Reiko Sakashita

It is very important for us to improve the nursing-care quality. To improve the nursing-care quality, the "Web based Nursing-care Quality Improvement System" have been proposed and operating continuously. In the Web-based system, freestyle Japanese texts, which are called "nursing-care texts," are collected through the Internet in Japan for evaluating actual nursing-care process. The nursing-care experts can evaluate actual nursing-care process by reading the collected nursing-care texts carefully and then recommend some improvements to nurses. However, it is hard to do the above-mentioned evaluation process for a large number of nurses because the number of nursing-care experts who can evaluate the nursing-care texts is a few. In order to assist nursing-care experts in evaluating the nursing-care texts, a computer aided nursing-care text classification system has been developed. In this paper, we propose a novel feature definition for the nursing-care text classification system. Dependency relations between terms are extracted from the nursing-care texts. The extracted dependency relations are used as feature values that represent characteristics of the nursing-care text. © 2013 Copyright TSI® Press.

目的:臨床の看護職に適した看護研究のあり方を検討するための基礎情報を得るため,臨床における看護研究の現状を明らかにする.方法:全国の中・大規模の病院のうち,無作為抽出した3000病院に所属する看護研究推進担当者に対し,郵送法による質問紙調査を実施した.結果:回答は1130病院(回収率37.7%)から得られ,回答時100床以上であった病院1116を対象に分析を行った.本研究において,中・大規模の病院では,高い頻度で(88.4%),看護研究が実施されていることが明らかになった.その目的としては,「スタッフの教育」が最も優先順位が高く,次いで「患者サービス向上」「業務の改善」であった.研究法としては,質問紙法による実態調査が多く,研究期間は1年が多く,研究時間や研究資金は不十分であり,研究成果を論文として発表する率は低かった(14.8%).看護研究を進めるのに不足しているものとして,データ分析や研究法の知識・技術があげられ,また病院内で研究を指導する人が求められていた.結論:本研究により,病院で取り組まれている看護研究における課題が明らかになり,今後,臨床の看護職により実施される看護研究の目的を明確にするとともに,組織外のリソースを活用した研究支援の必要性が示唆された.(著者抄録)

Since Japan is one of the most aging countries, it is very important for us to improve the nursing-care quality. For improving the nursing-care quality, a Web-based nursing-care quality improvement system have been proposed and operating experimentally and continuously. A kind of collected data by the Web-based system is freestyle Japanese text called "nursingcare texts". The nursing-care texts are used for evaluating actual nursing-care process. In order to assist nursing-care experts in evaluating the nursing-care texts, a computer aided nursing-care text classification system has been developed. In this paper, we propose a phrase based feature vector definition for classifying the nursing-care texts. The dependency relation based feature vector definition has been proposed in our previous work. As another feature vector definition method, we propose a phrase based feature vector definition method. Phrases are found by using the dependency relation analysis and stored into a phrase list.We also define a similarity between phrases because each phrase consists of some kinds of words. From experimental results, we show that our phrase based feature vector contributes the classification performance. © 2013 IEEE.

【目的】本研究の目的は、臨床看護職による学会誌掲載論文の現状を把握し、EBPの推進に寄与できる看護研究の実践に向け、その課題を明らかにすることである。【研究方法】2004年から2008年の5年間に25学術誌に掲載された原著論文、研究報告、実践報告として掲載された論文1,545編を対象とした。それら論文を「研究体制」、「論文の種類」、「研究対象」、「データ収集方法」、「倫理的配慮」、「研究法」、「研究デザイン」の側面から分類し、自作の研究デザイン別チェックリストに従い論文の記述内容を検討した。【結果】臨床看護職が第一著者である論文は210編(全体の13.6%)であり、論文の種類は研究報告、実践報告の占める割合が大きく、原著は42編であった。臨床所属の看護職が第一著者である論文の割合は5年間でやや減少傾向にあった。研究デザイン別にみると質的記述的研究が最も多く、次いで事例研究、実態調査・量的記述的研究であった。質的研究のうち事例研究はResearch Questionが明確でない文献が多かった。実態調査・量的記述的研究のほとんど(85.7%)は標本の代表性に関する記述がなく、便宜的サンプリングが実施されていた。量的研究全般において、収集する変数の説明が明確でなく、自作アンケートによるデータ収集が多かった。倫理的な配慮において、施設等の研究倫理審査を受けた記載のある論文は33編(17.0%)であった。【考察】臨床看護職による研究は看護のエビデンスの構築に充分寄与していないことが示唆された。質的研究のうち事例研究は、ベッドサイドの経験知を積み重ねる臨床看護職に適した研究デザインであるが、Research Questionを明確にし、緻密な研究のプロセスを踏む必要があると考えられた。量的研究は妥当性・信頼性の検討を経た質問票の使用により、より質の高い研究が可能になると考えられた。今後、教育・研究機関との連携等により、科学的研究法に添って研究を実施することで、より一層のEBPへの寄与が可能となることが示唆された。(著者抄録)

