Department of
Mental Health
Outline and Research Objectives
Outline
The department was first established as the 4th Department of Clinical Medicine andNursing in the School of Health Care and Nursing in the Faculty of Medicine University ofTokyo in 1953. The department was renamed to the department of Mental Hygiene according to the reorganization of the School of Health Care and Nursing into the School of Health
Sciences in 1965. In 1992, the department underwent second renaming to the Departmentof Mental Health and Psychiatric Nursing by the reorganization of the School of Health
Sciences into the School of Health Sciences and Nursing. In 1997, according to the restructuring of the Faculty of Medicine into the Graduate School of Medicine, the Department of
Mental Health and Psychiatric Nursing was divided into the Department of Mental Healthand the Department of Psychiatric Nursing.

Research Objectives
The research objectives of this department are to conduct clinical psychosocial studies inthe vast field of mental health and to disseminate results of those studies internationally.
For the last five decades, the department has had many clinical research projects, forexample, psychotherapy, forensic psychiatry, community mental health, mental health/psychiatric services, psychiatric rehabilitation, child and adolescent mental health, and developmental disorders, depending on the specialty and interests of faculty members, who haveconducted those studies in collaboration with researchers in and outside Japan by employing psychosocial methodologies adopted from diverse allied disciplines (i.e., psychiatry, clinical psychology, nursing, education and sociology).
For the past five years, this department has conducted clinical studies with close collaboration with the Department of Psychiatric Nursing established in 1997. The Department of
Psychiatric Nursing has many clinical research projects of its own to substantiate clinicalactivities in psychiatric nursing: time and motion studies of nurses in acute psychiatricwards; clinical competency of psychiatric nursing; skills of community psychiatric nursing;mother’s mental health and child abuse; issues of spirituality with cancer patients; and careburden of families with ALS clients.
For the last decade, the Department of Mental Health has concentrated its research
activities mainly in 5 areas: (a) developmental disorders, (b) child and adolescent mental
health, (c) mental health services, (d) geriatric psychiatry/mental health, and (e) social psychiatry/community mental health, as introduced in the past research and major accomplishment section.

Faculties and Students

Past Research and Major Accomplishments

Professor and Chair Hiroshi Kurita, MD, PhD (since 1992)
Associate Professor in Mental HealthIwao Oshima, PhD (since 1996)
Associate Professor in Psychiatric Nursing
Mami Kayama, PhD (since 2002)
Associate .................................1
Graduate student ..................37
Research student.....................8
Secretary .................................4

The major accomplishments of this department
are summarized below in 5 areas, with the number ofa related article listed in the select publications section in parentheses.

298(a) Developmental disorders (1-16)
In this area, studies on Childhood disintegrative
disorder (CDD) and related conditions (1, 5, 9) are particularly of note. CDD is an autistic condition of
unknown etiology characterized by severe metalregression emerged after normal mental development
at least by age 2 followed by a severe autistic andmentally retarded state. Prof. Kurita, one of leading
clinical researchers of CDD, has conducted diagnostic/nosological studies on CDD or its synonym, disintegrative psychosis (DP), in comparison with autismthat could show similar yet much milder regression
than CDD/DP. Those studies contributed to the adoption of CDD as a type of pervasive developmental disorders (PDD) in the two international diagnostic systems: the Diagnostic and Statistical Manual of Mental
Disorders 4th edition (DSM-IV) (American Psychiatric
Association, 1994) and the International Classificationof Diseases and Related Health Problems 10the revision (ICD-10) (World Health Organization, 1993).
(b) Child and adolescent mental health (17-24)
We conducted studies aiming at clarifying theprevalence of behavior and emotional problems in
Chinese children and their risk factors by using a
Chinese version of the Child Behavior Checklist(CBCL) in collaboration with the Department of
Psychiatry, Shandong Medical School, China. The
studies participated by about 3,000 children and adolescents and their parents and teachers in Shandong
province yielded a series of outstanding papers. The
findings in those studies would contribute to the promotion of mental health of Chinese children and adolescents.
(c) Mental health services (25-34)
Studies in this area clarified present status andchallenges of mental health services: service systems(26, 27, 30, 33); evaluation of services (28, 32, 34); andmental health problems in professionals (29, 31).
(d) Geriatric psychiatry/mental health (35-42)
Studies in this area clarified early neuropsychological deficits of patients with dementia (37, 38); pathophysiology of Alzheimer’s disease (35, 40, 41); mental
health problems of the elderly (39); and mental healthof caregivers of patients with dementia (36, 42).
(e) Social psychiatry/community mental health(43-46)This area involves studies on alcohol dependency(43), mental health problems of sexual harassment
victims (44), and supporting patients with schizophrenia (45, 46).

Current Research(a) Screening pervasive developmental disorders
Pervasive developmental disorders (PDD) are agroup of autistic conditions adopted in the current
international classification systems of mental disorders, DSM-IV and ICD-10. The prevalence of PDD wasrecently reported as high as 0.6%.
The early detection of PDD is important, since
early intervention is suggested as effective in ameliorating autistic symptoms and facilitating developmentof children with PDD even if the cure is not possible.
For early detection of PDD, we developed a Japaneseversion of CHAT (Checklist for Autism in Toddlers), a
promising screening tool for PDD developed in UK,
and are now gathering clinical data. We also used theTokyo Autistic Behavior Scale (TABS) developed by us
and the Infant Behavior Checklist (IBC), both of whichrate autistic behavior in infancy, in the same clinicalfields as the CHAT data are gathered to collect data on
early features of PDD. Based on these data, we areplanning to develop an efficient screening system for
PDD.
(b) Early development of high-functioning PDD
High-functioning PDD (HPDD) is a PDD with an
IQ over 70 (i.e., not mentally retarded). Although such
PDD was considered rare until late 1980s, more than
50% of PDD patients are now suggested to be HPDD.
However, social and vocational outcomes of HPDD
patients are quite unsatisfactory due to a lack of adequate programs for their education and social adaptation. It is quite unknown how HPDD differs frommentally retarded PDD in early developmental characteristics. Since such features would help early identification of HPDD among PDD, we are now gathering
relevant data in young PDD children by using theTABS, IBC and other scales.
(c) Adult outcomes of PDD patients
PDD is a life-long condition but its adult outcomesare still unclear, since many of long-term outcome
studies of PDD were conducted before 1990, when
remedial education and social support systems were
not well established. Since we have one of the largest
data bases on PDD in the world and have followed-up
a large number (more than 150) of adult PDD patients(over age 20). We are now conducting a comparative
study of adult outcomes between autistic disorder(prototypical PDD) and other PDD. We are also planning a study to clarify prognostic factors of adult outcomes of PDD.
(d) Difference and similarity of high-functioning
PDD and attention deficit/hyperactivity disorder(ADHD)In clinical settings, it is frequently difficult to differentiate between high-functioning PDD (HPDD) and
ADHD, though difference in treatment does exist
between them. We are now conducting a comparative299

study between HPDD and ADHD to identify clinicalvariables to differentiate between both conditions.

Future Prospects
The most important thing for the department in
the foreseeable future is to facilitate research activities
on mental health more intensively and extensively incollaboration with researchers in and outside Japan.
Since the current professor will retire in 2 years fromnow and in view of the diversity and broadness of the
field of mental health, it is difficult to prospect fixedresearch themes in the future. However, it is crucially
important to have a world-class clinical researcher
who can perform excellent studies on mental healthin his/her own specialty and educate graduate students based on those research activities. Such a person would come from any specialty relating to mental
health.
It is also important to facilitate psychiatric nursing
studies in collaboration with the Department of
Psychiatric Nursing established in 1997, which has
published many quality Japanese papers based on its
clinical studies and is now concentrating to publish
English papers. Since many graduate students haveparticipated in research projects in both departments,
it is productive to continue the close collaboration of
the two departments in clinical studies.

Research Grants (for the past 5 years)
1. The Research Grant (8B-3) for Nervous and Mental
Disorders (the Ministry of Health and Welfare).
Title: The study on pathophysiology and treatment
of disorders of behavioral, emotional and psychological development from infancy to adolescence. Term:
1996-1998. Head investigator: Hiroshi Kurita, MD
2. Grant-in-Aid for Scientific Research (C) (2) (theMinistry of Education, Science, Sports and Culture).
Title: A clinical study on symptoms, development
and course of childhood disintegrative disorders.
Term: 1997 to 2000. Head investigator: Hiroshi
Kurita, MD
3. Grant-in-Aid (11A-6) for Research on Nervous andMental Disorders (the Ministry of Health, Labourand Welfare). Title: A study on the relationshipbetween attention-deficit/hyperactivity disorder andpervasive developmental disorders. Term: 19992001. Investigator: Hiroshi Kurita, MD
4. Grant-in-Aid for Scientific Research (C) (2) (theMinistry of Education, Culture, Sports, Science andTechnology). Title: A nosological and diagnostic
study on other pervasive developmental disorders.
Term: 2001 to 2003. Head investigator: Hiroshi
Kurita, MD
5. Grant-in-Aid (14A-8) for Research on Nervous andMental Disorders (the Ministry of Health, Labourand Welfare). Title: A study on the difference and300

similarity of attention-deficit/hyperactivity disorderand pervasive developmental disorders. Term: 20022004. Investigator: Hiroshi Kurita, MD

Select Publications(a) Developmental disorders
1. Kurita H. Infantile autism with speech loss before
the age of thirty months. Journal of the American
Academy of Child Psychiatry 24, 191-196, 1985.
2. Kurita H, Uchiyama T and Takesada M. Tokyo Child
Development Schedule. I. Test-retest reliability andconcurrent validity. Folia Psychiatrica et Neurologica
Japonica 39, 129-138, 1985.
3. Kurita H. Variables relating to the mental development of children with infantile autism. Japanese
Journal of Psychiatry and Neurology 40, 161-168,
1986.
4. Kurita H. A case of Heller’s syndrome with school
refusal. Journal of Autism and Developmental
Disorders 18, 315-319, 1988.
5. Kurita H. The concept and nosology of Heller’s syndrome: Review of articles and report of two cases.
Japanese Journal of Psychiatry and Neurology 42,785-793, 1988.
6. Kurita H, Miyake Y and Katsuno K. Reliability andvalidity of the Childhood Autism Rating Scale—Tokyo Version (CARS-TV). Journal of Autism andDevelopmental Disorders 19, 389-396, 1989.
7. Kurita H and Miyake Y. The reliability and validity of
the Tokyo Autistic Behavior Scale. Japanese Journalof Psychiatry and Neurology 44, 25-32, 1990.
8. Kurita H. School refusal in pervasive developmental
disorders. Journal of Autism and Developmental
Disorders 21, 1-15, 1991.
9. Kurita H, Kita M and Miyake Y. A comparative studyof development and symptoms among disintegrative
psychosis and infantile autism with and without
speech loss. Journal of Autism and Developmental
Disorders 22, 175-188, 1992.
10. Kurita H, Shiiya J and Ito H. A nationwide survey of
day-care for children with mental retardation in
Japan. Japanese Journal of Psychiatry and Neurology
48, 57-63, 1994.
11. Kurita H and Nakayasu N. An autistic male presenting seasonal affective disorder (SAD) and trichotillomania. Journal of Autism and Developmental
Disorders 24, 687-692, 1994.
12. Kurita H, Saito T and Kita M. Regression in mental
development following a psychosocial stressor in disintegrative psychosis. Shimizu M (Ed.). Recent
Progress in Child and Adolescent Psychiatry, pp.2128, Springer, 1996.
13. Kurita H. Specificity and developmental consequences of speech loss in children with pervasive
developmental disorders. Psychiatry and Clinical
Neurosciences 50, 181-184, 1996.

14. Kurita H. A comparative study of Asperger syndrome
with high-functioning atypical autism. Psychiatry
and Clinical Neurosciences 51, 67-70, 1997.
15. Kurita H. Delusional disorder in a male adolescentwith high-functioning PDDNOS. Journal of Autism
and Developmental Disorders, 29:419-423, 1999.
16. Tachimori H, Osada H, Kurita H. Childhood Autism
Rating Scale--Tokyo version (CARS-TV) for screening
pervasive developmental disorders (PDD). Psychiatry
and Clinical Neurosciences (in press).

(b) Child and adolescent mental health
17. Liu XC, Ma DD, Kurita H and Tang MQ. Self-reported depressive symptoms among Chinese adolescents.
Social Psychiatry and Psychiatric Epidemiology 34,
44-47, 1999.
18. Mori M. The influence of father-daughter relationship and girl’s sex-roles on girl’s self-esteem.
Archives of Women’s Mental Health 2, 45-47, 1999.
19. Liu XC, Kurita H, Guo CQ, Miyake Y, Ze J and Cao
HL. Prevalence and risk factors of behavioral andemotional problems among Chinese children aged 611. Journal of the American Academy of Child andAdolescent Psychiatry 38, 708-715, 1999.
20. Liu XC, Kurita H, Sun ZX and Wang FX. Risk factorsof psychopathology among Chinese children.
Psychiatry and Clinical Neurosciences 53, 497-503,
1999.
21. Liu XC, Uchiyama M, Okawa M and Kurita H.
Prevalence and correlates of self-reported sleep problems among Chinese adolescents. Sleep 23, 27-34,
2000.
22. Liu XC, Kurita H, Guo CQ, Tachimori H, Ze J andOkawa M. Behavioral and emotional problems in
Chinese children: Teacher reports for ages 6 to 11.
Journal of Child Psychology and Psychiatry 41, 253260, 2000.
23. Liu XC, Guo CQ, Okawa M, Zhai J, Li Y, Uchiyama
M, Neiderhiser JM and Kurita H. Behavioral andemotional problems in Chinese children of divorced
parents. Journal of the American Academy of Childand Adolescent Psychiatry 39, 896-903, 2000.
24. Liu XC, Kurita H, Uchiyama M, Okawa M, Liu LQ
and Ma DD. Life events, locus of control, and behavioral problems among Chinese adolescents. Journalof Clinical Psychology 56, 1565-1577, 2000.
(c) Mental health services
25. Kumakura N, Ito H, Mori T, Saito T, Kurisu E, Asaka
A, Sasaki Y, Rhi B, Kim Y, Ha K, Rin H and Yang LY.
Attitudes change towards mental illness during nursing education: A cross-cultural study of student nurses in Korea, Republic of China and Japan. Asia-Pacific
Journal of Public Health 6, 120-125, 1992/1993.
26. Ito H, Mori T, Kumagai N, Miyauchi M, Harada S,
Yamamura M, Nakano R, Kurita H and Sasaki Y.
Changing pattern of mental health utilization in the
Hachijojima. Psychiatry and Clinical Neurosciences49, 185-187, 1995.

27. Ito H, Kishi Y and Kurosawa H. A preliminary studyof staff perception of psychiatric services in general
hospitals. General Hospital Psychiatry 21, 57-61,
1999.
28. Ito H, Shingai N, Yamazumi S, Sawa Y and Iwasaki S.
Characteristics of nonresponders to a patient satisfaction survey at discharge from psychiatric hospitals. Psychiatric Services 50, 410-412, 1999.
29. Ito H, Kurita H and Shiiya J. Burnout among directcare staff members of facilities for persons with mental retardation in Japan. Mental Retardation 37, 477481, 1999.
30. Ito H, Eisen SV, Sederer LI and Tachimori H.
Involuntary admission in Japanese psychiatric hospitals. International Medical Journal 7, 109-112, 2000.
31. Ito H, Eisen SV, Sederer LI, Yamada O andTachimori H. Factors affecting psychiatric nurses’
intention to leave their current job. PsychiatricServices 52, 232-234, 2001.
32. Ito H, Tachimori H, Miyamoto Y and Morimura Y.
Are the care levels of people with dementia correctly
assessed for eligibility of the Japanese long-term careinsurance? International Journal of Geriatric
Psychiatry 16, 1078-1084, 2001.
33. Ito H, Eisen SV and Sederer LI. Acute care psychiatryat McLean Hospital, Massachusetts. International
Medical Journal 8, 91-96, 2001.
34. Ito H and Sederer LI. Are publicly-insured psychiatricoutpatients in Japan satisfied? Health Policy 56, 205213, 2001.

(e) Geriatric psychiatry/mental health
35. Dai XY, Nanko S, Hattori M, Fukuda R, Nagata K,
Isse K, Ueki A and Kazamatsuri H. Association of
apolipoprotein E4 with sporadic Alzheimer’s diseaseis more pronounced in early onset type.
Neuroscience Letters 175, 74-76, 1994.
36. Matsuda O. The effect of coping on the caregiver of
elderly patients with dementia. Psychiatry andClinical Neurosciences 49, 209-212, 1995.
37. Matsuda O, Saito M and Sugishita M. Cognitive
deficits of mild dementia: A comparison between
dementia of the Alzheimer’s type and vasculardementia. Psychiatry and Clinical Neurosciences 52,
87-91, 1998.
38. Matsuda O and Saito M. Features of Alzheimer’s disease: Crystallized and fluid intelligence in elderly
patients with mild dementia of the Alzheimer type.
International Psychogeriatrics 10, 147-154, 1998.
39. Hashimoto K, Kurita H, Hratani T, Fujii K and
Ishibashi T. Direct and buffering effects of social
support on depressive symptoms of the elderly withhome help. Psychiatry and Clinical Neurosciences 53,
95-100, 1999.
40. Asada T, Motonaga T, Yamagata Z, Uno M and
Takahashi K. Association between retrospectively
recalled napping behavior and later development of
Alzheimer’s disease: Association with APOE genotypes. Sleep 23, 629-634, 2000.

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41. Asada T, Motonaga T and Kinoshita T. Predictors ofseverity of behavioral disturbance among community-dwelling elderly individuals with Alzheimer’s disease: A 6-year follow-up study. Psychiatry andClinical Neurosciences 54, 673-677, 2000.
42. Miyamoto Y, Ito H, Otsuka T, Kurita H. Caregiverburden in mobile and non-mobile demented
patients: A comparative study. International Journalof Geriatric Psychiatry 17, 765-773, 2002.

(d) Social psychiatry/community mental health43. Matsuoka K, Kim Y, Toshida S and Oshima N.
Relationship between age of onset, antisocial history
and general psychopathological traits in Japanese
alcoholics. Psychiatry and Clinical Neurosciences 54,
413-417, 2000.
44. Matsuoka K, Kurita H, Abe R and Osada H. Mental
health of sexual harassment victims in Japanesenurses. Archives of Women’s Mental Health 4, 1-4,
2001.
45. Kayama M, Zerwech J, Thornton K and Murashima
S. Japanese expert public health nurses empower
clients with schizophrenia living in the community.
Journal of Psychosocial Nursing and Mental HealthServices 39, 40-45, 2001.
46. Oshima I, Ito J, Taira N. Need for an integrated program of case management and pychoeducation inlong stay psychiatric patients in Japan. Kashima H,
Falloon IRH, Mizuno M and Asai M. (eds).
Comprehensive Treatment of Schizophrenia: Linking
neurobehavioral findings to psychosocial approaches.
Springer, Tokyo, pp.196-203, 2002.

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Department Of
Social Gerontology
Outline And Research Objectives
It is often voiced from the general public that recent advancement of medicinal technology would not necessarily lead to the happiness of people: Life prolongation technology
enables even the terminally ill to live for a considerable period. How to use the technology
is a serious problem in clinical practice. Also, there is evidence that the prolongation of life
expectancy for the elderly does not mean the prolongation of health and productivity, butthat of morbidity.
Taking another example, we are experiencing ethical dilemmas with the application of
medical technology such as genetic screenings and organ transplantation. When we turn to
the worldwide situation regarding health, we will find poverty and unequal distribution interms of health resources and outcomes.
The department is studying these health-related problems from psycho-social-ethicalperspectives, many of which are often difficult to decide upon. Major topics include elderly
health, cancer and/or terminal care, international health and bio-medical ethics among others. We are currently conducting several research projects as described below.

