筒井 孝子

位相振動子ネットワーク上の集団同期に関する蔵本モデルを自発的データクラスタリングに応用したデータ同期について世論形成の観点から論じ,Taylorらによって研究された定足数検出型同期との関連について考察した.

As part of an international, multicentered project, the burden of care, health, and subjective well-being experienced by select Australian family carers supporting a relative with disability at home were investigated. Some 448 family carers residing in New South Wales and Tasmania completed a battery of instruments, including a self-report demographic survey, the Family Caregiver Burden Inventory, the General Health Questionnaire, and the Personal Wellbeing Index. Respondents were predominantly females (mean age = 48 years), married, and supporting a son or daughter with an intellectual disability (mean age = 18 years). Although caring for their family member was not perceived to be a burden, respondents reported notable limitations on their social networks and social activities. They reported higher levels of unemployment than would be expected for the general population and were over represented in lower income groups. They reported seriously low levels of mental health and personal well-being when compared with the general population. The findings revealed that this group of family carers were at high risk of social and economic disadvantage and at high risk of mental health challenges. Social policy makers and service providers should take these factors into account, both in the interests of promoting the health and well-being of the carers and considering the long-term needs of family members with disability who rely on family carers for daily support when designing services.

地域包括支援センターが設置目的に沿って期待される機能を果たしえるかどうか,その成否を決めるのは,センターの活動を支える「地域包括支援ネットワーク」の構築にかかっている.この構築方法は,地域によって多様であるが,本稿においては,地域包括支援センターが行なっている,小地域ケア会議を中核とした地域支援ネットワークの実践について取り上げた.なお,この事例としては,岡山の総社市地区を取り上げ,これまでの成果及び課題について明らかにした.小地域ケア会議の活動によって,1.地域が抱える問題の把握及び共有化できた.2.きめ細かな情報提供の取り組みによる,福祉情報の集約及び提供が円滑化することが可能となった.3.地域からの情報が発信されることによってソーシャルアクションの流れが具現化した.4.住民による主体的な見守り・支えあいの仕組みづくりができた.最後に,住民にとって,5.個別支援を必要とする方々への認識が明らかにされた.といった成果が示された.わが国の地域包括ケアは,端緒についたばかりであり,現段階においては,`independence(自立性)'のある地域ケアには,至っておらず,行政による指導が中心ある.したがって今後は,住民の自立性を高めるという視点での,地域包括ケア体制の整備の推進が必要と考える.

高齢者虐待は,高齢者の尊厳ある生活を脅かし,対応が遅れると重篤化するため,早急に対応する必要がある.地域包括支援センターにとって,高齢者虐待の防止・予防の仕組みや,解決に導く仕組みの構築は,重要な課題である.これまで,様々な取り組みがなされているものの,住民や専門職の間でも虐待事例の通報に関する課題が指摘されるなど十分な成果が示されているとは言えない状況となっている.そこで本稿では,日本の地方都市である岡山県総社市における高齢者虐待に関する実態調査を通じて,地域における高齢者虐待の実態とその課題について考察することを目的とした.高齢者虐待と思われる事例の取り扱い時の意識については,介護支援専門員45人を対象に個別面接調査を行った.通報後の対応については,地域包括支援センターの高齢者虐待担当職員(12名)を対象に,詳細な聞き取り調査を行った.この結果,総社市では平成20年12月末までに85件の虐待通報があり,地域には虐待と思われる事例が顕在化せず存在していることが明らかになった.また,介護支援専門員の虐待の判断が不十分であり,通報義務等の周知ができていなかった.さらに,援助実施後の状況や対応の経過を把握し,適切な支援から終結へ導くための実施していくことは容易ではないということがわかった.虐待事例の早期発見・早期対応には,発見者となることの多い介護支援専門員に対しての積極的な法律の周知活動や認識を一致させるための行政側の対応も重要であり,介護支援専門員をはじめ各関係機関と連携を図ること,対応状況を確認しつつ,援助方法を再検討する必要があることから,この支援体制を維持するためには,地域支援ネットワークの構築は不可欠であることが明らかにされた.

