This report describes a framework of decision-making in expert home care nurses, in which an attempt to reflect patients' wishes was made. A prospective inductive qualitative study was conducted on five proficient nurses of two home care nursing stations. The purpose of this study was to research structural components in decision-making, which would guide the nurses to successful provision of home care. Data were collected during several home-visit observations, without intervention, and through send-structured interviews after home visits, which interviews were tape-recorded, with the consent of all subjects. All structural components concerned different thinking toward home care between patients and their families, in which home care nurses gave priority to patients' wishes. These components were grouped into 12 core categories. The two core categories were defined as a view-of-life concerning the home care nurses, and the ten were strategies to reach an agreeable compromise with regard to different thinking toward home care between patients and their families. According to the structural components and decision-making in five nursing practitioners, a framework of decision-making in home care nursing, or an approach to patients and their families with different thinking, could be found. This study suggested that expert home care nurses had established thinking of their view-of-life, including their position as home care nurses, giving priority to patients' wishes, and providing satisfying home care nursing as viewed by both patients and their families. This study was approved by the Ethics Committee of St. Luke's College of Nursing

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To obtain basic data for considering the care of housebound elderly persons, whose state has recently drawn attention from the standpoint of minimizing the necessity of nursing care for the elderly, an analysis of the incidence of housebound and its background factors in a certain town was performed. The survey was performed by questionnaire on 544 elderly subjects aged 65 or older extracted from the Basic Resident Register in consideration of family type, and also by recording the results of hearing and the observations of nurses. The questions were on the attributes, health condition, falls, lifestyle, roles, relationship with family members and friends, QOL, and environmental conditions. Excluding those who were bedridden, those suffering from dementia, and those prohibited from going outdoors for medical reasons, elderly subjects who went outdoors less than a few times a month were classified as "Housebound Group", and others as "Non-Housebound Group". The background factors of the two groups were compared by monovariate analysis using a single variant as an explanatory variable, and also, those items with significance less than 10% by the monovariate analysis were further analyzed by logistic regressive analysis. Out of a total of 472 respondents, the incidence of withdrawal was 6.6%. Items which were to be found significant as a result of multivariate analysis were whether the place of residence was on the side of a mountain or the sea, whether the respondent had friends or not, walking disability, and the regularity of lifestyle. Further research on the possibility of being bedridden among elderly people who are currently independent should be required. And it is also suggested that, in considering the care of elderly with a housebound state, it is important to pay attention to environmental conditions as well as the individual factors.

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The purpose of this study is to clarify the role awareness and expectations of public health nurses and home visiting nurses regarding family care nursing following the introduction of Long Term Care Insurance. We prepared a questionnaire using Likert Scale for 35 items of family care nursing, extracting items through interviews with public health nurses and home visiting nurses who were caring for the same family. Five questionnaires were sent to each municipality and Home Nursing Care Station in Kanagawa Prefecture and the results were compared by significance tests. We obtained responses from 491 nurses at 129 facilities. In regard to the role of public health nurses, team building with other professionals and informal networking, etc., were higher in scale, whereas in the role of home visiting nurses, care at stage changes in patient's illness, the building a good relationship with the caregiver and psychological support, etc., were higher. The highest ten items of role awareness and expectations were almost identical between public health nurses and home visiting nurses. However, 30 items regarding role awareness for home visiting nurses were significantly higher than expectations of public health nurses, whereas only four role awareness items for public health nurses were significantly different from expectations of home visiting nurses. And in 29 items both types of nurses saw differences between their own role and that of the others. Interpreting these results, we concluded that both public health nurses and home visiting nurses are aware that their roles differ and are oriented to effective role sharing.

