011 to March 2013). OUTCOME MEASURES: At a 1-year follow-up, we measured RSMC using a single-item question 'In the past year, have you ever refrained from visiting a hospital, clinic, acupuncturist or dentist despite your sickness (including a slight cold or cavity) or injury?' RESULTS: The results of Cox regression with robust variance showed that, after adjusting for potential confounders, the low WSC group (ie, the lowest tertile group) had a significantly higher relative risk (RR) of RSMC compared with the high WSC group (ie, the highest tertile group) among both men and women (overall WSC: RR 1.09 (95% CI 1.01 to 1.17) and 1.20 (95% CI 1.06 to 1.37); structural dimension: RR 1.13 (95% CI 1.04 to 1.22) and 1.25 (95% CI 1.07 to 1.45); and cognitive dimension: RR 1.11 (95% CI 1.03 to 1.20) and 1.21 (95% CI 1.06 to 1.38), respectively). Trend analysis using a continuous score of the WSC scale also showed a significant association of low WSC with a higher risk of RSMC among both men and women. CONCLUSIONS: Our findings suggest that the lack of social capital in the workplace is associated with RSMC among Japanese employees.

BACKGROUND: Although several studies have examined the association between occupational stress and turnover, these studies relied on cross-sectional designs, subjects' self-report, healthcare workforce, or small sample sizes. This study aimed to confirm whether occupational stress increases the risk of turnover in a large-scale prospective cohort study using actual turnover data from company records. METHODS: The participants were 3892 male and 5765 female employees aged 20-49 years in a financial service company. We followed them from October 2012 until April 1, 2016 and used company records to identify employees who resigned. We identified employees with high and low stress using the Brief Job Stress Questionnaire. Hazard ratios for turnover in high-stress employees were estimated using Cox proportional hazards models, and population attributable risks were calculated separately for men and women. RESULTS: During 11,475,862 person-days, 122 men and 760 women resigned. After adjustment for age, length of service, job type, and position, the hazard ratios (95% confidence intervals) for turnover in high-stress employees were 2.86 (1.74-4.68) for men and 1.52 (1.29-1.78) for women. The corresponding population attributable risks for high stress were 8.2% for men and 8.3% for women. The component scores, i.e., job stressors, psychological/physical stress response, workplace social support, and job strain (the combination of high job demands and low job control) were also significantly associated with turnover (p < 0.05). CONCLUSIONS: Occupational stress increases the risk of actual turnover. Measures to prevent occupational stress may be useful to prevent employee turnover.

目的 子ども食堂はボランティア等に運営され、子どもの社会的包摂に向けた共助のしくみとして注目されている。主なターゲット層である小・中学生の保護者を対象とした子ども食堂の認知に関する調査により、子ども食堂の地域における活用に関連する要因を明らかにすることを目的とした。方法 小学校1年生から中学校3年生の保護者3,420人(平均年齢42.6歳)を対象に、2018年10月にインターネット調査を実施した。属性、子ども食堂の認知と認識、利用経験、今後の利用希望とその理由を質問項目とした。対象者を二人親低所得(世帯年収400万円未満)世帯父親、二人親中高所得(400万円以上)世帯父親、二人親低所得世帯母親、二人親中高所得世帯母親、ひとり親世帯父親、ひとり親世帯母親に分け、群間の差はχ2検定により検定を行った。結果 子ども食堂の認知割合は全体の69.0%で、男性に比べ女性で高く、とりわけ二人親中高所得世帯母親で79.7%と高かった(P<0.001)。メディアで子ども食堂を知った者が87.5%で、子どもが一人でも行けるところ・無料または数百円で食事を提供するところ・地域の人が関わって食事を提供するところという認識や、安い・賑やか・明るいなどポジティブなイメージを持つ者が多かった。しかし、子ども食堂を知っている者のうち、子ども食堂に本人もしくはその子どもが行ったことのある者はそれぞれ4.5%、6.3%であった。今後、子ども食堂に子どもを行かせてみたいと思うと回答した者は全体の52.9%で、世帯構成による利用希望に違いがみられ、低所得世帯とひとり親世帯母親では利用希望者が過半数である一方、中高所得世帯とひとり親世帯父親では過半数が利用希望しなかった(P<0.001)。その主な理由として、必要がない・家の近くに子ども食堂がない・家で食事をしたいなどがあったが、少数意見として生活に困っていると思われたくない・家庭事情を詮索されそう・恥ずかしいという理由があった。また、中高所得世帯では子ども食堂にかわいそうというイメージを持つ者が多かった。結論 本研究の小・中学生の保護者は子ども食堂に対してポジティブ・ネガティブの両方の認識をしており、その内容は世帯状況により異なっていた。理解の定着と普及のためには子ども食堂への負のイメージの払拭や子ども食堂へのアクセスの確保などの対応が必要と思われる。(著者抄録)

