Investigation of the health condition of the "shukko" person in a certain Japanese company]

The influence of the "shukko" (temporary transfer) work system on health was examined. "Shukko" is a Japanese individual work system. The life-time employment system was general in Japan. "Shukko" work system was devised to reduce the number of personnel in Japan. "Shukko" personnel belong to their present company but they must do the work of another company. Generally, the disadvantages of "shukko". Personnel are greater than in former "shukko" The subjects are 483 office workers in a certain industrial company. 143 workers work in a subsidiary of this company (Age: 42.2 +/- 5.5) (strategic shukko group), 30 workers work in the other company, having resigned their administrative post in the head office (55.6 +/- 2.1) (Demotion by the manager shukko group), and 310 workers work in the head office of this company (41.8 +/- 5.2) (head office working group). The medical examination results (degree of obesity, systolic blood pressure (SBP), GPT, GGTP, total cholesterol, triglyceride (TG), fasting blood sugar (FBS), uric acid (UA), electrocardiography (ECG), and gastrography were compared by mean of multiple regression analysis. In the "Demotion by the manager shukko" group, the average age and SBP were higher than in the other groups. (p < 0.0001). The "strategic shukko" group was compared with the "head office working" group. There is no significant difference in average age. The average SBP (p < 0.001) and FBS (p < 0.0001) of the "head office working" group was significantly higher than those of the "strategic shukko" group. ECG findings were more serious in the "Demotion by the manager shukko" group than in the other groups (p < 0.0001). There is a significant correlation between SBP and "degree of obesity, FBS and UA" (p < 0.0001). There is significant correlation between FBS and "GGTP, SBP, UA, GPT and TG" (p < 0.0001). And there is significant correlation between ECG findings and "working form and SBP" (p < 0.05). The prevention and early diagnosis of geriatric diseases is important for the "Demotion by the manager shukko" group, and their average age is older than that of the other groups. A problem with the head office working group is obesity. In this group it is important to take into consideration life related diseases. The workers complaint a lot in the "strategic shukko" group, but there are no abnormal findings. We think that their complaints are due to their mental stress. In this group measuring mental stress is important.     

Reconsidering the "Good Divorce"

This study attempted to assess the notion that a "good divorce" protects children from the potential negative consequences of marital dissolution. A cluster analysis of data on postdivorce parenting from 944 families resulted in three groups: cooperative coparenting, parallel parenting, and single parenting. Children in the cooperative coparenting (good divorce) cluster had the smallest number of behavior problems and the closest ties to their fathers. Nevertheless, children in this cluster did not score significantly better than other children on 10 additional outcomes. These findings provide only modest support for the good divorce hypothesis.     

Psychological and physiological characteristics of sweet food "addiction"

OBJECTIVE: Drug addicts in general can be distinguished from nonaddicts by their affective and physiological and craving responses to drug-related cues. The purpose of this study was to examine similar affective, physiological, and behavioral variables in chocolate "addicts" and control subjects. METHODS: Sixteen addicts and 15 control subjects took part in two laboratory experiments in which their heart rate, salivation, and self-reported responses were measured. RESULTS: In the presence of external chocolate cues, chocolate addicts were more aroused, reported greater cravings, experienced more negative affect, and also ate more chocolate than control subjects. Self-report measures on eating attitudes and behavior, body image, and depression confirmed that a relationship exists between "chocolate addiction" and problem eating. Chocolate addicts showed more aberrant eating behaviors and attitudes than controls, and were also significantly more depressed. DISCUSSION: Chocolate addicts may be considered to be a parallel with addicts generally, because they differ from controls in craving for chocolate, eating behavior, and psychopathology (in respect of eating and affect).     