「目的」本研究の目的は、就労している母親が子どもの急病時の受診において困った内容と子どもの状態を明らかにし、就労中の母親への支援方法についての示唆を得ることである。[方法]兵庫県の保育所、放課後児童クラブ在籍児の母親を対象に、2009年8-9月にアンケート調査を倫理委員会の承認を得て実施した。[結果]有効回答1,913の内訳は、学童(7〜9歳)の母親806人(42.1%)、保育所(0〜6歳)の母親1,107人(57.9%)であった。子どもの急病時に困った経験のある母親は1,286人(67.2%)であった。休日夜間「見てくれる医療機関がみつからない」、「かかりつけ医が休診」などの理由で半数の母親が困っていた。さらに、「受診可能な病院までの距離が遠い」、「仕事の調整」などの困難が自由記載されていた。急病時の子どもの状態は、高熱・痙攣52.1%、消化器症状17.1%、乳幼児事故(骨折、転倒・転落、誤飲等)10.3%、呼吸器症状8.2%、乳幼児感染症1.8%であった。[考察]就労中の母親の子どもが病気の際、気兼ねなく休める就労環境を整えることは、子どもの病気回復において重要である。同時に、病児病後児保育施設などを、休日・夜間に就労する母親のニーズにも応じた整備が必要である。また、急病時、受診しやすいシステムを構築するとともに、受診までの間、母親が不安なく対応できるような母親への教育的支援も必要である。(著者抄録)

Purpose<br> The purpose of this study was to elucidate the responses and support needs of working mothers whose children are ill.<br>Method<br> A questionnaire was administered to mothers with children registered at nurseries and after-school childcare facilities in Hyogo prefecture.<br>Result<br> Altogether, 1,804 valid responses were used for analysis. Most respondents took leave from work to attend to their sick children, but they faced difficulties such as lack of understanding at the workplace, loss of income, and the need to find a substitute worker. When they did not take leave, they encountered difficulty in finding baby sitters. Under such circumstances, the respondents wished to have a childcare facility that would accept children with symptoms such as a runny nose, a cough or a temperature of 38.0±0.4°C. They asked their parents to care for their sick children whenever possible, and they regarded the cost and the distance from home as important facets of care giving.<br>Conclusion<br> It would be desirable to develop childcare facilities for sick and recuperating children in regular nurseries and in the after-school childcare facilities that the children normally attend. This would minimize disruption of the lifestyle patterns of both mothers and children, and would facilitate the recuperation of the children.

© Springer 2012. This study aimed to evaluate a health promotion program for the elderly to foster self-management of oral health. The results of the first district evaluated among four districts are reviewed. Subjects consisted of 31 people (average age, 73.1 ± 7.4 years). The intervention consisted of a group study and private consulta- tions for 3 months. As a consequence, subjects cleaned their teeth more often than before (P < 0.05). Deposits of plaque and tartar were significantly lower after inter- vention (P < 0.01-0.001), while scores for oral function did not significantly improve. Scores for QOL and cognitive function improved significantly (P < 0.05). These results suggest that this program promotes not only oral self-care, resulting in good oral health conditions, but also improvement of cognitive function of the elderly.

© Springer 2012. This study aimed to quantify Porphyromonas gingivalis (Pg) in subgingival plaque of periodontitis (P) and periodontally healthy (H) subjects in the elderly. Subsequently, fimA genotypes were determined, and compared between P and H sites in the same subjects. The proportion of Pg was higher in P than in H. The fimA genotypes of P were identified mainly as II and Ib, while those of H were as I-IV. In four out of five subjects in whom Pg was detected in H sites, the fimA genotype was identical between P and H sites, but the proportion of Pg was significantly higher in P sites than in H sites (P < 0.05). This study suggests that the increase of Pg and the specific fimA genotypes are associated with P in the elderly, and that Pg possibly transmits within the oral cavity.

In order to improve the nursing-care quality, freestyle Japanese texts which are called nursing-care texts are collected through the Internet in Japan. The nursing-care experts can evaluate actual nursing-care and recommend some improvements to nurses by reading the collected nursing-care texts carefully. Since the number of nursing-care experts who can evaluate the nursing-care texts is a few, it is hard to do the above mentioned evaluation process for a large number of nurses. To assist nursing-care experts in evaluating the nursing-care texts, a computer aided nursing-care text classification system has been developed. In this paper, we propose a method to improve the classification performance of the computer aided nursing-care text classification system. Conceptual fuzzy sets are constructed from the collected nursing-care texts and used to make feature vectors in our proposed method. © 2012 TSI Press.

