Purpose : This study aimed to investigate two on problems on HRQOL of patients with diabetes, Time Trade-Off method was used. First, why would out-patients trade their remaining life with disease for a short life without disease? Second, what factors affect the patient's preference of the health state (TTO values)?
Method : One hundred out-patients with diabetes were recruited from the out-patients clinic in a general hospital. Patients were asked individually about each item of TTO. The TTO value was measured.
Results : (1) 44.3% of patients would be willing to trade their life-time with disease for the life-time without disease (Trade-Off Group), but 55.7% of patients would not be willing to do so (No Trade-Off Group). (2) The mean TTO value of the Trade-Off Group was 0.43±0.31. (3) The number of patients with physical disabilities and negative feelings about daily life in the Trade-Off Group were significantly greater than those in the No Trade-Off Group (p<.01). (4) There were no differences in the numbers of insulin-treated patients and the mean scores of HbA _1c% between the Trade-Off group and the No Trade-Off group. (5) The TTO values of patients with complications were significantly lower in comparison with those of the patients without complications (p<.01). (6) Some social reasons were recognized for the preference of the health state of the two groups.
Conclusion : The present study found some new findings and suggested necessary cares for HRQOL in patients with diabetes. However, it is necessary to further investigate the influence of social factors on the TTO value and HRQOL.

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The object of this research was to describe what elderly residents of a rural community thought of their own health using behavior patterns and perception. I interviewed 23 people, including 13 elders from one village in S City. The data were collected and analyzed using ethnography.
The interview showed that maintaining health means maintaining pride. Issues that the elderly people could not change included physical decline from senility, loss of a job because of mechanization of agriculture, and loss of position in the family. However, they struggled to maintain their pride by attempting to do everything on their own, continuing to work in agriculture, and being helpful to their families. Their pride was maintained by working and by the strength and support provided by friends. I found that they perceived themselves as being healthy when they could maintain their pride in various situations.
This study suggested that it is important for us to understand elderly people in many aspects and support them in maintaining their pride, which is one of the practical supports for elderly people to promote their health independently.

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The purpose of this study is to clarify the emotional responses of the families of patients who are suddenly admitted to the ICU. Further, we considered the best nursing approach for helping the families cope with the situation. Eight subjects, whose family members were suddenly admitted to the ICU, participated in this investigation. We conducted semi-structured interviews and used participant observation to collect data on the emotional responses of subjects. We analyzed this data using qualitative induction.
The emotional responses of the subjects were categorized into 17 themes. These included 'concern regarding unpredictability', 'dependence on medical staff', 'being supported', 'burdensomeness', 'wish to protect a patient'. Upon considering the deepest meaning of the abovementioned responses, we could finally determine their roots as being :“expectation of recovery”, “reliance on medicine”, “not feeling alone”, “duty and responsibility”, and “familial ties”.
In summary, the nursing support required for helping the families of ICU patients cope with the situation involved the following : providing reaffirmation for the family's constant expectation of the patient's recovery, facilitating their realization that reliable medicine was available, ensuring that various aids were easily accessible to them, and encouraging their acceptance of long-term care.

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The purpose of this study was to examine the influence of the stress of childbearing on individual differences in the level of S-IgA in the colostrum, in relation to the stress system theory and the cognitive evaluation theory established by Lazarus et al. based on psychoneurological-immunological knowledge. The levels of stress-related hormones in the colostrum were also determined based on a knowledge of the in-vivo stress reaction pathways, for the purpose of objectively evaluating whether the level of S-IgA in the colostrum would be reflective of the stress of childbearing. The subjects were 62 mothers, consisting of both primiparous women and multiparous women. The analysis indicated that “behavior to cope with something”, one of the psychosocial factors assessed based on the theories propounded by Lazarus et al., was the most important factor that influenced the local colostrum immunity. The time to delivery, a physical stressor, indirectly influenced the colostrum S-IgA level mediated by adrenal cortisol secretion. Furthermore, the serum cortisol and CgA levels showed a strong correlation with the colostrum S-IgA level measured 60 minutes after delivery. Thus, it is clear that the colostrum level of S-IgA is an immune substance reflective of the stress of childbearing stress. The knowledge gained from such a study could pave the way for a new approach to early lactation plans by midwives, from an immunological standpoint, based on scientific evidence.

