坂下 玲子

Objective: This paper aims to establish a potential reference standard for the process of transition from milk to solid food in infants and preschool children in Japan, using the transitional food process (TFP) scale described by Sakashita et al. The background for variation and delay in the process are also discussed. Design: A randomized sample survey covering entire Japan. Setting: Mailing self-completion of questionnaires. Subjects: Randomized sample of 14 000 children aged 0-6 y and their family from 13 prefectures in Japan, namely Hokkaido, Aomori, Iwate, Niigata, Tokyo, Saitama, Fukui, Nagano, Nagoya, Hyogo, Yamaguchi, Kagoshima, and Okinawa. Methodology: Questionnaires requesting the TFP scale and background factors were sent to 14 000 children and families. The percentile ages were calculated. An eating ability index (EAI: number of accepted foods/total number of foods) × 100) was calculated. Regression analysis by analysis of covariance (ANCOVA; SPSS, 1997) was used to determine the influence of background factors on EAI. Results: From the 6747 (48.2%) effective answers received, percentile curves of the acceptability of each food on the scale were drawn, and used as initial reference standards. The 50 percentile age range of these 20 standard foods covers from 5 to 42 months after birth. The sensitive period for increasing the acceptance of foods in children was between 6 months and 2 1/2y of age. ANCOVA regression model (R2=0.605) showed that EAI was mostly influenced by age (P=0.000), followed by feeding style (P=0.000), infant food preparation (P=0.000), information source (P=0.000), and birth order (P=0.003). The dominant cause of digestive system problems was shown to be infection, not too-hard food. It seems that breast feeding, bottle feeding with chewing-type nipples, and the manner of preparing infant foods from the family table promote the progress in acceptance. Children whose mothers followed the information given in books or magazines showed a slower progress. Conclusions: It seems appropriate to use this reference standard in the study of the transitional process from milk to solid food in infants and preschool children in Japan. © 2004 Nature Publishing Group. All rights reserved.

看護教育における形態機能学(解剖生理)は看護活動の基盤をなし、その理論的根拠を与える重要な科目の一つであるが、生活援助や臨床看護の視点に乏しく、実際の臨床の場面での看護ケアの展開につながっていかないのが現状である。そこで、看護学的視点から形態機能学教育を再構築することを最終の目的とし、今回は、形態機能学が、臨床の看護の展開につながらない要因を検討し、形態機能学の看護学教育での位置付けを明らかにし、そのあり方を模索することを目的に、大学および臨床の多様性のあるメンバーからなる討議を重ね分析を試みたので報告する。討議は、病棟管理者1名、病棟新人教育担当看護師1名、若手看護師1名、臨地実習担当教官2名、形態機能学教育に携わる教官3名の計8名(男性2名、女性6名)を構成員とし、計5回実施された。討議の内容はテープに録音され、逐語記録され、カテゴリー化された。形態機能学が看護援助に役立ち必要であることが確認され看護も形態機能学に貢献する可能性があることが示された。形態機能学の深さと広がりとして、a)必須の基礎知識がある、b)形態機能学の知識は全部必要でない、c)看護には詳細なレベルの形態機能学の知識が必要なことがあるというカテゴリーが示された。形態機能学学習のバリアとして、a)形態機能学は看護に特化しにくい、b)知識と実践を統合するのは難しい、c)形態機能学は身につきにくい学問であることが抽出された。打開策として、問題解決型学習法を取り入れたa)事例を入り口として帰納的に学ぶ提案、b)知識習得と実践の繰り返しで学ぶ提案がされ、学習法の工夫として、学生を教える立場にさせる、繰り返し学習する機会をつくる、視覚的に学ぶなどが抽出された。今後は、典型的な事例を用いて看護の場面から問題思考型学習を取り入れた模擬授業を計画し、その効果を学習の到達度、実践への応用、マンパワーや時間の効率について検討を行う必要がある。

