Valid Response Rate Research Articles

The association of single and combined factors of sedentary behavior and physical activity with subjective cognitive complaints among community-dwelling older adults: Cross-sectional study.

Subjective cognitive complaints (SCC) might be a meaningful indicator of dementia onset or mild cognitive impairment, and identifying the related factors of SCC could contribute to preventing these diseases. However, the relationship between SCC and lifestyle factors remains largely unproven. The purpose of this study was to examine the association of type of sedentary behavior, physical activity, or their combination with SCC among community-dwelling older adults. In 2016, 6677 community-living elderly were recruited to participate in a survey investigating cognition, physical activity, and sedentary behavior. In total, 5328 participants responded to the questionnaire (79.8% valid response rate). SCC was assessed using the National Functional Survey Questionnaire (Kihon checklist). The relationships between SCC and physical activity, sedentary behavior (reading books or newspapers, and television viewing), or combined physical activity and sedentary behavior were examined via multiple logistic regression analysis. The analysis revealed that moderate-to-vigorous physical activity (≥150 min/week) was significantly related with a lower risk of SCC (odds ratio [OR] = 0.85; 95% confidence interval [CI] = 0.74–0.97), and that reading behavior showed a dose-response relationship with SCC (OR for 10–20 min/day = 0.63; 95% CI = 0.53–0.75; OR for 20–30 min/day = 0.59; 95% CI = 0.49–0.71; OR for ≥30 min/day = 0.47; 95% CI = 0.39–0.57). In addition, among those reporting high physical activity and ≥30 min/day for reading time, the OR for SCC was 0.40 (95% CI = 0.32–0.50) compared with the combined group reporting lower physical activity and non-readers. The present study shows that increased physical activity and reading time may be related to a reduced risk for SCC among community-dwelling older adults.

Valuing cultivated land protection: A contingent valuation and choice experiment study in China

This study is to examine the public’s preferences for cultivated land protection in Wenling City of China using a dichotomous choice contingent valuation method (CVM) and a choice experiment method. An empirical comparison of the welfare measures derived from the CVM and CE was conducted. We found that the valid response rate of the CVM was higher than that of the CE, while the CE data produced a higher percentage share of supporting votes for cultivated land protection than the CVM data. The estimation results show that the mean willingness to pay from the CVM is larger than that obtained from the CE, but they are not significantly different. Our results indicate that carefully designed CVM and CE were suitable to value cultivated land protection in China. The study results can contribute to the literature on comparing the willingness to pay estimates derived from the CVM and CE and can help improve our current understandings of local public’s preferences for cultivated land protection.

Influenza vaccination coverage of health care workers: a cross-sectional study based on data from a Swiss gynaecological hospital.

Background: Pregnancy is a risk factor for severe influenza and related complications. The vaccination has been recommended in healthcare workers as a strategy for preventing influenza in risk patients. The aim of this study was to analyze the influenza vaccination rate of the department of obstetrics and gynaecology of the Cantonal hospital St. Gallen in Switzerland.Methods: A cross-sectional study was carried out to investigate the influenza vaccination rates of all staff members of the Department of obstetrics and gynaecology (n=259). The vaccination coverage was compared according to sociodemographic variables using Chi-squared test. Associations were determined using a logistic regression model. Possible reasons for and against vaccination coverage were then investigated.Results: 200 questionnaires were included (valid response rate 77%). 15% reported being vaccinated against influenza (n=29). Reasons to be vaccinated are the belief of protection of patients (82%), oneself (75%) or family (61%). Reasons not to get vaccinated, including beliefs regarding the vaccine is not important (49%) and its ineffectiveness (44%). In the logistic regression analysis, the vaccination coverage among doctors (61% vaccinated) and nurses/midwives (4% vaccinated) is different from the vaccination coverage among the non-medical staff reference category (16% vaccinated; p=0.004, p=0.027), after controlling for the effect of other variables sex (p=0.807), age (p=0.438) and full time employment (p=0.298). Discussion: This study showed that doctors have a higher vaccination rate compared to other job roles, whereas the nurses and midwives had very low vaccination rates, which indicate a significant public health communication gap that needs to be addressed.

