Objective : This study focused on the characteristics of the sense of burden and positive feelings experienced by male caregivers providing defecation care for their spouses at home, to obtain information for the support given by visiting nurses. Methods : An anonymous self-report questionnaire survey was conducted on 229 spouses providing defecation care for individuals with a bedridden level of B or C who were using visiting nurse services. Survey contents were the characteristics of the caregiver and care recipient, conditions of defecation and defecation care, and sense of burden and positive feelings regarding defecation care. The 140 valid responses obtained were classified by sex for statistical analysis. Results : Compared to wife caregivers, husband caregivers had a significantly higher sense of burden regarding defecation care for "expenditures for care services", as well as the positive feelings of "promotion of kindness toward each other" and "provision of defecation care as a way of giving back to the spouse", but had a significantly lower "use of funding system for purchasing welfare equipment". Husband caregivers also had a significantly lower frequency of adjusting medications and meals in defecation care, and a significantly higher proportion of delegating defecation care to visiting nurses or helpers. Conclusion : Visiting nurses must confirm that husband caregivers are appropriately managing medications and meals without burden for defecation control, and support the use of healthcare and welfare information that maintains and promotes positive feelings such as a desire to give back and kindness among husband caregivers, or alleviates economic burden.

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Objective : The purpose of this paper is to clarify how and why public health nurses in private practice started a business and to evaluate their current business activities. Methods : We conducted semi-structured interviews with 9 public health nurses regarding their motivation for starting a business, their preparation for doing it, and their current business activities. The contents of interviews were analyzed descriptively and qualitatively. Results : 19 secondary categories and 8 primary categories related to business activities were extracted from verbatim transcripts of interviews. Primary categories were classified into three stages: "the situation in which an organization fails to provide service appropriate to each user," "the way of working that lets an owner make use of his/her strength," and "own mission as a public health nurse" (the first stage) ; "the acquisition of skills needed to run a business," and "the formulation of a business plan that offers one's own distinct service" (the second stage) ; "the emergence and expansion of new health service in private practice," and "the service of a public health nurse having ramifications on health promotion" (the third stage) ; and "the existence of a person who supports me" (all stages). Conclusions : Public health nurses in private practice started their own business in order to resolve problems arising from working for an organization. They made efforts to acquire skills necessary for running a business. Our analysis suggests that public health nurses in private practice would help meet diversified health needs.

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Objectives : The purpose of this study is to evaluate the reliability and validity of the Japanese version of UCLA LS3, which is an internationally standardized instrument to evaluate loneliness, for community-dwelling elderly in Japan. Methods : A cross-sectional survey was conducted using a mail-self-administered questionnaire. The target population was randomly selected 1,000 community residents, aged 65 years and over, living in B Ward, A City Japan, as of 2011. Questionnaire items encompassed the Japanese version of the UCLA LS3 and demographic data, as well as physical and mental states, social network, and objective health states. Results : The number of responses was 540 (valid response rate: 54.0%). The mean age ± SD was 73.6 ± 6.8years old. Two hundred and twenty five (50.8%) were male and two hundred and eighteen (49.2%) were female. The mean score of the Japanese version of UCLA LS3 was 42.2 ± 9.9 (male: 44.0 ± 9.1, female: 40.6 ± 10.4), ranging from 20.0〜78.0, under the normality of distribution. The Cronback a coefficient of total items of the Japanese version of UCLA LS3 was 0.92. Scores of the Japanese version of the UCLA LS3 had a significant correlation with GDS (r = 0.52, p < 0.01) and a significant negative correlation with SRH (r = -0.26, p < 0.001) respectively. Conclusion : The reliability and validity of the assessment tool of loneliness for community-dwelling elderly in Japan, the Japanese version of UCLA LS3, is demonstrated to be considerably high.

