[Evaluation of the effective use of the "health notebook"].

Since 1983, with the institution of the "Health Service Law for the Aged", the "health notebook" has been issued to people aged 40 years and over in order to aid in management of their health. Few people actually fill their health data in notebook by themselves. In order to develop effective use of the health notebook by residents and health professionals, the uses of the health notebooks by residents aged 40 years and over, public health nurses, and physicians were investigated. Three hundred and fifty four residents aged 40 and over, 41 public health nurses, and 18 physicians were studied in 1990, in Yamagata city. A majority of residents took their health notebooks with them to health consultations, and public health nurses used the notebooks to provide advice to them. Public health nurses effectively issued the health notebooks to residents using occasions where residents gathered. Some physicians reported that health notebooks were useful for motivating the people to maintain their health, while others preferred using a health card media. When comparing the health notebooks to the maternity passbooks, health notebooks need to be more easily utilized by users for recording information, and their value should be effectively explained to them. Furthermore, in order to promote self-care behaviors, greater use of health notebooks by all health professionals in indicated.

[Midterm achievement and problems of all municipal health and welfare plans for the elderly in Yamagata Prefecture].

PURPOSE: This study was made for providing information in the preparation of Social Welfare Systems in municipalities. METHODS: Based on seven official reports by Yamagata Prefecture, quantitative data on health and welfare services were analyzed. We investigated the midterm achievement and problems of a Municipal Health and Welfare Plan for the Elderly in all 44 municipalities by mail survey (response rate 100%). The questionnaire included the progress situation of the plan, the existence of an assessment organization, and the characteristics of the plan. RESULTS: Both health service and welfare service achieved targets level to a degree. Concerning the progress situation, "The midterm achievement is not satisfactory" for 65.9% (29 municipalities). The main reasons were "budgets" (93.1%, 27 municipalities) and "lack of manpower" (75.9%, 22 municipalities) all of which indicates "lack of home helpers". 58.6% of all 44 municipalities were reconsidering the plan. In assessment organization existed in 31.8% (14 municipalities) of all municipalities. CONCLUSION: It is necessary that analysis should consider not only use of quantitative data but also qualitative one. The major problems found are that community characteristics were not reflected and the opinion of inhabitants were not considered.

Prediction of embolism in atrial fibrillation: classification of left atrial thrombi by transesophageal echocardiography.

The current study was undertaken to clarify the relationship between cerebral/arterial embolism and the morphology of left atrial thrombi. Forty-one patients with atrial fibrillation and left atrial thrombi were followed for 1 year, using transesophageal echocardiography (TEE) to study how the shape, site, movability, number and maximum dimension of left atrial thrombi are related to embolism. Left atrial thrombi were classified by their shape and movability into movable ball (MB) type (n=13), fixed ball (FB) type (n=17) and mountain (MN) type (n=11). The thrombi were also classified by location into the interior section (n=3), middle section (n=8), and the entrance section (n=19) of the left atrial appendage, and the section outside of the left atrial appendage (n=11). The rate of embolism in the MB-type group was significantly higher than that in the other groups (ie, MB 76.9% vs FB 17.6% (p<0.01) vs MN 9.1%; p<0.01), which indicates that the MB-type thrombus is an important risk factor for cerebral/arterial embolism.