Recently, "Web based Nursing-care Quality Improvement System" have been proposed and operating continuously for improving the nursing-care quality in Japan. For evaluating actual nursing-care process, freestyle Japanese texts which are called "nursing-care texts" are collected through the Internet. The nursing-care experts read the collected nursing-care texts carefully to evaluate actual nursing-care process. Then they make a recommendation which includes some improvements, and send it to each nurse. The number of nursing-care experts who can evaluate the nursing-care texts is a few. Hence, it is hard to perform the above mentioned evaluation process because of a large number of nurses. In order to assist nursing-care experts in evaluating the nursing-care texts, we have been developing a computer aided nursing-care text classification system. In this paper, first, we introduce our computer aided nursing-care text classification system. Then we propose a method to improve the classification performance of the nursing-care text classification system. In our proposed method, dependency relation between terms is extracted from the nursing-care text The extracted dependency is used as a feature value which represents characteristics of each nursing-care text. From some experimental results for the actual nursing-care text sets, we show that our proposed feature definition is effective for improving the classification performance. © 2012 IEEE.

A tool for measuring the quality of nursing care was developed in Japan in 1993. This tool consists of three dimensions: structure, process, and outcome. One aspect of the outcome dimension, specifically nursing-sensitive medical incidents such as falls, downfalls, pressure ulcers, hospital infections and drug-related errors was measured. In this study, aspects of nursing care that may influence the frequency of medical incidents were examined. As the above five medical incidents were differentially related to each other, they were summarized under two factors using principal component analysis. Factor 1 comprised falls, downfall, pressure ulcers and drug-related errors. Factor 2 comprised hospital infections and pressure ulcers. All domains of the structure and process of 'incident prevention' were related to factor 1. These variables were able to explain 46.1% of the variance in factor 1. Most of all the domains of structure, and process of 'patient empowerment', 'direct care', and 'incident prevention' were related to factor 2. These variables were able to explain 45.5% of the variance in factor 2. © 2012 IEEE.

In order to improve the nursing-care quality, &#x00E2;Web based Nursing-care Quality Improvement System&#x00E2; have been proposed and operating continuously. In the proposed system, for evaluating actual nursing-care process, freestyle Japanese texts which are called &#x00E2;nursing-care texts&#x00E2; are collected through the Internet in Japan. The nursing-care experts can evaluate actual nursing-care process and recommend some improvements to nurses by reading the collected nursing-care texts carefully. Since the number of nursing-care experts who can evaluate the nursing-care texts is a few, it is hard to do the above mentioned evaluation process for a large number of nurses. To assist nursing-care experts in evaluating the nursing-care texts, a computer aided nursing-care text classification system has been developed. In this paper, we propose a method to improve the classification performance of the computer aided nursing-care text classification system. Dependency relation between terms is extracted from the nursing-care text and used the dependency as a feature value which represents characteristics of the nursing-care text. © 2012 IEEE.

The purpose of this study is to propose a convenient method to evaluate total oral bacterial count based on salivary ammonia concentrations by independent elderly.<BR>The Subjects were 146 elderly (mean age 71.7 years) living in Himeji City who had agreed to a study of their oral health behavior, and check ups. After rinsing with 3 ml of distilled water for 10 sec, the mouth rinsed solution (MRS) was then collected as an alternative saliva sample. The total bacterial count and the ammonia concentrations from the MRS were measured as an indicator of their oral cleanliness. The total bacterial count in the MRS was measured by real-time PCR methods and the ammonia concentrations were measured by using ammonia test paper (Ami-check^\_hTM).<BR>When it was assessed by logarithmic conversion, the concentrations of ammonia from MRS correlated positively with the total bacterial count (r=0.577) with a statistical significance at p<0.01.<BR>The ammonia production of oral and opportunistic microorganisms was examined with 40 standard microbial strains. In 23 species 31 strains of oral bacteria, 21 species and 26 strains produced ammonia. The most active bacteria was \_iPorphyromonas gingivalis. In addition, 6 species of the 9 strains of opportunistic bacterium, 5 species and 7 strains including \_iPseudomonas aeruginosa, \_iKlebsiella pneumoniae et al. produced ammonia.<BR>From these studies, it is suggested that the concentrations of ammonia from the MRS are useful indicators of oral cleanliness.

In this paper, we propose two term selection methods for classifying nursing-care texts. In a term selection method based on GA, two objectives which are maximizing correctly classified texts and minimizing selected terms are optimized. The weighted sum of these two objectives was used as the evaluation function. Therefore, GA-based term selection is performed aiming at the improvement in classification performance on testing sets. In a NSGA-II based term selection method, non-dominated solutions are found. As the result, we can have a set of pareto-optimal solutions. These solutions are helpful to analyze classification results from the viewpoint of terms. From experimental results, we show effectiveness of our proposed term selection methods. © 2011, TSI® Press Printed in the USA. All rights reserved.

In this paper, for improving performance of the nursing-care text classification, we introduce a mechanism of retrieving terms from Web. Every year, the nursing-care texts are collected by using Web application to improve nursing-care quality in Japan. The collected nursing-care texts are decomposed into morphemes (i.e., terms), and then terms are stored as a term list. Each text is represented as a feature vector by using the term list and classified using a SVM based classification system. The training data sets for constructing SVM based classification system are different from the evaluation data sets. That is, there are differences between the term lists of the nursing-care texts because the nursing-care texts are collected and evaluated every year. To cover this difference, we introduce a mechanism of retrieving terms from Web. A new term which appeared in the evaluation data sets is used as a query of a search engine. The terms in the term list are also used as queries. Terms are represented by the search results, and then are compared with each other. We use the most similar term in the term list as an alternative of the new term. From experimental results, we show effectiveness of our proposed method. © 2011 IEEE.

