[Comparison and clarification of public health and public health nursing competencies: A report of the Committee on Public Health Nursing (2017-2018)]

Objectives　The Committee on Public Health Nursing (2017-2018) of the Japanese Society of Public Health aimed to elucidate the competencies of public health and public health nursing to provide basic materials for public health, public health nursing education, practice, and research.Methods　We studied the core competencies of public health professionals and public health nursing in the United States and examined similarities to and differences from those in Japan.Results　The United States and Japan shared similar public health and public health nursing competencies in that they targeted populations, identified health problems, and clarified health challenges for effective actions. However, differences were noted in the understanding of target groups, perspectives for identifying health problems and overcoming health challenges, and conceptualization of individuals in populations. In public health, the target population practiced clear boundaries, such as residing in certain geographical areas and ethnic groups, among others. In health challenges, the top-down approach was employed to resolve health problems in certain populations. The individual was recognized as a part of a population composed of a certain group. In public health nursing, target population (e.g., from individuals/families to groups/communities/social groups) were understood in a continuous and multilayered manner. Individual/family health problems were associated with the characteristics of groups, communities, and social groups that encompass the continuum. Moreover, health challenges were addressed in a manner oriented toward the transformation of social groups as a whole. Public health nursing competencies in both countries, which share many similarities, were developed to achieve the objectives of public health. In the United States, the competencies and skills considered necessary, such as analytical/assessment and cultural competency skills, were clearly expressed and constructed in line with the core competencies of public health professionals. However, in Japan, skills and abilities necessary as competencies in public health nursing mentioned above were not specified.Conclusion　Elucidating the core competencies of public health professionals in Japan is essential to develop human resources that can contribute to effective practices in public health and public health nursing. Toward this end, skills and abilities necessary as competencies in public health nursing in Japan, which were not previously verbalized, should be described in detail.

[Vitalizing public health activities through community assessment: A report of the Committee on Public Health Nursing 2014-2017]

Objectives　This report aims to present the community assessment model developed by the Committee on Public Health Nursing (6th term) of the Japanese Association of Public Health. This new model was designed such that it could be applied to a broad range of public health activities. It aims at theorizing public health nurses' practice-based knowledge and sharing it among other public health professionals.Methods　The model was developed during seven committee meetings held from October 2014 to September 2017. In the first step, we brainstormed the definition and methods of community assessment and constructed a framework for a literature review. In the second step, information on theories, research, and practice relevant to community assessment was reviewed based on this framework. In the third step, the community assessment model was developed based on the results of the literature review and the practice experience of the committee members. In the last step, we examined the applicability of this model to the practice of occupational health and public health administration.Project activities　We defined community assessment as the "skills and methods based on applied science that drive Plan-Do-Check-Action (PDCA) cycles in every activity that aims at achieving a better quality of life (QOL)." We further classified community assessment into two types; comprehensive assessment and targeted assessment. The model underlined that community assessment was a continuous and developmental process that occurs throughout every stage of the PDCA cycle, and that it was oriented toward improving the QOL of community residents. This model also purported that the empirical and scientific intuition, and ethical sensitivity of assessors were among the key determinants of assessment quality.Conclusion　The model on community assessment developed in the present study based on the empirical knowledge of public health nurses could be applied to all types of public health activities in communities.

Supporting elder persons in rural Japanese communities through preventive home visits by nursing students: A qualitative descriptive analysis of students' reports

This article describes the evaluation of an innovative nursing education curriculum project, preventive home visiting practice, which began full implementation in 2015, in terms of students' learning outcomes. For the purpose of learning how elder persons live in community, all the 327 undergraduate nursing students, from freshmen to seniors, provided monthly or bi‐monthly visits to home‐dwelling elderly persons aged 75 or above in their home over 1 year period, in order to provide support for their independent living and to learn from them. The students' reports submitted at the end of the first academic year were qualitatively analyzed to evaluate what they learned. They acquired multiple perspectives for understanding elder persons, including a variety of individual and environmental aspects of wellness, prevention, and community life. They also acknowledged the importance of team practice through working and collaborating with different grade levels and generations. Overall, the observed learning contents were useful for future nursing education with elder persons and facilitating critical changes in nursing education systems to address the problems of aged society.

Healthcare costs for the elderly in Japan: Analysis of medical care and long-term care claim records

BACKGROUND

The population is aging rapidly in many developed countries. Such countries need to respond to the growing demand and expanding costs of healthcare (HC) for the elderly. Therefore, it is important to investigate the factors correlating such HC costs. In Japan, HC is composed of two sections, namely medical care (MC) and long-term care (LTC). While many studies have examined MC and LTC costs on their own, few studies have conducted comprehensive investigations of HC costs. The aim of this study is to examine the risk factors that influence HC costs for the elderly who enroll in the LTC insurance system in Japan.

METHODS

The inclusion criteria in the present study are as follows: being 65 years of age, or older; certified eligibility for, and use of services offered by the LTC insurance system at home or in an institutional setting in December 2009; and being covered by the National Health Insurance (NHI) system. MC and LTC insurance data were obtained from claim records for the elderly in July and December of 2007, 2008, and 2009 (i.e., a total of six survey points). Panel data, per subject, were constructed using MC and LTC claim records. The sample included 810 subjects and 4029 observations.

RESULTS

We estimated a regression equation with a censored dependent variable using a Tobit model. Significant associations between MC or LTC costs and interaction terms (household composition × seasonal effects) were investigated. MC costs significantly decreased and LTC costs significantly increased among subjects living alone during winter. Income level was also a positive determinant of MC costs, while eligibility level was a positive determinant of LTC costs.

CONCLUSIONS

We recommend that the health policy for the elderly focus more on seasonal effects, household composition, and income level, as well as on eligibility level.

Relationship between patient group participation and self-care agency among patients with a history of cardiac surgery: A cross-sectional study

BACKGROUND

Little is known regarding the influence of participation in patient groups on self-care in patients with a cardiac surgery history.

OBJECTIVES

To investigate the relationship between patient group participation and self-care among patients with a cardiac surgery history.

METHODS

Participants were 956 patients with cardiac surgery history from a patient group. Information on self-care agency, patient group participation, and health status was collected through a self-administered questionnaire.

RESULTS

There were 566 valid responses. Participants were mostly male (76.4%), and the mean age was 70.6 years. A high social support level from a patient group was associated with each subscale of the self-care agency as follows: self-care operations (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.04-1.12), adjusting one's condition (OR 1.04, 95% CI 1.01-1.07), and attention to self-care (OR 1.05, 95% CI 1.02-1.07).

CONCLUSIONS

Patient group participation may promote self-care performance in patients with a cardiac surgery history.

Association between Municipal Health Promotion Volunteers' Health Literacy and Their Level of Outreach Activities in Japan

OBJECTIVES

To explore the association between health literacy and levels of three types of core activities among health promotion volunteers (developing a healthy lifestyle, outreach to family, and outreach to community members).

