The effects of community health nurse monitoring on hypertension identification and control.

Identification and control of hypertension are important public health concerns. Lack of regular health care makes diagnosis and control difficult in some populations. Community health nursing services in settings where clients regularly congregate promote identification and control of hypertension. This study focused on the effects of community health nursing screening and monitoring services for hypertension provided to participants in a breadline, a senior nutrition program, an English as Second Language (ESL) class, and employees providing these services. Community health nurses (CHNs) provided 2,407 blood pressure-related service encounters. Blood pressures were elevated in 19% of encounters, and 10% of clients had elevations that warranted referral for medical assistance. At the end of the 18-month study period, 67% of all clients with elevations and 71% of those referred for medical assistance had achieved normal blood pressures. One-way analysis of variance indicated a significant relationship between the number of encounters with the nurses and a positive outcome for all clients with elevations. This relationship was not supported for those clients referred to medical assistance. The effectiveness of intervention appeared to vary somewhat among subgroups with some groups more likely than others to achieve a positive outcome. Group differences in outcome were not statistically significant.

[Home care and nursing administration in community health nursing--the integration of individual health care with community health care].

There has been a paradigm shift in community health nursing. In 1992, visiting nursing stations were first introduced. In 1994, the Community Health Act came into force and in recent years public health care insurance has become a major issue. In this paradigm shift, one of the roles of nursing in the community is to train people to become more autonomous as consumers of health care services, and to design and implement a system that enhances community members' health and provides support when they are ill. In 1990 and 1996, the national nursing curriculum was revised to reflect changes in the age of the population. Community health nursing now faces the challenge of developing a new nursing model that is in tune with Japanese cultural values. Dr. Katsunuma (1996) proposed two alternative approaches to health care services: the public health approach and the clinical approach. In this paper, it is suggested that home care offers a third alternative, which integrates the clinical approach with the public health approach. This third approach provides a paradigm for community health nursing that integrates individual health care with community health care. New roles and specialties for public health nurses include care management, care planning, community health nursing administration, and supervision. Community-based nursing centers that cooperate with schools of nursing will provide a setting and a concept for community health nursing.

A brief review of epidemiological studies on ischemic heart disease in Japan.

The age-adjusted death rate from ischemic heart disease in Japan is the lowest among developed countries and the rates have decreased since 1970. The incidences of myocardial infarction in selected populations ranged between 0.12 and 2.56 per 1,000 for middle-aged males, and between 0.00 and 1.52 per 1,000 for females. The incidences of sudden death within 24 hours were from 0.00 to 1.58 per 1,000 for males and from 0.00 to 0.76 per/1,000 for females. The incidences in Japanese populations appeared to be far below those in Western populations. In the Cox proportional hazard regression model, hypertension and smoking were selected as independent risk factors for myocardial infarction in an agricultural district. It was noteworthy that the level of serum cholesterol was not associated with development of myocardial infarction in rural areas. No positive relation between dietary fat and serum cholesterol was observed in school children, suggesting that growth, sexual maturation and others might be confounding variables between them. The levels of serum cholesterol for females were more affected by menopause than those of blood pressures and body mass index. Although some polymorphisms in selected candidate genes appeared to be associated with some serum lipids and apolipoproteins, the effect of individual RFLP on the inter-individual variations in serum traits was relatively subtle in comparison with that of lifestyle factors.

[A study on reduction in care burden of the family caregiver of the bedridden and senile elderly--examination of subjective factors about construction in care burden].

The purpose of this study was to develop a supporting system in the community which reduces care burden of the family caregiver members of bedridden elderly age 75 and over. Preliminary study was carried out in order to find out fundamental elements of care burden. Five families were picked up among the families living in Chuo ward in Tokyo who were provided professional nursing care services at home. A nursing intervention was done through home visits and interviews with caregivers and their subjects who need proper care services. 1. fundamental elements of a caregiver's care burden: a) main elements are health and mental condition of elders, b) influential elements are the function of caregivers, the function of assistant caregivers, the function of professionals and the function of care systems. 2. The line of stress defence: All the functions except that of caregivers were positioned at the line of stress defense, and in our view the caregiver's coping capability would be increased as the line of stress defense functions and, hence, the care burden might be reduced. 3. Assessment of fundamental elements shall be determined from 3 aspects a) health and mental condition of elders, b) accessibility to buffers and their quality and c) capacity and skill of a care giver. In order to reduce the care burden of the family caregiver, it is necessary to assess multilaterally the constituents and/or structures of care in the future, and at the same time the additional functions will be required to furnish information and educate the caregivers on how to utilize various social care services, there by enabling them to cope with psychological stress effectively. These findings suggest that it is also necessary to complete the training of professional concerning feasible means that could promote the caregivers' abilities to cope with the bedridden and senile elderly.

[A study on health and caregiving status of the elderly over age 75 living in urban Tokyo--comparing 1987 with 1993].