In order to reduce evaluation workloads for nursingcare experts, we have proposed a Support Vector Machine (SVM) based classification system. In this paper, for improving the classification performance, we propose a Genetic Algorithm (GA) based attribute selection method. First, we extract nouns and verbs from nursing-care texts by using of the morphological analysis software and store the extracted terms into a "term list." Next, some combinations of terms in the term list are selected by a GA with two objectives; (1) maximizing the number of correctly classified texts and (2) minimizing the number of selected terms. Then, we classify the nursing-care texts with these selected terms by using of a SVM-based classification system. From computer simulations, we show the effectiveness of a GA-based attribute selection method for classifying the nursing-care texts.

In this paper, for improving classification performance of a term selection based on GA, we modify its evaluation function and mutation operation. In the term selection based on GA, two objectives which are maximizing correctly classified texts and minimizing selected terms are optimized. The weighted sum of these two objectives was used as the evaluation function. Therefore, GA-based term selection is performed aiming at the improvement in classification performance on testing sets. This causes the performance deterioration over completely unseen texts. This is because terms are deleted excessively even when the terms have important role for the classification. First, we use NSGA-II for finding non-dominated solutions. As the result, we can have a set of pareto-optimal solutions. Each individual is evaluated by using SVM with -fold cross validation. In this paper, we also modify the mutation operation. The modified mutation operation uses the statistic information of each term as the mutation probability. From numerical simulation results, we show effectiveness of our modification.

In this paper, classification performance of a term selection based on GA is analyzed. In the term selection based on GA, two objectives which are maximizing correctly classified texts and minimizing selected terms are optimized. An objective function based on the classification per-formance of the SVM with 10-fold cross validation is used for evaluating each individual in GA. Therefore, GA-based term selection is performed aiming at the improvement in classification per-formance on testing text sets. This causes the performance deterioration over unseen texts in actual use by GA-based term selection because terms are deleted excessively even when such terms have important role for the classification. In this paper, relation between the terms deleted by the term se-lection based on GA and the terms which appears in unseen texts is clarified by numerical simulation results. © 2010 TSI Press.

This study aimed to clarify (1) what kind of symptoms the elderly were aware of, (2) the relationship between those symptoms and oral diseases, and (3) the relationship between those symptoms and oral health behaviors. Subjects consisted of 459 individuals 60 years and over, who were asked about subjective symptoms and oral health behaviors, and given an oral health examination. Findings were: (1) even though most subjects (75.2%) had the subjective symptoms, 55.7% of them did not think of them as health problems, (2) logistic regression analysis revealed that those who had subjective symptoms were at higher risk to have decayed teeth, periodontitis, and missing teeth (p < 0.01-0.05), and (3) the elderly who had oral complaints or the subjective symptoms used an interdental brush or a dental floss much more often than those who did not (p < 0.05). However, the elderly who had the oral complaint showed negative responses towards the visiting dentists (p < 0.05).

現在、多くの病院の看護部は積極的に看護研究に取り組んでいる。その支援体制は、時間や指導者、経済面などの問題を抱えているといわれているが、それらの支援体制の実態を広く調査したものはない。そこで、兵庫県内の病院を対象とし、看護部が取り組んでいる看護研究支援の実態を明らかにすることを目的とし調査を行った。今回は、上記の調査結果のうち「継続教育を目的とした看護研究」の支援体制の現状を報告する。<対象と方法>兵庫県下355病院に所属する看護研究推進担当者または看護部長を対象とし、郵送法による質問紙調査を実施した。質問紙は看護研究支援状況を問う選択回答式質問18項目から成り、複数の研究者が内容の妥当性を検討した。データは質問項目ごとに記述統計を用い分析した。<結果と考察>質問紙の回収数は132(回収率37.2%)であり、そのうち、継続教育を主な目的とした看護研究に取り組んでいると回答した病院は92病院(69.7%)であった。その病院の機能は、一般病院37病院(40.2%)、急性期病院31病院(33.7%)などであった。教育の対象者としては、ある経験年数の看護師全員という回答が68病院(73.9%)と多く、その他は看護師全員、あるラダーに達した者という回答であった。任意の希望者を対象としている病院は2病院(2.2%)だった。最も多かった支援内容は「所属部署の看護師長、主任、先輩看護師が指導している」71病院(77.2%)であり、「委員会を設け運営している」「外部講師から講義や結果の講評を受けている」は3割程度であった。時間の確保については、「業務内で収まるように時間を確保している」「一部個人の時間を使う」は16病院(17.4%)であり、「かなり個人の時間を使う」「原則として個人の時間を使う」は76病院(82.6%)であった。研究成果の公表は「院内研究発表会を開いている」は89病院(96.7%)であったが、院内の出版物や学術雑誌への投稿は少なかった。文献検討の方法は、「インターネット(文献データベースを含まない)」83病院(90.2%)「定期購読の和雑誌」78病院(84.8%)が多く、「有料文献データベース」40病院(43.5%)「無料文献データベース」30病院(32.6%)は少なかった。このように、多くの看護師を対象として看護研究の実施が進められているが、研究に必要な時間、リソース、文献検索の環境など支援環境は充分ではないことが明らかとなった。今後、教育を目的とした研究をどのように位置づけていくのか、環境はもちろんその成果をどのように評価し、支援体制を整えていくのかを検討していくことが必要であると考えられた。(著者抄録)

