A questionnaire survey regarding the work on improving measles immunization rate was conducted with public health nurses working at public healthcare sites and municipal public healthcare centers in Mie（ranked No. 1 in FY2008）, and Shiga（ranked 46th in FY2008）, prefectures. Regarding the implementation status of educational activities aimed at encouraging the first phase of measles immunization, there was a significant difference in immunization rates between the prefectures, with rates at the time of receipt of Mother and Child Health Record of 48.4％ in Mie and 13.1％ in Shiga, respectively. The comparable rates for this educational activity at the time of submission of birth registration were 24.7％ in Mie and 10.3％ in Shiga. Corresponding rates at the time of the 18-month health checkup were 97.4％ and 90.2％; the 3-year health checkup, 77.1％ and 49.5％; and the scheduled neonatal nurse visit, 79.6％ and 64.5％, respectively. Rates at the time of the explanation of immunization to those moving to the prefectures were 95.5％ and 86.7％, respectively. The educational activity rates in Mie Prefecture at all the above times were significantly higher than those in Shiga Prefecture.

　In Mie Prefecture, 4-month and 10-month health checkups are outsourced to medical institutions where pediatricians provide explanations on immunization, including that against measles, to parents and guardians. Moreover, with the digitization of immunization records, it is possible to keep track of the rates of all immunizations for children aged 18 months and 3.5 years. Meanwhile, in Shiga Prefecture, infant/child health checkups are mainly provided by municipal public health centers, where public health nurses provide explanations on immunizations. To improve measles immunization rates, it seems to be important that medical institutions engage in promotional activities in parent and guardian education that mutually complement related activities by public health nurses.

　The objectives of this study were to elucidate the medical treatment experience and quality of life （QOL）of middle-aged patients with rheumatoid arthritis who were undergoing outpatient treatment and to investigate the correlation between these two issues and biological therapies. Patients with rheumatoid arthritis who were undergoing outpatient treatment at advanced treatment hospitals in the Tokyo Metropolitan Area were asked to fill out self-administered questionnaires regarding background factors, treatment-related difficulties, and subjective assessment of QOL. Data from 77 patients aged 40 to 64 years were analyzed. The results obtained were as follows. Significant differences were observed between the group that used biological therapies （usage group）and the group that did not （non-usage group）in the following categories: hospitalization, use of medical and welfare services, and modified Health Assessment Questionnaire score. Similarly, significant differences in questionnaire response patterns were observed between the usage and non-usage groups regarding occupation, number of years since diagnosis, and number of hospitalizations. The patients in both groups listed disease progression and anxiety about the future as treatment-related difficulties that they were highly aware of. The patients in the usage group had lower QOL subjective assessment scores than those in the non-usage group. Treatment-related difficulties that had a high degree of correlation to subjective assessment of QOL in the usage group were difficulties with role accomplishment caused by deterioration of bodily functions and the associated psychological burden. The results of this study will help nurses understand the feelings and experiences of patients and allow them to work toward alleviating physical difficulties and reducing patient concerns about the treatmentrelated burden on their surroundings. Moreover, the results suggest the importance of providing patients with support that allows them to make choices that have their full comprehension and acceptance.

　This study aimed to clarify the workplace difficulties felt by mid-career nurses and the factors of the workplace continuation in small and medium-sized hospitals and to examine measures to promote their workplace retention. Semi-structured interviews were conducted with 11 participants, and the data were then qualitatively and inductively analyzed. As a result, seven categories were extracted from the difficulties felt by the participants from the start of their current employment to the present. Additionally, eight categories were extracted from factors of the workplace continuation, with the “feeling that one＇s job is worthwhile” being their foundation.

　The mid-career nurses felt confusion toward the different environment and anxiety about techniques they performed for the first time in their current workplace, and were expecting kind and detailed explanations regarding their new experiences in the current workplace and the things they did not yet know. As emotional support from superiors and colleagues is a factor in the workplace continuation, the findings suggested that chief nurses need to give accurate advice with attention to the thoughts and previous experiences of mid-career nurses. Precisely due to their experiences at other facilities, mid-career nurses usually have some questions about nursing methods in their current workplace, and need an environment where they can voice those questions to those around them. Follow-up training is considered to be one approach that provides a place where mid-career nurses can talk with one another, but effective approaches to training are an issue that will require further study.