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

BACKGROUND

Many reports argue that sleep is important for children's health, learning, and academic performance. The purpose of this longitudinal study was to examine the association between sleep and the development of social competence in infants.

METHODS

This study was conducted as part of a Japan Science and Technology Agency (JST) project. Caregivers responded to the Japan Children's Study Sleep Questionnaire when children were 18 months old. The interactions of caregivers and children were observed when children were 18, 30, and 42 months old, and rated with the Interaction Rating Scale, which is a measure of social competence.

RESULTS

Nocturnal sleep duration of more than 10 h and an earlier bed time than 22:00 were significantly correlated with two trajectory groups (low point and high point transition groups) of children's social competence at 18, 30, and 42 months. Further, total sleep duration of more than 12.25 h and an earlier bed time than 22:00 were significantly correlated with the trajectory of children's social competence at 18, 30, and 42 months.

CONCLUSIONS

Sleep duration and sleep onset time are important factors in children's development of social competence.Trial registration The ethics committee of the JST approved this study on March 19, 2001. The registration number is 356-1.

Effect of text messages to improve health literacy on medication adherence in patients with type 2 diabetes mellitus: A randomized controlled pilot trial

It has been suggested that low health literacy (HL) is associated with poor medication adherence. This study aimed to examine the effect of a text message-based HL intervention to promote medication adherence, compared with text messages that only sent medication reminders, in patients with type 2 diabetes. This was a single-center, open-label, randomized (1:1) controlled pilot study. The study period was 6 months. Intervention group was sent HL related text messages, compared to the reminder messages that were sent to the control group. The primary outcome was the difference in the change rate of scores on the Morisky Eight-Item Medication Adherence Scale (MMAS-8). Forty-one participants were randomized into the intervention (n = 21) and control (n = 20) groups and completed the 6-month follow-up. Although almost participants read and understood the information provided in the messages, no significant difference was observed between groups for the primary outcome (p = 0.78). Our results suggested that medication adherence at 6 months after discharge in patients with type 2 diabetes did not significantly change by text messages, which aimed to improve their HL levels.

Awareness of cardiopulmonary resuscitation among parents of 3-year-old children

BACKGROUND

Out-of-hospital cardiac arrest (OHCA) in infants or toddlers mainly occurs at home. Therefore, parents should be able to perform immediate cardiopulmonary resuscitation (CPR) when they witness OHCA. The status of knowledge regarding CPR among parents, however, remains unclear. The aim of the present study was therefore to determine the factors associated with awareness of CPR in parents of 3-year-old children.

METHODS

We analyzed a subset of data from a population-based, cross-sectional survey that served as an evaluation of a national campaign for maternal and child health in Japan. The questionnaire was distributed to 32 897 parents who visited public health centers for medical check-ups for their children in 2013. Multivariate logistic regression analysis was carried out using the obtained demographic data.

RESULTS

Overall, 26 971 parents (82.0%) responded to the questionnaire. On multivariate logistic regression analysis, birth order of the child, age of the mother at delivery, awareness of medical facilities for emergency services at night or during the weekend, current occupation status of the mother, and current economic status were independently associated with CPR awareness. When the mother was employed but the parents felt economically insufficient, the probability of having CPR knowledge decreased by 19%. Regardless of the parents' economic stability, the probability of having CPR knowledge declined by >35% when the mother was unemployed.

CONCLUSIONS

The current occupation status of mothers and the current parent economic status should be considered when planning educational strategies regarding CPR training for parents.