BACKGROUND: Using a one-year prospective design, we examined the association of job dissatisfaction with long-term sickness absence lasting one month or more, before and after adjusting for psychosocial work environment (i.e., quantitative job overload, job control, and workplace social support) in Japanese employees. METHODS: We surveyed 14,687 employees (7,343 men and 7,344 women) aged 20-66 years, who had not taken long-term sickness absence in the past three years, from a financial service company in Japan. The Brief Job Stress Questionnaire, including scales on job satisfaction and psychosocial work environment, was administered, and information on demographic and occupational characteristics (i.e., age, gender, length of service, job type, and employment position) was obtained from the personnel records of the surveyed company at baseline (July-August 2015). Subsequently, information on the start dates of long-term sickness absences was obtained during the follow-up period (until July 2016) from the personnel records. Cox's proportional hazard regression analysis was conducted. RESULTS: After adjusting for demographic and occupational characteristics, those who perceived job dissatisfaction had a significantly higher hazard ratio of long-term sickness absence than those who perceived job satisfaction (hazard ratio=2.91; 95% confidence interval, 1.74-4.87). After additionally adjusting for psychosocial work environment, this association was weakened and no longer significant (hazard ratio=1.55; 95% confidence interval, 0.86-2.80). CONCLUSIONS: Our findings suggest that the association of job dissatisfaction with long-term sickness absence is spurious and explained mainly by psychosocial work environment.

OBJECTIVES: This study examined the association between workplace rules and training programs regarding combining employees' work and treatment for chronic diseases, and actions actually taken by employees to manage this issue. These workplace measures (rules and training programs) are consistent with the Japanese Guideline for Workplace Patient Coordination and Disease Treatment. METHODS: In February 2018, we conducted an online, cross-sectional survey of 1134 employed individuals with chronic diseases who needed workplace support to combine work and disease treatment. All participants were aged 18-65 years and lived in Japan. We investigated associations between workplace rules and training programs (two items) and employee actions (eight items), using a questionnaire based on the guideline and logistic regression analysis. RESULTS: In total, 76.5% of the participants said they had reported their chronic disease to their employer (manager, personnel department, or occupational physician). However, less than half (47.5%) had submitted a written report about their job to their doctor. Employees were more likely to take action in workplaces that had rules or training programs than in workplaces without such measures. More actions were taken among employees in workplaces with both rules and training programs than in those with either measure alone. CONCLUSION: It is important to establish rules to support employees with chronic diseases and provide training to improve awareness of these rules to encourage employees with chronic diseases to take action to access the support they need.

BACKGROUND: Accumulating evidence has shown that high-quality early childhood education and care may be an effective way of promoting children's optimal health and development, especially for the most disadvantaged. However, socially disadvantaged families are less likely to enroll children in center-based childcare. In this study, we explored characteristics associated with use of center-based childcare among Japanese families. METHODS: We used data from two Japanese birth cohorts in 2001 (n = 17,019) and 2010 (n = 24,333). Enrollment in center-based childcare was assessed at the ages of three and four years in the 2001 cohort and at the age of three in the 2010 cohort. Logistic regression analyses were conducted. RESULTS: Children in the lowest quintile of household income were 1.54 (95% confidence interval, 1.20-1.98) times more likely to not receive center-based childcare than those in the highest-income quartile at the age of four in the 2001 cohort. Other socio-economic disadvantage (mother's low education, non-Japanese parent, and higher number of siblings) and child's health and developmental problems (preterm birth, congenital diseases, and developmental delay) were also associated with the non-use of center-based childcare at the age of three in the 2001 and 2010 cohorts. CONCLUSIONS: An inverse care law operates in the use of early childhood education (ie, children with the least need enjoy the highest access). Children with socio-economic, health, and developmental disadvantages are at a greater risk of not receiving early childhood education and care. Social policies to promote equal access to early childhood education are needed to reduce future socio-economic inequalities.

PURPOSE: This study examined the association between perceived organizational justice (i.e., procedural justice and interactional justice) and reporting of illness to one's company (illness reporting) among Japanese employees with chronic diseases. METHODS: This online cross-sectional survey included 1,134 employees (aged 18-65 years) who required workplace support to combine work with disease treatment. Participants were classified into tertiles of perceived organizational justice (low, moderate, and high). Multiple logistic regression analyses were conducted to examine sex differences in the associations between perceived justice and illness reporting. RESULTS: Males reporting perceived high levels of procedural and interactional justice had significantly higher odds of illness reporting than those with perceived low levels of procedural (odds ratio [OR] 2.62, 95% confidence interval [CI]: 1.47-4.66) and interactional justice (OR 4.34, 95% CI: 2.28-8.27). Females with perceived high levels of interactional justice had significantly higher odds of illness reporting than those with perceived low levels of interactional justice (OR 1.74, 95% CI: 1.08-2.80). There was no significant association between procedural justice and illness reporting among females. CONCLUSION: The findings indicate that high perceived organizational justice is positively associated with illness reporting among Japanese employees who require workplace support to combine work and disease treatment.

