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This study aimed to develop a group education program that facilitates a sense of coherence among patients with type 2 diabetes mellitus, which was provided four times, and to validate the effect of the program among the patients. Researchers allocated 40 patients with type 2 diabetes, who had been admitted to a general hospital in Japan for diabetes education for two weeks. Twenty-one patients were allocated to the intervention group and 19 to the control group. The control group undertook a lecture-based educational program that the facility offered. The intervention group received the program, in addition to the facility’s educational program. The sense of coherence scale and the Problem Areas in Diabetes Survey were used as evaluation indices. The average age of the intervention group was 59.1 years and that of the control group was 59.5 years. The intervention group showed a between-group effect of improvement in the sense of coherence score. Additionally, the intervention group showed a within-group effect of improvement in the sense of coherence score, as well as the comprehensibility and manageability scores, which are subdomains, and the Problem Areas in Diabetes Survey score. The within-group comparison showed a significant decrease in the early-morning FPG at both groups by an effect of treatment. The program suggested the possibility of improving the sense of coherence and the Problem Areas in Diabetes Survey. In order to enhance general use of the program, it is necessary to reach out to participating facilities and verify the effect of the program.

本研究は，地域精神保健福祉活動における保健師の慢性期の統合失調症者に対する訪問指導において訪問回数を決定する基準の実態を把握し，基準を作成することを目的とした。統合失調症者に対する訪問指導経験のある保健所保健師を対象に，郵送による無記名自記式質問紙法を実施した。結果，保健師が訪問回数を決定する時に，優先する判断項目は，病状全般，日常生活，家族のソーシャルサポートの順で、あった。訪問回数の頻度を3区分に設定し，訪問回数区分別に保健師が判断した病状の程度を基本にして，生活能力，ソーシヤルサポートの平均を算出し，在宅で生活する統合失調症者に対する訪問回数の判断基準を作成した。この基準は慢性期の統合失調症者へ関わる看護職が今後活用してくことができると考える。, In this study, the judgment index for the number of visits to schizophrenic patients that are undertaken by public health nurses (PHNs), as a part of the community mental health service, was determined using the result of actual conditions of judging. Subjects included PHNs working at health centers who were experienced in providing home visits to schizophrenic patients. Self-administered unsigned questionnaires were mailed to the subjects. The primary factors determining the judgment index were disease condition, daily living activities, and social support from the patients' family The judgment index for the number of visits was calculated based on the average performance of the daily living activities and requirement of social support according to the level of the disease condition observed during each section of visit number. Therefore, the nurses who provided care for chronic schizophrenic patients can use this judgment index to maxlmlze their services. In brief, this study presents the importance of using the judgment index for determining the number of home visits for schizophrenic patients, which in turn would help in improving their clinical judgment.

本研究の目的は保健師指導者のリーダーシップ能力の自己評価の実態と保健指導者育成プログラムの効果を明らかにすることである。北海道と2県内の保健師指導者を対象にプログラム実施前後に自記式質問紙調査を実施し，プログラムに参加し回答のあった102名を分析対象とした。調査内容は対象者の属性と自作のリーダーシップ能力の自己評価に関する5項目である。開始前のリーダーシップ能力と属性との関連はt検定を用いて解析し，プログラムの効果は対応のあるt検定を用いて解析した。対象者のリーダーシップ能力の自己評価はほぼ4点であった(できる6点―できない1点)。リーダーシップ能力の自己評価は職位と人材育成・看護管理研修受講の有無と関連していた。実施後にリーダーシップ能力に対する自己評価が全般的に向上し，プログラムの効果があった。今後，保健師指導者のリーダーシップ能力を高めるような現任教育体制を整備していく必要がある。, The aim of this study was to examine the self-evaluation of leadership skills of public health nurse leaders and evaluate the effect of the training program for public health nurse leaders. Self-administrative questionnaire surveys were conducted among public health nurse leaders in Hokkaido and 2 prefectures before and after the training program. The data of 102 subjects who participated in the training and completed the questionnaires were analyzed. The questionnaire comprised items concerning the characteristics and leadership skills of the subjects (the 5 items on leadership skills were developed by the authors of this study). The relation between self-evaluation of leadership skills and characteristics before the training was analyzed using t-test and the effect of the training was analyzed using paired t-test. The score of leadership skills of the subjects was about 4 point ("Yes, I can: 6 point" - "No, I can not: 1 point"). Self-evaluation of leadership skills were found to be related to position and participation/non-participation in human resources development and nursing management training programs. Self-evaluation of leadership skills of the subjects improved on the whole throughout the training period, proving the effectiveness of the program. It is necessary to develop an ongoing education system aimed at improving leadership skills of public health nurse leaders.

