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OBJECTIVE: Insomnia disorder is a global public health issue, commonly treated with hypnotics. However, long-term use of benzodiazepine derivatives (BZDs), especially polypharmacy with this kind of drug, carries risks for dependence and abuse. This study using large-scale medical insurance records investigated the causes of polypharmacy through the treatment of insomnia disorder. METHODS: A cross-sectional study analyzed anonymized medical record data from July 2014 to March 2018 provided by a nationwide Japanese health insurance association covering 405,952 individuals. Outpatients prescribed at least one sleep medication were included. Demographic data, pharmacological classification of the drugs, and comorbidities were assessed using hierarchical logistic regression analysis to explore their associations with polypharmacy. RESULTS: Of the 33,212 outpatients who were prescribed sleep medications, 32.5 % were prescribed multiple types. After adjusting for demographics and type of sleep medications as covariates, hypnotic polypharmacy was significantly associated with younger age, the presence of certain kinds of comorbidities, and using BZD anxiolytics before bedtime with the highest adjusted odds ratios (8.01-9.39) when referenced with BZD hypnotics. On the other hand, usage of orexin receptor antagonists, melatonin receptor agonists, and Z-drugs indicated lower odds ratios (0.74-0.87). CONCLUSIONS: Hypnotic polypharmacy is relatively common in the Japanese general population. With the introduction of non-pharmacological therapy in mind, assessing patients' comorbidities and avoiding the use of benzodiazepines, especially BZD anxiolytics, before bedtime would be recommended to prevent polypharmacy.

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Cardinal number knowledge-understanding "two" refers to sets of two entities-is a critical piece of knowledge that predicts later mathematics achievement. Recent studies have shown that domain-general and domain-specific skills can influence children's cardinal number learning. However, there has not yet been research investigating the influence of domain-specific quantifier knowledge on children's cardinal number learning. The present study aimed to investigate the influence of domain-general and domain-specific skills on Mandarin Chinese-speaking children's cardinal number learning after controlling for a number of family background factors. Particular interest was paid to the question whether domain-specific quantifier knowledge was associated with cardinal number development. Specifically, we investigated 2-5-year-old Mandarin Chinese-speaking children's understanding of cardinal number words as well as their general language, intelligence, approximate number system (ANS) acuity, and knowledge of quantifiers. Children's age, gender, parental education, and family income were also assessed and used as covariates. We found that domain-general abilities, including general language and intelligence, did not account for significant additional variance of cardinal number knowledge after controlling for the aforementioned covariates. We also found that domain-specific quantifier knowledge did not account for significant additional variance of cardinal number knowledge, whereas domain-specific ANS acuity accounted for significant additional variance of cardinal number knowledge, after controlling for the aforementioned covariates. In sum, the results suggest that domain-specific numerical skills seem to be more important for children's development of cardinal number words than the more proximal domain-general abilities such as language abilities and intelligence. The results also highlight the significance of ANS acuity on children's cardinal number word development.

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Objective: To explore the relationships between multidimensional self-esteems and health behaviors among adolescents by demographic background factors, so as to provide an important reference for the intervention of health promotion behavior and self-esteem education in the future. Methods: Taking adolescents in Chongqing as the object, this paper investigates the students in 24 primary and secondary schools (half of health promotion schools and half of non-promotion schools) by means of Stratified random sampling, and Using SPSS 21.0 and AMOS 19.0 statistical analysis software to process the collected data. Results: 1) gender and age significantly affected adolescents' self-esteem and health promotion behavior, which showed that boys's perception of self-esteem was lower than that of girls, while girls were more likely to implement health promotion behavior than boys; 2) Children from two parent families or families with higher parental education are more able to implement health promotion behavior and enjoy higher self-esteem, while family economic status has no effect on adolescents' self-esteem and health promotion behavior; 3) Compared with students in ordinary schools, adolescents in health promotion schools (HPS) have higher self-esteem and can implement health promotion behavior more; 4) The higher the self-esteem of adolescents, the better their health promotion behavior; The higher the sense of interpersonal ability, the more able to implement social support behavior; The higher the sense of physical ability and physiological value, the more able to implement sports behavior; The higher the sense of academic ability, the more able to implement nutritional behavior; The higher the external recognition and physiological value, the better the performance of nutritional behavior and stress management; The higher the internal evaluation, the more able to implement health responsibility and exercise behavior. Conclusion: Socio-economic background can indeed have a direct or indirect impact on adolescent health promotion behavior, and multidimensional self-esteem can explain about 70% of the variation of health promotion behavior, which seems to suggest that improving adolescent self-esteem is the focus of health promotion and health education in the future.