Objective: This paper describes the development of a reliable scale of standards for use in evaluating the progress of the transition from milk to solid food in infants and preschool children. The maturation of chewing and swallowing behavior in infants and young children, which enables processing of solid food, varies, and a scale would assist not only in the instruction of mothers and nurses but also in preventing delay in the introduction of solid food. Design: A range of 159 reference foods were selected on the basis of intake during the period of transition from liquid to solid food. These foods were listed in our previous study, Validity and reliability were tested to create a scale. Methodology: Foods were selected on the basis of 50% of the subjects studied being able to eat them, and on the food groups classified by cluster analyses using the Varclus procedure of SAS. Validity, of the scale was tested by using Pearson's correlation coefficient between the scale score of selected food items and the total score of all 159 food items. The total score of 159 food items was calculated using the general linear models (GLM) procedure of SAS. Reliability was tested using Cronbach's coefficient α. Setting: Public health centers in Aomori, Tokyo, Saitama, Nagano, and Okinawa (Japan). Subject: Five hundred and eighty healthy mothers and children from 2 to 46 months were randomly selected and 470 (81.0%) completed the study. To avoid regional bias, subjects were drawn from northern to southern prefectures in Japan, namely Aomori, Tokyo, Saitama, Nagano, and Okinawa. Results: Twenty food items were selected. By analyzing the score correlation using Pearson's correlation coefficient (R = 0.97, P < 0.001) and GLM (R2 = 0.95, P < 0.001), it was confirmed that these 20 food items adequately represented the original 159. The reliability was also found to be sufficient (Cronbach's coefficient α = 0.96). Conclusions: The findings demonstrate that a scale of standards for measuring progress in chewing ability can be created using 20 food items. Such a standard will provide a useful basis against which to assess delay of solid food introduction in childhood.

Secular changes in dental disorders among three populations were compared. Material used comprised 829 Japanese dry skulls and 1089 living Japanese, 1160 Chinese skulls, and 1326 British and Scottish skulls. Prevalence of tooth-to-denture-base discrepancy (the discrepancy), the frequency of carious, and carious and missing teeth, as well as the mean score of tooth attrition were calculated. The discrepancy and carious teeth showed relatively steady progression in the Japanese group, the only exception being a high frequency of carious teeth in the Yayoi period. In the British material, the prevalence of the discrepancy and frequency of carious teeth showed an increasing trend but there were local variations. In the Chinese group, neither the discrepancy nor the dental caries seem to show any meaningful trend. There were significant correlations between discrepancy and tooth attrition in the Japanese, and between discrepancy and carious teeth in the British. The Chinese data did not show any significant correlations, possibly because their economy was multifarious from pastoral to stock farming. The main determinative factor of the discrepancy and dental caries seemed to be the influence of the primary economy of the groups.

th to denture base discrepancy (the discrepancy) is the difference between the dental arch length and the sum of crown diameters of teeth in the jaw, a concept which was originally developed in orthodontics. Since the cause-effect relationship between a soft diet and the discrepancy has been demonstrated, the size of the discrepancy should indicate the amount of load on the masticatory system from chewing foods in jaws from archaeological periods. The dietary condition of 71 citizens compared to that of 186 slaves from the Yin-Shang period of China was reconstructed through a study of the discrepancy. The prevalence of the discrepancy in the Yin-Shang period was around 15%, almost the same as it was during the later Jomon to Yayoi (3000- 2000 BP) periods, when rice agriculture was introduced into Japan, and also the same as for present-day pastoralists around Lake Turkana, Kenya. Although the frequency of the discrepancy was slightly higher in male citizens, there were no significant differences in the frequencies between male citizens and female citizens or slaves. The differences in diet may not have been fundamental since the Yin-Shang period would be at the very beginning of the age in which differences of diet according social class began to appear, with implications for the load on the masticatory system. At that time agriculture may not been sufficiently intensified in variety or quantity to have produced a differentiation of the diet between social classes.