日本における地域包括ケアのシステム構築の取り組みは,2006年の介護保険制度改革において本格化した.そこでは基本理念として「自己選択」「利用者本位」「地域ケア」が掲げられているが,諸外国においても同様の理念を掲げる地域包括ケア構想を見ることができる.例えばイギリスでは,1997年のブレア労働党政権発足以来,`choice'`self care'`community based services'などのコンセプトを持つ地域包括ケアシステムづくりが進められてきた.本稿は,持続可能な介護サービスの供給体制としての地域ケアシステムについての今後の検討の一助とすべく,イギリスにおける地域包括ケアの取り組み,とりわけ`self care'という概念に着目し,その点において日英の地域包括ケアシステム構築について再考することを目的とした.イギリスの地域包括ケアでは,ケアサービスの取捨選択をめぐって,その責任主体・行為主体として利用者が位置づけられている点に特質がある.このセルフケア路線を補強すべく各種の保健医療福祉のプログラムが整えられてきており,そのうちの最大規模を持つものの一つがExpert Patients Programme(EPP)である.EPPは,慢性症状のある者を対象に,運営・指導すべての業務が慢性症状を持つ人々によって担われる`lay led'(非専門家主導)であり,この点においても徹底した「自己管理」「自己決定」というネオ・リベラリズムを土台とするセルフケア特性が見られる.日本では,2006年の介護保険制度改革以降,加速する公助志向に対してブレーキがかけられ,地域において何らかの形式による「自助」が構想されなければならなくなっている.また,増大する公助においては,fairnessの維持の面でも問題が出てきている.イギリス式の高齢者に対しても徹底した自己責任を投げかけるシステムが,どの程度日本社会にフィットするのか.多くのことが明らかになっていないが,まずは国家間の文化的・構造的相違点を考慮した上で,わが国の「自助」あるいは「互助」構想が検討されなければならない.

Background As part of an international, multicentre project, the service and support needs of Australian family carers were investigated. Method A sample of 1,390, 448 family carers completed a self-report survey, including an adaptation of the Family Needs Survey (FNS) and several open-ended questions. A mixed method design was used, employing quantitative and qualitative analyses. Results On the FNS the most frequently endorsed items were those relating to the need for information about services and, in particular, future, out-of-home accommodation. Similarly, the need for respite services was endorsed by over 80% of respondents. Comments indicated that access to and the quality of respite, day support, and therapy programs were a priority. Conclusions Participants expressed the need for greater access to information. Access to appropriate respite options, together with quality day support and therapy services, remain a priority for family carers.

We have recently developed a method for feature extraction from multivariate data using an analogue of Kuramoto's dynamics for modeling collective synchronization in a network of coupled phase oscillators. In our method, which we call data synchronization, phase oscillators carrying multivariate data in their natural and updated rhythms achieve partial synchronizations. Their common rhythms are interpreted as the template vectors representing the general features of the data set. In this study, we discuss the link of data synchronization to the self-organizing map algorithm as a popular method for data mining and show through numerical experiments how our method can overcome the disadvantages of the self-organizing map algorithm in that unintentional selections of inappropriate reference vectors lead to false feature patterns.

We developed a method for extracting feature patterns from multivariate data using a network of coupled phase oscillators subject to an analogue of the Kuramoto model for collective synchronization. Our method may be called data synchronization. We applied data synchronization to the care-needs-certification data, provided by Otsu City as a historical old city near Kyoto City, in the Japanese public long-term care insurance program to find the trend of the major patterns of the aging process for elderly people needing nursing care.

We propose a method for extracting general features from multivariate data using a network of phase oscillators subject to an analogue of the Kuramoto model for collective synchronization. In this method, the natural frequencies of the oscillators are extended to vector quantities to which multivariate data are assigned. The common frequency vectors of the groups of partially synchronized oscillators are interpreted to be the template vectors representing the general features of the data set. We show that the proposed method becomes equivalent to the self-organizing map algorithm devised by Kohonen when the governing equations are linearized about their solutions of partial synchronization. As a case study to test the utility of our method, we applied it to care-needs-certification data in the Japanese public long-term care insurance program, and found major general patterns in the health status of the elderly needing nursing care.