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BACKGROUND: Functional constipation (FC), a functional bowel disorder with symptoms of constipation, has considerable impact on quality of life. As data regarding its prevalence and epidemiology are lacking, this study aimed to evaluate the prevalence, population composition, lifestyle, quality of life, and clinical characteristics of these individuals by comparing people with and without FC. These parameters were also compared among individuals with strong and weak awareness of constipation. METHODS: An internet survey was conducted among 10,000 individuals aged 20-69 years from the general Japanese population; they were registered with an internet survey company. The following data were obtained: age, sex, educational history, occupation, residence, history of other diseases, lifestyle (including smoking/drinking habits using the Japanese Health Practice Index, medication use, symptoms of constipation according to the Rome III criteria, stool types according to the Bristol stool scale, and use of laxatives, including the place of purchase and cost per month or acceptable cost per month. The 8-item Short Form Health Survey Questionnaire was also used; FC was diagnosed based on Rome III criteria. All respondents were classified according to their awareness of constipation (i.e. strong or weak), and their characteristic features were compared. RESULTS: The data of 3000 respondents were evaluated; 262 (8.7%) had FC, which was common among older adults, women, and homemakers. FC was associated with changes in the frequency of bowel movement, sensation of incomplete or scanty evacuation, and the use of manual maneuvers; these are consequential clinical symptoms of FC. These individuals frequently skipped breakfast, had insufficient sleep, had more severe constipation, and had purchased laxatives in pharmacies or online more often than those without FC. A strong awareness of constipation was significantly more prevalent among women and homemakers. A history of anemia and cardiovascular disease was significantly more frequent in the strong awareness group, whereas a history of hypertension was more frequent in the weak awareness group. CONCLUSIONS: Appropriate and comprehensive management should be provided for FC, based on the understanding of its characteristic features and considering the symptoms and lifestyle.

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Immigrant children are exposed to high levels of psychological distress, leading to an increased risk of mental and physical health problems. In the present study we investigated the impact of first and second generation immigrant children's proficiency in the host country language on their psychological well-being one year later. The effects of gender, family SES, and classmates' characteristics were also examined. A structural equation model was tested on 2334 immigrant children in a representative sample of 561 Italian primary schools taking measurement errors into account. Children's language proficiency significantly predicted their psychological well-being one year later, both in first and second immigrant generations (B = .23; p < .001). None of the other variables had a significant impact. Improving the language skills of immigrant children could promote their mental health, regardless of their backgrounds and whether they were born in the host country or not.

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We investigated the relationship between teacher support at school intended to promote students' autonomy and immigrant adolescents' psychological well-being. A structural equation model was tested on 3130 immigrant adolescents who attended a representative sample of 654 Italian high schools. Gender, socioeconomic status, previous school achievement and immigrant generation were included in the analysis as control variables. Results showed that when teachers are perceived as adopting an approach that is supportive of autonomy, immigrant adolescents report significantly higher levels of psychological well-being. Gender appears to be the most relevant background factor, with girls being more at risk than boys as regards mental health. Overall, our findings suggest that interventions of enacted support by teachers at school that aim to foster students' autonomy would be an effective approach for protecting against mental illness in immigrant adolescents.

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BACKGROUND: Child physical abuse (CPA) is an extensive public health problem because of its associations with poor health outcomes. The aim of this study was to examine which of the background factors of CPA committed by a parent or other caregiver relates to self-reported poor health among girls and boys (13; 15 and 17 years old): perpetrator, last year exposure; severity and frequency; socioeconomic load and foreign background. METHODS: In a cross-sectional study in a Swedish county (n = 8024) a path analysis was performed to evaluate a model where all background variables were put as predictors of three health-status variables: mental; physical and general health problems. In a second step a log linear analysis was performed to examine how the distribution over the health-status categories was different for different combinations of background factors. RESULTS: Children exposed to CPA reported poor health to a much higher extent than those who were not exposed. In the path analysis it was found that frequency and severity of abuse (boys only) and having experienced CPA during the last year, was significantly associated with poor health as well as socioeconomic load in the families. Foreign background was significantly negatively associated with all three health indicators especially for girls. Neither mother nor father as perpetrator remained significant in the path analysis, while the results from the log linear analyses showed that mother-abuse did in fact relate to poor general health and mental as well as physical health problems among boys and girls. Father-abuse was associated with poor mental health if severe abuse was reported. Poor mental health was also associated with mild father-abuse if exposure during the last year was reported. CONCLUSION: Despite the limitations that cross-sectional studies imply, this study provides new knowledge about factors associated with poor health among physically abused children. It describes details of CPA that have significant associations to different aspects of poor health and thus what needs to be addressed by professionals within mental health providers and social services. Understanding how different factors may contribute to different health outcomes for exposed children is important in future research and needs further studies.