The nursing care quality improvement is very important for our life. Currently, nursing-care freestyle texts (nursing-care data) are collected from many hospitals in Japan by using Web applications. The collected nursing-care data are stored into the database. To evaluate nursing-care data, we have already proposed a fuzzy classification system [1], a neural network based system [2], a support vector machine (SVM) based lassification system [3], [4]. Then, in order to improve the classification performance, we have proposed a genetic algorithm (GA) based feature selection method [5] for generating numerical data from collected nursing-care texts. In this paper, we propose a fuzzy rule extraction method from the nursing-care text data. First, features of nursing-care texts are selected by a genetic algorithm based feature selection method. Next, numerical training data are generated by using selected features. Then we train neural networks using generated training data. Finally, fuzzy if-then rules are extracted from the trained neural networks by the parallelized rule extraction method [6], [7]. From computer simulation results, we show the effectiveness of our proposed method. © 2009 IEEE.

The authors have been developing a tool for measuring for the quality of nursing care since 1993. This tool consisted of three dimensions: structure, process, and outcome. Each dimension was constructed from measurements of six domains into which the applicants responses were previously categorized, such as "understanding individuality", "patient empowerment", "family care", "direct care", "medical team coordination " and "incident prevention". It has been developed and posted on a web site for gathering data from, and returning feedback to the participants' units for the quality improvement of nursing. In this study, a fuzzy recommendation system for the feedback was developed through an expert panel then evaluated by participants. © 2009 IEEE.

This study aimed to clarify the systems and disaster preparedness that are in place at health care facilities involved in cancer treatment to ensure that cancer patients receiving outpatient treatment can continue receiving treatment during a disaster, and to propose appropriate systems for ensuring continuation of treatment for cancer outpatients in times of disaster. In this study, interviews were conducted in five medical facilities that take precautionary measures in preparation for possible disasters in the near future, including a regional hub hospital for cancer treatment. Twelve people in charge of disaster preparedness and response were interviewed for approximately one hour about what system is in place at their respective hospitals to allow cancer outpatients to continue their treatment during a disaster and about how their hospitals prepare for disasters. The interviews revealed that the hospitals studied had no system in place to identify patients who need to continue treatment during a disaster, or to ensure that cancer patients receiving outpatient chemotherapy or taking pain medicines can continue receiving treatment or medication. It was also revealed that, though there was no system specifically designed for use in disaster situations, it was possible to identify patients who needed to continue receiving treatment during a disaster by using the system employed during ordinary times in the following three ways: (1) using patient information acquired in ordinary times through health care professionals; (2) using electronic information media; and (3) using information stored on paper media such as medical records and name lists. The interview survey suggests that it can be expected that cancer specialist hospitals can serve as centers for cancer treatment in times of disaster by forming a network of cancer care hub hospitals. It is also suggested that it is necessary to improve self-care skills and abilities of cancer patients and their families to ensure that cancer patients receiving outpatient chemotherapy and taking pain medicines can continue their treatment/medication during a disaster.

The study aimed to evaluate the Care Package for Cancer Patients during Disaster situations, developed in 2004 by the Cancer Nursing Group. Studied were 33 people who agreed to a request seeking cooperation with the study online. The study involved questionnaires consisting of structured and open-ended questions online, designed by researchers to get feedback from participants in order to consider the care package. Participants' responses to structured questions were analyzed using descriptive statistics from closed-ended questions; comments on evaluation of the care package were categorized. As a result, regarding appropriateness of character and illustration size, 19 (58%) answered "appropriate" and 13 (39%) answered "reasonably appropriate." Regarding terminological and idiomatic appropriateness, 18 (55%) answered "appropriate" and 14 (42%) answered "reasonably appropriate." Regarding usefulness in actual life, 19 (58%) responded "seems useful" and 13 (39%) responded "seems relatively useful." As noted above, 32 (97%) responded positively ("appropriate," "reasonably appropriate," "seems useful," "seems relatively useful") to the three questions regarding appropriateness of the illustration/character size, terminology, and usefulness in actual life. Regarding appropriateness of the volume of information provided, 19 (58%) answered "appropriate," but 14 (42%) answered "too large." Useful information in the pamphlets was classified into the following categories: information on coping with specific situations themselves during disasters; information on eating during cancer treatment; information on self-management in cancer treatment during disaster preparation; knowledge regarding chemotherapy I and others. Although the survey results indicated the necessity for improvement in terms condensation of volume, they also indicated that the care package was rated "appropriate" overall. The fact that 'information on coping with specific situations themselves during disasters' and 'information on self-management in cancer treatment during disaster preparation' ranked high as useful information suggests the pamphlets can be used to help cancer patients improve their self-care skills and abilities, as originally intended by the Cancer Nursing Group.

