The purposes of this study were to develop a self-efficacy scale and an intervention program for prevention of hyperlipidemia in adults in their 30s and 40s. The development of the self-efficacy scale consisted of 2 stages. The 1st stage defined health behavior for prevention of hyperlipidemia based on interviews and the creation of an original scale. Then, seven experts examined the original scale. As a result, the self-efficacy scale was modified to 40 items. In the 2nd stage, we asked local government officials in their 30s and 40s to answer a questionnaire. The questionnaire included items about health behavior and the 40 self-efficacy items for prevention of hyperlipidemia. A total of 594 valid responses were analyzed. As a result of factor analysis, the self-efficacy scale for prevention of hyperlipidemia for adults in their 30s and 40s was finalized at 3 factors and 16-items. The three factors were "exercise and activity modification without excess," "basis of behavior modification" and "active modification of diet." The internal consistency of the self-efficacy scale indicated by Cronbach's standardized alpha was 0.855. Test-retest reliability was 0.809. The self-efficacy scale was significantly associated with health behavior, and reflected health behavior for hyperlipidemia prevention. In addition, the reliability of the self-efficacy scale was indicated. However limitations of this study were that selection bias and response bias occurred.

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Purpose: The purpose of this study is to identify the intention of public health nurses to support care managers who experience difficulties. Method: A semi-constitutive interview was performed to 17 public health nurses working for local governments in N and G prefectures. They all have experience in supporting care managers. The interview was on the contents and intentions of support they provided to care managers. Then qualitative and inductive analysis was performed. Result: Twenty items were extracted concerning support intention of public health nurses. They were further classified in such phases as "decision on support necessity," "identification of problems," "implementation of support," "evaluation of support" and "development of community support system." The public health nurses provided support to care managers by combining different options. Support intentions include "enhancement of care management competencies" of care managers and "preparation for better care management". Each support action combines both perspectives. Disscusion: In support to care managers, public health nurses caught difficulty factors from the various sides and decision on support necessity, and they utilized their care management and family support skills to help that care managers be able to carry out the high quality care management. Furthermore, expertise of public health nurses in developing challenges and issues into system were visible in their support activities.

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Purpose: Health promotion volunteers (HPVs) who are members of community health organizations have been fostered by municipal administrative officer including public health nurses and they have worked in local communities in Japan. The purposes of this study are to compare the attitude toward community of HPVs, explore factors related to their attitude toward community, by years of experience, and find ways for promoting and supporting the activities of HPVs. Methods: The subjects were 604 HPVs in two cities in a prefecture. A mail-in self-check questionnaire survey was conducted in September 2005. Results: A total of 432 questionnaires were analyzed (valid response rate: 71.5 %). Two factors, 'activeness' and 'cooperativeness,' were obtained based on factor analysis for the attitude scale toward community. Both the activeness and the cooperativeness were significantly higher in the group of 9 or more years of experience than in the groups of 1-3 years. The higher the motivation for activities at the time of training completion in the groups of 1-3 years and 4-8 years and the cooperation by the head of the community with their activities in the group of 9 or more years were, the higher the activeness of HPVs was. The higher the motivation for activities at the time of training completion in the groups of 1-3 years and 4-8 years, the support provided by colleagues in the groups of 1-3 years and 4-8 years and the support provided by local residents in all groups were, the higher the cooperativeness of HPVs was. Conclusion: It was important to strengthen the relationships among members and encourage members to participate in the activities with local residents to promote their activities. Administrative officer could support HPVs by working on the head of the community to cooperate with their activities and by strengthening mutual support of HPVs and collaboration with local residents.

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Purpose: This study was to investigate prevalence of depression and its related factors, for developing care program to promote mental health in the elderly living alone in an urban area. Methods: Subjects were 250 elderly living alone 65 years and older in A ward in Tokyo. The unsigned and self-writing questionnaire was sent to the subjects by mail. The variables were demographic data, depression (Geriatric Depression Scale-15) as dependent variables, and the Tokyo Metropolitan Institute of Gerontology Index of Competence, social networks, number of the health medical welfare service, outing frequency, with or without pet, and so on as independent variables. Results: The prevalence of depression was 43.6 %. Factors significantly related to depression were a period of living alone, a degree of long-term care need, and social networks. Conclusion: It was necessary for the elderly living alone in urban area to develop the intervention program suitable for their period of living alone, a degree of long-term care need, and social networks.

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Purpose: To review research related to public health nursing for child abuse and neglect and clarify issues regarding the improvement of its practice and research. Methods: Research articles published between 1996 and 2006 were searched using Japanese Central Review of Medicine and MEDLINE. Results: Author reviewed 34 relevant research articles. The findings revealed 3 important features: (1) the characteristics of clients supported by public health nurses (PHNs), (2) practices and competency of PHNs, and (3) new roles of PHNs. PHNs usually supported clients requiring maternal and child health services. Specific practices were related to mental support for abusive parents and assurance of children's safety and development. There was limited information available regarding family support and organizational coordination. PHNs required skills in social work and case management, and hoped to receive appropriate training in these areas. Recently, new roles for PHNs have been identified in the field of child protection. Some articles also clarified issues of training and cooperative frameworks inside and outside the workplace. Discussion: The following are future challenges: (1) further application and evaluation of maternal and child health services to prevent child abuse and neglect, (2) need for further research regarding family support, (3) further research and evidence-based practice with regard to coordination and social work, (4) continuing and enriching research on the new roles of PHNs, and (5) refinement of training programs and the establishment of cooperative frameworks inside and outside the workplace.