STUDY DESIGN

A cross-sectional, anonymous, self-administered postal survey of registered health promotion volunteers in the Konan area in Shiga Prefecture in Japan, conducted in January 2010. The study sample was 575 registered health promotion volunteers.

METHODS

The survey collected data on health literacy, gender, age, education, self-rated health, perceptions about the volunteer organization, and perceptions of recognition in the community. The level of engagement in health promotion activities was measured by the extent to which the participants engaged in seven healthy behaviors and promoted them to family members and the community. The authors compared the health literacy level and other characteristics of the participants by core health promotion activities, using a chi-squared test, to examine the associations between demographic and other variables and the three core activities (healthy lifestyle, outreach to family, and outreach to community).Logistic regression analysis was conducted to examine the association between the degree to which the volunteers engaged in core activities ("healthy lifestyle," "outreach to family," "outreach to community") and the levels of health literacy (low, medium, high) among health promotion volunteers, controlling for the effects of age, gender, health condition, education which may also have an impact on volunteers' outreach activities.

RESULTS

Four hundred and fifty-four questionnaires were returned, a 79.0% response rate. Excluding 16 cases with missing values on health literacy or the degree of health promotion activities, 438 research subjects were included in the analysis (valid response rate: 76.2%). Health literacy and a few demographic and other characteristics of the volunteers were associated with the three core health promotion activities. In bivariate analyses, active participation in the core activities was more prevalent among older volunteers (p<0.001 for all three activities). Self-rated health condition was associated with both outreach to family (p = 0.018) and community (p = 0.046). Years of experience as volunteer and perception of being recognized in the community also had statistically significant association with outreach to the community (p<0.001). In multiple logistic regression, those with higher level of health literacy were more likely than others to actively engage in outreach to family (OR = 1.70, 95% CI 1.03 to 2.80; OR = 1.76, 95%CI 1.04 to 3.00 for medium and high, respectively) and outreach to community (OR = 2.26, 95%CI 1.34 to 3.83; OR = 2.61 95%CI 1.49 to 4.58 for medium and high, respectively). Perception of being recognized in the community also had a statistically significant and positive impact on outreach to the community (OR = 1.52, 95%CI 1.17 to 1.99).

CONCLUSIONS

Volunteers with higher health literacy were more likely to actively engage in outreach to family and outreach to community. Providing educational programs to improve volunteers' health literacy may facilitate their work.

A Trial to Support Family Caregivers in Long-Term Care Insurance in Japan: Self-Help Groups in Small Communities

In this article, the authors discuss issues regarding the families of impaired elders in the long-term care insurance program for the elderly in Japan and the activities of self-help groups (SHGs) in the support of family caregivers in small communities. Using data from a qualitative and quantitative research study, the effects of SHGs on family caregivers were clarified. A process in which family caregivers found meaning through their participation in SHGs emerged. Through this process, SHGs alleviated the care-givers' mental distress related to caregiving, and caregivers had the potential to promote a change from traditional and cultural norms regarding family caregiving to new norms that support the use of home care services. There was also a discussion about the support that health and welfare professionals provide to caregivers both in the empowerment process and as they explain activities and issues related to caregiving to community members.

The Implementation of Long-Term Care Insurance in Japan: Focused on the Trend of Home Care

In April 2000, the new long-term care insurance (LTCI) program was implemented in Japan. This program represents a major policy change and system redesign. This article briefly describes the factors leading to the development of LTCI and explains the philosophy and mechanism of LTCI, including patients' access to the system, its financial cost, changes in long-term care (LTC) system patterns, and the impact on institutional care and home care after its implementation. By presenting the current situation of LTCI, the authors want to share with readers outside Japan how this experience brought remarkable change in the delivery of LTC in the country. The experience of seeing what happened should be shared by all to keep the positive opportunities alive and to mitigate the negative experiences. Home care professionals firmly believe that it is essential to encourage further development relevant to the needs of families and society.

Effectiveness of community-based health services by nurse practitioners: protocol for a systematic review and meta-analysis

INTRODUCTION

To realise universal health coverage in an ageing society, adequate provision of appropriately trained human resources is essential. The nurse practitioner (NP) is an autonomous and independent, advanced practice nurse capable of providing treatment and care that can be substituted for some aspects of a medical doctor's (MD's) role, especially in a community setting. Previous systematic reviews found higher levels of patient satisfaction with services provided by NPs than those provided by MDs. As non-communicable diseases become a major health burden requiring long-term healthcare in community settings, this systematic review aims to assess the equivalence of NP services to standard care provided by MDs, and to determine whether their practice is an effective alternative to that of MDs in community settings.

METHODS AND ANALYSIS

Relevant randomised controlled trials (RCTs) and cluster RCTs will be searched in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and the British Nursing Index. We will assess patient and health system utilisation outcomes of interventions comparing treatment and care provided by NPs in community settings with that provided by MDs. Two authors will independently screen studies for inclusion, consulting with a third author where necessary to resolve discrepancies. The risk of bias of included studies will be assessed using the Cochrane Collaboration risk of bias tool, and quality of evidence using the GRADE approach. Meta-analysis of included studies will be conducted using fixed-effect or random-effects models depending on the degree of between-study heterogeneity. Results will be presented using risk ratios with 95% CI for dichotomous outcomes and standardised mean differences with 95% CI for continuous outcomes.

ETHICS AND DISSEMINATION

This systematic review and meta-analysis protocol does not require ethical approval. We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

PROSPEROCRD42014009627.

Identifying Residents' Health Issues Six Weeks after the Great East Japan Earthquake

OBJECTIVE

The aim of this study was to identify the characteristics and health issues of residents in need of assistance in a town affected by the Great East Japan Earthquake, six weeks after the disaster, through an outreach initiative.

DESIGN AND SAMPLE

A cross-sectional qualitative design was used. Public health nurses conducted comprehensive semi-structured interviews during home visits with residents. A total of 5,082 residents from the affected town.

MEASURES

These included demographic information, public records of the extent of the damages, and qualitative interview data to determine the urgency of the necessary interventions.

RESULTS

A total of 281 residents needed some kind of assistance and were identified as "requiring early intervention (within two weeks)" or "requiring assistance (within 12 weeks)." The most common health issue requiring early intervention was "interruption of treatment" (25.0%), followed by "need for mental care." The most frequent health issue requiring assistance within 12 weeks was the "need for mental health care" (39.7%), followed by "interruption of treatment," and "need for nursing care."

CONCLUSIONS

During a disaster, it is imperative to identify cases requiring early intervention. Home-visit interviews were necessary to identify existing health concerns to prevent the development of more serious health problems.