Objective: The aim of the current study was to validate the Japanese version of the family supportive supervisor behaviors (FSSB-J) measure. FSSB is conceptualized as a multidimensional, superordinate construct constituted of four dimensions: emotional support, instrumental support, role modeling behaviors, and creative work-family management. Methods: The Japanese translated and back-translated FSSB-J questionnaire was administered to 1,670 men and women aged 20-59 years who were registered with a Japanese online survey company in November 2017. Confirmatory factor analyses were performed to evaluate the factorial validity of the FSSB-J. Cross-time measurement invariance was tested using multi-group confirmatory factor analyses. Construct validity was assessed with the potential consequences of FSSB (e.g., work-family spillover, work engagement, intention to leave, job satisfaction, and psychological distress) and convergent validity was assessed using similar concepts (e.g., organizational justice and social support). Internal consistency and test-retest reliability were examined to evaluate the reliability of the four dimensions of the FSSB. Results: A series of confirmatory factor analyses using the multiple-group method revealed that the four-factor model fitted the data best. The latent factor structure demonstrated configural, metric, and scalar invariance across time. Construct and convergent validity were generally in line with expectations. Cronbach's α coefficient and test-retest reliability were sufficient for each of the four dimensions of the FSSB. Conclusion: This study suggests that FSSB-J is an adequate measure of FSSB in the Japanese context.

Background: Previous studies in the UK and Denmark found no significant association between low socioeconomic status (SES) and weight faltering. However, to our knowledge, there are no studies from other developed countries. We examined the association between parental SES and weight faltering in infants up to 1.5 years of age, and investigated whether the inequalities changed between 2001 and 2010 in Japan. Methods: We used data from two Japanese population-based birth cohorts started in 2001 (n = 34,594) and 2010 (n = 21,189). Parental SES was assessed as household income and parental education when the infant was 6 months old. Weight faltering was defined as the slowest weight gaining in 5% of all children in each cohort. Logistic regression analyses were conducted with adjustment for covariates. The relative index of inequality was used to assess relative impact of parental SES on weight faltering. Results: Infants in the lowest quartile of household income were 1.29 (95% confidence interval [CI]: 1.10, 1.52) and 1.27 (95% CI: 1.03, 1.56) times more likely to experience weight faltering than those in the highest income quartile both in the 2001 and 2010 cohorts, respectively. The relative index of inequality for household income was 1.66 (95% CI: 1.36, 1.96) in 2001 and 1.86 (95% CI: 1.42, 2.31) in 2010. Conclusions: Infants from lower income families have a greater risk of weight faltering in Japan. Additionally, the income-related inequalities in weight faltering did not change between the two cohorts. Social policies to address maldistribution of weight faltering due to household income are needed.

BACKGROUND: It remains unclear whether treatment of dyslipidemia with 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) reduces the risk of developing hypertension.
OBJECTIVE: In this post-hoc analysis of the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study, a large-scale primary prevention trial with pravastatin, we examined the preventive effect of pravastatin on the future development of hypertension in patients with hypercholesterolemia.
METHODS: Of the overall (MEGA) Study population, 3397 nonhypertensive patients at baseline were enrolled in this study. The patients were randomly assigned to either the diet alone group (n = 1722) or the diet plus pravastatin group (n = 1675) and then were followed-up for a median of 36 months to determine new-onset hypertension.
RESULTS: During the follow-up period, 1595 patients developed hypertension (49.1% in the diet alone group and 44.7% in the diet plus pravastatin group). After adjusting for multiple covariates, the diet plus pravastatin group showed a 10% reduction in the risk of developing hypertension (hazard ratio 0.90, 95% confidence interval 0.81-0.998), compared with the diet alone group. Subgroup analyses revealed that the preventive effect of pravastatin on the development of hypertension was pronounced in patients aged years, men, those with chronic kidney disease or diabetes mellitus and those without obesity.
CONCLUSIONS: Pravastatin reduced the risk of developing hypertension in Japanese patients with hypercholesterolemia. The risk reduction of cardiovascular disease with statins could be partly explained by their preventive effect on the development of hypertension. (C) 2017 National Lipid Association. All rights reserved.