要介護高齢者の家族介護者1,085名のデータを用いてコーピングを測定する尺度を開発し,コーピングと精神的健康との関係を明らかにすることを目的とした。開発した尺度は,「自己解決型コーピング」と「他者協力解決型コーピング」の2因子を下位概念とした「介護関連ストレス・コーピング尺度」としてモデル化したものである。本モデルについて,この2因子で構成される斜交モデルのデータへの適合度は,計学的な許容水準に達しており,その妥当性が示された。さらに,介護関連ストレス・コーピング得点と精神的健康得点との関係を分析したところ,「自己解決型コーピング」を使用する者ほど精神的健康得点は高く,「他者協力解決型コーピング」を使用する者ほど精神的健康得点は低かった。これは,主介護者のストレスへの対処方法を勘案した支援方法を検討する際に重要と考えられた。

Objective: The present study was conducted to clarify the prevalence of the use of alcohol and hypnotic medication as sleep aids, and associated factors, in the general population in Japan. Methods: The survey was conducted in June 2000, using self-administered questionnaires, targeting a population that was selected randomly from among 300 communities throughout Japan. A total of 18,205 responses indicating alcohol use and 16,804 responses indicating hypnotic medication use were analyzed. Results: The prevalence of alcohol use as a sleep aid one or more times per week was 48.3% among men and 18.3% among women. The prevalence of the use of hypnotic medication one or more times per week was 4.3% among men and 5.9% among women. The prevalence of alcohol used as a sleep aid increased gradually for men and women up to age 55-59 years and 40-44 years, respectively, and then declined with increasing age thereafter. The prevalence of the use of hypnotic medication among both men and women showed a trend toward a gradual increase with age. The use of alcohol as a sleep aid was associated with "difficulty maintaining sleep," but no such problem was associated with the use of hypnotic medication. Conclusions: Alcohol is a more popular sleep aid than hypnotic medication. The factors associated with the use of alcohol and of hypnotic medication are different. (C) 2006 Elsevier B.V. All rights reserved.

Japan implemented a mandatory social long-term care insurance (LTCI) system in 2000, making long-term care services a universal entitlement for every senior. Although this system has grown rapidly, reflecting its popularity among seniors and their families, it faces several challenges, including skyrocketing costs. This article describes the recent reform initiated by the Japanese government to simultaneously contain costs and realize a long-term vision of creating a community-based, prevention-oriented long-term care system. The reform involves introduction of two major elements: "hotel" and meal charges for nursing home residents and new preventive benefits. They were intended to reduce economic incentives for institutionalization, dampen provider-induced demand, and prevent seniors from being dependent by intervening while their need levels are still low. The ongoing LTCI reform should be critically evaluated against the government's policy intentions as well as its effect on seniors, their families, and society. The story of this reform is instructive for other countries striving to develop coherent, politically acceptable long-term care policies.

Objective. This study was conducted to estimate the prevalence of smoking among pregnant women living in Japan and to analyze the factors associated with their smoking behavior. Method. Five hundred institutions with maternity services were randomly sampled from a list of the Japan Association of Obstetricians and Gynecologists. Of these institutions, 260 participated in the survey which was conducted in February 2002. Using a self-reported anonymous questionnaire, a survey on smoking behavior, drinking behavior and sleep status was conducted on pregnant women. Chi-square tests and logistic regression analyses were used to examine the factors associated with their smoking behavior. Results. Data were obtained from a total of 16,414 pregnant women. The prevalence of smoking during pregnancy was 9.9% [95% confidence interval (CI) 9.4%, 10.4%]. The quit rate of smoking among pregnant woman was 61.9% [95% Cl 60.4%, 63.4%]. The odds ratios for smoking during pregnancy were significantly higher in women with relatively young age, less schooling, multiparous, exposure to passive smoking, short sleep duration and in women who drank. Conclusion. Smoking among pregnant women remains an important public health problem in Japan. It is necessary to promote antismoking measures based on the results of this study. (C) 2007 Elsevier Inc. All rights reserved.