Seventy-one skulls from the Yin-Shang period tombs of Anyang, China, were examined for the incidence of observable dental diseases, including dental caries, alveolar bone resorption (an index of periodontal disease), ante-mortem tooth loss and tooth attrition. Because the remains were excavated from tombs with funerary items, the burials are believed to be of Anyang citizens. Our study indicates carious tooth frequency in the Yin- Shang period was rather low (2.9-4.0%). Periodontal disease frequency was 18.3-26.9%, and ante-mortem tooth loss frequency was 2.0-7.5%. To determine the relative prevalence of overall dental health in the Yin-Shang populations, observations from the 42 male crania were compared to those from 183 male crania of slaves from 'sacrificial pits' from the Yin-Shang period (Inoue et al. [1992] J. Anthropol. Soc. Nippon 100:1-29). Results from this comparison indicate no apparent difference between social classes in younger age groups. However, in the older ages the rates of the ante-mortem tooth loss, periodontal disease and tooth attrition were significantly higher in the citizen sample. The findings would suggest dietary development in the Yin-Shang period was not dissimilar enough between social classes to induce clear differences in dental diseases at least at younger ages. Conversely, it appears there must have been significant differences between social class diets in the earlier phase of the Yin-Shang period to produce the differences in dental disease present in the older samples.

It was reported that the activity of the masticatory muscles is reduced in bottle fed babies. The effects of chewing type bottle teats distributed in Japan on masticatory muscle activity were evaluated. Myoelectric activities of the masseter muscles of 12 babies bottle fed with chewing type bottle teats were recorded and analyzed by the same method as in the previous study. The electromyographic records of 12 breast fed babies and 12 babies bottle fed with regular sucking type bottle teats, which were reported in a previous study, were used as controls. The results show that the masseter muscle activity of babies bottle fed with chewing type bottle teats was similar to that of breast fed babies qualitatively as well as quantitatively. However, activity was visibly different from that of babies bottle fed with sucking type bottle teats, showing significant difference by ANOVA. These data suggest that babies who are ingesting milk from chewing type bottle teats do so with a chewing action similar to that of breast feeding, but very different from that of bottle feeding with sucking type bottle teats. The conclusion was that the chewing type bottle teat is useful for establishing masseter muscle activity.

Our previous studies suggested that there are significant differences in the growth of the jaw and in muscle activity between breast- and bottle-fed infants. To confirm these differences quantitatively, myoelectric activities of the masseter muscles of bottle-fed babies were studied. Twelve bottle-fed babies, as well as 12 breast-fed babies as a control group, were examined electromyographically during bottle or breast feeds. The duration time of sucking bursts, interval time, cycle time, 0-to-peak amplitude, integrated amplitude of bursts, and integrated amplitude/duration tune were measured and the number of bursts over 30μV was counted. All differences of means were significant by t-test. The masseter muscle activity in bottle-fed babies is significantly reduced. Our results are contrary to previous papers in which almost the same sucking actions in both breast and bottle feeding were reported. The reason why previous researchers thought that the sucking patterns in breast- and bottle-fed babies are essentially the same is considered, and the implications of the differences for dental health are discussed. © 1995.

The oral condition of 1274 living people was examined in 3 districts of Kenya and in 117 Kenyan skulls of recent age from the Natural History Museum, London; Cambridge University; and the Smithsonian Institution, Washington D.C. The traits of ritual ablation of mainly mandibular central incisors were observed in 57 cases out of 233 examinees of over 10 years of age (24.5%) in Lodwar, 29 of 210 (13.8%) in Kericho, and 3 of 190 (1.6%) in Nairobi, and in 25 mandibles out of 29 skills (86.2%). Thus, the existence of ritual ablation of the front teeth in modern Kenyans was confirmed, but the incidence is lower than in the skeletal group, and much less in urbanized areas than in rural districts. The size of the remaining space showed a significant correlation with tooth-to-denture-base discrepancy, but not with the lapse of time since extraction. © 1995, The Society of Practical Otolaryngology. All rights reserved.