Preliminary evaluation of "interpreter" role plays in teaching communication skills to medical undergraduates

RATIONALE AND OBJECTIVES: Multiculturalism presents linguistic obstacles to health care provision. We explored the early introduction of "interpreter" role-play exercises in teaching medical undergraduates communication skills. The interpreter role creates a natural barrier in communication providing an active prompt for recognizing learning needs in this area. METHODS: Bilingual Cantonese first-year medical students (n=160) were randomly allocated to either "Observer" or "Interpreter" role plays at a small-group introductory communication skills workshop using a quasi experimental design, counterbalanced across tutors. Students assessed their own skill competence before and, together with their perceptions of the different role plays' effectiveness, again after the workshop, using an anonymous 16 item Likert-type scale, analysed using ANOVA and MANOVA. RESULTS: Students' assessments of their skills improved significantly following the workshop (F=73.19 [1,156], P=0.0009). Students in the observer group reported greater changes in their scores following the workshop than did students in the interpreter group (F=4.84 [1,156], P=0.029), largely due to improvement in perceived skill (F=4.38 [1,156], P=0.038) rather than perceived programme effectiveness (F=3.13 [1,156], P > 0.05). Subsequent MANOVA indicated no main effect of observer/interpreter conditions, indicating these differences could be attributed to chance alone (F=1.41 [16 141], P > 0.05). CONCLUSION: The workshop positively influenced students' perceived communication skills, but the "Interpreter" role was less effective than the "Observer" role in achieving this. Future studies should examine whether interpreter role plays introduced later in the medical programme are beneficial.     

Presenting the problem in pediatric encounters: "symptoms only" versus "candidate diagnosis" presentations

This article examines 2 practices that are used to present children's problems to their pediatricians in acute care encounters. Using the methodology of conversation analysis, this article examines the alternative stances embodied by problem presentations, which offer "symptoms only" versus problem presentations, which also include a "candidate diagnosis." This article suggests that parents who offer only symptoms in their problem presentations are hearable as adopting a stance that they are primarily seeking medical evaluations of their children. By contrast, a parent who includes a candidate diagnosis of the problem is hearable as adopting a stance that he or she is seeking confirmation of the diagnosis and treatment for that illness condition. This communication practice may be treated by physicians as placing pressure on them to prescribe treatment-in particular antibiotic treatment. The implications of this are discussed.     

Diagnosing "dayans" and "demons"

The new ?Witch Craft Prevention Bill? prohibiting witch hunting was passed in Bihar, India, in reaction to the branding and subsequent killing of more than 500 helpless women as "dayans" (witches) in the past 7 years. Most of them were single, widows, or deserted women victimized by the pathological greed of some of the male members of their families or by some powerful persons in the village community interested in claiming their property. Even with the passage of the bill, though, most of these crimes will remain unpunished because the community is an accomplice in them, and they tend not to be reported. What is needed overall is socioeconomic and political development that will lead to the empowerment of women to ensure that there will be an end to the cruel and inhuman activities (such as witch hunting) instigated by traditional healers or "Ojhas".     

The use of "impotence" and "frigidity": why has "impotence" survived

The negative connotations and decreased utility of the terms "impotence" and "frigidity" prompted an investigation of their use in the literature. Psychological Abstracts were reviewed from 1940 to 1983 for titles containing these terms. It was found that both impotence and frigidity titles fluctuated at low levels from 1940 to 1969. Frigidity titles then increased slightly, but dropped to zero after 1979. Impotence titles, however, have continued to increase at a significant rate. Classic sexual behavior and therapy works are reviewed to explain this discrepancy since both terms are equally inappropriate.     

"Above the influence": how college students communicate about the healthy deviance of alcohol abstinence

Consumption of alcohol is widespread in U.S. culture, particularly among college students. Using a communication privacy management framework ( Petronio, 2002 ), this study examined how college students who abstain from alcohol negotiate communication of their nondrinking status and establish meaning in a culture in which drinking is the norm. Through 25 face-to-face interviews, this article explores the experiences of "healthy deviants"-individuals who engage in healthy behavior that violates traditional norms. Interviews identified that participants relied on privacy rules when determining whether and how to disclose their nondrinking status. If participants perceived more costs from the disclosure than rewards, they did not disclose. Participants enacted specific strategies to manage (non)disclosure of their abstinence from alcohol, providing practical ways for people who engage in healthy deviance to avoid or manage stigma.     