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The purpose of this study is to examine the reliability and validity of the Japanese-language version of the Mishel Uncertainty in Illness Scale-Community Form (MUIS-C). The scale has been developed to measure perceived uncertainty among chronically ill patients or their families. As such, outpatients suffering from autoimmune diseases and type-2 diabetes participated in the study.
In terms of internal reliability, the results were sufficient (i. e., above the criteria value). Cronbach's coefficient alpha was 0.82 and 0.88. When the Spearman-Brown split half formula was incorporated into the split-half method, the coefficients were 0.71 and 0.86. However, the test-retest method obtained r=0.61 for type-2 diabetes patients, which is slightly smaller than the criteria value of 0.7.
In terms of validity, since the responses closely agreed with the characteristics of their illnesses, clinical validity is sufficient. Concurrent validity was supported by the correlation coefficient between MUIS-C and the scale of Problem Area in Diabetes Survey and was 0.42 (p<0.01). Construct validity was evaluated based on the model of perceived uncertainty in illness. Multiple linear regression analysis indicated that uncertainty, symptom instability, and social support were significantly related to the quality of life which corresponds to a psychological adaptation of the model of perceived uncertainty in illness.
Therefore, this study suggests that the Japanese-language version of MUIS-C is in need of further refinement, but is considered an efficient tool for clinical use.

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The purpose of this study is to explore the autonomy of preschool children in the process of preparation for day surgery and the structure of that autonomy through the interaction of child and mother. The subjects were mothers of 40 children between the ages of 3 and 6 years undergoing day surgery for lower abdominal disease. Data was collected through an interview-style survey using a semi-structured questionnaire. Factors and the relationships were explored through content analysis. The autonomy of preschool children in the process of preparation for day surgery included nine elements: <interest>, <doubt>, <acceptance>, <refusal>, <reenactment>, <negotiation>, <search>, <alarm>, and <initiative>; and was constituted according to three categories: {concern about health problems and treatment}, {the expression of free will in regard to the treatment}, and {the process that regulates and directs the self}. In addition, children showed their mothers four modes of self-control in the process of preparation for day surgery: [the feeling of being manipulated by the expectations of the situation], [the feeling of being out of tune with the expectations of the situation], [the feeling of being in tune with the expectations of the situation], and [the intention to be in tune with the expectations of the situation]. Children received two types of care from their parents: [the extension of motivation and curiosity to the child] and [the extension of security and confidence to the child]. Consequently, children flexibly shift the four modes of self-control to improve autonomy.

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For a new trial to risk cognition of infectious diseases, mental images, knowledge and awareness associated with 26 risks (infectious diseases: 13 items, and others: 13 items) were first assessed, and a risk cognition map of infectious diseases, consisting of a fear-factor axis and an unknown-factor axis, was then trailed. In order to investigate the influences of knowledge and experience for infectious diseases on risk cognition, the subjects were in the following five groups: (1) 51 nurses worked in the N hospital, who had knowledge and experiences of mass infection; (2) 53 students belonged to the S university, who had experiences of mass infection; (3) 50 nurses worked in K hospital, who had knowledge of mass infection; (4) 50 nursing students attended to K university, who had some knowledge of mass infection; and (5) 111 F university students and adults who had no knowledge or experience of mass infection.

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The objective of the present study is to determine the effects of timing of maternal attachment to fetus on attachment to infant and to identify related background factors. Eighty-three prima gravida women participated in a longitudinal study, answering a total of four surveys conducted in the early, middle and late stages of pregnancy and at one month postpartum. The results were as follows:
1) Among the three stages of pregnancy, maternal attachment to fetus during the late stage had the greatest impact on maternal attachment to neonate.
2) When mothers with a high prenatal attachment inventory score (PAI) were compared to those with a low PAI, the higher the attachment during the late stage, the greater the husband collaboration during pregnancy, and the greater the marital satisfaction. In addition, the higher the attachment during the middle and late stages, the higher the frequency of thinking about the baby or experiencing fetal movements. Also, the higher the attachment during the late stage, the greater the degree of involvement of the mother in delivery.
Given these results, maternal attachment to fetus during the late stage of pregnancy is important to the relationship with the infant. Thus medical professionals should become promote this attachment by providing health guidance during the late stage of pregnancy.

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The purpose of this study was to clarify how certified nurses perceived their own clinically specialized abilities and the awareness structure of those abilities. Subjects included 275 nurses certified to have skilled nursing techniques and knowledge in specialized nursing fields by the certified nurse system of the Japan Nursing Association. Questionnaire surveys were sent out by mail from June to September 2001. The collection rate was 33.3% (87 persons). The results of the analyses revealed the following:
In their self assessments of their specialized practical abilities, the certified nurses rated their abilities in“clinical practices requiring specialized knowledge and techniques” the highest, and their “research activities for improvement and development of nursing practice” the lowest.
In their assessments of the awareness structure of their specialized practical abilities, they cited the following five factors:“skilled clinical practice,” “collaborations,” “improvement and development of nursing practice,” “consultation,” and “correspondence to ethical dilemmas and their solution.”

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