[The relationship between parenting anxiety in mothers and the resources from which they routinely sought advice: The final "Healthy Parents and Children 21" survey]

Objectives　This study aimed to examine the relationship between parenting anxiety in mothers and the resources from which they routinely sought advice.Methods　Data consisted of the 75,662 survey responses from parents of children who had undergone health checkups between April and August of 2013. A logistic regression analysis was performed using parenting anxiety (computed using the responses to the two survey items "I don't feel confident as a parent" and "I wonder if I'm mistreating my child") as the response variable. The people or resources from which the mothers sought parenting advice and the number of such resources were used as the explanatory variables.Results　Across all ages, the percentage of mothers selecting "husband" as a parenting resource was the largest, and most mothers indicated they had three resources. Common across all ages, mothers who indicated that they had their husband or the child's grandmother or grandfather as resources had a significantly lower odds ratio of having parenting anxiety than mothers who did not. In contrast, mothers who selected "nursery school or kindergarten teachers" or "the Internet" as resources had a significantly higher odds ratio of having parenting anxiety than mothers who did not select these resources. Across all ages, no significant relationship was found between mothers' parenting anxiety and the number of resources they used for parenting advice. There was a significantly higher odds ratio of mothers of children aged 18 and 36 months who indicated that they wondered if they were mistreating their child if they had nobody to talk to than if they had one resource. When the number of resources increased to three, four, or five, the odds ratio was significantly reduced.Conclusion　For mothers of children of all ages, results showed that those who routinely sought advice from their husband or their child's grandparents had a significantly lower probability of experiencing parenting anxiety. On the other hand, this probability was significantly higher when their resources were nursery school or kindergarten teachers or the Internet. This study also suggests that, for mothers of young children, having a larger number of people from whom to routinely seek advice may reduce their anxiety about their parenting ability.

International investigation into the relationship between social expenditure for family and total fertility rate

Purpose Declining birth rates are an important social issue worldwide, and allocating resources to benefits for child-rearing households is a necessary countermeasure. In this study, we investigate and compare the relationship between child-related social security costs and total fertility rate internationally.Method In 2011, the ratios of family- and elderly-related social spending to gross domestic product (GDP) were recorded in 34 Organisation for Economic Co-operation and Development (OECD) member countries. The former was designated as the percentage allocated to members of the population between the ages of 0 and 14 (young population ratio), and the latter was designated as the percentage allocated to members of the population over the age of 65 (elderly population ratio). We compared these two factors for every country and performed correlation and partial correlation analyses of total fertility rates and family-related social spending to GDP adjusted by population proportion to examine the relationship between the two.Results The comparison of the youth and elderly populations' spending ratios in the total social spending to GDP ratio revealed that OECD countries had an average family-related social spending ratio of 0.13 and an average elderly-related social spending ratio of 0.47. Comparatively, Japan has a family-related social spending ratio of 0.10 and an elderly-related social spending ratio of 0.45. In the correlation analysis for total fertility rates and family-related social spending to GDP ratio, the benefits-in-kind to GDP ratio and total fertility rates indicated a trend toward correlation (r=0.32, P=0.06). In addition, the results for the partial correlation between family-related social spending to GDP ratio and total fertility rates showed a significant correlation between the two. When divided into cash benefits and benefits-in-kind, the partial correlation analysis of the GDP ratios and total fertility rates revealed a significant correlation (r=0.51, P<0.01). Benefits-in-kind (r=0.45, P<0.01) had a stronger correlation than did cash benefits (r=0.39, P=0.03).Conclusion In an international comparison accounting for economic standards, the social security cost of children and child-rearing families in Japan was low. Further, in terms of social security spending, increasing benefits-in-kind, such as improving childcare services or preschool education, is one factor that improves the total fertility rate.

Current situation and issues using maternal and child health-related information in the "Healthy parents and children 21" campaign across municipalities in Japan