Faculties and Students
Professor and Chair

Ichiro Kai, M.D., M.P.H. (since
1997)
Associate Professor and Lecturer None
Associate .................................2
Visiting Researcher ...............22
Graduate student ..................18
Research student.....................3

Past Research And Major Accomplishments
1. Elderly HealthThis is the major field of interest of our department. Several most important researches will bebriefly described.
1) Psychotic manifestations of the demented elderly and their relationship with caretakers
We examined the correlation between the psychotic symptoms of the demented elderly and theirrelationship with caretakers. We developed a scalemeasuring the relationship (CPR Scale), and conductedsurvey in three culturally different areas, Tokyo,
Nagano and Okinawa. We found the better relationship indicated by higher CPR score led to less psychotic symptoms. The results suggest that the psychotic
manifestations of dementia can be influenced by environmental factors. (References 2-5, 12,17)2) Functional capacity and active life expectancy(ALE) of the elderly
The health status of a population is traditionallymeasured by mortality. However, indices based on
mortality are increasingly unsatisfactory to assess
health status, especially in an aging society. We conducted survey on functional capacity of the elderly
and its chronological changes, using a large-scalecohort of the community residents in Nagano
Prefecture. We calculated active life expectancy (ALE)and suggested it could be a useful health indicator for
elderly population. (References 16,18, 37-38, 46)3) Reciprocity of social support on subjective
well-being of the elderly
Traditional support study emphasizes the importance of receiving support. We examined the patternof support exchange (i.e., receiving and providing) andits effects on the subjective well-being of the elderly inrural Japan as well as a number of Asian countries
such as Korea, Malaysia and Indonesia. In Korea, both
receiving and providing support correlated to better
subjective well-being, while only providing did inJapan. We concluded the meaning of receiving support
were different between the two cultures. The findings
led to further intervention study, as described later inthis document. (References 23, 41-42)
4) Long-term care of the elderly
Long-term care of the elderly becomes increasingly
important medical/welfare issue in Japan. Geriatricintermediate care facilities (GICFs) were established in1986 to facilitate discharge from hospitals and sup-303

port home care. Since then, we have conducted surveys on how the GICFs were used in Japan, and proposed the policy for their effective utilization.
(References 20, 22, 39)
2. Cancer Care and Terminal Care
We conducted several surveys on cancer/terminal
care with special emphasis on psycho-social and quality of life (QOL) aspects. We emphasize the importanceof effective communication between patients andhealth care providers. Recently, we are interested insocio-cultural aspects of sexuality after cancer therapy.
The latter is partly supported by Grant-in-Aid for
Scientific Research from Japanese Society for
Promotion of Science (JSPS). (References 14, 19, 24,
34, 36, 40)
3. International Health
The majority of the studies regarding international
health were done while I was affiliated with
Department of International Community Health,
School of International Health, from 1992 to 1997.
We were particularly interested the prevention of
AIDS in Japan and the other countries in Asia.
(References 10-11, 13, 15, 25, 28-29)
4. Bio-medical Ethics
The majority of the studies regarding bio-medical
ethics were done in collaboration with Prof. Akira
Akabayashi, who was a lecturer of our department
and is now the chair of Department of Health
Economics. Most studies are questionnaire surveys,
and the topics include the ethics education in medical
schools and the role of ethics committees among others. (References 21, 26-27, 31, 33, 35, 43-44)

Current ResearchTwo of the ongoing research projects of the department will be described below.
1. Intervention Study on Social Support Exchange
Our previous study suggests that providing support to spouse, children and friends is important topromote the subjective well-being of the elderly. We
devised an intergenerational program involving theelderly and college students. The intervention was
basically an interview in which the elderly were supposed to help the college students by telling their life
history to the students and, in turn, were benefitedby the interview. We found the majority of outcome
indices such as life satisfaction and the attitudes
toward young generation had improved considerably
after the intervention. This study was partly supported by Grant-in-Aid for Scientific Research from JSPS.

304

2. Frequency of Going Outside and Risk ofFunctional Decline among the Frail Elderly
To be house-bound is hypothesized to heighten
the risk of functional and intellectual deterioration
among the frail elderly. We followed up a cohort of
the frail elderly in Nagano Prefecture, and examined
the relationship between the frequency of going outside home and various physical and psychological outcomes indices. Even after controlling a number of confounding factors, going outside home was shown toinversely correlate to deterioration in physical andpsychological health one-year later. These findings
suggest the importance of preventing house-boundstatus of the frail elderly. Subsequently, we are conducting an intervention study involving home visitingby public health nurses. This study is partly supported by Grant-in-Aid for Longevity Study from Ministryof Health, Labor and Welfare and Mitsubishi
Foundation.

Future Prospects
Two of the possibly important research fields forour department will be briefly mentioned below.
1. Study on Successful Aging and Productivity
Successful aging is an important concept in thefield of contemporary gerontology. One of the key factors to enable successful aging is productivity. We
plan to conduct survey on productivity includingsalaried work, household work and volunteer, and its
relationship with the health of the elderly. Large-scaleintervention study on prosocial behaviors by the elderly (e.g., providing support to others) will be done aswell.
2. Effective Policy for Long-term Care
Since the establishment of Long-term Care
Insurance (LCI) in 2000, care of the frail elderly has
become important social issue. In future, we plan toput more emphasis on practical aspects and policy
issues in social gerontology. We plan to conduct alarge-scale survey on LCI users in Tokyo Metropolitan
Area and make recommendations on the policy for
effective long-term care in Japan.

Research Grants
1. Intervention study on social support exchange: Anintergenerational program involving the elderly andhigh school students. Grant-in-Aid for Scientific
Research (KAKENHI) from JSPS (three years from1998 to 2001) 2.8 million yen
2. Change and its related factors in sexuality forpatients experiencing breast cancer surgery. Grant-

in-Aid for Scientific Research (KAKENHI) from JSPS
(three year from 2000 to 2003) 3 million yen
3. Frequency of going outside home and functional
decline among the frail elderly. Grant-in-Aid forLongevity Study (KAKENHI) from Ministry of
Health, Labor and Welfare (three years from 2000 to2003) 5.35 million yen
4. Effectiveness of a home visiting program for thehouse-bound elderly. Mitsubishi Foundation (twoyears from 2001 to 2003) 2 million yen
5. Predictors for frailty and/or mortality among therural elderly. Daiwa Health Foundation (one year
from 2001 to 2002) 1 million yen

Select Publications(1) Original Articles
1. Kai I, Inaba Y: Statistical analysis on large-scale foodpoisoning outbreaks of unknown etiology. Food
Hygiene Study 29(12):1031-1040, 1979 (in Japanese)
2. Ohi G, Miyama T, Kai I, et al.: Psychotic manifestations in the bedfast elderly: The role of intellectual
impairment and environmental stress. Jap. J.
Gerontology 6(2):124-138, 1984 (in Japanese)
3. Kai I, Ohi G, Suzuki S: Applicability of Hasegawa’s
Dementia Rating Scale in rural areas in Japan:
Comparative study in Tokyo and Okinawa.
Gerontological Psychiatry 2(2):293-298, 1985 (inJapanese)
4. Ichikawa S, Nakagawa M, Ohi G, et al.: Developmentof caretaker-patient relationship assessment scale forthe frail elderly. Jap. J. Public Health 32(5):253-257,
1985 (in Japanese)
5. Miyama T, Suzuki S, Ohi G, et al.: Psychotic manifestations in the elderly with intellectual impairment:
Influence of the degree of their intellectual deterioration and caretaker-patient relationship. Jap. J. Public
Health 32(7):325-332, 1985 (in Japanese)
6. Nagahashi M, Yamazaki N, Ohi G, et al.: Dietary fiber
intake and diverticular disease of the colon: A casecontrol study. Jap. J. Hygiene 40(4):781-788, 1985 (inJapanese)
7. Takenaga N, Kai I, Ohi G: Evaluation of three cervicalcancer detection programs in Japan with special reference to cost-benefit analysis. Cancer 55(10):25142519, 1985
8. Yamaoka K, Ohi G, Miyama T, et al.: Burden of caretakers of the bedridden elderly: Development of aunidimensional scale. Jap. J. Public Health 33(6):279284, 1986 (in Japanese)
9. Ohi G, Hasegawa T, Kumano H, et al.: Why are cadaveric renal transplants so hard to find in Japan?: Ananalysis of economic and attitudinal aspects. Health
Policy 6:269-278, 1986
10. Ohi G, Kai I, Kobayashi Y, et al.: Epidemic potentialof AIDS and health policy in Japan. Jap. J. Public
Health 34(2):49-54, 1987 (in Japanese)
11. Kai I, Ohi G: Infectious disease specialists in academeand AIDS epidemics: Comparison of specialists inpublic health and clinical medicine. Jap. J. Public
Health 34(4):195-198, 1987 (in Japanese)
12. Takenaga N, Kai I, Ohi G, et al.: The caretakerpatient relationship and psychotic manifestations in
the bedridden elderly. Jap. J. Hygiene 42(2):563-569,
1987 (in Japanese)
13. Ohi G, Kai I, Kobayashi Y, et al.: AIDS prevention in
Japan and its cost-benefit aspects. Health Policy 8:1727, 1987
14. Kobayashi Y, Yamaoka K, Ohi G, et al.: The economic
analysis of home and hospital care for terminally illpatients. Jap. J. Public Health 35(1):11-18, 1988 (inJapanese)
15. Ohi G, Terao H, Hasegawa T, et al.: Notification of
HIV carriers: Possible effect on uptake of AIDS testing. Lancet II:947-949, 1988
16. Kobayashi Y, Kai I, Ohi G, et al.: A study on instrumental activities of daily living and its related factors
in the elderly in the farming community. Jap. J.
Public Health 36(4):243-249, 1989 (in Japanese)
17. Ohi G, Kai I, Ichikawa S, et al.: Psychotic manifestations in the bed-fast elderly: A preliminary communication. J. Human Ergology 18:237-240, 1989
18. Kai I, Ohi G, Kobayashi Y, et al.: Quality of life: A
possible health index for the elderly. Asia-Pacific J.
Public Health 5(3):221-227, 1991
19. Kai I, Ohi G, Yano E, et al.: Communication between
patients and physicians about terminal care: A survey in Japan. Soc. Sci. & Med. 36(9):1151-1159, 1993
20. Ishizaki T, Kai I, Hirayama T: Factors influencing
users’ destination upon discharge from a geriatricintermediate care facility in an urban area. Jap. J.
Geriatrics 32(2):105-110, 1995 (in Japanese)
21. Nishimura T, Miyasaka M, Akabayashi A, et al.: The
development of evaluation method for bioethics education in Japan: A questionnaire for measuring the
ethical problem identification ability. Bioethics
5(1):73-77, 1995 (in Japanese)
22. Ishizaki T, Kai I, Hisata M, et al.: Factors influencing
users’ return home on discharge from a geriatricintermediate care facility in Japan. J. Am. GeriatricSoc. 43(6):623-626, 1995
23. Kim HK, Lee SK, Hisata M, et al.: Social support
exchange and quality of life among the Korean elderly in a rural area. Jap. J. Public Health 43(1):37-49,
1996 (in Japanese)
24. Hisata M, Okazaki N, Kai I, et al.: Attitudes of outpatients toward informed consent in cancer treatment.
J. Jap. Soc. Cancer Therapy 31(3):171-185, 1996 (inJapanese)
25. Ohi G, Uemura I, Akabayashi A, et al.: Preventive
behaviors against HIV transmission adopted by
Japanese commercial sex workers (CSWs). Environ.
Health & Prev. Med. 2(3):132-134, 1997
26. Akabayashi A, Kai I, Itoh K, et al.: The acceptabilityof advance directive in Japanese society: A questionnaire study for healthy people in the physical checkup settings. Bioethics 7(1):31-40, 1997 (in Japanese)
27. Fukatsu N, Akabayashi A, Kai I: The current statusof ethics committees and decision making proce-305

dures in general hospitals in Japan. Bioethics
7(1):130-136, 1997 (in Japanese)
28. Nishimura-Takahashi T, Akabayashi A, Kai I, et al.:Social and behavioral factors associated with condom
use among female commercial sex workers (CSWs)
in Tarlac, the Philippines. Environ. Health & Prev.
Med. 2(4):167-171, 1998
29. Takai A, Wongkhomthong S, Akabayashi A, et al.:Correlation between history of contact with people
living with HIV/AIDS (PWAs) and tolerant attitudes
toward HIV/AIDS and PWAs in rural Thailand.
International J. STD & AIDS 9(8):482-484, 1998
30. Honda T, Kai I, Ohi G: Fat and dietary fiber intake
and colon cancer mortality: A chronological comparison between Japan and the US. Nutr. & Cancer
33(1):95-99, 1999
31. Akabayashi A, Miyasaka M, Kai I, et al.: Survey of
medical ethics education in Japanese medical
schools. Med. Education 30(1):47-53, 1999 (inJapanese)
32. Yokokawa Y, Kai I, Nakajima T: Development of a
“Self Efficacy for Health Promotion Scale” in community-dwelling elderly. Jap. J. Public Health 46(2):103112, 1999 (in Japanese)
33. Akabayashi A, Kai I: Study of 5th-year medical students interest in medical ethics and related factors.
Med. Education 30(2):77-82, 1999 (in Japanese)
34. Akabayashi A, Kai I, Takemura H, et al.: Truth
telling in the case of a pessimistic diagnosis in Japan.
Lancet 354(9186):1263, 1999
35. Miyasaka M, Akabayashi A, Kai I, et al.: Teaching
medical ethics: An international survey of medical
ethics curricula in Asia. J. Med. Ethics 25(6):514-521,
1999
36. Takahashi M, Kai I, Akabayashi A, et al.: Whoshould meet the needs of breast cancer patients?: Aquestionnaire survey of Japanese surgeons. Jap. J.
Breast Cancer 14(4):495-502, 1999 (in Japanese)
37. Ishizaki T, Kai I, Kobayashi Y: Estimation of active
life expectancy by Katz method: The results from
Saku Cohort Study. Health Indices 46(4):23-27, 1999
(in Japanese)
38. Ishizaki T, Kobayashi Y, Kai I: Functional transition
in instrumental activities of daily living among older
Japanese. J. Epidemiol. 10(4):249-254, 2000
39. Ishizaki T, Kai I: Risk of acute hospitalization among
long-term care patients. Jap. J. Geriatrics 37(6):472478, 2000 (in Japanese)
40. Watanabe Y, Akabayashi A, Ikeda T, et al.: An analysis of CPR decision-making by middle-aged and elderly healthy people in Japan. Bioethics 10(1):111-119,
2000 (in Japanese)
41. Kim HK, Kai I, Hisata M, et al.: Social support
exchange and subjective well-being among theJapanese elderly in a rural area. Jap. J. Gerontology
22(3):395-403, 2000 (in Japanese)
42. Kim HK, Hisata M, Kai I, et al.: Social support
exchange and quality of life among the Korean elderly. J. Cross-Cultural Gerontology 15(4):331-347, 2000

306

43. Watanabe Y, Kai I, Akabayashi A: Attitude of generalpublic toward genetic testing for colon cancer.
Bioethics 12:32-40, 2001 (in Japanese)
44. Akizuki Y, Kai I, Akabayashi A: Attitudes of the general public toward artificial insemination by donor.
Bioethics 12:62-70, 2001 (in Japanese)
45. Ohta M, Kai I: The development of a filial responsibility scale. Jap. J. Social Welfare 42(2):130-7, 2002
(in Japanese)
46. Ishizaki T. Kai I, Kobayashi Y, et al.: Functional transitions and active life expectancy for older Japaneseliving in a community. Arch. Gerontology &Geriatrics 35(2):107-119, 2002

(2) Other Papers (Books And Proceedings In English)
47. Ohi G, Kai I, Terao H, et al.: Cost-benefit aspects of
AIDS prevention programs: Its limitation in policy
making. in Fleming AF, et al. (eds.): The Global
Impact of AIDS , Alan R. Liss, Inc. (New York),
pp.251-262, 1988
48. Ohi G, Hisata M, Kai I: High-rise living and the elderly. in Takano T (ed.): Urban Health, Kyoiku Syoseki(Tokyo), pp.7-13, 1993
49. Ishizaki T, Kai I, Hisata M, et al.: Factors influencing
users’ destination upon discharge from a geriatricintermediate care facility. in Beregi E, et al. (eds.):
Recent Advances in Aging Science, Monduzzi Editore(Bologna), pp.2193-2196, 1993
50. Kai I.: Active life expectancy and its correlates among
the elderly living in a rural community in Japan. in
Hisamichi S, et al. (eds.): WHO-CC Monograph No.3
Active (Disability-Free) Life Expectancy , WHOCollaborating Center for Well-being in Aging(Sendai), pp.52-53, 1995

Department of
Health Economics /Health Promotion Sciences /Biomedical Ethics
Outline and Research Objectives
The former Department of Health Administration was established in 1967 and Dr.
Tsuneo Tanaka became its first professor in 1974. He devoted himself to the developmentof the community health care system in Japan and publishes numerous papers concerning
the social theory of health administration and the data management systems for community health care. He also contributed to the establishment of the School of Health Sciences. In
1985, Dr. Atsuaki Gunji became the second professor of the department. During Dr. Gunji’stenure, two major research projects were undertaken. One was “the effects of physical activity and inactivity on health.” From 1990, a 20- day bed rest human experimental study was
conducted in the context of an international cooperative research project that was supported by government grants. The other project concerned health care systems, especiallyhealth care economics and the quality of hospital care.
In 1996, the Department of Health Administration was devided into two departments:
the Department of Health Economics and the Department of Health Promotion Sciences.
Both were established as departments of the Graduate School of Medicine. In 1998, Dr.
Yasuki Kobayashi became professor of the Department of Health Economics. He conducted
research into health care delivery systems in Japan. In 2001, he moved to the Department of
Public Health. Since 1996, Dr. Kiyoshi Kawakubo has been taking charge of the Department
of Health Promotion Sciences.
In June 2002, Dr. Akira Akabayashi (now concurrently at Kyoto University) was appointed as Dr. Kobayashi’s successor. Dr. Akabayashi’s research area is in biomedical ethics and a
new Department of Biomedical Ethics will be officially established in April 2003.

Faculties and Students
Professor and Chair

Akira Akabayashi, M.D., Dr. Med.
Sc., (2002~, concurrently at Kyoto
University)
Associate Professors Kiyoshi Kawakubo, M.D., Dr.
Med. Sc., (1996~)
Associates ...............................1
Postdoctoral Fellows ........none
Graduate Students ..................7
Research Students...................2
Secretaries ...............................3

Past Research and Major Accomplishments
Past research can be divided into two fields, healtheconomics and health promotion sciences. In the fieldof health economics, analysis of terminal care cost for
the aged in a community, analysis of regional differences in medical care costs for the aged and analysis
of hospital care costs and revenues were the main
research topics. About 70% of the regional differences

was accounted for by the overall quantity of medicalcare supplies such as the number of hospital beds.
Other topics were related to the economic aspects ofhealth care and the quality of care. Both supply anddemand analyses were performed on, for example,
hospital costs and patient behavior. Tools for evaluating the quality of hospital care were also developed.
Recent research topics include studies related to either
or both the supply and demand sides of health care in
Japan such as physician distribution, outcomes of theseparation of pharmaceutical dispensing from medical
practice, and patient behavior under Japan’s national
health insurance system. The main research questions
are related to how the health and social systems
shape the health care systems and health itself, andwhat system should be established in order to maintain both efficiency and equity.
The focus of research activities of the Department
of Health Promotion Sciences is on the scientific basisof health promotion, specifically the effects of physical activity and inactivity on health status. Since 1991,
a bed rest study has been performed, involving the307investigation of the effects of simulated microgravity
on cardiovascular and metabolic parameters as well as
on bone density. This is the first bed rest study conducted in Japan. The “Healthy Japan 21“ strategy was
introduced in 2000 by the former Ministry of Healthand Welfare, and the department has devoted part ofits “physical activity and exercise” studies to this strategy. Currently the department is engaged in the development of health promotion strategies for the community and workplace. The assessment of health promotion resources in the community and workplace isthe major concern of these research activities.