The "Sandwich mom": in the throes of a medication safety "perfect storm"

America is entering into a proverbial "perfect storm" of medication errors. Medications are more complex and their use is increasing, consumers are more involved in their healthcare decisions, and the population is aging and with it comes diminished cognitive skills. "Sandwich moms" are likely to bear the brunt of the ravages of this storm. These are the women who serve multiple roles as caregivers for their children, spouses, and, increasingly, their parents. This study explores how concerned these caregivers are about potential harm from medication use and how likely they would be to become more involved in medication management activities.     

"Good jobs" to "bad jobs": replicated evidence of an employment continuum from two large surveys

The goal of this study was to offer an expanded conceptualization of the employment continuum and test its utility by examining the association of different employment statuses with physical health and depression. Using data from two large cross-sectional surveys we develop five different employment categories (i.e., "optimal", "economically good", "psychologically good", "barely adequate", and "inadequate" employment) in addition to unemployment to form an employment continuum. Evidence from these studies indicates that less than optimal forms of employment are not randomly distributed throughout the population, and that a substantial number of adults are working in "inadequate or "barely adequate" jobs. Moreover, our analyses revealed a consistent association between less than optimal jobs and poorer physical and mental health among adults. We conclude our paper by discussing important policy implications of these findings and offering suggestions for future research.     

"They don't trust us; we're just kids:" views about community from predominantly female inner city youth

The cornerstones of health promotion are the concepts of empowerment and community participation. There has been little research, however, on how these concepts are actualized within a youth population and even less from a gender perspective. Girls are socialized to be more compliant and cooperative; thus they feel less assertive to express themselves. The benefits of community participation, such as the development of personal identity and increased self-determination, may therefore be more important for girls' development. In this qualitative study I explored youth's perceptions about community, their ability to be heard, and their power to effect community change. Responses to focus groups and an on-line sentence completion exercise by 23 well-functioning, predominantly female (83%) youth, at an inner-city school in Canada, revealed that youth perceived that they were not heard and felt disempowered in the larger community. Three subthemes explain these threats to empowerment: "grown-ups run everything" (they had no actual decision-making power), "we're just kids" (they were low in the social hierarchy), and "they don't trust us" (they felt mutual mistrust of and by adults). Boys showed some evidence of feeling more empowered than girls. Boys and girls identified that they perceived they could make a difference, particularly in their school. Five themes of empowerment help to explain this perception, including, "adults who know us, trust us" (they were trusted by some adults), in school "they ask us what should we do" (they had some participation in decision making), "we can make a difference" (they felt self-efficacy), "we can do it as a group" (they had a belief in group action), and they could "get someone big so they would listen" (they demonstrated political efficacy). Implications for community health practitioners are discussed.     

'Doing the "right" thing': how parents experience and manage decision-making for children's 'normalising' surgeries

Using cleft lip and palate as an exemplar, this article examines parents' decision-making for children in the context of elective treatments which aim to 'normalise' a child's function, appearance, communication or identity. Using purposive and theoretical sampling, 35 parents with children from infancy to young adulthood were recruited through a specialist cleft centre in England. Parents were interviewed in-depth between 2006 and 2008 about their beliefs and motivations in relation to treatment decision-making in this context. A grounded theory approach was used to analyse the data. Findings revealed a core category, 'doing the "right" thing', that encapsulated parents' main concern in relation to their children's treatment and highlighted several emotional, social and cultural considerations underpinning their decision-making stance. Parents fulfilled a perceived 'moral' obligation to be 'good' parents by pursuing the 'normalising' treatments, particularly surgeries, made available to their children. Such treatments were viewed as a way of facilitating their child's social inclusion and helping them reach their full potential. In order to enable their continued pursuit of treatments over the long-term, parents also constructed specialist practitioners as highly competent and particularly trustworthy. This article captures the complexities involved in parents' decision-making for children's elective 'normalising' treatments, where both functional and appearance-related concerns are involved. It suggests that social norms about parenting, physical appearance and healthcare practitioner power may significantly shape decision-making in this context, so that such choices may be viewed primarily as 'moral' rather than social. Services could support parents with such challenges, by gauging their needs for information about surgery and its likely outcomes and providing emotional/decisional support to consider all available options.     