Management of group b streptococcus-positive pregnant women at maternity homes in JAPAN: a questionnaire survey of compliance among midwives

BackgroundPer the 2014 Japanese Midwives Association (JMA) guidelines, midwives were allowed to manage the deliveries for group B streptococcus (GBS)-positive pregnant women in labour at maternity homes without the supervision of a medical doctor if they complied with the guidelines of the Japan Society of Obstetrics and Gynecology (JSOG), wherein midwives working for maternity homes are expected to cooperate with commissioned obstetricians and paediatricians in cooperative medical facilities. We examined the rate of compliance with these JMA and JSOG guidelines regarding the management of GBS-positive pregnant women among midwives at maternity homes in Japan.MethodsBetween October and December 2015, an anonymous questionnaire was distributed to 337 maternity homes registered with the JMA by mail. The questionnaire obtained information regarding the timing of GBS screening, specimen collection, transfer of GBS-positive pregnant women from a maternity home to a hospital, administration of intrapartum antibiotic prophylaxis, and collaboration between midwives and commissioned obstetricians. Data were analysed using descriptive statistics. We used frequency distribution as the statistical test.ResultsResponses were received from 246 (73.0%) maternity homes, of which complete responses from 204 maternity homes (valid response rate, 60.5%) were analysed. Of these 204 maternity homes, only 97 (47.5%) conducted a GBS screening test during 33–37 weeks of gestation as recommended by the JSOG guidelines. Although midwives alone managed GBS-positive pregnant women in labour at 135 maternity homes (66.2%), intrapartum antibiotic prophylaxis, as recommended by the JSOG guidelines, was conducted in only 111 (54.4%). Moreover, only 37.0% (50/135) and 82.2% (111/135) of maternity homes ensured that GBS-positive pregnant women in labour with an elapse of ≥18 h after PROM and a body temperature of ≥38.0 °C, respectively, were transferred to a hospital by ambulance. Only at 58.3% (119/204) of maternity homes did midwives discuss the management of labour for GBS-positive pregnant women with commissioned obstetricians.ConclusionsSome midwives working for maternity homes did not follow the JMA and JSOG guidelines of the management of GBS-positive pregnant women. For improving compliance rates, midwives at maternity homes should discuss the management of GBS-positive pregnant women with commissioned doctors more carefully and concretely per the existing guidelines.

Relationships between daytime sleepiness and sleep quality, duration, and phase among school-aged children: a cross-sectional survey

A cross-sectional survey was conducted to simultaneously evaluate sleep quality, duration, and phase in school-aged children and correlations between each dimension of sleep and daytime sleepiness were comprehensively examined. A cross-sectional survey was conducted with school-aged children enrolled in four public elementary schools in Joetsu city, Niigata prefecture in Japan (n = 1683). Among the collected responses (n = 1290), 1134 valid responses (547 boys and 587 girls) were analyzed (valid response rate was 87.90%). Data on daytime sleepiness, sleep quality (problems in sleeping at night), sleep duration (the average sleeping time during a week), and sleep phase (sleep timing: bedtime and rising time on weekdays, and sleep regularity: differences in bedtime and rising time between on weekdays and weekends) were collected. The results of multivariate logistic regression analysis indicated that the following dimensions were significantly correlated with daytime sleepiness: the decline in sleep quality [adjusted odds ratio (AOR) = 2.62, 95% confidence interval (CI) = 1.71–4.00], bedtime after 21:30 on weekdays (AOR = 1.58, 95% CI = 1.15–2.18), bedtime delay on weekends, compared to weekdays (AOR = 1.75, 95% CI = 1.27–2.41), and bedtime advance on weekends, compared to weekdays (AOR = 3.33, 95% CI = 1.78–6.20). Sleep dimensions that significantly affected daytime sleepiness in school-aged children are sleep quality, bedtime-timing, and regularity of bedtime. It is important to detect problems in night sleep and establish treatments, as well as to provide support for early bedding on weekdays and for a regular bedtime both on weekdays and on weekends to prevent daytime sleepiness in school-aged children.

