Journal references to 22 midwifery clinics over a 20- year period ending in 2001 were searched, and the information they presented on the factors leading to establishment of the clinics, their activities, how they were run and relevant issues were analysed. The greatest number of 14 facilities were established in the nineties, for such purposes as improving systems of maternity management, improving care and exploiting the professional skills of midwifes. Establishment of the facilities required the existence of both midwifes having leadership capabilities and obstetricians with understanding. Midwifes having 3-5 years clinical experience had charge of the clinics. In 18 of them, the distinctive function of the midwife's role was exercised throughout all aspects of physical examinations, testing and health super vision for normal pregnancies.

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(Purpose) A comparison of the health problems felt by the people with those assessed by the community nurses and to obtain clues to design a specific methodology in citizen- centered community nursing through the interactive process between the citizens and the community professionals. (Method) The data was obtained in community meetings held between 1996 and 1999. Data from the 1996 community meetings was used for analysis. The meetings were held in B Town, A City of Gunma Prefecture. The participants were the citizens of B Town. (Result) The first meeting was attended by 33 citizens (11 males and 22 females) with an average age of 70.6 (56 83). Three concepts, "intergenerational exchange", "information on life and health" and "safe and peaceful space", were found to be needed to share health problems submitted at the community meetings with other citizens and to solve problems. (Discussion; The community meeting approach is effective in understanding community diagnosis based on community assessment of citizen-centered health problems. It is especially useful to collect important information when designing specific programs to solve community health problems.

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A survey was conducted using questionnaires filled out by subjects for the purpose of clarifying the courses of obtaining degrees by nursing professionals who have acquired a Master's or Doctoral degree along with their needs with respect to postgraduate education. Responses were obtained from 102 persons and the following findings were obtained : (1) the course followed until acquisition of a Master's degree or Doctoral degree (obtained by a completing a university doctoral course) varies according to age, (2) postgraduate education provides a valuable opportunity to meet various people and acquire human resources, and research activities are conducted more actively among persons who have acquired a Doctoral degree, and (3) roughly 70% of those persons who have acquired a Master's degree desire to acquire a Doctoral degree, and the main reasons for encountering difficulties in acquiring that degree consist of a lack of available time and economic factors. On the basis of the above results, it was suggested that it is necessary for postgraduate nursing education to provide a curriculum and educational environment capable of accommodating a diverse range of needs so that individual nursing professionals are able to continue their education and enhance their careers in a manner that matches their own lifestyles.

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The purpose of this research was to investigate the effect of discontinuing the use of restraint among elderly persons who were restrained (physically constrained) in a geriatric hospital by the use of a standardrized assesement form (MDS). The subjects of this research consisted of 83 elderly persons hospitalized at Hospital A at which the use of restraint had been completely discontinued. A comparison was made of the status before and after discontinuation of restraint using the MDS for 17 elderly persons who had previously been restrained (restraint group) and 66 elderly persons who had never been restrained (non-restraint group). As a result, those parameters for which the restraint group demonstrated improvement as compared with the non-restraint group consisted of the three parameters of "Dl. Feeling of sadness and apprehension" (p<0.05), "D5. Handling of problematic behavior" (p < 0.05) and "D9. Apprehension over personal relationships" (p < 0.01), all being in the category of "D. Mood and Behavior". On the other hand, those parameters that became worse among the elderly in the restraint group consisted of four parameters in the categories of "B. Recognition and Communication" and "C. Physical Function".

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In order to investigate the relationship between changes in blood pressure and autonomic nerve activity during sitting positions, a graded sitting-position experiment was conducted. In the experiment, a graded bed up (0°, 30°, and 60°) of the upper body was performed. The electrocardiogram (ECG) and the blood pressure (JFNTOW) of 13 healthy subjects were recorded with the aid of the PowerLab System (PowerLab/8sp ; ADInstruments, Power Mackintosh 7200/90 ; Apple Computer), The systolic blood pressure at 60° poison showed a significant decrease as compared with the counterparts at the 0° and 30° positions (p < 0.005 and p < 0.01, respectively). No significant differences in the diastolic blood pressure were observed though the tendency of a decrease was exhibited as the angle load increased. The mean blood pressure at the 60° bed rise decreased as compared with the 0° position (p < 0.01). The areal ratio of the low-frequency power spectral component (LF) to the high-frequency one (HF), LF/HF, which is considered to serve as an index of the sympathetic nerve activity, significantly increased at the 60° position as compared with the 0° position (p < 0.05). On the other hand, the ratio of HF to the total area (TO), HF/TO, which is considered to serve as an index of the parasympathetic nerve activity, significantly decreased at the 60° position as compared with the 0° position (p < 0.0001). From these results, it was suggested that the spectral analysis of heart-rate variability can provide a non-invasive method for the evaluation of the autonomous adjustment.