Promoting the Use of Visiting Nurse Services for Patients Discharged From Hospital

A project to encourage the adequate use of visiting nurse services (VNS) after discharge was conducted by “K” City, Japan. Eligible individuals were inpatients of general hospital ready for discharge and assessed as potentially needing VNS, and their out-of-pocket fees for VNS within 1 month following discharge were covered by the city. To clarify this project’s effect, patient/family’s intention to use VNS and the utilization of VNS at each time point were evaluated. Eighty-eight residents used the project. Before initial hospitalization, less than one quarter of users had recognized the necessity of VNS. Many participants (88.6%) continued to use VNS even after the completion of the project period despite having to cover the VNS cost by themselves, indicating that this project had a positive impact on appropriate VNS use.

Effects of lifestyle factors on urinary oxidative stress and serum antioxidant markers in pregnant Japanese women: A cohort study

Oxidative stress plays a major pathological role in pregnancy-related complications. Although oxidative stress is induced by exogenous toxins in association with a poor lifestyle in normal subjects, there is little information on the factors altering oxidative stress and antioxidant levels during pregnancy. The purpose of this study was to determine the relationship between lifestyle factors and oxidative stress/antioxidant levels during each trimester and 1-month postpartum. This prospective cohort study followed 54 healthy women through pregnancy; first, second, and third trimester and 1-month postpartum. Participants were administered a questionnaire on characteristics and lifestyle factors. Morning blood and urine samples were obtained to measure urinary biopyrrins and serum coenzyme Q10 (CoQ10) levels. The levels of urinary biopyrrins and serum CoQ10 increased significantly throughout pregnancy, with peak values registered during the third trimester. Higher biopyrrin levels were significantly associated with non-consumption of morning meal during the first trimester, smoking during the third trimester and 1-month postpartum, alcohol consumption during the third trimester, high food-based polyunsaturated fatty acid intake during the third trimester, and poor mental health scores during the first and third trimesters. Higher CoQ10 levels were significantly associated with no smoking during pregnancy and at 1-month postpartum, and with a high frequency of exercise during the third trimester and 1-month postpartum. Thus, pregnancy represents a state of oxidative stress, which can be counterbalanced by increased levels of antioxidants, such as CoQ10. We speculate that certain lifestyle choices such as avoiding smoking can reduce oxidative stress and increase antioxidant levels during pregnancy.

Guest editorial

The global nursing shortage has caused competition and cooperation between countries desperate for registered nurses (RNs), and has led to an increase in migration and international recruitment of nurses. Some nursing diplomas or degrees earned in one country may not be transferable to another. As a result, there is growing interest in common standards and competencies of entry-level nurses to guide future registered nurse agreements between countries or multi-country licensure programs. An exploratory study was conducted to investigate how entry-level nurses are educated throughout the world. The researchers sent a nursing education questionnaire to nurse educators in eleven countries inviting them to participate in the study. Nurse educators from The People's Republic of China, Japan and Turkey were the first to agree to participate in the study. They responded to questions about their country's nursing history, types of nursing programs, use of national nursing licensing examination, and social and political influences on nursing education. The nurse researchers did an analysis and comparison of the nursing education in each country.

Characteristics of Clients Using Home Visiting Nursing Services at Nighttime and Early Morning in Japan

Our objectives were to classify the characteristics of clients such as their diseases and the period of services provided to clients who are using home visiting nurse agency (HVNA) services at nighttime. The nighttime HVNA services provided to 31 clients were analyzed. Two major reasons for cancellation of nighttime and early morning HVNA service were identified: (1) cancellation due to death, and (2) cancellation as a result of achieving goals for receiving the service. As to the former reason, those who died of terminal cancer used the service for approximately 2 months, whereas those who died of other causes used the service for approximately 11 months. The establishment of such a service system requires the development of a method to achieve stable management of an HVNA.

The first nurse practitioner graduate programme in Japan

Aim

This paper describes the establishment of the first Japanese nurse practitioner graduate programme and legislative activities to institutionalize nurse practitioners in Japan.

Background

To address the super-ageing population, Oita University of Nursing and Health Sciences initiated the first academic graduate level nurse practitioner programme in Japan, based upon the global standard defined by the International Council of Nurses.

Conclusion

In 2010, Oita University of Nursing and Health Sciences graduated the first nurse practitioner. We believe that nurse practitioners will be highly valued in Japan for thoughtful nursing care to the fragile elders living in rural and urban Japan.

The tsunami's impact on mortality in a town severely damaged by the 2011 Great East Japan Earthquake

This study identifies the relationship between tsunami damage and mortality through a demographic pyramid of a town severely damaged by the tsunami following the Great East Japan Earthquake of 11 March 2011. It uses cross-sectional data collection. Volunteers visited all households, including shelters, and asked residents about the whereabouts of family members and neighbours. The information was collated with lists of evacuees and the dead to confirm the whereabouts of all residents about 50 days after the disaster. Demographic pyramids for the whole population based on pre- and post-disaster data were drawn. In all, 1,412 (8.8 per cent) were dead or missing, 60.2 per cent of whom were aged 65 and over and 37.5 per cent aged 75 and over, suggesting that the very old should be located beyond the reach of tsunamis. The mortality rate of children was lower than that in other studies, which may indicate the efficacy of disaster evacuation drills.

[Mothers' difficulty in childrearing classified in terms of their children's behavioral characteristics]

OBJECTIVES

Mothers who experience difficulty in childrearing are becoming increasingly more prevalent in Japan. This study described and classified mothers' childrearing difficulty in terms of their children's behavioral characteristics and related factors.

METHODS

Self-administered questionnaires were distributed to 818 mothers at their children's 3-year-old health checkup in eight suburban cities in Japan. The questionnaire consisted of items assessing the mother's experience of difficulty in childrearing for the child undergoing the checkup. The subjects were classified into four groups according to their children's behavioral characteristics: "low needs," "internalizing behavior," "externalizing behavior," and "comorbid internalizing-externalizing behavior." Multiple regression analysis was performed to examine the relationships between mothers' difficulty in childrearing and related factors.

RESULTS

A total of 775 respondents were divided as follows: 332 mothers had children with low needs, 104 had those with internalizing behavior, 230 had those with externalizing behavior, and 109 had those with comorbid internalizing-externalizing behavior. Mothers in the low needs group showed less childrearing difficulty than did mothers in the other groups. Childrearing difficulty increased by group in the following order: internalizing, externalizing, and comorbid internalizing-externalizing. In all four groups, mothers with low self-efficacy and less appraisal support from their family encountered greater childrearing difficulty. In the low needs group, experiencing childrearing difficulty with another child was related experiencing childrearing difficulty with the child undergoing the checkup. In the internalizing behavior group, mothers who had experienced greater difficulty in childrearing were more likely to be housewives and of younger age, and were more likely to have had boys as the child undergoing the checkup. In the externalizing behavior group, mothers with more difficulty in childrearing were more likely to be younger and less healthy, have less appraisal support from their friends, and live in apartments. In the comorbid internalizing-externalizing group, if the mothers were housewives, they were more likely to have difficulty in caring for their other children, receive less appraisal support from their friends, and experience more difficulty in childrearing.

