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脊髄損傷による対麻痺者に合併する生活習慣病に関する文献的研究
Get PDF本研究は、保育所に勤務する保育士が子どもの健康についてどのような認識を持っているかを明らかにし、子どもの健康づくりのための実践内容とその背景を把握することを目的とした。データ収集時点で保育所に勤務し子どもの保育に当たっている5名を対象に、保育士自身の健康観や健康な子どもについての考え、日頃の保育活動における子どもの健康づくりのための実践などに関して半構成面接を実施し、質的帰納的に分析した。分析の結果、【健康な子ども観】【健康実践を支える自分自身の健康観】【健康実践を支える保育観】【子どもの健康に関する保護者との情報交換】【子どもの健康状況についての査定】【子どもの健康づくりのための保育実践】【子どもへの健康教育】という7つのカテゴリーが抽出された。【健康な子ども観】では、従来の健康観に見受けられる「からだの健康」や「こころの健康」だけでなく。「遊ぶ力」力寸重要視されていることがわかった。また、【子どもの健康づくりのための保育実践】では、昨今の食育についての必要性の指摘と連動するように「健康的な食習慣のしつけ」に力が注がれていた。しかし、子どもの健康づくりは各々の保育士の価値観や過去の経験から実践され系統的な介入にはなっておらず、今後健康な子どものための健康教育のあり方を求めていく必要性が示唆された。The objectives of this study are to clarify the perception about children's health among nursery nurses working at preschools, then to obtain their practice and its background for children's health management. The subjects are five nursery nurses who were working at preschools at the data collection period. We made half structured interview to the subjects on the view of the health themselves, their thought about healthy children, the contents of health management practices at daily nursery activities and so on. The results of the interview are analyzed qualitatively and inductively. From the results of the analysis, following seven categories are extracted. Those are "the view of healthy children", "the view of nursery nurses' health to support their activities for children's health practices", "the view of nursery activities to support children's health management", "information exchange with parents about children's health", the assessment of children's health status", "the nursery activities for children's health management" and "the health education for children". In "the view of healthy children" category, not only "physical health" and "mental health" as cited in traditional view of the health but also "the ability of playing" is emphasized. In "the nursery activity for children's health management" category, "education of healthy diet practice" is stressed related to recent indication to needs for the diet education. However, children's health management is practiced with nursery nurses' sense of value and their past experiences, it is not intervened systematically. This article those that we should find how to education health education for chidren.総説departmental bulletin pape
老研究者の覚え書 養育院時代(2) : 心臓弁膜の老化、老年者の弁膜症、老年者の先天性心奇型、国立小児病院循環器グループとの協同研究
Get PDF養育院病院における老人282連続剖検例の検討から、心臓弁膜の老化は長年月繰返された開閉による機械的刺激の累積が弁尖閉鎖縁プロキシマリスの線維弾性板肥厚、スポンジオザ増生;体部のスポンジオザ吸収を伴うフィブロザ肥厚;弁輪結合織の類線維素・硝子様変性、脂肪沈着、石灰化など血行力学的変化として表現される事実が判明した。老化とランブル突起、窓形成の関連も検討した。老年者の弁膜症としては、弁老化病変の進行による変性型弁膜症が特徴的である。弁輪石灰化による僧帽弁逆流7、大動脈弁狭窄4;弁・支持組織弱体化による僧帽弁逸脱7、大動脈弁下垂5;計23剖検心の検索からその成因に結合組織内酸性ムコ多糖類の関与が示唆された。老年者の先天性心奇形は小型心房中隔欠損3、閉鎖または閉鎖進行中の心室中隔欠損4、新概念の部分的左室低形成2、異型大動脈縮窄2、内臓錯位を伴う左心症1;計12剖検例が経験された。小奇形は全剖検心の39%に合併、うちわけは卵円孔開存12%、キァリ網10%が主役である。著者はシカゴより帰国後、東京の国立小児病院の循環器グループの臨床病理検討会CPCに定期的に参加し、症例報告と研究に参画する機会を得た。心奇形に合併する心外奇形のシカゴと本邦の比較では、両者で殆ど同じ結果がみられたが、心室中隔欠損の頻度と型に日米間に相違があり、本邦での血液型B,CCDeeと高位中隔欠損の高率出現が相関する事実が明らかになった。A clinicopathological study using 282 consecutive elderly autopsy cases in the Yoikuin Hospital, clarified the characteristic features in ageing changes of the cardiac valves as follows: accumulated mechanical stress due to long time persisted valvular action, produced hemodynamic changes to the valvular tissue, which consisted of fibroelastic hypertrophy of the proximalis, proliferation of the spongiosa at the closing edges, hypertrophy of the fibrosa with consumption of the spongiosa at the valvular bodies, and degenerative changes of the connective tissue, such as fibrinoid and hyalinoid degeneration, fatty infiltration, calcification in the valvular rings, and so on. Lambl's excrescence and