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Purpose : The purpose of this study was to clarify effective intergenerational program interventions and their outcomes for effective intergenerational practices. Methods : Research articles published between 2001 and 2010 were searched by using Ichushi Web, Citation Information by National Institute of Infomatics, PubMed, CINAHL Plus with Full Text, PsychINFO, and SocINDEX database and the Journal of Intergenerational Relationships. There was a total of 26 articles containing a description of programs and outcomes, twenty six articles were analyzed by using Outcome models. Results : The participants were elders and children, from preschool children to graduate school students. The programs were varied depending on the age of the children. Seven reciprocal outcomes were identified: (1) mutual understanding; (2) increasing generativity; (3) expansion in relationships; (4) increasing psychological well-being; (5) increasing physical well-being; (6) increasing social well-being (7) increasing sense of community. Discussion : The intergenerational program was considered to be a useful method for public health nursing. The important points for effective intergenerational practice were the focus of the participants' goals depending on their age and needs, to consider the mutual outcome for both generations, and to establish a methodology based on theory.

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Aim : To identify characteristics and effectiveness of support program for parents of preschool children with developmental disabilities. Method : Electronic literature searches were conducted using PubMed and the Japanese Central Review of Medicine from April 1994 to March 2010. Results : Nine artieles met our eligibility criteria. The programs consisted of 8-12 weekly sessions. The goal of the program was to improve parental management skills when dealing with the child's behavior problems. All articles discussed the teaching of parenting strategies to parents by the therapist. These strategies varied according to the type of developmental disabilities. The programs were designed to provide feedback for the parents on the implementation of parenting strategies, and to develop individual goals based on an assessment of the children's and parents' strengths and needs. Discussion : To develop a parenting support program for parents of children with developmental disabilities, and it is necessary to select parenting strategies according to the type of children's developmental disabilities. Furthermore, support is needed for parents to apply the parenting strategies to their living style and the characteristics of their child's behavior. Therefore, it is indispensable to design programs to develop individual goals based on an assessment of the children's and parents' strengths and needs, and provide feedback for the parents on the implementation of parenting strategies

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Purpose : The purpose of the present study is to examine the evaluation of a program to understand dementia disease, healthful behaviors to prevent dementia and the needs for community support in elders with dementia and their families among community-dwelling people. Methods : Subjects were 106 community-dwelling people aged 50 or older who participation in all sessions at 6 areas of 2 cities in Osaka. Evaluation of the program was carried out by examining questionnaires which included questions on the image and knowledge of dementia, self-efficacy of how support to elders with Behavioral and Psychological Symptoms of Dementia (BPSD) and the need for community support in elders with dementia and their families. Results : Regarding the image of dementia, scores between pre and post program were significantly improved, including 'dementia is shameful', 'dementia is sad', 'dementia is not a disease' and 'dementia is my concern'. The total scores of knowledge of dementia and scores of self-efficacy supporting elders with symptoms of dementia like 'verbal or physical aggression' were improved in the post program. Also, scores between pre and post program were significantly improved, including the response 'I think we could support elders with dementia and their families in my community'. Conclusion : This program had limits of interpretation on results, but it also had the potential to promote understanding of dementia and the needs for support to elders with dementia and their families among people living in community.

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Objective : The objective of this study was to clarify the elderly's situation on withdrawal of the use of long term care services for economic reasons, its influence and the coping of the care manager. Methods : A self-administered, questionnaire survey was distributed to care managers in A city, and 350 responded were analyzed statistically. (Primary survey) Among them 18 care managers who consented were interviewed using semi-structured questionnaire, and the data was analyzed by qualitative inductive method. (Secondary survey). Questionnaire items included methods to find clients with economic problems, its influence on the client and the family, and the management of care manager. Results : Primary survey: Forty-seven percents of care managers had managed elderly clients who had economic difficulties. The influences were worsening of the health status of the clients (52.1%) and increase of care burden on the family (47.9%). Secondary survey : the economic reason was "low income over criteria of Livelihood Protection law", "intention of the client" and "family circumstances", etc. Coping by care manager was "over-time work", "collaboration with the faculties" and "utilizing community networks", etc. Conclusion : Almost half of the care managers experienced worsening health status of the client and increase of family care burden, because of economic reasons. Reinforcement of the support system for the care managers to cope with the elderly with economic difficulty is needed.

