This cross-sectional study examined potential demand-side barriers to women's use of basic health services in rural southern Egypt (Upper Egypt). Face-to-face interviews with a structured questionnaire were carried out on 205 currently-married women, inquiring about their use of health facilities: regular antenatal care (ANC) during the last pregnancy and medical treatment services when they suffered from common illness. Questions about their perceptions of barriers to the use of health services were categorized into three primary dimensions: structural, financial, and personal/cultural barriers. Distance and transportation to health facilities (structural barriers) prevented about 30 % of the women from seeing a doctor. Forty-two percent of them felt the difficulty paying for health services (financial barriers). Approximately a quarter of women answered that gaining family permission, allocating time to go to health facilities, or concern about lack of female physicians (personal/cultural barriers) was a big problem for them. After controlling for potential confounding factors, structural barriers showed an inverse association with the use of health services. Financial barriers indicated a strong association (OR=0.18, P<0.001) with the use of curative services (medical treatment), but not with the use of preventive services (regular ANC). Contrary to our expectation, personal/cultural barriers had no statistical significance with women's use of health services. Although the Egyptian government had successfully extended basic health service delivery networks throughout the country, women in rural Upper Egypt were still facing various barriers to the use of the services, especially structural and financial barriers.

Although non-communicable diseases (NCDs) have become the predominant health problems of Palauan society, there have been no comprehensive data on NCD risk factors available to develop effective control strategies. Therefore, the first Palauan national STEPwise approach to risk factor Surveillance (STEPS) was completed in mid-2013 to provide information on its adult population aged 25 to 64 years. This study aims to obtain corresponding data from the younger adults aged 18 to 24 years, who remained to be surveyed. We conducted an epidemiological study, targeting the 18- to 24-year-old age group. A survey station and a mobile team were established to recruit voluntary participants dwelling in Koror. A slightly modified WHO STEPS instrument was used, including a structured questionnaire for behavioral risk factors, physical measurements, and blood tests. A total of 356 young people were recruited during the survey. In both sexes, nearly half of the participants were overweight/obese. The prevalence of hypertension was higher in men than in women (17.6% vs 1.7%). Raised blood glucose and impaired fasting glucose were observed in 3.5% and 5.2% of the total participants, respectively. About 36% of the subjects were observed to have raised levels of total cholesterol. More than 70% of the young people were current tobacco users, in terms of all kinds of tobacco products. The current survey, for the first time, revealed a high prevalence of NCD risk factors, especially overweight/obesity and tobacco use, among young people in Palau. This indicates that swift measures against NCDs are required even in this young age group.

Background: Work-family conflicts (total-WFCs) could associate with mental health, and having ikigai (a purpose of life) may mediate this association.Methods: In a cross-cultural study of 4792 Japanese Aichi Workers’ Cohort study participants and 3109 Egyptian civil workers, the Midlife Development in the United States (MIDUS) questionnaire measured total-WFCs and Center for Epidemiological Studies Depression (CES-D) 11-item scale measured depression. Logistic regression models estimated odds ratios (ORs) of having depression and a high-ikigai across levels of total-WFCs (low, moderate, and high), and the PROCESS macro of Hayes tested the mediation effect.Results: The prevalence of high total-WFCs, depression, and having a high-ikigai were 17.9%, 39.4%, and 70.1% in Japanese women, 10.5%, 26.8%, and 70.1% in Japanese men, 23.7%, 58.2%, and 24.7% in Egyptian women, and 19.1%, 38.9%, and 36.9% in Egyptian men. Compared with participants with low total-WFCs, the multivariable ORs (95% CIs) of depression in Japanese women and men with high total-WFCs were 4.11 (2.99-5.65) and 5.42 (4.18-7.02), and those in Egyptian women and men were 4.43 (3.30-5.95) and 4.79 (3.53-6.48). The respective ORs of having a high-ikigai were 0.46 (0.33-0.64) and 0.40 (0.31-0.52) in Japanese women and men and were 0.34 (0.24-0.48) and 0.28 (0.20-0.39) in Egyptian women and men. No interaction between total-WFCs and country was observed for the associations with depression or ikigai. Ikigai has mediated (up to 18%) the associations between the total-WFCs and depression, especially in Egyptian civil workers.Conclusions: Total-WFCs were associated with depression, and having low-ikigai mediated these associations in Japanese and Egyptian civil workers.

