片山 貴文

OBJECTIVE: To determine the effectiveness of a web-based educational program regarding local healthcare planning by public health nurses (PHNs) in Japan. DESIGN: A single-blind randomized controlled trial. SAMPLE: Full-time PHNs working for local governments across Japan. MEASUREMENTS: The primary outcome was nurses' self-perception of competencies in public health policy. The secondary outcome was self-perception of knowledge, skills, and perspectives regarding local healthcare planning. We analyzed intergroup differences using the intention-to-treat principle and the Mann-Whitney U-test. INTERVENTION: The intervention group received six web-based learning modules including substantial knowledge and skills regarding local healthcare planning based on the analysis, design, development, implementation, and evaluation model and adult learning theory. RESULTS: Totally, 273 PHNs registered, and 38 were excluded without completing the baseline survey; 235 were randomly allocated to either the intervention (n = 118) or control (n = 117) groups. Sixty-four participants in the intervention group completed the program. Over 70% of the participants lacked opportunities to learn about local healthcare planning. The intervention group showed significant improvement in self-perception of competencies, knowledge, and skills regarding local healthcare planning, except for items related to evaluation. CONCLUSIONS: The web-based learning program effectively improved participants' self-perception of competencies in local healthcare planning.

The body's water balance is changed by food and beverage intake, metabolism, and excretion. In this study, we performed a cross-sectional study that investigated the changes of water intake and water output in healthy Japanese young and elderly people and handicapped adults. Water balance was assessed by water intake from foods and beverages, metabolic water production, non-renal water losses (NRWL), and urine volume. Most of the parameters did not change with aging in healthy adults. Estimated total water intake (ml/kg/day) increased with aging. In the healthy men, healthy women, and handicapped adults, daily water intake (median [interquartile range]) accounted for 49.4 (41.4-59.9) ml/kg, 42.9 (38.7-51.8) ml/kg, and 50.9 (43.8-74.0) ml/kg, respectively. Water loss from the kidney accounted for 19.2 (16.2-29.2) ml/kg, 22.0 (16.2-26.6) ml/kg, and 27.5 (22.7-47.2) ml/kg, respectively. NRWL accounted for 26.6 (18.5-35.2) ml/kg, 22.4 (16.2-28.8) ml/kg, and 23.5 (19.8-28.5) ml/kg, respectively. Our findings suggest that a daily total water intake of more than 50-55 ml/kg is required to prevent dehydration in healthy and handicapped adults. J. Med. Invest. 70 : 195-199, February, 2023.

OBJECTIVE: This study investigated the association between receiving off-the-job training and the involvement of public health nurses in local healthcare planning. DESIGN: A nationwide, cross-sectional study design. METHODS: We sent self-report questionnaires to 2,185 public health nurses with experience in developing local healthcare plans in Japan since 2013 and collected information related to three main categories: demographic data, involvement in local healthcare planning and strategies for healthcare planning. RESULTS: We received 1,281 responses (return rate of 58.6%), of which 231 did not meet the inclusion criteria. Thus, we analysed 1,050 valid responses. Among the 1,050 respondents, 496 (47.2%) had received off-the-job training in healthcare planning. A subsequent logistic regression analysis revealed that the following factors were associated with this achievement: holding a managerial position, receiving healthcare planning education at the undergraduate level, having mentors regarding the promotion of it, partially conducting cross-sectional coordination and conducting groupwork with community-dwelling residents.

BACKGROUND: Promoting of local healthcare planning is crucial for assisting public health nurses in improving community health inequities. However, there is no effective educational program for developing relevant skills and knowledge among these nurses. Therefore, this study aims to assess the feasibility of a newly developed web-based self-learning program to promote the involvement of public health nurses in the local healthcare planning process. METHODS: A pilot randomized control trial randomly allocated eligible public health nurses to intervention and control wait-list groups [1:1]. The former will be exposed to six web-based learning modules from July to October 2021. After collecting post-test data, the wait-list group will be exposed to the same modules to ensure learning equity. The primary outcome will be evaluated by implementing a validated and standardized scale designed to measure public health policy competencies at the baseline and post-intervention, while secondary outcome will be measured on an action scale to demonstrate the necessity of healthcare activities. The third outcome will be the knowledge and skills related to local healthcare planning by public health nurses. The participants will provide feedback through free descriptions on the trial feasibility and a web-based self-learning program to identify improvement points for continual refinement. DISCUSSION: The results will provide suggestions in preparation for a future definitive randomized controlled trial. This will provide preliminary data for an intervention aimed at improving relevant competencies among public health nurses who are tasked with resolving health inequities in their respective communities through local health planning. TRIAL REGISTRATION: The protocol for this study was registered with the University Hospital Medical Information Network Clinical Trials Registry and approved by the International Committee of Medical Journal Editors (No. UMIN000043628 , March 23, 2021).

To compare all available accuracy data on screening strategies for identifying cervical intraepithelial neoplasia grade ≥ 2 in healthy asymptomatic women, we performed a systematic review and network meta-analysis. MEDLINE and EMBASE were searched up to October 2020 for paired-design studies of cytology and testing for high-risk genotypes of human papillomavirus (hrHPV). The methods used included a duplicate assessment of eligibility, double extraction of quantitative data, validity assessment, random-effects network meta-analysis of test accuracy, and GRADE rating. Twenty-seven prospective studies (185,269 subjects) were included. The combination of cytology (atypical squamous cells of undetermined significance or higher grades) and hrHPV testing (excepting genotyping for HPV 16 or 18 [HPV16/18]) with the either-positive criterion (OR rule) was the most sensitive/least specific, whereas the same combination with the both-positive criterion (AND rule) was the most specific/least sensitive. Compared with standalone cytology, non-HPV16/18 hrHPV assays were more sensitive/less specific. Two algorithms proposed for primary cytological testing or primary hrHPV testing were ranked in the middle as more sensitive/less specific than standalone cytology and the AND rule combinations but more specific/less sensitive than standalone hrHPV testing and the OR rule combination. Further research is needed to assess these results in population-relevant outcomes at the program level.

The changes in the serum 25-hydroxyvitamin D (25(OH)D) concentrations after daily 1000-IU vitamin D intake for 3 months (3-month-VD), 6 months (6-month-VD) and then 6-month cessation of vitamin D in-take (6-month-VD cessation) were examined. The serum 25(OH)D levels in 11 male and 16 female subjects were 12.1±3.5 ng/mL at baseline, increased to 27.1±4.7 ng/mL at 3-month-VD, 28.5±5.1 ng/mL at 6-month-VD and decreased to 16.4±4.0 ng/mL at 6-month-VD cessation. The present study suggested that a vitamin D intake of 1000 IU/day is required to maintain the 25(OH) D concentration at 30 ng/mL or higher without vitamin D intoxication. J. Med. Invest. 69 : 135-140, February, 2022.