Current ResearchWith the establishment of the new department of
Biomedical Ethics in April 2003, the foci of theresearch projects may shift to healthcare ethics andhealth promotion sciences (behavioral science).
Research in the field of health economics will also be
performed in close relationship with the Departmentof Public Health (chaired by Dr. Y. Kobayashi). The
research projects being conducted mainly by Dr.
Akabayashi are described below.
Grant-supported research projects (within 5
years)
1. Study of the methods for the formation of social
consensus related to advanced medical technology. The purposes of this project are: 1) to clarify
ethical, legal, and social issues related to theimplementation of new medical technology, and2) to explore methods for the formation of social
consensus and policy. This project includes thetheoretical aspects of social consensus, historicalcase analysis of organ transplantation and genetherapy in Japan, and three nationwide surveys.
Supported by the Special Coordination Fund for
Promoting Science and Technology, The Ministryof Education, Culture, Sports, Science andTechnology.
2. Publication of a medical ethics case book forJapan. The purpose of this project is to collectillustrative cases of ethical issues and to produce acasebook for the field of medical ethics in Japan,
which is hoped to become a standard textbook for
those who study or teach medical ethics as well asa resource for research. The book is also expected
to help explain current Japanese medical ethics tointerested persons in other countries. Supported
by a Grant-in-Aid for Scientific Research (B), The
Ministry of Education, Science, Sports andCulture.
3. Study of the functions and responsibilities of
ethics committees in Japan. The growing numberof ethics committees (ECs) indicates that signifi-308

cant changes have occurred in the decision making process in the clinical setting in Japan. The
main purposes of this study are:1) to investigate
the current status; 2) to make guidelines for establishing and running an EC in a general hospitalsetting; 3) to explore the extent of discretion andresponsibility of ECs, and 4) to make a comprehensive proposal.. Supported by a Grant-in-Aid for
Scientific Research (C), The Ministry of Education,
Science, Sports and Culture.
4. Comparative study of clinical ethics in the Asian
region. The purpose of this project is to engenderongoing inter and intra regional dialogue,
research, education and development of clinicalethics throughout the Asian region. Specifically,
this project will focus on issues that stem from thenature of the clinician-patient relationship, such as
how information is shared (informed consent,delivering bad news, role of the family, etc.), competence or decision-making capacity, confidentiality, and end-of-life decision making. The results
obtained through this preliminary study will be
used as the basis for a comprehensive study..
Supported by a Grant-in-Aid for Scientific
Research (C), The Ministry of Education, Science,Sports and Culture.
5. Others: Other research activities include research
into the acceptability of advance directives inJapan (a grant from the Ministry of Education in
1996-1997), the development of evaluation methods for biomedical ethics education (a grant from
the Ministry of Education in 1995-1996), and theethical and psycho-social aspects of living related
liver transplantation.

Future Prospects
Modern biomedical ethics in Japan has emerged asa new medical field and many medical schools are
establishing relevant departments or units. As long as
this discipline remains in the medical arena, it needs
to deal with both theoretical and practical issues.
Even though this discipline has not been fully established yet, many issues have already arisen. It is clearthat the focus will have to be on the development ofbasic teaching and research methods that can garnerthe support of both the medical community and society in general. Ethics committees constitute aninescapable part of the activities related to this discipline. Without sound ethics committees, no research
involving human subjects can be implemented.
Within this departments unit, health economics andbehavioral science make a major contribution to thestudy of biomedical ethics because allocation of healthcare resource is a major topic in healthcare ethics, andbehavioral science is essential for the teaching of com-munication skills with patients and an understandingof patient behavior. In the near future, this departments unit is hoped to become a domestic as well as
an Asian regional center for academic research.

Research Grants (within 5 years)
1. Study of the methods for the formation of social consensus related to advanced medical technology .
Special Coordination Fund for Promoting Scienceand Technology, The Ministry of Education, Culture,
Sports, Science and Technology 2001-2002,¥55,000,000 (PI: Akabayashi, A)
2. Study on the health promotion environmental
indices for the community: The Ministry of Health,
Labor and Welfare, Health Sciences Research Grant,
2000-2001, ¥55,000,000 (PI: Kawakubo, K)
3. Publication of a medical ethics case book for Japan.
Grant-in-Aid for Scientific Research (B), 1998-2000,
The Ministry of Education, Science, Sports andCulture, ¥3,600,000 (PI: Akabayashi, A)
4. Comparative study of clinical ethics in the Asian
region. Grant-in-Aid for Scientific Research (C), 2000,
The Ministry of Education, Science, Sports andCulture, ¥1,200,000 (PI: Akabayashi, A)
5. Study of the functions and responsibilities of ethics
committees in Japan . Grant-in-Aid for Scientific
Research (C), 1997-1999, The Ministry of Education,
Science, Sports and Culture, ¥2,200,000 (PI:Akabayashi, A)

Select Publications
1. Akabayashi A. Euthanasia, assisted suicide, and cessation of life support: Japan’s policy, law, and ananalysis of whistle blowing in two recent mercy
killing cases. Social Science & Medicine 55: 517-527,
2002.
2. Akabayashi A, Nishimori M, Fujita M, Slingsby BT.
Living related liver transplantation: a Japanese experience and development of a checklist for donor’s
informed consent. Gut 51: 2002 (in press)
3. Akabayashi A, Slingsby BT, Voltz R. Advance
Directives. In Bruera E. eds., Palliative Care in
Neurology Oxford University Press, New York, NY,
2002 (in press).
4. Matsushima T, Akabayashi A, Nishitateno K. The current status of bereavement follow-up in hospice andpalliative care in Japan. Palliative Medicine 16: 151158, 2002.
5. Akabayashi A. “To Intervene?”, “Misrepresenting
Research” (commentary). In Thomasma DC andKushner T eds., Ward Ethics, Cambridge University
Press, NY, pp. 244-247, 249-251, 2001.
6. Akabayashi A, Voltz R. Advance Directives in
Different Cultures. In Portenoy RK and Bruera E eds.,
Topics in Palliative Care vol. 5, Oxford University
Press, New York, NY, pp.107-122, 2001.
7. Lee JS, Kawakubo K, Sato H, Kobayashi Y, Haruna Y.
Relationship between total and regional bone miner-

al density and menopause state, body compositionand life style factors in overweight Japanese women.
Int J Obese 25: 880-886, 2001.
8. Lee JS, Kawakubo K, Kobayashi Y, Mori K, Kashihara
H, Tamura H. Effects of ten year body weight variability on cardiovascular risk factors in Japanese middle-aged men and women. Int J Obese 25: 10631067, 2001.
9. Akabayashi A, Fetters MD. Paying for informed consent. Journal of Medical Ethics 26: 3; 212-214, 2000.
10. Fukusaki C, Kawakubo K, Yamamoto Y. Assessmentof the primary effect of aging on heart rate variability
in humans. Clinical Autonomic Research 10: 123130, 2000.
11. Kashihara H, Ohno H, Tamura M, Kawakubo K,
Gunji A. Risk factors for ischemic heart disease in an
urban area of Japan: a case-control study in AMHTS.
Method Inform Med 39: 223-228, 2000.
12. Ishizaki T, Kobayashi Y, Kai I. Functional transitionsin instrumental activities of daily living among older
Japanese. Journal of Epidemiology 10: 249-254, 2000.
13. Akabayashi A, Kai I, Takemura H, Okazaki H. Truth
telling in the case of a pessimistic diagnosis in Japan.
The Lancet 354;1263, 1999.
14. Akabayashi A, Fetters MD, Elwyn TS. Family consent, communication, and advance directive for cancer disclosure: A Japanese case and discussion.
Journal of Medical Ethics 25 : 4; 296-301, 1999.
15. Miyasaka M, Akabayashi A, Kai I, Ohi G. An international survey of medical ethics curricula in Asia.
Journal of Medical Ethics 25: 6; 514-521, 1999.
16. Voltz R, Akabayashi A, Reese C, Ohi G, Sass HM.
Attitude of health care professionals towards clinicaldecisions in palliative care: A cross-cultural comparison. Journal of Clinical Ethics 10: 4; 309-315, 1999.
17. Akabayashi A. Transplantation from a Brain Dead
Donor in Japan. The Hastings Center Report MayJune 29(3): 48, 1999.
18. Haruna Y, Lee JS, Kawakubo K, Suzuki Y.
Cardiovascular reserve to orthostatic stress in active
living elders. J Gravit Physiol 6: 107-108, 1999.
19. Suzuki Y, Takenaka K, Haruna Y, Akima H,
Fukunaga T, Kawakubo K, Gunji A. Relatively shorter but intensive isotonic exercise in legs prevented
the decrease in maximal aerobic power after 20 daysof head down tilt bed rest in man. J Gravit Physiol 6:
117-118, 1999.
20. Oba M, Kawakubo K, Lee JS, Haruna Y, Suzuki Y,
and Gunji A. Degraded Diet Induced Thermogenesis
Induced by 20-days 6º Head-Down Bed Rest and the
Effect of Resistance Training. J Gravit Physiol 6: 14950, 1999.
21. Akabayashi A. Female circumcision - A health issue
or a human rights issue. Health Care Analysis 6 (1):55-58, 1998.
22. Takai A., Wongkhomthong S, Akabayashi A, Kai I,
Ohi G, Naka K. Correlation between history of contact with people living with HIV/AIDS(PWAs) and
Tolerant Attitudes toward HIV/AIDS and PWAs inrural Thailand. Int J STD and AIDS 9: 482-484, 1998.

309

23. Voltz R, Akabayashi A, Reese C, Ohi G, Sass HM.
End-of-life decisions and advance directives in palliative care: A cross-cultural survey of patients andhealth care professionals. Journal of Pain and
Symptom Management 16: 153-162, 1998.
24. Ohi G, Akabayashi A, Miyasaka M. Japan’s healthcare system as egalitarian: A brief analysis of its history and selected social systems. Health Care
Analysis 6 (2): 141-149, 1998.
25. Nishimura-Takahashi T, Akabayashi A, Kai I,
Cabigon J, Ohi G, Naka K. Social and Behavioral
Factors Associated with condom use among femalecommercial sex workers (CSWs) in Tarlac, thePhilippines. Environmental Health and Preventive
Medicine 2(4): 167-171, 1998.
26. Yanagibori R, Kondo K, Suzuki Y, Kawakubo K,
Iwamoto T, Itakura H, Gunji A. Effect of 20 days’ bed
rest on the reverse cholesterol transport system inhealthy young subjects. J Intern Med 243: 307-312,
1998.
27. Murakami T, Yamada N, Kawakubo K, Oku J,
Mizushima Y, Lino S, Sugimoto T. Lipoprotein
abnormalities in non-insulin dependent diabetic
patients with ischemic heart disease. Artery 22: 206232, 1997.
28. Akabayashi A. Finally done -- Japan’s final decision
on organ transplantation. The Hastings Center
Report Sep-Oct 47, 1997.
29. Akabayashi A. Japan’s parliament passes brain-deathlaw. The Lancet 349: 9069, 1895, 1997.
30. Voltz R, Akabayashi A, Reese C, Ohi G, Saas HM.
Organization and patients’ perception of palliative
care: A crosscultural comparison. Palliative Medicine
11: 351-357, 1997.
31. Gunji. A. Short review of human prolonged horizontal bed rest studies in Japan. J Gravit Physiol 4: S1-9,
1997.
32. Akabayashi A. The concept of happiness in oriental
thought and its significance in clinical medicine. In
Japanese and Western Bioethics , Philosophy &Medicine Series 54, Kluwer Academic Publishers,
Netherlands, pp.161-164, 1997.
33. Akabayashi A. Questions raised over release of sideeffects data in Japan. The Lancet 350: 9071, 124,
1997.
34. Sass H, Bonkovsky F, Akabayashi A, Kielstein R,
Olick RS. Advance Health Care Documents in
Multicultural Perspective. Ann. Rev. of Law andEthics. Band 4, 465-508, 1996.
35. Suzuki Y, Akima H, Igawa S, Fukunaga T, Kawakubo
K, Goto S, Makita Y, Gunji A. Decrease of bone mineral density and muscle and/or strength in the leg
during 20 days horizontal bed rest. J Gravit Physiol
3: 42-43, 1996.
36. Linnarsson D, Sundberg CJ, Tedner B, Haruna Y,
Karemaker JM, Antonutto G, Prampero PE. Bloodpressure and heart rate responses to sudden changesof gravity during exercise. Am.J.Physiol. (Heart Cir.
Physiol. 39): H2132-H2142, 1996.

310

37. Akabayashi A. Financing health care - A Japaneseperspective. Health Care Analysis 3: 123-125, 1995.
38. Akabayashi A. Open letter to those diet members
responsible for legislating Japanese organ transplantation. Health Care Analysis 3: 358-360, 1995.
39. Suzuki Y, Haruna Y, Kuriyama K, Kawakubo K, Igawa
S, Goto S, Makita Y, Gunji A. Effects of 20 days bed
rest on mechanical efficiency during upright cycling
and leg muscle mass in young males. J Gravit Physiol
2: 74-75, 1995.
40. Haruna Y, Suzuki Y, Yanagibori R, Kawakubo K,
Gunji A. Activated renin-angiotensin-aldosterone
system and its effects on cardiovascular system during 20-days horizontal bed rest. J Gravit Physiol 2:
27-28, 1995.
41. Miyashita S, Haruna Y, Suzuki Y, Gunji A. Effects ofposture on cardiorespiratory responses during mild
exercise. J. Phys. The. Sci. 7: 21-25, 1995.
42. Lee JS, Aoki K, Kawakubo K, Gunji A. A study on
indices of body fat distribution for screening for obesity. J Occup Health 37: 9-18,1995.
43. Jeong HS, Gunji A. The influence of system factors
upon the macro-economic efficiency of health care:
implications for the health policies of developing anddeveloped countries. Health Policy 27: 113-40,1994.
44. Koyano W, Hashimoto M, Gunji A, Fukawa T,
Shibata H. The social support system of the Japaneseelderly. Journal of Cross-Cultural Gerontology 9: 32333,1994.
45. Kawakubo K, Gunji A, Sakamoto S, Nakamura F.
Exercise-induced ST segment changes and coronary
risk factors in asymptomatic men. Jpn Heart J 35:
531-532, 1994.
46. Suzuki Y, Kashihara H, Takenaka K, Kawakubo K,
Makita Y, Goto S, Ikawa S, Gunji A. Effects of daily
mild supine exercise on physical performance after
20 days bed rest in young persons. Acta Astronautica
33: 101-11,1994.
47. Bonde-Petersen F, Suzuki Y, Kawakubo K, Gunji A.
Capillary filtration rate, venous compliance, andblood flow in arms and legs do not change during
bed rest for 20 days. J Grav Physiol 1: 27-8, 1994.
48. Suzuki Y, Murakami T, Kawakubo K, Haruna Y,
Takenaka K, Goto S, Makita Y, Igawa S, Gunji A.
Regional changes in muscle mass and strength following 20 days of bed rest, and the effects on orthostatic tolerance capacity in young subjects. J Grav
Physiol 1: 57-8,1994.
49. Akabayashi A, Morioka M. Ethical issues raised by
medical use of brain-dead bodies in the 1990s.
BioLaw II (48): S531-538, 1991.
50. Akabayashi A, Morioka M. Research on dead persons. Ann. Intern. Med. 111 (1): 89, 1989.

Department of Biostatistics /Department of Epidemiology
and Preventive Health Sciences
Outline and Research Objectives
These two departments were established from the department of Biostatistics andEpidemiology in 1996 according to the reorganization of the Graduate School. They are now
jointly managed under the supervision of Prof. Ohashi, who moved to the School in 1990
from the University Hospital Computer Center, the University of Tokyo Hospital. When
Prof. Ohashi moved to the School, the name of the department was ‘Epidemiology’ and thename was changed into the above ‘Department of Biostatistics and Epidemiology’ in 1992
according to the reorganization of the undergraduate and graduate schools and their educational systems. This department was the first official department of biostatistics in Japanese
universities, which shows this interdisciplinary and indispensable specialty field required
for medical research has been neglected in Japanese university educational system. Now
there are three departments of biostatistics; the two others are in Kitasato University (from1999) and Kyoto University (from 2000), respectively. Our department has, as the firstdepartment which can provide comprehensive educational courses in epidemiology and biostatistics from the under-graduate level, brought up and sent many biostatisticians and theoretical epidemiologists to research institutions including Kyoto University, the Ministry of
Health, Labor and Welfare and the National Cancer Center as well as pharmaceutical industry.
(1) Development of statistical-analytical methodology required for medical research including genome data analysis (such as microarray data)(2) Development of methodology of clinical trials including data management(3) Collaborative epidemiological research (JALS Study described later)(4) QOL research(5) Outcome research, pharmacoeconomical and/or pharmacoepidemiological research
The last research project is now conducted in collaboration with the department ofPharmacoepidemiology (established in 1993 with the main support from our department)
and the department of Pharmacoeconomics in the School of Pharmacy. The partnershipwith the Clinical Bioinformatics Educational Unit, which was just established in 2002, will
deepen and expand our research activities especially in the field of clinical epidemiology.

Faculty and Students
Professor and Chair Yasuo Ohashi Ph.D. (1990-)
Associate .................................2
Postdoctoral Fellow ................3
Graduate student7 (doctor) 8 (master)
Research student...................12
Secretary .................................3

Past Research and Major Accomplishments(number in the parenthesis is the paper inthe selected list)
A new methodology of random allocation, the centralized dynamic balancing, was firstly introduced by
Ohashi (in 1988 and (1)) into Japan and implemented
in many clinical fields rather than oncology, the original application field. The possibility of utilizing Web(internet) system for registration/randomization was
firstly (in the world) discussed in (21) and implemented in the UMIN (University Medical Information
Network: one of the largest medical network systemmanaged by the University Hospital Computer
Center). As a statistician, Ohashi participated into
many clinical trials, especially large-scale long-termclinical trials which had been very rare in Japan until
1990 and contributed to the design, conduct andanalysis. Clinical areas include: oncology (37), hematology (25), organ-transplantation, bone-marrowtransplantation (45), infectious diseases (8,38), diabetes, cardiovascular diseases (48), hypercholesterolemia (44), cerebrovascular diseases (10,36), kidney diseases (28), neurological disorders and urology(9,32). These collaborative studies stimulated new
methodological developments in design and analysisof clinical trials. Examples include:311

Fig.1 Clinical Trial Research Model・ Bayesian dose-escalation design in early cancer
clinical trials (29,50)
・ Drug randomization and deliverly system using
network (35)・ Analysis method for investigating institutional differences (27,33,34,47)
・ Analysis method of recurrent events (31)・ Analysis method of bivariate longitudinal data
(23,41)
Consultation is a major mission of biostatisticiansin medical institutions and contributes to new findings in each research area as well as confirming usefulness of statistical methodology and education ofyoung statisticians. Illustrative examples we experienced include:・ Application of time-dependent covariate analysis(2,4,6)・ Application of kernel smoothing (30)・ Application of cluster analysis (5)Ohashi and his colleague conducted several metaanalyses of Japanese original oncology drugs, which
had been widely used in the surgery adjuvant setting
and criticized due to lack of clinical evidence, and provided the data for evaluating the risk-benefit ratio(42). Pharmacoepidemiology is a new active field
explored in collaboration with the department ofPharmacoepidemiology. Besides specific reserches(15,39), we have established the original adverseevents monitoring system (J-PEM) with participationof pharmacists and published the results of pilot studies (40,49). Some pure epidemiological researches
have been conducted by Ohashi and colleagues(19,46), and they are highly evaluated for their rigorous methodology. These experiences lead to a newresearch area, a prospective collaborative meta-analy-

312

sis (JALS) of Japanese representative cohort studies
which is described later.
QOL research is an interdisciplinary area which
requires collaboration with not only care providers
but also other specialists such as psychologists andstatisticians. Ohashi started pioneering works inJapanese oncology area (12,43) as a statistician and arepreparing several papers based on the results of largescale clinical trials in breast cancer and non-small-celllung cancer.