CONCLUSION

The results showed that mothers' difficulty in childrearing and the factors related to this difficulty differed according to their children's behavioral characteristics. Public health nurses could provide more effective care and support to mothers by considering children's behavioral characteristics.

Adapting the Pregnancy Physical Activity Questionnaire for Japanese pregnant women

OBJECTIVE

To assess the psychometric properties of the Pregnancy Physical Activity Questionnaire (PPAQ) for women who read and speak Japanese.

DESIGN

This longitudinal study used a self-report questionnaire and quantitative biometric and instrumental measurements (actigraph) to assess the reliability and criterion validity.

SETTING

A university hospital in Tokyo, Japan.

PARTICIPANTS

Sixty-nine pregnant women living in Tokyo and its suburbs were recruited.

METHODS

The test-retest reliability of the Japanese version of the Pregnancy Physical Activity Questionnaire (PPAQ-J) was evaluated through intraclass correlation coefficients (ICCs) between PPAQ-J results administered three times (at recruitment, 7 and 14 days later). Criterion validity was assessed by comparing results to actigraph measures using Spearman's correlation coefficients. Participants wore the actigraph over the 2-week research period. Data from 58 participants were analyzed for test-retest reliability. The data of 54 participants were used to analyze criterion validity.

RESULTS

The ICCs for the first and second and for the first and third PPAQ-J questionnaires were ≥0.56 for total activity and activities broken down by intensity and type (in metabolic equivalents [METs] × hours/day). To evaluate criterion validity, Spearman's correlation coefficients were calculated between the first measurement of the PPAQ-J and three published cut-points used to classify actigraph data (minutes/day); correlations ranged from .02 to .35 for total activity, -.21 to -.25 for vigorous activity, -.09 to .38 for moderate activity, and .01 to .28 for light activity.

CONCLUSION

The PPAQ-J is a psychometrically sound and comprehensive measure of physical activity in pregnant Japanese women.

Home Visiting Nurse Agencies for Community Dwelling Elderly at Nighttime in Japan

Our objectives were to describe the care provided during the nighttime and to discuss the characteristics of individuals who are more likely to be cared for at nighttime by visiting nurses of home visiting nurse agencies (HVNAs). Thirty-one clients participated in this study. Eight clients were physically independent and 23 clients were chair/bed bound. Among the physically independent group, the contents of the care at scheduled times were insulin injection and blood sugar measurement in four clients. Among the chair/bed-bound group, the most frequently given medical treatment was sputum suction (16 clients). The majority of clients who received HVNA services at night and early in the morning required medical treatment. The disease condition of clients was unstable and assessment of changes in disease condition was desirable.

Anxiety and depression after thoracic aortic surgery or coronary artery bypass

BACKGROUND

although the outcome of thoracic aortic surgery has improved remarkably, mortality remains high, and mental distress is often present. Psychological outcomes of coronary artery disease have been increasingly researched but few studies have been conducted in thoracic aortic surgery patients.

OBJECTIVE

to compare the psychological outcomes of patients undergoing thoracic aortic surgery with those of patients undergoing coronary artery bypass grafting.

METHODS

a questionnaire was mailed to 190 patients who underwent thoracic aortic surgery or coronary artery bypass, at 1-5 years postoperatively. Psychological outcomes were assessed using the hospital anxiety and depression scale.

RESULTS

128 patients responded; 49 had aortic surgery and 79 had coronary artery bypass. The incidence of borderline or significant anxiety was 14% in thoracic aortic surgery patients and 16% in coronary bypass patients; depression was present in 28% and 20%, respectively. Psychological outcome scores in the 2 groups did not differ significantly. Emergency surgery was associated with depression after aortic surgery, and symptoms such as chest pain and fatigue were associated with both anxiety and depression after coronary artery bypass.

CONCLUSIONS

some psychological problems remain in the midterm following thoracic aortic surgery. While we expected a more psychologically compromised outcome in the thoracic aortic surgery group, psychological outcomes were quite similar to those in coronary artery bypass patients. The similarity of the profiles of both groups suggests that thoracic aortic surgery patients have a parallel course of midterm psychological improvement following surgery.

[Home care and place of death for elderly people living in the remote islands of Japan. An examination on the presence of inpatient facilities]

OBJECTIVES

The purpose of this study was to clarify the actual status of end-of-life care for elderly people living in the remote islands of Japan, and whether the presence of inpatient facilities was related to the place of death, so as to obtain suggestions for constructing a system of end-of-life care.

METHODS

The survey targeted caregivers (85 people) who cared for elderly people (aged 65 and over), who had been legally certified for long-term care, and who had died between April 2009 and July 2011 in five islands of Japan. Islands were selected from a list of remote islands specified in the Remote Islands Development Act and related laws. Using a mixed method embedded design, we conducted semi-structured interviews using a questionnaire that assessed the place and cause of the elderly patient's death, age at death, gender, and whether the patient or family members had requested that the patient be allowed to die at home.

RESULTS

The proportion of elderly people who died at home in the group living on remote islands with no inpatient facilities was 39.0% (16 of 41 people), compared with 18.2% (8 of 44 people) living on islands with inpatient facilities. The difference was significant (P=0.029). Among the 24 elderly people who died at home, 6 died of cancer. Terminally ill cancer patients were released to die at home under three conditions: the caregivers could provide sufficient care, the visiting physician was present, and pain control was provided. It was also possible for elderly cancer patients to receive end-of-life care in remote islands that did not have inpatient facilities. In addition, among the elderly people who died at home in the remote islands, home care had been recommended by medical staff.

CONCLUSION

It is important for professionals coordinating home care to understand the characteristics of diseases, perform early assessment of caregiver situations, and collaborate with medical staff.

Perinatal immunization education improves immunization rates and knowledge: a randomized controlled trial

OBJECTIVES

To determine if providing perinatal immunization education positively changes the immunization status of infants, influences the infant immunization knowledge, attitudes and beliefs of mothers and affects the intent to vaccinate children in Japan where immunization education is limited.

METHODS

Pregnant women were recruited from three sites in Tokyo, Japan and were assigned to two intervention (pre- or postnatal education) groups and a control group. The immunization status of infants was assessed and a written survey was performed before and after the intervention.

RESULTS

Among 119 study participants, 106 subjects replied to the post-survey. The intervention groups (34.3%) had higher immunization rates in infants at three months of age than the control group (8.3%) (P=0.005); however, no differences were observed between the prenatal (29.4%) and postnatal groups (38.9%) (P=0.40). The percentage of women intended to vaccinate their infants was higher in the intervention groups (61.4%) compared to the control group (33.3%) (P=0.01). The improvement in score for basic knowledge was higher in the intervention groups, particularly in the prenatal group (mean±S.D.: 3.4±1.8) compared to the control (1.9±1.9) (P=0.003).