目的 本研究の目的は，保健師が策定に参画した保健医療福祉計画（以下，計画とする。）の実行段階における住民との協働に関連する要因を解明し，地域全体の健康レベルの向上に貢献できる保健活動への示唆を得ることである。 方法 研究の概念枠組みとしてPlan-Do-Check-Act（以下，PDCAとする。）サイクルを用いた。本調査で焦点を当てた計画の実行段階は「Do」に相当するため，調査項目は「Plan」の段階の内容を中心に構成し，計画の実行段階における住民との協働をどの程度取り入れたか，回答者の属性，計画策定への参画状況，組織要因，計画策定の際に用いた方策を含めた。調査対象者は，地方自治体に勤務する常勤保健師のうち，保健師活動指針が発出された2013年以降に計画策定に参画した経験を有する者とした。協力意思を示した220地域（36都道府県，41保健所設置市，153市町村）に2,185人分の調査票を2019年10月～11月に郵送した。二項ロジスティック回帰分析により，住民との協働を取り入れたことと独立変数との関連について検討した。 結果 1,281人から回答を得た（回収率58.6%）。2013年以降に計画策定の経験がなかった203人と欠損値の多かった50人を除く1,028人について分析した（有効回答率47.0%）。計画の実行段階で住民との協働を「全く取り入れなかった」と回答した者は125人（12.2%），「あまり取り入れなかった」者は293人（28.5%），「少し取り入れた」者は482人（46.9%），「とても取り入れた」者は128人（12.4%）だった。二項ロジスティック回帰分析の結果，係長級以上の職位に就いていること，健康増進計画の策定への参画，住民へのアンケート調査やグループワークの実施，ワーキンググループや計画策定委員会の委員への住民の参加，すでに発表されている研究成果の活用，ターゲット集団の設定および計画実施の進捗管理の実施が，住民との協働を取り入れたことと有意に関連していた。 結論 保健師が，計画の実行段階における住民との協働を進めていくためには，地域の健康・生活課題解決に向けて住民の声やエビデンスに基づく計画を策定し，確実に実行されるように進捗管理を行う必要性が示唆された。

BACKGROUND: Although cervical cancer screening has been performed as a national program since 1983 in Japan, the participation rate has remained below 20%. Equity of access is a basic requirement for cancer screening. However, taking smears from the cervix has been limited to gynecologists or obstetricians in Japan and it might be a barrier for accessibility. We examined the current access and its available human resources for cervical cancer screening in Japan. METHODS: We analyzed the number of gynecologists and obstetricians among 47 prefectures based on a national survey. A systematic review was performed to clarify disparity and use of human resources in cervical cancer screening, diagnosis, and treatment for cervical cancers in Japan. Candidate literature was searched using Ovid-MEDLINE and Ichushi-Web until the end of January 2020. Then, a systematic review regarding accessibility to cervical cancer screening was performed. The results of the selected articles were summarized in the tables. RESULTS: Although the total number of all physicians in Japan increased from 1996 to 2016, the proportion of gynecologists and obstetricians has remained at approximately 5% over the last 2 decades. 43.6% of municipalities have no gynecologists and obstetricians in 2016. Through a systematic review, 4 English articles and 1 Japanese article were selected. From these 5 articles, the association between human resources and participation rates in cervical cancer screening was examined in 2 articles. CONCLUSIONS: The human resources for taking smears for cervical cancer screening has remained insufficient with a huge disparity among municipalities in Japan. To improve accessibility for cervical cancer screening another option which may be considered could be involving general physicians as potential smear takers.

AIM: To identify self-reported competencies of public health nurses for reflecting community healthcare needs in local healthcare plans. DESIGN: We conducted a nationwide cross-sectional survey in Japan from October 7-November 30, 2019. METHODS: We sent 2,185 self-reported questionnaires to public health nurses in Japan who had developed a local healthcare plan since 2013. Self-reported questionnaires included questions regarding demographic data and the reflection of community healthcare needs in local healthcare plans, and the involvement in local healthcare planning. RESULTS: We analysed 1,042 questionnaires: 651 (62.5%) were from public health nurses who reported that they elicited and shared community views to be reflected for purposes of local healthcare planning (the reflecting group), and 391 (37.5%) of the remaining public health nurses who reported that they did not do so (the non-reflecting group). The logistic regression analysis revealed that public health nurses in the reflecting group were more likely to be in a managerial position, have colleagues who played an active role in healthcare planning, conduct a questionnaire survey, engage in group work, participate in a municipal healthcare planning committee with community-dwelling people, and identify the opinions of the professional organizations. CONCLUSIONS: Identifying community healthcare needs through collaboration with community-dwelling people and professional organizations should be essential competencies for public health nurses (the reflecting group) in developing needs-oriented local healthcare plans. IMPACT: Identification of their related competencies for developing a needs-oriented local healthcare plan as an upstream strategy to mitigate the prevalence of health inequities in each community.

Age-related changes in muscle strength and physical functions, and the association between vitamin D status and skeletal muscle functions were investigated in 36 men (21-90 years old) and 52 women (21-104 years old). Significant ageing-related decreases in several skeletal muscle functions and serum 25-hydroxyvitamin D [25(OH)D] levels were observed in both men and women. Cut-off values for the Timed up and go (TUG) test, walking speed, handgrip strength and Barthel Index (BI) detecting walking difficulties in the receiver operating characteristic (ROC) analysis were 11.1 sec, 0.60 m / sec, 17.0 kg, and 90.0 in males, and 28.6 sec, 0.43 m / sec, 13.9 kg, and 67.5 in females, respectively. By comparing personal present data of muscle strength with these cut-off values, people can easily understand their process to walking difficulty. Therefore, these results are important and useful to avoid or to delay a handicapped and dependent status by improving the vitamin D level, rehabilitation and nursing care. J. Med. Invest. 68 : 48-52, February, 2021.

An intervention study was conducted to investigate the effects of daily 1,000-IU vitamin D-fortified milk intake on skeletal muscle mass, power, physical function and nutrition status in 26 healthy people and 8 older adults living in a nursing home. The serum 25-hydroxyvitamin D [25(OH)D] level was 13.4 ± 0.8 ng / mL and it markedly increased to 29.6 ± 0.9 ng / mL after daily 1000-IU vitamin D-fortified milk intake for 6 months. Handgrip strength (kg) also significantly increased in the 21-50 years and total groups, and male subjects, and the timed up and go test significantly improved in the 21-50 years and total groups, and female subjects after 6-month vitamin D intake. However, there were no significant differences between baseline and post-treatment in the Barthel Index (BI), walking speed (m / sec) or skeletal muscle mass (kg, % of BW, kg / m2). Therefore, the present study suggested that vitamin D-fortified milk intake is effective at improving muscle strength and physical function in Japanese, although further studies are needed, particularly for older adults. J. Med. Invest. 68 : 249-255, August, 2021.

A clearer understanding of skeletal muscle mass (SMM) in middle-aged and elderly individuals is important for maintaining functionality. In the present study, age-related changes in SMM, the threshold of SMM with walking difficulty, intestinal nutrient absorption rate, and various serum factors were examined in Japanese populations of different ages. We used 24-h creatinine excretion as a measure of total body SMM. Age-related decreases in SMM, intestinal nutrient absorption rates, and serum 25-hydroxyvitamin D [25(OH)D] concentrations were significantly higher in women than in men. The cut-off values for SMM (kg), its percentage of total body weight (BW), the SMM index [SMMI] (Kg / m2), and creatinine height index (CHI) (%) in elderly individuals with walking difficulty were approximately 8-10 kg, 17-20% of BW, 3.9-4.6 kg / m2, and 44%, respectively. Serum 25(OH)D concentrations were closely associated with SMM (kg, % of BW, kg / m2) and CHI (%) as well as the intestinal absorption rates of nitrogen (%) and phosphorus (%) in women, but not in men. The present results demonstrate that vitamin D is an important metabolic factor in skeletal muscle, and contributes to the optimal management of skeletal muscle and the prevention of sarcopenia. J. Med. Invest. 67 : 151-157, February, 2020.

