論文

Women who rear children have two types of roles: the maternal role and the self-role. Previous studies have suggested that maternal role satisfaction is related to anxiety, but the importance of self-role satisfaction in promoting the health of mothers has received less attention. The changing roles of women in society, especially in urban areas, have altered mothers' views of child-rearing. Our primary focus was on the relationship between maternal/self-role satisfaction and anxiety in mothers. To examine this, we conducted a cross-sectional survey using self-administered questionnaires that were distributed in 2011 to 2,342 mothers attending the 18-month health checkup of their children, in 7 cities of the Tokyo metropolitan area. A total of 881 responded (effective response rate = 38.0%). Multiple regression analysis revealed that maternal role satisfaction and self-role satisfaction were both significantly and negatively associated with anxiety. Thus, self-role satisfaction should be considered alongside maternal role satisfaction in evaluating and reducing anxiety. Health care professionals in community settings should conduct comprehensive assessments of maternal role satisfaction and self-role satisfaction.

This study examined the effects of providing vaccination education during the perinatal period on Japanese parents' knowledge, attitudes, and beliefs about childhood vaccination. A cluster-randomized controlled-trial method was used on a sample of 160 pregnant women recruited from 9 obstetrical sites in Niigata, Japan. The treatment group received a stepwise interactive education intervention, while the control group received a general vaccination leaflet. Changes in parental attitudes toward and beliefs about infant vaccination were assessed on the child's one-month and 6-month birthdays using paper questionnaires. Of the initial 188 participants, 160 (90.4%) completed the final post-survey questionnaire. Scores on injunctive social norms (a morally neutral perception of the behavior of the majority) and descriptive social norms (a moral perception of what individuals should do) significantly increased in the treatment group (p = .02 and p = .01, respectively). There was a significant difference between the 2 groups over time in terms of perceived benefit (efficacy of available preventive actions) (p = .03), but no significant differences in perceived severity (seriousness of a disease outcome), perceived susceptibility (likelihood of getting a disease), perceived benefits, perceived behavioral control, or descriptive social norms between the groups at any time point or in the patterns of change over time (p > .31). Thus, stepwise perinatal vaccination education was found to positively influence maternal attitudes and beliefs about infant vaccination. This study suggests the importance of vaccination education during the perinatal period.

Background: Home care service demands are increasing in Japan; this necessitates improved service allocation. This study examined the relationship between home visit nursing (HVN) service use and the proportion of elderly people living within 10 min' travel of HVN agencies. Methods: The population of elderly people living within reach of HVN agencies for each of 17 municipalities in one low-density prefecture was calculated using public data and geographic information systems. Multilevel logistic analysis for 2641 elderly people was conducted using medical and long-term care insurance claims data from October 2010 to examine the association between the proportion of elderly people reachable by HVNs and service usage in 13 municipalities. Municipality variables included HVN agency allocation appropriateness. Individual variables included HVN usage and demographic variables. Results: The reachable proportion of the elderly population ranged from 0.0 to 90.2% in the examined municipalities. The reachable proportion of the elderly population was significantly positively correlated with HVN use (odds ratio: 1.938; confidence interval: 1.265-2.967). Conclusions: Residents living in municipalities with a lower reachable proportion of the elderly population are less likely to use HVN services. Public health interventions should increase the reachable proportion of the elderly population in order to improve HVN service use.

Background Perinatal immunization education is important for improving the immunization outcomes of infants; however, the content of educational materials used at each perinatal period has not been carefully evaluated. We hypothesized that stepwise education offered at different perinatal periods would improve infant immunization status and enhance maternal immunization knowledge. Methods In this cluster-randomized controlled trial, pregnant women were recruited from nine obstetric sites in Niigata, Japan. The intervention group received a stepwise, interactive education intervention (prenatally, postnatally, and 1 month after birth). The control group received a leaflet containing general information on immunization. Infant immunization status was evaluated at 6 months of age, and maternal immunization knowledge was evaluated by a written survey after each intervention. Results Among 188 study participants, 151 (80.3%) replied to the final post-intervention survey. At 6 months of age, the percentage of children who completed three doses of inactivated polio, diphtheria, tetanus toxoid, and acellular pertussis (DTaP-IPV) vaccine was higher in the intervention group than in the control (p = 0.04); however, no differences between groups were observed for the Haemophilus influenzae type b (Hib) (p = 0.67) or 13-valent pneumococcal conjugate (PCV13) vaccines (p = 0.20). The duration to the completion of the third dose of the DTaP-IPV, Hib, and PCV13 vaccines was shorter in the intervention group than in the control (p = 0.03, p < 0.01, and p < 0.01, respectively). Furthermore, maternal knowledge scores exhibited significantly greater improvement in the intervention group over time compared with those of the control group (p = 0.02). Conclusions Stepwise perinatal immunization education improved immunization schedule adherence for required vaccines and improved maternal immunization knowledge.