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Purpose : Caregivers of amyotrophic lateral sclerosis (ALS) patients have experienced a considerable burden. However, there was no study evaluating the burden of caregivers of ALS patients. The purpose of this study was to investigate the subjective burden of caregivers of ALS patients at home and to clarify the factors of patients, caregivers and social support resources which were related to this burden. Methods : We questionnaired 75 caregivers of ALS patients at home about their subjective burden of caregiving and its factors of patients, caregivers and social support resources from August to November in 1999 Subjective burden of caregivers of ALS patients was evaluated by the Japanese version of the Zarit Caregiver Burden Interview. Results : We had 67 responses (89.3%). The mean score for burden was 41.2 (SD = 13.5). As a result, caregivers' burden was found to be correlated with these three factors , the duration of caregiving at home, the times and the amount of hours of visiting nursing. These findings suggest that caregivers' burden is subject to the duration of caregiving, so we should reconsider the way how we can give more effective visiting nursing and support caregivers of ALS patients at home.

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The purpose of this study was to evaluate the community-based health promotion activities for the elderly (welfare square) using the questionnaires including demographic data and the indicator for measuring the effects of these activities from the perspectives of the participants. The demographic data of four hundred and twenty four participants were analyzed. One hundred and seventy eight participants who answered all items of the indicator for measuring the effects of activities were analyzed to examine the structure of the effects of activities using exploratory factor analysis. The results were as follows ; 1 The female participants were four times greater than males Furthermore, over more than half of the participants were over seventy years old. 2. "The opportunities of enjoyment have increased" was the highest response for the items of the indicator for measuring the effects of activities. The next highest response was "the interaction with others has increased". 3 The results of the exploratory factor analysis with varimax rotation showed three factors transformation of self-understanding (factor 1) , developing relationships with others (factor 2), and health promotion (factor 3). The factor solution was able to explain for 61.3% of the variance. From these results, it appeared that these community-based health promotion activities for the elderly could prevent social isolation and bed bound, and could increase the opportunities of enjoyment for the elderly. It is possible that the indicator that was used in this study could be applied to another community-based health promotion activities.

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The purpose of this study was to examine the effects of an intervention of home care program for prevention to a decline of daily living activities in the bed-ridden elderly at home in Japan. Subjects were 82 bed-ridden elderly 65 years and older, and assigned to either intervention group or control one. For the intervention group, a home care program consisting of sitting tolerance training was provided for 1.5 years by home care nurses, on the other hand, for the control one, the usual home visit nursing care was provided. As a result ; 1) There was not a significant difference in life expectancy but in residential status, and the rate of living at home in the intervention group was significantly higher than the rate of the control one at the 1.5 years follow-up ; 2) There were significant differences in self-care function in daily living activities and non-lying time in bed per one day, and the intervention group significantly improved these function for 1.5 years. Judging from the results, we conclude that the home care program consisting of sitting tolerance training can be effective for bed-ridden elderly to improve their self-care function in activities of daily living and to live at home as long as possible.

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Purpose : The purpose of this study was to clarify the changes of cognitive appraisal of disability and coping strategy for stroke victims at discharges (T1), after 2 weeks (T2) and 3 months (T3) from the discharges. Methods : Subjects were 105 stroke victims (34.4%) with the first discharge from a hospital to their home (except for stroke victims with a difficulty to understand questionnaires examined by MDs.) in 305 stroke victims (100%) discharged from 3 hospitals located in a metropolitan area from October 1998 to February 1999. The following data were obtained from the subjects by interviews at T1, T2 and T3 : demographic data, ADL (activities of daily living), cognitive ability, appraised stress, coping strategy ; (1)subjective (confrontive, emotive and palliative) (2)objective (activities), and QOL (quality of life). The changes of cognitive appraisal of disability and coping strategy were analyzed by Repeated Measure ANOVA and multiple comparisons (Tukey test) for 85 subjects (27.9%) who completed 3 times interviews. Results : Stress especially changes of condition and beliefs of self-care were significantly increased at T2. Emotive coping tended to increase and confrontive coping tended to decrease at T2. Stress was significantly decreased at T3. Emotive coping tended to decrease and confrontive coping tended to increase at T3. Activities tended to increase at T3. Conclusion : The results of this study suggest that stroke victims must be stimulated to have stable feeling by care for emotion rather than urging more training. Emotional stability would occur more action on their own initiative. These results can be useful to understand psychosocial changes on disability for stroke victims.

