Objective : This study aimed to clarify the situation with domestic falls among elderly women, and investigate ways to prevent such falls, which can lead to the need for long-term care. Methods : Of the 1,706 elderly women who had experienced a fall within the past year, the 1,562 who were not diagnosed as needing long-term care were chosen as the subjects. A questionnaire was sent to each subject to collect general information, as well as information such as whether or not the subject experienced repeated domestic falls, the place the falls took place, their residential environments, and physical and social factors. Results : For all items, comparisons between the 100 subjects who suffered repeated domestic falls and the 436 who did not were made using the χ² statistical test for category variables and the Mann Whitney test for age. Multiple logistic regression analysis was conducted on whether subjects had repeated domestic falls as well as other significant items. As a result, the following were extracted: "living alone (or not)" (OR=1.67; 95% CI=1.01-2.75) ; "furniture in the home may pose as obstacles (or not)" (OR=2.74; CI=1.63-4.61) ; "IADL (instrumental activities of daily living) score (1 point)" (OR=0.65; CI=0.49-0.86) and "intellectual activeness score (1 point)" (OR=0.68; CI=0.52-0.88), the latter two being subscales in the TMIG Index of Competence. Conclusion : In cases where furniture in the home posed obstacles, the risk of repeated domestic falls increased. This indicates the need to conduct a residential environmental evaluation that will help identify the risk of falls inside a home, in addition to conventional exercise programs to serve as a preventive measure.

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Purpose : The purpose of this study was to gain an understanding of the actual state of measures against disasters and the relationship between that state and the attributes of community comprehensive support centers (hereinafter 'centers') in their ability to promote measures that best protect elderly people in the event of a disaster. Methods : A questionnaire was sent via postal mail to the heads of 238 facilities in Shin'etsu, Japan, an area that faces the Japan Sea. Results : Ninety-five valid responses were received (response rate 39.9%). Most of the centers had adopted a system for maintaining contact with their employees and for them to keep in touch with one another during an emergency, and more than 70% had reporting standards in place and a chain-of-command structure designed to provide an initial response to a disaster. However, only about half of the centers had compiled their own disaster response manual. The study revealed insufficient preparation for community support activities to follow the initial response, such as establishing systems for confirming that residents were uninjured. In the past year, only 20% of the responding centers had conducted evacuation drills involving the local community, and only 10% had provided local people with education in disaster prevention. Discussion : In light of our current observations that only about half of the centers have compiled their own disaster manual, and that not all such manuals provide adequate information, we conclude it to be necessary to compose manuals that give instructions on specific items, and to hold drills based on these manuals.

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Purpose : This study aimed to describe the methods used by public health nurses (PHNs) to provide culturally sensitive health counseling to prevent lifestyle-related diseases in residents of suburban Japan. Methods : Seven PHNs from two cities were observed during health counseling sessions and semi-structured interviews were conducted by the authors. Responses to the following research questions were analyzed qualitatively: a) What cultural themes did PHNs consider during health counseling? And b) How did PHNs use those cultural themes to enhance behavioral change? Results : The cultural themes were categorized into seven groups. Furthermore, six methods of applying these cultural themes by the PHNs were identified as follows: encouraging counselees to talk freely by talking about their interests or by matching their tone, assessing the risks of lifestyle-related diseases with regard to the suburban lifestyle, accepting practices favored by the counselees even when they may be risk factors for lifestyle-related disease, creating awareness of health risks in the daily lives of the counselees, encouraging self-care methods that can be easily incorporated into their daily lives, and proposing behavioral changes based on the interests or abilities of the counselees. Discussion : PHNs are required to understand the counselees' meaning of living in the suburbs and offer viable lifestyle options, taking into account suburban culture. This method supports a lifestyle option that reflects the counselees' values and attitudes and also nurtures love for their home town. It is suggested that PHNs understand that people are not only influenced by culture but also create new culture.

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Purpose : This study aimed to examine the effects on workers' lifestyles of intervention using webbased health guidance program. Methods : The participants were 17 male workers, who underwent a medical checkup. At the beginning of the 24-week program, all participants were provided with face-to-face guidance by a health nurse in order to help them to set goals for improving their lifestyles. They were randomly divided into 3 groups: 6 workers in the Intervention Group, 6 in Control Group A, and 5 in Control Group B. Workers in the Intervention Group had access to information on ways to improve their lifestyle, a bulletin board, and a diary for self-monitoring on the website. Additionally, they received online advice individually, 4 times during the first 12 weeks, based on what was written in the diary. Those in Control Group A had access to the same health guidance, but did not get the online advice. Those in Control Group B only had access to information on the website. All workers underwent medical checkups on the 12th and 24th week of the program and answered questions on their lifestyle and self-efficacy. The criteria were the medical checkup data, lifestyle, self-efficacy, and the frequency of use of the website. Results : Participants in the Intervention Group showed significant improvements in weight, BMI, LDL-cholesterol level, and ALT level, whereas those in Control Group B showed improvements in the LDL-cholesterol level. Participants in Control Group A did not show significant improvement. Discussion : Participants in the Intervention Group showed significant improvement, while those in Control Group A, who had access to the same website content as those in the Intervention Group, did not. Thus, individual online advice has positive effects.

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In this study, we examined correlates of home care nurses' collaborative practice with care managers and home health aides for the elderly in the terminal stage. We distributed questionnaires to 1/2 of the home visit nursing agencies in 13 prefectures and asked primary home care nurses to complete them for 2 deceased elderly cases for whom they had provided care. We analyzed 155 cases in which home care nurses collaborated with both care managers and home health aides. This was classified into 3 categories: namely 'collaboration between home care nurses and home health aides', 'collaboration between home care nurses and care managers', and 'building on strength as a team' by factor analysis. The items significantly related to 'collaboration between home care nurses and home health aides' were frequent collaboration, and home health aides' experiences of terminal care. The items significantly related to 'collaboration between home care nurses and care managers' were giving advice to care managers, and collecting information about clients' wishes. It is important to establish an information exchange system among all staff concerning clients' medical status and the way they wish to live. Also, home care nurses should provide many learning opportunities about terminal care to home health aides.

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Purpose : To clarify workers' depression in small and medium-sized workplaces and relationships between depression and various relevant factors. Method : A survey involving a self-administered questionnaire was conducted of 1,129 workers working in 28 workplaces with less than 100 workers. The questionnaire items covered demographic data and working conditions, depression, and social support. Results : The 146 (12.9%) questionnaires analyzed revealed that 65.1% of the respondents were men and 34.9% women with an average age of 40.6 ± 11.9, 63.0% of whom reported they could not make a reasonable living, and 25.3% rated themselves subjectively as unhealthy. Working time averaged 47.8 hours ± 13.1. The SDS (Self-Rating Depression Scale) responses showed 45.2% of the respondents rated themselves as not depressed, 39.0% as slightly depressed, 11.6% as moderately depressed and 4.1% as seriously depressed. Multiple logistic regression analysis disclosed that the factors significantly associated with depression were: female gender and inability to make a reasonable living, subjective self-rating as unhealthy, working time of 41 hours or more, and a lack of emotional support. Conclusion : More than half of the workers at small and medium-sized workplaces were in some state of depression. Relationships between depression and subjective self-rating as unhealthy, long working hours, and poor economic conditions were clarified, indicating that the municipal government and community occupational health centers must cooperate to deal with the urgent task of enhancing mental health measures available in small and medium-sized workplaces.

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[in Japanese]

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[in Japanese]

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