[Relationship between the number of public health nurses and the total number of people receiving home-visit nursing services for mental health/intractable diseases, and those numbers' regional differences].

Objectives　The primary aim of this study was to clarify the relationship between the number of public health nurses (PHNs) and the total number of people who received home-visit nursing services for mental health or intractable diseases. The secondary aim was to clarify the extent of regional differences in the number of PNHs and mental health or intractable diseases.Methods　This study used the total number of people who received home-visit nursing services for mental health or intractable diseases in 2019 from the Portal Site of Official Statistics of Japan (e-Stat) and population and area data in January 2020. Single and multiple regression analyses (covariates: population and area) were performed on the relationship between the number of PHNs per 100,000 population (abbreviated as "ratios of PHNs") and the total number of people who received home-visit nursing services for mental health or intractable diseases per 100,000 population (abbreviated as "mental health/intractable disease achievements"). Regional differences in ratios of PHNs and mental health/intractable disease achievement were examined using mean, standard deviation, maximum/minimum values, and Gini coefficients. Analyses were performed for each of the five units: the prefectures as a whole, prefectural public health centers, municipalities within the jurisdiction of prefectural public health centers, and cities in which public health centers are established (including or not including special wards).Results　Regression analyses indicated a positive relationship between the ratios of PHNs and mental health/intractable disease achievements. Multiple regression analysis indicated that both achievements were positively associated with population size and negatively associated with area size. The largest regression coefficients between the ratios of PHNs and achievements were 34.07 and 5.48 regarding mental health achievements and intractable disease achievements, respectively. For regional differences, the smallest Gini coefficient was the ratios of PHNs, and the largest was intractable disease achievements. The smallest and largest coefficient of the prefectures as a whole was 0.15 and 0.34, respectively. The maximum/minimum values of the prefectures as a whole also indicated that the smallest was 3.8 in the ratio of PHNs and the largest was 30.0 in intractable disease achievement.Conclusions　Increasing number of PHNs is needed to provide more home-visit nursing services for mental health and intractable diseases. It is particularly important to fill up the larger number of PHNs in smaller populations or larger area prefectures. Due to regional differences in the home-visit nursing service, it is important to promote the increase in the level of these activities.

Functional independence measure scores predict level of long-term care required by patients after stroke: a multicenter retrospective cohort study.

PURPOSE: To examine whether Functional Independence Measure (FIM) scores on admission can predict the future care levels of patients after acute stroke. METHODS: In this multicenter retrospective cohort study, we enrolled post-acute stroke patients and assessed stroke subtypes, self-care abilities using FIM scores, and discharge destination. Patients' care levels were assessed according to the Long-Term Care Insurance (LTCI) system (0-5: slight impairment to bedridden), the national insurance plan for care in Japan, at discharge. We divided patients into two groups according to LTCI care levels (0-2 versus 3-5) to compare their clinical characteristics using multivariate logistic regression analysis. The trial was registered with the UMIN Clinical Trials Registry (UMIN000012653). RESULTS: Of the 1261 patients (47% female, mean age 75 years), 492 (39%) fulfilled LTCI care levels 0-2. FIM scores on admission were significantly correlated with LTCI care levels (p < 0.001). On multivariate analysis, age and FIM scores on admission were found to be independent predictors of LTCI care levels 0-2. CONCLUSIONS: FIM scores on admission after stroke can independently predict later care requirements. Early prediction of LTCI care levels may contribute to the early supported discharge and improve the efficiency of healthcare planning. Implications for Rehabilitation There is a clear relationship between Functional Independence Measure (FIM) scores and the care levels certified by the Long-Term Care Insurance (LTCI) system, a national healthcare and insurance system in Japan. FIM scores on admission can predict future LTCI care levels required for patients after acute stroke. Early prediction of LTCI care levels may contribute to early supported discharge, improve the efficiency of stroke management and assist healthcare planning.

[Three-case reports--a program of strength training for home health care on frail elderly patients with protein rich supplement just after the training].

We have a program of strength training for home health care with protein rich supplement just after the training on frail elderly patients. Three cases (80-90 years old) received a new good taste protein rich supplement. They were also frail patients after acute clinical treatments, and were able to go home directly against their physical moving problems for daily life. We performed cardio-pulmonary and swallowing function, energy intake, parameters of muscle strength and the status for daily life before and after the training. Practical results were very different among the patients. But, the status for daily life of all was better than before. It was not clear that the new supplement was effective for the parameters of muscle strength, or not. But a trial for programs with thus foods should be an option for promoting to home health care after hospitalization in frail elderly.