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This study was aimed at (1) investigating characteristics of judgment by experienced visiting nurses with regard to various home cares which would arise while on duty and (2) obtaining information that will be useful for improving educational programs for visiting nurses. The study was based on semi-structured interviews with 14 visiting nurses employed at three different visiting nurse stations in F prefecture. These nurses were asked about the decision-making process they use to solve the problems that they face. [Results] We obtained information on 58 incidents (19 cases) that had been managed based on decisions by individual nurses. The information obtained with regard to the respective incidents was analyzed and classified inductively on the basis of both content and process of decision-making. 1. The content of these decisions was classified into four major categories : a. Decisions on the direction of care management. b. Judgment with regard to the knowledge and skills of the nurses as well as the system for home care. c. Judgment on developing ways to care for the patient. d. Decisions on developing ways to care for the family of the patient. 2. As for the decision-making process, visiting nurses were actively carrying out their duties based on independent thinking and decision-making as a result of their observations and experiences. The three characteristics revealed about the decision-making process were : a. The ecological type of decision-making was based on an understanding of the living conditions of their patients. b. The circulatory type of decision-making regarding the home care was based on feelings and opinions of both patient and family. c. The inquiry type of decision-making was based on an effort by the nurses to utilize effectively the limited information that is available on home care. 3. In conclusion, the importance of introducing systematic and continuous educational programs for visiting nurses and the supervisors who could provide leadership for the less experienced visiting nurses in the field of home care has been shown.

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Objective : The purpose of this study was to explore an evaluation method of effectiveness of home care in practice. We studied an adjustment method of clients' background related to outcomes in order to enable us to compare standard outcomes (improvement and stabilization of clients) in five home care agencies. Based on the adjustment method, we identified outcomes of each agency. Method : Subjects were those who were aged 40-64 years eligible for the long-term care insurance and those who were aged 65 years and older. Of 609 clients in five home care agencies from September to December 1999, we excluded terminal clients who were difficult to measure outcomes. We analyzed 451 clients who received consecutive two-month care and whose outcomes were measured. We studied the summary version of OASIS (The Outcomes Assessment Information Set) mandated for Medicare patients in the United States developed by Peter W. Shaughnesssy, et al. and used all the items in our study because the outcome study by Japan Visiting Nursing Foundation found its applicability. For clients' background information, we analyzed 6 items necessary for Japan from the previous literature. Results : Clients' backgrounds related to outcomes in five home care agencies were independent (four levels, J A B C in the Independence of Disabled Elderly in Daily Life) and dementia levels (six levels, non-dementia to M in the Independence of Demented Elderly in Daily Life). The results clearly revealed that these two levels needed to be adjusted for clients' outcomes (improvement and stabilization) in each agency. We tested differences between percentages of each agency and all the agencies, and significant differences were outcomes we should pay attention. In Agency A where many items were significantly higher than the standards, improvement was seen in grooming, washing, ambulation, preparation of snacks, pain and incontinence when the independent level was adjusted, while grooming, washing, transferring, preparation of meal and medicine administration were improved when the dementia level was adjusted. As a result, outcomes in each agency can be objectified and accuracy of evaluation can be improved by adjusting standard outcomes and clients' background related to outcomes. This study can be useful for identifying care services which should be improved in quality, clients' outcome management by care manager, and the third-party evaluation. Also, users will be able to choose home care agency if evaluation results are open to the public.