We examined the association between objective and perceived neighborhood characteristics and self-reported leisure-time physical activity (PA) in older Japanese residents living in areas ranging from metropolitan to rural in 2016. Objective measures used were walkability and the numbers of parks/green spaces and sports facilities within 500 or 1000 m of subjects’ homes, calculated using geographic information systems. Subjective measures were the subjects’ perceptions of their neighborhoods, assessed using a structured questionnaire. All variables were divided into three groups, and the lowest tertile was used as the reference. We assessed the location and frequency of strolling or brisk walking, moderate-intensity PA, and vigorous-intensity PA (sports) using a self-reported questionnaire and defined as performing a certain type of PA 3–4 times/week as a habit. Living in a neighborhood in the highest tertile for walkability and number of parks/green spaces as well as perception of having good access to recreational facilities, observing others exercising and the presence of walkable sidewalks was associated with walking and sports habits (multivariable odds ratios (ORs): 1.33–2.46, all p < 0.05). Interestingly, objective measures of PA-friendly environmental features were inversely associated with moderate-intensity PA habits, potentially because moderate-intensity PA consisted predominantly of gardening. In conclusion, living in an environment supportive of PA, whether objectively or subjectively measured, is related to leisure-time PA habits among older Japanese adults.

Background: The term "nonrestorative sleep (NRS)" refers to unrefreshed feeling at wake-up and is a domain of poor sleep quality. Previous researches have demonstrated that NRS is linked to a number of diseases and adverse health outcomes, but less is known regarding the link between NRS and diabetes, particularly in Japanese.Methods: We studied 3665 middle-aged male participants of the Aichi Workers' Cohort Study who were followed-up from 2002 to 2019. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of incident type 2 diabetes mellitus (T2DM) in relation to NRS adjusted for potential confounding variables.Results: During a median follow-up of 14.6 years, 421 type 2 diabetes cases were identified. Participants with NRS had a higher crude incidence rate of T2DM (11.2/1,000 person-years), compared to participants without NRS (9.3/1,000 person-years). In the fully adjusted model, individuals who reported having NRS had a significantly higher risk of developing T2DM (HR: 1.36, 95% CI: 1.10-1.67). The association was observed only in participants under 50 years old (HR: 1.82, 95% CI: 1.36-2.43), not in the older (50 years or older) participants (P for interaction =0.025). In contrast, stratified analyses by the presence of shift work, obesity or sleep duration showed similar associations in all the strata.Conclusions: NRS was associated with higher risk of T2DM in middle-aged Japanese male workers independent of a variety of lifestyle factors and other sleep problems.

Background: There is limited evidence regarding the relationship between Diabetes mellitus (DM) in middle age and mild cognitive impairment after a follow-up. Therefore, we investigated the relationship between fasting blood glucose (FBG) levels in middle age and cognitive function (assessed using the Japanese version of the Montreal Cognitive Assessment (MoCA-J) in later life, following over 15 years of follow-up in the Aichi Workers’ Cohort Study in Japan.Methods: Participants were 253 former local government employees aged 60–79 years in 2018 who participated in a baseline survey conducted in 2002. Using baseline FBG levels and self-reported history, participants were classified into the normal, impaired fasting glucose (IFG) and, and DM groups. Total MoCA-J score ranges from 0 to 30, and cognitive impairment was defined as MoCA-J score ≤25 in this study. A general linear model was used to estimate the mean MoCA-J scores in the FBG groups, adjusted for age, sex, educational year, smoking status, alcohol consumption, physical activity, body mass index, systolic blood pressure, total cholesterol, and estimated glomerular filtration rate.Results: The mean MoCA-J score in the total population was 25.0, and the prevalence of MoCA-J score ≤25 was 49.0%. Multivariable-adjusted total MoCA-J scores were 25.2, 24.8, and 23.4 in the normal, IFG, and DM groups, respectively. The odds ratio of MoCA-J score ≤25 in the DM group was 3.29.Conclusions: FBG level in middle age was negatively associated with total MoCA-J scores assessed later in life, independent of confounding variables.