Objective: Socioeconomic status as a determinant of mental health problems has received scant attention in Japan, which has long been considered an egalitarian society. This study examined the association between socioeconomic status and psychological distress and its trends over 6years among Japanese adolescents.
Methods: We used data from a nationally representative sample of 9491 adolescents aged 12-18years who participated in three repeated cross-sectional surveys between 2007 and 2013. The K6 scale was used to assess psychological distress. Socioeconomic status indicators included household income, parental education, parental working status and household structure.
Results: Psychological distress prevalence decreased significantly from 2007 (10.7%) to 2013 (7.6%). However, the socioeconomic status patterns of psychological distress were consistent through the study period. Adolescents living in both lower (odds ratio=1.61; 95% confidence interval=[1.27, 2.05]) and higher income households (odds ratio=1.30; 95% confidence interval=[1.03, 1.62]) were more likely to report psychological distress than their middle-income counterparts. Adolescents with low household income were more likely to feel stress from interpersonal relationships and less likely to have help-seeking behaviors, while those with high household income were more likely to feel stress about school achievement. Psychological distress was also associated with parental poor education and single parenthood.
Conclusions: Socioeconomic status disparities in adolescent psychological distress were evident and consistent during the 6-year period. There is a unique U-shaped relationship between household income and psychological distress among adolescents in Japan, unlike those from other countries. However, the underlying mechanisms may differ by income status. Future prevention efforts should consider socioeconomic status as a determinant of adolescent mental health problems.

Background: Japan's stagnant economy has produced increasing income disparities, and the effect of poverty on health and health-care utilization is a significant issue. Co-payments could be a trade-off for patients when seeking medical care and limit health-care utilization. We sought primary care physicians' experiences in dealing with financially deprived patients and their perspectives about reducing co-payments by low-income patients.
Methods: We used a convergent mixed-methods approach in a mail survey; it was distributed to 1989 primary care physicians practicing in areas with the highest proportions of socially disadvantaged individuals in Tokyo. The survey items included an open-ended question, seeking the participants' perspectives about reducing co-payments by low-income patients from the current 30%, and closed questions, asking their experience of patient behavior related to financial burdens during the previous 6 months.
Results: We analyzed the responses of 365 physicians. Sixty-two percent of the primary care physicians agreed with lowering co-payments for financially deprived patients; however, the remainder disagreed or were uncertain. Those who disagreed were less likely to have experienced patient behavior related to financial burdens. The participants suggested challenges and potential measures for reducing co-payments by low-income patients in light of tight governmental financial resources and rapidly increasing health-care expenditures in Japan. The physicians were also concerned about the moral hazard in health-care utilization among patients receiving social welfare who obtain care at no cost.
Conclusions: From their experience in having dealt with low-income patients, the majority of physicians were positive about lowering co-payments by such patients; the remainder were negative or uncertain. It may be necessary to raise awareness of patients' socioeconomic status among primary care physicians as a possible deterrent for seeking care. To maintain health-care equity, policy makers should consider balancing co-payments among individuals with differing financial levels and health-care needs.

The aim of this study was to develop a risk prediction model for incident hypertension in a Japanese male population. Study participants included 15,025 nonhypertensive Japanese male workers (mean age, 38.8±8.9 years) who underwent an annual medical checkup at a company. The participants were followed-up for a median of 4.0 years to determine new-onset hypertension, defined as a systolic blood pressure (BP) ⩾140 mm Hg, a diastolic BP ⩾90 mm Hg, or the initiation of antihypertensive medication. Participants were divided into the following two cohorts for subsequent analyses: the derivation cohort (n=12,020, 80% of the study population) and the validation cohort (n=3005, the remaining 20% of the study population). In the derivation cohort, a multivariate Cox proportional hazards model demonstrated that age, body mass index, systolic and diastolic BP, current smoking status, excessive alcohol intake and parental history of hypertension were independent predictors of incident hypertension. Using these variables, a risk prediction model was constructed to estimate the 4-year risk of incident hypertension. In the validation cohort, the risk prediction model demonstrated high discrimination ability and acceptable calibration, with a C-statistic of 0.861 (95% confidence interval 0.844, 0.877) and a modified Hosmer-Lemeshow χ2 statistic of 15.2 (P=0.085). A risk score sheet was constructed to enable the simple calculation of the approximate 4-year probability of incident hypertension. In conclusion, a practical risk prediction model for incident hypertension was successfully developed in a working-age Japanese male population.

Background: Socioeconomic status (SES) as a determinant of obesity has received scant attention in Japan. This study examined the association between SES and overweight among Japanese children and adolescents.
Methods: Cross-sectional analyses of a representative sample of Japanese children (6-11 years: n = 397) and adolescents (12-18 years: n = 397) were performed, with measured heights and weights from the 2010 National Health and Nutrition Examination Survey and the 2010 Comprehensive Survey of Living Conditions. Overweight, including obesity, was defined by International Obesity Task Force cut-offs. SES indicators included household income, equivalent household expenditure, parental educational attainment, and parental occupational class.
Results: Overweight prevalence was 12.3% in children and 9.1% in adolescents. Adolescents living in middle-income households were more likely to be overweight than those living in high-income households (OR 2.26, 95% CI, 1.01-5.67) after adjustment for age, sex, and parental weight status. Similarly, adolescents living in households with low expenditure levels were more likely to be overweight than those living in households with high expenditure levels (OR 3.40, 95% CI, 1.20-9.60). In contrast, no significant association was observed among children.
Conclusions: Our results indicated that low household economic status was associated with being overweight, independent of parental weight status, among Japanese adolescents.

