To clarify the state of coordination and collaboration between midwives and obstetricians during in-hospital birth center, we conducted individual, semi-structured interviews with midwives and obstetricians with professional experience. Each subject was interviewed for approximately 30 minutes, during which they were asked about their experience of transferring parturient women to the obstetrics ward from the in-hospital birth center due to weak pains. The interviews mainly focused on the process up until a final decision on ward transfer and what factors were prioritized in the decision making. As a result, it was found that obstetricians left substantial decision-making on ward transfer to midwives; the obstetricians gave the explanations regarding ward transfer to the parturient women and their family members; the ward transfer during the day shift was a factor prioritized in making a decision by both midwives and obstetricians; and facility standards on transfer from in-hospital birth center to obstetric ward were set in each hospital, but they were not strictly enforced and were applied in accordance with the situation. Thus, it appears that the switch from midwife-led birth to obstetrician-led birth was made swiftly based on judgment by midwives, and the day shift was of priority due to management system issues. Results also suggested that the ward structure influenced decisions on ward transfer.

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In this study, we aimed to elucidate the types of difficulties faced by home-visit nurses in caring for home-care patients with mental disabilities in intervening in case of inappropriate care of home-care patients, but which are not classified as abuse. An open-ended questionnaire survey was conducted on home-visit nurses at member home-visit nursing stations of the National Association for Home-visit Nursing Care. We performed a qualitative regression analysis on the responses from 136 nurses and identified the following difficulties experienced by nurses when they recognized abuse: “Difficulties to surfacing problem facts” and “Difficulties in intervening with the abuser and the abuse victim at the same time.” They visited homes while recognizing a growing “Empathy with the abuser” because they had built a relationship with the family and experienced “Hesitation in making the intervention” and “Dilemmas due to difficulties in not being able to reach a common multi-professional understanding.” The results suggested the need for an educational system to reinforce an objective judgment and collaboration, which are essential for intervening in case of gray-area abuse and an improvement of the environment to reduce the nurses’ psychological stress.

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[Purpose] The purpose of this study was to examine the effect of percutaneous electrical stimulation of the leg muscles under acute normobaric hypoxic environment on blood glucose concentration. [Methods and Results]Ten healthy subjects in a low oxygen （14.5％） environment at normal pressure received percutaneous electrical stimulation of the lower limbs for 20 minutes using a technique called Belt electrode Skeletal muscle Electrical Stimulation（ B-SES）, and its effects on glucose metabolism were measured. After 30 minutes of acclimatization to the normobaric hypoxic environment before the stimulation, decrease in percutaneous oxygen saturation was observed. The electrical stimulation did not further decrease the percutaneous oxygen saturation. Heart rate had not increased after the acclimatization or after the electrical stimulation; it is thought that B-SES had little influence on the cardiorespiratory system. B-SES caused a significant mean decrease of 16.2 mg/dl （0.9 mmol/L） in blood glucose concentration. [Conclusion] B-SES in normobaric hypoxia may enhance the efficiency of glucose metabolism and lower blood glucose concentration.

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Purpose: The present study aimed to determine factors associated with changes in neuropsychiatric symptoms （NPS） among frail elderly persons before and after a short-term stay in a geriatric health care facility. Methods: Fifty frail elderly individuals receiving short-term residential respite care at a single geriatric healthcare facility in southeast Hyogo Prefecture participated in the present study. We assessed NPS using a modified neuropsychiatric inventory （NPI） scale with twoday observational periods before and after a short-term stay in the facility. Time spent away from bed at the facility was compared with that at home. Frail elderly persons were divided into groups according to the presence or absence of changes in the modified NPI scale. We investigated factors associated with changes in NPS and cut-off values. Results: Logistic regression analysis selected an increased amount of time spent away from bed compared with that at home as an independent factor associated with improved NPS （odds ratio, 1.297; 95％ CI, 1.004-1.676; p ＜ 0.05）. An increase of 2.5 hours in the amount of time spent away from bed in the facility was identified as an optimal cut-off for improvements in NPS（ sensitivity, 0.647; specificity, 0.879）. Conclusion: Improved NPS among frail elderly persons after a short stay in a care facility was associated with an increase in the amount of time spent away from bed.

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Many accidents in which head trauma is caused by falling indoors have been reported. In this study, numerical simulation was used to quantitatively evaluate the protective effect of carpet against head trauma caused by fall accident. Four postures （faint, slip, trip, step down） of falling were assumed and simulated. The collision motion between the head and the floor was reproduced by using a whole body numerical model, then the obtained mechanical response of the head was input to a finite element human head model. The posture, translational and rotational velocity before the collision, translational and rotational acceleration of the heads during the collision were input. Injury risks of skull fracture, cerebral contusion, concussion are evaluated by using the calculated mechanical parameter. For each posture of falling, three types of floor structures （flooring, carpet and flooring, underfelt and carpet） were simulated. The results showed that in all injury risk, falling to the flooring was the highest and falling to the combination with underfelt and carpet was the lowest. By comparing the results of the various head injury risks, the use of carpets has the effect of reducing the risk of head injury and carpets with high cushioning properties have high protection performance.

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