Current Research and Future Prospects
The research objectives described in the earlier
section are pursued in collaboration with inside andoutside researchers as in the past; the recent topics
includes:・ Analysis method for multiple (different type)
events・ Joint modeling of longitudinal data and events・ Analysis method for determining the racial difference in drug responses
・ Method of sample size re-estimation in clinical trials
・ Method of cluster randomization in clinical trials
In addition, new research models emerged recently.
In 2001, Ohashi established a NPO titled Japan
Clinical Research Support Unit (J-CRSU) as a chair-person for・ Support for investigator-initiated clinical researchthrough statistical analysis, data management andquality assurance
・ Educational support of clinical research methodology and biostatistics, especially education of clinical research coordinators (CRC; research nurses)
・ Support for education and dissemination of medical writing and he also started a model projectFig.2 JALS participating cohorts

called Comprehensive Support Project forOncology Research-Breast Cancer (CSPOR-BC) in
the Public Health Research Foundation for・ Planning and conduct of investigator-initiated clinical trials for breast cancer patients
・ QOL research in oncology
・ Education of CRC
・ Information support for breast cancer patients andresearchers/CRC
The research model is described in Fig.1, where
quality control is conducted through the collaboration
between data center located in the NPO and CRC dispatched from site management organizations (SMO)or CRC hired in each institution. For increasing efficacy (reducing cost) and keeping security, remote data
entry system utilizing UMIN and private virtual network system is designed. Three clinical trials on thisscheme are ongoing or will be started by the end of
2002 (2 breast cancer trials (1200 and 2500 patients,
respectively) supported by CSPOR-BC and 1 osteoporosis trial (1800 patients) supported by the similar
project called A-TOP).
One big epidemiological research project called
Japanese Arteriosclerosis Longitudinal Study (JALS)
has started from 2001 supported by the Japanese
Arteriosclerosis Prevention Fund. The objective of
JALS is to conduct a prospective meta-analysis collecting the base-line and follow-up data from individuallyconducted Japanese cohort studies (including thefamous Hisayama cohort) and estimate the gender-age
specific incidence rates of cardiovascular and cerebrovascular events as well as quantify the influence ofvarious risk factors. The operation office is located in
the NPO and we have conducted the standardization

procedures including standardization of blood-pressure measurements, lipid measurements and developments of the common questionnaires for nutrition
intake and physical activities. At present (November,
2002), the cohort size is expected to be 90,000(regional cohorts) and 25,000 (job-office cohorts) as
shown in Fig.2.
All department staffs and students are involved in
the above research activities and these models will
provide new opportunities of collaboration and education not only for inside persons but also outside
researchers and students as well as industry persons.
Recent research topics conducted in these activities include:
・ Development of analytical methodology required
for meta-analysis
・ Validation of physical activity questionnaire using
a newly developed instrument measuring acceleration every 4 seconds
・ QOL and neurotoxicity by chemotherapy in breast
cancer patients・ Epidemiology of postmenopausal symptoms anddepression in breast cancer patients
A variety of research fields are expected to emerge
from mutual stimulation and enlightenment.

Research Grants
11 grant projects from the Ministry of Health, Laborand Welfare and 1 grant project from the Ministry of
Education and Science are ongoing in 2002 including:(1) Establishment of the tailor-made strategy for osteoporosis(2) Mild hypothermia therapy for severe head injuries inhuman: a multicenter randomized control trial

313

(3) Establishment of novel treatment strategy for breast
cancer using cDNA array technology(4) Clinical development of new modality of allogeneic
hematopoietic stem cell transplantation with areduced-intensity regime(5) Study on establishment of clinical trial system of
good quality through cooperative group mechanism

Select Publications (* with reprints)
1. Ohashi Y : Randomization in cancer clinical trials :Permutation test and development of a computer
program. Environmental Health Perspectives; 87: 137., 1990.
2. Funatsu H, Yamashita H, Ohashi Y, Ishigaki T :Correlation between progression of diabetic retinopathy and blood gulcose control. Japanese J.
Ophthalmology; 35: 306-16., 1991.
3. Shiina S, Fujino H, Uta Y. Ohashi Y et al. :Relationship of HbsAg subtypes with HbeAg/antiHbe status and chronic liver disease. Part I: Analysisof 1744 HbsAg carriers. The American J.
Gastroenterology; 86: 866-71., 1991.
4. Funatsu H, Yamashita H, Ohashi Y, Ishigaki T : Effectof rapid glycemic control on progression of diabetic
retinopathy. Japanese J. Ophthalmology; 36: 356-67.,
1992.
5. Suzuki Y, Araie M, Ohashi Y : Sectorization of the central 30゜visual field in glaucoma. Ophthalmology;
100(1): 69-75., 1993.
6*. Yoshimoto M, Sakamoto G, Ohashi Y : Time dependency of the influence of prognostic factors on relapse
in breast cancer. Cancer; 72(10): 2993-3001., 1993.
7. Yamada N, Gotoda T, Yoshinaga H, Ohashi Y et al :Increased risk factors for coronary artery disease inJapanese subjects with hyperinsulinemia or glucose
intolerance. Diabetes Care; 17(2): 107-14., 1994.
8. Morikawa Y, Ohashi Y, Harada K, Asai T et al : A multicenter, randomized, controlled trial of intravenous
gamma globulin therapy in children with acute
Kawasaki disease. Acta Paediatrica Japonica; 36: 34754., 1994.
9. Isaka S, Shimazaki J, Akimoto S, Ohashi Y et al : A
prospective randomized trial for treating stages B2and C prostate cancer : Radical surgery or irradiation
with neoadjuvant endocrine therapy. Japanese J.
Clinical Oncology; 24(4): 218-23., 1994.
10. Sasaki T, Ohta T, Kikuchi H, Ohashi Y et al : A phase
II clinical trial of recombinant human tissue-type
plasminogen activator against cerebral vasospasm
after aneurysmal subarachnoid hemorrhage.
Neurosurgery; 35(4): 597-605.
11. Matsumoto T, Yamada N, Ohashi Y, Kikuchi M :Coronary heart disease mortality is actually low indiabetic Japanese by direct comparison with the
Joslin cohort. Diabetes Care; 17(9): 1062-3., 1994.
12. Yasue M, Sakamoto J, Morimoto T, Ohashi Y et al :Evaluation of the effect of pancreatic resection inadvanced pancreatic cancer with special reference314

using hospital-free survival as a measure of quality oflife. Japanese J. Clinical Oncology; 25: 37-45., 1995.
13. De Mulder PHM, Williams R, Ohashi Y, Blumenstein
BA et al : The Design of clinical trials for new therapies in bladder cancer: Is it time for new strategies?
International J. Urology; 2(Suppl2): 113-6., 1995.
14. Tanimoto K, Nakano K, Kano S, Ohashi Y et al :Classification criteria for polymyositis and dermatomyositis. The Journal of Rheumatology; 22(4): 66874., 1995.
15. Matsuyama Y, Ohashi Y, Uchino H, Takaku F et al :Vesnarinone-induced WBC Disorders in Japan.
Pharmacoepidemiology and Drug Safety; 5: 87-93.,
1996.
16. Sakamoto J, Teramukai S, Koike A, Ohashi Y et al :Prognostic value of preoperative Immunosuppressive
Acidic Protein in patients with gastric carcinoma.
Cancer; 77(11): 2206-12., 1996.
17. Homma Y, Kawabe K, Tsukamoto T, Yamaguchi, O,
Ohashi Y et al : Estimate criteria for diagnosis andseverity in benign prostatic hyperplasia.
International J. of Urology; 3: 261-6., 1996.
18. Sato K, Nohtomi K, Shizume K, Ohashi Y et al : 17
β-Estradiol increases calcium content in fetal mouseparietal bones cultured in serum-free medium only at
physiological concentrations. Bone; 19(3) :213-21.,
1996.
19. Honda H, Shimizu Y, Misumi K, Niimi M, Ohashi Y :Cumulative incidence and prevalence of childhood
autism in children in Japan. British Journal
Psychiatry; 169: 228-35., 1996.
20. Ohashi Y, Izumoto T : Comparison of intra-subject
variability for different formulation by crossover trials. F.I.P.Bio-International`96;113-8., 1996.
21*. Kiuchi T, Konishi M, Bandai Y, Kosuge T, Ohashi Y: A World Wide Web-based user interface for a data
management system for use in multi-institutional
clinical trials-Development and experimental operation of an automated patient registration and random allocation system. Controlled Clinical Trials; 17:476-93., 1996.
22. Kim−Motoyama H, Yasuda K, Yamaguchi T,
Yamada N, Ohashi Y : A mutation of the β3−adrenergic receptor is associated with visceral obesity but decreased serum triglyceride. Diabetologia; 40:469-72., 1997.
23*. Matsuyama Y, Ohashi Y : Mixed models for bivariate response repeated measures data using Gibbs
sampling. Statistics in Medicine 1997; 16:1587-601.
24. Fukuda H, Ohashi Y: A guideline for reporting resultsof statistical analysis in Japanese Journal of ClinicalOncology. Japanese J. of Clinical Oncology 1997;
27(3): 121-7., 1997.
25. Ohno R, Miyawaki S, Hatake K, Kuriyama K, Ohashi
Y et al : Human urinary macrophage colony - stimulating factor reduces the incidence and duration offebrile neutropenia and shortens the period required
to finish three courses of intensive consolidation
therapy in acute myeloid leukemia: A double-blindcontrolled study. J. of Clinical Oncology 1997; 15(8):2954-65., 1997.
26. Hukuhara S,Tanabe N,Sato K,Kurokawa K,Ohashi Y :Good Clinical Practice in Japan before and after ICH:
Problems and potential impacts on clinical trials andmedical practice. International J. of Pharmaceutical
Medicine; 11: 147-53., 1997.
27*. Matsuyama Y, Sakamoto J, Ohashi Y : A Bayesianhierarchical survival model for the institutional
effects in a multi-centre cancer clinical trial. Statistics
in Medicine; 17: 1893-908., 1998.
28. Akiba T, Marumo F, Owada A, Ohashi Y et al :Controlled trial of falecalcitriol versus alfacalcidol in
suppression of parathyroid hormone in hemodialysis
patients with secondary hyperparathyroidism.
American J. of Kidney Diseases; 32(2): 238-46., 1998.
29. Furuse K, Kawahara M, Nishiwaki Y, Ohashi Y :Phase I/II study of vinorelbine, mitomycin and cisplatin for stage IIIB or IV non-small-cell lung cancer.
Journal of Clinical Oncology ; 17-10: 3195-200., 1999.
30*. Hinotsu S, Akaza H, Kotake T, Ohashi Y :Intravesical chemotherapy for maximum prophylaxisof new early phase superficial bladder carcinoma
treated by transurethral resection: A combined
analysis of trials by the Japanese Urological Cancer
Research Groupusing smoothed hazard function.
Cancer; 86: 1818-26., 1999.
31*. Matsui S, Ohashi Y : Analysis of recurrent events:
Application to a clinical trial of colony stimulating
factor with the endpoint of febrile neutropenia.
Statistics in Medicine; 18: 2409-20., 1999.
32. Akakura K, Isaka S, Akimoto S, Ohashi Y et al :Long-term results of a randomized trial for the treatment of stages B2 and C prostate cancer : Radical
prostatectomy versus external beam radiation therapy with a common endocrine therapy in both modalities. Urology; 54-2 : 313-8., 1999.
33. Skamoto J, Mtsuyama Y, Ohashi Y: An analysis ofinstitutional effects in a multicenter cancer clinical
trials- Is it also plausible from the clinicians’ point ofview-. Japan Journal of Clinical Oncology;29-8:403-5.,
1999.
34. Yamaguchi T, Ohashi Y : Investigating centre effects
in a multi-centre clinical trials of superficial bladdercancer. Statistics in Medicine; 18-15: 1961-71., 1999.
35*. Gotoh F, Ohashi Y and the Cilostazol Stroke
Prevention Study group: Design and organization of
the Cilostazol Stroke Prevention Study. J. of Stroke
and Cerebro- vascular Diseases; 9: 36-44., 2000.
36. Gotoh F, Tohgi H, Hirai S, Ohashi Y et al : Cilostazol
Stroke Prevention Study : A Placebo-controlled double-blind trial for secondary prevention of cerebral
infarction. J. of Stroke and Cerebrovascular Diseases;
9:147-57., 2000.
37. Takayama T, Sekine T, Makuuchi M, Ohashi Y et al :Adoptive immunotherapy to lower postsurgicalrecurrence rates of hepatocellular carcinoma: a randomised trial. The Lancet; 356: 802-7., 2000.
38. Morikawa Y, Harada K, Asai T, Ohashi Y et al :Coronary risks after high-dose γ-globulin in chil-dren with Kawasaki disease. Pediatrics International;
42: 464-9., 2000.
39*. Matsuyama Y, Tominaga T, Nomura Y, Ohashi Y etal : Second cancers after adjuvant tamoxifen therapy
for breast cancer in Japan. Annals of Oncology; 11:1537-43., 2000.
40*. Kubota K, Kawabe E, Hinotsu S, Ohashi Y et al :Pilot study of Prescription-Event Monitoring in Japan
comparing troglitazone with alternative oral hypoglycemics. Eur. J. Clin. Pharmacology; 56:831-8.,
2001.
41. Toyoda I, Matsuyama Y, Ohashi Y : Estimation andcomparison of rates of change in repeated-measures
studies with planned dropout. Controlled Clinical
Trials; 22(6): 620-38., 2001.
42. Sakamoto J. Teramukai S. Watanabe Y. Ohashi Y etal : Meta-analysis of adjuvant immunochemotherapy
using OK-432 in patients with resected non-smallcell lung cancer. Journal of Immunotherapy; 24(3):250-6., 2001.
43. Fumimoto H. Kobayashi K. Chang C H. Ohashi Y. et
al : Cross-cultural validation of an international questionnaire, the general measure of the Functional
Assessment of Cancer Therapy Scale (FACT-G) forJapanese. Quality of Life Research; 10: 701-9., 2001.
44. Ito H. Ouchi Y. Saito Y. Ohashi Y. et al : A comparison of low versus standard dose pravastatin therepy
for the prevention of cardiovascular events in theelderly: The Pravastatin Anti-atherosclerosis Trial in
the Elderly (PATE). Journal of Atherosclerosis andThrombosis; 8(2): 33-44., 2001.
45. Hiraoka A. Okamoto S. Moriyama Y. Ohashi Y. et al :Phase III study comparing tacrolimus (FK506) withcyclosporine for graft-versus-host disease prophylaxis after allogeneic bone marrow transplantation.
Bone Marrow Transplantation; 28: 181-5., 2001.
46*. Ohashi Y, Nakai S, Tsukamoto T, Masumori N et al: Habitual intake of lactic acid bacteria and risk
reduction of bladder cancer. Urologia Internationalis;
68: 273-80., 2002.
47. Yamaguchi T, Ohashi Y, Matsuyama Y : Proportional
hazards models with random effects to examine centre effects in multicentre cancer clinical trials.
Statistical Methods in Medical Research; 11: 221-36.,
2002.
48. The EPOCH Study Group : Effects of pimobendan on
adverse cardiac events and physical activities inpatients with mild to moderate chronic heart failure:
The effects of pimobendan on chronic heart failure
study (EPOCH Study) Circulation J.; 66: 149-57.,
2002.
49. Samizo K, Kawabe E, Hinotsu S, Ohashi Y et al :Comparison of losartan with ACE inhibitors anddihydropyridine calcium channel antagonists. A pilot
study of Prescription-Event Monitoring in Japan.
Drug Safety; 25: 811-21., 2002.
50. Ishizuka N, Ohashi Y : The continual reassessment
method and its applications: a Bayesian methodology
for phase I cancer clinical trials. Statistics in
Medicine; 20: 2661-81., 2001.

315

Department ofAdvanced Clinical Nursing /Department of
Nursing Administration
Outline and Research Objectives
The origins of the Departments of Advanced Clinical Nursing and Nursing
Administration can be tracked down to the Department of Fundamental Nursing, one offour nursing departments in the School of Health Care and Nursing. In 1953, the School of
Health Care and Nursing was instituted at the Faculty of Medicine, the University of Tokyo,
as the second 4-year baccalaureate nursing program in Japan. In 1965, the school was reorganized and renamed as the School of Health Sciences, with a focus on health sciences education. Accordingly, the four nursing departments were integrated into one department, theDepartment of Nursing, which became primarily responsible for undergraduate nursing education at the school until 1992. In that year the school was again, reorganized and renamed
as the School of Health Sciences and Nursing, taking on the nation-wide momentum forenhancing baccalaureate programs in nursing. Three departments, including adult healthand nursing, family nursing, and community health nursing, were instituted in addition to
the Department of Fundamental Nursing (formerly the Department of Nursing). In 1997, as
the result of the shift to the chair system of the Graduate School of Medicine, theDepartment of Fundamental Nursing was reorganized into two graduate departments—the
Department of Advanced Clinical Nursing and the Department of Nursing
Administration—.
Currently, these two departments are also responsible for undergraduate education in
the following subjects: Fundamental Nursing (introductory lectures, skills laboratory, andpracticum; 10 credits in total); First Aid and Cardiopulmonary Resuscitation (1 credit);
Nursing Research (2 credits); and Nursing Administration (lecture and practicum, 2 credits).
The major research activities of the two departments include: studies on the links between
nursing quality and patient safety and outcomes; studies on nursing management issues;
the development and validation of nursing quality measurements; and physiological studies
on human body responses to psychophysiological stress (e.g., patients’ responses to invasive
treatment, family caregivers’ responses to nighttime caregiving activities).

Faculty, Staff, and Students
Professor and Chair

Katsuya KANDA, R.N., PhD. (since
2002)
Associate .................................2
Graduate student ....................7
Research student.....................4
Secretary .................................2

Past Research and Major Accomplishments
The author has primarily been conducting studies
on nursing administration, especially on the issue ofnursing quality and care delivery management.
Secondly, the author has been conducting physiological studies on human body responses to psychophysiological stress and stimulus, such as invasive treat-316

ment or intensive caregiving activities.
The author’s initial research involvement in thearea of nursing administration was a study of nursing
home staffing in the United States of America (USA).
In 1983, as part of the national strategies to control
the ever-increasing medical expenditures in the
Medicare reimbursement system, the federal government of the USA introduced the prospective payment
system (PPS), utilizing the diagnosis related groups(DRGs) as the payment basis. As a result of the PPS
introduction, elderly patients who were not fully
recovered from their illnesses were transferred from
hospitals to nursing homes. However, the tight budget situation brought about reductions in the numberof nursing home staff and the quality of nursing,despite ever-increasing disease severity and careneeds of nursing home residents. The author and col-leagues analyzed the time-series data of multiple nursing homes obtained from a health data center in thestate of Pennsylvania, and verified the above-mentioned issue of understaffed nursing homes.
In Japan, the author conducted a series of studies
on the links between nurse staffing and patient safety
and outcomes. The primary factor affecting the quality of nursing is the nurse-patient ratio. The claim thatthe understaffing of nurses brings about a too busy
working environment for nurses to pay attentions to
the details of patient care (which may cause unfavorable consequences to patients) has been an unspoken
agreement among nurses for many years. The average
length of hospital stay is one of the patient outcome
indices that reflect the quality of healthcare and nursing. The author obtained permission from the
Ministry of Health and Welfare (MHW) to use thedata of “Hospital Reports” surveyed by the MHW, andanalyzed the relationship between the number of“nursing staff” (including licensed practical nurses andnurses’ aids) assigned per bed and the averagepatients’ length of hospital stay. The data obtained
from approximately 7,000 general hospitals were analyzed in this study. The average length of stay amonghospitals with a high “nursing staff”-to-bed ratio wasshorter than that of hospitals with a low “nursing
staff”-to-bed ratio. The average length of stay amonghospitals with a high ratio of registered nurses (RNs)
to “nursing staff” tended to be shorter than that of
hospitals with a low RNs-to-“nursing staff” ratio.
Similar results were confirmed after variables related
to hospital characteristics (which are known to have astrong link to patient characteristics) were adjusted.
The author then obtained permission from theManagement and Coordination Agency to use thedata of “Patient Survey” and “Survey of Medical Care
Institutions” surveyed by the MHW, and analyzed therelationship between the nurse staffing level approvedon the nursing fee schedule of health insurance revenue and the incidence of adverse events, such ascomplications. The “Patient Survey” data have twovariables related to diagnostic classifications (the primary diagnosis and the secondary diagnosis, if applicable). Two nurse researchers with advanced clinicalexpertise independently evaluated the incidence ofadverse events from approximately 295,000 in-hospital patients’ survey data. Discrepancies between thetwo nurse researchers’ evaluations were discussed andresolved by incorporating a third nurse researcher’s
independent evaluation. The result of this adverse
event analysis was appalling: the decreased number ofnurses per patient was associated with an increased
incidence of adverse events; especially, the incidenceof adverse events was different between hospitals
with a patient-to-nurse ratio of 2.5-to-1 and hospitals
with a ratio of 3-to-1.