The purpose of the study was to investigate the over-time effects of physical, psychological and social resources on the incidence of depression in family caregivers of the disabled elderly. Data were collected twice at a one-year interval from 1,141 primary caregivers of a disabled older person in an urban area of Japan using a self-reported questionnaire survey. The questionnaire included physical health as an indicator of physical resources, caregiving satisfaction and intention to care as indicators of psychological resources, and instrumental and emotional support network and formal home care service utilization as indicators of social resources. The mental health outcome measure was the General Health Questionnaire 12-item version (GHQ-12). Complete data on 235 non-depressed female caregivers were separated into 3 groups according to the relationship type (wife, daughter and daughter-in-law) and analyzed separately. Multivariate logistic regression models controlling for duration of caregiving, care-recipient's gender, ADL dependency and behavioral problems demonstrated that significant predictors of depression were caregiving satisfaction and intention to care in wives, caregiving satisfaction in daughters, and physical health and emotional support network in daughters-in-law. Noteworthy, intention to care increased the risk of depression in wives, while decreasing the risk of depression in daughters-in-law. The findings indicate that the effects of care-givers' resources on mental health may differ by relationship type. Copyright© 2007 by Okayama University Medical School.

集団同期の蔵本モデルを応用したデータマイニング手法を提案する.位相振動子の自然周波数をベクトル量に拡張し,これらの多変量データを代入する.位相差の関数としての短距離相互作用を振動子間に導入し,ベクトルデータの仮想的な集団同期を実現する.この同期現象はデータ集団における相転移と解釈され,同期周波数を同期集団の代表値と見なすことによってデータクラスタリングが達成される.本手法を要介護保険の認定データに適用し,要介護高齢者の健康状態におけるパターンの抽出を行った.その結果,3つの典型的パターンが存在することが明らかとなった.

We devised a method for data mining from multivariate data using a network of coupled phase oscillators subject to an analogue of the Kuramoto model for collective synchronization. In our method, the natural frequencies of the phase oscillators are extended to vector quantities to which multivaxiate data are assigned. The common frequency vectors of partially synchronized groups of phase oscillators are interpreted to be the template vectors representing the major features of the data set. We applied our method to care-needs-certification data in the Japanese public long-term care insurance program, and extracted major patterns in the health status of the elderly needing nursing care and their dependence on the model parameter representing the level of coarsegraining for data clustering.

本研究は,高齢者虐待の発生予防に向けた効果的な介入指針を論議するための資料を得ることをねらいとして,認知症高齢者の家族介護者を対象に,介護負担態と心理的虐待の関連性について検討することを目的とした。調査は,韓国のソウル市と釜山市において在宅で介護している300名の主介護者とし,質問紙を用いた半構造化面接法により行った。分析には,各項目に欠損値がない245名の資料を使用した。構造方程式モデリングによる分析の結果,介護負担感の下位因子である「拒否感情」のみが心理的虐待の下位因子である「言語的攻撃」と「拒絶」に対して有意な影響を与えていた。以上の結果は,認知症高齢者に対する心理的虐待の予防あるいは防止を図る上で,介護負担感の軽減,とりわけ「拒否感情」に焦点を当てた介護者支援の必要性を示唆している。

We devised a new method of data mining for a large-scale database. In the method, a network of locally coupled phase oscillators subject to Kuramoto's model substitutes for given multivariate data to generate major features through phase locking of the oscillators, i.e., phase transition of the data set. We applied the method to the national database of care needs certification for the Japanese public long-term care insurance program, and found three major patterns in the aging process of the frail elderly. This work revealed the latent utility of Kuramoto's model for data processing.