fenestration are increasing with age. Senile valvular diseases developed mainly from progression of the ageing changes and were characterized to be "degenerative type", included 7 cases of mitral regurgitation due to ring calcification, 4 cases of aortic stenosis due to ring and cusp calcification, 7 cases of mitral valve prolapse and 5 cases of aortic valve prolapse due to weakened valve supporting tissue. Acid mucopolysaccharides produced by connective tissue cells, seemed to be participated to progression of the connnective tissue degeneration. Congenital major cardiac malformations in the elderly, consisted of 3 cases of small atrial septal defect, 4 cases of closed or closing ventricular septal defect, 2 cases of newly proposed entity "partial hypoplasia of left ventricle", 2 cases of atypical coarctation of the aorta, and 1 case of isolated levocardia with visceral heterotaxia. Minor malformations were complicated up to 39% of the senile consecutive autopsy cases, and included patent foramen ovale to 12% and rete chiari to 10%. The author joined a clinicopathological conference in the national children's hospital in Tokyo, since come home from Chicago, and participated to make several case reports and cooperative researches related to a comparison between USA and Japan on cardiac malformations, and they revealed the evidence which extracardiac malformations with congenital cardiac anomalies were almost equal in both countries, but the high septal VSD showed higher incidence that paralleled the blood type B and CCDee incidence in Japan.資料departmental bulletin pape
褥婦における麻疹・風疹・水痘および流行性耳下腺炎の予防接種・罹患率の状況
Get PDF予防接種法がさまざまに改正されている中、群馬県(中毛地区)の褥婦の予防接種率・罹患率の現状を把握し、今後の感染症に対する母子の安全確保のための予防接種の指針を得ることを目的に麻疹、風疹、水痘、流行性耳下炎(以下ムンプス)の予防接種率、罹患率等に関する質問調査を行った。その結果、438名(初産婦246名、経産婦192名)から回答を得た。予防接種については、麻疹・風疹・水痘・ムンプスの感染症のうち麻疹・風疹を除くと予防接種率は50%前後であった。また、これら4種の感染症各々において予防接種歴「わからない」が約40%を占めた。一方、罹患歴「わからない」が約10～30%を占めた。これらの結果から、親が自らの予防接種と罹患について正確に把握していない状況がうかがえた。そして、妊娠・出産・育児という大切な時期であるにも関わらず胎児および新生児に大きな影響を及ぼす疾患についての知識、それらに対する予防策と予防接種への関心の低さが考えられた。さらに、妊婦はもちろんのこと医療者においても、妊娠中にも風疹、麻疹、水痘、ムンプスに罹患するということへの認識が不足しているのではないかと思われた。その点を考慮し生殖年齢にある全ての人に予防接種の大切さ、適切な助言や介入などの教育的啓蒙をしていく必要性があることが示唆された。In consideration of the various amendments to the Preventive Vaccination Law, a questionnaire survey on factors such as the vaccination and incidence rates of measles, rubella, varicella, and mumps was conducted in order to determine the current vaccination and incidence rates of puerperae admitted to a hospital in central Gunma prefecture and to obtain vaccination guidelines for protecting mothers and children against infections in the future. Responses were obtained from 438 puerperae (primipara, n=246; multipara, n=192). With regard to vaccinations against the infections of measles, rubella, varicella, and mumps, vaccination rates were approximately 50% with the exception of measles and rubella. In addition, approximately 40% of puerperae were "unsure" about their history of vaccination against each of these four infections. Moreover, approximately 10-30% of puerperae were "unsure" about their history of infections. These results showed that parents did not have an accurate understanding of their own vaccinations and infections. Furthermore, despite the importance of the stages of pregnancy, childbirth, and child rearing, parents were thought to possess limited knowledge of these diseases, which significantly affect fetuses and neonates, in addition to awareness of preventive measures and vaccination against these diseases. In addition, an insufficient recognition of the fact that infections such as measles, rubella, varicella, and mumps may also occur during pregnancy was suggested not only among pregnant women, but also medical personnels. These findings suggest the need for educational awareness, including appropriate advice and intervention that consider these data and highlight the importance of vaccinations for all individuals of reproductive age.原著論文departmental bulletin pape