Aim: Over 60% of Japanese people hope to die at home; hence, assisting clients in achieving this outcome is an important responsibility of home care providers. This study investigated the effects of nurses' relational coordination with physicians on clients' place of death in home visiting nursing (HVN) agencies. Method: Secondary analysis of a public survey conducted in 2015 by local governments in Kurume city, Fukuoka prefecture, Western Japan. Manager nurses from 17 HVN agencies provided data about themselves and their relational coordination with community physicians and 85 deceased clients Results: Among 85 deceased clients, 52 (61.2%) had died at home. Four regression models showed significant positive effects of HVN nurse managers' relational coordination on clients' home death (the odds ratios (95% CI) were 2.488 (1.442-4.293) 2.111 (1.014-4.396), 2.562 (1.409-4.658) and 2.275 (1.079-4.796) in models 1-4, respectively. Conclusion: Measuring relational coordination among HVN nursing managers and physicians indicated readiness for home death among HVN clients in an agency or community.

Objective: Prevention of frail skin is important in older people because frail skin is associated with a risk of injury in this population. In this study, we investigated the association of nutritional status and habitual dietary intake with skin conditions in community-dwelling older people. Design: Cross-sectional study. Setting: Three community settings in Japan from autumn to winter. Participants: Older people aged ≥65 years without care-need certification (n=118). Measurements: Malnutrition and obesity were evaluated to assess the nutritional status. Nutrient and food group intakes per 1000 kcal were evaluated using a brief self-administered diet history questionnaire. Dietary patterns based on food groups were evaluated by principal component analysis. Skin condition parameters, including stratum corneum hydration, appearance of xerosis (specific symptom sum score [SRRC score]), and dermal intensity by high-frequency ultrasonography, were measured on a lower leg. Multiple linear regression analysis was performed with adjustment for confounders. Results: The mean (standard deviation) age was 74.1 (4.8) years, and 83.1% of participants were female. A higher intake of plant fat (p=0.018) was associated with a lower SRRC score. Higher intakes of α-tocopherol (p=0.050) and vitamin C (p=0.017) were associated with increased dermal intensity. A body mass index ≥25 (p=0.016) was associated with decreased dermal intensity. A dietary pattern characterized by higher vegetable and fruit intake was associated with a better skin condition. Conclusion: Plant fat, antioxidant vitamins, and a dietary pattern characterized by vegetables and fruits showed positive and obesity showed negative associations for frail skin in community-dwelling older people.

To empirically measure the quality of home visiting nursing (HVN) agencies in Japan, we longitudinally observed the duration of clients’ HVN use and identified the factors correlated with hospitalization/institutionalization. Medical and long-term care insurance data were analyzed from 1,722 persons with disabilities aged at least 75 years who began using an HVN. At the 12-month follow-up, 67.7% of clients were no longer using the HVN; among these, 48.9% were hospitalized/institutionalized and 23.6% had died. Cox regression analysis showed that risk of hospitalization/institutionalization in HVN agencies depends on client characteristics at service commencement. Measuring the quality of HVN agencies by weighting clients’ characteristics as risk factors for hospitalization and/or institutionalization may be appropriate.

Aim: To investigate the relationship between maternal mindfulness and maternal anxiety 1month after childbirth. Methods: A cross-sectional design was used, featuring anonymous questionnaires that were completed between July and December 2014 at two Japanese hospitals. The participants (n=151) completed the Mindful Attention Awareness Scale (Japanese version) and the State-Trait Anxiety Inventory Form X (Japanese version). The data analysis was carried out by using a hierarchical multiple regression. Results: The state and trait anxiety scores showed significant relationships with mindfulness, the mother's age, and the perceived difference between the expectations of motherhood before childbirth and the reality of post-partum daily life. Furthermore, the amount of average sleep time in the past week (including naps) showed a negative association with the state anxiety score, whereas the marital relationship showed a positive association with trait anxiety. Finally, at 1month post-partum, the mothers with greater mindfulness scores showed lower anxiety. Conclusions: Improvements in mindfulness could help mothers to reduce their post-partum anxiety.

