Purpose The purpose of this study was to assess the care system for intractable neurological patients in the community of T public health center in prefecture A, and to identify its process towards system formation and factors contributing to it at four points in time between 1987 and 1997. Method The following items were surveyed through the material concerned and interviews of relevant staff members: the number of patients who were recognized by the public health center, individual and group-oriented services provided by the public health center and other organizations concerned. In addition, interviews and questionnaires to related staff members were administered to analyze the process towards system formation and the factors contributing to it. Results and Discussion 1. Community T provided health, medical and social welfare services to highly meet patients' needs. The public health center implemented group-oriented services, which had been improving, and it collaborated/cooperated with related organizations. On the basis of results of this study, it was concluded that community T needed to increase the number of organizations, and expand their function towards the integration stage or completion of system formation. 2. The first stage of the system formation process in this community was to understand the difficulties of patients and their families. The second stage was to provide care in usual ways.
In 1992 we started a longitudinal study aiming to identify the maternal psychophysiological change relating to reproduction and childrearing. The subject mothers, who dwelled in the urban area of Tokyo Metropolitan, were asked to participate in the study at their regular antenatal check in the obstetric department. From 1992 to 1999 five studies were conducted for these subjects: gestation period (n=318), one month postnatal (n=230), three months postnatal (n=211), a year after childbearing (n=183) and six years after childbearing (n=55). This paper mainly dealt with the findings from the fifth survey, focusing on the following two issues: the association between the nurturing environment and childbearing behavior, and the impact of socio-economical change on psychophysiological adaptation of the mothers. We found that the stagnant economic status of the household resulted not only in high frequencies of maternal depressed mood and anxiety but also in retarded development of the partnership between the spouses. It was revealed that the economic bust in the early 1990's, which reduced household budget in Japan, indirectly worsened the childrearing condition of the subjects. The subjects whose mothers had been engaged in paid work had her first baby at younger age and wished to have more children than those whose mother had not. The subjects who had two or more siblings experienced more pregnancies and had more children than those who had one or no sibling. It was also revealed that a subject mother who had two or more siblings tended to consider it easier to bear and to rear children than her counterpart with one or no sibling. These facts indicated that the inter-generational transmission of fertility and fecundity between the subjects and their mothers. We concluded that the economic condition had impacts on the individual maternal adaptation and that the biological and socio-cultural components of reproductive behavior were transmitted over generations, although the sample size (n=55) may not be large enough to draw firm conclusions.
In prefectural medical care project planning stipulated in the Medical Service Law, both centralized management of medical care by bed allocation and comprehension of regional medical care with systematic action are required. First, a correlation was found nationwide between the medical care resources in secondary medical care zones and the intrazonal proportion of inpatients in these zones. This suggests that the intrazonal proportion of inpatients is reflective of the adequacy of these resources, and that bed allocation through medical care planning would contribute to the proper disposition of these resources and fulfillment of the community needs. Since this correlation is weak, however, satisfying zonal needs solely through allocating beds and doctors is probably difficult. Second, we attempted to understand current medical care functions from the circumstances of medical treatment in each branch of medicine in 11 secondary medical care zones in Kanagawa prefecture. A strong correlation was observed between the intrazonal proportion of inpatients, partially reflecting the adequacy of the intrazonal medical care resources, and the administration of medical treatment. This suggests that understanding the ituation of medical treatment is essential for comprehending medical care functions in secondary medical care zones.