Background: We aimed to examine whether serum levels of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, and C-reactive protein (CRP) are associated with the risk of developing metabolic syndrome in middle-aged men. Methods: In this longitudinal study, serum ADMA and CRP levels were measured in Japanese men without metabolic syndrome, which was diagnosed according to the currently accepted unified criteria. The subjects were followed-up for a maximum of four years to determine new-onset metabolic syndrome. A Cox proportional hazards model with adjusting for potential confounders was applied to determine the hazard ratio (HR) for developing metabolic syndrome according to serum levels of ADMA and CRP, considered either alone or in combination. Results: Of the 848 subjects (mean age, 43. ±. 6. years), 100 subjects developed metabolic syndrome. High ADMA levels (≥. 0.45. μmol/L) alone did not show a significant HR for developing metabolic syndrome, while high CRP levels (≥. 0.3. mg/L) did (HR 1.75, 95% CI 1.12-2.74). The combination of high levels of both CRP and ADMA had a high HR (2.09, 95% CI 1.12-3.76) as compared to low levels of both markers. In contrast, the HR was not significant in the combination of high CRP and low ADMA levels, as well as low CRP and high ADMA levels. Conclusions: Serum CRP, but not ADMA, levels were associated with the risk of metabolic syndrome. Nevertheless, the risk of metabolic syndrome could be predicted more reliably by considering these two markers together rather than CRP alone.

Objectives This study examines whether precarious employment increases the risk of serious psychological distress (SPD) in a nationally representative cohort of Japanese middle-aged people.
Methods From 2005-2009, we followed 8486 male and 6736 female participants (aged 50-59 years) in the Longitudinal Survey of Middle-aged and Elderly Persons. All individuals were employed and free of SPD, cardiovascular disease, and cancer at baseline. The participants were classified into two groups based on their baseline employment contract: precarious and full-time permanent work. SPD was assessed at each year during the study, using the K6 scale, a self-rated 6-item scale that screens for mood or anxiety disorders. We used discrete-time survival analysis, with a complementary log-log link, to examine the effect of precarious employment on SPD incidence.
Results During a maximum follow-up period of four years, 374 men and 364 women developed SPD. Male precarious employees were more likely to develop SPD than male full-time permanent employees (hazard ratio 1.79, 95% confidence interval 1.28-2.51) in the full model, after adjusting for sociodemographic and occupational factors, cardiovascular disease risk, and K6 scores at baseline. By contrast, no significant association was observed among female employees. However, an analysis stratified by marital status revealed an association similar to that found among men but only among unmarried women.
Conclusions The findings suggest that precarious employment is associated with double the risk of SPD incidence among middle-aged Japanese men and when stratified by marital status among unmarried women. This highlights a major gender difference in the association between precarious employment and risk of SPD.

BACKGROUND
The aim of this study was to examine the predictive value of serum cystatin C (CysC) and that of creatinine-based estimated glomerular filtration rate (eGFR(Creat)) for the risk of incident hypertension in a middle-aged male population.
METHODS
Serum CysC levels were measured in 904 nonhypertensive, Japanese male subjects (mean age = 44 +/- 6 years) who received an annual general health examination in a company. Serum creatinine levels were simultaneously measured, and eGFR(Creat) was calculated. Subjects were followed-up for a maximum period of 4 years, and annual blood pressure measurements were recorded.
RESULTS
During the follow-up period, 124 subjects developed hypertension, defined as systolic/diastolic blood pressure &gt;= 140/90 mmHg or use of antihypertensive medications. In the Kaplan-Meier analysis, both the third quintile of CysC and that of eGFR(Creat) showed the lowest 4-year cumulative incident rate of hypertension. The multiadjusted hazard ratio for incident hypertension was significantly increased in the highest quintile of CysC compared with the third quintile (2.60; 95% confidence interval (CI) = 1.41-4.77; P = 0.002), as well as compared with the lowest 4 quintiles combined (1.89; 95% CI = 1.26-2.84; P = 0.002). However, eGFR(Creat) did not show significant hazard ratios for incident hypertension in any of the adjusted models.
CONCLUSIONS
Elevated serum CysC levels could predict the risk of incident hypertension in this study population with a maximum follow-up period of 4 years. In contrast, eGFR(Creat) did not show predictive value for the risk of incident hypertension.