Massage therapy for home care patients using the health insurance system in Japan

ObjectivesTo clarify the status of home care massage services provided to patients. This will help in understanding how many patients utilize this service and the circumstances under which treatment is provided. DesignA retrospective study. SettingFifty-four acupuncture, moxibustion, and massage clinics. Participants were patients who had received home care massage for six months or more. We collected a total of 1587 responses from these 54 massage clinics; of these, 1415 responses (mean age = 79.1 ± 11.5 years) were valid (valid response rate 89.2%). Main outcome measuresActual patients and actual care services. ResultsThe most common disorder observed among patients who utilized home care massage services was cerebrovascular disease (at approximately 36%), while the second most common were arthropathy-related disorders (16.3%). Although most patients received massage, approximately 30% received manual therapy (e.g. manual correction) and hot fomentation as part of thermotherapy. Notably, only around 10% of patients received massage alone; the majority received treatment in combination with range of motion and muscle-strengthening exercises. ConclusionsThis study helped to clarify the actual state of patients receiving home care massage and the details of the massage services provided. This study clearly showed the treatment effectiveness of massage, which can be used by home medical care stakeholders to develop more effective interventions.

The relationship between intra- and inter-generational exchange and mental health among young and older adults

Objective The purpose of this study was to examine the relationship between intra- and inter-generational exchange and mental health among young adults aged 25-49 years and older adults aged 65-84 years.Methods In 2016, a community-based, cross-sectional survey was conducted. A total of 3,334 young adults (valid response rate: 24.6%), and 3,116 older adults (valid response rate: 46.0%) completed the survey and were included in the analysis. Their mental health was evaluated using the World Health Organization-Five Well-Being Index (WHO-5), and those who scored under 13 or scored less than one on any item were considered to have poor mental health. To evaluate the intra- or inter-generational exchange, participants were asked about their frequency of interaction with people aged 20-49 years or aged ≥70, excluding family and co-workers. Young adults who interacted with people aged 20-49 years or older adults who interacted with people ≥70 were classified as "having intra-generational exchange," while young adults who interacted with people ≥70 years or older adults who interacted with people aged 20-49 years were classified as "having intergenerational exchange." Therefore, individuals who interacted with both generations were classified as "having multi-generational exchange," and those who did not interact with any generation were categorized as "no exchange." We conducted a logistic regression analysis that included mental health as a dependent variable, intra- and inter-generational exchange as independent variables, and gender, age, educational attainment, marital status, living situation, subjective economic status, social participation, employment, self-rated health, and Instrumental Activity of Daily Living as covariates.Results Of the 3,334 young adults, 61.5% were mentally healthy, 51.3% had intra-generational exchange, 21.9% had inter-generational exchange, 16.5% had multi-generational exchange, and 42.7% did not have any exchange. Of the 3,116 older adults, 65.8% were mentally healthy, 67.9% had intra-generational exchange, 34.3% had inter-generational exchange, 29.9% had multi-generational exchange, and 21.1% did not have any exchange. A logistic regression analysis revealed that "having intra-generational exchange" and "having intergenerational exchange" were significantly related to better mental health in both young adults (intra-generational; Odds ratios (OR) 1.19, 95% confidence intervals (CI) 1.10-1.30: inter-generational; OR 1.13, 95% CI 1.03-1.25) and older adults (intra-generational; OR 1.15, 95% CI 1.02-1.29: inter-generational; OR 1.46, 95% CI 1.30-1.65). Therefore, "having multi-generational exchange" was more strongly related to better mental health compared with "only having intra-generational exchange."Conclusion Among young and older adults, intra- and inter-generational exchange were related to better mental health, and multi-generational exchange showed the strongest relationship with better mental health.

Disaster Nursing Knowledge and Competencies Among Nursing University Students Participated in Relief Activities Following the 2016 Kumamoto Earthquakes.

ObjectiveThis study examined disaster nursing knowledge and competencies among university nursing students who participated in relief activities following the 2016 Kumamoto earthquakes.MethodsParticipants were university nursing students involved in disaster relief activities. Of the 260 individuals to whom a self-report questionnaire was distributed at nursing universities and hospitals located in Kyushu, southwestern Japan, 201 participants returned the questionnaires by mail (response rate 77.3%), of which 108 questionnaires were complete (valid response rate 41.5%). Questions involved experiences related to their volunteer activities, their motive for volunteering, type of relief activities performed, and use of disaster nursing knowledge and competencies.ResultsWe identified four categories of disaster nursing competencies: “understanding and implementation of assistance to victims in collaboration with other members of the disaster response team,” “understanding the natural disaster’s influence on victims,” “ethical practice in a disaster recovery area,” and “understanding of their role within the disaster relief organization.” Those who had completed a disaster nursing program had superior measures of performance across all four competencies compared with those who had not yet completed the program.ConclusionsFour domains of disaster nursing knowledge and competencies used by university nursing students during the 2016 Kumamoto earthquake relief activities were identified. Those who had completed a disaster nursing program had higher competencies than were those who were either currently or not yet enrolled in it.