OBJECTIVES: To evaluate the impact of web-based learning modules for health program planning competency, recognition, knowledge and skills among mid-level public health nurses (PHNs). DESIGN: Parallel-group randomized controlled trial. SAMPLE: During 2018, 244 Japanese PHNs were eligible as participants with 5-20 years experiences as a PHN were randomly allocated to the intervention (n = 121) or control group (n = 123). MEASUREMENTS: The outcome was assessed using the Competency Measurement of Creativity for PHNs (CMC) and 26 questions about recognition, knowledge, and skills for health program planning. INTERVENTIONS: Eight web-based modules. RESULTS: No significant differences in CMC scores between the control and intervention groups at base line and post-intervention. By contrast, significant differences in total score of the 26 items of knowledge and skills. In an exploratory analysis, there was a significant difference identified in CMC scores in the demographic of post graduate training in program planning at base line and post-intervention. (p = .034). CONCLUSIONS: The findings suggested that web-based learning with flexibility in terms of time and location would improve competency, skills and knowledge of health program planning among mid-level PHNs.

OBJECTIVE: To evaluate the effectiveness of an education program for mid-level Japanese public health nurses (PHNs) to improve their competencies in program planning, which will fulfill community health needs. DESIGN: Randomized control trial. SAMPLE: During 2017, 103 PHNs with 5-20 years of PHN work experience in Japan were enrolled and randomly allocated to the intervention (n = 51) or control group (n = 52). MEASUREMENTS: The primary outcome measured competency in program planning based on Competency Measurement of Creativity for PHNs (CMC), knowledge, and skills regarding program planning. INTERVENTION: Six web-based learning modules followed by two face-to-face group sessions. RESULTS: The PHN participants averaged about 12 years of experience. In the intervention group, 25 PHNs completed all modules (49.0%). Post intervention, there were no statistically significant differences among any between-group CMC scores. However, the intervention group's CMC 3 score was significantly higher than that of the control group of ≥12 years of experience. Total knowledge and skill scores also improved significantly in the intervention group compared with the control group. CONCLUSIONS: The results suggest that PHNs with ≥12 years of experience are a suitable target of this educational program, and should play a key role in program planning.

BACKGROUND & AIMS: A late evening snack (LES) is recommended as a nutritional therapy for liver cirrhosis to minimize early starvation. In patients with liver cirrhosis, the maintenance of the branched-chain amino acid (BCAA) levels is important during muscle synthesis at night. Therefore, we investigated the effects of a LES with BCAAs on the Fischer ratio in patients with liver cirrhosis. METHODS: This study included 10 outpatients with liver cirrhosis who did not consume a LES. Regarding the patient characteristics, the mean age was 73.1 ± 8.9 years, the male:female ratio was 5:5, and the mean body mass index was 23.3 ± 2.4 kg/m2. The etiology was hepatitis C virus in eight patients and alcoholism in two patients. Amino acid levels were measured in all 10 patients at four time points: before LES (control) and 1 month after the administration of each BCAA. The administration levels included 1) LES: BCAA-enriched enteral nutrition (BCAA-EN) containing BCAAs 6.1 g as a LES; 2) GP-no LES: BCAA-enriched granule product (BCAA-GP) containing 4 g BCAAs per pack, two packs per day, and BCAA-EN until dinner containing BCAAs in total 14.1 g per day; and 3) GP-LES: BCAA-GP, two packs per day, and BCAA-EN as a LES containing BCAAs in total 14.1 g per day. The Friedman nonparametric test with a post-hoc Dunn's multiple comparison was used for statistical analyses. RESULTS: There were no significant changes in body weight and serum albumin levels between the three types of BCAA administration. Valine significantly increased following LES and GP-LES, isoleucine significantly increased following GP-LES, and tyrosine significantly decreased following LES and GP-LES compared with those in the control. There was no significant difference in the leucine and phenylalanine levels among the groups. The Fischer ratio in the LES (2.2 ± 0.8) and GP-LES (2.3 ± 0.8) groups were significantly higher than that in the control (1.8 ± 0.6), but there was no significant difference compared with the Fischer ratio in the GP-no LES (1.8 ± 0.7) group. Furthermore, the Fischer ratio was significantly higher in the GP-LES group than in the GP-no LES group. CONCLUSION: These results suggested that it is not only the amount of BCAAs, but also LES with BCAAs, which is needed to improve the Fischer ratio at fasting.

OBJECTIVES: Perioperative nutritional management is essential for early recovery after liver surgery. The aim of this study was to assess changes in amino acid levels in serum and urine after hepatectomy. METHODS: Serum samples were collected from 16 patients with hepatocellular carcinoma before and 1, 3, and 14 d after hepatectomy (S0, S1, S3, and S14, respectively). Spot urine samples were collected before and 3 d after the hepatectomy (U0 and U3). Metabolites in the serum and urine were analyzed. RESULTS: Compared with S0, insulin levels significantly increased in the S1 and S3 samples. Valine levels significantly decreased in S1 and S14, and leucine levels significantly decreased in S14. Phenylalanine levels significantly increased in S1 and S3, and tyrosine levels significantly increased in S1. The Fischer ratio (branched-chain/aromatic amino acids) significantly decreased in S1 and S3. In multiple regression analysis, changes in serum taurine levels were related to the white blood cell count in S1 and S3, and inversely related to alanine aminotransferase levels in S14. Changes in serum glutamine levels were negatively related to C-reactive protein levels in S3. Serum glutamine levels decreased in S3 and S14, and tended to increase in U3, suggesting a deficiency of glutamate resulting from the invasive surgical procedure. CONCLUSIONS: These findings highlight the usefulness of metabolome analysis for characterizing perioperative patterns after liver resection. The observed amino acid pattern, including the reduction in Fischer ratio, underscores the need for specialized nutritional support.

The Bethesda system (TBS) has been used for cervical cytological diagnosis in Japan since 2008. Evaluation of specimen adequacy is the most important aspect of quality assurance and for precise diagnosis in TBS. A systematic review and meta-analysis were carried out to assess the unsatisfactory specimen rate in the primary cervical cancer screening setting in Japan. Ovid Medline and Ichushi-Web databases were searched from inception through to May 2017. Prospective and retrospective studies that reported the proportion of unsatisfactory specimens in healthy asymptomatic Japanese women in a cervical cancer screening program were eligible for inclusion; 17 studies were included in the meta-analysis. The random-effects model meta-analysis calculated summary estimates of the unsatisfactory rate of 0.60% (95% confidence interval [CI], 0.18-1.96%; I2 = 99%) for conventional cytology and 0.04% (95% CI, 0.00-0.35%; I2 = 99%) for liquid-based cytology (LBC). However, comparative results between conventional and liquid-based cytology, based on four direct and nine comparative studies, showed no significant difference (summary odds ratio = 3.5 × 10-2 favoring LBC [95% CI, 6.9 × 10-4 -1.7]; I2 = 98%). In the subgroup analyses and meta-regressions, use of non-cotton devices for conventional cytology and use of a particular platform for LBC were associated with lower unsatisfactory rates. Meta-regression also suggested chronological improvement in unsatisfactory rates for both tests. In Japanese cervical cancer screening programs, conventional cytology remains prevalent. Future research needs to focus on evaluating the impact of screening programs using LBC by comparing the accuracy, performance, and cost-effectiveness with conventional cytology in the Japanese population.