著者最終原稿版, 喫煙とインターロイキン6(IL6)は炎症の主要因子である。本試験では、日本の運送業の男性従業員347名を対象に、IL6-634C/G多型 (rs1800796)とその喫煙との相互作用が、血清中C反応性タンパク質(CRP)濃度に影響を及ぼすかどうかを検討した。IL6-634C/G多型の遺伝子型を決定した。年齢、体格指数(BMI)、収縮期圧などで調整後、非喫煙者より現喫煙者において平均CRPが有意に高かった。3つの遺伝子型を比較したところ、喫煙とCRP濃度によって現れるIL6-634C/Gとの間には有意な相互作用が認められた。喫煙状況を層別化したところ、CRPは、非喫煙者のIL6-634C/Gの遺伝子型グループ間で有意に異なっていたが、現喫煙者には有意差が認められなかった。-634C/CとC/G+G/Gとを比較しても、喫煙者とIL6-634C/G遺伝子型との間に有意な相互作用が認められた。以上より、-634G対立遺伝子がCRP上昇に及ぼす影響は、現喫煙者よりも非喫煙者の方が大きいことが示唆される。

The aim of the present study was to identify relations between occupational stress and occupational class in Japanese civil servants, using two occupational stress models – the Effort-Reward Imbalance (ERI) Model and the Job Demand-Control (JDC) Model. The subjects were employees of three local public organizations. We distributed self-administered questionnaires and assessed occupational stress by ERI and JDC. We used seven occupational categories based on the Standard Occupational Classification for Japan. The data of 6,423 male and 1,606 female subjects were analyzed by logistic regression analysis to obtain odds ratios (OR) for relations between occupational stress and occupational class. In JDC, male clerical workers, transport/communication workers and protective service workers showed a significantly higher OR of being in the high occupational stress group, compared to managers. In ERI, male professionals/technicians, transport/communication workers, clerical workers and protective service workers showed a significantly higher prevalence OR, compared to managers, the two models giving different results. In ERI, female production workers/laborers and clerical workers had a significantly lower prevalence OR, compared to managers. The results of this study showed that occupational stress differed by occupational class and the two occupational stress models gave different results for occupational classes with high occupational stress.

本研究は，地域精神保健福祉活動における保健師の統合失調症者に対する訪問指導において訪問回数の判断を困難にする要因を検討することを目的とした。統合失調症者の訪問指導を行っている保健所保健師を対象に無記名自記式質問紙法を実施し，自由記載内容を質的に分析した。結果，訪問回数評価が「不適切である」と判断した理由には11サブカテゴリーが得られ，それらは5カテゴリーに分類できた。「わからない」の理由として，13サブカテゴリーが得られ，それらは4カテゴリーに分類できた。「不適切である」，「わからない」理由を比較した結果2つの同じカテゴリー，すなわち【統合失調症者の特性の影響】と【対象理解不足】が認められた。訪問の必要性の判断を困難にしている場合，関わり初期から，事例の十分な情報収集とアセスメントをし，対象理解の再検討をすること，また保健師個々の判断ではなくチーム全体で事例検討し判断能力を向上させていくためのサポート体制を充実することが重要であることが示唆された。, The purpose of this study was to clarify factors making it difficult that public health nurses (PHNs) decide how often they should visit schizophrenic patients. Subjects were PHNs working at ten health centers located in areas where were relatively affluent in social resources in Hokkaido, who made nursing home visits to schizophrenic patients. A self-administered and unsigned questionnaire was collected by mail. The questionnaire included demographics of the PHNs and each case, the frequency of visits, and the assessment of the frequency. What respondents freely wrote the reasons why they judged the frequency of visit 'not just' and 'no understandable', were analyzed by Berelson's contents analysis. 11 subcategories were obtained from the reasons of 'not just'. and were classified into 5 categories. 13 subcategories were obtained from the reason of 'no understandable' and classified into 4 categories. After comparing categories from reasons of 'not just' and of 'no understandable', two similar categories were obtained: the influence of a schizophrenic characteristic and lack of object understanding. In the case where the judgment of frequency of visits was difficult, the case should be examined by the entire team, and it was suggested that we should make a support system for improving judgment capabilities complete.

Aim: In the recent years, strategies for preventing job stress related diseases have been drawing much attention, and the role of occupational health nurses is now viewed as extremely important. The objective of this study was to identify the association between self-rated health, job stress and acute stress reactions among workers. Methods: Self-administered questionnaires were mailed to 434 employees working for 9 enterprises in north Japan in December, 2004. Three hundred forty seven responses were returned (response rate - 80.0%). Acute stress reactions and job stressors were measured using the NIOSH General Job Stress Questionnaire, and their association with self-rated health was analyzed. Results: In men, self-rated health had weak correlations with the three scales of acute stress reactions. In females, self-rated health had moderate correlations with depression and somatic complaints. In both men and women, no correlations were found between subjective health and the three scales of job stressors. Conclusion: Self-rated health provides important information for decreasing and preventing mental health problems in the workplace. Therefore, it should be widely used in developing occupational health strategies.