Our first study sought to define oral health behaviors patterns of elderly people through a qualitative study, and to develop a questionnaire. Using that questionnaire, a second study aimed to refine the relationships between oral health behavior and lifestyle or oral problems. <Subjects and Methods> In the first study, 94 individuals 60 years old and over agreed to take part. They were asked open-ended questions about what they did for oral health and a questionnaire was then compiled based on the data gathered. In the second study, 66 people (25 males and 41 females) 60 years old and over old participated. <Results and Discussion> Most of these (63 individuals=95.5%) lived with their families and 52 (78.8%) exercised regularly. The average number of teeth present was 22.7±8.0, that of decayed teeth was 1.3±2.7, and the average CPITN score was 2.5±1.3, which showed good oral health compared to the results of a national survey. However, more than half the individuals complained of some form of oral problem. In terms of oral health behavior, all participants brushed their teeth more than once a day. Two-thirds had devised a method of tooth brushing either by following instructions or by developing their own method. Twenty nine (43.9%) participants visited a dentist regularly. The relationship between brushing time and the amount of dental plaque was noted. Those who spent more time on brushing had less dental plaque (P<0.05). Further study using larger samples would be needed to incorporate psychological and physiological aspects, and to arrive at an effective and acceptable oral health behavior for elderly people.

Walk-in nursing stations are being introduced at several locations as a new system of community nursing in Japan. To assist with this project, our study aimed to investigate oral health consultation skills required for work with elderly people. <Subjects and Methods> Focus group interviews were conducted with oral hygienists who agreed to participate in this study. They were recruited until the category was saturated. Three to five people were group-interviewed about 1) common consultation themes and their responses to these, 2) successful consultation and 3) consultation tips. The interviews were taped and each contribution was analyzed and categorized. <Results and Discussion> A total of 27 hygienists were interviewed, making up seven groups and one individual. The average age was 36.8 ± 9.5 years (25-60). All participants were female. Average practice period was 15.4±8.4 years (5-36years). The participants practiced at various sites, including district health centers, visiting dental care units, and similar venues. A total of 225 units of data were extracted from the dialogues and categorized as follows: 1) Introduction: "Inviting clients to a consultation", "building a confidential relationship" and "wait for client to be ready to speak"; 2) The consultation itself: "probing the real problem", "helping the client understand their own problem", "finding a solution together"," bringing about positive health behavior" and "encouraging client to continue positive health behavior"; 3) Closing the session: "making the next appointment" and "setting a goal for the next visit". Participants talked frequently about how to deal with concrete oral problems such as denture management and dry mouth. Management skills of this nature were not felt to be the primary focus of our study and are therefore not discussed here. The consultation skills which were observed in this study might not always apply to nursing consultations. However, many similarities were observed between the skills noted in our findings and those required for nursing care, and these consultation skills are likely to be useful at walk-in nursing stations.

The nursing-care quality improvement is very important in the medical field. Currently, nursing-care freestyle texts are collected from many hospitals in Japan through the Internet by using Web applications. Some nursing-care experts evaluate the collected data for improving nursing-care quality, and then return a recommendation for improvement to each nurse. Since this Web based nursing-care quality evaluation system is a novel system in Japan, participation of many hospitals is desired. However, it is very difficult to increase the number of hospitals because the only few experts evaluate the collected nursing-care texts. In this paper, for evaluating many nurses, we develop a support vector machine (SVM) based classification system. And we propose a new attribute definition by using the expert's knowledge such as the length of a text and words or expressions which are focused by experts. First, for generating numerical training data, we extract attribute values from the nursing-care freestyle texts. And then, we classify the nursing-care numerical data using the SVM. Computer simulation results show the effectiveness of our proposed attribute definition. From the result of this paper, since many nurses can be evaluated by our proposed system, we can expect the quality improvement of the nursing-care in Japan.

The nursing care quality improvement is very important in the medical field. Currently, nursingcare freestyle texts (nursing-care data) are collected from many hospitals in Japan by using Web applications and stored into the database. Some nursing-care experts evaluate the collected data to improve nursing care quality. For evaluating the nursing-care data, experts need to read all freestyle texts carefully and then classified them into four classes. However, it is a very hard task for each expert to evaluate the data because of huge number of nursing-care data in the database. In order to reduce workloads evaluating nursing-care data, we have proposed a support vector machine (SVM) based classification system. In this paper, to improve the classification performance, we propose a feature extraction method for generating numerical data from collected nursing-care texts. In our proposed method, the frequency in use of a term in the term list is used for selecting features which contribute to the classification. And then, the nursing-care numerical data are classified by the SVM based classification system. From computer simulation results, we show the effectiveness of our proposed method.