BACKGROUND & AIMS: We reported decreased nonprotein respiratory quotient (npRQ) after liver resection in patients with hepatocellular carcinoma (HCC); however, whether liver resection volume affects energy metabolism in these patients is unclear. We aimed to examine the relationship between liver resection and energy metabolism indices. METHODS: NpRQ was measured in 53 patients with HCC and seven with at the pre- and postoperative days. Patients were classified into four groups: Minor-lowICG group (n = 17): minor (subsegment or less) resection and low indocyanine green retention rate at 15 min (ICGR15) (<15%); Minor-highICG group (n = 18): minor resection and high ICGR15 (≥15%) and Major-lowICG group (n = 18): major (lobe) resection and low ICGR15 (<15%). We investigated dietary intake and blood biochemistry at energy measurement. The difference in npRQ and nonesterified fatty acid (NEFA) pre- and post-hepatectomy was shown as ΔnpRQ and ΔNEFA, respectively. RESULTS: Compared with the preoperative values, npRQ significantly decreased in the Minor-highICG and Major-lowICG groups and NEFA significantly increased in the Major-lowICG group at postoperative day 14. In single regression analysis, ΔnpRQ significantly correlated with HCV infection and ΔNEFA with resection volume, HCV infection, and ICGR15. In multiple regression analysis, ΔNEFA significantly correlated with resection volume after adjusting for age, etiology, and ICGR15. CONCLUSIONS: These results suggest that postoperative nutritional recovery is slower in major resection than in minor resection patients. Hence, nutritional care to prevent starvation is needed in major resection patients.

By using 24 hour urinary creatinine levels, skeletal muscle mass (kg), its rate (%) of body weight and creatinine height index (%) were determined in old Japanese women suffering from walking difficulty in nursing home and compare with those of young university students. Those of old subjects showed approximately 30-50%, 36-44% and 44-46% of young subjects, respectively. It is suggested that these values are important and useful biomarkers for the planning and the achievement of rehabilitation program for the maintaining and restoring skeletal muscle mass and for the careful support by registered care workers to aged persons.

Humans have a high preference for fat, and its excessive intake leads to obesity. This study aimed to investigate the effects of dose-dependent fat intake on biological responses and postprandial appetite sensation in healthy adult subjects. Age and body mass index were 29 ± 1 years and 21.1 ± 0.4 kg/m2, respectively. We conducted a randomized, crossover trial and measured laboratory data and appetite sensation via the visual analog scale. Each participant was provided with four different test meals. They consisted of common, basic foods and contained 75 g liquid glucose and 4 slices of crackers to which 0 g butter (control), 10 g butter (B10), 20 g butter (B20), and 40 g butter (B40) were added, respectively. The results indicated that single ingestion of butter did not influence laboratory values of glucose, insulin, glucose-dependent insulinotropic polypeptide (GIP), total bile acids, or high-sensitivity CRP (hs-CRP). Regarding postprandial appetite sensation, appetite ratings for fullness were the highest after the B40 meal (p < 0.05);however, satisfaction ratings were not significantly different after the ingestion of this meal. Ratings were significantly different after the B20 meal. In conclusion, healthy adult subjects experienced fullness and satisfaction after ingesting 20-40 g of butter. J. Med. Invest. 65:203-207, August, 2018.

Background: Developing health services is a key strategy for improving the community health provided by public health nurses. However, an effective educational program for improving their skills in planning such services has not been developed. To describe our program and its evaluation protocol for the education of middle-level public health nurses to improve their skills in developing new health services to fulfil community health needs in Japan. Methods: In this randomized control trial, eligible participants in Japan will be randomly allocated to an intervention group and a control wait-list group. We will provide 8 modules of web-based learning for public health nurses from July to October 2018. To ensure fairness of educational opportunity, the wait-list group will participate in the same program as the intervention group after collection of follow-up data of the intervention group. The primary outcomes will be evaluated using the scale of competency measurement of creativity for public health nurses at baseline, immediately after the intervention. Secondary outcomes will be knowledge and performance regarding program development of public health nurses. Discussion: This study will enable the analysis of the effects of the educational program on public health nurses for improving their competency to develop new health services for fulfilling community health needs and enriching health care systems. Trial registration: We registered our study protocol to the University hospital Medical Information Network- Clinical Trials Registry approved by International Committee of Medical Journal Editors (No. UMIN000032176, April, 2018).

本研究は、成人期にある自閉症スペクトラム障害(以下ASD)をもつ人の家族支援ニーズを明らかにすることを目的とし、当事者の家族16名、ならびに支援経験を有する支援者28名を対象に、半構造的面接法を用いてインタビューを実施した。分析の結果、支援者が考える必要な支援として、9つのカテゴリーと23のサブカテゴリーが明らかとなり、家族が考える必要な支援として、7つのカテゴリーと14のサブカテゴリーが明らかとなった。両データについて、本質的な意味に注目しながら比較検討したところ、多くの共通点やつながりみられ、意味のまとまりとして統合することができた。結果として、《当事者に対する適切な理解と対応につながる具体的な支援》、《サポート資源の活用の拡大と継続の支援》、《家族同士の交流がもてる機会の提供》、《気づきの拡がりを通して主体性と自己コントロール力を高める支援》、《今後の生活について現実的な見通しが立てられる支援》の5つが導き出された。考察では、既存の研究との比較を行い、5つの支援のうち《気づきの拡がりを通して主体性と自己コントロール力を高める支援》が、これまでの研究では十分に焦点があてられなかった新知見であることを示した。さらに、今後、支援プログラムを開発するにあたり、5つの支援をどのように内包するべきかついての検討を行った。(著者抄録)

OBJECTIVE: The incidence of breast cancer has progressively increased, making it the leading cause of cancer deaths in Japan. Breast cancer accounts for 20.4% of all new cancers with a reported age-standardized rate of 63.6 per 100 000 women. METHODS: The Japanese guidelines for breast cancer screening were developed based on a previously established method. The efficacies of mammography with and without clinical breast examination, clinical breast examination and ultrasonography with and without mammography were evaluated. Based on the balance of the benefits and harms, recommendations for population-based and opportunistic screenings were formulated. RESULTS: Five randomized controlled trials of mammographic screening without clinical breast examination were identified for mortality reduction from breast cancer. The overall relative risk for women aged 40-74 years was 0.75 (95% CI: 0.67-0.83). Three randomized controlled trials of mammographic screening with clinical breast examination served as eligible evidence for mortality reduction from breast cancer. The overall relative risk for women aged 40-64 years was 0.87 (95% confidence interval: 0.77-0.98). The major harms of mammographic screening were radiation exposure, false-positive cases and overdiagnosis. Although two case-control studies evaluating mortality reduction from breast cancer were found for clinical breast examination, there was no study assessing the effectiveness of ultrasonography for breast cancer screening. CONCLUSIONS: Mammographic screening without clinical breast examination for women aged 40-74 years and with clinical breast examination for women aged 40-64 years is recommended for population-based and opportunistic screenings. Clinical breast examination and ultrasonography are not recommended for population-based screening because of insufficient evidence regarding their effectiveness.