Japan has fewer numbers of registered nurses
assigned to patients in acute care hospitals comparedto other developed countries. A large number of registered nurses per patient does not necessarily bringabout better quality of care; however, a small numberof registered nurses per patient never brings about
better quality of care. The author maintains that an
adequate number of registered nurses assigned per
patient is a “necessity” of better quality of nursing.
In relation to studies of care management, theauthor and colleagues actually developed and implemented a critical pathway for patients with abdominal aortic aneurysms undergoing surgery. The authors
measured the effects of the critical pathway before
and after its introduction to a vascular surgical careunit at the University of Tokyo Hospital. A criticalpathway is one of the patient care management tools.
Multidisciplinary members involved in patient careneed to participate in the process of critical pathway
development, making suggestions and modifications
on pathways from their clinical expertise. Nurses
should clarify as to when and for which components
of care they are accountable. Therefore, a study ofcritical pathway implementation is also a study ofnursing care itself. Additionally, critical pathways arehighly effective for those patients with high-risk diseases who tend to be vulnerable to multiple complications, and without adequate care management, theytend to have delayed recovery and discharge. We disseminated the study results to nurses and educatedthem, emphasizing that critical pathways are usefulfor high-risk patients, and that a comprehensive discussion among multidisciplinary team members isnecessary during the process of pathway development.
One of the most serious nursing administrative
issues involves the frequent uses and their side effectsof physical restraint on patients. Regarding physiological studies, the author and colleagues studied theeffects of physical restraint on patients via electroencephalography. Elderly healthy volunteers participating in this experimental study with a crossover design
received loose physical restraints. Their electroencephalography data showed deviations from normal
patterns, despite the fact that they rarely reported
subjective discomfort. Nursing research also encompasses patient family members as study subjects. In
order to contribute to the knowledge of interventions(the development of supporting systems) for nighttime family caregivers at home, the authors studied
the sleep patterns of female family caregivers who
were routinely providing nighttime care to bed-ridden
elderly individuals. The authors compared their sleep
patterns via electroencephalography data with thoseof an age-matched healthy control group. The study
results confirmed that the nighttime family caregiver317

group had less slow-wave sleep (deeper sleep stages)
than did the control non-caregiver group.

Current Research
A nation-wide healthcare reform, including systematic renovations to the functions of healthcare
facilities, is currently underway in Japan in order toimprove the efficacy of healthcare delivery systems.
Given this situation, healthcare facilities are beingclassified into two levels: acute care and long-termcare facilities. Nurses at long-term care settings needto assume a role different from that of acute care settings. For example, a high proportion of physicallydependent or mentally impaired residents (as opposed
to residents with medical needs), and a high proportion of care workers who are responsible for residents’personal care and assistance in their daily life activities are characteristic to long-term care settings. The
authors have just completed part of a survey involving
nurses’ roles, clinical expertise, job assignment andsharing in relation to care workers, and staffing levels
necessary to maintain a good quality of care at longterm care settings, such as health services facilities forthe elderly or sanatorium-type wards of hospitals.
The history of research on nursing care quality andthe methods of quality evaluation are very new toJapan; the availability of such data is very limited. The
authors are conducting studies to identify and establish patient outcome indicators that have: (1) known
empirical or theoretical strong links to the quality ofnursing; (2) reliable and accurate information widely
available to the majority of facilities; and (3) ease ofmeasurement or ease of access to information sources.
The authors are also attempting to standardize datacollection methods of such quality indicators. The
authors conducted a pilot study at a facility, identified
quality indicators meeting the above-mentioned criteria, and developed a trial version of standardized datacollection methods. A follow-up study at multiple
sites is underway in order to validate the utility ofthese indicators and methods.
Regarding studies on critical pathways, theauthors are currently conducting a study to examine
the utility of critical pathways in rehabilitation settings in addition to acute care settings. Specifically,
the authors are conducting a study of critical pathways for patients with hip fractures undergoing surgery, comparing the data from multiple sites regarding
the entire process of introduction and revisions ofcritical pathways, and the efficacy of the process.
Regarding studies of physical restraint, the authors
are examining an application of alternative and complimentary therapies that are recently attracting public attention as a method of alleviating psychologicalstress. When physical restraints are unavoidable with318

an understanding of their risks and unfavorable
effects, can we alleviate the psychosomatic distress ofpatients who are under restraint by using aroma therapy? We conducted an experimental study with a control group in order to measure the relaxing effects oflavender aroma on individuals under physicalrestraint. Currently, we are analyzing the electroencephalography and electrocardiography data.
Additionally, we are conducting a study to compare
the effects of the chair-sitting position (with the upper
body upright and detached from the back of a chair)and of the wheelchair-reclining position (with theupper body reclined on the back of a wheelchair) on
activities in the autonomous nervous system. Part ofthe literature and practice guidelines suggest the useof the chair-sitting position instead of the widely andfrequently used wheelchair-reclining position for
physically dependent or mentally impaired elderly
individuals. Some evidence supports the notion thatthe wheelchair-reclining position, given that the upper
body is totally reclined onto the back of the wheelchair, may decrease their ability to maintain theirbody position, or may decrease activities in the autonomic nervous system (as well as mental alertness).

Future Prospects
First, the long-term objective of research on nursing administration includes the development and validation of standardized methods and measurements(indices) of patient outcomes related to the quality ofnursing. A nation-wide database of nursing quality
indicators should be developed, starting off withinviting a certain number of hospitals willing to participate in the study. Continuous quality improvement
in healthcare and nursing involves organizational
efforts to identify their own national rankings and torenovate themselves through system-wide learningand changing. Such efforts of national database development and benchmarking would enable comparisonsamong organizations and would provide opportunities
for them to learn from top-ranked organizations.
When the nursing profession establishes such anational database of quality indicators, the author
believes that this profession would be able to takepolitical action and make suggestions with convincing
evidence to the government regarding concrete strategies for improving the quality of nursing. The author
would also like to conduct studies on the reliability
and sensitivity of quality indicators in order toincrease the validity of the comparisons.
Secondly, nursing research must provide convincing evidence that nursing can contribute to the healthpromotion of individuals/family/community (or the
optimization of their health experiences), so that theefficacy of nursing is reasonably recognized by thepublic. The effectiveness of nursing, including
patients’ psychophysiological responses to care, tended to be addressed more by anecdotal experiences
than by scientific studies providing evidence.
“Evidence-based nursing” is currently a widely-usedcatch phrase in Japan; however, the evidence regarding the effectiveness of care is still very weak. The
author believes that the Departments of Advanced
Clinical Nursing and Nursing Administration, which
are responsible for the fundamentals of nursing andskills laboratories in undergraduate education, arealso responsible for conducting studies on the efficacy
of nursing. With respect to critical pathways, many
retrospective studies have been conducted so far bynurse researchers in Japan. The author is planning toconduct a prospective and comparative study on theeffectiveness of critical pathways in order to obtain
more reliable and convincing evidence than that previously obtained. The author believes that randomized comparative studies from multiple sites are necessary to conduct in the future.
Finally, nursing informatics is one of the areas ofresearch and education still underdeveloped in thesedepartments. The author strongly believes that
research and educational programs of nursing informatics need to be developed in the future because of
the following reasons: (1) The implementation of abetter quality of nursing and an evaluation on its outcomes involves the development of evaluation criteria
and standards on the performance and quality ofnursing, and the actual implementation of evaluation
measures and procedures, thus ensuring accurate andhigh-quality information on healthcare and its administration; and (2) The study of nursing informatics
lays the foundation of practice, administration, education and research in nursing. Informatics in nursing
provides meaningful links among these areas and promotes development in each of these areas of nursing.

Research Grants
1. Principal Investigator: Physical Restraint of theElderly in Institutional Care Setting and Alternatives
to Restraint Use. Grant-in-Aid for Scientific Research,funded by the Ministry of Education, Science andCulture, 1996-1997.
2. Principal Investigator: Economic Evaluation of
Nursing Services. Grant-in-Aid for Health Sciences
Research, funded by the Ministry of Health andWelfare, 1996-1998.
3. Principal Investigator: Nurse Staffing and Nurses’ Job
by Type of Healthcare Facility. Grant-in-Aid for
Health Sciences Research, funded by the Ministry of
Health and Welfare, 1999-2001.
4. Principal Investigator: Effect Verification of
Development and Implementation of Critical
Pathway for Hip Fracture. Funded by JapaneseNursing Association, Project of Promotion of
Infrastructure Improvement for Nursing Policy
Planning, 2001.

Select Publications
1. Minamisawa H, Takeo K, Kanda K. Body positions
and heart rate: focusing on patient’s daily life.
Nursing 33(12): 44-51, 1981. (in Japanese)
2. Tagami Y, Hatano H, Hashimoto M, Kanda K, Tanaka
T. A study on the distribution of medical facilities insmall cities. Hospital Administration 19: 257-284,
1982. (in Japanese)
3. Takeo K, Minamisawa H, Kanda K, Hasegawa S: Heartrates during the daily activity of “Zen” priests.
Journal of Human Ergology 13: 83-87, 1984.
4. Kanda K. Promotion of home care and visiting nursing. The Tokyo Journal of Medical Science 95: 387390, 1988. (in Japanese)
5. Takeo K, Minamisawa H, Kanda K, Tukamoto M,
Kimura K, Mori Y, Ishida M, Watanuki S. Daily activity and food intake in patients with senile dementia.
Annual Report of Sasakawa Health Science
Foundation, 5(2), 103-112, 1989. (in Japanese)
6. Kanda K, Minamisawa H. How do nurse practitioners
use their time? In “The Improvement of the Quality
of Nursing Care by Introducing Primary Nursing,”
Report of Grant-in-Aid for Scientific Research from
the Ministry of Education, Science and Culture (pp.
65-82), 1990. (in Japanese)
7. Kanda K, Mezey M: Registered nurse staffing in
Pennsylvania nursing homes: Comparison before andafter implementation of Medicare’s Prospective
Payment System. Gerontologist 31: 318-324, 1991.
8. Kanda K, Maitoko M, Shimada Y, Takenawa N,
Awaya N, Mitoh M. How much are nurses performing other health care professionals’ duties in hospitals? Japanese Journal of Nursing Administration 1:
371-376, 1991. (in Japanese)
9. Kanda K, Takahashi M, Fujieda C. Nurse staffing at
outpatient clinics. Japanese Journal of Nursing
Administration 2: 55-61, 1992. (in Japanese)
10. Kanda K, Takahashi M, Fujieda C. Activities andfunctions performed by nurses in ambulatory caresetting. Japanese Journal of Nursing Administration
2: 179-185, 1992. (in Japanese)
11. Fujieda C, Takahashi M, Bojo N, Miyamoto A, Kanda
K. A survey on the levels of staffing by nurses in
hospitals. Japanese Journal of Nursing
Administration 2: 307-311, 1992. (in Japanese)
12. Kanda K, Fujieda C, Takahashi M, Bojo N, Miyamoto
A. Nurse staffing mechanism with relevance to casemix of patients. Japanese Journal of Nursing
Administration 2: 363-370, 1992. (in Japanese)
13. Kanda K, Takahashi M, Fujieda C, Bojo N, Miyamoto
A. Actual condition of hospital structure and equipment influencing nursing service. Japanese Journal of
Nursing Administration 3: 52-55, 1993. (in Japanese)
14. Kanda K. Trend of registered nurse staffing in nursing homes. Report of Research Activities by319

Sasakawa Health Science Fellowship Grantees, 7-17,
1993. (in Japanese)
15. Maitoko M, Kanda K. Factors effecting medication
errors. Journal of Japan Academy of Nursing Science
13(2): 29-36, 1993. (in Japanese)
16. Kanda K, Kusakari J, Awaya N. A study on the characteristics and length of employment of nonrotatingshift night nurses. Hospital Administration 30: 215222, 1993. (in Japanese)
17. Mitoh T, Takeo K, Minamisawa H, Kanda K, Hirose
H. A study to determine necessity of QOL and ADL
evaluation and care of institutionalized senile elderly.
Report of Grant-in-Aid for Scientific Research from
the Ministry of Education, Science and Culture, 1993.
(in Japanese)
18. Maitoko M, Kanda K. An approach to evaluation ofquality of nursing, focusing on medication errors.
Japanese Journal of Nursing 58: 122-125, 1994. (inJapanese)
19. Kanda K. Proportion of high-acuity patients according to hospital characteristics. Journal of Japan
Academy of Nursing Science 15(4): 9-14, 1995. (inJapanese)
20. Kanda K, Watanuki S, Kunioka T, Tama E, Kojima Y.
The development and increased use of machineryand equipment in nursing: Current availability andusage. Japanese Journal of Nursing Administration 6:
742-747, 1996. (in Japanese)
21. Kanda K, Watanuki S, Kunioka T, Tama E, Kojima Y.
The development and increased use of machineryand equipment in nursing: Issues related to future
development and increased usage. Japanese Journalof Nursing Administration 6: 834-841, 1996. (inJapanese)
22. Sakaguchi M, Kanda K, Sakai I, Chen JX, Tamura Y,
Shiga Y, Takeo K: Survey on the care needs of persons with health problems and their families living
in urban areas of Japan. Journal of Shiga Academic
Society of Nursing Science 1: 15-19, 1996.
23. Kanda K, Koike J. Predicting quantity of care needs
and nursing intensity. In “Measuring Care Needs ofPatients in Medical Care Institutions,” Report ofGrant-in-Aid for Health Sciences Research from the
Ministry of Health and Welfare (pp. 29-35), 1996. (inJapanese)
24. Kanda K, Sato R, Nagata A. Effects of intermittent
wakening on sleep pattern of nighttime caregiver:
An EEG study with a single subject. Journal of Japan
Academy of Nursing Science 17(1): 75-81, 1997. (inJapanese)
25. Kojima M, Horiuchi S, Ota K, Oikawa I, Kaharu C,
Nomura M, Toyomasu K, Hatono Y, Kanda K,
Tanaka Y. A study of nursing systems in transition
in developed countries. Bulletin of St. Luke’s College
of Nursing 23: 49-68, 1997. (in Japanese)
26. Kanoya Y, Domon Y, Sato R, Kanda K. The nurses’
contribution to the quality improvement of care
under the health care policy to contain costs: areview. Japanese Journal of Nursing Administration
7: 668-675, 1997. (in Japanese)

320

27. Kanda K. Association of nursing service with lengthof hospital stay of patients. Japanese Journal of
Nursing 61: 1018-1022, 1997. (in Japanese)
28. Sato R, Osaka Y, Nomura I, Fuse S, Kanda K. Nurses’
selection of analgesics and the frequency of theiradministration to the patients in 24 hours after transcatheter arterial embolization, transcatheter arterial
infusion, and transcatheter hepatic angiography.
Japanese Journal of Nursing Arts 44: 1001-1006,
1998. (in Japanese)
29. Watanuki S, Kanda K, Kimura K, Minamisawa H,
Mori Y, Takeo K, Tsukamoto M. Body weight loss
and BMI(Body Mass Index) decrease of hospitalized
elders with senile dementia. Journal of Japan
Academy of Nursing Science 18(2): 51-62, 1998. (inJapanese)
30. Sato R, Kanda K, Nagatomo M, Kusakari J.
Relationships between task performance of visiting
care agencies and physicians’ orders. Hospital
Administration 35: 177-184, 1998. (in Japanese)
31. Matsumoto A, Kanda K. Concept and effects of discharge planning. Japanese Journal of Nursing Arts
44: 710-713, 1998. (in Japanese)
32. Kanda K. Physical Restraint of the Elderly in
Institutional Care Setting and Alternatives to
Restraint Use, Report of Grant-in-Aid for Scientific
Research from the Ministry of Education, Science
and Culture, 1998. (in Japanese)
33. Nagatomo M, Kanda K, Sato R, Kusakari J.
Relationship between physicians’ orders and nurses’
service sphere of activity -- a comparison between
home health care agencies and university hospitals.
Hospital Administration 36: 5-16, 1999. (in Japanese)
34. Kanda K, Sato R, Kodama S, Takemura Y, Matsumoto
A. Relations between nurse-staffing levels andadverse outcomes. In “Economic Evaluation of
Nursing Services,” Report of Grant-in-Aid for Health
Sciences Research from the Ministry of Health andWelfare (pp.16-41), 1999. (in Japanese)
35. Sato R, Kanda K, Anan M. Sleep patterns of middleaged and older female family caregivers providing
routine nighttime care for elderly individuals at
home. Journal of Japan Academy of Nursing Science20(3): 40-49, 2000. (in Japanese)
36. Kanda K, Takemura Y. Research agenda for criticalpathways. Japanese Journal of Nursing Research 33:
221-230, 2000. (in Japanese)
37. Kanda K, Sato R, Matsumoto A, Yamagishi M,
Takemura Y. Nurse Staffing and Nurses’ Job by Typeof Healthcare Facility -- Job and Role Expectations ofNurses in Health Services Facilities for the Elderly,
Report of Grant-in-Aid for Health Sciences Researchfrom the Ministry of Health and Welfare, 2000. (inJapanese)
38. Zhao H, Kanda K. Translation and validation of theStandard Chinese version of the EORTC QLQ-C30.
Quality of Life Research 9: 129-137, 2000.
39. Takemura Y, Kanda K. The elements and the processof ‘good nursing practice’ perceived by nurses.

Japanese Journal of Nursing Research 34: 329-339,
2001. (in Japanese)
40. Kanda K, Sato R, Emori K, Takemura Y, Matsumoto
A, Ogawa R. Nurse Staffing and Nurses’ Job by Typeof Healthcare Facility -- Role and Job of Nurses inGeneral Clinics, Report of Grant-in-Aid for Health
Sciences Research from the Ministry of Health andWelfare, 2001. (in Japanese)
41. Kanda K, Zhao H, Takahashi Y. Quality of life inChinese patients with gynecological cancer.
Proceedings of the 2nd Conference on Nursing
Education & Research between School of Nursing,Seoul National University and School of Health
Sciences & Nursing, The University of Tokyo : 6-10,
2001.
42. Kawana N, Ishimatsu S, Kanda K. Psycho-physiological effects of the sarin attack on the Tokyo subway
system. Military Medicine 166 Suppl. 2:23-26, 2001.
43. Ibe T, Ichiduka K, Kawano R, Kanda K, Moriwaki M,
Yanagisawa H. Actual Condition of Nurses as ClinicalResearch Coordinators: Comparison of the Results
Surveyed in 1998, 1999 and 2000. Japanese Nursing
Association, 2001. (in Japanese)
44. Kanda K, Takemura Y, Ogawa R, Yamagishi M,
Kodama S. Nurse Staffing and Nurses’ Job by Type of
Healthcare Facility -- Role and Job of Nurses in
Sanatorium-type Wards of General Hospitals, Reportof Grant-in-Aid for Health Sciences Research from
the Ministry of Health and Welfare, 2002. (inJapanese)
45. Yamagishi M, Kanda K, Takemura Y. Development ofmethods for detecting occurrences of adverse events
as nursing quality indicators. Journal of Japan Societyfor Health Care Management 3: 363-369, 2002. (inJapanese)
46. Matsumoto A, Kanda K, Shigematsu H. Development
and implementation of a critical pathway for abdominal aortic aneurysms in Japan. Journal of VascularNursing 20:14-21, 2002.
47. Kanda K, Ozawa M, Irimura R. Allocation of nursing
time at university hospitals in Japan. Journal of
Nursing Studies National College of Nursing, Japan 1:
17-26, 2002.
48. Kanda K, Kodama S. Determinants of nursing service
in urban public hospitals: An economic perspective.
Nursing and Health Sciences 4: 63-72, 2002.
49. Takemura Y, Kanda K, Matsumoto A, Yamagishi M.
Role expectations of nurses in health service facilities
for the elderly. Nursing and Health Sciences 4: 73-83,
2002.
50. Sato R, Kanda K, Anan M, Watanuki S. Sleep EEG
patterns and fatigue of middle-aged and older femalefamily caregivers providing routine nighttime carefor elderly persons at home. Perceptual and Motor
Skills (in press).

