【はじめに，目的】本研究は，在宅で過ごす神経筋疾患患者が入院中にどのような日常生活活動の制限を受け，ストレスを感じているかを調査することであり，在宅生活と入院中のADLの格差がストレスになっているかを明らかにすることにある。【方法】対象者は，日本難病・疾病団体協議会に加盟している難病患者9団体及び神経筋疾患の患者団体を運営している8団体に所属し，在宅療養している神経筋疾患患者である。方法は，患者団体の代表者から研究協力の承認を得た上で，オンラインアンケートを実施（実施期間2015年8月1日～9月30日），対象者は回答を持って研究の同意を得た。入院経験について調査するためにアンケートを実施，基本情報（疾患，罹病期間，人工呼吸器の使用等），在宅と入院時のBarthel Index（BI），Hospital Stress Rating Scale（HSRS）等について調査する。統計学的検討項目として，在宅時BIと入院時BIについて比較し，HSRSにおける因子分析を行う。また，基本情報及びBIからHSRSについて調査する。【結果】本研究へのアクセスは178人あり，有効回答数が113人，欠損値を排除すると83人のデータとなった。基本情報として，疾患はALS，MS，MD等が多く，平均罹病期間は10年，人工呼吸器装着は59.5%であった。在宅BI52.1±34.5点，入院時BI47.5±34.1点と有意差があり（p＜0.01），独立して，移動，歩行，排泄，入浴，整容においても入院BIは在宅BIと比較し，有意に低値であった（p＜0.01）。HSRSにおいて，因子抽出法として最尤法を用い，回転法Kaiserの正規化を伴うバリマックス法8回の反復で回転が収束した。回転後の因子行列よりグループ名をつけた結果，プライバシー，環境，疾患と治療，医療者との関係，家族との関係，部屋の快適さの6つに分類することができた。HSRSは，在宅と入院時BIの格差，入院回数，年齢，性別，罹病期間に有意な差を認めなかった。【結論】本研究の対象は患者会でweb利用できる方であり，過去を想起し回答しアンケート調査を行っていることなど多くの問題や限界はあるため神経筋疾患全体を反映しているものにはならない。しかしながら，在宅療養患者が持つ入院時に感じる入院時の制限やストレスについて明らかにしていくことは療養支援において極めて重要なことである。入院が在宅と比較し，自律しにくい環境であるからこそ，理学療法士の存在する意義があるものと考える。

Emotional labour increases among long-term care workers because providing care and services to impaired elders causes conflicting interpersonal emotions. Thus, we investigated the associations between emotional labour, general health and job satisfaction among long-term care workers. We conducted a cross-sectional study among 132 established, private day care centres in Tokyo using a mail survey. The outcome variables included two health-related variables and four job satisfaction variables: physical and psychological health, satisfaction with wages, interpersonal relationships, work environment and job satisfaction. We performed multiple regression analyses to identify significant factors. Directors from 36 facilities agreed to participate. A total of 123 responses from long-term care workers were analysed. Greater emotional dissonance was associated with better physical and psychological health and worse work environment satisfaction (partial regression coefficient: -2.93, p=.0389; -3.32, p=.0299; -1.92, p=.0314, respectively). Fewer negative emotions were associated with more job satisfaction (partial regression coefficient: -1.87, p=.0163). We found that emotional labour was significantly inversely associated with health and job satisfaction. Our findings indicated that the emotional labour of long-term care workers has a negative and positive influence on health and workplace satisfaction, and suggests that care quality and stable employment among long-term care workers might affect their emotional labour. Therefore, we think a programme to support emotional labour among long-term care workers in an organized manner and a self-care programme to educate workers regarding emotional labour would be beneficial.

:Emotional labour increases among long-term care workers because providing care and services to impaired elders causes conflicting interpersonal emotions. Thus, we investigated the associations between emotional labour, general health and job satisfaction among long-term care workers. We conducted a cross-sectional study among 132 established, private day care centres in Tokyo using a mail survey. The outcome variables included two health-related variables and four job satisfaction variables: physical and psychological health, satisfaction with wages, interpersonal relationships, work environment and job satisfaction. We performed multiple regression analyses to identify significant factors. Directors from 36 facilities agreed to participate. A total of 123 responses from long-term care workers were analysed. Greater emotional dissonance was associated with better physical and psychological health and worse work environment satisfaction (partial regression coefficient: -2.93, p = .0389; -3.32, p = .0299; -1.92, p = .0314, respectively). Fewer negative emotions were associated with more job satisfaction (partial regression coefficient: -1.87, p = .0163). We found that emotional labour was significantly inversely associated with health and job satisfaction. Our findings indicated that the emotional labour of long-term care workers has a negative and positive influence on health and workplace satisfaction, and suggests that care quality and stable employment among long-term care workers might affect their emotional labour. Therefore, we think a programme to support emotional labour among long-term care workers in an organized manner and a self-care programme to educate workers regarding emotional labour would be beneficial.

Background : In Japan, over 30,000 people per year have commited suicide in the course of 14 years since 1998. It is clear that many workers suffer from workplace stress. Mental health wellness is addressed by the industrial world yet mental health insurance coverage for individual workers is extremely difficult. The purpose of this case study is to improve the conditions of, and make changes for, the workers of a small to mid-sized company (company XYZ) whose employee had committed suicide from a psychosomatic point of view. Methods : We investigated the mental state and the workplace relationships of the eleven coworkers who were left behind by the one who committed suicide. Through interviews and participant-observer approach, the coworkers' conversational data were collected, and then analyzed by the KJ method, to reveal their relationships to each other and their socio cultural background. Two years after measures to prevent the recurrence of suicide were implemented, the coworkers were interviewed again and pre- and post-preventative measure implementation differences were analyzed. Results : Immediately after the suicide, in a social context, interviewees expressed their suffering as physical, mental, social, and existential pain. In addition to being an employee, the one who committed suicide had social roles as a father and husband. After his death, his personal financial hardship and his lack of interpersonal relationships at the workplace were revealed. Many of his coworkers were dissatisfied with company xyz's feudal culture. Their suffering, which stemmed from the work environment and business procedures, was improved by the implementation of mental health education and measures to prevent the recurrence of suicide ; this resulted in vast improvements to employer-employee relationships and their understanding of each other. They have started to care for each other and their behaviors have started to change. Discussion : It is best when industrial medical professionals take care of workers from a psychosomatic perspective. If that cannot happen, outside resources like consultants and non medical professionals, as well as the employees themselves, have the potential to improve health by carrying out a medical anthropological approach to prevent the recurrence of suffering.