BACKGROUND AND OBJECTIVES: Although high energy density foods are highly palatable, their overconsumption leads to obesity because of high fat content. Low energy density foods are more effective for preventing individuals from becoming overweight. We investigated how different amounts of a single vegetable affect the sensory properties of meals with different energy densities. METHODS AND STUDY DESIGN: In a randomized crossover design, 40 young Japanese women consumed control and high-fat (HF) lunches. Control meals contained the same amount of rice and hamburger and 80 g (C80), 120 g (C120), 160 g (C160), 200 g (C200), 240 g (C240), or 280 g (C280) of broccoli. HF meals were control meals to which 38.1 g of oil was added (HF80, HF120, HF160, HF200, HF240, and HF280). Sensory properties before intake and 0.5, 1, 2, 3, 4, and 5 h after meals were assessed using a visual analog scale. RESULTS: Fullness was significantly lower with C80 than with C200 and C280 at 0.5 h and all time points, respectively, after consumption. In contrast, satisfaction with all HF meals was similar at all time points. Fullness and satisfaction were higher with almost all HF meals than with control meals; however, fullness and satisfaction were similar between HF200 and all control meals 1-4 h after consumption. CONCLUSIONS: Fat increases satiety when a single vegetable is included in the meal; however, at least of 200 g of vegetable in a 500- kcal meal with low fat content provides fullness and satisfaction similar to those provided by an HF meal.

Reducing dietary calorie density (CD) is useful in body weight management. This study investigates the association between dietary habits and preferences for different CDs. We conducted a randomized crossover study of 232 healthy subjects who consumed packed lunch boxes containing a control, high-meat and low-rice, low-vegetable, medium-fat and low-vegetable, high-fat, and high-fat and low-vegetable meals over six sessions. The subjective levels of sensory properties were assessed over time using a visual analog scale and the area under the curve. Subjects were assessed for dietary habits using a brief-type self-administered diet history questionnaire (BDHQ) and were divided into two groups based on a daily fat energy ratio ≥ 25% (high fat [HF], n=116) and < 25% (normal, n=116) that was matched for age, body mass index, and sex ratio. Our findings indicate that the desire for sweetness was higher in the HF group than in the normal group, regardless of the meals consumed. Particularly, among the 500-kcal low-CD meals, a high-protein meal provided greater fullness and satisfaction and lower prospective consumption in the HF group than in the normal group. Therefore, our study demonstrates that postprandial appetite sensation is associated with dietary habits of fat intake. J. Med. Invest. 63: 241-247, August, 2016.

The isomaltulose based liquid formula (MHN-01), suppresses postprandial plasma glucose and insulin levels in healthy persons and patients with impaired glucose tolerance (IGT) or type 2 diabetes. MHN-01 intake as a part of breakfast also suppresses glucose and insulin levels after lunch, suggesting second meal effect. The objective of this study was to investigate the effects of nutritional counseling and long-term (24 weeks) MHN-01 ingestion on biomarkers of metabolic syndrome. Forty-one subjects with criteria of metabolic syndrome participated in this study composed with the control period (0-12 week) followed by nutritional counseling and the experimental period (12-36 week) followed by 200 kcal (837 kJ) of MHN-01 or dextrin-based standard balanced liquid formula (SBF) loading as a part of breakfast. In 16 of 41 subjects became to out of criteria for liquid formula loading study during control period (unqualified group). In the unqualified group, several biomarkers were improved. In experimental period, serum HbA1c levels significantly increased in SBF group (n = 12) but did not change in MHN-01 group (n = 10). Thus, intake of 837 kJ MHN-01 as a part of breakfast may be effective for suppression of deteriorating glucose metabolism in metabolic syndrome.

Mammographic screening with clinical breast examination has been recommended in Japan since 2000. Although mammographic screening without clinical breast examination has not been recommended, its introduction is anticipated. The efficacies of mammographic screening with and without clinical breast examination were evaluated based on the results of randomized controlled trials. PubMed and other databases for studies published between 1985 and 2014 were searched. The study design was limited to randomized controlled trials to evaluate mortality reduction from breast cancer. Five studies were eligible for meta-analysis of mammographic screening without clinical breast examination. The relative risk for women aged 40-74 years was 0.75 (95% confidence interval, 0.67-0.83). Three studies evaluated the efficacy of mammographic screening with clinical breast examination. The relative risk for women aged 40-64 years was 0.87 (95% confidence interval, 0.77-0.98). The number needed to invite was always lower in mammographic screening without clinical breast examination than in mammographic screening with clinical breast examination. In both screening methods, the number needed to invite was higher in women aged 40-49 years than in women aged 50-70 years. These results suggest that mammographic screening without clinical breast examination can afford higher benefits to women aged 50 years and over. Although evidence of the efficacy of mammographic screening without clinical breast examination was confirmed based on the results of the randomized controlled trials, a Japanese study is needed to resolve local problems.

OBJECTIVE: To examine the effects of lunches with different dietary energy densities on food preferences between genders. DESIGN: Randomized crossover study. Participants were administered the following packed test meals once weekly on a specified day during six sessions: control (150 g of rice with a sautéed beef entrée containing 40 g of raw beef and 240 g of vegetables), high-meat/low-rice, low-vegetable, medium-fat/low-vegetable, high-fat and high-fat/low-vegetable meals. Subjective levels of sensory properties were assessed over time using visual analogue scales. SETTING: University of Tokushima Graduate School, Tokushima, Japan. SUBJECTS: Sixty-five men and sixty-five women matched by age and BMI. RESULTS: Men showed significantly stronger desires for salty and fatty foods after meals (P<0.05). Women showed a significantly stronger desire for sweetness from 2 h after the low-vegetable meal, and increasing fat content under high-vegetable conditions caused a significant stimulated sweetness desire in women more than in men (P<0.05). Moreover, after a high-meat/low-rice meal with 100 g of rice, sweetness desire was stronger in women (P=0.024), whereas no significant differences in sweetness desire were shown between genders after another low-energy-density control meal with 150 g of rice. CONCLUSIONS: Men had significantly stronger desires for salty and fatty foods, whereas women preferred sweet food after meals. The sweetness desire in women was stimulated by increasing fat content, even with a high vegetable intake. Low rice intake in a low-energy-density diet also caused a relative stimulation of sweetness desire in women.

OBJECTIVE: Perioperative nutritional assessment is critically important to reflect nutritional management because liver transplantation (LTx) often is undertaken in patients with poor nutritional status. The aim of this study was to evaluate nutritional status, including the non-protein respiratory quotient (npRQ), resting energy expenditure (REE), nitrogen balance, and blood biochemical parameters in patients before and after LTx. METHODS: Fourteen patients undergoing LTx and 10 healthy controls were enrolled in this study. The npRQ and REE were measured using indirect calorimetry before LTx and at 2, 3, and 4 wk after the procedure. Blood biochemistry and nitrogen balance calculated by 24-h urine collection were performed concurrently with indirect calorimetric measurement; the results were compared between the two groups. RESULTS: Before LTx, npRQ was significantly lower and serum non-esterified fatty acid levels were significantly higher in the patients than in the controls. Furthermore, a negative nitrogen balance was observed in the patients. These, however, improved significantly at 4 wk after LTx. REE did not significantly increase compared with the preoperative values in recipients. Blood biochemistry showed gradually increasing levels of serum cholinesterase and albumin. These failed to reach to normal levels by 4 wk post-transplant. CONCLUSIONS: The findings revealed that improvement of nutritional metabolism after LTx may require 4 wk. Additional nutritional strategies, therefore, may be needed to minimize catabolic state during the early post-transplant period. Adequate, individualized nutritional guidance before and after LTx should be performed in these patients.

