Objective : To evaluate extent to which preventive procedures against osteoporosis performed by Japanese municipalities are based on evidence, and to clarify factors associated with preventive procedures based on firm evidence. Methods : A questionnaire survey by mail was performed for 1,978 municipal health centers throughout Japan. The major survey items were the characteristics of the planning process of preventive procedures, the specialists who were involved, reference materials, subjects and methods for screening osteoporosis, and subjects and contents of health education. Logistic regression analysis was performed to quantify the effect of characteristics in planning process of preventive procedures in eventually conducting a highly evidence-based procedure. Results : The measurement method was quantitative ultrasound in approximately 40% and dual X-ray absorptiometry in the lumbar spine or proximal femer in 5%. Instruction regarding a “dietary calcium intake≥800 mg/day” was given by 3%, “do not smoke” by 25%, and “activation of daily life” for elderly females by 15%, all of which have high level of evidence. Participation of nurses in the planning process and performance of bone density measurement without outsourcing increased the probability of institutions which targeted all females aged≥65 years for screening. Planning using instruction manuals produced by some prefectures or certain commercially available osteoporosis prevention manuals decreased its probability. Factors that increased the probability of institutions providing evidence-based health education were the participation of nutritionists or physiotherapists in the planning process, use of appropriate reference materials and conducting the education in municiparity's own health centers. Conclusion : Evidence-based procedures were performed frequently in various items but not in others. Some factors relating to conducting evidence-based practices were clarified, and could be used to improve planning process for the preventive procedures for osteoporosis in municiparities.
Purpose : Most of life-style surveys rely heavily on visual perception. However, the balanced utilization of sense is essential in healthy human development. In this paper, the author focused on tactile sense, and developed a new procedure to study subject's life. Methods : The following empirical rules were obtained through experiential education trials in Fukuoka University from 1997 ; (1) Think about life by tactile sense, (2) Use haptic glance, (3) Reflect life from objects, and (4) Let systemic arrangement of objects reveal characteristic of lifestyle. These rules were combined with Two-Dimensional Mapping (TDM) procedure, and Haptic TDM was developed. Results : Three visually impaired subjects were asked about their life using Haptic TDM as cues to think and reflect. All subjects completed their Haptic TDM within 15 minutes, and started to talk and narrate about their lifestyle. To assess the meaning of tactile cue in comparison to verbal cue, seven students with normal vision reflected their daily life by hearing words (such as meal) and touching daily objects (such as spoon). Spoken words tend to trigger the general image of life style, and touched objects tend to trigger the relatively narrow and specific image of life style. Students admitted that their hidden dimension of lifestyle was revealed by Haptic TDM. Conclusion : Haptic TDM is concluded as a narrative research method utilized both of sighted people and visually impaired people.
Communities were divided into three categories, those employing full-time midwives (M-communities), and those employing public health nurses (PHNs) either with midwife license (PM-communities) or without (P-communities). Maternal and child health (MCH) services rendered and their intent to employ more midwives were investigated. A questionnaire concerning these achievements and the reasons for considering employing more midwives was sent to 579 communities with a population greater than 50,000 in 2002, and 285 valid responses were obtained. These consisted of 32, 121 and 132 responses from M-, PM- and P-communities, respectively. A statistical analysis was made of the variables by chi-square test. 75.2% of these PM-communities responded for various reasons that they had no greater need for midwives, indicating that the midwife license is not highly valued. M-communities had the highest intention of employing more midwives at 53.1%, and also attained higher fulfillments in MCH services than the others, which provided sub-optimal service in many areas of care. Although some PHNs had midwife licenses, their midwifery expertise was not fully provided for. Considering the often low general level of MCH services and the relatively higher achievements of the M-communities, increased employment of full-time midwives should be considered by the administrators concerned.