Objectives The use of maternal and child health-related information is an issue faced by the "Healthy parents and children 21" campaign, a national campaign to improve the health standards of mothers and children in Japan. This study described the current situation and issues faced by municipalities across Japan that use this information.Methods Data across municipalities selected for the current survey of promoting the "Healthy parents and children 21" campaign in 2013 were analyzed in this study. First, we chose prefectures where collected and analyzed maternal and child health-related information was provided by the municipalities. Then, we divided the municipalities according to those prefectures where the municipalities regularly reported the maternal and child health-related information and those that did not report it regularly. Finally, the characteristics about maternal and child health in those municipalities were investigated.Results Of the 47 prefectures analyzed, 35 prefectures (74.5%) collected and analyzed maternal and child health-related information provided by the municipalities. The 35 prefectures included 1,242 municipalities, of which 700 (56.4%) regularly reported maternal and child health-related information, and 542 (43.6%) did not report it regularly. The proportion of municipalities, where information about smoking during pregnancy, immunization, or low birth weight in infants was positively used, was significantly lower among municipalities that did not regularly report maternal and child health-related information than among those that regularly reported it (P<0.001). The proportion of municipalities that coordinated projects on prevention of child abuse or low birth weight in infants with the prefectures was significantly lower among municipalities that did not regularly report maternal and child health-related information than among those that regularly reported it.Conclusion Among municipalities that did not regularly report maternal and child health-related information, coordinating projects about child abuse with the prefectures might be associated with an increase in using the information. In addition to collecting and analyzing maternal and child health-related information provided by municipalities, prefectures should help municipalities coordinate projects about those issues to increase the use of the information in municipalities.

Pubertal timing and a family history of hypertension: Prospective cohort study

BACKGROUND

Hypertension is heritable, and genetic factors likely exert an effect from childhood. Puberty is an early life milestone that may relate to adult hypertension. Therefore, this study examined whether there is an association between a family history of hypertension and pubertal growth.

METHODS

The participants were children from a prospective cohort study called Project Koshu, who were born between 1991 and 1998 in Japan. Data on family history of hypertension, maternal characteristics, birth and early life factors were collected from the questionnaire administered to the mothers at the time of pregnancy registration or medical check-up. Child age at peak height velocity (early or non-early) was calculated from the anthropometric data collected during annual school check-up.

RESULTS

Data on 919 children (479 boys and 440 girls) were included in the analysis; 478 participants had a family history of hypertension. After adjustment for potential confounders (birth month, maternal body mass index, maternal work status, maternal education, and paternal education), early age at peak height velocity was found to be associated with a family history of hypertension (OR, 1.52; 95% confidence interval (CI): 1.04-2.24; P = 0.03) and specifically, with having at least one maternal hypertensive relative (OR, 1.81; 95%CI: 1.23-2.68; P = 0.003).

CONCLUSIONS

Together with previous reports on the relationship between puberty and adult hypertension, the present results suggest that the timing of pubertal growth is involved in the process of hypertension development in people with a family history of hypertension. Further confirmative studies are needed.

Evaluation of the associations between changes in intraocular pressure and metabolic syndrome parameters: a retrospective cohort study in Japan

OBJECTIVE

The contributions of highly correlated cardiovascular risk factors to intraocular pressure (IOP) are not clear due to underlying confounding problems. The present study aimed to determine which metabolic syndrome parameters contribute to elevating IOP and to what extent.

DESIGN

Retrospective cohort study.

SETTING

A private healthcare centre in Japan.

PARTICIPANTS

Individuals who visited a private healthcare centre and underwent comprehensive medical check-ups between April 1999 and March 2009 were included (20,007 in the cross-sectional study and 15,747 in the longitudinal study).

PRIMARY AND SECONDARY OUTCOME MEASURES

Changes in IOP were evaluated in terms of ageing and changes in metabolic syndrome parameters. Pearson's correlation coefficients and mixed-effects models were used to examine the relationship of changes in IOP with ageing and changes in metabolic syndrome parameters in cross-sectional and longitudinal studies, respectively.

RESULTS

In the cross-sectional study, IOP was negatively correlated with age and positively correlated with waist circumference, high-density lipoprotein cholesterol (HDL-C) levels, triglyceride levels, systolic blood pressure (SBP), diastolic blood pressure (DBP) and fasting plasma glucose (FPG) levels. In the longitudinal multivariate analysis, the associated IOP changes were -0.12 (p<0.0001) mm Hg with male sex; -0.59 (p<0.0001) mm Hg with 10 years of ageing; +0.42 (p<0.0001) mm Hg with 1 mmol/L increase in HDL-C levels; +0.092 (p<0.0001) mm Hg with 1 mmol/L increase in triglyceride levels; +0.090 (p<0.0001) mm Hg with 10 mm Hg increase in SBP; +0.085 (p<0.0001) mm Hg with 10 mm Hg increase in DBP; and+0.091 (p<0.0001) mm Hg with 1 mmol/L increase in FPG levels.

