[Survey on the Actual Situation of Home Care Support by Outpatient Nursing Managers and on the Awareness of Regional Cooperation].

Shortened hospitalization periods result in an increase in discharged patients with a lack ofself -care agency and families with lower caring ability. The role ofoutpatient nurses becomes more important in such situations. In this study, to clarify the role played by outpatient nurses, we surveyed them about their actual situation ofhome care support and awareness of regional cooperation. Subjects included outpatient nursing managers ofgeneral hospitals with inpatient facilities publicized in Osaka Prefecture; for the survey, questionnaires were sent to them via mail. The questionnaire collection rate was 16.5%. Regarding issues related to outpatient nursing, insufficient manpower was the most frequent response. Although efforts to provide nursing care have been made, such as the use ofmedical professionals and the arrangement ofcertif ied nurses and specialized nurses, the actual situation was clarified with difficulty to ensure nursing quality such as working shifts of the staffs and arrangement standard. Reasons why nursing quality cannot be ensured included the following: readiness of the patient cannot be understood, time cannot be ensured because ofthe large non-nursing workload, and nursing volume cannot be determined. Although efforts such as arrangement of certified nurses and establishment of outpatient sections for nursing were found to ensure nursing quality, insufficient regional cooperation was clarified with issue of nursing cooperation inside hospitals. This situation was considered to be influenced by large nursing-related workload, such as shortened waiting time, concentrated treatments, and smooth functioning.

[Development of a learning outcome creation program to enhance the competence of public health nurses part of action research to contribute to the local community].

OBJECTIVES: In recent years, accompanying the increased diversification and growing seriousness of public health concerns, the duties demanded of nurses have been expanding and becoming more sophisticated. The objective of this research project was to assess a study achievement creation program to enhance the competence of public health nurses, etc., carried out in the curriculum for the first half of a graduate school doctorate course. METHODS: The program was developed undergoing a process of two test trials and corrections. The program's concept was "what I learn will contribute to tomorrow," and the program was composed of five group sessions during a four-month period and four individual interviews conducted between the group sessions. During this period, the participants clearly defined the problems seen in the field and their own themes of study to resolve them, and then worked toward attainment of achievement targets that they themselves had selected. The researchers, acting as study supporters, assisted to maximize the participants' study achievements. The targeted students were eight public health nurses who were enrolled in the program for the three semesters from October 2008 to March 2010, and included four graduate students and four others registered to complete the course. The program's outcome was assessed by measuring competence before and after program implementation, and process evaluation was conducted by ascertaining whether the participants had passed through three essential stages in their study: 1) awareness of the actual conditions and of the problems concerned; 2) implementation of an improvement plan; 3) confirmation of improvements. RESULTS: As a result of implementing the program, a certain degree of success, as indicated below, was verified. In the before-and-after outcome assessment, participant A exhibited a significant degree of advancement. Furthermore, the degree of satisfaction scores of the participants after program implementation were sufficiently high to conclude that results worthy of the costs expended were obtained. In addition, it was ascertained that the essential stages of passage, as indicated in the methodology, featured in the study process of the participants. CONCLUSION: In the future, this program may find application in graduate school education and for active service public health nurses by municipal governments or companies working in cooperation with universities and associations for public health nurses. Hereafter, areas that must be tackled in order to enrich the program include establishment of study support methods in response to diverse circumstances, development of educational materials and qualitative evaluation indicators and establishment of systems to train study supporters.

[Social development of twins: the need for intervention to avoid adverse effects of twin language].

Social competence is one of the most important accomplishments of human development, and this skill in human relationships is learned through communication. Therefore, it is considered that delays in language development could be a barrier to building human relationships and social competence. Although it is well known that there are delays in language development in twins compared with that of singletons, little is known about how these linguistic delays affect the development of social competence. Because twin language is a language that is unique to each pair of twins and cannot be understood by either their mother or others, it may be assumed that the social competence of twins who have a twin language is less than that of twins who don't have a twin language. Therefore, in this prospective longitudinal study we also investigated the relationship between twin language and social competence. A mailed questionnaire survey was conducted in 958 mothers as a follow-up of a study conducted in 2004. As a result, 522 respondents returned the questionnaire (53.9%). In this study, we used only 256 twins aged 6- 12-years-old (school-age children) for analysis, excluding those with missing values. Multiple logistic regression analysis was employed. In the second child of twins, a low birth weight, the appearance of twin language and gestosis of the mother were positively related with social unbalance (OR = 1.846, 2.022 and 1.903). On the other hand, with the first child, however, there was no such link. The present results indicate that twin language might influence social competence in school-age children. It has been believed that linguistic intervention is unnecessary, because most twin language disappears spontaneously. However, early intervention, for example linguistic assistance by public health nurses or psychologists and early enrollment in a preschool may be necessary for twins with a twin language, to avoid adverse consequences in social competence at school-age.