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This investigation was carried out to clarify the relation between social support and self-efficacy and personal factors such as age, family structure; occupational status and symptoms for Hashimoto diseased patients living at home. The subjects of 225 patients were selected from 4 towns in Urakawa health center and 139 complete answers targeted in this analysis. The mean age was 54.7 years old and the female percentage was 92.8%. In this study, both social support and self-efficacy variations were analyzed according to Kin's scales (1996). The first scale is based on social support provided by emotional support in daily life and behavioral support for disease. The second self-efficacy scale is based on active coping behavior with disease and controllability for heath. The followings were found, 1. Only social support was significantly affected by personal factors such as age, family structure, and symptoms, but self-efficacy has no effect on all the personal factors including sex, occupational status, duration of the disease, and the treatment condition. A significant difference was fond in age, symptoms, and the family structure of behavioral support for disease. Subjects within 35 to 49 years of age, singles and no symptoms were found to be low degree in behavioral support for disease. The occupational status has significant difference in active coping behavior with disease. The symptoms and sex have significant difference in controllability for heath. 2. There was a high correlation between social support and self-efficacy. In this study, I would like to suggest the following conclusions, 1) The necessity of nursing the Hashimoto diseased patients living at home and improving the self-efficacy, especially symptoms and employed in the community. 2) An essential progressive social support such as selfhelp group activities to improve their health.

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The relationship of the QOL (quality of life) of elderly people to their ADL (activities of daily living), physical functioning and social activity was analyzed. The subjects were elderly people (over 65 years of age) living in agricultural districts, responding to an existing self-entry questionnaire (KALS, VAS). To study the effects of farm work, the data were compared between a group of elderly people who were or had been engaged in farm work (the farmer group) and a group of elderly people who had not participated in farm work (the non-farmer group). The following results were obtained: 1. Of the 180 males, 81(45%) were assigned to the farmer group and 99(55%) to the non-farmer group. Of the 231 females, 135 (58.4%) were assigned to the farmer group and 96 (41.6%) to the non-farmer group. 2. No correlation was observed between QOL and age ADL, physical functioning and social activity were found to significantly determine QOL. 3. Neither males nor females showed a significant difference in average QOL scores between the farmer and non-farmer groups. 4. A close correlation between QOL and social activity was observed in males. 5. A close correlation between QOL and physical functioning was observed in males from the farmer group and females from the non-fanner group.

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The behavior to maintain the body weight in an appropriate range was evaluated in 369 females aged 18-69 years. The following three indices were derived as scales of the weight-control behavior from the present body weight (A), target body weight (B), and standard body weight (C). (1) Whether the subject wished to reduce or increase the weight (A-B) : A positive value means the desire to reduce the body weight, and a negative value means the desire to increase it. (2) The strength of determination [(A-B)/A×100] : Since the absolute value of (A-B) is affected by the present body weight (A), it was corrected for the effect of the present body weight (A) to compare the strength of determination among groups in different body weight ranges. A negatively larger value indicates stronger desire to increase the body weight, and a positively larger value indicates stronger desire to reduce the body weight. (3) Validity of the target body weight [(B-C)/A×100] : The target body weight is considered more valid as this value is closer to zero. Evaluation was made by dividing into three age groups. The desire to reduce the weight was observed in all three age groups. The strength of determination to control weight showed no significant difference among the three age categories. However, significant differences were observed in the validity of the target body weight, being less valid in those aged 18-24 years and more valid in those aged 50-69 years. A positive correlation was observed between the strength of determination to control weight and the parameters of obesity. The desire to reduce the body weight was stronger in more obese subjects, and the desire to increase the body weight was stronger in leaner subjects. The parameter of obesity that was most closely related to the strength of determination was the body mass index in all age categories. On comparison of the correlation coefficient among the age categories, the relationship between the sum of subcutaneous fat thickness and the strength of determination was closer in those aged 50-69 years than in the younger subjects. These results suggest that the perception of the appropriate body weight in females should be undertaken for health consultation, and information concerning obese indices that may motivate them to control the body weight differed by age categories.

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This study surveyed the consulting tasks and support positions by public health center nursing in municipal community health service areas. This study also defined the purpose of consultations and which consultations should be performed by the public health center nurses. In Summary, the results are noted below : 1. Approximately 90% of municipal public health nurses have indicated their desire to carry out the responsibility of consultations. Public health center nurses feel the consultation aspects should be kept under the task of the public health center nurse position and at this time, 50% of the consultation tasks are done by them. 2. The public health center nurses perform all of the consultation processes in support of the municipal community health services. 3. The areas of support in municipal community health services by the public health center nurses should include, sharing problems with the municipal community health services through teamwork, clarifying problems and finding solutions together, clarifying time of solving problems.