Invited commentary: Structure and context matters--the need to emphasize "social" in "psychosocial epidemiology"

A high level of influence on core aspects of life in general and at the workplace in particular is believed to reduce the risk of ill health. In this issue of the Journal, Joensuu et al. (Am J Epidemiol. 2012;175(7):609-619) shake this belief by presenting prospective associations between high decision authority at work and increased all-cause, cardiovascular, and alcohol-related mortality among Finnish forest company employees followed through 2005. In this invited commentary, the author welcomes these findings as a much needed inspiration for reflections on the current state of psychosocial epidemiology and how it can be advanced in the future. Although it is important to investigate possible harmful effects of too high decision authority, the author argues that it is even more important to be aware that psychosocial factors originate from societal structures and social contexts. Understanding these structures and contexts, their changes over time, and their relation to psychosocial factors is key for understanding the effect of psychosocial factors on health and illness. Joensuu et al. have presented thought-provoking findings. It is the hope of the author that this will push the research community to emphasize the "social" in "psychosocial epidemiology."     

"Prequit attrition" among weight-concerned women smokers

The impact of concerns about postcessation weight gain is sometimes minimized based on the finding of many (though not all) studies of an association between actual weight gain and successful quitting. A possible explanation is that many weight-concerned individuals either never attempt cessation or terminate their attempts very early, without seeking treatment. To investigate further, we compared attrition after screening and acceptance but prior to the first treatment session of women in two cessation trials, one targeting women with high dieting severity and concerns about body shape, the other not. The trials were similar in length and intensity. As expected, dieting severity scores for the groups were significantly higher for participants in the weight-concerns trial (WCT) than in the trial that did not involve weight concerns (NWCT). Race distribution and Body Mass Index (BMI) did not differ significantly between trials. Compared with the WCT, women accepted into the NWCT were significantly older, significantly more nicotine dependent, smoked significantly more cigarettes per day, and were significantly more depressed. Yet, despite a profile predictive of poorer outcome, "prequit attrition" was significantly lower for NWCT than for WCT (3% vs. 16%). Among WCT participants, those who dropped out scored significantly higher on dieting severity than those reporting for treatment, even after covarying for degree of dependence. To the extent that "prequit attrition" represents a proxy for unwillingness to enter treatment, our findings support the hypothesis that weight concerns constitute a more serious barrier to quitting than is evident simply from looking at treatment outcomes, since these individuals may never make it into the trial samples.     

"Patient Portals" and "E-Visits"

"Patient Portals" enable patients to review their medical record and add information to it. Clinics are using "E-Visits" to substitute for a face-to-face office visit. This article describes the experience of one healthcare system with "Patient Portals" and "E-Visits."     

Moving from "small qa" to "large qa". An outcomes framework for improving quality management

In this article we describe an "outcomes framework" for planning and analyzing quality management systems in relation to their ultimate purpose, enhancing the wide range of health care benefits. "Small qa" includes those methods that focus on structure or process and induce improvement of outcomes. These methods are essential but, predictably, often involve minimal improvement of health care. "LARGE QA" is defined as those methods that focus on unacceptable outcomes and deduce processes and structures to be changed to enhance outcomes. These methods focus on either "problems" or "opportunities" that predict substantial improvement in health care benefits. We briefly describe and analyze this outcomes framework for quality management in terms of its conceptual factors and its current and future emphasis. We then describe several major national program developments and resources that will facilitate moving the balance of quality management effort from small qa to LARGE QA.     