The Japanese Study of Adult Twins Reared Apart and Growing Old Separately.

More than 100 pairs of adult twins, reared apart and growing old separately, have participated in the Japanese Study of Adult Twins Reared Apart and Growing Old Separately since it began in 1974. The subjects are 161 pairs of adult twins born between 1910 and 1945 in Japan. The main focus of this study is to investigate the influences of environmental factors and life history on life satisfaction and psychological well-being in later adulthood. A mail survey has been conducted on these twins each year since 1974. To date, the Wechsler Adult Intelligent Scale, Maudsley Personality Inventory, Newgarten Life Satisfaction Index, comprehensive medical examinations and personal interviews have been conducted for 12 twin pairs residing in various areas of Japan.

The Osaka University Aged Twin Registry: epigenetics and identical twins discordant for aging-dependent diseases.

The Osaka University Aged Twin Registry (OUATR) is the largest adult twin registry in Japan. Since its establishment in 1974, the OUATR has conducted a number of studies with particular focus on the environmental contribution to physical-cognitive-mental aging, longevity and aging-dependent diseases in later adulthood. The registry consists of 12,000 pairs of Japanese twins born between 1900 and 1935. Two hundred and fifty pairs of twins have undergone comprehensive medical examination to date. Follow-up questionnaires have been mailed out on a regular basis, for the purpose of checking current vital statuses, health conditions, and so forth. The main objective of this longitudinal twin study is to contribute to the prevention of lifestyle-related diseases and the promotion of successful aging.

[Intrapair comparisons of diet and food preference in adult twins].

OBJECTIVES: An investigation was conducted on the influence of genetic and lifestyle factors related to the determination of eating behavior of human beings. The objective was to obtain information about lifestyle factors that may help health professionals intervene in terms of the prevention of diet-related diseases. METHODS: The subjects were 180 pairs of adult twins aged over thirty, comprising of 134 monozygotic (MZ) and 46 dizygotic (DZ) pairs. Every subject was given an interview concerning dietary habits, food preference, food intake, as a part of medical examination. The intake of food containing salt and fat, the intake of food meals, the frequency of daily meals, and the frequency of eating 18 sorts of food were assessed on an individual basis, with a questionnaire on nutrition. The expected and observed values of intrapair concordance rates were calculated, and compared within each zygosity, using the chi-square test. RESULTS: Significant differences between the expected and observed for intrapair concordance rates were shown with monozygotic twins, regarding every category of question. Comparing MZ pairs who had lived apart before their twenties with the other MZ pairs, the latter had a tendency to show significant differences between the expected and observed values of intrapair concordance rate, regarding every category of question. In each case, the observed values were higher than the expected values. CONCLUSIONS: The study implied that both genetic and lifestyle factors influence the determinants of eating behavior of human beings. This finding shows the importance of understanding individual characteristics of food preference and eating behavior for intervention regarding lifestyle factors for prevention of diet-related diseases.

A gerontological cohort study of aged twins: the Osaka University Aged Twin Registry.

We describe subject recruitment and research results from the Osaka University Aged Twin Registry (OUATR). The research focus of OUATR is the genetic and environmental contributions to physical-cognitive-mental aging which we examined in Japanese twins in later adulthood. Within this large-scale registry (12,000 pairs) of oriental twins born between 1900 and 1935, approximately 10% of participants are MZ twins reared apart from early childhood. Two hundred and fifty pairs have had comprehensive medical examinations, including various blood chemical panels, lymphocyte subtests, WAIS (Wechsler Adult Intelligence Scale), and urine analysis. The future foci of this study are primarily on longevity, decline of cognitive functions with aging, bio-physiological functions, lifestyle and behavior genetics, and psycho-spiritual functions.