Objectives: The aim of this study was to examine whether the association between employment contract and self-rated health differs by household structure in a representative sample of employees in Japan. Methods: The participants were 81,441 male and 64,471 female employees aged 18-59 years who had participated in the 2010 Comprehensive Survey of Living Conditions. We assessed the interactive effect of employment contract (permanent or precarious) and household structure (couple only, couple with children, single parent, single person, or other multi-person) on fair/poor health, adjusting for covariates by using logistic regression. We then calculated the relative poverty rate by employment contract and household structure. Results: The interaction effect was significant for women (p&lt
0.001) but not for men (p=0.413). A higher percentage of female precarious workers who lived in single-parent households (20.2%) reported fair/poor health compared with those in other types of households (10.4-13.2%), although the prevalence of fair/poor health did not differ substantially by household structure among female permanent workers. The relative poverty rates of female precarious workers who lived in single-parent households were higher compared with those of other female workers. Conclusions: Our results suggest that female precarious workers are not a homogeneous group and that those living in single-parent households suffer from poor health due to low income and insufficient coverage by insurance firms and family-based safety nets.

AimIt has been controversial whether metabolic syndrome (MetS) is associated with depression. We aimed to clarify the correlation between MetS and depression, considering atypical features of depression.
MethodsParticipants were 1011 Japanese men aged 20-59 years. MetS was diagnosed according to criteria set by the International Diabetes Federation. Clinical interviews for major depressive disorder (MDD) employed the DSM-IV; MDD was classified into atypical and non-atypical types. The prevalence of MetS was compared between the groups with no MDD, atypical depression, and non-atypical depression via trend analyses. Multiple logistic regression analyses examined the association of MetS with atypical depression and the features thereof.
ResultsIn total, 141 (14.0%) participants were diagnosed with MetS and 57 (5.6%) were diagnosed with MDD (14 had atypical and 43 had non-atypicalMDD). The prevalence of MetS was the highest in the group with atypical depression, followed by the non-atypical depression and no MDD groups, respectively, with a marginally significant trend (P=0.07). The adjusted odds ratios of MetS associated with depression were 3.8 (95% confidence interval [CI] 1.1-13.2) for atypical depression and 1.6 (95%CI 0.7-3.6) for non-atypical depression. Among the five features of atypical depression, only hyperphagia was significantly related to MetS (odds ratio 2.7, 95%CI 1.8-4.1).
ConclusionThere was a positive association between MetS and atypical depression, but not between MetS and non-atypical depression. Specifically, hyperphagia seems to be an important factor affecting the correlation between MetS and atypical depression.

This study aimed to quantify the contributions of the factors that have influenced changes in income-related health inequalities. We used data from a nationally representative sample of Japanese men and women aged 20-59 years who participated in eight repeated cross-sectional surveys between 1986 and 2007. A concentration index (Cl) was used to measure income-related inequalities in self-rated health (SRH) and decomposed into contributing factors. We then examined temporal changes in CIs and their contributing factors. Results showed that income-related inequalities in SRH, unfavourable to low-income groups, persisted throughout the study period. Despite widening income inequalities, inequalities in SRH narrowed during the period of economic stagnation since the late 1990s because of the profound deterioration in SRH among middle- to high-income groups. Decomposition analysis showed that income itself and unemployment or economic inactivity were the most important contributors to inequalities in SRH for both sexes at almost all time points. However, from 1986 to 2007, the relative contribution of income to these inequalities decreased from 78% to 14% in men and from 85% to 38% in women. By contrast, the relative contribution of unemployment or economic inactivity increased from 18% to 77% in men and from 10% to 31% in women. Our results suggest that a reduction in avoidable health inequalities could be achieved by reducing the influence of unemployment or economic inactivity on health. (C) 2012 Elsevier Ltd. All rights reserved.

Objective: We assessed the cross-sectional association between sleep duration and untreated diabetes in Japanese men.
Methods: Participants included 20,744 men aged 30-64 years who first visited the general hospital in Tokyo for routine health assessments during 2003-2007. Untreated diabetes was defined as not being under diabetes treatment and fasting blood glucose of &gt;= 126 mg/dL or hemoglobin A(1c) of &gt;= 6.5%. Sleep duration (&lt;= 5, 6, 7, or &gt;= 8 h) and confounders were assessed using a questionnaire. Logistic regression was used to calculate odds ratios (ORs) for diabetes after adjustment for confounders.
Results: The prevalence of untreated diabetes was 3.4% in all men. The prevalence of untreated diabetes by sleep duration was as follows: &lt;= 5 h: 3.5%; 6 h: 3.3%; 7 h: 3.2%; and &gt;= 8 h: 5.1%. Men who reported sleeping for, &lt;= 5 h (OR: 1.52, 95% confidential interval [CI]: 1.22-1.90) and &gt;= 8 h (OR: 1.39, 95% Cl: 1.05-1.85) were significantly more likely to have untreated diabetes compared with those who reported sleeping for 7 h. In stratified analyses by obesity (body mass index &gt;= 25.0 kg/m(2)), the association between long sleep duration (&gt;= 8 h) and untreated diabetes remained significant only in obese men.
Conclusion: Short sleep duration was significantly associated with untreated diabetes in both nonobese and obese men. Regarding long sleep duration, a significant association was observed in obese men only. (C) 2011 Elsevier B.V. All rights reserved.

