Aim: The purpose of this qualitative study was to describe the significance of community involvement of elderly men living alone in mountainous rural areas in Japan, as well as to obtain suggestions for community development in order to prevent social isolation of elderly men in mountainous rural communities.

Method: The study was designed as a qualitative descriptive approach. Data were collected through semi-structured interviews with six elderly men living alone, who were the primary informants（PI）, and nine health and welfare professionals, who were the key informants（KI）in A city in Akita Prefecture, Japan. This study was affiliated with a research institution and informed consent was obtained from the participants.

Results: The study identified five categories that described the significance of involvement with the community of elderly men living alone in mountainous rural areas: “Male tendency produced in the community,” “Grounds for drawing boundaries from others,” “Determination to live the remainder of one’s lifetime,” “Heritage of reducing territorial bonding and blood relatives,” and “Acceptance of irresistible nature and declining village.”

Discussion: For the development of mountainous rural communities, they as individuals are not only receivers but also leaders of community development; thus, it is necessary to create opportunities for their participation in the community. Also, it is necessary to promote the transformation of the sense of values and the culture of their families, neighborhood, village, and even administration, in order to prevent social isolation of the entire mountainous rural community.

Objective: This study aimed to clarify the process by which alcoholics maintain both employment and abstinence, and consider support methods.

Method: Semi-structured interviews were conducted with 9 alcoholics who are members of Danshu-Kai（an alcohol abstinence group）and the data was analyzed using a modified grounded theory approach.

Results: “A person who is being manipulated by alcohol” selected hospitalization for an “edge of the cliff decision” and participated in “Danshu-Kai to ease my loneliness”. Although they had a “workplace that supports reinstatement” they experienced “difficulty with reinstatement”. Under these circumstances, they were constantly performing “self-activation to prevent alcohol relapse”. They became “reborn”, and they take on a “way of working like oneself” because “I want to cherish my family”. Furthermore, “self-activation to prevent alcohol relapse” was the central category of the process.

Discussion: This study clarified the process by which alcoholics who are working performed “self-activation to prevent alcohol relapse” and became aware of a “way of working like oneself”. It is important to understand the background of alcoholics who have been drinking for a long time in order to relieve their stress and depressive symptoms. Supporters, including public health nurses, need to continue support to provide for reducing “anxiety about relapse”.

Objective: The purpose of this study was to consider effective education programs targeting public health nursing managers.

Method: We searched the literature on education programs for public health nursing managers published from 2000 through 2017 using the Ichushi Web, Citation Information by the National Institute of Infomatics, PubMed, and CINAHL Plus with Full Text. We selected 5 articles which described overviews of education, curriculum contents, evaluation method, and effectiveness. We compared 11 articles on education for nursing managers, and considered effective education programs.

Results: Education programs were different, but all education programs used action learning method. It was the same as education for nursing managers, but the educational purpose was not detailed, and inadequate validity measuring instruments were used as evaluation methods compared to education for nursing managers.

Discussion: We found the program using action learning method combined with lecture and group discussion an effective education program. It contains clarification of their problems as public health nursing managers, taking action to solve problems, and engaging in reflective learning. Additionally, we found the program which incorporates mentoring was effective because it promoted reflection. We need to clarify abilities necessary for each job position, then it will be possible to use them for target groups and to verify the effect properly.

Purpose: The purpose of this study was to clarify and suggest the support of home-visit nurses to coordinate social resources including healthcare, nursing-care, and welfare services for middle-aged terminal cancer patients at home depending on their needs.

Method: The study participants were six home-visit nurses working at four home-visit nursing stations in the capital region. The data were collected using semi-structured interviews as qualitative descriptive design and analyzed from the viewpoint of the experience and support of home-visit nurses. This study was approved by an ethical review committee.

Results: The areas of support of home-visit nurses in coordinating social resources for middle-aged terminal cancer patients at home were identified in five categories: “advising compromise proposal decision about social resources utilization for the satisfaction of both patients and families”；“selecting social resources depending on developmental stage or role conflict of the family”；“intermediating between multiprofessional professionals and patients and families appropriate to various patients and families”；“flexible application of social resources depending on range available for services”；“making patient’s and family’s wishes come true in a limited time by optimizing social resources.”