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Purpose : The purpose of this study was to find the caregivers' cognitions when the elderly with dementia receive medical treatment, and to discuss the different and common cognitions of caregivers of the elderly with Alzheimer-type dementia (ATD) and vascular dementia (VD). Methods : The subjects were 8 caregivers who currently attend medical institutions. They were interviewed using semi-structured questionnaire. All interviews were transcribed, and analyzed using the qualitative method Results : Nine phases were found in the cognitions of caregivers of the elderly with ATD and with VD. 1) Difficulty in having the cared received medical treatment. 2) Purposes to receive medical treatment. 3) Medical plans made by the doctors. 4) Accompanying to hospitals. 5) Evaluation of experiences in hospitalization. 6) Dealing with acute symptoms. 7) Doctors' attitudes toward the family. 8) The families' questions and needs to doctors. 9) Significance of consulting Centers for Senile Dementia. Of these 9 phases, some different and common characteristics between caregivers of ATD and VD were found. The major differences were firstly in the difficulty in attending hospitals. The ATD caregivers had recognized difficulty in dealing with the cared at medical institutions, while VD caregivers had recognized difficulty in preparing at home before receiving medical treatment Secondly, ATD caregivers had recognized the consultation to find out the degrees of progress of the dementia and to keep contacts with medical institutions. VD caregivers had recognized as to treat and control basal diseases. Thirdly, in evaluating how hospitalization influenced the cared, ATD caregivers recognized lowered cognitive ability, and VD caregivers recognized lowered physical ability. Fourthly, in doctors' attitudes, ATD caregivers had recognized doctors' considerate attitudes toward them ; VD caregivers had received instructions for medical treatment. Thus ATD caregivers needed doctors to explain the treatment more and to understand their life as well as to have a better attitude to the cared. VD caregivers needed more information on demential diseases. Common cognitions were in difficulty with hospitalization and dealing with acute symptoms These 9 cognitions highlighted 3 issues to consider medical treatment to the elderly with dementia : 1) to understand the caregivers difficulty and needs related to medical treatment. 2) to organize better conditions for consultations with doctor and 3) to deal with acute symptoms ; which will be important to ensure continual medical treatment and to support continual home life.

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With an increasing number of nuclear families and decreased birth rates, providing social support to mothers has become an important issue. The literature in the West has pointed out that depression in mothers adversely influences the mother-child relationship so much so as to interfere the growth and development of the child. As a result m the West research has been conducted in an effort to identify the influencing factors that appear to be related to the child's health. In Japan, however, a very few studies have been undertaken to examine the relationship between the mother's mental health and its effect on the child. Therefore, a study was conducted to elucidate the nature of the interaction between the mother's depression and its associated factors. The study was conducted at 3 different sites a parenting class where 33 first-time mothers who attended in city U, a check-up clinic where 57 mothers visited with their 3-months in city K, and 49 mothers whose children attended a nursery school in city K, a total of 139 mothers. The following instruments were administered on the mothers Zung's Depression Scale, the Health Practice Scale, the Child-Rearing Consciousness Scale, the Child-Rearing Worries Scale, the Social Support Scale, and the Marriage Satisfaction Scale, together with a questionnaire to ask about the subjects' and the family characteristics. χ² square and ANOVA were used to compare the depression scores among the 3 groups of mothers. Pearson's r was used to examine the relationship between the mothers' depression and its related factors. Results : 1. The average score of depression for the first-time mothers was 39.9, that of the mothers with infants was 39.0, and that of the mothers with nursery school children was 39.0. The degree of depression was divided into mild (40-47) and moderate (48-55) or severe (56 or over) based on Zung's Depression Scale. In the first-time mothers, those who had mild depression was 42.2% and those who had moderate or severe depression was 9.1%. Likewise, in the mothers who had infants, mild depression was 31.6% and moderate or severe depression was 14.0%. In the mother who had nursery school children, mild depression occupied 27.7% and moderate or severe depression was 8.5%. There were no statistically significant differences observed among the 3 groups of mothers. Interestingly enough, the results from the mothers' depression scores with infants corroborated the scores obtained from nursing students or women in the community. 2. Next, associated factors were examined in each group of mothers. For the first-time mothers, associated factors with their depression were life-style and marital relationships. As to those mothers with their 3-months, all factors from the instruments used in the study were related to their depression. As far as those mothers with their nursery school children were concerned, marital relationships and the extent of and the nature of social support were related to their depression. From the above, the authors concluded that in order to minimize mother's depression, providing social support to them is crucial for mothers to care for their children in an effective way. Of all supports, that from the family, from the husband in particular, is of paramount importance. The community health nurse is in a position to provide social support to mothers through the family so that mothers may carry out their child rearing responsibility in a successful manner.