生後2日目から生後2ヵ月未満の健康な乳児41名を対象とし,哺乳瓶哺乳時の瓶内圧の測定と,咬筋,側頭前腹の活動電位の記録とを行った。生後1週未満の新生児では瓶内圧の低下は全く認められないか,あるいは弱くて,咀嚼筋の活動電位が優勢にみられ,生後の早い時期では咬合型の顎運動が存在する。この傾向は日齢が進行しても母乳哺育児では変わらず,咬合型の顎運動が確認され,瓶内圧の低下は全くみられないか,あるいは非常に弱いものが多かった。しかし哺乳瓶哺乳を行うものでは,日齢にともない,瓶内圧の低下が著しくなる傾向が認められ,吸引型の哺乳行動は哺乳瓶哺乳という哺育環境に対する適応現象である

1)乳房哺育児と哺乳瓶哺育児とでは,哺乳パターンが異なること,すなわち,乳房哺育児においては,咀嚼筋の活動と顎運動主体の哺乳パターンであるが,吸引主体の哺乳パターンを示し,咀嚼筋の活動が失われていくことが再確認された.2)育児上問題となっていた「ミルク嫌い」の重要な原因のひとつとして,乳房哺育児と哺乳瓶哺育児の哺乳パターンの相違が考えられた.3)哺乳パターンは不変なものではなく,学習可能なものと考えられ,現在,自分が使っている乳首から最も効率よく乳汁が飲める方法を学習していくものであることが示唆された.4)哺乳瓶用乳首使用による咀嚼器官の発達の低下の弊害を防ぐ方法として,測定用乳首のような機能をもつ乳首を使うことの可能性が示唆された

中華民国(台湾)中央研究院において,中国河南省安陽県殷墟の犠牲坑から出土した398体の頭骨標本の調査を行う機会を得た.侯家荘西北高における,1928年から1937年まで通算15回の発掘による標本の数は,1,000体におよぶものであったというが,当時の中央研究院が戦乱を避けて移動する間に,現在の数にまで減少したという.甲骨文字の解読による史実と,同時に出土した遺物との対照によれば,1,400～1,100BC頃,すなわち殷商時代の後半と推定されている.この標本群は,歴史的な裏付けのある資料としては恐らく最古のものであり,しかも,標本数も大きい点で,古い時代の形質と文化との関わりを知るための資料としてきわめて貴重なものと考えられる.<br>この資料についての過去の研究の中でとくに関心がもたれた重要な課題は,殷商王朝の創建者はどのような人種であったのかという点であるという(楊,1985b).すなわち,本来の中国人というべきものがすでに存在していたのか,東夷あるいは西戎であったのか,また,単一民族であったのか,あるいは楊が指摘したように数種の異民族を包括して統治していたものかなどである(Fig.1～Fig.3).もし,複数民族の存在が事実であるならば,それは,同一の時間,同一の空間に異民族が共存していたという比較的まれな例であるということができる.本研究は,長年にわたる人種論争にあえて参加する立場はとらず,各群が,群として認められるに足りる形態学的な根拠をもっかどうかを検討し,さらに文化の影響としての歯科疾患が,同じ生活圏に存在したと考えられる異なる民族群においてどのように分布するかを知り,著者らがすでに指摘した形質と文化との独立性をさらに確かめることを目的とした.

最近,ケニアを訪ねる機会があった.現代ケニアにおける文化,身体形態,歯科疾患,保健環境などに関する綜合的な調査を行う可能性を探るための予備調査で,ナイロビを中心に西部から北部辺境部にかけての諸部族と接触し,一部のものの口の中を観察した.その際,Table 1に示すように,8人のものに風習による抜歯痕が見られ,また,この風習の意味や抜歯の時期と方法などにっいての聞き取りを行うことができた.<br>抜歯痕が認められたものは,4部族8人で,このうちルオ族の1人を除く7人では下顎両側中切歯が,またルオ族の1人は下顎両側の6前歯が抜去されていた.抜歯の理由は,単なる風習であると考えているものが4人,破傷風あるいは蛇に噛まれた場合に,歯の食いしばりがあっても水あるいは牛乳を流し込むことができるようにというものが4人であった.抜歯の時期は6歳頃で,長老が子供達を集め,小刀を2本の歯の間に差し込んで歯を動揺させて抜くという.今回の観察例の中で,最年少者は25歳であったが,30歳の男性の例では,今となっては歯が欲しいといって,補綴の方法を聞いてきたものがあった.現代文化の影響がケニアの辺境部にまで浸透してきたことを示すものと考えられ,この地における抜歯風習の終焉も間近いように思われた.<br>まったくの偶然によって得られた情報であり,資料は必ずしも十分ではないが,生体における抜歯例の観察を通じて,抜歯の時期,方法,抜歯習慣の意味,及び抜歯空隙の閉鎖と歯と顎骨の不調和との関係など,古人骨標本の観察結果から推定されてきこととは異なる点が認められたので,とりあえず報告した.上記の綜合的な調査が実現すれば詳細な情報が得られることが期待できるので,その段階では改めて報告したい