Background: Nurses with higher levels of work engagement tend to be highly efficient in their work and more willing to keep working and to provide patient-centred care. However, whether more engaged nurses provide end-of-life care more proactively has not been examined in the home-care setting. Aim: This study aimed to examine work engagement among home-visiting nurses in Japan and its relationship with their attitudes toward caring for dying patients and their families. Methods: A total of 343 nurses working in 62 agencies across Chiba prefecture, eastern Japan, received an anonymous self-administered questionnaire from July to August 2012. The authors performed multiple regression analysis to explore the relationships between home-visiting nurses" work engagement and attitudes. Results: Data from 184 nurses (53.6%) was analysed. Work engagement was significantly positively related to the nurses" attitudes toward caring for dying patients and their families. Conclusion: As more engaged nurses tend to have more positive attitudes toward caring for dying patients and their families, further research is needed to identify the factors that might help nursing managers to enhance their staffs engagement and perhaps thereby improve their attitudes, with the ultimate aim of achieving better outcomes for patients and families.

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.

OBJECTIVES: The Relational Coordination Scale is used to measure teamwork with specific subjects about specific tasks. We translated the scale into Japanese (J-RCS) and examined its reliability and validity.METHODS: We translated the scale into Japanese. In July 2013, we conducted an internet survey for 124 home visiting nurses of 11 agencies in Shiga prefecture. The J-RCS items asked about teamwork with physicians, care managers, and colleague nurses.RESULTS: Eighty-one home visiting nurses (65.3%) answered the survey, and 70 (56.5% of the responders) answered the re-test survey. Cronbach's alpha coefficients of J-RCS were 0.770 to 0.859, and the intraclass correlation coefficients for test-retest reliability were 0.673 to 0.830 (P<0.001). In the confirmatory factor analysis, only J-RCS ［physicians］ met the well fit indices and showed factorial validity. Concurrent validity was supported by correlations of J-RCS and the degree of confidence about collaboration (r=0.559 to 0.585, P<0.001) and social support (r=0.549 to 0.789, P<0.001).CONCLUSION: While issues such as factorial validity and the concentration of responses on some scale items will be a topic for further research, the J-RCS has been shown to have an acceptable level of reliability and validity.

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.

Objective: To develop a Home Visiting Nursing Service Need Assessment Form (HVNS-NAF) to standardize the decision about the need for home visiting nursing service. Methods: The sample consisted of older adults who had received coordinated services by care managers. We defined the need for home visiting nursing service by elderly individuals as the decision of the need by a care manager so that the elderly can continue to live independently. Explanatory variables included demographic factors, medical procedure, severity of illness, and caregiver variables. Multiple logistic regression was carried out after univariate analyses to decide the variables to include and the weight of each variable in the HVNS-NAF. We then calculated the sensitivity and specificity of each cutoff value, and defined the score with the highest sensitivity and specificity as the cutoff value. Results: Nineteen items were included in the final HVNS-NAF. When the cutoff value was 2 points, the sensitivity was 77.0%, specificity 68.5%, and positive predictive value 56.8%. Conclusions: HVNS-NAF is the first validated standard based on characteristics of elderly clients who required home visiting nursing service. Using the HVNS-NAF may result in reducing the unmet need for home visiting nursing service and preventing hospitalization.

Aim: Studies have suggested that some home care recipients have unmet needs for visiting nurse services. In particular, such needs are greater just after hospital discharge than at other times. Thus, there is concern that there exist unmet needs for visiting nurse services among patients after hospital discharge. The purpose of this study was to investigate the current situation of unmet needs for visiting nurse services among older patients discharged from acute hospitals. Methods: This was a cross-sectional correlation study. Participants were patients aged 65 years or over who had been discharged from the general units in all hospitals in four prefectures in Japan after a hospital stay of 14 days or more. Nursing staff gathered the patients' information and assessed unmet needs for visiting nurse services after discharge. Results: There were 1594 eligible participants; 190 (11.9%) utilized visiting nurse services after discharge and 87 (5.4%) were judged to have no visiting nurse services despite a need for such services. Need for assistance in activities of daily living, presence of a respiratory disease, need for continued medical/nursing care after discharge, inadequate capacity for family caregiving, and implementation of discharge planning were related to use of, and need for, visiting nurse services. Conclusion: After controlling for other factors, implementation of discharge planning determined the utilization of, and the need for, nursing care after discharge. Therefore, an adequate discharge planning screening system is necessary.