[Social welfare for the neurotic].
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This is a report on the joint cooperative control of nursing and old-age homes by the Public Health and Social Welfare Offices in Duisburg, Germany. A total of 40 of such homes were inspected and checked jointly by the physician and pharmacist of the local Public Health Office within a one-year period while collecting data on the intensity and quality of care in these homes. A total of 3883 inmates were covered. These data included, inter alia, information on the intensity of care, prevalence of urinary and fecal incontinence, feeding by means of percutaneous endoscopic gastrostomy, prevalence of bedridden patients and of cases of pressure sores. The data conveyed information on the overall situation (frequencies for all the Duisburg nursing and old-age homes) on the one hand, and for each individual home on the basis of its particular data on the other hand. It became evident that two-thirds of all the inmates of nursing homes were classified as belonging to nursing stages II and III. Urinary incontinence was present in 63 per cent of the cases, fecal incontinence in 43 per cent, whereas 32 per cent were severely confused. Of a total of 447 permanently bedridden patients (11.5 per cent of all the inmates) 131 had pressure sores or necroses of the heels (3.37 per cent of the total population). More than one-half of the pressure sores had been acquired by the patients during their hospital stay, i.e. before their referral to a home, whereas 56 inmates developed their pressure sores in the homes concerned.
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Though Japan is noted for the custom of respect for the elderly, gerontological education is not widely practiced. At present it is only done in the training of several professionals and semi-professionals in health and welfare services for the elderly, i.e., medical doctors, nurses, social workers, and care workers for the disabled and older persons. In the training of social workers who are expected to serve as the pivot of a team for psycho-social help and caregiving, gerontological education is given as a part of social work education. In schools for care workers for the disabled and older persons that are two-year vocational schools, practical gerontological knowledge and skills needed in the care of the elderly are taught as an important base for their future work. In schools of nursing, most of which are two-year or three-year vocational schools in Japan, gerontological education is included as an indispensable component of the curriculum and is being given increasing importance these days.
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I intend to analyze in this paper tha activities of the Ophthalmic Rehabilitation Clinic at Juntendo University in order to clarify how social welfare is incorporated with medical care in rehabilitation. The patients who feel little hope of recovery often suffer a great sense of emptiness until they finally manage to rehabilitate themselves in society. The clinic was founded for them in 1964 inside the Department of Ophthalmology, Juntendo University. The Department has been providing consultation with the visually handicapped. The program consists of counseling, educational guidance, daily training, etc. It is quite remarkable that the rehabilitation program, in addition to the medical examination, has been introduced to the outpatients who have visual handicaps.
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Byzantine medicine was guided by Hippocratic principles and Christian theological precepts, all of which viewed the human being as a psychosomatic entity. Medical philosophy and Christian theology had achieved an alliance, and the well-being of the entire person was the central objective of both. Along with pharmaceutical herbs and drugs, diet and baths, exercises and optimistic outlooks, Byzantine physicians, whether laymen or clergymen, emphasized rational treatment but also the need for religious faith and hope. Even though the holy man and his miraculous therapeutic powers were highly respected, appreciation of the power of logic had never gone into a total eclipse throughout the Byzantine era. Thanks to the work of good physicians and their impact on the welfare of society medicine obtained high respect in 9th century. Nevertheless, the dialogue between secular medicine and sacred medicine, and the debate between secular and spiritual approaches to health and social welfare continued unabated down to the fall of the Byzantine Empire.
We evaluated functional disabilities of disabled workers at vocational aid facilities and a social welfare factory to reveal whether evaluation of the functional disabilities is useful for occupational health care activities. Subjects were 121 persons with a physical disability working at Fukuoka Colony (FC workers) and 35 persons with mental retardation working at Nanomi Kogei (NK workers). The Self-Rating Barthel Index, Self-Rating Frenchay Activities Index, and Satisfaction in Daily Life (SDL) were used for the evaluation of basic activities of daily living (ADL), lifestyle, and subjective domain of quality of life, respectively. The FC workers were almost independent in basic ADL: had a high capability in self-care activities and moderately disturbed capability in mobility activities, and had a more active lifestyle than the NK workers. The total SDL score indicated that the FC workers were less satisfied with overall daily life, although not significant, and were less satisfied with the SDL items of physical health, gait, house facilities, and having a job than the NK workers. Because these results indicated the features of disabled workers and gave an occupational health physician valuable information about disabilities, the evaluations used in this study can be regarded as useful for occupational health care activities.