目的&emsp;本研究では，保健師が連携業務を促進するための能力形成に関する方法論を検討するために，第 1 に，全国すべての市区町村保健師（以下，保健師と略す）を対象とし，彼らの連携実態を把握すること。第 2 に，連携をしている保健師と連携をしていない保健師の個人的要因や業務の特徴を明らかにすることを目的とした。<br/>方法&emsp;調査の実施に先立ち，全国3,190市区町村に対して所属する保健師の所属部署を把握するための事前調査を実施し，保健師人数および勤務場所等の実態を把握した。次に，事前調査で把握された全国の市区町村保健師21,631人に対する郵送法による質問紙調査を実施した。調査期間は2003年12月から2004年 8 月までであった。<br/>&emsp;なお調査項目の内容は，「保健師の性別，年齢，職位，最終学歴，総勤務年数，現在の所属機関での勤務年数，所属部署，業務の種類，実施の状況，連携および連携している機関，専門職等の状況，連携評価尺度における項目」とした。<br/>結果&emsp;全国の保健師の約 8 割にあたる13,024人保健師のデータが収集された。まず保健師の連携実態としては，保健師は，保健所等の行政および保健医療機関との連携はなされているが，精神や障害者福祉施設との連携は密ではなく，また他機関の保健師や行政職，医師との連携はしていたが薬剤師や精神保健福祉士との連携は少なかった。<br/>&emsp;また，専門機関ならびに専門職毎に分析した結果において，連携あり群は，無し群よりも連携得点は有意に高く，この得点は実態としての連携状況を反映していると考えられた。保健師は，業務経験が長い程，常勤である程，連携得点は高かった。また，学歴との有意な差は，20歳代以外はなかった。業務内容との関係においては，新規事業の展開やこのための予算獲得をしている群のほうが得点は有意に高かった。日常的な業務の実施状況からみると新たな知識を必要とする業務や高度な能力が要求される業務を行っている保健師の方がこの得点が高いことが明らかにされた。<br/>結論&emsp;保健師における連携は，実態として保健関連部署や専門職との連携はよく行っていたが障害者福祉および精神福祉関連の部署との連携は密ではなかった。また連携得点によって連携の実態だけでなく，事業展開といった業務の評価も可能であることから，これらの得点別の研修等が実施されることが考えられる。

質を担保しようとする場合、その構造・過程・成果の３側面から行われることが望ましいとされているが、看護をただ単に頭数で評価することは前者２つについて担保しているに過ぎない。しかし実際には成果評価は容易でないが、これまで長年の研究によりようやく看護をその中身をも加味して評価できるアセスメントツールである「看護必要度」を完成させることができた。本研究ではこの「看護必要度」を看護職員の労務管理へ活用できる方策について検討をした。

BACKGROUND: Benefits of breast-feeding are not only limited to nutrition and sanitation in developing countries but also extend to cost-saving health care and alleviation of anxiety related to childrearing in developed countries. This study aims to elucidate factors associated with exclusive breast-feeding in Japan and use this information to achieve child-rearing support worldwide by promoting breast-feeding. METHODS: This cross-sectional study used data from a survey conducted by Ministry of Health, Labour and Welfare of the Japanese government, the First Longitudinal Survey of Babies in 21st Century. All subjects were infants (n = 53,575) born in Japan in 2001 between January 10 and 17 and between July 10 and 17. According to the data, the exclusive breast-feeding rate in Japan during the first 6 months of life was 21.0%. We examined the factors associated with exclusive breast-feeding using univariate and multivariate logistic regression analyses. RESULTS: Among the factors examined, the adjusted odds ratio (OR) for exclusive breast-feeding was low for late childbearing, low birth weight infants, multiple births, smoking parents, living with grandparents, and feeling burdened by childrearing. The adjusted OR was high for factors that included sufficient childcare leave and consultation about childrearing with the spouse, a birth attendant and/or nurse, and a peer in a child-rearing circle. CONCLUSIONS: Exclusive breast-feeding is associated not only with medical factors but also with social factors. This study clarifies the necessity of social support to reduce the child rearing burden and a political system to promote paternal participation in childrearing and to improve the childcare leave system.

Background. Passive smoking is a well-known health hazard for infants. This study was conducted to: (1) estimate the prevalence of passive smoking among Japanese infants and (2) clarify the prevalence of indoor smoking and associating factors among parents having infants. Methods. Subjects were all 53,575 infants born throughout Japan on January 10-17, 2001 or July 10-17, 2001. When the infants reached 6 months of age, the questionnaires were mailed to the homes. Family members answered questions that included information about the current smoking behavior of the parents. Results. A total of 44,562 questionnaires (83.2%) were analyzed. The prevalence of smoking among the mothers and the fathers were 17.1% and 63.5%. The percentages of mothers and fathers who smoked indoors were 12.1% and 36.2%. The percentage of households where mothers and/or fathers smoked indoors was 37.5%. Multivariate logistic analysis indicated that young age, having a spouse who was a smoker, infants having many siblings, the mother not breast-feeding, and lower annual incomes had significantly higher odds ratios for both the mother's and the father's indoor smoking. Conclusions. Passive smoking is common among Japanese infants. To protect Japanese infants from passive smoking, further public health measures must be taken. (c) 2005 Elsevier Inc. All rights reserved.