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The purpose of this study was to examine the cross-validity of Barthel Index (BI) among institutional elderly. The study subjects were 7,215 in special nursing home for the aged (111 facilities) and 5,807 in health care facility for the elderly (58 facilities). The survey was conducted by care-workers in each facility. We assessed the one-factor model reported by Wade (1987) using a confirmatory factor analysis (CFA). The results of our CFA indicated that the one-factor model yield statistically acceptable fit indices. In addition, a simultaneous factor analysis with six groups divided by sex and age buckets was performed in order to examine the factorial invariance of the one-factor model. The results indicated that the one-factor model provided statistically acceptable fit among six groups and supported its strong factorial invariance. These findings suggested that BI is a cross-valid index applicable to institutional elderly in both United States and Japan.

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The purpose of this study was to examine tin- construct validity of the Hachisuka's Barthel Index using the sample of pre-school children with and without mental/physical impairment. Study subjects were 655 impaired pre-school children in 33 welfare institutions for mentaly and physically impaired children, and 866 pro-school children without impairment in 14 public nursery' schools. We assessed an one factor model reported by Wade (1987) using a confirmatory factor analysis (CFA). Our CFA results indicated that the one-factor model yield statistically acceptable fit indices. Moreover, we built a factor model to explore whether with or without impairment affect components of ADL. As a result, presence of impairment has significantly influenced on all ADL components and it provides evidence for external construct validity of this scale. These findings implies that Hachisuka's can discriminate between normal and impaired pre-school children.

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The goal of this research was to clarify the actual condition of long term care services including types of care and times required to provide care in the Long term Care Insurance System, in order to examine appropriate methods for providing nursing care services to the elderly. The research placed particular emphasis on seniors exhibiting behavioral disturbances. In the context of family care provided by family caregivers, the most common type of care was "daily conversation" and other forms of communication, and care related to meals, such as "preparing meals." There were dramatic differences from one family to the next in terms of the amount of time spent in providing care. "Day services" were among the most common type of nursing care services. At present, there has been no indication that care is being provided in keeping with the condition of the individual seniors; there were no cases of services being used above and beyond the monetary limits provided according to specific long-term care needs levels; and only 40% of the maximum long-term Care Insurance payments was being used. Furthermore, the results of individual interview surveys showed that family caregivers have little access to methods of providing care to demented elderly, and to information related to such care provision methods, and that as a result, these family caregivers are subject to an even greater burden from providing this type of care. These results suggest that in the future, studies should be undertaken with regard to support programs and other measures aimed at educating family caregivers about methods of responding to the needs of demented elderly.

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In public nursing care insurance, the wheelchair is rented in the- welfare tools in home care service. Therefore, it can change according to condition of a user. However, in the nursing home, many wheelchair users are still using the standard wheelchair of nursing home possession. The standard wheelchair which is ready made does not fit well in long time use, especially a safety belt for hemiplegia patient to prevent slipping down from the wheelchair makes the factor of deformity and pressure sore, and eventually it is a major the factor of pressure sore, because of pressure, friction, wetting, etc. We found that we can deduct the number of people suffering from pressure sore by selecting the right wheel-chair to adapt to their body function at the nursing home.

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We performed the survey of the diagnostic X ray equipments with respect to accuracy control of them in Tokyo metropolitan hospitals. Items investigated are the situation of installed equipments, a maintenance contract, maintenance check, occurrence of failure, situation of accuracy control of X-ray equipment, situation of measuring instruments for accuracy control, etc. Although inverter type X ray equipment with X ray high voltage generators has been used widely up to 67%, there were relatively old equipments operated about ten years. They are needed to update periodically. Although the maintenance contract was almost performed with the expensive equipment, such as X-ray CT scanner and angiographic X ray equipment, the maintenance contract ratio of general radiographic equipment was still low. It is necessary to carry out maintenance check and self-check and to strive for performance maintenance of X ray equipment and accuracy control. However, there are few clinical institutions which have measuring instruments, such as X ray lube voltage, X-ray tube current, irradiation time, and X ray dose required for accuracy control of X ray equipment. Therefore preparation and efficient use of the measuring instrument in a clinical institution are desired.

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