OBJECTIVE: Perioperative nutritional care is important to maintain preoperative and postoperative nutritional status. However, few reports have investigated energy metabolism after hepatectomy. The aim of this study was to determine differences in energy metabolism, blood biochemistry, and nutritional status before and after liver resection in patients with hepatocellular carcinoma (HCC) and healthy living donors for liver transplantation. METHODS: Eighteen hospitalized patients with HCC group and 13 living donors for liver transplantation (donor group) were enrolled in this study. The donor group was divided into two groups on the basis of age; Y-donor group (age < 40 y, n = 7), and O-donor group (age ≥ 40 y, n = 6). Energy metabolism was measured by indirect calorimetry at preoperative day and postoperative day (POD) 7 and 14, and blood biochemistry was also examined. RESULTS: Recovery of non-protein respiratory quotient (npRQ) and blood biochemical data such as total bilirubin, aspartate aminotransferase and alanine aminotransferase levels were observed in Y-donor group on POD 14. However, although biochemical data improved in the HCC and O-donor group, npRQ remained unchanged on POD 14. CONCLUSIONS: Improvement of npRQ took longer than blood biochemical data in patients with HCC and older donors. Because the recovery of npRQ is associated with donor age, careful nutritional management may be required for a longer time depending on the pathophysiological condition of each patient after hepatectomy.

Obesity is a risk factor for the onset of liver cancer in patients with cirrhosis. To prevent overfeeding and obesity, estimation of energy requirement is important, but energy expenditure in patients with liver cirrhosis has not been fully elucidated. This study aimed to investigate resting energy expenditure (REE) and energy intake in patients with cirrhosis and determine adequate energy intake criteria. In this cross-sectional study, indirect calorimetry measurement was conducted in 488 Japanese inpatients with cirrhosis. We compared REE measured by indirect calorimetry (M-REE) with basal energy expenditure (BEE) predicted by the Harris-Benedict equation (H-BEE) and Dietary Reference Intakes (DRI) for Japanese (D-BEE). Mean M-REE (1256 kcal) was significantly lower than H-BEE (1279 kcal); however, it was not significantly different from D-BEE (1254 kcal). Mean M-REE expressed in relation to body weight (BW; REE/kg BW) was 21.7 kcal/kg BW. H-BEE was significantly higher than M-REE in patients in the first and second quartiles of BMI, and D-BEE was significantly different from MREE in patients in the highest and lowest quartiles of BMI. Average energy intake was 30.5 kcal/kg BW, which was 1.4 times greater than REE/kg BW. Although DRI is a useful tool for the estimation of REE in patients in the second and third quartiles of BMI, M-REE is recommended to ensure the provision of adequate nutritional care to patients with cirrhosis, including those in the highest and lowest quartiles of BMI.

BACKGROUND: The effective energy density (ED) diet model for customized meal plans has not been adequately explored, and the specific differences in appetite sensation among age groups remain unclear. DESIGN: A randomized, crossover study was conducted in 2010 to examine the effects of lunches with different dietary EDs on sensory properties across age groups. PARTICIPANTS/SETTING: In this experiment, 276 healthy Japanese subjects aged 22 to 59 years consumed packed lunches over six sessions. Using the control meal (150 g cooked rice, sautéed beef menu containing 40 g raw beef, and 240 g vegetable) as a reference, a high-meat/low-rice meal, a low-vegetable meal, a medium-fat/low-vegetable meal, a high-fat meal, and a high-fat/low-vegetable meal were served as modified test meals with varying macronutrient distribution and ED. MAIN OUTCOME MEASURES: Subjective levels of fullness and satisfaction were assessed over time by visual analogue scale ratings. STATISTICAL ANALYSES PERFORMED: Data were analyzed using analysis of variance with body mass index as a covariate followed by Bonferroni post hoc tests. RESULTS: Meals with high vegetable content resulted in greater fullness and satisfaction than meals with low vegetable content, regardless of the diner's age. Particularly among the 500-kcal low-ED meals, a high-meat meal resulted in greater fullness and satisfaction than a medium-fat/low-vegetable meal among participants aged 30 to 40 years. Postprandial fullness was significantly higher with control meal than with high-meat meal among participants aged 40 to 50 years. CONCLUSIONS: This study indicated that high vegetable content in the low-ED diet model provided sufficient fullness and satisfaction despite the low energy content and increased rice content is more effective for satiety than increased meat content for Japanese adults aged around 40 years.

Background & aims: A late evening snack (LES) is recommended for improving starvation state in cirrhotic patients. The non-protein respiratory quotient (npRQ) is an important index for evaluating the indications and effectiveness of LES. Indirect calorimetry is used to determine npRQ, but it is expensive and not available in many hospitals. The aim was to find blood biochemical markers reflecting npRQ. Methods: A total of 183 cirrhotic patients (M/F=149/34) were enrolled. For each patient, fasting state npRQ was determined by indirect calorimetry. The relationships between npRQ and indices such as age, body mass index, platelet count, etiology, and levels of aspartate aminotransferase, alanine aminotransferase, total bilirubin, albumin, blood glucose, and non-esterified fatty acid (NEFA) were statistically analyzed. Results: There was a significant negative correlation between the measured npRQ and serum NEFA levels, and the NEFA level was the strongest predictor of npRQ. Multiple regression analysis identified that the NEFA and Hepatitis B virus were predictors of npRQ. Conclusion: These data suggest that fasting serum NEFA level is the most relevant biomarker to determine npRQ if indirect calorimetry is unavailable. Thus, serum NEFA levels may be useful to determine the indications and effectiveness of LES therapy in cirrhotic patients. © 2013 European Society for Clinical Nutrition and Metabolism.

BACKGROUND/AIMS: Transcriptomics technology in human nutrition intervention studies would allow for genome-wide screening of the effects of nutrients. We observed the time course of gene expression changes in peripheral white blood cells (WBC) to elucidate the metabolic changes in the postprandial state that are a reflection and a marker of whole body metabolic changes. METHODS: In a randomized crossover study, 7 healthy subjects consumed test meals of glucose (GL), white rice (WR) and rolled barley (BAR), each containing 75 g of available carbohydrate, and water (WAT). Blood glucose, insulin and nonesterified fatty acid concentrations, as well as the subjective levels of fullness and hunger were measured. Microarray analysis of the WBC and the real-time PCR were examined during 360 min after the intake of the test meals. RESULTS: The number of genes that changed more than 1.5-fold and the expression patterns in the time course were different between the GL, the WR and the BAR groups. Several genes involved in glycolysis and fatty acid β-oxidation were markedly changed after the intake of the GL, the WR and the BAR; however, these genes did not change at any time point in the WAT. CONCLUSIONS: Gene expression profiling in the WBC can reflect food-related metabolic changes, even in the postprandial state.

