Purpose : The purpose of this research is to make the index clear which concerns the judgment of the visit numbers of the public health nurse in the community mental health services, and to examine the course factors which make the judgment difficult. Subjects and Methods: Subjects were 52 public health nurses working at 10 local health offices in Hokkaido, who engage in visit nursing for the schizophrenia. The methods of research was the unsigned and self-writing questionnaires sent to them by mail, and they were asked to fill in them about the cases of the chronic schizophrenia symptoms that visit and nurse in the investigation period. The contents of the research were ; 1) public health nurses basic factors, 2) cases basic factors, 3) living disability, 4) psychiatric symptoms, 5) social support conditions, 6) public health nurse judgment. Data made a discrimination analysis, Kruskal-Wallis examination and multiple comparisons. SPSS Ver.10 was used as statistics analysis. Result and Consideration : The questionnaires were sent to 52 subjects and received 43 responses. 83 cases were obtained from them and analyzed. as the result of discriminate analysis, held on 52 cases evaluated as appropriate yearly visiting times, the judgment index made the visit numbers less than three times consists of the following three categories ; "emotional supports except families" "negative symptoms" and "interpersonal relations", and it needed that the case had no trouble for them. The judgment index made more than ten times visits a year consists of the following three categories ; "family's emotional supports" "endurance and stability" "work", and it needed that the case had some trouble for them. The unsuitable factors of visiting times judgment concerned the assessment regarding the lack of emotional the factors which make difficult the judgment of the visiting times concerned the lack of the assessment regarding the living abilities and emotional supports of the schizophrenia. The schizophrenia has the co-existence of disease and disability, and has always the danger of return and deterioration of disease, so it is necessary to evaluate and support self-care ability and family care ability. Therefore, these indicators will be effective in the field of home visiting to judge the frequency of visiting and to clarify the judgment evidence.

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The purpose of this study was to examine self-help groups (SHGs) for family caregivers of the elderly with dementia and to describe the processes by which group members' activities have effects on the community. Data were generated by semi-structured formal interviews with 13 group members, participant observations of group activities, and examination of documents written about the group members' caring experiences. Data were analyzed using the grounded theory approach. The results are as follows : 1. We found a process by which group members shared their caregiving experiences with community members. It was divided into four stages : (1)group members are unable to talk about their caring situation to anyone in the community ; (2)they have to discuss their situation with someone ; (3)group members attend a caregiver SHG and speak about their experiences ; (4)-1) after attending a SHG, they want to share their experiences with community members ; and (4)-2 they willingly share their experiences with the community. 2. The SHG members' difficult experiences at the stage of being unable to talk about their caring situation later became a motivational factor to share their experiences with the community. 3. By repeatedly sharing their caregiving experiences at the SHG meetings, group members changed their fixed ideas concerning caring for the demented elderly and the role of SHG supporters. This made it possible for them to become supporters themselves. 4. The group members not only enhanced the methodology but also progressively expanded the sharing of their experiences from caregivers' self-help groups, to specific individuals, and then to the community at large. These results showed that it is necessary for public health nurses to support SHGs and their members according to each of the developmental stages.

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Purpose: We compared implementation of care management by care managers' occupations in order to study contributing factors of care management to outcome improvement of home care elderly, and clarified effective care management. Methods: We analyzed 64 (29 nurses, 24 social workers, and 11 other occupations) care managers and 384 clients after completing twice assessments as a set of 6 cases of different care levels for two months in 2001. Results: (1) Of 36 client outcome items, improvement was seen in 18 items by nurses, and 9 items by social workers and 9 items by other occupations. (2) Effective care management for outcome improvement includes utilization of expertise (e.g. nurses should be in charge of clients with demanding medical needs), combining services to meet the client needs, explanation for clients and obtaining their consent, and client confirmation of implementation of care management services.

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[in Japanese]

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[in Japanese]

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In rural and fishing villages, particularly in the northeastern regions of Japan, the traditional social activity "OCHANOMI" is one means of maintaining social relationships between elderly individuals. Local governments are utilizing "OCHANOMI" in community-based health activities for the elderly. However, very few studies have investigated the effects of "OCHANOMI". The purpose of this study was to determine the effects of "OCHANOMI" on elderly individuals, aged between 65 and 74 years, with regard to social support, subjective well-being, and results of social exchanges. Questionnaires were mailed to 1,000 randomly chosen elderly individuals (aged 65-74 years) living in T town of M prefecture, Japan. Valid responses were obtained from 703 individuals. The results were as follows : 1) Those who participated in "OCHANOMI" were 67.9% of 703 subjects, and those who participated in "OCHANOMI" between 3 and 4days a month were most (23.1%) prevalent. 2) The results of multivariate analysis showed that participating in "OCHANOMI" was positively correlated with the emotional and instrumental support from friends, neighbors and acquaintances. Additionally, participating in "OCHANOMI" was positively correlated with positive outcomes from social exchanges, but participating in "OCHANOMI" was not correlated with subjective well-being. 3) "OCHANOMI" was confirmed to be a positive factor in social relationships of the present subjects.

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Purpose : The purpose of this study was to investigate caregivers' recognition of the behavior troubles of elderly people with dementia who were being looked after at home between Japan and the UK. Method : A questionnaire survey was administered (in Japan in 2000 and in the UK in 2001) to the samples respectively. The analyzed Japanese sample consisted of 141 caregivers involved in looking after elderly people with dementia and making use of a day service in T Region, M Pref., and that of the UK consisted of 69 caregivers of the same condition in S County. Results : Among the results of logistic regression analyses on the caregivers' recognition of behavior troubles in elderly people with dementia, three of them were significantly different between Japan and the UK. In Japan, "easily becomes excited" and "cannot use telephone" achieved a higher odds ratio, and "noisy or wanders around at night" attained a higher ratio in the UK. The caregivers' recognition of problematic behavior troubles was different in that "is incontinent" and "wanders around at night" and they were both found to be higher in the UK. Conclusion : Caregivers' recognition of the behavior troubles and problematic behavior troubles of elderly people with dementia were different between Japan and the UK. It might be possible that Japanese caregivers recognize problematic behavior troubles of elderly people with dementia less than the behavior troubles of them.

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