Introduction: There is little evidence indicating whether dietary factors influence prostate-specific antigen (PSA) concentrations. We examined whether nutritional factors, including energy, protein, fat, and carbohydrate intake were associated with PSA in healthy men. Subjects and Methods: We investigated 13,594 men aged 50 years and over who visited a hospital for a routine health checkup between 2003 and 2007. Dietary intake was assessed using a food frequency questionnaire. We performed a multiple linear regression to examine the association between PSA and dietary intake. Results: After controlling for age, body mass index, and physical activity, PSA was significantly negatively associated with percent protein intake (p for trend &lt; 0.001). Compared with the lowest quintile, PSA was 5.8% lower (95% CI: -8.9 to -2.5%) in the highest quintile. We also observed a significant positive association between percent fat intake and PSA concentration (p for trend 0.043). PSA was 3.4% greater (95% CI: 0-6.9%) among men in the highest quintile compared with those in the lowest quintile. Conclusions: Men who had a lower percent protein intake and higher percent fat intake had an elevated PSA level, although the magnitude of these associations was small. Copyright (C) 2012 S. Karger AG, Basel

Background: The evidence for an association between insomnia symptoms and blood hemoglobin A(1c) (HbA(1c)) level has been limited and inconclusive. The aim of this study was to assess whether each symptom of initial, middle, and terminal insomnia influences HbA(1c) level in Japanese men.
Methods: This cross-sectional study examined 1,022 male workers aged 22-69 years with no history of diabetes at a Japanese company's annual health check-up in April 2010. High HbA(1c) was defined as a blood level of HbA(1c) &gt;= 6.0%. Three types of insomnia symptoms (i.e., difficulty in initiating sleep, difficulty in maintaining sleep, and early morning awakening) from the previous month were assessed by 3 responses (i.e., lasting more than 2 weeks, sometimes, and seldom or never [reference group]).
Results: The overall prevalence of high HbA(1c) was 5.2%. High HbA(1c) was positively and linearly associated with both difficulty in maintaining sleep (P for trend = .002) and early morning awakening (P for trend = .007). More specifically, after adjusting for potential confounding factors, high HbA(1c) was significantly associated with difficulty in maintaining sleep lasting more than 2 weeks (adjusted odds ratio, 6.79 [95% confidence interval, 1.86-24.85]) or sometimes (2.33 [1.19-4.55]). High HbA(1c) was also significantly associated with early morning awakening lasting more than 2 weeks (3.96 [1.24-12.59]).
Conclusion: Insomnia symptoms, particularly difficulty in maintaining sleep and early morning awakening, were found to have a close association with high HbA(1c) in a dose-response relationship.

Background: Despite a growing number of studies on leaving the organization or long-term care among professional caregivers for older people, little is known about the impact of types of employment on leaving.
Objectives: To examine the association between the type of employment and intent to leave among Japanese professional caregivers.
Design and settings: Secondary analysis of data from the 2006 Working Conditions Survey in Long-term Care, a nationally representative cross-sectional survey done in Japan.
Participants: 10,107 professional caregivers aged 18 years and older.
Methods: Predictor of intent to leave was type of employment (full-time permanent, full-time precarious, and part-time precarious). Precarious work was defined as employment that failed to meet the standard of full-time permanent employment, including fixed-term, temporary agency, and part-time work. Covariates included demographics, home or facility care, tenure in the profession, national qualification for caregivers, having other jobs, overtime work, and night shift work. We used multinomial logit models to estimate the strength of the association between the type of employment and intent to leave and to explore the possible mechanisms explaining this association.
Results: In the unadjusted model, when compared to part-time precarious workers, full-time permanent workers (OR = 2.37; 95% CI = 2.06, 2.72) and full-time precarious workers (OR = 2.41; 95% CI = 2.01, 2.88) were more likely to report intent to leave. After adjustment for covariates, these odds ratios were attenuated, but nevertheless remained significant. Overtime work greatly attenuated these odds ratios in both full-time precarious and full-time permanent workers, and having national qualification for caregivers only did in the case of full-time permanent workers.
Conclusions: In contrast to people in other professions, full-time caregivers are more likely to have intent to leave than part-time caregivers. This study highlights the importance of policy strategies for retaining full-time workers by reducing their overtime work and rewarding caregivers who have national qualifications. (C) 2010 Elsevier Ltd. All rights reserved.