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This study aimed to identify relationships between the burden of overwork (levels and quality) and the mental health of architects. Relationships among the burden of overwork, work-related stress, social support, and overcommitment were also investigated. In August 2010, a self-administered questionnaire survey was conducted involving 206 employees working at an architectural design office. Architects were divided into overwork (levels and quality) "burden-present" and "burden-absent" groups. In total, 117 architects (burden-present group: 74 (63.3%), burden-absent group: 43 (36.7%)) were analyzed as the subjects. The results of chi-square tests revealed that a relatively large number of subjects in the burden-present group had moderate to severe physical symptoms (p=.005) and anxiety and insomnia (<.001) compared to the burden-absent group. The results also revealed that those who feel stress due to workplace relationships (p=.025) were likely to show a high risk of overcommitment (p=.001), which represents obsession about work. To support architects with the burden of overwork, the following interventions are needed: 1) implementation of screening for physical symptoms, insomnia, and anxiety, 2) creating a better working environment to reduce workplace stresses, and 3) modification of obsessive work patterns.

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Purpose: The purpose of this study was to clarify the process of health and lifestyle cognition development among community activity participants considered to be at high risk of lifestyle-related diseases. Method: The subjects were local residents participating in community activities after completing a program for lifestyle-related disease prevention. The author conducted semi-structured interviews with the subjects and analyzed qualitative and inductive factors. Results: The process of health and lifestyle cognition development had three phases: lack of awareness, efforts to change health and lifestyle, and development of cognition regarding the health and lifestyle issues of surrounding people and the community. The first phase was characterized by ignorance/lack of knowledge and reflection on one's own lifestyle/determination to change; the second phase was characterized by efforts for lifestyle change using a method appropriate for the individual and conflict related to missing aspects of the previous lifestyle; and the third phase was characterized by a sense of control of one's own lifestyle/confidence in life and concern regarding the health issues of surrounding people. Discussion: The process of health and lifestyle cognition development among people at high risk of lifestyle-related diseases was based on their conscious decisions to change their lifestyles, and awareness regarding the health and lifestyle issues of surrounding people and the community arose from the feeling of happiness that resulted from physical change.

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Purpose: This study aimed to clarify the stages in which mutual trust was established between public health nurses (PHNs) and mothers of newborns during newborn home visits by PHNs through the assessment of the mother's behavior by PHNs. Method: The study involved ten PHNs with 10 or more years of work experience in a municipality. Data were collected through semi-structured interviews and analyzed using inductive and qualitative methods. The mutual trust that developed between mothers and PHNs during newborn home visits was classified into six stages. Results: The six stages identified were as follows: the mother greets the PHN as a guest (Stage 1); the mother acknowledges the PHN as a person close to her (Stage 2); the mother acknowledges the PHN as a professional support (Stage 3); the mother shares her feelings with the PHN (Stage 4); the mother freely expresses herself to the PHN (Stage 5); and finally, the mother recognizes and approves the relationship with the PHN as a partnership, establishing mutual trust (Stage 6). Conclusions: These results showed that the relationship between PHNs and mothers of newborns through the assessment of the mother' s behavior by PHNs progressed from a general relationship to a relationship resulting from provision of healthcare services and finally to a partnership. The results also suggest that mutual trust development between Stages 2 and 5 was dependent on the outcome of Stage 1. In addition, the relationship progressed from Stages 2 to 5 moving back and forth between these stages.