CONCLUSIONS

Elevation of IOP was related to longitudinal worsening of serum triglyceride levels, blood pressure and FPG and improvement in serum HDL-C levels.

Association Between Maternal Smoking During Pregnancy and Birth Weight: An Appropriately Adjusted Model From the Japan Environment and Children's Study

Background

There has been no large nationwide population-based study to examine the effects of maternal smoking status during pregnancy on birth weight that simultaneously controlled for clinical information, socioeconomic status, and maternal weight. Thus, this study aimed to determine the association between maternal smoking status during pregnancy and birth weight, while taking these confounding factors into consideration.

Methods

This study examined the first-year fixed dataset from a large nationwide birth cohort study that commenced in 2011. The dataset consisted of information on 9369 singleton infants born before December 31, 2011. Children were divided into 4 groups for statistical analysis: those born to mothers who did not smoke (NS), who quit smoking before pregnancy, who quit smoking during early pregnancy, and who smoked (SM). Multiple linear regression models were conducted for each sex to examine the association between maternal smoking status during early pregnancy and fetal growth. Birth weight was estimated using the least-squares method after controlling for covariates.

Results

After controlling for potential confounding factors, maternal smoking status during pregnancy was significantly associated with birth weight. There was a significant difference in birth weight between NS and SM for both male and female infants (male infants, 3096.2 g [NS] vs 2959.8 g [SM], P < 0.001; female infants, 3018.2 g [NS] vs 2893.7 g [SM], P < 0.001).

Conclusions

Using data from a large nationwide birth cohort study in Japan, we have shown that maternal smoking during pregnancy may reduce birth weight by 125–136 g.

Do body mass index trajectories affect the risk of type 2 diabetes? A case-control study

Background

Although obesity is a well-studied risk factor for diabetes, there remains an interest in whether “increasing body mass index (BMI),” “high BMI per se,” or both are the actual risk factors for diabetes. The present study aimed to retrospectively compare BMI trajectories of individuals with and without diabetes in a case–control design and to assess whether increasing BMI alone would be a risk factor.

Methods

Using comprehensive health check-up data measured over ten years, we conducted a case–control study and graphically drew the trajectories of BMIs among diabetic patients and healthy subjects, based on coefficients in fitted linear mixed-effects models. Patient group was matched with healthy control group at the onset of diabetes with an optimal matching method in a 1:10 ratio. Simple fixed-effects models assessed the differences in increasing BMIs over 10 years between patient and control groups.

Results

At the time of matching, the mean ages in male patients and controls were 59.3 years [standard deviation (SD) = 9.2] and 57.7 years (SD = 11.2), whereas the mean BMIs were 25.0 kg/m² (SD = 3.1) and 25.2 kg/m² (SD = 2.9), respectively. In female patients and controls, the mean ages were 61.4 years (SD = 7.9) and 60.1 years (SD = 9.6), whereas the mean BMIs were 24.8 kg/m² (SD = 3.5) and 24.9 kg/m² (SD = 3.4), respectively. The simple fixed-effects models detected no statistical significance for the differences of increasing BMIs between patient and control groups in males (P = 0.19) and females (P = 0.67). Sudden increases in BMI were observed in both male and female patients when compared with BMIs 1 year prior to diabetes onset.

Conclusions

The present study suggested that the pace of increasing BMIs is similar between Japanese diabetic patients and healthy individuals. The increasing BMI was not detected to independently affect the onset of type 2 diabetes.

Buffering effect of parental engagement on the relationship between corporal punishment and children's emotional/behavioral problems

BACKGROUND

Previous research has established links between corporal punishment and children's developmental problems, but few studies have investigated the moderating effect of positive parenting between corporal punishment and children's developmental difficulties in detail. This study investigated the buffering effect of parental engagement on the association between corporal punishment and children's emotional/behavioral problems.