Conclusion: This study suggested the importance of coordination function introduced before discharge, promoting collaboration with social resources such as persons, organization, facilities or information working for health, medical and welfare, and developing new community care systems to address various potential needs of middle-aged terminal cancer patients who cannot utilize existing institutions or long-term care insurance services.

Objectives: To evaluate the relationship between normal weight obesity and metabolic syndrome risk in community-dwelling people aged 65–74 years.

Method: Body composition and BMI were measured, the lifestyles were investigated and the metabolic syndrome risk was assessed in 197 men and 203 women aged 65–74 years. Subjects were categorized according to whether their skeletal muscle index（SMI）was low（men: ≤ 7.0 kg/m²；women: ≤ 5.7 kg/m²）or normal and whether their percent body fat（%BF）was high（men: ≥ 25%；women: ≥ 30%）or normal. The differences between the groups with normal %BF and the groups with high %BF in the BMI normal group were compared using the t-test, Mann-Whitney U test and chi-square test.

Results: The prevalence of a high %BF in the BMI normal group was 38.9%（56 participants）in men and 58.3%（84 participants）in women. The prevalence of sarcopenic obesity in the BMI normal group was 18.8%（27 participants）in men and 22.2%（32 participants）in women. The metabolic syndrome risk in the group with high %BF was higher than in the group with normal %BF for both men（0.9［0.8］vs. 1.4［1.0］，p＝0.007）and women（0.3［0.5］vs 0.8［0.8］，p＜0.001）．

Discussion: Sarcopenic obesity was distributed across the normal BMI group and normal weight obesity was associated with metabolic syndrome risk. The results suggest that health guidance based on body composition is necessary for people aged 65–74 years with normal weight obesity in men and women.

Objective: To understand the actual conditions of injuries in one and a half year-old children, the injury prevention measures taken by mothers at home, and to clarify the related factors.

Method: We carried out an anonymous self-registered questionnaire survey of 606 mothers of one and a half year-old children who underwent medical examination in two cities in the A prefecture. The survey items were basic attributes, experience of injury in children, feeling of mothers’ child-rearing burden, awareness of injury prevention, based on the Health Belief Model, and injury prevention measures at home. We scored experience of injuries and how to prevent injuries at home. After that, we divided two groups of the median of total scores of injury prevention score. Furthermore, we did χ²test, Mann-Whitney’s U test, multiple logistic regression to clarify the correlation of each item and injury prevention high and low score groups.

Results: Injuries at home were experienced by 44.1% of children. Our findings on the correlation with experience of injuries are that the first child had more experience of injury, the mothers’ feeling of childcare burden was high, and the “recognition of injury possibility” and “difficulty of injury prevention” were also high. In the group of low-level injury prevention measures, the mothers’ childcare burden feeling was high, “recognition of injury possibility” and “difficulty of injury prevention” were also high. From multiple logistic regression analysis, it became clear that “confidence in preventive action” and “difficulty of injury prevention” are related to injury prevention measures.

Discussion: To prevent child injuries, support based on mothers’ feeling of childcare burden is necessary. To encourage injury prevention measures, it is important to devise educational material for infant medical examinations and encourage “confidence in preventive action”．

Aim: Japan’s health promotion strategy has shifted to community development in order to transform the social environment with the aim of correcting health inequalities. The policy is to aim at community health promotion measures implemented by public health nurses to address health inequalities and promote health through community development. The approach has been shifting. Therefore, I analyze and define the concept of “Community Development” in Community Health Activities.

Method: I searched the literature and clarified the definition using the methodology of conceptual analysis of Rodgers.

Results: There were three attributes: 【Activity process to solve problems and needs】【Promotion of growth of people involved】【Relationship between cooperation of residents, stakeholders and administrative authorities】. There were two consequences: 【Improvement of QOL by means of the way of life that is unique to the person makes it possible to solve the problem】【Residents / Public health nurses / community power acquisition】. The five antecedents were: 【Understanding community health issues】【Inadequacy of activity goals and methods】【Necessity of community rebuilding with change of health promotion strategy】【Question for public health nurses’ functions】【Necessity of collaboration with residents】.

Discussion: This concept was defined as “Promote the growth of people involved in process of solving problems and meeting needs through discussions and consensus building with residents as a starting point for community diagnosis, and foster the relationship of collaboration among residents, stakeholders and the administration. As a result, it is possible for problem solution to enable a person-centered way of life and improve QOL, and for the residents, public health nurses, and the community to gain strength”.