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OBJECTIVES: Siewert type II esophagogastric junction adenocarcinoma encompasses both gastric cardia adenocarcinoma (GCA) and Barrett's esophageal adenocarcinoma (BEA) due to short-segment Barrett's esophagus. We compared these two types of Siewert type II esophagogastric junction adenocarcinoma in terms of background factors and clinical outcomes of endoscopic submucosal dissection (ESD). METHODS: We enrolled 139 patients (142 lesions) who underwent ESD from 2006 to 2014 at our institution. Background factors evaluated were age, sex, body mass index, hypertension, hyperlipidemia, hyperuricemia, diabetes mellitus, smoking, drinking, double cancer, and endoscopic findings. Clinical outcomes evaluated were procedure time, en bloc resection rate, curative resection rate, and adverse events. RESULTS: There were 87 GCA lesions (61.2%) and 55 BEA lesions. Features of BEA [55 lesions (38.8%)] included a younger age, small diameter, and a protruding type, along with a high frequency of esophageal hiatal hernia and less mucosal atrophy. There were no significant differences in lifestyle-related background factors between the GCA and BEA groups. Curative resection rate was greater for GCA (81%) than for BEA (66%) (P = 0.01). There were no serious adverse events in either group. Among the factors for noncurative resection, lymphovascular invasion and depth of invasion were greater for BEA (33.3 vs. 7 and 20.7 vs. 8.2%, respectively (P < 0.01). Of the noncured patients, 70% underwent additional surgery and none had postoperative lymph node metastasis. CONCLUSIONS: Siewert type II adenocarcinoma encompasses two types of cancers with different etiologies: GCA and BEA. Although there are no significant differences in lifestyle-related background factors between GCA and BEA, BEA is a risk factor for noncurative resection via ESD.

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BACKGROUND: Sudanese children with congenital heart defects (CHDs) were found to have poorer oral health than those without CHDs. The aims of this study were to: describe the patterns of oral-health-related background factors in children with and without CHD and explore any differences, and to evaluate the effects of background factors on caries and gingivitis prevalence and dental services utilisation. METHODS: In this analytical cross-sectional study, caregivers of children aged 3-12 years with (CHD cases n = 111) and without CHDs (Controls n = 182), underwent face-to-face interviews using a structured questionnaire. The questionnaire items covered several oral health background factors (independent variables) including: child's health status, oral hygiene practices, dental services utilization, mother's level of education, and caregiver's perception and awareness of their child's oral health. The relationship between these factors and occurrence of 'caries' and 'gingivitis' as well as 'child's dental services utilisation' (dependent variables) were explored using multiple adjusted and hierarchal logistic regression analyses. RESULTS: Compared with controls, CHD cases had lower frequencies of brushing and use of fluoridated toothpaste, and their caregivers were less knowledgeable about caries. Among CHD cases, the variables (brushing and fluoridated toothpaste use) had significant impacts on caries prevalence (odd ratio (OR) =5.6, 95% confidence interval (CI): 1.4-22.8 and OR = 0.3, 95% CI: 0.1-0.8 for infrequent compared to frequent ones, respectively) as well as the mother's level of education (OR = 2.6, 95% CI: 1.0-6.4). When differences in background factors were controlled for, the adjusted ORs for caries and gingivitis prevalence in CHD cases compared with controls were 1.8, (95% CI: 1.1-3.2) and 5.3 (95% CI: 2.9-9.4), respectively. Among CHD cases, the child's age (8-12 years: OR = 11.9, 95% CI: 1.9-71.6), and the mother's level of education (lower education: OR = 0.2, 95% CI: 0.03-0.9) were significantly associated with the child's dental services utilisation. CONCLUSIONS: Lower frequencies of brushing and use of fluoride tooth paste were reported among CHD cases, and brushing had the predominant significant impact on caries prevalence. The child's age and the mother's level of education were the main factors affecting the child's (CHD cases) dental services utilisation.

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Although fruit and vegetable consumption is highly recommended for a healthy and balanced daily diet, several European countries do not meet these recommendations. In Italy, only 45% of young people are consuming at least one portion of vegetables per day. Therefore, this paper aims to understand the main determinants of vegetables consumption among young adults to suggest possible intervention strategies. A cross-sectional study was conducted on a samples of Italian students (n = 751), using the theory of planned behaviour (TPB) as a conceptual framework. A structural equation model (SEM) was developed to test the TPB predictors for vegetable consumption, and the role of background factors (socio-demographic and personal characteristics) in improving the TPB model's explaining power. Overall, 81% and 68%, respectively, of intentions and behaviour variance is explained by the TPB model. Socio-demographic and personal characteristics were found to influence intentions and behaviour indirectly by their effects on the theory's more proximal determinants. Interventions should be targeted to improve perceived behavioural control (PBC), attitudes and subjective norms that significantly affect intentions. Tailored interventions for male students, enrolled in courses other than food science, and doing less physical activity may have a larger effect on behavioural change.