There have been only a few studies on the relationship between sleep disturbances and somatic and psychological complaints in Japanese people. In this study, we analyzed this relationship using the data of the health and welfare survey performed in 2000 by the Ministry of Health, Labour and Welfare, Japan. The purpose of this study was to evaluate the relationship between sleep disturbances and somatic and psychological complaints among the Japanese general population. The survey was performed in members of households in 300 areas extracted randomly from all over the country using a self-reported questionnaire. The questionnaire items included somatic and psychological complaints (headache, dizziness, palpitation/dyspnea, epigastric discomfort, constipation/diarrhea, stiff neck/shoulder, backache, easy fatigability, persistent fatigue, irritability, anxiety, and worrying about health) and sleep disturbances. Data obtained from 28 714 subjects, aged 20 years or more, were analyzed. The prevalences of almost all complaints were significantly higher in the females than in the males. In the subjects who had a larger number of somatic and psychological complaints, the prevalence of symptom concerning sleep disturbances, such as difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, insomnia, short sleep duration, and subjective insufficient sleep, were higher. Multivariate analysis demonstrated that individual somatic and psychological complaints were independently associated with each symptom of sleep disturbance. It is important to apply the results of this study to the treatment of sleep disturbances and sleep hygiene. © 2006 The Author Journal compilation © 2006 Japanese Society of Sleep Research.

在宅で要援護高齢者を介護している主介護者1143名(うち,女性873名.26〜93歳,平均年齢60.2±11.7歳)の精神的健康度を,英国版GHQ12項目(以下,GHQ-12)を用いて測定した.GHQ-12の12項目で構成される1因子モデルを想定し,データへの適合度を検討した結果,統計的な許容水準をほぼ満たしており,GHQ-12は下位概念(因子)を想定せず,そのまま観測変数の合計点をもって精神的健康度の程度とみなせると考えた.また,主介護者の精神的健康に対する主介護者の性,年齢,介護期間がGHQ-12の調査項目に与える影響をMIMICモデリング(Multiple Indicators Multiple Causes)で検討した結果,主介護者の精神的健康と性別に有意な相関が認めれ,女性が男性に比べ精神的健康度が劣悪な状態にあることが分かった

本研究の目的は,居宅で介護を行っている家族介護者のデータを用いて,Zarit Caregiver Burden Interview (ZBI)日本版評価尺度の因子構造を明らかにし,日本におけるこの尺度の利用について検討することを目的とした。調査村象は,S県O市に在住し,平成14年4月1日現在,要介護認定を受けた第1号被保険者5,189人の要介護高齢者のうち,調査協力が得られたその主介護者1,143人であった。ZBI評価尺度の構造的妥当性を検討するため,探索的因子分析と確証的因子分析を用いてデータを分析した。分析の結果,以下の3つの因子,「個人的な制限感」,「情緒的負担感」と「介護を行う上での義務感」が確認された。さらに確証的因子分析を行った結果,これらの因子を含むと仮定した斜交モデルと2次因子モデルが成立した。しかし,1次因子モデルに関しては,データの適合度指標をみると,このモデルは成立しなかった。確証的因子分析の結果,3つ因子を含む斜交モデルにおいてその妥当性が検証された。このように痴呆性高齢者の家族介護者における介護負担感尺度であるZBIにおいて,その因子構造が明らかにされたことは重要であり,痴呆性高齢者と家族介護者の介護負担感に関する因果関係を明確にする可能性が見出せた。ただし,1次因子モデルは成立しなかったことから,示された3因子については,さらに検討が必要と考えられた。

The public long-term care insurance program for the elderly in Japan set out in 2000 toward establishing a new system whereby citizens can be assured that they will receive care and be supported by the society as a whole. The insurance program includes computer-aided certification processes to estimate the needs for nursing care for clients. In this work, we show the applicability of an adaptive local nonlinear approximation method associated with the Japanese national database for automatic inference of the care class.