METHODS

The main caregivers completed the Evaluation of Environmental Stimulation Scale (EES), which is an evaluation of daily parenting behaviors, and the Strengths and Difficulties Questionnaire (SDQ), which evaluates children's developmental problems.

RESULTS

Corporal punishment was associated with worse emotional and behavioral problems in children, whereas parental engagement in games or sports was associated with fewer emotional symptoms. Similarly, parental engagement in homework or housework significantly moderated the association between corporal punishment and children's behavioral problems.

CONCLUSIONS

Parental engagement positively moderated the association between parental corporal punishment and children's developmental difficulties. This association varied with child gender.

Childhood growth trajectories according to combinations of pregestational weight status and maternal smoking during pregnancy: a multilevel analysis

Pregestational weight status and maternal smoking during pregnancy are significantly associated with fetal and childhood growth. However, few studies have examined associations between childhood growth and combinations of these factors using multilevel analysis. This study aimed to describe differences in childhood growth trajectories according to these combinations, using data from a prospective cohort study in Japan. The study participants were 1,973 women and their singletons, who were born between April 1, 1991 and March 31, 2003. Children were categorized according to whether they were born to normal-weight, nonsmoking mothers (NN); normal-weight, smoking mothers (NS); underweight, nonsmoking mothers (UN); underweight, smoking mothers (US); overweight, nonsmoking mothers (ON); or overweight, smoking mothers (OS). Birth weight and anthropometric data were collected from 1,965 children at birth (99.6%), 1,655 aged 3 (83.9%), 1,527 aged 5 (77.4%), 1,497 aged 7–8 (75.9%), and 1,501 aged 9–10 (76.1%). Multilevel analysis examining both individual and age as different level variables according to sex was used to describe the trajectories of body mass index z scores for statistical analyses. Although children of the OS group were the leanest at birth, their body mass indices had increased rapidly by 3 years of age. Moreover, body mass index was also likely to increase in boys in the NS and ON groups. A different trend was observed in girls. Body mass index decreased from 5 years of age in girls in the US group. There were no remarkable differences in body mass index trajectories between children in the other groups. In conclusion, childhood growth trajectories differed according to combinations of pregestational weight status and maternal smoking during pregnancy. Further, there were sex-related differences in the associations between childhood growth and factor combinations.

Maternal smoking during pregnancy and growth in infancy: a covariance structure analysis

Background

Smoking during pregnancy is related to fetal constraint and accelerated postnatal growth. However, the pathways between these factors have not been clarified. Pathway analyses that link these factors can help us better understand the mechanisms involved in this association. Therefore, this study aimed to examine pathways between maternal smoking during pregnancy and growth in infancy.

Methods

Participants were singletons born between 1993 and 2006 in rural Japan. The outcome was the change in weight z-score between birth and 3 years of age. Pathways from maternal smoking and other maternal factors (such as maternal body mass index and work status) to growth in infancy via birth factors (such as birth weight and gestational age) and breastfeeding were examined using structural equation modeling.

Results

Complete data were available for 1524 children (775 boys and 749 girls). The model fit appeared adequate. Lower birth weight and non-exclusive breastfeeding mediated the association between maternal smoking during pregnancy and rapid growth in infancy. Maternal smoking was also directly linked to rapid growth in infancy (standardized direct effects 0.06, P = 0.002). Taking all pathways into account, the standardized total effect of maternal smoking on growth in infancy was 0.11.

Conclusions

Maternal smoking during pregnancy may both indirectly, through birth weight and breastfeeding status, and directly influence growth during infancy; however, there may be other pathways that have not yet been identified.