We engaged in a project to develop a questionnaire to measure cognitive variables in oral health behavior among the elderly. When developing an effective program of oral health promotion for elderly people, it is very important to understand how their cognitive activity affects their health behavior. This study was aimed at discerning cognitive patterns which might affect health behavior and developing a questionnaire for measuring cognitive variables. <Subjects and Methods> The first study had 93 participants who had enrolled in an oral health check program at a community College for Senior Students, and who agreed to take part in the research. The participants were questioned about their approach to oral health, and their answers were then analyzed qualitatively. Based on the results, a self-reported questionnaire was designed, and specialists consulted. The questionnaire was then submitted to 215 persons over 60 years old, in order to evaluate the constituent factors. <Results and Discussion> Facilitators of oral health behavior were categorized as follows: Underpinning belief and norm, avoiding painful experiences, dealing with the problem faced, feeling of effects, following advice, and habits. Barriers to positive oral health behavior were categorized as: Lack of concern about oral health, belief and norm, and difficulty with continuation. Based on the results, the data were grouped under overall headings, namely concern about oral health, underpinning belief and norm, fear of painful experiences, facing the existence of the problem, feelings of effects and following advice. The questionnaire had a total of 24 questions using a 5-point Likert-type scale. After an explanatory factor analysis, five factors with 22 items were indicated to be the best fitting model. These were: Positive underpinning belief and norm, following advice on oral problems, resignation regarding oral health, feelings of effects, and confidence in oral health. Though the questionnaire was drawn up to measure the cognitive variables effecting the health behaviors of elderly people, further studies would be needed to uncover the relationship between the cognitivefactors found through our study and actual health behavior.

Aim: The purpose of the study was to identify the actual circumstances of treatment and nursing care for cancer patients during a time of disaster. Methods: The study subjects were 17 nurses working in eight institutions who engaged in nursing activities for cancer patients in the wake of the 1995 Hanshin-Awaji Earthquake at hospitals located in and around the stricken areas. The data were collected through focus group interviews and were analyzed by inductive and qualitative methods to categorize needs. The results were compared with the data categorized by Knowledgeocean, a text-mining tool for analyzing unstructured text in order to examine data validity. Results: The actual circumstances of the treatment and nursing care of cancer patients in disaster situations were divided into three major categories and 10 subcategories. The major categories were: "difficulty in keeping track of patients" undergoing outpatient treatment, "adjustment in treatment" in an effort to continue various therapies for cancer treatment, and "care for patients and their families before and after the last moment" in the case of terminally ill patients. Conclusions: The results suggest that the following issues should be addressed in the future: the need for an information management system for the resumption of interrupted treatment and the transportation of patients, the need for enhancing the self-care ability of cancer patients in ordinary situations so that they can be more self-sufficient in disaster situations, and the need for the creation of a suitable location for dying patients and their families and the development of grief care strategies in disaster situations. © 2007 The Authors.

Aim: The aim of this study is to develop a care package to help cancer patients improve their self-care abilities and better prepare for a disaster, so that they can continue treatment and perform symptom management strategies in disaster situations. Methods: In this study, the "Care Package for Cancer Patients in Times of Disaster", which comprises four pamphlets, was developed through discussions among the eight members of the study group. The care package was produced by making additions and modifications, based on the findings obtained in the above two steps, to the patient education booklets developed in the area of oncology. Results: Of the areas that cancer patients find difficult in times of disaster, the following six were extracted: difficulty in continuing treatment, the possibility of running out of pain medicines and how to store pain medicines, the possibility of not being able to go to a regular hospital, the shortage of stoma-care appliances and other products, the possibility of exposure to infections at a shelter, and the necessity of providing care for cancer patients and their families before and after death. By incorporating these pieces of information, we developed the four pamphlets. These pamphlets are posted on the website for public use. Conclusion: The newly developed pamphlets incorporate information on how to cope with specific situations in times of disaster, based on the findings obtained from the "Survey on Actual Conditions of Treatment and Nursing Care to Cancer Patients in Disaster Situations". © 2007 The Authors.

Nursing-care data in this paper are Japanese texts written by nurses which consist of answers for questions about nursing-care. The nursing-care data are collected via WWW application from many hospitals in Japan. The collected data are stored into the database. The nursing-care experts evaluate the collected data to improve nursing-care quality. Currently, the collected data are evaluated by experts reading all texts carefully. It is difficult, however, for experts to evaluate the data because there are huge number of nursing-care data in the database. In this paper, to reduce workloads for the evaluation of nursing-care data, neural networks are used for classifying nursing-care data instead of fuzzy classification system. We use standard three-layer feedforward neural networks with back-propagation type learning. First, we extract attribute values (i.e., training data) from texts written by nurses. And then, we train a neural network using the training data. From computer simulations, we show the effectiveness of our proposed system using the leaving-one out method. © 2007 IEEE.

The nursing care quality improvement is very important in the medical field. Currently, nursing-care freestyle texts (nursing-care data) are collected from many hospitals in Japan by using Web applications. Some nursing-care experts evaluate the collected data to improve nursing care quality. For evaluating the nursing-care data, experts need to read all freestyle texts carefully. However, it is a hard task for an expert to evaluate the data because of huge number of nursing-care data in the database. In order to reduce work-loads evaluating nursing-care data, we propose a support vector machine(SVM) based classification system. © 2007 IEEE.