CONCLUSIONS

Perinatal immunization education improved the immunization status of infants, increased the women's knowledge on immunization and intention to vaccinate their infants.

Measuring the efficiencies of visiting nurse service agencies using data envelopment analysis

This study develops a measure of the efficiency of visiting nurse (VN) agencies in Japan, examining the issues related to the measurement of efficiency, and identifying the characteristics that influence efficiency. We have employed a data envelopment analysis to measure the efficiency of 108 VN agencies, using the numbers of 5 types of staff as the input variables and the numbers of 3 types of visits as the output variables. The median efficiency scores of the VN agencies were found to be 0.80 and 1.00 according to the constant returns to scale (CRS) and variable returns to scale (VRS) models, respectively, and the median scale efficiency score was 0.95. This study supports using both the CRS and VRS models to measure the scale efficiency of VN service agencies. We also found that relatively efficient VN agencies filled at least 30 % of staff positions with experienced workers, and so concluded that this characteristic has a direct influence on the length of visits.

Exploring the ideal combination of activity satisfaction and burden among health promotion volunteers: a cross-sectional study in Japan

Background

Health promotion volunteers (HPVs) who are expected to function as leaders in promoting community health in Japan feel both satisfaction and burden associated with their community engagement activities. The purposes of this study were 1) to describe the prevalence of volunteers with differing levels of activity satisfaction and burden; 2) to examine the association between satisfaction and burden with activity involvement and persistence, and life satisfaction; and 3) to explore associated factors by satisfaction/burden levels among Japanese HPVs. The research question for this study was as follows: What is the relationship between activity satisfaction and burden among HPV?

Methods

A mail-in self-administered questionnaire survey was distributed to 604 HPVs in the cities of Konan and Koka, Shiga Prefecture, central Japan, in September 2005. Questions encompassed demographic data, variables regarding HPV activity such as organizational environment, social support, and the relationship with the neighborhood association, and overall satisfaction and burden related to the activity.

Results

The analyzed sample comprised 422 HPVs. Those with high satisfaction/low burden represented the largest number of study participants (group A; 38.4%). HPVs with high satisfaction/high burden (group B), low satisfaction/low burden (group C), and low satisfaction/high burden (group D) represented 23.0%, 11.1%, and 27.5% of participants, respectively. HPVs in groups A and B reported a greater total number of activities undertaken than those in group C. However, HPVs in group A had higher life satisfaction than those in groups C and D. Multinomial logistic regression analysis used to explore group differences showed that HPVs in group B had lower initial motivation and received less social support from colleagues, and those in group C felt the head of the neighborhood association was uncooperative. Those in group D had lower initial motivation, rated their organizational climate as worse, and considered the head of the neighborhood association uncooperative compared with group A.

Conclusions

We found that feeling satisfied and lightly burdened facilitated HPVs’ active participation in community-based activities. Findings suggest the importance of improving activity environments surrounding HPVs.

Individual and organizational factors related to work engagement among home-visiting nurses in Japan

AIM

The increasing number of elderly people has caused increased demand for home-visiting nurses. Nursing managers should develop healthy workplaces in order to grow their workforce. This study investigated the work engagement of home-visiting nurses as an index of workplace health. The aim of the present study was to reveal factors contributing to work engagement among Japanese home-visiting nurses.

METHODS

An anonymous, self-administered questionnaire was sent to 208 home-visiting nurses from 28 nursing agencies in three districts; 177 (85.1%) returned the questionnaires. The Job Demands-Resources model, which explains the relationship between work environment and employee well-being, was used as a conceptual guide. The authors employed three survey instruments: (i) questions on individual variables; (ii) questions on organizational variables; and (iii) the Utrecht Work Engagement Scale (Japanese version). Multiple regression analyses were performed in order to examine the relationships between individual variables, organizational variables, and work engagement.

RESULTS

Nurse managers and nurses who felt that there was a positive relationship between work and family had significantly higher work engagement levels than others. The support of a supervisor was significantly associated with work engagement. Nurses in middle-sized but not large agencies had significantly higher work engagement than nurses in small agencies.

CONCLUSION

Supervisor support and an appropriate number of people reporting to each supervisor are important factors in fostering work engagement among home-visiting nurses.

[Loneliness and social relations among mothers with infants]

OBJECTIVES

To provide support for child-rearing mothers under circumstances in which they are likely to experience loneliness by studying the status of their social network (contact frequency) and social support as well as the relationship of these variables with loneliness.

METHODS

An anonymous questionnaire was distributed to 978 mothers who visited 4 health care centers in Ward A in Tokyo for medical check-ups of their infants aged 3-4 months between August and November 2008. Examined parameters were the revised UCLA Loneliness Scale; basic attributes of mothers and infants; child-rearing environment; presence/absence of a husband (partner), biological parents, friends who were also mothers (''mother friends''), and other friends; presence/absence of an active social network (contact frequency); and social support. Contact frequency was counted and classified according to face-to-face contacts and other contacts. The first multiple regression analysis was performed with loneliness score as the dependent variable and presence/absence of a husband (partner), biological parents, mother friends, and friends as independent variables. The second multiple regression analysis used the loneliness score as a dependent variable to examine relationships among loneliness, social support, and contact frequency with a husband (partner), biological parents, mother friends, and friends. Those with no contact person or supporter or with a missing value were excluded. Therefore, a sub-analysis among mothers with no mother friends was performed.

RESULTS

In total, 432 questionnaires were completed and 417 had effective responses (effective response rate, 43.3%). The mean Loneliness Scale score was 34.4±9.0 points. Multiple regression analysis showed that the Loneliness Scale score was higher in those with no mother friend or friends. Mothers with all types of contact persons and supporters had higher loneliness scores if they had longer conversations with husband (partner), less frequent face-to-face contact with mother friends and friends, and less social support from biological parents, mother friends, and friends. However, having supporters and contact persons without mother friends had no apparent relationship with contact frequency, social support, or the loneliness score, but correlated with interpersonal attitudes and mother's awareness.

CONCLUSION

To prevent and mitigate the loneliness of mothers engaged in child care, it is important to assess the presence/absence of mother friends and friends; relationships with biological parents, mother friends, and friends; and interpersonal attitudes and awareness of mothers, and then take actions to enhance positive images of maternal roles, provide opportunities for face-to-face contact with mother friends and friends, and obtain social support from biological parents, mother friends, and friends.

[Difficulties and solutions related to the experience of developing a new project by Japanese municipal public health nurses according to their seniority]

OBJECTIVES

Public health nurses (PHNs) have to regularly develop new projects that actively solve community health problems. The purpose of this study was to clarify the difficulties encountered by PHNs while developing a new project and their solutions for them. We also aimed to examine the effect of experience of Japanese PHNs in developing new projects, according to their seniority.