産後の女性の10〜13%が産後うつ病に罹患しているといわれているが、多くは適切な治療やサポートを受けられていない。本研究の目的は、産後うつ病対策に必要とされる支援や効果的な介入方法を明らかにし、その結果に基づいて、産後の女性とその家族、さらに母子保健医療に携わる看護職が利用できる「インターネットを利用した周産期メンタルヘルスサポートプログラム」を開発することである。産後うつ病に関する文献検討、および周産期メンタルヘルスに携わる看護職を対象とした面接調査の結果、産後うつ病対策に必要とされる支援や効果的な介入方法は次のように考えられた。1)母子保健医療に携わる専門家が周産期メンタルヘルスに関する知識、関心を深める、2)看護職による産後の母親への心理社会的援助、3)産後の女性の精神健康状態を適切にアセスメントし、精神健康状態に応じて支援する、4)産後の女性やその家族への産後うつ病に関する情報提供と教育、5)産後の女性の気兼ねや気遣いに配慮する、6)インターネットを利用した支援。以上に基づいて周産期メンタルヘルスサポートプログラムを作成した。また作成されたサポートプログラムについて、周産期メンタルヘルスに関する専門家によって内容の妥当性が、また地域母子保健に携わる看護職等によって表現等の適切さ、明確さ、および有用性が検討された。その結果、いずれの項目も概ね肯定的な評価が得られた。ただし、プログラムの評価は少数の看護職によってしか行われておらず、今後は産後の女性やその家族を含むより多くの利用者から評価を得るなど、プログラムの有用性をさらに問う必要がある。(著者抄録)

離島や僻地を含む近畿地方2府4県の医療機関に勤務する医療者(医師153名、看護師459名)を対象に、看護師の業務拡大に関する意識調査を実施した。その結果、医療行為を行える看護師の養成については、看護師よりも医師の方がより必要を感じており、看護師が医療行為を行うことに対して医師のほうがより肯定的であった。その理由として、「医師の負担の軽減」「医師不足の解消」を挙げていた。それに比較して、看護師自身が医療行為を行うことに対して消極的な姿勢であり、その理由として、「より責任が重くなる」「看護本来の業務を見失う」ことが挙げられていた。医療行為の一部を看護師が肩代わりするミニドクターを目指すのではなく、看護の視点に基づいた医療行為のアプローチを確立することが必要である。

AIM: In patients with liver cirrhosis, abnormal energy metabolism induces low health-related quality of life (HRQOL) scores. However, late-evening snack (LES) prevents morning starvation in cirrhotic patients. Our aim is to assess the effect of long-term LES on HRQOL in cirrhotic patients, using the 36-item Short Form (SF-36) health survey. METHODS: Thirty-nine cirrhotic patients classified as Child-Pugh grade A were recruited. The patients were randomly divided into two groups: 24 were assigned to the non-LES group and 15 to the LES group. SF-36 scores, anthropometric data and serum biochemical parameters were examined in the non-LES and LES groups at 0, 6 and 12 months. RESULTS: Neither anthropometric data nor laboratory data showed significant differences between the non-LES and the LES groups at 0, 6 and 12 months. The role-emotional (RE) HRQOL scores at 6 months and mental health (MH) scores at 6 and 12 months were significantly reduced from the baseline level in the non-LES group. In contrast, these scores remained unchanged in the LES group. General health perception (GH) scores at 12 months, RE at 6 months and MH at 6 and 12 months in the LES group were significantly higher than those of the non-LES group. CONCLUSION: Long-term LES administration may be helpful in maintaining higher HRQOL in patients with cirrhosis.

目的:本研究では、まちの保健室(Town Healthcare Room)のなかで中年男性に対しテーラーメイドな運動支援プログラムを開発し、参加者にみられた効果や変化を記述し、プログラムの評価を行った。方法:対象者9名にオリジナルなプログラムを適用した。初回に運動バリア・食行動評価・運動に関するレディネスを調査し、月一回の集団運動支援・座談会・個別面接と電話による支援を6ヵ月間実施した。研究デザインは、対照群無しの前後比較介入試験とし、介入にはTranstheoritical model(Prochaska & DiClemente)と社会的認知理論(Social Cognitive Theory,Bandura)を使用した。介入の評価は、3ヵ月・6ヵ月・一年後(終了後半年)に実施した。結果:内臓脂肪・体脂肪・体重については開始と終了時(6ヵ月時)の比較で統計的に有意であった。6ヵ月後において、体脂肪量は身体測定の対象者8人全員の値が改善し、内臓脂肪・体重については7人が改善した。運動に関するレディネスのプロセスを考慮し介入した結果、専門家や家族の支援、ライフサイクルの中で退職時が有効であるという示唆を得た。しかし、1年後にも効果が継続していたのは体重のみであった。結論:参加者はほぼ全員が歩行やストレッチなどの運動習慣を確立でき、その結果、研究終了時(6ヵ月時)の内臓脂肪断面積・体脂肪量・体重、1年後の体重について改善した(p<0.05)。個別支援を実施した結果、参加者が陥りやすい運動バリアと運動開始によって起こった行動変容が明らかになった。更なる効果を得るには骨格筋を鍛える目的としてのレジスタンス運動の実施が必要であることがわかった。今後このような判断指標や結果を参考に、多くの対象者にテーラーメイドな支援プログラムを実施していくことができると考える。(著者抄録)

【目的】本研究は、エレベータ停止と階段利用を促進するメッセージ掲示の一連の組み合わせが、職場において、どのくらい階段利用を増加させるのかを評価することを目的とした。【方法】A市の管理する5階建ての別館建物に勤務する市職員で、同意が得られた60名を研究協力者として、観察研究を行った。市の管轄である1階から4階の72段の階段を対象に、それぞれ異なる29種類の階段利用を促進するメッセージを掲示した。エレベータと階段の利用状況は、各期間の1日あたりの平均的な利用として自記式のアンケートにより後ろ向きに調査した。ベースライン調査(直近1ヵ月における1日あたりの平均的な階段利用の調査)の10日間後に、10日間(勤務日数で7日)のエレベータのサービス停止があった。エレベータのサービス再開から9日後(エレベータと階段使用の両方とも利用可能であった期間)に、2回目の調査(直近1週間における1日あたりの平均的な階段利用に関する調査)を実施した。2回目の調査から3日後に、階段使用を促進するメッセージを、階段と壁に掲示した。これらのメッセージは、3週間掲示した後に撤去した。撤去の翌日に、3回目の調査(直近2週間における1日あたりの平均的な階段利用に関する調査)を実施した。また、撤去から1ヵ月後に、追跡調査(直近3週間における1日あたりの平均的な階段利用に関する調査)を実施した。【結果】階段利用率(昇りと下りの合計)は、エレベータ停止後で、ベースラインの53%から変化しなかった(オッズ比OR1.03、95%CI:0.84-1.26)。しかしながら、3フロア以上の昇りは、ベースラインの16%から33%へと有意に増加した(OR2.56、95%CI:1.56-4.21)。メッセージの掲示後は、ベースラインの53%から64%へと統計学的に有意に変化した(OR1.62、95%CI:1.31-1.99)。この有意な増加は、撤去して1ヵ月後も維持されていた(階段利用率62%、OR1.45、95%CI:1.18-1.79)。これらの階段昇りの増加は、男性、40歳以上、4階職員、運動習慣がない者で、有意な増加を示していた。ただし、性、年齢、勤務場所は、お互いに関係があり、これらの階段昇りの増加は、主に4階職員が影響を及ぼしていると思われた。【結論】エレベータ停止とメッセージ貼り付けの一連の組み合わせは、総移動に対する階段利用率を10ポイント以上増加させる効果があり、これはメッセージ刺激を撤去してからも持続していた。エレベータ停止と階段利用を促進するメッセージの掲示は、コストも人手もかからないため、職場において、健康を増進するためのポピュレーション・アプローチになると思われる。(著者抄録)