321

Department of
Adult Nursing / Terminal andLong-term Care Nursing
Outline and Research Objectives
The origin of the Department of Adult Nursing /Terminal and Long-term Care Nursing
was “Department of Adult Health” in the School of Health Sciences (1965-1992), and afterthat “Department of Adult Health and Nursing” in the School of Health Sciences & Nursing(1992-).
From 1995 to 1997, the Graduate School of Medicine shifted to the chair system ofGraduate Schools, and our new two departments were established. The members of two
departments cooperate in education and research together.
Our major research objectives are concerning followings issues.
1. Cancer Nursing
2. Adult Health Nursing
3. Nursing Care System for Outpatients
4. Evaluation of Palliative Care Services
5. Spiritual Care for Terminally Ill Persons and Their Families
6. Continuity in Palliative Care System
7. Dissemination of Palliative Care
8. Methodology of Nursing Research and Education

Faculties and Students
Professor and Chair

Keiko Kazuma, M. of Hlth.Sc., The
Univ. of Tokyo, School of Health
Sciences, 1976; Dr. Hlth.Sc., The
Univ. of Tokyo, 1989. Since 1999
Lecturer
Masako Kawa, M. of Hlth.Sc., The
Univ. of Tokyo, School of Health
Sciences, Since 1996
Associate .................................2
Postdoctoral Fellow ................4
Graduate student ..................14 (Dr. program;6, Ms. program;8)
Research student.....................7
Secretary .................................1

Past Research and Major Accomplishments
1. Cancer Nursing
One of the main subjects of our cancer nursing
research is cancer risk counseling, especially in genetic
counseling of patients and /or kindred of patientswith familial cancer syndrome, expressed in adulthood. In genetic counseling, ethical consideration isvery important for application of gene testing. At
present, prophylactic surgery is the first choice as a322

preventive strategy for familial cancer syndrome
expressed in adulthood. We have studied clients’needs and the role of nurse-counselors, based on theirbackground of familiarity and practical experienceswith perioperative management and intervention foradaptation to the patients’ altered intestinal structure
after surgery. We developed a decision tree for theprocess of cancer risk counseling based on the foreign
literature and our clinical experience with familial
adenomatous polyposis family. The decision tree wasagreed with peer group of cancer genetic counselingand is introduced in seminars for familial cancer counselors.
Another concern is intervention to facilitate adaptation after cancer surgery. We developed a measurement scale for feeling of stability in daily life with astoma for people with a permanent colostomy
because of malignancy, and explored the factors influencing the feeling of stability. The results showedthat the frequency of the stoma clinic and support
from nurses contributed to that feeling
2. Adult Health Nursing
The domain of adult health nursing contains work
concerning health promotion and symptom management. For the former, a brisk walking program wasapplied for the middle nurse managers, a group thattends to lack of exercise. Several positive effects inserum characteristics were approved in the intervention group compared to control group.
The subjects of symptom management researchwere patients who underwent surgery for gastrointestinal disease or inflammatory disease. After gastrectomy, we found that increased symptoms wererelated to changes in eating behavior associated withreturn to the workplace, and it was suggested thenecessity of intervention after discharge. A measurement scale was also developed to evaluate difficulties
in daily life after surgery for oral tumor.
The subjects of symptom management for inflammatory disease were patients with ulcerative colitis(UC) or rheumatoid arthritis (RA). UC patients experience difficulties in daily life related to decreased vigor
and altered defecation. We developed an instrument
to measure the difficulties of life, and explored thefactors influencing it. For RA patients, a series of studies was carried out on association with fatigue, coping
behavior, and nutrition, and an exploratory study was
implemented on home exercise and the factors influencing it.
3. Nursing Care System for Outpatients
Recently, nurses’ role in hospital outpatient departments and in home care settings has been changing
dramatically, because of the shortening of hospital
stays, changes in types of disease, and increasing elderly population. Several surveys were conducted onnurses’ recognition of the care needs of outpatients,
evaluation of nurses’ activities for outpatients, andfact-finding about consultation and teaching activities
by nurses throughout Japan (dental university hospital, and all hospitals above 200 beds).
4. Evaluation of Care Services in Palliative Care
Institutions
It was difficult to investigate quality of life in vulnerable patients, so that it was assumed that theeffectiveness of palliative care could be clarified byclinical audit, which is the systematic critical analysisof the quality of clinical care by the audit tool insteadof the QOL questionnaire. Therefore research by theaudit tool was instituted. The feasibility of the
Support Team Assessment Schedule (STAS) and
Edmonton Symptom Assessment System (ESAS),developed abroad as an audit tool, was examined in
two palliative care units. In this study we collaborated
with a research group investigating the reliability andvalidity of the Japanese version of the STAS.
5. Spiritual Care for Terminally Ill Persons andTheir Families
This theme resulted from the spiritual pain discovered in reviewing patients’ complaints of distressing
conditions recorded on their charts. The study on

spirituality was undertaken as collaborative researchwith other universities. After a literature review, interviews were conducted with patients admitted to palliative care units, and the data from the interviews
were analyzed by Grounded Theory Approach.
6. Continuity in the Palliative Care System
We used a questionnaire to investigate the status
and needs of people attending hospice clinics. The
results showed that consultation in which patientsdecide where to stay should be provided at an appropriate time before referral to a palliative care institution.
7. Promotion of Palliative Care;
A member of the teaching staff of our department
joined the working group on “Attitudes toward terminal care” in research implemented by the Ministry of
Health and Welfare in 1998. The results showed thatpalliative care needed to be further understood byboth the general public and the clinical staff. We subsequently conducted a survey of nurses working in
general hospitals to investigate the difficulties
encountered in the care of terminally ill cancer
patients and related factors.
8. Methodology of nursing research and education;
This contains several issues, including surveys andcritiques for application of statistical techniques innursing research, review of utilization of the concentric circle model of body extremities as a non-invasive
measurement tool, and concerning the nursing
process, nursing diagnosis, and terminology in nursing.

Current Research
1. Cancer Nursing;To establish nurses’ role in cancer genetic counseling in Japan, we have joined a research project with
MDs in a continuous study group.
Negotiations concerning to a prospective cohort
study of people with a stoma is in progress with theaim of collaboration between our group and otherinstitutions concerning the process of how to acquirea feeling of stability
2. Adult Health Nursing
Concerning about health promotion, we started acollaborative research program on physical activity
and physical component in frail elderly with a Koreangroup at Seoul National University to promote health.
Symptom management research is conducted in
UC patients after total colectomy. Difficulties in a tem-323

porally ileostomy period are focused on. We are analyzing the cross-sectional data from 84 patients
whether related or not to body weight loss in that
period. And despite of case studies with a few
patients, we ascertained that body weight loss andhypoglycemia were not appeared in patients forwhom educational intervention was period about how
to eat in that period.
3. Nursing Care System for Outpatient
Nursing function and efficiency in hospital outpatient department is being surveyed with diabetics notusing insulin as the model, and a prospective cohort
study is being planned.
4. Evaluation of Palliative Care Services
The study of the reliability and validity of theJapanese version of the STAS has just been completed. We are now preparing a booklet to encourage useof this tool in clinical settings. We are also participating in a study group that is establishing evaluation criteria according to the peer review method developedin the UK.
5. Spiritual Care for Terminally Ill Persons andTheir Families
Interview data are being analyzed and some of theresults are being prepared for submission to a foreign
journal. Next, we must plan a study on appropriate
spiritual care for terminally ill persons.
6. Continuity in the Palliative Care System
We obtained a grant for Day Care research.
Preparation for needs assessment prior to development of a day care program is in progress. Researchon consultation and support for patients discharged
from cancer centers is also continuing.
7. Promotion of Palliative Care;
Barriers to palliative care are being examined topromote palliative care in general practice. In addition, research on palliative care for other chronic illnesses is being planned.
8. Methodology of nursing research and education
Projects of terminology in nursing are being continued in International Classification of Nursing
Practice (ICNP) and nursing actions in Japan.

Future Projects
Both departments intend to continue to develop
current research projects. A new project is being considered: making the measurement scales we developed available on our homepage. This project will be

324very useful in refining the scales and compiling clinical data.

Research Grants
1. Keiko Kazuma: The Ministry of Education, Culture,
Sports, Science and Technology (MEXT), Grant-inaid for Scientific Research (C); The Development of
Nursing strategy for the postoperative patients withlower gastro-intestinal Diseases (2,300,000 yen,
Representative researcher, 2000-2003).
2. Keiko Kazuma: The Ministry of Health, Labor andWelfare (MHLW), Grant-in-aid for Scientific
Research; Nursing function of outpatient department
in hospital for chronically ill people (6,500,000
yen;2002, Collaborative researcher, 2002-2003).
3. Keiko Kazuma: Japan Society for the Promotion of
Science (JSPS), The Japan-Korea Basic Scientific
Cooperation Program; A Comparison of Bio-psychosocial status related to Physical Activity of theElderly between Korea and Japan: Biophysical Index,
Health status, Competence of Daily Activity andDepression. (2,400,000 yen, Representative
researcher, 2002-2004).
4. Masako Kawa : The Mitsubishi Foundation, Grant
for Social Welfare Activities and Research; Basic
study on the development of spiritual care for thewell-being of terminally ill patients with cancer.
(2,000,000 yen, 2000-2001.)
5. Masako Kawa : Japan Society for the Promotion of
Science (JSPS), Grant-in-aid for Scientific Research(C); The development of palliative day care program
for the persons with advanced cancer. (3,900,000
yen, Representative researcher, 2002-2004.)

Select Publications
1. Imamura Y, Ozawa T, Miyashita M, Kawa M, Kojima
M. Consultation service at hospice clinic and information given at referrals on hospice and palliative
care: The attitude among terminally ill patient withcancer and family members. J Jpn Soc Cancer Nurs
13(2): 60-68., 1999. (in Japanese)
2. Ojima T, Nakamura Y, Hashimoto S, Miyashita M,
Hayashi M, Kato M, Matsumura Y, Fukutomi K. The
development of the regional health and welfare
indexes. Journal of Health and Welfare Statistics
46(15): 3-9., 1999.(in Japanese)
3. Takeda Y. Parents’ attitudes to predictive genetic
testing in their children for familial adenomatous
polyposis. The Ochanomizu Medical Journal 47(3):129-146., 1999. (in Japanese)
4. Koike T. The relationship between fatigue and nutritional status in patients with rheumatoid arthritis.
The Ochanomizu Medical Journal 48(3･4): 95-107.,
2000. (in Japanese)
5. Furuse K, Kawahara M, Nishiwaki, Fukuoka M,
Takada M, Miyashita M, Ohashi Y. Phase I/II studyof vinorelbine, mitomycin, and cisplatin for stage

IIIB or IV non-small-cell lung cancer. Journal of
Clinical Oncology 17(10): 3195-3200., 1999.
6. Ito N, Miyashita M, Kojima M. The self-care ability
and medical/social support in ostomates. J Jpn Soc
Cancer Nurs 1999. 13(1): 25-34., (in Japanese)
7. Miyashita M, Hashimoto S, Kawa M, Kojima M.
Attitudes towards terminal care among the general
population and medical practitioners in Japan.
Japanese Journal of Public Health 46(5): 391-400.,
1999. (in Japanese)
8. Matsumura Y, Nakamura Y, Hayashi M, Kato M,
Miyashita M, Ojima T, Hashimoto S, Fukutomi K.
Prefectural differences of the proportion of the smoking population. Journal of Health and Welfare
Statistics 46(6): 23-28., 1999. (in Japanese)
9. Miyashita M, Hashimoto S, Ojima T, Nakamura Y,
Hayashi M, Kato M, Fukutomi K. An estimation of
the proportion of handicapped people and healthexpectancy for aged person: prefectural estimation
based on existing health statistical resources. Journalof Health and Welfare Statistics 46(5): 25-29., 1999.
(in Japanese)
10. Hashimoto S, Miyashita M, Tsuji I, A comparison of
calculation method for health expectancy. Journal of
Health and Welfare Statistics 46(4): 12-16., 1999. (inJapanese)
11. Hayashi M, Hashimoto S, Kato M, Ojima T,
Nakamura Y, Miyashita M, Fukutomi K. The importance or regional health and welfare indexes. Bulletinof Fukushima school of nursing 1: 33-38., 1999. (inJapanese)
12. Kazuma K, Kawagoe H, Kawamura S, Yamazaki M.
Development of the nursing protocol for management of medical treatment in home care, (1) The fact
finding study of visiting nurse station providing
management of medical treatment. Kango 51: 110116., 1999. (in Japanese)
13. Kazuma K, Kawagoe H, Kawamura S, Yamazaki M.
Development of the nursing protocol for management of medical treatment in home care, (2) The fact
finding study of visiting nurse station providing
management of medical treatment. Kango 52: 108114., 1999. (in Japanese)
14. Kitano K, Kawamura S, Kazuma K. A study on working women caring for their husbands with an
intractable disease. J J Intrac Ill Nurs 3: 53-66., 1999.
(in Japanese)
15. Mizuno Y, Ogura A, Kawamura S, Kazuma K. Studyon planning and nursing management for safe outside activities for ventilator-assisted-individuals. J J
intrac Ill Nurs, 3: 42-52., 1999. (in Japanese)
16. Amano S, Kawamura S, Kazuma K, Ushikubo M.
Protocol of pressure ulcers management in homehealth care-algorithm of nutritional assessment andmanagement. J Jpn Acad Home Health Care, 2: 5159., 1999. (in Japanese)
17. Kazuma K. Utilization of the concentric circle modelin clinical nursing: a Review. Journal of Medical and
Dental Sciences. 46(4): 139-143., 1999.

18. Takeda Y, Kazuma K. The nurses’ role in cancer
genetic testing and counseling. Nursing Today, 14:
72-74., 1999. (in Japanese)
19. Kazuma K. The Current of nursing process and nursing diagnoses. Jpn Nurs Admin, 9: 671-677., 1999.
(in Japanese)
20. Kawa M. Supporting the bereaved family. In Ohba
M, Endo E, and Inayoshi M (eds.). The new cancer
nursing, Brain Press, Tokyo 361-365., 1999. (inJapanese)
21. Kawa M. The subjects to be studied in palliative care.
In Ohba M, Endo E, and Inayoshi M (eds.). The newcancer nursing, Brain Press, Tokyo 366-374., 1999.
(in Japanese)
22. Kazuma K, Takeda Y: Genetic counseling in cancer
nursing, in Ohba M, Endo E, Inayoshi M (eds.). New
cancer nursing, Brain Press,: 59-71., 1999. (inJapanese)
23. Okusaka k, Kazuma K. Investigation of changes insymptoms and eating behavior associated with thereturn to the workplace of postgastrectomy patients.
J Jpn Acad Nurs Sci 20(3): 60-68., 2000.
24. Koike T, Kazuma K, Kawamura S. The relationshipbetween fatigue, coping behavior, and inflammationin patients with rheumatoid arthritis. The Japan
Rheumatism Association and Springer-Verlingere
Tokyo 2000. Mod Rheumatol. 141-149, 2000.
25. Hashimoto M, Koike T. Development of instrument
to measure difficulties of life in patients with ulcerative colitis. The Ochanomizu Medical Journal 48(2):71-76., 2000 (in Japanese)
26. Aoki H, Sakai E. Proposal of a measurement scale toevaluate difficulties of daily life in patients after surgery of oraltumor. The Ochanomizu Medical Journal
48(2): 63-70., 2000.(in Japanese)
27. Koyama C, Kawa M, Kasahara Y. Progression of disease and process of psychological change of terminally ill patients with cancer, An analysis of medical
and nursing charts. Japanese Journal of ClinicalThanatology 5(2): 85-91., 2000. (in Japanese)
28. Koike T, Kazuma K. Recognition by nurses of theneed for outpatient consultation and guidance, andchallenge for the future. J Jpan Acad Nurs Admin
Policies 4(1): 23-32., 2000. (in Japanese)
29. Kazuma K, Yokomura T, Hara M, Aoki H, Okamoto
N. Practice and evaluation of primary nursing in outpatient department. J Jpan Acad Nurs Admin Policies
4(1): 34-38., 2000. (in Japanese)
30. Kato M, Hashimoto S, Miyashita M, Hayashi M,
Nakamura Y, Ojima T, Matsumura Y, Fukutomi K.
The transition of elderly welfare policy differences in
prefectures and municipalities. Journal of Health andWelfare Statistics 47(4): 8-13., 2000. (in Japanese)
31. Ushikubo M, Kazuma K. Research and challenge forthe care of chronically ill people. J J Nurs Res 33: 203211., 2000. (in Japanese)
32. Takeda Y, Kazuma K. Family cancer and nursing.
Gastroenterolog Surg Nurs 15: 205-211., 2000. (inJapanese)32533. Sato M. How to assessment defecation dysfunction
and how to approach these patients. The Japanese
Journal of Nursing Art 46(11): 26-32., 2000. (inJapanese)
34. Kawa M. The nursing role in palliative care. In:
Higashiha M and Kondo M (eds.). Palliative Care.
Nursing QOL Books. Igakushoin. Tokyo 117-128.,
2000. (in Japanese)
35. Kazuma K. Risk counseling for familial cancer. Journalof Family Tumor 1(1): 9-15., 2001. (in Japanese)
36. Hayakawa E, Ushikubo M, Kawamura S, Kazuma K,
Yuasa S, Takagi K. Analysis of the activity of the
medical counseling services for intractable illnesses(Nanbyo) of the Tokyo medical association. Jpn J
Prim Care 24(3): 189-196., 2001. (in Japanese)
37. Okano Y, Okamura H, Watanabe T, Narabayashi M,
Katsumata N, Ando M, Adachi I, Kazuma K, Akechi
T, Uchitomi Y. Mental adjustment to first recurrence
and correlated factors in patients with breast cancer.
Breast Cancer Res Treat 67(3): 255-262., 2001.
38. Murakami Y, Gondo N, Okamura H, Akechi T,
Uchitomi Y. Guilt from negative genetic test findings.
Am J Psychiatry 158(11): 1929., 2001.
39. Kazuma K, The relationship between fatigue andnutritional status in patients with Reumatoid
Arthritis. The international conference. Tokyo
University, Oita University & S.N.U. Seoul: 109-112.,
2001.
40. Agata T, Kawa M. Research on medicine and nursing. In Agata T. (ed.), PubMed, Impact Factor for
EBM. Chugaiigakusha, Tokyo:1-20., 2001. (inJapanese)
41. Takeda Y, Kazuma K. Practice of genetic nursing; cancer. In Andou H. et al (eds.), Genetic Nursing.
Ishiyaku Publishing Co., 108-118., 2001. (in Japanese)
42. Imamura Y. Hospice home care. Kango 53(10): 98102., 2001. (in Japanese)
43. Takeda Y. Need of the support system for family
members with hereditary cancer. The Japanese
Journal of Nursing 65(10): 948–951., 2001. (inJapanese)
44. Aoki H, Ohta K, Kazuma K. The current status andproblems of nursing for outpatients department oforal surgery of dental university hospitals in Japan.
The Journal of the Stomatological Society, Japan
69(2): 9-14., 2002. (in Japanese)
45. Emoto A. A study on the long-term effects and contributing factors of pelvic floor muscle exercise in
women with stress urinary incontinence. The
Ochanomizu Medical Journal 50(1): 19-34., 2002.(inJapanese)
46. Watanuki E. Nursing staff’s understanding of their
liability in nursing practice. Jpn Nurs Res 25(2): 6169., 2002. (in Japanese)
47. Sato N, Kato A, Sugimura H. Physician’s level ofknowledge regarding genetic counseling in the fieldof clinical genetics. Journal of Familial Tumor 2(1):20-25., 2002. (in Japanese)
48. Imamura Y, Kawa M, Kayama M, Mizuno M, Otsuka
M, Murata H. Conceptual structure on spirituality in

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end-of-life patients with cancer. The Japanese
Journal of Hospice and Palliative Care 12(5): 425434., 2002. (in Japanese)
49. Kawa M, Koyama C, Imamura Y, Miyashita M,
Ashiya T, Kasahara Y. Physical state and psychological expression of terminally ill patients with cancer
in a palliative care unit. The Japanese Journal of
Clinical Thanatology 7(1)., 2002. (in press)
50. Furukawa F, Kazuma K, Kawa M, Miyashita M, Niiro
K, Kusukawa T, Kojima M. Effects of an off-site
walking program on energy expenditure, serum
lipids, and glucose metabolism in middle-aged
women. Biological Research for Nursing 4(3)., 2002.
(in press)Department of
Family Nursing
Outline and Research Objectives
The Department of Family Nursing was established in April 1992 and was started at
October 1992 when Dr.Sugishita had a position of Professor of Family Nursing. Currently, it
has four faculty members; one professor, one associate professor and two associates.
Our department is based on new concept which combines together the following four
nursing fields: maternal-child nursing, pediatric nursing, gerontological nursing and family
nursing.
Our department provides lectures, clinical practicums and fieldwork on the four nursing
fields to the undergraduate students of School of Health Sciences and Nursing. Our department also gives two required lectures, that is, “clinical immunology ” and “laboratory methods in health science” to the undergraduate students of our school.
We also have responsibilities to give special lectures, advanced seminar and laboratory
and/or field work on family nursing to the postgraduate (master’s and doctoral) students.
Our research field concerns the development of methodology to improve nursing skills
and techniques, and the development of physical, psychological and interactive assessment
procedures for patients and families in our field.