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Purpose: To compare the dietary habits of Japanese middle-aged men in rural areas by marital status, household composition and food preparer, and to find the needs for support among non-married men. Method: Subjects were 6, 452 men aged 40-64 in a rural area in Japan. Self-administered anonymous mail-in survey was conducted. Variables related to health and dietary habits were obtained. Results: A total of 2, 514 questionnaires were analyzed (39.0%). Among them, 376 persons (15.0%) were non-married. The married had better dietary habits than the non-married, but both had low level of dietary habits. The non-married were classified into the following three groups. Group A (non-married living with their parents): most were aged 40-49, and the main food preparer were their mothers or fathers. Group B (non-married living with their parents and preparing main food by themselves): they were older than people in Group A, and 30% of them had persons who need care at home. They often cooked at home. Group C (single-household): most were aged 55-64, and 70% of them had diseases under medical treatment. The proportion of people usually buying prepared foods at convenience store for dinner was higher than those in other groups. They also engaged in more undesirable dietary behavior than people in Group A. Conclusion: It became apparent that support for dietary habits of middle-aged men in rural areas was necessary regardless of their marital status. It is important that health professionals consider their characteristics by marital status, household composition and food preparer in order to provide them with support.

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Purpose : This study aims to clarify cases of individual support measures for the elderly that were implemented by cooperation between neighbors and public health nurses (PHNs) based at comprehensive community support centers (CCSC) in Japan. Methods : Qualitative and inductive analysis was performed. Semi-structured interviews were conducted with nine PHNs having over two years of experience at CCSCs. The interviewees were asked about their intentions and actions in the cases wherein they sought the cooperation of the community in providing formal services. Results : Four categories were extracted as the supports of PHNs at CCSCs: "extending network in order to obtain information on the elderly from other community members," "understanding the present situation and prospecting possible directions of support for each case based on consultation and paying attention to information," "Establishing the foundations of a support system involving the neighbors," "increasing neighbors' supporting ability through motivation and empowering of individual neighbors." Conclusion : As seen in cases wherein individual support measures are implemented through the cooperation of neighbors, PHNs in CCSCs have created a system to acquire information about elderly residents in the community and empower the neighbors, which is an approach similar to the process of community empowerment

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Purpose : The objective of this study was to describe how public health nurses (PHNs) support mothers, who have vague worries about bringing up children or feel somewhat isolated, by introducing them to peer support groups (Groups). Methods : The subjects were five PHNs. The data were collected from semi-structured interviews about support provided to mothers, and analyzed using summarized content analysis. Results : The supports were classified into five sequential phases and the findings indicated there are direct and indirect interventions when working with representatives or the Groups themselves. The first phase includes "providing detailed information that helps the mothers picture what the Groups are like," and "telling mothers about the advantages of participation." The second phase involves "keeping in touch with the mothers," and "requesting representatives to discuss the mothers' needs." The third phase includes "introducing the mothers to representatives," and "staying with the mothers to observe them." The fourth phase involves "asking about their impressions after the first meeting," and "sharing information about the mothers with representatives." The fifth phase includes "monitoring the physical and emotional state of the mothers and their children by continually being involved in regular health examinations," and "keeping in touch with representatives." Discussion : The supports from PHNs include: providing detailed information that motivates mothers to join the Groups; observing the mothers and evaluating their conditions, while still respecting the mothers' autonomy; and all the while trying to establish mutual trust. Ultimately, the aforementioned is to reduce the mothers' worries.

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Purpose: We examined the relationship between the body composition and lifestyles in older people who visited "Town health care room". We also considered the efficacy of providing their body composition assessment to them. Method: Fifty people (68.0 ± 6.1 years old) participated in this study. We surveyed their health history and life style through the questionnaire and interview, and divided them into groups according to their daily schedule for meals, the frequency of going out, and walking time every week. We also measured their blood pressure, their body fat percentage, bone mass, and leg muscle mass with the body composition analyzer to compare them with lifestyles. Results: Fifty one percent of them had a history of hypertension and 41% had hyperlipidemia. Participants who were eating irregularly tended to increase the body fat percentage (p=0.09). Participants who had gone out more than four days a week and walked more than 15 minutes had significantly more bone mass and lower body fat percentage than those who had neither (p<0.05). Conclusion: There was an association between their lifestyles and body composition. There is a possibility that visitors can objectively review their own lifestyles by being provided with an assessment of their body composition. We need to survey the effects on lifestyle by continually providing assessment of body composition to visitors of town health care room.

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[in Japanese]

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[in Japanese]

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