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OBJECTIVES: The purpose of this cross-sectional study was to determine the prevalence of hoarseness in children attending the first or second grade of primary school and to explore possible background factors for hoarseness in children. METHODS: The participants were 217 children, aged 6-10 years, from 10 different schools. Questionnaires were filled in by the parents and the teachers of the children and voice samples were recorded. The voice samples from the children were perceptually evaluated by eight trained listeners and intra- and inter-rater reliability was calculated. Additionally, the parents and teachers were in the questionnaires asked to rate the children's voices. Connections between background factors and voice quality were explored. RESULTS: Both the intra- and inter-rater reliability for the trained listeners were relatively high and significant. The prevalence of hoarseness for the whole group was 12.0% as judged by the trained listeners. For girls, the prevalence of hoarseness was 7.8% and for boys 15.8%. A lower teacher rating of degree of maturity correlated significantly with the voice quality. Additionally, there was a significant negative correlation between the amount of talking at home and voice quality. For girls, heavy voice use as an infant correlated significantly with voice quality. For boys, being the youngest sibling correlated significantly with voice quality. CONCLUSIONS: The results from the present study indicate that more attention should be paid to hoarseness in children and that background factors should be further explored.

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<b>Background</b> : With the recent progression of the aging society in Japan, what is now seen as important is not simply treatment of disease alone, but also increased quality of life. We have investigated the correlation between the feeling of subjective health and mortality after mean 3.8 year among local residents.<br><b>Methods</b> : In fiscal 2008, a self-recording questionnaire survey was conducted by mailing the questionnaire to 2,657 local residents. Correlation with deaths after mean 3.8 years was investigated based on the Resident Register. With regard to the evaluation items, as background factors related to death, social life conditions (gender·age), health conditions (history of cardiovascular disease, state of depression, subjective happiness, subjective health)and basic activities of daily living (BADL : walking, diet, excretion, bathing, dressing, and ambulation)were evaluated using a 4-point scale ranging from total assistance to completely independent. The Tokyo Metropolitan Institute of Gerontology (TMIG : instrumental independence, intellectual activity, and social role)was used to evaluate the lifestyle factors.<br><b>Results</b> : Of 1825 subjects, 767 males (mean age : 67±13 years)and 1058 females (mean age : 68±11 years), could be analyzed. There were 91 deaths from 2008 to 2012. Investigation of factors that increased subjective health revealed that age, cardiovascular disease, state of depression, intellectual activities, and subjective happiness were items that showed significant correlation. Multivariate logistic regression analysis revealed that subjective health was a significant explanatory variable of death.<br><b>Conclusion</b> : How one personally feels about one's state of health and how one recognizes that, are important. Though not seen physically, they can be considered as important parameters that predict prognosis.

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OBJECTIVES: This study evaluates the influence of several determinants on the presence of early childhood caries (ECC) in preschool children living in northern Sardinia, Italy. These determinants include the educational level and occupational status of the parents as a proxy for the socioeconomical level (SES) and behavioral factors (dietary and oral hygiene). METHODS: An observational cross-sectional study was designed with a dental examination and a standardized questionnaire. Five hundred forty-four subjects (260 girls and 284 boys) were enrolled and categorized into two age groups: 359 children were aged 18-47 months and 185 children were aged 48-60 months. RESULTS: The total caries prevalence was 15.99%. Caries risk increased with lower parents' educational level (P = 0.01), increased number of siblings (P < 0.01), the use of bottle feeding (P = 0.02), and the use of a sweetened baby's pacifier at night (P = 0.01). In robust multivariate analysis, a high parental educational level played a protective role on the presence of caries lesion [odds ratio (OR) = 0.51, 95% confidence interval (CI) 0.34-0.78]; the mother's being employed had a positive statistically significant association with the child having decayed, missing, filled tooth surfaces = 0 (OR = 0.64, 95% CI 0.23-0.97). The presence of more than one sibling in the family was associated with caries (OR = 1.70, 95% CI 1.20-2.40). CONCLUSION: ECC prevalence evaluated was similar to other western countries, and SES and behavioral habits influence the development of ECC.

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