頭部X線規格写真の計測値から判別関数を求め,性別の判定を試みた.まず,性別が明らかな近世泰雅族頭骨標本,男性24例,女性21例の頭部X線規格写真を用い,肉眼的観察に際して重視される眉間および乳様突起部の計測を行い,判別関数を求めた.これを45例に適用したところ93.3%の的中率を得た.ついでこの方法を,中国殷墟出土の頭骨標本に応用し,性別不明のすべての例の分類を試みた結果,頭部X線規格写真の計測値によって性別がかなりよく判別できた

幼稚園児107名の食行動の観察から噛める子・噛めない子の判別には,"食べるのが遅い"が最も高い偏相関を示した.ついで"食べないで呆然とする","片手で弁当箱を押さえて食べる","ため息をつく","食物が口からこぼれそうになる"などの食行動がみられた

食生活の短期的影響としてとりあげた歯肉炎においてもまったく同様であり2つの歯科疾患の原因として共通なパターンの食生活があげられることを再確認されると共に飲物などの間食を控え食事が充分おいしく食べられるようにするといった食生活指導の目標は,正しかったと考えられる

Five thousand eight hundred elderly persons (2, 212 males and 3, 588 females) aged 40 years or above, who lived in Miyako district, Okinawa, were examined for the occuccence of dental caries, periodontal diseases, and tooth loss with reference to systemic conditions of the examinees.<BR>The Average number per person of present, intact, and carious teeth decreased with increase of age, and the rate of carious teeth (the total, untreated and heavy) and tooth loss increased. However, the relative number of persons who suffered from dental diseases, namely dental caries. periodontal diseases, or untreated tooth defects, decreased with higher age. Compared to ambulatory (non-bed-ridden) persons aged 60 years or higher, the bed-ridden had fewer present and intact teeth and the rate of untreated and severe carious teeth was higher. The Majority of the bed-ridden also had multiple and severe dental diseases, mainly dental caries and tooth loss, at higher rate. The tooth defects were mostly untreated but no other dental diseases coexisted in most of the cases.<BR>A significant number (41.3%) of the examinees had systemic disorders, mainly cardiovascular diseases. Most of the patients suffered from multiple diseases (40.2%) and required medical treatment (51.9%). Approximately two-thirds (63.4%) of the examinees required dental treatment. The bed-ridlen had generally a multiple number of systemic diseases, of which more than half (55.3%), compared to onefourth (28.1%) for the healthy, required prompt medical examination and treatment. The neccessity of dental treatment was higher (61.9%) for the bed-ridden than for the ambulatoy (53.9%), and in most cases prompt treatment was desirable.

A dental health examination of 908 inhabitants, 40 years of age and over, of Ueno, Okinawa, was carried out in concurrence with a general health examination.<BR>This study is deals especially with dental caries and general diseases. The prevalence of dental caries was 81.8%, and the prevalence of untreated dental caries was 42.6%, and these decreased with advancing age. This tendency was particularly marked in those aged 70 years and over, and also indicated the influence of the high rate of missing teeth in inhabitants of this age. The ratio of carious teeth, the ratio of untreated teeth, and the ratio of missing teeth increased with advancing age. This tendency was particularly marked in those aged 80 years and over.<BR>Some general diseases were present in 55.5% of the inhabitants examined, 36.4% of whom were suffering from two diseases or more. Particularly in subjects aged 60 years and over, the prevalence was as high as 67.6%, 58.9% of which were evaluated as requiring treatment. The incidence of locomotorial, connective tissue and cardiovascular diseases, and nervous, sensory diseases was high, and 28.1% of the sujects with carious teeth requiring treatment were also suffering from gneral diseases for which treatment was necessary. The incidence of general complications in the subjects aged 60 years and over was particularly high, 37.7%. These results suggest that it is necessary to formulate a new medical examination system that will be able to accomodate general conditions in the aged for the establishment of dental science and treatment in this group.