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In order to establish effective public health nurse support, the present study assessed motivation during the early stage in patients with Parkinson's disease or spinocerebellar degeneration living at home; 7 patients were interviewed individually in a semi-structured manner. Based on verbatim transcriptions of the interviews, qualitative and descriptive analyses were performed. The results indicated that, among the 9 subcategories of patients, including "patients accept their current disease status and situation," "patients continue to maintain a relationship with others and society," and "patients attempt to carry out their role and responsibilities as much as possible," the patients demonstrated 3 levels of motivation: "As the disease worsens, the patient actively deals with the situation," "The patient is involved socially and interacts with others," and "The patient tries to achieve self-realization by discovering the meaning of the disease." The early-stage patients tried to understand the reality of having an intractable disease and attempted to cope with the presence of the disease through different approaches. These results suggest that such patients should be supported through symptom management, identifying the limitations imposed by their impaired functions, creating opportunities for interaction with others, including patients with the same disease, and by helping the patients find new meaning in their lives, so as to be able to live with their disease. It is necessary to conduct a comprehensive assessment of these patients' motivation. Continuous support measures should be implemented for in-home patients in the early stage of illness, based on the content and level of their motivation.

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Purpose: Driving with dementia is a public safety issue; however, giving up driving would mean losing the client's independence. This study is aimed at describing the process of driving cessation of clients with early dementia and related-factors. Methods: Thirteen clients with early-stage dementia and their caregivers were recruited for the study. The clients were asked to stop driving after being diagnosed as having dementia at a university hospital. From October 2003 to December 2005, the clients were interviewed and family members were consulted about driving cessation. Data was obtained from medical records, verbatim transcripts of interviews, and consulting records to gather the information on disease progression, clients' thoughts about driving, how the family coped, and living environments. Factors associated with difficulties in driving cessation were qualitatively analyzed. Results: Eight clients experienced traffic accidents and stopped driving, and the remaining five kept driving during the study period. For some clients, it took five years to give up their driver's licenses. Lacking alternative transportation and conflicting views on driving cessation within the family were the major factors associated with difficulty in driving cessation, especially for young clients. The family members experienced various stresses in convincing the client to stop driving. The coping ability of the families influenced the process of adaptation to life without driving. Conclusions: It is necessary to identify drivers with early-stage dementia to prevent accidents. Family members need to be consulted on safe driving and when to stop driving. Alternative transportation needs to be discussed with the family.

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The purpose of this study was to identify PHN's specific core competencies which need to be acquired to strengthen position in PHN's field recently. Qualitative data was collected from 7 scholars of erudition and experience, 7 PHNs and 2 health care related experts through focus group discussion and one to one interviews. Competencies were classified and integrated by researchers. The validity and priority of competencies were investigated by 225 PHNs who were in charge of PHN's education working in both Public Health Departments and Community Health Centers, by mailing out questionnaires. As a result of analysing the qualitative data, the following 5 competencies were refined: a) Protecting equality of health/well-being of the population, b) Empowering the population's capacity for promoting community health development, c) Creating strategic policy and resources from the clients' view point, d) Demonstrating the necessity and the effects of action, e) Developing and sustaining PHNs' professionalism. As a result of investigation, all competencies met with over 90% of subjects' approval and competency c) and d) were thought high priority by about 70% of subjects. Five competencies were identified with consensus. These results showed that it is necessary for PHN to acquire these competencies, especially c) d), we have to develop an effective education program and system as soon as possible.

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Purpose: The present study aimed to identify the actual situations of low back pain (LBP) prevention in special nursing homes and clarify problem cognition for LBP in care workers on manager side. Method: Interviews were conducted for the persons in charge of caring at 13 special nursing homes in September to November 2005. Results: Of the 13 facilities, 9 were found to have problem cognition for LBP in care workers. At most facilities, seminars or guidance programs focusing on nursing-care methods and body mechanics were provided for care workers. It was said that improvements in nursing-care methods that aim to increase safety for facility users consequently led to prevent LBP. Both the facilities that do not have care workers with LBP and problem cognition and other facilities that have those provide the same prevention programs. However few of the facilities had enough caring spaces and utility spaces for care workers. Ten of the 13 facilities identified lack of time as an obstacle to prevent LBP. Conclusion: The present results suggest that although care workers do not directly act to prevent LBP, improvements in nursing-care methods that aim to increase safety for facility users consequently ease physical load and prevent LBP in care workers. In addition to that, it is suggested that the maintenance of working environment and health care-safety system is needed.