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The purpose of this study is to clarify the mental process of elderly people who receive care to find their own "harmonious life" in the community, where they have long lived, affirmatively accepting their daily lives and taking steps toward matured aging. We define this process here as a way to "harmonious life." We have made our study on a total of 11 elderly people aged from 70 to 89 who receive visiting care or home help in their daily lives in Tokyo. Our data is based on the interviews with them, using the content analysis method of Berelson. As a conclusion, we have found that the following four major elements constitute a "harmonious life." They are, "a principle of life to have a happy life," "life adjustment along with aging," "health which secures a sense of self-respect," and "a sense of security by livelihood protection." It is presumed that these four elements, intertwined with each other, make up a process toward matured aging. From our study, we have also found a possibility to newly establish a concrete and individual support strategy in the field of community nursing, incorporating these four major elements into a new nursing support concept.

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The purpose of this investigation is to determine the average number of professional staff members within a local government providing dental health care and to describe their actions as they relate to membe'rs of the community, especially the elderly. We also examine the role of public health nurses in the coordination of dental health care, and evaluate the nature of their activities. Subjects for the analysis were selected from 860 organizations (effective answer rate of 26.4%) and the following results were obtained : 1) The percentage of public health nurses involved in dental health care was 67.0%, which was the highest rate of all full-time health care providers. The rate for dental hygienist was the highest of all part-time workers at 47.7%. 2) Dental health care was provided for the elderly in 427 of the 852 institutions surveyed, for a total rate of 50.1% (wards/cities under special government ordinance 84.0%, cities 66 5%, towns 42.8%, villages 32 4%). 3) The average number of health care workers per 100,000 people providing health care for the elderly was the highest in villages, followed in descending order by towns, cities and wards/cities under special government ordinance. 4) In wards/cities under special government ordinance, the percentage of public health nurses and dental hygienists with a full-time job providing dental health care for the elderly was 14.2%. 5) The total rate of evaluating practice of health organizations involved in providing dental health care for the people was 45.3 %. In conclusion, the results demonstrated the need for a greater number of health care professionals providing dental health care for the elderly in the future.

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[in Japanese]

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Purpose : This report described public health nurses' understanding and practice of community nursing assessment and discusses the issues regarding the development of competence in community assessment. Method : The subjects were four public health nurses with more than three years of experience who had supervised nursing students in community practice. Semi-structured interviews were tape-recorded. Data were analyzed to identify core thoughts. Results : They assessed community members in order to identify the evidence of health care practice, to implement a basic health plans, and to identify community needs that would be shared with the health care team. They sought to understand the community comprehensively and objectively ; to understand the lives of the people ; and to uncover issues related to health services. They had no systematic assessment framework. In data collection, they emphasized practical events, so they paid attention to real people's voices and individual issues that might develop into community health issues. They had limited competence in systematic assessment, the use of qualitative data and statistical analysis. They recognized the need for a practical assessment tool. As a result of their assessments, they expected to have fulfillment of their work goals ; to implement health services ; to meet people's needs ; to be able to make health care policy ; and to have a smooth running health care team. They had unreasonable expectation of a community assessment. They recognized a gap between community diagnosis and community nursing assessment. Conclusion : To develop the public health nurse's community assessment skills, it is important for the nurse to understand the difference between whole community assessment and assessment of health service practice. It is necessary to establish methods for systematic collection and analysis of community health care data as soon as possible.