Introduction: An externally applied force to the cranial vault has been reported to affect the growth of the facial skeleton. However, the effect on the mandible is unclear. The purpose of this study was to investigate the relationship between anteroposterior cranial vault deformation and mandibular morphology. Methods: The study sample included 44 women's crania with intact faces and bases that were excavated from archaeological sites in the Azapa Valley in northern Chile. The crania were divided into anteroposterior deformation (AP) and undeformed (U) groups according to frontal, parietal, and occipital curvatures. The sizes of the cranial vault, middle face, and mandible were measured with calipers. Lateral cephalograms were taken and analyzed according to a conventional method. Results: Cranial base angle, bizygomatic breadth and upper facial height, bicondylar breadth, anterior breadth, and mandibular body length were significantly larger, and the mandibular angle was significantly smaller, in the AP group than in the U group. Conclusions: The anteroposteriorly shorter and wider cranial deformation caused by externally applied forces in infancy might affect the bone-remodeling process of the mandibular angle, leading to a smaller mandibular angle in adulthood. © 2006 American Association of Orthodontists.

Objective: In an effort to promote adequate development of the masticatory system and prevent dental diseases, the Oral Health Promotion Project (OHPP), which focuses on diet, was started in 1984. The intervention was carried out over eight years and then followed up for a further nine years, in a district with no regular dental service, on Miyako Island, Okinawa, Japan. The aims of this study were to evaluate the project's effect on dental caries and masticatory function. Research design: Longitudinal data on the complete deciduous dentitions(IIA) at age 4 (n=163) and on the permanent dentition (IVA) at age 13-15 (n=112) were compared to control age-matched groups, aged 4 (n=105) and aged 13-15 (n=70). The control data were collected from a neighbouring district. Instructions on diet were gradually introduced to those in charge of the subjects' food regimes. Results: Mothers reported that children born after the OHPP was begun took less snacks and caloric drinks (p<0.001) and more fibre-rich food (p<0.05) than those who born before the start of the project. The number of carious teeth decreased significantly among subjects born after the start of the project. The masticatory function was summarized in one factor using chewing performance, bite force, muscle activity duration time (using EMG) and mean amplitude of muscle activity. The factor score was higher for those born after 1984 than for those born in 1981-1983 and for those in the control district (GLM, p<0.001). Conclusion: It is suggested that OHPP can promote the masticatory function and prevent dental caries, but that it would be crucial to begin intervention soon after birth. © BASCD 2006.

A model for measuring the quality of nursing care has been developed in Japan since 1993 by Katada. Then a self evaluation model was developed in 2002 by Abe et al. This model consisted of three dimensions: structure, process, and outcome. Each dimension was constructed from measurements of six domains which applicants categorized previously, such as 'understandi individuality', 'patient empowerment', 'family care', 'direct care', 'medical team coordination', and 'incident prevention' In this study, it has been developed and posted on a web site for inspection and examined for its usability. © 2006 The authors and IOS Press. All rights reserved.

With the aim of preparing for disasters, care information packages for the support of patients with cancer and their families during disaster situations were developed in our previous study, and were provided via the internet with a questionnaire asking the face validity and the usefulness of such information. Thirty replies were received. Most subjects thought the care packages were appropriate and useful in the actual settings, however 43.3% of them thought the amount of information was excessive. Many comments and suggestions on the care information packages also could be obtained via the internet. © 2006 The authors and IOS Press. All rights reserved.

The structure and function of the human body (integrated anatomy and physiology) is regarded as a subject of fundamental importance in nursing education. However, it has been claimed that the subject contributes little towards developing nursing care. To further develop the teaching of this subject in nursing education, specialists' sessions and focus group interviews among students were conducted. In earlier studies, the following topics had been addressed: 1. Learning through case studies, 2. Connecting body structure and function with nursing, 3. Refresher courses in both knowledge and practice, 4. Focus on disease, 5. Demonstrating nursing practice, and 6. Using audio-visual material. Utilizing the findings from these studies, an experimental class was set up. This paper aims to evaluate the effect of this class, and to seek a better approach to education from the responses of the students. A total of three sessions were held. The first half of each session consisted of a lecture, while the second half focused on practice. Seven volunteer female high school students (16-17 years olds) were given a myocardial infarction case to work on. The following four types of results were then analyzed: 1. Students' responses in class, 2. Group interview after class, 3. Understanding of the class on a 5 point scale by students and 4. Written examination before and after the sessions. Learning through case studies and demonstrating the role of nursing in a concrete situation, students appeared to understand the nursing, and how knowledge of structure and function of the human body applies to nursing practice. Role-playing methods also helped students to understand the patient. However, factors like an inadequate image of nursing, lack of vocabulary in both technical terms and literary expression, together with inadequate experience, were found to be barriers against acquiring further knowledge. Given these findings, the guidelines of learning should be refined.