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Objectives: To study husbands' childrearing support provided to their wives and identified the connection between the husband's childrearing support and the marital relationship. Methods: The subjects of this study were mothers who visited Health Center "A" in metropolitan Tokyo for infant health checkups. A self-entry, anonymous questionnaire survey drawn up by the researcher was carried out to investigate the husbands' childrearing support (5 items) and marital relationship (8 items) as well as the subjects' basic attributes. Results: Of the 407 subjects, 196 sent in responses (collection rate: 48.2%). 1) The subjects' mean age was 32.4 ± 4.2 years; mean age at the time of marriage was 26.5 ± 4.2 years; and 91 subjects, or 47.2%, had brought their first child. 2) As a result of conducting a factor analysis of "husbands' childrearing support" and "marital relationships," each was found to constitute one factor. They were named "a sense of partnership" and "a sense of intimacy," respectively. 3) As a result of conducting a correlation analysis of the scores obtained for "husbands' childrearing support" and "marital relationships," a strong positive correlation was shown to exist (r=0.759, p<0.01). 4) The average values of the scores obtained for "husbands' childrearing support" and "marital relationships" were compared according to the mother's basic attributes and by views on the division of labor by gender role. No significant differences were seen as a result (p<0.01). Conclusion: The husbands' childrearing support and marital relationships during childrearing constituted one factor each, and both were concepts with numerous overlapping components. This study suggested the possibility that, if mothers can perceive "a sense of intimacy," they can be expected to see their "sense of partnership" boosted.

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As specialists responsible for the improved health of the communities that employ them, public health nurses (PHNs) develop public health programs based on the needs of individuals, families, groups, and the community as well as the policies of the health department and other governmental authorities. During the routine process of program development it is sometimes the opinions of PHNs conflict with those of the administrators. PHNs are troubled by how best to assess such situations and what actions might be taken. This paper presents an analysis of such situations based on written descriptions of 35 PHNs reporting conflicts. These PHNs were among 144 attendees at a continuing education program for PHNs in one prefecture where a total of 66 responded to a questionnaire at the end of the program. Conflicting opinions were especially prevalent at the planning stage. Analysis of the substance of the differences confirmed that PHNs and administrators differ in their thinking. Nurses were more interested in the content of the program while administrators were more concerned about numbers to be served, budget, cost-effectiveness, and needed documents and approval processes. Because PHNs and administrators share the same over-riding goal, to improve the health of the public, it is important that PHNs routinely describe programs and their effects in ways understandable to administrators and be willing to listen to administrator's views. This suggests the necessity of both parties learning from each other and collaborating closely to coordinate efforts.

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Purpose: The purpose of the present study is to examine the effects on preventive care program for cognitive function decline among community-dwelling frail elderly people. Methods: Subjects were 16 frail elderly people, included seven male and nine female, and whose mean age was 79.6 (SD7.5). The care program consisting of activities stimulate their cognitive function for two hours, four times during two months. We measured GDS (Geriatric Depression Scale) as depression, MMSE (Mini-Mental State Examination) and Stroop Color-Word Test as cognitive function at the time of pre-intervention and post-intervention. Results: Scores of GDS have decreased, although the change is not significant. Scores of MMSE significantly improved (p=0.002) at the point of post-intervention. Orientation, subscale of MMSE, significantly improved (p=0.03). Regarding Stroop Color-Word Test, three subjects who could not complete the task at the point of pre-intervention could complete it at the point of post-intervention with few mistakes. Scores of MMSE were improved significantly among male subjects (p=0.03) and younger subjects (p=0.03). Discussion and Conclusion: The results suggest that the present preventive care program was effective to improve cognitive functions among community-dwelling frail elderly people. Future research should be conducted, expanding numbers of subjects, examining the effect on gender or age difference.

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[in Japanese]

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The purpose of this study is to analyze how public health nurse students learn community-health nursing diagnosis during community-health nursing training and to collect basic data to educate them about the fundamental ability necessary to make a community-health nursing diagnosis. Procedures: Out of 22 seniors at E College, 10 who consented in writing and who attended the orientation during training were selected. The contents of their training journals were qualitatively analyzed to find the learning process of community-health nursing diagnosis. Results: 1. During the local orientation they learned health services necessary to the community from the viewpoint of systems of a public health center and the local government, public health services, and public health nurse's activities. At the first inspection they realized how people live in terms of natural environment, traffic, and groups of people. 2. By analyzing the training journals longitudinally, it became apparent that the learning process of community-health nursing diagnosis has 5 stages: they see the real images of people and community; they see objects concerning subjects; they analyze connecting data; they extract health problems and find the background and advantage of the community; they realize the outline of designing a plan. The analysis of data during the community-health nursing diagnosis seemed to follow the thinking process that after grasping the picture of the community roughly, they focus on and integrate data. As stated above, the learning process of students in community-health nursing diagnosis became clear. The necessity to assist them during each stage was also suggested.

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