The purpose of this study was to describe two-years changes in activities of daily living (ADL) among community-dwelling frail elderly people using the Japanese long-term care insurance system. In this 2-year longitudinal study, data were collected from 472 noninstitutionalized frail elderly persons aged 65 years or older. By functional limitation and cognitive dysfunction, the subjects were classified into 4 types: moderate dysfunction group, severe functional limitation group, severe cognitive dysfunction group, or severe dysfunction group. Changes of score on ADL were seen from the baseline to the follow-up survey. The patterns of the ADL decline were different between four groups. Severe cognitive dysfunction group was more likely to decline in ADL than moderate dysfunction and functional limitation groups. Functional limitation and cognitive dysfunction were related to ADL decline. These findings suggested that intervention programs for prevention of becoming ADL disabled should be more intensively targeted among frail elderly people with cognitive dysfunction.

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The purpose of this study was to survey the status of use of ambulance services, including the reasons for requests for ambulance services and the time zones of most frequent use, among children aged between 0 and 19 years who were delivered to medical institutions by ambulances of the Tokyo Fire Department during the 7-year period between 1997 and 2003. The subjects were 166,768 patients who used ambulance services on week days for acute diseases or ordinary injuries. The major reasons for the dispatch of ambulances were seizures (19.8%), high fever (15.1%), pain (13.6%), tumble (10.2%), and falling from heights (5.6%). When classified according to the age group, seizure and high fever accounted for 50.1% of all cases in the 0-2 years' age group. The request for ambulances for the two abovementioned reasons increased after 4:00 p.m. In the 3-5 years' age group, the ambulance service requests for seizures (24.9%) showed a biphasic increase between 10:00 a.m. to 4:00 p.m. and 5:00 p.m. to 9:00 p.m. In the 6-14 years' age group, tumble and falling from heights accounted for 67.2% of all ambulance requests, and the most frequent time zone for the requests was between 12:00 noon and 6:00 p.m. In the 15-19 years' age group, pain accounted for 29.0% of all ambulance requests, and the most frequent request period was between 7:00 and 9:00 a.m. Promotion of first aid for high fever, prevention of accidents at homes and schools, and coordination for dispatch of ambulances according to the seriousness of the patient's condition are considered necessary.

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The purpose of this study was to make a trial production of an atmospheric-pressure hyperoxia controlled room (APHCR) and to verify its possibility for application of therapeutic exercise for pulmonary disorder patient and elderly. This room was with a vinyl chloride air tent, and hyperoxia gas generated system was used by a separate system of the polyimide membrane. This system could control O_2 concentration from atmosphere to 35% variably. Physiological changes were observed at rest and during exercise in different conditions of 20.9% and 30% O_2 concentration. SpO_2 in 20.9% O_2 condition decreased from 98.1% at rest to 96.9% at exercise, but SpO_2 in 30% O_2 condition was not changed between rest and exercise. Significantly higher physical working capacity (Watts) was observed at the same physiological strain(120bpm in heart rate) in a condition of 30% O_2 (73.3 Watts) compared with that in 20.9% O_2 (94.1 Watts). The results suggest that this trial production of APHCR can be applied to patients who can not perform whole body exercise to keep and improve their physical fitness due to pulmonary dysfunction or aging in atmospheric condition.

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Objectives: As a preliminary survey, to define the participants' views on husbands' childcare support for mothers with infants and on marital relationships, and to identify the two concepts' factor structure. Methods: A self-entry, anonymous questionnaire survey drawn up by the researcher was carried out, targeting 95 mothers who visited Health Center "A" for their children's 18-month health checkups, and their husbands. The questionnaire focused on issues such as "husbands' childcare support" and "marital relationships," as well as the subjects' basic attributes. Results and discussion: Valid responses were obtained from 84 wives and 34 husbands. 1) As a result of conducting a factor analysis of "husbands' childcare support" and "marital relationships," each was found to constitute one factor. 2) With respect to the average scores of a number of questions pertaining to "husbands' childcare support" and "marital relationships" and the average factor scores for "marital relationships," the husbands' average scores tended to be higher than those of the wives. 3) If a husband and wife were regarded as a pair, the couple was deemed to have more or less the same awareness/in their answers concerning "husbands' childcare support" and "marital relationships." Conclusion: This study suggested the need to carry out a reexamination in the future by increasing the number of data to sufficient levels, and to take into consideration the subjects' basic attributes and special characteristics.

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The purpose of this study was to evaluate the self-efficacy of people with schizophrenia to improve their living in the community. For this purpose, 34 schizophrenia patients, attending to a sheltered workshop, a small-scale vocational training facility or a group work facility, were examined by Self-Efficacy for Community Life Scale (SECL), Psychiatric Rehabilitation Rating Scale of Activities (REHAB), and WHO/QOL-26. There was a statistically significant correlation between the answers to question 'Can you alleviate your stress by appropriate activities?' of SECL and 'Clearness of speech' of REHAB (p<0.01), as well as between the answers to question 'Do you go to the hospital if your disease gets worse?' of SECL and 'Communication outside the ward' of REHAB (p<0.05). There was also a statistically significant correlation between the results of SECL and WHO/QOL-26, except for that between the 'Therapy activities' of SECL and 'Social relationships' or 'Overall QOL' of WHO/QOL-26. There was also a negative correlation among the particular results of SECL, WHO/QOL-26 and REHAB. It was concluded that the improvement of self-efficacy could have positive effects on living in the community of people with schizophrenia.

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The purpose of this study was to clarify the features of Nursing Judgments of different condition patient's models; chronic patient's model and acute patient's model. A questionnaire survey was done on 378 nurses at both wards, to which 91 responded, (response rate, 24.7%) The subjects were asked to respond to the same questionnaire, which included two models, one from each ward, and related 18 questions with 6 alternatives on the average. The findings included the following: (1) Significant differences were observed in 10 priority items between the judgments of nurses presently working in the two different wards; (2) No significant differences were observed in most of the questions or related items. However, significant differences were found on further analyses of each model.; (3) The Nursing Judgments with high priority in both models included such items as 'patient's wishes' and 'physical assessment' 'prevention of disease aggravation' etc. The characteristic features in the Nursing Judgments of both models were clarified. Nursing Judgment for the chronic model included 'present QOL of patients', and 'respect for family's wishes' for items related to 'time of hospitalization' and 'discharge' and 'effective use of the ward' for items related to 'ward environment'. Those of acute model included 'considerations for physical burden', and 'medical data' for items related to 'time of hospitalization', 'changes in disease conditions' and 'discharge'. In items for 'time of emergency' and 'treatment termination', no significant differences were observed between the two models.

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