The purpose of the present study was (1) to clarify whether individuals could be classified in terms of dieting using latent class analyses; and (2) to review the resulting classes were related to body dissatisfaction, body mass index, depressive mood, and binge eating. The present sample comprises 441 Japanese high-school girls. The optimal solution consisted of three latent classes: (1) unhealthy dieter (27%); (2) healthy dieter (39%); and (3) nondieter (34%). Inclusion in the unhealthy dieter class was predicted by body dissatisfaction and the girls in this class showed a high frequency of binge eating, while that in the other classes was not associated with any variable. This study identifies three classes with regard to dieting among female high-school students in Japan. (C) 2009 Elsevier Ltd. All rights reserved.

OBJECTIVE: In this study we investigated dietary consciousness, dietary behavior, dietary environment and dietary intake in Japanese urban schoolgirls and their mothers, and examined some useful indicators for their dietary education. METHODS: The survey was conducted during Sept 2005. Participants: The subjects were 262 junior high school girls (age 12-13yrs) and 240 mothers, 145 senior high school girls (age 15-16yrs) and 90 mothers, total subjects were 737. OUTCOME: 1. The questionnaire asked about their weight perception, eating behavior, environment, habits, and health condition in 76 questions. 2. Energy intake was assessed by 2 day dietary record method. 3. Age, height and body weight were measured by a teacher. Those with a tendency towards obesity were ≧120, and those underweight were ≦80%, based on the baseline degree of obesity by the Ministry of Education. A TANITA scale was used and BMI was calculated based on the degree of obesity in the Japanese Obesity Association. RESULTS: 1. Significant correlation coefficients were obtained between the body type classification and the degree of obesity, (junior high school girls: p&lt;0.001, senior high school girls: p&lt;0.001). Many schoolgirls perceived themselves overweight notwithstanding that weights were at an appropriate level. 2. Significant correlation coefficients were obtained between the self-rated energy intakes and the degree of obesity, (junior high school girls: p&lt;0.001, senior high school girls: p&lt;0.01). 3. Energy intakes by 2day dietary record method were not enough compared to their EER (estimated energy requirement), junior high school girls: 1685±410kcal, senior high school girls: 1670±433kcal. Micronutrient intake of Ca, Fe, VC and dietary fiber were less than DG (tentative dietary goal), but the ratio of fat energy was over the UL (tolerable upper intake level), junior high school girls: 32.5%, senior high school girls: 34.6%. 4. Energy intake of the mothers significantly correlated with that of their children in evening meals (breakfast: r=0.23, lunch: r=0.21, evening: r=0.35, total intake: r=0.25). 5. Correlation of between-item by Theory of quantification III showed 2 patterns. One correlated to the healthy dietary behavior, perception and environment, the other one had contradictory pattern that correlated to &quot;overeat&quot;, &quot;overweight&quot; and &quot;dieting practice&quot; (η^2=0.13). DISCUSSION: In this study we describe probable associations which may provide an understanding of some aspects of nutrition education for Japanese urban schoolgirls.

本研究の目的は,摂食障害とアレキシサイミア傾向の関連を,健康な対照群との比較から検討することである.68名の摂食障害女性患者[神経性食欲不振症制限型(AN-R)28名,神経性食欲不振症むちゃ食い/排出型(AN-BP)25名,および神経性過食症排出型(BN-P)15名]と236名の女子学生を対象に,日本語版Toronto Alexithymia Scale-20(TAS-20)ならびに日本語版Eating Attitude Test-26(EAT-26)を用いて自己記入式質問紙による調査を施行した.その結果,摂食障害患者においては病型に関係なくアレキシサイミア傾向が強いことが明らかになった.また,TAS-20の下位尺度である&quot;感情の同定困難&quot;と摂食障害の症状の重症度との間に関連が認められた.以上により,摂食障害患者の治療においては,アレキシサイミアを考慮したアプローチが重要あることが示唆された(著者抄録)

摂食障害の予防,早期発見,治療のシステム確立が望まれている.今回,全国8府県の全中学校,高等学校(2,252校)の養護教諭に対してアンケート調査を行った(全体回収率:54.7%).質問内容は主に学校保健現場で観察される生徒の食行動などの特徴,摂食障害に関連する生徒の現状・動向,医療機関との連携上の問題点などである.その結果,中学,高校ともに不適切な食生活・行動の生徒数の増加,摂食障害と思われる事例数の増加,また紹介医療機関の不足,医-教育の連携不足による問題点などが明らかになった.この調査結果は,わが国の学校保健現場からみた中学,高校生の摂食障害の現況,その早期発見,また対策の確立のための有益な資料となった(著者抄録)