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Purpose : The health problems of the school children who enter school health rooms not only concern illnesses and injuries, but also the degrees of illness and injury A nurse-teacher sometimes has to deal with more than one visitor to the health room at a time, because there is only one nurse-teacher on staff at every school. The purpose of this research was to observe the way of how the nurse-teachers get the information about the school children who enter the health room to decide on what or if any course of treatment should be taken. We wanted to find out the nurse-teachers' opinion of the children's health problems, and what the actual process of diagnosis was. Content of observation : The situation m which the nurse-teachers deal with the school children who enter the school health rooms. Period of research: May 98 - Sept 98 Subject of the study: 13 nurse-teachers from public primary and secondary schools in H Prefecture. Results : We found out that the nurse-teachers paid attention to how the school children entered the school health rooms, and used this information to help m their medical diagnosis. The nurse-teachers observed whether the school children had injuries or illnesses and checked their health levels. The nurse-teachers immediately made decisions bridging both educational and medical domains. When there was more than one visitor, the nurse-teachers had to make decisions on which child they should deal with first according to the degree of illness and injury.

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Recently, in Japan, the trend towards fewer children has progressed and the family structure has been also changed from a large, multi-generational family to a nuclear family In this situation, the circumstance surrounding,chtld-rearing is forced to change. The purpose of child and maternal health care is to solve problems about childcare for mothers, and support them to rear their children healthy, The aim of this study is to clarify the parental anxiety for and their expectations of Health. Examination for 18-month-old children (HE18). Methods : A questionnaire was sent to 240 mothers of 18 months old babies, who had attended HE18 of one health center between September 1998 and November 1998. Results : The number of mothers who had complained some problems of their childcare was 157 Who had anxieties about their chadren themselves, were more than those about problems (116 versus 41) Almost all (97.5%) attended HE18 in order to confirm whether their children had grown healthy or not. In spite of their anxieties for their child rearing, a lot of them did not expect to solve or consult their problems at HE18, especially within mothers whose problems except their children themselves. Conclusion : Because many mothers think that they could not resolve their anxieties, HE18 should support not only child-rearing but also their mental health dare. However, HE18 could correspond to only some problems about their children themselves. Thus it is expected that the support system for mothers themselves have been rapidly established.

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[in Japanese]

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[in Japanese]

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Purpose : Many women had the osteoporosis examination at the community health event on their own will. Some of them were conscious of osteoporosis symptoms because of obesity. Our purpose is to make clear the problems of health education to those women. Method : Subjects were 151 women from 30 to 70 years old. They attended this osteoporosis examination, and answered self-writing questionnaires, which were 18 items about such lifestyles as food intake, physical activity and so on. These questionnaires were according to Ministry of Public Welfare's osteoporosis examination manual inquiry list Bone density was measured by using ultrasonograph (Lunar Co. A-100+) at right calcaneus's. Result : 1) In this research, we paid attention to body mass index (BMI) especially, and relationship of the bone density to obesity. These data were gotten by self-writing questionnaires. As the result we knew about those women who were over BMI 24.2, appearance rate of osteoporosis symptoms was significantly high. 2) Among obesity women (over BMI 24.2), over 60 years old women had more needed to have the follow up examination (for the women, under 71 stiffness value) than under 50 years old women In over 60 years old women; there was no significant different between obesity women (over BMI 24.2) and the Women (under BMI 24.2) in the rate of having the follow up examination. It was found that women over BMI 24.2 should be regarded as having serious risk of osteoporosis through all ages. We think it is better for them to get suitable healt education.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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