Determinants Strengthening Japanese Nurses' Intention to Stay at Their Current Hospital.

In order to retain nursing staff, it is crucial to have a comprehensive understanding of the factors that motivate nurses to stay at an institution. Toward this aim, we identified a variety of factors that strengthen nurses' intention to stay at their current hospital. A cross-sectional questionnaire survey was conducted at 12 hospitals in the Tohoku and Kanto regions of Japan. Of the 1,034 nurses working in those hospitals, 713 returned the questionnaire (response rate: 69.0%). Of these, we analysed the data of 485 nurses (17.42 ± 9.83 years of clinical experience, 95.3% female) (valid response rate: 46.9%) who met the inclusion criteria of planning to stay at their current hospital and completing all questionnaire items. An exploratory factor analysis indicated that variables strengthening intention to stay at the current hospital could be grouped into five factors: "comfortable workplace environment," "passive motivational factors," "convenience of hospital location," "favorable work-life balance," and "fulfilment in nursing." Nurses who were married or had children placed a higher priority on a "favorable work-life balance" in remaining at their current workplace. Regular employees or nurses working in the smaller cities tended to display higher "passive motivational factors," which comprised various extrinsic factors. Though extrinsic factors are considered to make only short-term contributions to employee retention, they could generate positive synergistic effects when combined with intrinsic motivations such as "fulfilment in nursing." Effective nurse-retention strategies should be developed by capitalizing on the interaction among the five factors that strengthen nurses to stay at their current hospital.

Trends in domiciliary dental care including the need for oral appliances and dental technicians in Japan.

The need for domiciliary dental care (DDC) for people requiring long-term nursing care is increasing as the super-aged society of Japan grows still older. Dysphagia diagnosis and rehabilitation are becoming more important in DDC; thus, the need for prostheses used for dysphasia rehabilitation is presumed to be increasing. To identify DDC trends in Japan, as well as the need for prostheses and dental technicians for DDC, we sent a self-administered questionnaire to dentists providing DDC and analyzed responses from 138 dentists (valid response rate, 39.8%). The results showed that 37.7% of respondents reported treating ≥50 patients per month. The most frequently performed procedures were removable prosthetic treatment and oral care, followed by dysphagia rehabilitation. Use of palatal augmentation prostheses was experienced by 54.3% of respondents, and most indicated that the prostheses were effective for improvement of oropharyngeal function. The rates of cooperation with primary care doctors and nursing care professionals were 76.8% and 85.5%, respectively. Only 6.5% of respondents reported accompanying dental technicians to DDC. The present analysis of trends in DDC indicates that oral care and dysphagia rehabilitation have become more frequent and that cooperation with healthcare professionals other than dental technicians has increased in recent DDC.

Relationship between eating alone and dietary variety among urban older Japanese adults