沖縄県伊良部町における40歳以上を対象とする老人保健法に定める住民検診に参加し,受診者1,243名より得られた調査結果のうち,とくに齲蝕と全身疾患の実態について検討を行った.1) 40歳以上の高齢者においては,年齢とともに健全歯率,処置歯率が低くなるが,これにともない,齲歯率,未処置歯率,欠損歯率は高くなり,とくに80歳以降においてこの傾向が著明であった.2)齲歯有病者率は67.5%,未処置歯有病者率は34.2%で全国平均より低い傾向がみられ,この地域の高い欠損歯率の影響と考えられた.3)受診者の45.6%に何らかの全身疾患がみられ,そのうちの25%が2疾患以上を合併していた.とくに60歳以上では有病者率が57.1%と高い割合を示し,そのうちの62.8%が治療を要する全身疾患を有していた.また,有病者の58.6%が循環器疾患を有しており,そのうち高血圧症が最も多くを占めた.4)治療が必要な齲歯を有するものの32.3%が治療を要する全身疾患が合併しており,とくに60歳以上では41.8%と高い割合を示した

集団健診における乳歯咬合期歯周疾患評価のための基準歯の選択を行った.3歳児では,歯肉炎発症重症度は上顎Eが高いこと,主成分分析より発症には上顎前歯部,下顎前歯部,臼歯部の3つのパターンがあり,各群より1単位ずつ選択するとよいこと,左右差がないことから,上顎B,上顎最後歯(E),下顎Bを候補とした.重回帰分析の結果,3変化数で8割以上を説明できること,最適変数での説明率と上顎B,上顎最後歯,下顎Bでの説明率に大差がなかったことから,左右いずれかの上顎B,上顎最後歯,下顎Bの3つの基準歯を選択した.上顎B,上顎最後歯,下顎B3つの基準歯のスコアを平均したものと従来の平均歯肉炎スコアとの相関関係は,いずれの組合せにおいても0.9前後であった.また,1歳6ヵ月児に同法を適応し,上顎B,上顎最後歯(D),下顎Bにおける歯肉炎スコアの平均と平均歯肉炎スコアとの相関係数も0.9前後であった.以上より,乳歯咬合期においては,左右いずれかの上顎B,下顎Bおよび上顎最後歯の3ヶ所を診査する方法が,集団健診には適していると考えた

Processing the data from dental health examinations requires detailed procedures for many items. In order to use the computed data to the best advantage for regional health programs and for personal health guidance, the arrangement of our work environment to enable precise data processing is an urgent need. For this, we used to process examination data on the main computer system of the Computer Center, at the University of Tokyo. However, preparing a file for the data processing on a computer is always annoying and time consuming. Therefore, we designed here an input software to directly prepare a data file on a personal computer, and put it to trial in an actual dental health examination. We were able to file and process the examination data very quickly. The application of a computer to dental health examinations is thus very useful and helpful for further development of dental health science

To investigate the extent of oral diseases in the aged, a dental examination was conducted in combination with medical examinations of elderly inhabitants of Miyako district, Okinawa pref.<BR>Abnormal oral findings were noted in 1, 655 (29.19 %) of 5, 670 examinees. The incidence of oral disease tended to increase with age. Among the oral disease detected, oral mucosal diseases showed the highest frequency. Suspected malignant tumors were found in 0.14%, benign tumors in 4.36 %, leukoplakia in 1.29 % and diseases presumably due to insufficient oral care by dentists or patients in 8.77 % of the examinees. Evaluation of the state of disease revealed that a higher proportion of systemic diseases were under medical treatment as compared with oral diseases. Further detailed examination was indicated in 50 (0.88 %) examinees with oral diseases.