Recently, mental health management in the work place has been an important issue for occupational health nursing. The objective of this study was to focus on occupational environment factors and identify the association of workload perception with acute stress reactions and job stressors. Self-administered questionnaires were mailed to 434 employees working for 9 enterprises in Hokkaido in December, 2004. 347 responses were returned (response rate - 80.0%) and 327 valid responses were analyzed. Acute stress reactions and job stressors were measured using the NIOSH General Job Stress Questionnaire, and their association with workload perception was analyzed. Employees' perception of being overloaded proved to be associated with depression, somatic complaints, and other acute reactions. It was also associated with job stressors such as quantitative and mental workload. Prevention of the negative influence of workload is necessary for maintaining physical and mental health of employees. Employees' workload perception provides important information on their mental health. Therefore it should be actively used in developing preventive measures for mental health problems.

著者最終原稿版, メタボリックシンドローム(MS)と、C反応性蛋白(CRP)値上昇及び動脈硬化進展との関連性、及びMSとCRPの値を組合わせたデータの方がMS単独データよりも動脈硬化との関連が強いかどうかについて検討した。35歳以上の男性3412名及び女性854名を対象に生活習慣に関するアンケート調査を実施し、一般的身体計測、血液検査、更にbaPWV(脈波伝播速度)、CRP値測定を行った。統計学的に、baPWV及びCRPはMSの構成要素の数と有意に関連したが、動脈硬化進展の予測において、MSとCRP値の組合せデータを用いてもMSデータ単独を用いる場合と殆ど効果は変わらないことが判明した。

本研究の目的は、定期健康診断のメンタルへノレス問診票の活用実態を明らかにし、事業所で使用しているメンタルヘルス問診票の妥当性を検討することである。北海道内の事業所101ヶ所を対象にメンタルヘルス問診票の活用状況について自記式質問紙による郵送調査を行い、協力の得られた9事業所に勤務する職員434名を対象に現行問診票の妥当性を評価するために自記式質問紙による郵送調査を行った。日本語版NIOSH職業性ストレス調査票の6つの尺度を外的基準として、現行問診票の妥当性を分析した。問診票を使用していた事業所は、35.7%で、そのうち84.0%は事業所で独自に作成した問診票で、あった。現行問診票は、ストレス反応である抑うつについては男女ともかなりの相関がありストレス反応をよく反映していた。しかし、仕事の量的・精神的負荷や対人関係などのストレス要因については事業所によって違いはあるが十分反映されてはいなかった。, Objective: To identify the contents and application methods of medical questionnaires on mental health used in regular medical examinations for employees' mental health assessment, and examine their validity. Methods: Self-administered surveys concerning presently used medical questionnaires on mental health were mailed to 101 enterprises in Hokkaido. Next, self-administered surveys were mailed to 434 employees working for 9 enterprises in Hokkaido to assess the validity of four types of presently used medical questionnaires. Six scales from the Japanese Version of the NIOSH General Job Stress Questionnaire were used as an extemal validity standard. Correlation analysis of subjects was conducted to examine correlations with presently used medical questionnaires. Results and discussion: 35.7% of enterprises were using medical questionnaires in regular medical examinations. 84.0% of the enterprises used questionnaires of their own. Presently used questionnaires proved to have average correlations to depression scale. While job stressors such as job demands, job load, intergroup conflict didn't show very correlations, though there is a difference by enterprises.

近年、ストレス対策は産業保健上の重要な課題になっている。本研究は、ラインによるケアを支援するために管理監督者が心の健康問題を持つ労働者への対応について困難を感じていることを明らかにすることを目的とした。対象は、道内の某事業所で2000年から2003年に27回開催されたメンタルヘルス研修会に参加した管理監督者延798名である。研修会で参加者が発言した内容を記録した事業報告書の記述内容を分析した。発言内容を類似する内容に分類してカテゴリーを抽出した。管理監督者が困難を感じていた内容として、心の健康問題の理解では「精神疾患の理解」「職員の病態像の理解」の2つ、心の健康問題を持つ職員への対応では「職員自身への対応」「同僚への働きかけ」「家族との関わり方」「主治医との連携」の4つのカテゴリーが抽出された。産業看護職は、管理監督者が困難を感じていることを理解してラインによるケアを支援する必要がある。, In recent years, the stress management and coping with stress in the workplace have become an important subject. The purpose of this research was to identify the difficulties that administrators have had in caring for workers with mental disorders in order for occupational health nurses to support administrators. The research subjects were 798 administrators who participated in seminars organized by occupational health nurses in a workplace, which were held for administrators to learn about mental health care 27 times total in the 2000-2003 in Hokkaido. The Contents which participants spoke in the seminars were recorded by the organizers each time. Those contents were classified by similarities of concepts and categorized. In relation to knowledge of mental disorders, the following two were categorized. 1. Knowledge of mental diseases, 2. Understanding the workers with mental disorders themselves. Four were categorized about care for workers with mental disorders. 1. Care for patients in the workplace, 2. Care for coworkers, 3. Relation to patient's family, 4. Cooperation with patient's physician. This research showed that occupational health nurses should understand the difficulties that administrators have in caring for workers with mental disorders in order to support administrators.