Perceiving active listening activates the reward system and improves the impression of relevant experiences

Although active listening is an influential behavior, which can affect the social responses of others, the neural correlates underlying its perception have remained unclear. Sensing active listening in social interactions is accompanied by an improvement in the recollected impressions of relevant experiences and is thought to arouse positive feelings. We therefore hypothesized that the recognition of active listening activates the reward system, and that the emotional appraisal of experiences that had been subject to active listening would be improved. To test these hypotheses, we conducted functional magnetic resonance imaging (fMRI) on participants viewing assessments of their own personal experiences made by evaluators with or without active listening attitude. Subjects rated evaluators who showed active listening more positively. Furthermore, they rated episodes more positively when they were evaluated by individuals showing active listening. Neural activation in the ventral striatum was enhanced by perceiving active listening, suggesting that this was processed as rewarding. It also activated the right anterior insula, representing positive emotional reappraisal processes. Furthermore, the mentalizing network was activated when participants were being evaluated, irrespective of active listening behavior. Therefore, perceiving active listening appeared to result in positive emotional appraisal and to invoke mental state attribution to the active listener.

Adolescent growth in overweight and non-overweight children in Japan: a multilevel analysis

BACKGROUND

A trend towards earlier pubertal growth has been identified along with an increase in childhood obesity rates. The study aimed to identify the differences in growth patterns during adolescence between overweight/obese and non-overweight children in Japan.

METHODS

The participants were children from a prospective cohort study called Project Koshu, who were born between 1991 and 1998, in Japan. They were classified as overweight/obese or non-overweight according to their body mass index (BMI) in the first grade of elementary school (6-7 years of age) and were followed until graduation from junior high school (14-15 years of age). Anthropometric data were collected at an annual medical check-up in their school. Height gain trajectories were constructed by BMI categories using multilevel analyses. This analysis was stratified by gender.

RESULTS

Overall, 111/850 (13.1%) girls and 109/911(12%) boys were defined as overweight/obese at baseline. Approximately 80% of the children were followed until the third grades of junior high school. Overweight/obese girls gained more height in the first half period, reached their peak height gain about a year earlier than non-overweight girls, and experienced an earlier decline in height gain. Similarly, overweight/obese boys gained more height than non-overweight boys initially. Additionally, non-overweight boys maintained a higher rate of height gain from the age at peak height gain, although the age at peak height gain did not differ between the two groups.

CONCLUSIONS

The overweight/obese children grew faster than the non-overweight children in the early pubertal stages, and the non-overweight children caught up and exceeded in height gain at a later stage.

[The influence of caregivers' anxiety and the home environment on child abuse. A study of children attending child-care centers]

OBJECTIVES

The prevalence of child abuse is increasing in Japan. Therefore, we need appropriate and practical approaches for implementing feasible prevention, early detection, and support services for abused children. The purpose of this study was to examine child-rearing anxieties and the home environment as factors affecting caregivers of suspected abused children who attend child-care centers .

METHODS

First, we applied the millennium edition of the Japan Child and Family Research Institute (JCFRI) Child Rearing Support Questionnaire, and the Index of Child Care Environment (ICCE), for 1,801 caregivers whose children were enrolled in child-care centers based in City A. The millennium edition of the JCFRI Child Rearing Support Questionnaire measures difficulties in childcare for caregivers in terms of feelings, anxiety, and tendencies toward depression. The ICCE measures the quality and frequency of involvement of caregivers with their children and the child-care environment. Next, we interviewed the directors and child-care professionals in the centers to collect information on child abuse. The children were divided into two groups: abused and non-abused. The "abused group" consisted of the children whom the directors and professionals of the child-care centers suspected of being "possibly abused" and so had been placed under the protection of the center; furthermore, the center exchanged information with the City A Municipality "City A municipal government" about these children. We conducted Fisher's exact test to examine the relationship between the "abused group" and the "non-abused group," in relation to child-rearing anxiety and the children's home environments. Questionnaire scores from the two groups were assessed. We calculated odds ratios to examine the significant factors related to child abuse. Our dependent variable was child abuse, our main independent variables were items related to child-care difficulties and the child-care environment, and the moderating variables were age and gender. We used multiple logistic regression to assess the actual child abuse predictors.

RESULTS

The odds ratios obtained by comparing the "abused group" with the "non-abused group" showed that the caregivers of children in the "abused group" had a 5.5-fold greater odds of saying, "I am riddled with uneasiness and awful feelings," and a 4.6-fold greater odds of saying, "I do not have anyone to look after my child except a child-care center." The moderating variables (age and gender) were not significant.