Objectives This study aimed to investigate the practice of eating alone, including its frequency, among urban older Japanese adults and to clarify its association with dietary variety.Methods In June 2016, self-reported questionnaires were mailed to 15,500 men and women aged 65 years or older living in Ota City, Tokyo without nursing care certification. Of these, 11,925 questionnaires were returned (a 76.9% response rate), and responses from 8,812 subjects were analyzed (a 56.9% valid response rate). The frequency of eating alone, defined as the number of days per week eating alone for each meal, was reported as zero, one to three, four to six, or seven days. A Dietary Variety Score (DVS) was obtained based upon consumption frequencies per week of 10 food groups. Total points were calculated, and three or fewer points indicated low dietary variety. The association between eating alone and low dietary variety was analyzed by binomial logistic regression, with adjustments for potential confounding variables including age, body mass index (BMI), location, educational history, equivalent income, employment, living alone, medical history, and smoking and drinking habits.Results The results indicated that 47.1% of men and 48.5% of women ate alone at least one day per week, and 14.9% of men and 16.9% of women ate alone every day. For men, after adjusting for potential confounders (ORs=1.51-2.00), the odds ratios (ORs) of low DVSs were significantly higher among those who ate alone one to three days, four to six days, or seven days per week compared to those who ate with others. For women, adjusted ORs were not significant among those who ate alone every day (OR=1.15, 95% CI=0.92-1.43). Men and women who ate alone had significantly lower ORs of eating green or yellow vegetables, fruits, and fats/oils almost every day compared to those who ate with others.Conclusion Among urban Japanese older adults, about 50% of subjects reported eating alone. Eating alone was associated with lower dietary variety scores regardless of age, income, and family status. Therefore, the present findings might be useful for developing strategies for addressing undernutrition among urban older adults eating alone.

Medical equipment deployment in pediatric emergency prehospital medical units in Japan.

The deployment status of pediatric emergency equipment in ambulances in Japan is unknown. To investigate the status of and issues associated with prehospital emergency medical care for pediatric patients, we conducted a descriptive epidemiological study. We carried out a Web-based survey of 767 fire defense headquarters in Japan, of which 671 responded (valid response rate, 88%). Most of the fire defense headquarters equipped all of their ambulances with oxygen masks (82%), bag-valve masks (for neonates, 83%; for children, 84%), straight laryngoscope blades (for neonates, 47%; for children 68%), blood pressure cuffs for children (91%), oximeter probes (78%), and stiff neck collars (91%); but despite the need for other equipment such as nasopharyngeal and oropharyngeal airways, and Magill forceps, they were insufficiently deployed. In Japan, prehospital emergency medical equipment deployment does not meet the needs of pediatric patients. Minimum equipment standards need to be established for pediatric prehospital care.

THE ROLE OF INTRA-ORGANIZATIONAL FACTORS IN ACCOUNTING INFORMATION SYSTEM EFFECTIVENESS

This study examines the influence of intra-organizational factors on Accounting Information System (AIS) effectiveness in Nigeria. These are internal organizational capabilities such as the internal control quality, training, and top management support that can significantly affect the success of AIS among the Nigerian Banks. In this study, exploratory research approach was adopted. A self-administered questionnaire was distributed to regional and branch offices of banks in Nigeria. A valid response rate of 48.4% was achieved, and the survey data were analyzed using Statistical Package for Social Sciences (SPSS) for the descriptive statistics and structural equation modeling for inferential analysis. The results of the study revealed that internal control quality and training are the most crucial factors in ensuring AIS effectiveness. The result further revealed that top management support is less important for the success of the systems. The findings suggest that banks should pay more attention to the internal control quality and training since they were found to be influencing the effectiveness of the system. Thus, when managers provide all the required in-house resources to support AIS, it would lead to the success of the system and which eventual result to realizing the full potential of their investment.

The property of the Japanese version of the Recovery Knowledge Inventory (RKI) among mental health service providers: a cross sectional study

BackgroundThe Recovery Knowledge Inventory (RKI) is one of the influential scales to assess knowledge and attitude toward recovery-oriented practices among mental health service providers. In the present study, we aimed to develop a Japanese version of RKI and examine the validity and reliability.MethodsWe translated RKI into Japanese by reference to the guidelines for translating and adapting psychometric scales. A cross-sectional questionnaire survey was conducted with mental health service providers. Of a total of 475 eligible professionals, we used data from the 299 participants without missing value for the analyses (valid response rate = 62.9%). The questionnaire included Japanese RKI, Recovery Attitudes Questionnaire, The positive attitudes scale, and Japanese-language version of the Social Distance Scale. To examine the factorial validity of RKI, explanatory factor analysis and confirmatory factor analysis was employed. Convergent validity was assessed by calculating Pearson’s correlation coefficients between the total RKI score and the scores for the other three scales. We also calculated Cronbach’s α coefficients for the total score and for each domain of RKI to assess internal consistency reliability.ResultsThe participants’ mean age was 40.4 years and 30.4% were men. 20-item RKI did not provide any adequate or interpretable factor solutions at any number of factors by EFAs. Thus four items (#1, 4, 5, and 13) were subsequently eliminated in stages, then 16-item RKI was employed as a consequence for further analyses. EFA with four factor structures yielded marginally interpretable constitution. Each factor represented the knowledge regarding psychiatric symptoms and recovery; knowledge about the recovery process; the understanding of what is important for recovery; and the understanding of the challenges and responsibility in recovery, respectively. Subsequent CFA suggested good fit to the data. Good convergent validity and understandable internal consistency reliability were also observed.ConclusionsThe Japanese 16-item RKI revealed reasonable factorial validity, good convergent validity, and understandable internal consistency reliability among mental health professionals. Japanese cultural settings seemed to influence the four-factor structure in the present study. It can be used for future study in Japan, while future large-scale research is required to ensure robust verification.