Faculties and Students
Professor and Chair

Chieko Sugishita R.N., Ph.D.
1992~
Associate Professors Kiyoko Kamibeppu R.N., Ph.D.
Associate .................................2
Postdoctoral Fellow ................5
Graduate student ..................10
Research student...................15
Secretary .................................2

Past Research and Major Accomplishments
Topics of our past research projects were as follows.
①Control of maternal-child transmission of microorganism, ②Control of body fluid circulation in
women supported with physical compression, ③
Evaluation of antiboby development after immunization in children and analysis of immune system, ④Environment/food factors of allergic diseases amongchildren, ⑤Recent anxiety coping strategies in Japan,⑥Psychological factors of the family caregiving forthe frail elderly, ⑦Development of new devices forevaluating autonomic nervous activities of the frail
elderly, ⑧Development of Japanese version of family
functioning survey.

Major accomplishments were as follows.
Number indicates the number of research project.
①We examined the samples from neonates, theirmothers, medical staffs and environment in amaternal ward to isolate some bacteria in order todemonstrate the route of transmission toneonates. Some of the neonates had the same bacteria as their mothers, medical staffs and environment at the point of discharge. Therefore, Several
bacteria could have been transmitted to theneonates from their mothers, medical staffs
and/or environment in hospital.
Our data also showed that mamma trouble did
not decrease even if they use nipple wiped withsterilized cotton. It seemed that hand washing
before breastfeeding was more important.
② The physical compression with stocking was effective to control the blood pressure decrease whensupine position was changed to standing up position, especially in the elderly. It was suggested thestocking might prevent the orthostatic hypotension in the elderly.
③Vaccine-induced immunity of measles, mumps,
rubella and chickenpox at one to three years ofage continued until nine years of age. But the levelof immunity was lower than naturally aquired
immunity.

327

④This study showed that incidence of atopic children
was decreased by age, but any risk factors could
not be found in atopic children compared with
non-atopic children.
⑧We developed Japanese version of Feetham Family
Functioning Survey (FFFS)which enables to evaluate the family functions for young families withchildren.

Current Research
Current research projects include four fields, thatis, maternal-child nursing, pediatric nursing, gerontological nursing and family nursing.
Topics of our current research projects are as follows: ①Control of hospital infection such as transmission of bacteria including MRSA between mothers
and their babies, ②Exploring the new nursing caremodel for the children with disabled and/or chronic
illness in the community, ③Interaction between nursing home residents and their families, ④Nurses’ interests in family care for critical patients, ⑤Assessmentof autonomic nervous activity in the elderly withchronic illness in hospital, ⑥Incidence of adverse
reactions associated with Japanese-style medical
acupuncture for the elderly, ⑦Follow up study ofphysical, mental and social activities of patients withdementia.

Future Prospects
Since two more Departments, ‘Midwifery Nursing
and Women’s Health’ and ‘Gerontological Nursing’,
will be established in 2002 and 2003 respectively, ourdepartment will be responsible mainly for Family
Nursing and Pediatric Nursing.
Concept of family nursing was introduced to Japancountry only ten years ago, and The Japanese
Association for Research in Family Nursing was
founded by our department in 1994. Our department
will explore the establishment of the theory in family
nursing collaborating with its research, practice andeducation.
Education and research of pediatric nursing arealso involved in our activities. We intend to research
new fields of pediatric nursing in the viewpoints ofchild rights, good prognoses of severe illness, birth ofchildren with diversified origins on the basis of the
progress of reproduction technology, and well-being
for all of the families.

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Research Grants (within 5 years)
1, Chieko Sugishita, Naohiro Hohashi: Infection control among nursing mothers and neonates, andrelated quality of nursing care -According to analyses of bacteria including MRSA in a maternity clinic-, Grants-in-Aid for Scientific Research (B)(2),
1998-1999, The Ministry of Education, Culture,
Sport and Science, ¥10,200,000
2, Chieko Sugishita, Noriko Yamamoto, Mamoru
Kumada: Development of passive of leg cycle exercise for the elderly to improve the walking rhythm
and enhance the autonomic nervous activity.
Grants-in-Aid for Scientific Research (B)(2), 19992000, The Ministry of Education, Culture, Sportand Science, ¥6,400,000
3, Chieko Sugishita, Kunihiko Hayashi, Naohiro
Hohashi, Kunie Mituhashi: Development of two
dimensional scale in order to assess the familysystem and care ability, Grants-in-Aid for
Exploratory Research, 1999-2000, The Ministry of
Education, Culture, Sport and Science, ¥2,100,000
4, Hiroko Torii, Hideko Mori, Chieko Sugishita:
Study on nurses’ views on family and family nursing, Grants-in-Aid for Exploratory Research, 19992000, The Ministry of Education, Culture, Sportand Science, ¥800,000
5, Chieko Sugishita, Kiyoko Kamibeppu, Keiko
Murata, Naohiro Hohashi, Hiroko Torii, Makiko
Owaki, Kunihiko Hayashi: Development of nursing practice model for the children with chronic
illness or/and disabilities and their families incommunity. Grants-in-Aid for Scientific Research(B)(1), 2001-2003, The Japan Society for the
Promotion of Science, ¥12,100,000

Select Publications
1. Sugishita C, O’shea S, Best J, and Banatvala J E.
Rubella serology by solid-phase radioimmunoassay.
its potential for screening programmes.
Cline.Exp.Immunol 31(1), 50-54, 1978.
2. Shishdo A, Sugishita C, Takahashi C, Sakata H,
Hirayama M, and. Kimura M. A ten-year follow-up
study on measles vaccination in Japan: Evaluation of
the efficacy analyzed on a computer system.
Japanese Journal of Medical Science & Biology 31(4),339-356, 1978.
3. Kono R, M. Hirayama, Sugishita C, and Miyamura K.
Epidemiology of rubella and congenital rubella infection in Japan. Reviews of Infectious Diseases,
Supplement 1, 56-63, 1985.
4. Maekawa K, Nozaki H, Fukushima K, Sugishita C,
and Kuriya N. Clinical analysis of measles, mumps
and rubella vaccine meningitis?Comparative study ofmumps, mumps meningitis and MMR meningitis?.
Jikeikai Medical Journal 38(4), 361-368, 1991.
5. Iida Y, Sugishita C, Matsuura K, and Torii H. English
education in colleges of allied health sciences.
Bulletin of Tokyo Metropolitan College of Allied
Medical Sciences 7 97-102, 1994.
6. Nagase H and C. Sugishita. Mother’s anxiety related
to their child rearing on telephone consultation.
Analysis of statement about the in health center-. J
Child Health 53, 668-76, 1994. (in Japanese)
7. Sugishita C, Tezuka K, Hohashi N and Higurashi M.
Effects of medical compression stockings on lower
leg girth in healthy women. Jpn J Maternal Health
35,50-53, 1994.(in Japanese)
8. Hohashi N, Etoh T, Kurahashi T, Tejima R and
Sugishita C. Seroepidemiology of primary school children in the third grade for naturally acquired or vaccine
inducedimmunityofmeasles,mumps,rubella,and chickenpox determinedby presence of IgG antibody. Infection and Immunity
in Childhood 6,251-4, 1994. (in Japanese)
9. Sugishita C, Mori H, Nagase H, Tezuka K, Kurahashi
T and Hirayama M. Immunization of communicabledisease and morbidity rate in handicapped children
and young adults. J Child Health 53, 842-8, 1994. (inJapanese)
10. Tamura T, Naoko H, Nagase H, Morokata T, Igarashi
O, Oshimi Y, Miyazaki S and Nariuchi H. Early activation signal transduction pathways of Th1 and Th2cell clones stimulated with anti-CD3. J. Immunol 24,
4692-4701,1994.
11. Yoshimoto T, Nagase H, Nakano H, Matsuzawa A
and Nariuchi H. AVβ8.2-specific superantigen fromexogenous mouse mammary tumor virus carried by
FM mice. Eur.J.Immunol. 24, 1612-1619, 1994.
12. Sugishita C, H Yonezawa, N Hohashi, Y Iida, F
Komoda, T Iwata and H. Hayakawa. The significanceof guidance for mothers of allergic children withregard to dietary restrictions. Proceeding of The

XVth World Conference of the International Union
for Health Promotion and Education. 312-315, 1995.
13. Sugishita C, Morotomi C, and Murata I, etc.
Evaluation of PHA/RIA antibody responses to CHO
cell derived HB vaccine compared with yeast andplasma derived HB vaccines. Clinical Virology 23,
231-236, 1995.
14. Sato Y, Sugishita C, Kataoka Y. The effect of walking
on blood pressure changes and accelerated plethysmogram (APG) in middle aged and elderly people
with hypertension. Jpn J Res Fm N 2, 28-35, 1996.
15. Hohashi N, Hayashi T, Fusaki N, Takeuchi M,
Higurashi M, et al. The protein tyrosine kinase Fyn
activates transcription from the HIV promoter via
activation of NF K b-like DNA-binding proteins. Int.
Immunol 7, 1851-1859, 1995.
16. Tezuka K, Sato R, Igarashi T and Sugishita C. The
effect of pneumatic massage on the leg circumferences of healthy women. Clinical Report 30, 203-209,
1996.
17. Tezuka K, Sugishita C, Kuwaki T, Higurashi M and
Kumada M. Effects of compression stockings onblood pressure and its orthostatic change in female
subjects. Pathophysiology 4, 81-86, 1997.
18. Iwata T, Hayakawa H, Komoda F, Koseki M,
Miyakawa T, Sakurayama T, Yamasaki K, Honjou M,
Hirakawa N, Inoue K, Hohashi N, and Sugishita C.
Prospective study of atopic status in infants of thecohort in Tokyo,Japan. Allergology International 46,
221-225, 1997.
19. Miki A, Haratani T, Sugishita C, Kawakami N, Araki
S, and Kawamura N. The effects of job stressors on
depression and job satisfaction among hospital nurses in Japan. Proceedings 15th Asia Conference On
Occupational Health 226-231, 1997.
20. Yoshidome A, C. Sugishita.A study on the relationship between mamma trouble and practice of nipple
wipping with sterilized cotton. Japanese Journal of
Maternal Health 38, 350-354, 1997. (in Japanese)
21. Tsuchiya H, Kusaka S, Hohashi N, Sugishita C. The
decrease of the seroprevalence of antibodies against
herpes simplex virus and cytomegarovirus among
students of nursing college and consideration of
their lifestyles and rearing environments. Infection
and Immunity in Childhood 9, 95-102, 1997. (inJapanese)
22. Page J, Lim H, Lynett L-Y, Heller R, Fukuhara H, Ban
S, Yamamoto N, and Kurokawa K. Critical appraisal
workshop in Japan: a short term evaluation.
Education for Health. 10, 371-377, 1997.
23. Yamamoto N and Wallhagen M I. The continuationof family caregiving in Japan, Journal of Health andSocial Behavior. 38, 164-175, 1997.
24. Nagase H, Wang C, Yoshimoto T, Sugishita C, andShiroishi T, Matuzawa A and Nariuchi H. Analysis ofnovel mutant mice secreting soluble CD4 without
expression of membranebound CD4. Eur.J.Immunol
28, 403-412, 1998.

329

25. Naito N, Hashimoto Y, Sugishita C. Development of
the childcaring perspective scale for mothers withchildren aged three or younger(CPS-M 97): -Validity
and Reliability of the CPS M 97-. Journal of Japan
Academy of Nursing Science 18, 1-9, 1998. (inJapanese)
26. Torii H and Sugishita C. Behavioral problems of thechild when his/her mother is stating with his/her
hospitalized sibling. Japanese Journal of Research in
Family Nursing 4, 18-23, 1998. (in Japanese)
27. Matsui N, Ju K, Kumada M and Sugishita C. The
effect of water exercise with a jet on the frail elderly.
The Autonomic Nervous System 35, 419-423, 1998.
(in Japanese)
28. Yamamoto N and Sugishita C. Utilization patters ofcare assistance by family caregivers of visitors to aclinic for the elderly. Japanese Journal of Gerontology
19, 129-139, 1998.
29. Yoshinaga, A., and Horibe, H. Serum lipid concentrations in Japanese children: A synthesis of 27 studies.
CVD Prevention. 1: 55-70, 1998.
30. Yamamoto N, and Wallhagen M I. Service use by
family caregivers in Japan. Social Science andMedicine, 47, 677-691, 1998.
31. Sugishita C. Development of family nursing in Japanpersent and future perspectives. Journal of Family
Nursing 5(2), 239-244, 1999.
32. Matsui N, Ju K, Sugishita C and Kumada M.
Assessment of baroreceptor reflex sensitivity duringpassive leg cycle exercise using bivariate autoregressive model. Proceedings of the IFMBE/IMIA 3rd
International Workshop on Biosignal Interpretation.
91-94, 1999.
33. Omine F, Hamamoto I, Odo S, Miyagi M, Sunagawa
Y, Sugishita C. A Study of the Effect of Peer
Education on Student Sexual Awareness. Journal ofJapan Academy of Nursing Science 19(3), 64-73,
1999. (in Japanese)
34. Nakatani Y, Hohashi N and Sugishita C. Changes ofhemodynamics due to white noise stress according
to the extents of obesity. The Japanese Journal of
Health and Human Ecology 65, 208-218, 1999. (inJapanese)
35. Hohashi N, Matsumoto K and Sugishita C. National
survey of actual conditions related to MRSA conducted through home-visit nursing care station-Focusing
on incidence of MRSA and problems related to homecare-. Japanese Journal of Research in Family Nursing
4, 119-124, 1999. (in Japanese)
36. Mori N, Ito T, Tsushima R, Hhashi N, Hiramatu K
and, Sugishita C. Bacteriological and molecular epidemiological analysis of methicillin-resistant staphylococcus aureus isolated in a maternity hospital.
Environmental Infections 14, 296-302, 1999. (inJapanese)
37. Yamamoto-Mitani N, and Sugishita C. Discharge education for neurology patients and their family:
Comparison between the recognition of nurses,

330

patients, and their family. Japanese Journal of
Research in Family Nursing 5(2), 4-18, 1999. (inJapanese)
38. Yamamoto N M, Tamura M, Deguchi Y, Ito K and
Sugishita C. The attitude of Japanese family caregivers toward the elderly with dementia.
International Journal of Nursing Sutudies 37, 415−
422, 2000.
39. Mori N, Hitomi S, Okuzumi K, Yoneyama A,
Sugishita C, and Kimura S; Susceptibility to vancomycin of methicillin-resistant staphylococcus
aureus isolated in a university hospital in Japan. J. J.
A. Inf. D. 74(11), 966-972, 2000.
40. Yamamoto N M, Abe T, Yamada Y, Yamazato C,
Amemiya H, Sugishita C and Kamata K. Reliability
and validity of Japanese quality of life scale for theelderly with dementia. Nursing and Health Sciences2(2), 69-78, 2000.
41. Matsui N, Ju K, Ohmori N, Sugishita C and Kumada
M. A new device for evaluating autonomic nervous
activity of cardiovascular system. Biomedical
Sciences Instrumentation 36, 87-92, 2000.
42. Maeda M, Hohashi N, Sugishita C. Survey of thefamily accompaniment of hospitalized children.
Japanese Journal Research in Family Nursing 5, 94100, 2000. (in Japanese)
43. Kudo Y and Sugishita C. A Study of infection control
among HPN patients. Infection Control 179-182,
2000. (in Japanese)
44. Yamamoto-Mitani N and C. Sugishita. The effectiveness of nurses’ discharge education and post-discharge patient problem evaluation. Japanese Journalof Nursing Science 20(2), 21-28, 2000. (in Japanese)
45. Hohashi N, Maeda M and Sugishita C. Developmentof the Japanese-language Feetham Family
Functioning Survey(FFFS) and evaluation of its effectiveness. Japanese Journal of Research in Family
Nursing 6, 2-10, 2000. (in Japanese)
46. Yamashita H, Tsukayama H, Hori N, Kimura T and
Tanno Y. Incidence of adverse reactions associatedwith acupuncture. J Altern Complement Med. 6(4),345-350, 2000.
47. Kobayashi N. Formal service utilization of the frail
elderly at home during the last six months of life,
Nursing and Health Sciences 2, 201-204, 2000.
48. H Yamashita, H Tsukayama, and Sugishita C; Local
adverse reactions commonly seen in Japanese-style
medical acupuncture practice. Clinical Acupuncture
and Oriental Medicine 2, 132-137, 2001.
49. Yamashita H, Tsukayama H, White A R, Tanno Y,
Sugishita C, and Ernst E. Systematic review ofadverse events following acupuncture: the Japanese
literature. Complementary Therapies in Medicine, 9,98-104, 2001.
50. Yamamoto-Mitani N, Sugishita C, Ishigaki K,
Hasegawa K, MaekawaN, Kuniyoshi M, and Hayashi
K. Development of instruments to measure appraisalof care among Japanese family caregivers of the eld-

erly, Scholarly Inquiry for Nursing Practice: An
International Journal, 15, 113-135, 2001.