CONCLUSION

Child-care professionals have a policy for ensuring there is concrete and usable support for caregivers, depending on the relationship between the abused child and the difficulties present in the child's environment. We suggest that awareness of these relationships can be promoted as an aid for early child abuse detection, support, and prevention.

Effect of maternal smoking cessation before and during early pregnancy on fetal and childhood growth

Background

Maternal smoking during pregnancy is a major cause of intrauterine growth restriction and childhood obesity, but only a few studies have examined the association of smoking cessation before and during pregnancy with fetal and childhood growth. We examined this association in a prospective cohort study in Japan.

Methods

Our study included children born between 1991 and 2006 and their mothers. Using a questionnaire, maternal smoking status was recorded at pregnancy. The anthropometric data of the children were collected during a medical check-up at age 3 years. Multiple linear and logistic regression models were used for data analysis stratified by sex.

Results

In total, 2663 mothers reported their smoking status during early pregnancy, and data were collected from 2230 (83.7%) children at age 3 years. Maternal smoking during pregnancy was associated with a significant reduction in birth weight (approximately 120–150 g). Body mass index at age 3 years was significantly higher among boys born to smoking mothers than among boys born to nonsmoking mothers. Maternal smoking during pregnancy was associated with overweight at age 3 years among boys (adjusted odds ratio, 2.4; 95% CI, 1.03–5.4). However, among women who stopped smoking in early pregnancy, there was no increase in the risks of a small for gestational age birth or childhood overweight at age 3 years.

Conclusions

Children born to mothers who stopped smoking before or during early pregnancy had appropriate fetal and childhood growth.

Factors associated with health service utilization in Ulaanbaatar, Mongolia: a population-based survey

BACKGROUND

Understanding patterns of health service utilization can improve health care and increase use of health services. We examined patterns of health service utilization among residents of Ulaanbaatar, Mongolia.

METHODS

A total of 500 adults were surveyed using paper-based questionnaires. The χ(2) test and multiple logistic regression were used to identify associations between factors.

RESULTS

44.1% of respondents had visited a physician during the previous 12 months. After controlling for determinants, the significant predictors of utilization of health service were attention to health examinations (OR = 3.6, CI: 1.93-6.76), being married (OR = 2.7, CI: 1.50-4.72), being satisfied with the overall cleanliness of the hospital (OR = 2.4, CI: 1.12-5.19), being a nonsmoker (OR = 2.2, CI: 1.21-3.98), having periodic physical examinations (OR = 2.2, CI: 1.25-3.71), not being a hospital patient during the previous 3 years (OR = 2.1, CI: 1.22-3.73), having proper documentation (OR = 1.9, CI: 1.10-3.43), having medical insurance (OR = 1.9, CI: 1.96-3.28), not wanting to receive information on food and nutrition (OR = 0.6, CI: 0.36-0.96), having more than 5 household members (OR = 0.5, CI: 0.50-0.85), low income (OR = 0.5, CI: 0.30-0.85), lack of concern for food and nutrition (OR = 0.5, CI: 0.28-0.84), self-medication during the past 12 months (OR = 0.4, CI: 0.24-0.69), and desire for treatment abroad (OR = 0.4, CI: 0.20-0.60).

CONCLUSIONS

A number of health-related behaviors and sociodemographic factors were important predictors of health service utilization.

A pilot study of social competence assessment using interaction rating scale advanced

Purpose. The purpose of this paper is to clarify the validity of the Interaction Rating Scale Advanced (IRSA) as an evidence-based practical index of social skills. Methods. The participants in our study were 17 high school students. The participants completed the five-minute interaction session and were observed using the IRSA. Their teacher evaluated their social competence based on regular observation in school. Results. The results indicated the high correlation between IRSA scores and teacher's practical evaluation. IRSA can measure social competence with high validity. Conclusion. The IRSA provides further evidence of the fact that in order to study social competence development, it is important to evaluate various features of the interaction like IRSA subscales.