METHODS

Using random sampling, we chose 374 of 1871 municipalities that could not be consolidated with neighbouring municipalities in 2005, and 305 municipalities responded to questionnaires. The self-administered questionnaires were mailed to 2306 Japanese PHNs working within the municipalities. The questionnaire included items on the following: (1) PHN-related variables; (2) whether the PHN had experience in project development; (3) open-ended description of the difficulties and solutions related to the development of new projects by the PHN; (4) the reasons why the PHN could not create new services. We used content analysis to categorize the descriptions based on commonalities. We divided PHNs into 4 groups according to their seniority: Novice, Lower middle-level, Upper middle-level, and Expert. We performed the chi2 test (Fisher's exact test) to examine the relationship between experience and parameters such as "the difficulties" and "the solutions" in each group.

RESULTS

Among the 1270 respondents, 340 PHNs were in the Novice group, 347 in the Lower middle-level group, 329 in the Upper middle-level group, and 254 in the Expert group. The chi2 test (Fisher's exact test) revealed that there was a significant difference between difficulties and having experience in all 4 groups: 'Facing a busy schedule.' In these 4 groups, the following 7 solutions were statistically related with experience: 'Deepening the understanding of the PHNs' work of supervisors and colleagues,' 'Explaining the need for creating a new system with evidence,' 'Sharing information for creating a new service on a daily basis, 'Organizing the evidence to demonstrate the need for developing a new project,' 'Making a practical project plan,' 'Cooperating with persons concerned and facilitating consensus-building among them,' 'Coping with the cost of a new program.

CONCLUSION

In order to overcome difficulties encountered by PNHs while developing new projects, our findings suggest that the work done by PHNs' should be better understood by supervisors and colleagues. Further, evidence should be used to explain the need for creating a new system, and a consensus should be built at carefully. Moreover, the budget of the new program should be carefully managed.

The strategies of Japanese public health nurses in medication support for high-risk tuberculosis patients

OBJECTIVE

The purpose of this study was to describe the support provided by Japanese public health nurses (PHNs) to high-risk tuberculosis (TB) patients, focusing specifically on the support aimed at preventing interruptions in treatment.

DESIGN AND SAMPLE

A qualitative descriptive approach was used with a convenience sample of 11 PHNs in Japan who cared for TB patients at highest risk for medication adherence problems.

MEASURES

Semi-structured interviews were conducted to learn the scope and practice of PHNs with high-risk TB patients. Data were analyzed using a qualitative descriptive analysis process.

RESULTS

One main theme was identified: "Supporting the patients in overcoming tuberculosis, regaining health, and living a healthier life." Three categories with five subcategories described the nurses' activities: (1) empathetic and reliable support, (2) motivational strategies for medication adherence, and (3) developing a foundation for healthier life.

CONCLUSIONS

The nurses interviewed described creative and extraordinary strategies used to promote medication adherence and facilitate development of a healthy posttreatment lifestyle. Their approach was patient-centered and culturally congruent. Findings may be transferrable to PHN practice in other regions as care for this economically disadvantaged and marginalized population is a critical need.

Institutional care versus home care for the elderly in a rural area: cost comparison in rural Japan

INTRODUCTION

The rise in institutional care costs, such as that associated with care in chronic hospitals or nursing homes, is a serious social concern in Japan, and this is particularly so in rural areas which are more rapidly aging than others. This has led to a proposal to reduce costs by deinstitutionalizing the disabled elderly. However, the actual financial benefit of deinstitutionalizing the disabled elderly is unclear.

OBJECTIVE

To examine the effectiveness of deinstitutionalizing the disabled elderly with the aim of cost reduction.

METHODS

This study utilized a cross-sectional design and complete census survey. The participants were 139 residents of a rural town in Hokkaido who were institutionalized as of 1 July 2007, and whose Care Needs Levels were classified according to Long-Term Care Insurance (LTCI) in Japan. Of these, 87 participants were considered candidates for deinstitutionalization. Participants who were considered unable to stay alone at home, such as those with behavioral problems, at risk of falling, or in need of hospital medical care, were excluded. Data were collected on institutional care costs, and an original questionnaire was distributed asking institutional staff about participant characteristics and physical function levels. Existing costs were collected and costs were calculated if participants were discharged from institutions to their homes.

RESULTS

Approximately 20% of participants lived alone, and 80% had a severe disability. The estimated costs of discharging patients to their homes were higher than existing institutional care costs for 98% of participants. The gap in cost tended to be greater in patients with higher care needs.

CONCLUSION

The deinstitutionalization of disabled elderly is not an effective measure to help reduce healthcare costs in rural areas of Japan.

Effects of Nonnursing Assistance on Home Visit Nurses’ Time Spent In Japan: One Group Repeated Pretest-Posttest Trial

To determine means of improving the efficiency of home nursing services, we conducted an experimental pretest-posttest study to compare the time spent by home visiting nurses (HVNs) on providing care with or without assistance. HVNs’ job-related satisfaction levels were also compared. Forty-four clients in six visiting nursing offices in Fukuoka prefecture were selected for this study, which was conducted between July 2009 and January 2010. With assistance, HVNs’ total care time and time spent performing trivial tasks decreased and time spent on communicating or teaching increased. Furthermore, HVNs were more satisfied with providing care than with their usual visits. We conclude that introduction of a skill mix might improve home visiting nursing service efficiency through shortening the HVNs’ length of stay at a client’s home.

Expansion of discharge planning system in Japan: Comparison of results of a nationwide survey between 2001 and 2010

Background

In response to the rapid aging of the population in Japan, many care systems have been created in quick succession. Establishment of discharge planning departments (DPDs) in hospitals is one of them. In this study, we compared the distribution and characteristics of DPDs and the characteristics of the hospitals that have DPDs between 2001 and 2010 in Japan.

Methods

We mailed a questionnaire about the characteristics of hospitals and existence and situation of DPDs to all general hospitals with 100 or more general beds in 2001 and in 2010.

Results

In 2001, of the 3,268 hospitals queried, 1,568 (48.0%) responded and 1,357 (41.5%) were selected for data analysis. In 2010, among 2,600 hospitals, 940 hospitals (36.1%) responded and 913 (35.1%) met the inclusion criteria. The percentage of hospitals with DPDs increased from 30% to more than 70% between the two surveys. More departments were under the direct control of the hospital director and more physicians participated in discharge planning activities in 2010 than in 2001. In 2001, private hospitals and hospitals with an affiliated institution or agency tended to have a DPD; however, the relationship between these factors and the presence of a DPD had disappeared in 2010. Larger hospitals and hospitals with more nurses per patient tended to have a DPD both in 2001 and 2010.

Conclusions

Since 2008, the establishment of a DPD has been directly connected to medical fees so hospital administrators might have recognized the DPD as a “necessary and paid for” department. Having a DPD was the majority’s policy in Japan, and we must recognize the importance of quality assurance through DPDs from now on, especially in small hospitals.