Development of the Self-Regulated Learning Scale in Clinical Nursing Practice for nursing students: Consideration of its reliability and validity.

This study aimed to develop the Self-Regulated Learning Scale in Clinical Nursing Practice (SRLS-CNP) for the assessment of nursing students and to validate it. Questionnaires, including the SRLS-CNP item pool, were sent to 766 students in the second-to-fourth grades of nursing universities in Japan. The analysis involved an exploratory factor analysis, Cronbach's α, confirmatory factor analysis, and calculation of the Spearman's rank correlation coefficient. In order to confirm stability, 198 students underwent test-retest reliability. Responses were received from 437 students (return rate: 57.0%); the data of 376 students (valid response rate: 86.0%) were analyzed. Following the factor analysis, the SRLS-CNP was divided into the motivation subscale (two factors, seven items) and learning strategies subscale (three factors, nine items). The motivation subscale items were termed "intrinsic motivation" and "achievement motivation." The learning strategies subscale items were termed "synthesized knowledge and nursing skills," "multidimensional thinking," and "effort control." The Cronbach's α for the SRLS-CNP was 0.853. The verification model in the confirmatory factor analysis showed good conformance; a strong positive correlation was evident between the motivation subscale and the learning strategy subscale. The correlation coefficient for test-retest reliability was 0.77. As shown by its Cronbach's α coefficient, test-retest reliability results, and content, criterion-related, and construct validity, the SRLS-CNP was found to have good reliability and validity.

Willingness to Pay for Elderly Telecare Service Using the Internet and Digital Terrestrial Broadcasting.

BackgroundIn Japan over the past few years, more attention has been focused on unnoticed solitary death in the context of an aging society and the trend toward nuclear family. A number of institutions and companies have implemented a prevention measure with digital terrestrial broadcasting telecare services for the elderly: Hokkaido University; TV-Asahi Corporation; Hitachi, Ltd; Iwamizawa City; Hokkaido Television Broadcasting Co, Ltd; and Hamanasu Information Co, Ltd. Although this system is provided free of charge as a demonstration test, determining the appropriate price for the service is required for its sustainable operation.ObjectiveThe aim of this study was to quantify individual willingness to pay (WTP) so as to test the tenability of digital terrestrial broadcasting service for elderly telecare.MethodsWe used the contingent valuation method (CVM) to estimate the WTP for this service among 305 citizens (valid response rate 76.0%) living in Japan. A questionnaire survey was conducted for people aged 18 to 100 years according to Japanese age distribution from September 2016. To elicit WTP, we adopted a double-bound dichotomous choice method to ask the respondents whether they agree or disagree with the price we offered.ResultsThe median WTP for this service’s monthly fee is estimated to be 431 JPY (approximately US $3.7). The finding suggests that gender (0.66, P=.01), health consciousness (1.08, P=.01), willingness to use (2.38, P<.001), and seeing others less than once a week (1.00, P=.06) made a positive effect on WTP.ConclusionsWe conclude that reliable WTP was elicited by CVM based on an Internet survey. Calculated median WTP for digital terrestrial broadcasting service for elderly telecare was 431 JPY (approximately US $3.7). In the analysis of factors that affect WTP, constant factors, log-bid, health consciousness, gender, see others less than one time for week, and willingness to use made positive effect to probability of acceptance. In comparison of WTP in different groups, age groups showed that WTP of the elderly group was higher than WTP of the middle age group and younger age group. However, WTP surveys need to be carefully conducted to minimize the sampling bias and allocate accurate structure of gender distribution.