331

Department ofCommunity Health Nursing
Outline and Research Objectives
Department of Community Health Nursing (CHN) was established in June 1992 with theappointment of Dr. Katsuko Kanagawa as the first professor of the department. In May
1993, Dr. Sachiyo Murashima joined as associate professor and took charge as professor
after Dr. Kanagawa’s retirement.
During ten years since the department’s inauguration, 12 students have succeeded ingaining the degree of Doctor of Health Sciences; 19 the degree of Master of Health Sciences,and in the undergraduate course 20 students elected to write theses in community healthnursing.
In order to enhance the practice of nursing and public health, the department strives toundertake research for improvement of quality of life (QOL) of people in various community
settings by focusing on:
1. Developing a comprehensive health care system for community care through publichealth nursing leadership;
2. Intervention projects to demonstrate efficacy of new initiatives directed at improvementof QOL of bedridden, frail and demented elderly;
3. Preventive programs to improve clinical practice in home (e.g. falls) and to reform policy
directions;
4. Undertaking commissioned research with government and non-governmental organizations driven by needs and resources of individuals, families, targeted population groups
and organizations in order to measure cost-effectiveness and quality of care;
5. Developing models for community nursing practice to provide efficient care in partnership with other professionals, families and communities.
The major studies undertaken by the members of the CHN department can be classified
as following;
Directed at

Descriptive studies

Intervention studies

Individuals• Influencing factors of social rehabilitation among former
patients with Hansen’s disease• Meaning of health among cancer patients• Home visiting for schizophrenic patients• Prevention for deterioration of ADL among bedridden elders• Effectiveness of reminiscence for the demented elderly(RCT)• Effectiveness of early discharge planning(RCT)Families• Attitude and interaction of grand children to the demented elders at home • Effectiveness of improved home visit program for• Care of families of children with chronic disease
newborne babies

Aggregates• Characteristics of professional support to family groups of
psychiatric patients• Meaning and strategy of rural women for maintaining both
agriculture and care-giving• Effectiveness of improving support program tofamily groups of psychiatric patients (RCT)Home health service • Community diagnosis and networking• Development and evaluation of around-the-clock
and a community• Comparison between two types of around-the-clock in-home care systems : in-home care system
workinga single type of home help service and a combination type with nursing

Faculty and Students
Sachiyo Murashima, D.Hlth.Sc.,
R.N., P.H.N. (2001~)
Associate Professor Noriko Nishikido, D.Hlth.Sc.,
R.N., P.H.N.
Associates ...............................2
Graduate Students ................11 (7 in Master course; 4 inDoctoral course)
Research Students...................2
Secretaries ...............................3

Past Research and Major Accomplishments

Professor and Chair

332

Research Areas of Community Health Nursing
Community health nursing research has been considered from three perspectives; ‘nursing in the community’, ‘nursing of the community’ and ‘nursing into
the community.’ A majority of studies have focusedon continuity of care and empowering people bystrengthening their potentiality through creating caresystems.

1. ‘Nursing in the community’‘Nursing in the community’ means offering nursing services or health promoting activities to people inthe community in collaboration with other professionals and/or lay people. It is operationalized bydeveloping and testing a new programs to meet needsof individuals or aggregates.
In 1993, when I was transferred to the Universityof Tokyo, care burden for the elderly was a topicalissue in Japan. Following favorable reports of nighttime home helpers’ visiting service, a need to add visiting nurse service was strongly solicited. A study
testing the efficacy of model programs involving four
visiting nurse stations providing around-the-clocknursing care (ACC) commenced with assistance from
the Ministry of Health and Welfare in 1994.
Based on the needs assessment for ACC, an intervention of visiting nursing care early in the morningand evening was provided; and simultaneous evaluation was carried out before, during and after 3
months. Major findings indicated positive effects
related to stabilized medical status, reduced stress,
thereby reduced complications such as decubitus (seearticle number 22).
The results also impacted on policy change: in1996 the fees for ACC visiting nurses, which enabled
the night time visits by nurses, were included in thenational health insurance program. The combination
type of nursing and home help service functioned
more effectively than a single type of home help service (see article number 34).
2. Nursing of the community
Research for ‘nursing of the community’ means
creating care systems in the community for providing
effective care of individuals to enhance their capacity.
A study depicting the role of public health nurses inenabling the community to establish its own care system to solve problems (see article number 25) was in arural town M with a focus on ACC system.
The major purpose of this study was to test thefeasibility of ACC visiting nurse service as desired by
the community, to measure its effectiveness and eventually to develop a policy for providing this service
within the local government health plan. The intervention included establishing the need and acceptance of service, involving residents and other healthworkers, resulting in whole community handling conflicting concepts such as ‘Sekentei’, a kind of socio-cultural norm (see articles number 31, 43, and 48).
Intervention and control population were used forcomparison to measure the effectiveness of aroundthe-clock visiting nurse service. The outcomes of ACC
by nurses and home-helpers indicated lower rates of
institutionalization and reduced waiting lists in the
study town, compared with the control town,
although control town rates of institutionalization did
not differ from all Japan rates (see article number 47).
3. Nursing into the community: Creating seamless
care
The third area, ‘nursing into the community’,refers to developing models to assist patients andfamilies when patients return home through multidisciplinary and collaborative discharge planning in hospitals in order to implement seamless care. To determine the effectiveness of newly established dischargeplanning service, several studies were conducted,
including the characteristics of patients referred fordischarge planning and of those identified being at
risk (see article number 35).
A quasi-experimental trial rexamined the effectiveness of early discharge planning for at-risk hospitalized elders. The findings indicated decreased anxiety
in patients and caregivers, and effectiveness in terms
of prevention of prolonged hospital stay (see article
number 36).
A book ‘Discharge Planning: A Challenge at theTokyo University Hospital’ was published in 2002, as
one of scholarly outcomes of this research activity.

Current Research Projects
Current research of the community health nursing
department is dedicated to further exploration ofways to promote health and continuation of projects
in the preceding years. To list a few are;1. Support program for the lonely elderly, fall prevention program, and demonstration projects such as
developing check list of unilateral spatial neglect
and related disorders amongst cerebro-vascularpatients in community settings.
2. Review and expansion of long-term care in a ruraltown, Town M, for the evaluation Long-Term Care
Insurance.
3. Seamless care between hospital and community 1)
Development and test of usefulness of check list333

for potential high-risk patients for referral of discharge planning support team; 2) Investigation ofdaily life problems immediately after discharge.

Future Plan
Since numbers of elderly in Japan are rapidly
increasing and family support is dwindling, thedepartment endeavors to take a lead role in research
related to establishing basic home care programs thatare efficient, acceptable by funding bodies (e.g. government) and adaptable by the local communities.
Therefore,
1. Faculty and graduate students of department arededicated to developing community interventions
specifically for care of demented and bed-ridden
elders.
2. Health promotion intervention studies to strengthen community competence and lines of resistancethrough programs, such as: 1) developing volunteer networking which offers day care programs toprevent elders from deterioration, and bed-ridden
or demented; 2) support programs for 75 years
and older by offering preventive home visiting 2-3
times a year; 3) strengthen and support community health nurses in developing skills and sustainable capacity-building developmental approaches
towards community partnerships and activities in
the community.

Research Grants (selected 5)
Sachiyo Murashima (P.I.), Katsuko Kanagawa, Hiromi
Kawagoe.
A study on organization and specification of functions of home care nursing: From the viewpoint of
24-hour care plan.
Grant-in-Aid for Scientific Research (B) by the
Ministry of Education and Culture in 1998-1999;￥12,400,000.
Sachiyo Murashima (P.I.), Shuhei Ryu, Masako Yamada,
Yutaka Tagami, Hiromi Watanabe, Naomi Sumi,
Naoko Takeuchi.
A study on promoting the model project of a combination type of nursing and home-help service.
Research Grant for Welfare of the Elderly by the
Ministry of Health, Labour and Welfare in 1999;￥5,000,000.
Sachiyo Murashima (P.I.), Tomoe Nogawa.
A research on promotion of well-being of the elderly
by public health nurses’ activities.
Research Grant for Welfare of the Elderly by the
Ministry of Health, Labour and Welfare: Research
Project for Supporting Independent and Healthy
Elders in 2000;￥10,000,000.
Hidetoshi Endo (P.I.), Sachiyo Murashima, Satoko
Nagata.

334

A study on effectiveness of the support system ofdischarge planning for hospitalized elders in special
functioning hospitals.
Research Grant for Longevity Sciences from the
Ministry of Health, Labour and Welfare in 20002002; ￥1,500,000 in each year.
Sachiyo Murashima (P.I.), Ryutaro Takahashi, Satoko
Nagata, Megumi Haruna.
Effectiveness of the program for discharge planningfor elderly in-patients.
Grant-in-Aid for Scientific Research (B) by the
Ministry of Education and Culture in 2001-2002;￥9,200,000.

Select Publications*: copy attached.
1. Murashima S and Iida S. A study on health behavior
and life style of primary school children: The difference between urban and rural communities, fifteen
years ago and now. Research Journal of School
Health 23(11), 531-539, 1981. (in Japanese)
2. Murashima S, Ryu S, Tanaka T and Tomari T. A
study on trends of the regional variations of physicalstandards in Japanese schoolchildren. Research
Journal of School Health 24(2), 89-97, 1982. (inJapanese)
3. Murashima S. A case study on family life of young
women with Diabetes Mellitus: How much can theirhusbands, relatives, neighborhood and children
understand their situations? Journal of Japan
Academy of Nursing Science 2(1), 39-47, 1982. (inJapanese)
4. Murashima S, Iida S, Ishii Y, Fujita A, Matsushita K
and Watanabe H. Health condition and home care of
the aged with 75 years and over: Regional differences
between urban and suburban areas. Bulletin of St.
Luke’s College of Nursing 15, 28-43, 1989. (inJapanese)
5. Murashima S, Iida S, Ishii Y, Matsushita K, Fujimura
M, Sanuki J, Hanazawa K, Watanabe H and Sakurai
N. Health conditions and home care of the frail elders with 75 years and over: Regional differences
between urban and suburban areas. Bulletin of St.
Luke’s College of Nursing 16, 60-69, 1990. (inJapanese)
6. Yoshio K, Murashima S and Iida S. A study onchanges of DM patients’ life style and the affecting
factors. Journal of Japan Academy of Nursing Science10(1), 24-36, 1990. (in Japanese)
7. Fukanoki T, Murashima S and Iida S. Analyses offactors affecting home oxygen therapy (HOT)patients’ Quality of Life: Focusing on their life satisfaction. Journal of Japan Academy of Nursing Science11(1), 9-21, 1991. (in Japanese)
8. Fukaya A, Murashima S and Iida S. Analyses of factors affecting the change in ADL of post-infarcthemiplegics elders living at home: Focusing on thedaily life style of the patients and their families.

Journal of Japan Academy of Nursing Science 11(2),44-54, 1991. (in Japanese)
9. Murashima S, Iida S, Matsushita K, Sakurai S andNaruki H. Building a care system for frail elderly inthe community. Annual Report: St. Luke’s College ofNursing, WHO Collaborating Center for Nursing andMidwifery Development in PHC 1990/1, 48-54, 1992.
10. Mizuno T, Murashima S and Iida S. Analyses on careburden and cognitive discrepancies of care role
between frail elders and their care-givers. Journal ofJapan Academy of Nursing Science 12(2), 17-29,
1992. (in Japanese)
11. Murashima S, Satoh R, Naruki H, Kurebayashi M and
Iida S. Issues in mobilizing the bedridden elderly athome. Annual Report: St. Luke’s College of Nursing,
WHO Collaborating Center for Nursing andMidwifery Development in PHC 1991/2, 8-20, 1993.
12. Nishio J, Murashima S and Iida S. Health behavior
model based on analysis of factors affecting alcohol
behavior of company employees. Japanese Journal of
Public Health 41(7), 607-617, 1994. (in Japanese)
13. Murashima S. Limitation of care-giving to the elders
by the families and the conditions for the society totake care of the elders. Research Journal of Care andWelfare 2(1), 23-30, 1995. (in Japanese)
14. Ota K, Tamura M, Sei M, Koyama M, Hishinuma M
and Murashima S. The content and its teaching
method of nursing for elderly in Baccalaureate
Program. Bulletin of St. Luke’s College of Nursing 21,
34-40, 1995. (in Japanese)
15. Murashima S, Murakami K, Kadokawa T, Sasaki M,
Naruki H, Kawakami H, Arai H, Iwanaga T and
Iwamuro S. Strategies of public health nurses topractice in rural areas and urban areas. Japanese
Journal of Public Health Nurses 51, 91-96, 1995. (inJapanese)
16. Murashima S, Yamada M, Tagami Y, Satoh M,
Uchida E, Miyazaki W, Kawagoe H, Hoshi T, Ooura
H, Horii T, Nakayama I and Yamazaki M. Factsthrough the project of around-the-clock nursing andcare provided by visiting nurse service stations.
Japanese Journal of Home Care Nursing 1(2), 83-92,
1996. (in Japanese)
17. Murashima S, Kim J and Fukui S. Outcomes in homecare. Japanese Journal of Nursing Research 30(5),351-363, 1997. (in Japanese)
18. Murashima S, Fukui S and Kim J. Several kinds ofrecording formats for home care developed on thebasis of outcome. Japanese Journal of Nursing
Research 30(5), 47-63, 1997. (in Japanese)
19. Okada M, Murashima S and Asahara K. A study oncompetencies used by public health nurses in creating new health care systems in the community.
Japanese Journal of Public Health 44(4), 309-321,
1997. (in Japanese)
20. Murashima S and Yamada M. Support for home carein the community: Principles of providing home help
and nursing care. Health Sciences 14(1), 6-11, 1998.
(in Japanese)

21. Murashima S. Role and issues of visiting nurse service in the aging society: For effective home care.
Japanese Journal of Gerontological Sociology 20(1),16-24, 1998. (in Japanese)
22*.Murashima S, Zerwekh JV, Yamada M and Tagami Y.
Around-the-clock nursing care for the elderly inJapan．Image: Journal of Nursing Scholarship 30(1),37-41, 1998．
23. Konishi K, Murashima S and Kanagawa K. A study
on stress-coping in the stroke rehabilitation process:A qualitative analysis on problems recognized bypatients. Japanese Journal of Home Care 1(1), 56-66,
1998. (in Japanese)
24. Okamoto E, Murashima S and Saito E. The significance of day care service for elders with dementia
and their caregivers: What is the difference between
the day with day care service and the day with noservice? Japanese Journal of Public Health 45(12),1152-1161, 1998. (in Japanese)
25*.Murashima S, Hatono Y, Whyte N and Asahara K.
Public health nursing in Japan: New opportunities
for health promotion. Public Health Nursing 16(2),133-139, 1999.
26. Murashima S. Function and role of nurses in aroundthe-clock in-home care service. Health Care 40(5),387-392, 1998. (in Japanese)
27. Murashima S, Ryu S, Asahara K, Yamada M and
Tagami Y. A system supporting the elderly at home:
Demand and effectiveness of 24 hour home carewhich includes medical treatment. GeriatricMedicine 36(12), 1789-1795, 1998. (in Japanese)
28. Yamawaki A and Murashima S. Home care service
utilization by severely mentally and physically handicapped persons. Japanese Journal of Public Health45(6), 499-511, 1998. (in Japanese)
29. Ito A, Murashima S, Choi J and Horii T. The meaningof the characteristics on the function of night-timenurses’ visits: Through the analyses of the users’
record of the visiting nurse station which provides
around-the-clock in-home care by three shifts ofnurses. Journal of Japan Academy of Home HealthCare 3(1), 68-77, 1999. (in Japanese)
30. Murashima S, Saito E, Hattori M, Hagiwara A, Sumi
N, Ueno M and Kanagawa K. Study on competenciesof community health nurses and introduction of theactivity by Dr. Joyce Zerwekh: Focused on home visits and visiting nurse service. The Japanese Journal of
Nursing Research 32(1), 3-14, 1999. (in Japanese)
31*.Murashima S, Asahara K, White MC and Ryu S. The
meaning of public health nursing: Creating 24 hourcare in a community in Japan. Nursing and Health
Sciences 1, 83-92, 1999.
32. Murashima S and Hollaender L. How do the people
in Denmark treat with elders with dementia. The
Japanese Journal of Occupational Therapy 34(5), 594597, 2000. (in Japanese)
33. Murashima S. Evaluation of home care service.
Health Care 42(4), 263-269, 1999. (in Japanese)
34*.Takeuchi N, Murashima S and Hattori M.
Comparison between two types of around-the-clock335

in-home care systems: A single type of home help
service and a combination type of nursing and home
help service, focused on the way of collaboration andits influence. Journal of Japan Academy of Home
Health Care 4(1), 24-30, 2000. (in Japanese)
35*.Murashima S, Nagata S, Toba K, Ouchi Y and Sagawa
Y. Characteristics of patients referred for dischargeplanning from a geriatric ward at a national university hospital in Japan: Implications for improving hospital programs. Nursing and Health Sciences 2, 153161, 2000.
36*.Sumi N, Murashima S, Toba K and Ouchi Y. The
effectiveness of early discharge planning for hospitalized elders who had expected difficulties of discharge: A quasi-experimental trial in a geriatric wardof a highly advanced medical center. Journal of theJapanese Society on Hospital Administration 38(1),29-40, 2001. (in Japanese)
37. Yokoyama A, Murashima S, Nagata S, Yanagisawa A,
Wakabayashi K, Tashiro T, Toba K and Ouchi Y.
Follow-up study of patients who received dischargeplanning by a special department in a national university hospital. Journal of the Japanese Society on
Hospital Administration 38(1), 53-61, 2001. (inJapanese)
38. Kayama M, Zerwekh J, Thornton KA and Murashima
S. Japanese expert public health nurses empower
clients with schizophrenia living in the community.
Journal of Psychosocial Nursing 39(2), 40-45, 2001.
39. Toba K, Akishita M, Tanaka S, Kato T, Kawai S,
Yamaguchi N, Murashima S, Iguchi A and Sasaki H.
Knowledge and utilization on the comprehensive
evaluation of functions and of physicians’ opinionsin Japan: Joint research based on a wide variety of
hospitals and facilities in Japan. Journal of Japan
Academy of Geriatric Medicine 38(2), 139-147, 2001.
(in Japanese)
40. Nagata S and Murashima S. Current situation andissues of support program for early discharge. HealthCare 44(2), 95-99, 2002. (in Japanese)
41. Murashima S, Nagata S and Haruna M. Visiting
nurse service: Transition from hospitals to visiting
nurse service stations. The Japanese Journal of
Nursing Research 35 (1), 15-24, 2002. (in Japanese)
42. Kim J and Murashima S. Comparison of the homecare system for the elderly in Japan and Korea:
Towards an advanced home care system. Journal of
Korean Academy of Nursing 31(7), 1166-1173, 2001.
43*.Asahara K, Momose Y, Murashima S, Okubo N and
Magilvy JK. The Relationship of social norms to useof services and caregiver burden in Japan. Journal of
Nursing Scholarship 33(4), 375-380, 2001.
44*.Murashima S, Nagata S, Magilvy JK, Fukui S andKayama M. Home care nursing in Japan: A challenge
for providing good care at home. Public HealthNursing 19(2), 94-103, 2002.
45. Asahara K, Momose Y and Murashima S. Familycare-giving of the elderly and Long-Term Care
Insurance in rural Japan. International Journal of
Nursing Practice 8, 167-172, 2002.

336

46. Honda A, Saito E, Kanagawa K and Murashima S.
The relation between characteristics and activities ofdaily living of the elderly living alone. Japanese
Journal of Public Health 49(8), 795-801, 2002. (inJapanese)
47*.Murashima S and Asahara K. The effectiveness of
the around-the-clock in-home care system: Did it
prevent the institutionalization of frail elderly? Public
Health Nursing 20(1): 13-24, 2002.
48*.Choi J, Murashima S, Hattori M, Horii T, Nagata S
and Asahara K. Factors influencing the utilization ofvisiting nursing and home-help services. Japanese
Journal of Public Health 49(9), 948-958, 2002. (inJapanese)
49. Murashima S, Yokoyama A, Nagata S and Asahara K.
The implementation of the Long-Term Care
Insurance in Japan: Focused on the trend of homecare. Home Health Care Management & Practice15(6), 2002 (in press).
50. Momose Y, Asahara K and Murashima S. A trial tosupport fam;;ily caregivers in the Long-Term Care
Insurance: Self-help groups in small communities.
Home Health Care Management & Practice (in press).