【目的】多数の住民が避難所に殺到したり、職員の人手が不足する場合、停電や通信途絶した場合などの様々な状況で、早期に健康問題を把握してケアを提供することを目的として、看護記録シートを開発した。【方法】ボランティアとして避難所で活動した経験のある看護師とともに、避難所で被災者に使用する看護記録のあり方と問題について議論し、解決する方法を考案した。【結果】災害時の看護記録シートとして、つぎの3種類を開発した。(1)初回調査シートは、被災者の支援の緊急性や必要度の評価に使用する。(2)健康管理シートは、被災者の自覚症状を捉え、感染症や食中毒、災害関連疾患の予防のために使用する。(3)清潔・生活環境評価シートは、避難所の清潔や環境改善を図ったり、災害関連疾患を予防するために使用する。多数の住民が避難所に殺到したり、職員の人手が不足していても混乱しないように、状況に応じて看護職者や被災者のどちらでも、初回調査シートと健康管理シートに記入できるようにした。また、停電や通信途絶時でも使用できることから、簡単な記入方法としてマークシート形式を採用し、コンピュータ作業を軽減した。さらに、普通紙に対応した電子ペンを使用することで、手書き内容をコンピュータに入力する作業を軽減した。特別な機材を使用せず、普通紙や無料のマークシート認識ソフトを利用しているため、被災地外からの機材の持ち込みを可能にした。用紙の裏面を利用して独自の調査項目を印刷して使用できるなど、運用面で多くの柔軟性を持たせた。【結論】この看護記録シートは、多くの柔軟性があり、また様々な作業を軽減できるため、避難所で早期に健康問題を把握して、ケアを提供するために役立つものと思われる。(著者抄録)

我々は，中学生を対象に，防災だけでなく豊かな人間性や社会性を育むことを目標にした防災教育プログラムを試みた。最初に，生徒たちはコンピュータを利用して災害への備えを評価した。つぎに，CGアニメーションにより，平常時の近所の人とのコミュニケーションの大切さなど，いくつかの問題を学んだ。避難所における様々な人々の行動を描いた寸劇シナリオを使用して，体験的な学びを行った。最終的に，高齢者や障害者の目線から，地域の危険な所や安全な所を地図に描くことで，学びの場をe-learningから現実の世界へと広げていった。この防災教育を通じて，生徒たちは，豊かな人間性と社会性を育むことができた。

減災のためには、一人一人の意識を高めるだけでなく、地域全体で平常時から取り組むことが重要である。そこで我々は、個人および地域全体の減災意識を高める目的で、災害看護の視点から、災害(地震)の備えチェックシステムの開発を行った。このシステムは、災害への備え度が点数で自己評価でき、同じ居住地域の人とも比較できるものである。また、県や全国の状況と比較することで、競いながら減災への行動変容を促すものである。2006年4月下旬にWeb公開してから、12月末までにシステムを利用した人は、628人であった。2回以上の回答があった258人について、初回の点数と現在の点数を比較したところ、総合得点と、災害への備えの5要素中の3要素において、統計学的に有意な改善がみられた。以上より、このシステムを継続的に利用することで、減災意識が高められると思われる。今後、さらなる普及を目指して、システムを改善していきたい。(著者抄録)

思春期講座の充実にむけての示唆を得るために、高校生の性知識、性意識、性行動に関する実態調査を行った。高校1年生から3年生の男女1000例から回答が得られ、有効回答は993例であった。性知識について、10項目の問題の正解率は全体の58.8%で、性知識は主に友人・漫画・雑誌・テレビから得ていた。性に対するイメージは、男子・女子ともに恥ずかしいと捉えていた。同年代が性交・出産を容認する傾向は学年が進むにつれ高くなった。性交の実践率はいずれも男子より女子のほうが高く、全体では14.4%であった。避妊は、コンドームを使用した者が一番多かった。性感染症防止、避妊に対する具体的な指導の必要性が示唆された。

Objective: This study investigates the effects of a late evening snack (LES), of 200kcal of rice ball, on energy metabolism in cirrhotic patients. Impaired nutritional metabolism has been associated with cirrhosis, and frequent intake of small meals may prevent early-onset starvation, and maintain nourishment in these patients. Subjects: Twenty-one cirrhotic patients and 26 control subjects (Control) were recruited for this study. Patients were subsequently treated by LES (LC-LES) and by a non-LES regimen (LC-NLES). Method: Resting energy expenditure and respiratory quotient (RQ) were assessed by indirect calorimetry at 0830, 1130 and 1430. Blood glucose and non-esterified fatty acids (NEFA) were measured just before the energy metabolism measurements. The regular diet included three major meals and LES, at 0900, 1200, 1800 and 2100, respectively. The Control and LC-NLES groups received only the major meals, whereas the LC-LES group received three meals plus 200kcal LES for 7 days. There was no difference in the total energy intake among Control, LC-NLES and LC-LES groups. Results: Respiratory quotient in LC-NLES was significantly lower than that of Control at 0830. Respiratory quotient value in LC-LES significantly elevated from that in LC-NLES. The RQ values did not differ among Control, LC-NLES and LC-LES at 2h after the meal (1130 and 1430). Non-esterified fatty acids in LC-LES were lower than that in LC-NLES after overnight fasting. Conclusions: The ingestion of a 200 kcal rice ball LES can improve the nutritional metabolism in cirrhotic patients.

山間地域の在宅高齢者のQOLと健康長寿度との関連を明らかにすることを目的に,過疎化が進行する山間地域のある町の全高齢者を対象にアンケート調査を実施し,2679名より有効回答(86.2%)を得た.その結果,対象の約7割が高齢者のみ及び一人暮らしであったが,10点の生活満足度を回答した者が35.4%おり,現在の生活に高い満足度(QOL)をもっていた.また,生活に対する満足度が高い群は健康長寿度も良好な状態を示しており,これには,物理的な居住環境や生活支援,近隣や家族との相互作用による社会的関係から得られる被支援感の影響が示唆された

2型糖尿病における治療の遅れと合併症について検討した.対象は,徳島県下の24医療機関で加療中の2型糖尿病患者396名(男性204名,女性192名・平均63.4歳)で,治療年数と有病年数が一致の「早期治療群」(298名)と治療年数の方が短い「治療遅れ群」(98名)に分けて比較した.その結果,「早期治療群」に対する「治療遅れ群」のオッズ比は有病期間「0〜19年」では網膜症で発症リスクが1.88倍と有意差を認め,腎症1.73倍,神経障害1.63倍となり,有病期間で調整した場合は網膜症1.73倍,腎症1.72倍で共に有意差を認め,神経障害1.51倍のリスク増加であった.虚血性心疾患,脳血管疾患,動脈硬化症では治療の遅れとの関連はなかった.また性・年齢・血糖コントロールで補正した場合,有病期間「0〜19年」では治療1年遅れ毎に網膜症,神経障害で12%,細小血管系疾患13%,脳血管疾患14%のリスク増大となることが判明した