Study of the Midwifery Care in 6 Obstetrical Facilities in Okinawa-Self- Completed Retrospective Questionnaires for One Month Postpartum Women

The purpose of this study was to investigate the effective midwifery care from pregnancy to postpartum in order to promote evidence-based midwifery practice in improving childbirth satisfaction and breastfeeding. The subjects were one-month postpartum mothers who came to one-month check-up during July to October in 2010. The purpose of the self-administered questionnaire developed by the research group was explained, then provided to mothers who agreed to participate in the survey at 4 hospitals each with more than 300 beds and 1 clinic with more than 500 deliveries annually in Okinawa. The questionnaire was collected on the same day or via postal mail. A total of 540 mothers agreed to complete the survey, and 434 responses were considered valid for this study (valid response rate: 80.4%). Vaginal delivery group was 223 (82.3% with medical intervention rate of 15.2%), and the cesarean section group was 48 (17.7%). The most helpful one-on-one guidance was "nipple care in preparation for breastfeeding" during pregnancy, "encouragement" during delivery, and "Kangaroo (skin-to-skin) care" immediately after the delivery. An Application rate of episiotomy was 65.2% for primiparous women and 30.5% for multiparous women. The rate of perineal laceration enlarged to more than third degree in cases with episiotomy is three times more than the cases with no episiotomy. Additionally, the prevalence of breastfeeding at one-month postpartum was significantly higher in the mothers rooming-in with the baby (76.2%) than mothers in separate room (28.3%). Moreover, 60.3% of the mothers in the complete rooming-in group answered they had not felt difficulty with childcare while it dropped to 46.2% among the mothers in the separate room group.

Investigating the organisational factors associated with variation in clinical productivity in community pharmacies: a mixed-methods study

Background Community pharmacies play a key role in health-care systems, dispensing prescriptions and providing medicine-related services. Service provision varies across community pharmacy organisations and may depend on organisational characteristics, such as ownership, staffing and skill mix. Objectives To inform the commissioning of community pharmacy services by (1) exploring variation in clinical productivity (levels of service delivery and service quality) in pharmacies, (2) identifying the organisational factors associated with this variation and (3) developing a toolkit for commissioners. Design Mixed-methods study: community pharmacy survey, administrative data analysis, patient survey, stakeholder interviews and toolkit development. Setting Nine socioeconomically diverse geographical areas of England. Participants Stage 1: community pharmacies in nine study areas. Stage 2: in 39 pharmacies, two consecutive samples of approximately 30 patients each following receipt of (1) dispensing and (2) medicines use review (MUR) services. Pharmacy and commissioning representatives from across all types of pharmacy and study sites. Main outcome measures Stage 1: dispensing, MUR, new medicines service volume and safety climate. Stage 2: patient satisfaction, Satisfaction with Information about Medicines Scale (SIMS) and Medication Adherence Report Scale (MARS). Data sources Stage 1: (i) community pharmacy activity data; (ii) socioeconomic and health needs data; and (iii) community pharmacy questionnaire (ownership type, organisational culture, staffing and skill mix, working patterns, management structure, safety climate, pharmacy–general practice integration), all linked by pharmacy postcode and organisational ‘F’ code. Stage 2: (i) patient questionnaire (background, patient satisfaction, SIMS, MARS); (ii) semistructured stakeholder interviews (variation in quantity and quality of service provision, opportunities and barriers to clinical productivity, mechanisms by which different organisational characteristics may help or hinder clinical productivity). Quantitative data were analysed by fitting a series of fixed-effects linear, logistic and multilevel logistic regression models in Stata® (version 13; StataCorp LP, College Station, TX, USA). Qualitative data were analysed thematically using a framework approach in NVivo10 (QSR International, Warrington, UK). Results In stage 1, 285 out of 817 pharmacy questionnaires were returned [valid response rate 34.6% (277/800)]. In stage 2, 1008 out of 2124 patient questionnaires were returned [valid response rate 46.5% (971/2087)]. Thirty pharmacy and 10 commissioning representatives were interviewed face to face or by telephone. Following integration of stage 1 and 2 findings, clinical productivity was associated with pharmacy ownership type, organisational culture, staffing and skill mix, and pharmacy–general practice relationships. Extra-organisational associations included local area deprivation, age profile and health needs, pharmacy location, public perceptions and expectations, supply chain problems, commissioning structures/processes, levels of remuneration and legal/regulatory constraints. Existing arrangements for monitoring clinical productivity focused primarily on quantity. Limitations Non-random selection of study sites and non-participation by four major pharmacy chains limited generalisability. Investigation of the full scope of pharmacy service provision was prevented by a lack of available activity data for locally commissioned services. Quantitative exploration of service quality was limited by available validated measures. Conclusions These findings have important implications for community pharmacies and service commissioners, highlighting the importance of ownership type, organisational culture, staffing and skill mix for maximising the delivery of high-quality pharmacy services and informing the development of a commissioners’ toolkit. Future work Future studies should (1) develop tools to measure community pharmacy service quality; (2) describe and evaluate different models of skill mix; and (3) explore how services are commissioned locally from community pharmacies and the extent to which local needs are met. Funding The National Institute for Health Research Health Services and Delivery Research programme.