The purpose of this study is to propose the improvement of the community care service and caregivers' support system. A questionnaire was sent to the elderly over age 75 living in Chuo Ward of Tokyo, on their living place, previous illness, health status, degree of assistance needed, and their caregivers. The same kind of surveys were made in 1987 and 1993, and the health status and home care were compared and changes in caregiver services were examined. Valid responses of 3,294 (response rate of 81.3%) in 1987 and 3,409 (response rate of 76.3%) in 1993 were analyzed and compared with each other. The results are following; (1) The total number of bedridden elderly persons decreased from 214 (6.5% of the total) in 1986 to 61 (1.8% of the total) in 1993. The number of elderly over age 75 with high health status increased. (2) The rate of the elderly who stay only indoors, although physically non-handicapped and in good health, was 20%. (3) The statistic of caregivers' concern about care services in the answer to open ended questions showed the increase of the desire for the supply of information, and the fact of more suitable pieces of advice having been given about the resources for care, care-give service, and family adjustment. It is necessary to establish the system to support and develop home care in the community in the future. Social support will also be necessary not only for infirm or handicapped elderly people, but also for demented, living in solitude, or non-social withdrawn healthy aged people to make use of community care service, counseling of care service and short stay at nursing homes. Especially the importance of community care service to prevent the elderly from being bedridden was suggested. Moreover, general broad support is necessary, such as social education, income guarantee and housing measure as well as that from the point of view of health and welfare.

[A study on health and caregiving status of the elderly over age 75 living in urban Tokyo--social services and caregiving for the bedridden and senile elderly].

Interviews during home visits were used to assess social services and caregiving status for the bedridden and senile elderly living at home in urban Tokyo. In Chuo ward 197 bedridden and senile elderly were identified from 3,409 mailed surveys (response rate 5.8%). This study analyses data from 110 subjects who were followed up with interviews during home visits. As indicated by the Karasawa senile scale, 70% of the respondents have communication problems with the elderly person in their care. Incontinence problems are reported in 56.7% of the frail elderly. There is no significant association between incontinence problems and decisions by caregivers to institutionalize the elderly. The mean age of the main caregiver is 61.9 +/- 12.7 years. There are 55.5% of the families with secondary caregivers. The mean period of care is 6.3 +/- 8.2 years. Even the families who take care of their elderly relative for longer periods of time have no one to consult about caregiving. Caregiver strain was measured by the Family Maslach Burnout Inventory. The subscale, emotional exhaustion, occurs most frequently. Only 25.0% of caregivers indicate willingness to accept social services, on the other hand 63.5% of the caregivers desire family care. The questionnaire listed twenty five resources currently available for families in this ward for social services. Only 52.2% know about resources for social services. Only 8.5% of the respondents use social services. Respondents know about and use social services for direct care of their elderly relative more than they use support for adapting the home environment for the care of the elderly. These findings suggest the following: (1) In order to promote effective use of social services a systematic case finding and assessment plan is needed. (2) Development of services from the viewpoint of prevention and emotional support are needed. (3) Case management is needed to achieve a mix of both the family care and social services.

[A study on the primary prevention of essential hypertension (1). Evaluation of blood pressure response during exercise and effect of habitual exercise].

Hypertension is one of the risk factors of cardiovascular diseases, which are widely prevalent maladies that result in burdensome medical expenditures. Therefore, it is important to explore primary preventive measures for hypertension. Until recently, it was thought that exercise was a risk factor for hypertension, but recent reports have suggested that low-intensity physical training actually lowers blood pressure. However, habitual physical exercise has still not been clearly proven to prevent the development of hypertension. To clarify this point, one must first establish a method for predicting hypertension and second examine the possibility of preventing the development of hypertension by changing the subject's environment. In this study we have investigated a method for predicting hypertension by classifying blood pressure responses to increasing exercise intensity and the effect of habitual exercise on blood pressure response. This study was composed of three experiments. Experiment one involved female students (n = 42) and experiment two, male students (n = 38), in whom blood pressure response rates during exercise were recorded. In experiment three, the same group of female students (n = 23) was subjected to training in order to chart its effects on blood pressure response, both while exercising and while at rest. The exercises were performed with a bicycle ergometer in an upright position. There were four different degrees of work intensity. Blood pressure was measured using the auscultation method, with Riva-Rocci mercury measured by the same investigator. High blood pressure responses at rest were noted among some normotensive female and male students. The systolic blood pressure responses during the peddling exercise showed significant individual differences at the lowest work load; the distribution of the increment of the systolic blood pressure ratio at the lowest work load against the increment while resting showed two peaks. This result suggests that this increment ratio is an important variable related to the prediction of hypertension. The increment ratio showed no significant change in female students after three months of aerobic exercise. The high-response group showed high readings of the TPR indicator (MBP/VO2). Aerobic training was shown to be effective in significantly lowering the TPR indicator both at rest and during exercise. This result suggests that habitual exercise may contribute to preventing the development of hypertension.