Evaluation of doctoral nursing programs in Japan by faculty members and their educational and research activities

Evaluation of doctoral programs in nursing is becoming more important with the rapid increase in the programs in Japan. This study aimed to evaluate doctoral nursing programs by faculty members and to analyze the relationship of the evaluation with educational and research activities of faculty members in Japan. Target settings were all 46 doctoral nursing programs. Eighty-five faculty members from 28 programs answered the questionnaire, which included 17 items for program evaluation, 12 items for faculty evaluation, 9 items for resource evaluation, 3 items for overall evaluations, and educational and research activities. A majority gave low evaluations for sources of funding, the number of faculty members and support staff, and administrative systems. Faculty members who financially supported a greater number of students gave a higher evaluation for extramural funding support, publication, provision of diverse learning experiences, time of supervision, and research infrastructure. The more time a faculty member spent on advising doctoral students, the higher were their evaluations on the supportive learning environment, administrative systems, time of supervision, and timely feedback on students' research. The findings of this study indicate a need for improvement in research infrastructure, funding sources, and human resources to achieve quality nursing doctoral education in Japan.

Evaluation of doctoral nursing education in Japan by students, graduates, and faculty: a comparative study based on a cross-sectional questionnaire survey

Evaluation of doctoral education in nursing is needed with the rapid increase in doctoral nursing programs in Japan. This study aimed to compare the evaluations of doctoral nursing education by students, graduates, and faculty. All 46 doctoral nursing programs in Japan were target settings. 127 students who had been in the doctoral program, 24 graduates and 87 faculty members had responded to the survey. A questionnaire with 17 items for program evaluation, 12 items for faculty evaluation, 9 items for resource evaluation, and 3 for overall evaluations was distributed in November and December 2008. Responses to 1 program evaluation item, 2 faculty evaluation items and 4 resource evaluation items indicated significant differences among evaluators. While 79.2% of graduates responded positively that the number of faculty members was sufficient to facilitate learning, only 36.1% of faculty members and 49.6% of students responded affirmatively. Graduates' ratings were the most positive and faculty members were the least positive, especially for infrastructure or equipment such as libraries, computers, and the number of technical and support staff. The significant differences among the evaluators suggested that having evaluators in various roles is important to evaluate the quality of doctoral nursing education.

[Factors associated with delay in seeking medical treatment in pulmonary tuberculosis patients in Japan]

OBJECTIVES

As the number of tuberculosis (TB) cases has decreased, early diagnosis of TB has become more difficult. Delayed diagnosis of TB may lead to worsening of the affected individual's condition and may spread the disease in the community. The purpose of this study was to find factors associated with patient delay in seeking treatment after developing symptoms of TB.

METHODS

Structured interviews were conducted with adult TB patients from 17 health centers registered under the national Japanese TB surveillance system from January 1, 2010 to November 30, 2010. The questionnaire used for the interview included items on symptoms, type of coping behavior from the time of onset of symptoms to the time of the first hospital visit, recognition of and experience with TB, priorities in terms of health behavior, and demographic characteristics of the patients.

RESULTS

Among the 60 patients interviewed, only 53 patients' data were analyzed. Seven patients were excluded from analysis because they had no symptoms, were non-Japanese, had extrapulmonary tuberculosis, or were undergoing retreatment. The mean age of the patients was 60.2 +/- 19.2 (mean +/- SD) years. Twenty-two patients (41.5%) visited a hospital after a gap of more than two months from the time of onset of their symptoms (hereafter referred to as "patient delay"). Factors associated with patient delay were presence of sputum and hemoptysis, positive sputum smear, low priority given to health, lack of a family physician, lack of consultation, taking over-the-counter drugs, and disliking hospital visits.

CONCLUSION

Factors associated with patients' seeking medical treatment more than two months after developing symptoms of TB included taking over-the-counter drugs disliking hospital visits and not consulting health professionals or the people around them. In order to prevent patient delay, our findings suggest the following actions. Health care professionals need to provide information about symptoms of tuberculosis and the merits of early hospital visits to patients. It is also necessary for health care professionals in public health centers, etc., to communicate the need to have people available whom patients can consult regarding their symptoms and receive appropriate advices or secure appropriate treatment when they have symptoms of tuberculosis.

Characteristics of family caregivers with sleep dissatisfaction in Japan: identification using CHAID dendrograms

The rapid increase in the population of the elderly has raised several social issues. The current study focused on sleep dissatisfaction in family caregivers to identify family caregivers with a heavy care burden. This study aimed to detect the characteristics of caregivers who are most likely to have sleep dissatisfaction. A chi-squared automatic interaction detection technique was used to analyze data collected from 92 research care managers who collected demographic and sleep dissatisfaction information from 280 caregivers and their care recipients. Caregivers whose care recipients were unstable and bedridden were most likely to have sleep dissatisfaction. When care recipients were not stable or non-bedridden, had severe dementia symptoms, and were physically independent, their caregivers were the second most likely to have sleep dissatisfaction. When care recipients were not stable or non-bedridden, had moderate dementia symptoms, and did not need help in transferring, their caregivers had the lowest risk of sleep dissatisfaction. Although many recent studies have found a high prevalence of insomnia among the elderly, describing the characteristics of caregivers who are most likely to have sleep dissatisfaction is a significant challenge. When care recipients are physically independent, the severity of the recipient's dementia symptoms relates to the caregiver's dissatisfaction with his/her sleep. In physically dependent care recipients, the severity of the recipient's dementia did not contribute to the caregiver's dissatisfaction with his/her sleep.

Validity and reproducibility of folate and vitamin B(12) intakes estimated from a self-administered diet history questionnaire in Japanese pregnant women

Background

No validated dietary questionnaire for assessing folate and vitamin B₁₂ intakes during pregnancy is available in Japan. We evaluated the validity and reproducibility of intakes of folate and vitamin B₁₂ estimated from a self-administered diet history questionnaire (DHQ) in Japanese pregnant women.

Methods

A sample of 167 healthy subjects with singleton pregnancies in the second trimester was recruited at a private obstetric hospital in metropolitan Tokyo from June to October 2008 (n = 76), and at a university hospital in Tokyo from June 2010 to June 2011 (n = 91). The dietary intakes of folate and vitamin B₁₂ were assessed using the DHQ. The serum concentrations of folate and vitamin B₁₂ were measured as reference values in the validation study. To assess the reproducibility of the results, 58 pregnant women completed the DHQ twice within 4-5 week interval.

Results

Significantly positive correlations were found between energy-adjusted intakes and serum concentrations of folate and vitamin B₁₂ (r = 0.286, p < 0.001 and r = 0.222, p = 0.004, respectively). After excluding the participants with nausea (n = 121), the correlation coefficient for vitamin B₁₂ increased to 0.313 (p = 0.001). When participants were classified into quintiles based on intakes and serum concentrations of folate and vitamin B₁₂ , approximately 60% were classified in the same or adjacent quintile. The intraclass correlation coefficients of the two-time DHQ were 0.725 for folate and 0.512 for vitamin B₁₂ .