Association between the time perspective and type of involvement in bullying among adolescents: A cross-sectional study in Japan.

To examine the association between the types of involvement in bullying and the time perspective among Japanese adolescents. A questionnaire was conducted among Japanese junior high school students at eight public schools that were located in two cities in Shizuoka Prefecture, Japan. Shirai's Experiential Time Perspective Scale was used, which comprises four subscales: goal-directedness, hopefulness, self-fulfillment, and acceptance of the past. An analysis of covariance was applied, with the time-perspective subscales as the objective variable, type of involvement in bullying as a fixed factor, and grade, family structure, and economic status as the covariates. The analysis sample included 2630 adolescents (valid response rate: 88.6%). The bullying rate of the boys was 10.8% and 4.1% for the girls, for the male victims it was 10.1% and 14.5% for the female victims, and for both the bully and the victim, it was 8.5% and 5.4%, respectively. The students who were not involved in bullying had the highest scores of hopefulness, self-fulfillment, and acceptance of the past. For both sexes, bullying was significantly associated with hopefulness, self-fulfillment, and acceptance of the past. Goal-directedness was not associated with the type of involvement in bullying. The victims of bullying had low time perspectives of hopefulness, self-fulfillment, and acceptance of the past. Providing support that increases hopefulness, self-fulfillment, and acceptance of the past might help to prevent pessimistic decision-making, such as that seen in cases of suicide.

Relationships between bone mass and dietary/lifestyle habits in Japanese women at 3–4 months postpartum

ObjectivesThe relationships between calcaneal bone mass and dietary/lifestyle habits in women at 3–4 months postpartum were examined in the context of osteoporosis prevention. Study designCross-sectional survey. MethodsWe measured bone mass using calcaneal ultrasound in mothers who brought their 3- to 4-month-old babies to healthcare centers in Japan for health examination and administered a self-report questionnaire on physical characteristics and dietary/lifestyle habits to those who agreed to participate in the survey. Valid data were available for 1220 women (valid response rate, 97.5%). ResultsBased on their stiffness score, a measure of bone mass, 70.9% (n = 865) of the participants were classified as ‘no apparent abnormality (stiffness score ≥78.8)’ (low-risk group), 18.2% (n = 222) as ‘guidance required (≥70.1–<78.8)’ (intermediate-risk group), and 10.9% (n = 133) as ‘complete examination required (<70.1)’ (high-risk group), according to the criteria for osteoporosis screening test results. The percentage of individuals with a history of fracture was higher in the guidance required/complete examination required than in the no apparent abnormality group (P = 0.016). The analysis of relationships between the consumption frequency of certain foods, such as calcium-rich foodstuffs, and bone mass found that women who reported lower frequencies of milk and dark-colored (beta-carotene rich) vegetables for breakfast consumption had a significantly lower bone mass than those who consumed these foods more often. Furthermore, the guidance required/complete examination required group had a significantly lower calcium intake than the no apparent abnormality group (P = 0.022). ConclusionsThese results indicate the need to provide postpartum women with dietary education programs to promote healthy eating habits, such as increased consumption of calcium-rich foods, and prevent osteoporosis.