The holding of "International Symposium on Children's Environmental Health"

In the recent year, a summit of the environment ministers of the G8 nations including the U.S.A., U.K, and Japan, presented the "Declaration of the G8 Environment Leaders on Children's Environmental Health" in which G8 countries agreed to actively address this issue. Fetuses and infants are more liable than adults to be affected by hazardous chemicals, being more sensitive to them due to their small body weight, and are more likely to come into contact with them due to the fact that they tend to play extensively on the floor and ground, and frequently bring whatever they have in their hands to their mouths. However, those who have high sensitivity, including children, are often not well-considered by our present legal system and risk assessment practices for protecting people from chemical substances. This material summarizes the proceedings of the symposium, in order to exchange opinions internationally and develop domestic professional human resources. Also, it introduces what researchers, governments, and NGOs from the U.S, EU, WHO, and Canada are working on, as well as the program of the Ministry of the Environment in Japan.     

Disproportionality at the "front end" of the child welfare services system: an analysis of rates of referrals, "hits", "misses", and "false alarms"

Data from NIS-4, NCANDS, and the State of California were used to analyze the front end of the child welfare services system--the referral and substantiation components--in terms of the system's ability to diagnose or detect instances of child maltreatment. The analyses show that Blacks are disproportionately represented in rates of referral into the system. Moreover, the analyses demonstrate that the system is less accurate for Blacks than for other racial or ethnic groups. There is a higher rate of false positives (or "false alarms") for Blacks than for other groups--that is, referrals leading to unsubstantiated findings. There is also a higher rate of false negatives (or "misses") for Blacks than for other groups--that is, children for whom no referral was made but who are in fact neglected or abused. The rate of true positives (or "hits")--children for whom a referral has been made and for whom that allegation has been substantiated--is generally higher for Blacks than for other groups, but this is attributable largely to the higher rate of referral for Blacks. In sum, the system demonstrates lower levels of accuracy for Blacks than for other groups. A model is proposed demonstrating that random error, as opposed to systematic bias, could produce a pattern of results much like that observed in the data.     

Developmental Growth in "ACTION"

This paper describes a pilot program in a work acrivity center. Called the "ACTION Group," the project involved six c ients whose selection was based on low productivity rates on work assignments. The purpose of the "ACTION Group" was to allow clients who were experiencing failure to be motivated by tasks structured to their performance needs. The hypothesis is that productivity improves when clients are presented with purposeful and appealing activities at their developmental level.     

Defining the "community" in community consultation for emergency research: findings from the community VOICES study

This article explores the application of the concept "community consultation" in the context of emergency medical research. Emergency medicine researchers are permitted, by the World Medical Association regulations and in the United States by U.S. Federal Regulations, to conduct emergency medical research on individuals with a life-threatening condition without obtaining their consent or that of their surrogates if certain conditions are met. Among these conditions is the requirement that researchers observe a number of special protections for the participants, including "community consultation and notification" prior to the initiation of such studies. The term "community" is not defined clearly and the process for conducting community consultations is not specified in these regulations. This study explores the feasibility of conducting community consultation in the context of emergency medical research by examining: research participant's definitions of community in New York, the factors that help shape their definitions of community and the people they would authorize to render participation decisions on their behalves. Findings from this study suggest that participants' definitions of community vary as a function of the purpose of the definition and the demographics of the respondents. Most significantly, this study reveals that although respondents can identify potential spokespersons for their communities, these community spokespersons were rarely identified as those who should have decision-making authority in medical emergencies. Finally, this article explores the implications of these findings for the definition of community as it applies to community consultation for emergency medical research.