Conclusion

The present study indicated that the DHQ had acceptable validity and reproducibility for assessing folate and vitamin B₁₂ intakes in Japanese pregnant women.

The effects of an intervention program for promoting interorganizational network building between multidisciplinary agencies and community-based organizations: a cluster trial in Japan

BACKGROUND

Strengthening interorganizational relationships in the community has become an increasingly valued strategy for improving public health in recent years. However, no intervention strategy to foster an interorganizational network in the community has yet been devised. The purpose of this study was to examine the effects on members of an organization of an intervention program designed to promote interorganizational network building between multidisciplinary agencies and community-based organizations (CBOs).

METHODS

The program was conducted in Setagaya and Suginami wards, Tokyo, Japan, for staff of community comprehensive support centers (CCSCs), which are multidisciplinary organizations responsible for the support of the elderly. A cluster non-randomized design with a CCSC as a cluster unit (N = 47) was used. The intervention group comprised 20 centers and the control group 27 centers. Those 27 centers declined to participate in program sessions, but did participate through completing pre- and post-intervention surveys. In total, 158 staff members were eligible to participate in this study, 73 from the intervention group and 85 from the control group. Of the 73 members in the intervention group, 19 participated in the monthly program sessions, over a period of 10 months. Attendees participated in group discussions during the sessions. The effects of the intervention were examined by comparing three groups (attendees and non-attendees of the program from the intervention group, and the control group) and between two groups (intervention group and control group).

RESULTS

We found no significant difference in any outcome between the intervention group and the control group. However, among the three groups, a significant effect was found in the recognition of knowledge and skills for building networks with CBOs. Recognition of knowledge and skills increased significantly among the attendees compared to non-attendees in the intervention group and the control group. In addition, there was a significant effect, particularly on those with relatively low baseline scores, for the recognition of knowledge and skills.

CONCLUSIONS

The tested intervention proved effective for attendees regarding their recognition of knowledge and skills for promoting interorganizational network building with CBOs.

Relationship between perceived time pressure during visits and burnout among home visiting nurses in Japan

AIM

The rapidly rising number of older people has inevitably caused an increasing demand for home visiting nurses. Nursing managers must develop a healthy workplace to recruit and retain a workforce of nurses. This study focused on home visiting nurses' perceptions of time pressure as a changeable work demand. The aim was to investigate perceptions of time pressure and reveal the relationship between perceived time pressure and burnout among home visiting nurses.

METHODS

From 32 agencies in three districts, 28 home visiting nurses agreed to participate in this study. Two hundred and eight home visiting nurses received an anonymous self-administered questionnaire by mail, and 177 (85.1%) filled out and returned the questionnaire to the researchers. The Job Demands-Resources model for burnout, which explains the relationship between a work environment and employee well-being, was used as a conceptual guide. Three survey instruments were employed: questions on sociodemographic variables and worksite environments, including time pressure; the Japanese burnout inventory; and a Japanese version of the job content questionnaire. Multiple regression analyses were performed to examine the relationships between time pressure and burnout inventory scores.

RESULTS

About 30% of home visiting nurses perceived time pressure frequently. When home visiting nurses perceived time pressure more frequently, they experienced higher emotional exhaustion and depersonalization.

CONCLUSION

Time pressure was often perceived as another job demand and had a significant relationship with burnout. This indicates the importance of lessening time pressure to develop healthy work places for community health nurses.

[Health behavior for prevention of knee pain among young-old persons living in a rural area: focus on presence of knee pain and sex differences]

OBJECTIVES

To determine the prevalence of knee pain, and implementation status of health behavior for knee pain among young-old persons living in a rural area in Japan by sex, and to study related factors.

METHODS

An anonymous self-administered questionnaire covering demographic variables, lifestyle such as smoking, drinking, farm work, snow removal, 'ochanomi' (tea break with friends), hospital visits, knee pain, JKOM (Japanese knee osteoarthritis measure) and health behavior was distributed to 2,758 persons aged 65 to 74 years living in Minamiaizu town, a rural and snowy town of Fukushima Prefecture in November, 2008.

RESULTS

Valid responses were obtained from 1,415 (response rate: 51.3%). The prevalence of knee pain was 35.1%, and twice as many women as men had pain in their knees. People with knee pain had a higher body mass index, higher risk of motor deterioration, lower frequency of going out, and more hospital visits than people without knee pain. Health behavior was emphasized by 657 persons (46.3%), and the rate was higher in people with knee pain. As to companions and information source for health behaviors, 'ochanomi' friends were popular for women and family members for men. Walking was more common and exercise and diet were less common in men than in women. Among the women with knee pain, the implementation rate of health behavior was higher in non-smokers, farm workers, and 'ochanomi' participants than in others. Among men without knee pain, the implementation rate was higher in non-smokers and in people with high scores on the JKOM subscale of "pain or stiffness" and "health status". Among women without knee pain, more people living alone and going out once or more a week focused on health behavior more than the other people.

CONCLUSION

The prevalence of knee pain in this study was similar to that in a previous study on elderly living in a mountain area. Type, information source, companion and related factors of health behavior differed by sex and presence of knee pain; therefore, approaches for encouraging health behavior should be suited to the target population's characteristics. Many people obtain information from non-professionals, so health care workers should provide details about adequate methods for health behavior in a careful manner.

Association between oxidized LDL and folate during pregnancy

High levels of oxidized low-density lipoprotein (ox-LDL) during pregnancy are a risk factor for preeclampsia. Ox-LDL levels might be affected by folate and total homocysteine (tHcy) levels because of their effects on oxygen free radicals. The relationships between ox-LDL and folate and tHcy during pregnancy, however, remain unclear. The present study investigated whether serum folate levels and plasma tHcy levels were associated with plasma ox-LDL levels in pregnant women. A sample of 137 healthy subjects with singleton pregnancies (age 30.3 ± 4.5 years) was recruited from a prenatal clinic in metropolitan Tokyo between June and October 2008. Their levels of plasma ox-LDL, plasma tHcy, and serum folate were measured, and lifestyle variables were obtained using a questionnaire. Dietary intake was assessed by means of a validated self-administered diet history questionnaire. A negative correlation between plasma ox-LDL levels and serum folate levels was found (r(s) = -.218, p =.011). However, there was no association between plasma ox-LDL levels and plasma tHcy levels (r(s) = .055, p = .525). The mean of the logarithmic ox-LDL levels was significantly lower among the participants taking folic acid-containing supplements regularly than among those who were not, after adjusting for confounding factors (p = .024). Serum folate levels and folic acid supplementation might be associated with plasma ox-LDL levels, independent of tHcy levels. The association observed between ox-LDL and folate can be used as evidence for dietary instruction by prenatal care providers.