ホットパック療法における治療時間の検討
Get PDF温熱療法は痛みの治療、循環の改善、筋緊張の緩解等の治療で、最もよく使われる治療法である。その温熱療法の中では、その手軽さからホットパック療法がよく使われる。ホットパック療法は、シリカゲルを厚手の布袋に詰めたものを熱水(80～90℃)に浸した後、バスタオルでくるみ患部に当て、温熱刺激を与えるものである。シリカゲルは、多孔質で、比熱のきわめて高い物資で、水分を含んだシリカゲルは、ゲル状の半固形化することで、水分子の対流を防止する。このようなことから、比熱が高いので熱容量が大きく、また、対流をなくすことで、熱エネルギーをゆっくりと身体に伝えることができる。このホットパックの熱伝達の特徴を表面温、深部温、皮下血流量を指標として、ホットパック療法の最も適した治療時間を研究したものである。実験は、右下腿部にホットパック療法を30分間行なった時の表面温、深部温、皮下血流量を測定し、その変化から最適な治療時間を求めた。その結果、表面温は、治療開始後18分で最高温度に達し、その後9分間ほぼ同じ温度を保ち、治療終了後徐々に下降した。治療終了後30分においても治療前の温度よりも高い状態であった。深部温は、治療開始後26分で最高温度に達し、治療終了後1分まで同じ温度を保ち、その後徐々に下降した。治療終了後30分においても治療前の温度より高い状態であった。皮下血流量は、治療開始後30分において最高の増加を示し、その後、徐々に減少するが、治療終了後30分においても治療前より増加を示した。また、治療側と反対側の表面温と深部温を同時に測定し、その変化を調べた。その結果、非治療側の表面温、深部温のわずかな上昇をみた。以上のようなことから、ホットパック療法は、20～30分の治療時間が必要と認められた。また、治療側と離れた部位の温熱刺激を行なうことができることも確認できた。Thermotherapy is the most utilized medical treatment for curing pain, improving circulation, and alleviating muscular tension. Among various types of thermotherapy, hotpack therapy is often used because of its simplicity and ease of application. In hotpack therapy, thermal stimulus is given to the affected area using silica gel packed in a thick cloth bag, which is soaked in hot water (80-90℃) and then applied by wrapping with a bath towel. The silica gel used in this method is a porous substance that has an extremely high specific heat. In silica gel that contains water, convection of water molecules is prevented by semi-solidification in a gel state. The high specific heat gives the gel a large heat capacity, and the absence of convection makes it possible to convey the thermal energy to the body slowly. A study of the optimal treatment time for hotpack therapy was conducted using three indicators, namely, skin temperature, deep temperature, and blood flow under the skin, all of which are characteristics of heat transfer in hotpack therapy. The experiment was carried out by measuring the skin temperature, deep temperature, and blood flow under the skin when hotpack therapy was given on the lower right leg for 30min, and the optimal treatment time was obtained based on the changes in these indicators. The results revealed that the skin temperature reached its maximum 18min after starting the therapy, maintained the same temperature for 9min, and then gradually decreased after the completion of therapy. Skin temperature was higher 30min after the completion of therapy than before therapy. Deep temperature reached its maximum 26min after starting the therapy, maintained the same until 1min after the completion of therapy, and then gradually decreased. Deep temperature was higher 30min after completion of therapy than before therapy. The volume of blood flow under the skin increased to its maximum 30min after starting the therapy, and although it gradually decreased, the volume after the completion of therapy was higher than that before therapy. The skin temperature and deep temperature on the opposite side from the treated area were also measured at the same time to study the changes in other areas. Both skin temperature and deep temperature showed some rise on the opposite side. Based on these results, a hotpack therapy time of 20-30min is considered necessary. The results also confirmed that thermal stimulus by hotpack therapy is effective in parts at some distance from the treated area.原著論文departmental bulletin pape
森林浴効果の生理学的研究 : 川場村における癒しと健康効果の検討
Get PDF我々は、川場村において「癒しと健康をもたらす」とされる、森林浴の生理学的効果を検討した。被験者は、川場村在住の19名の高齢者(男性11名、女性8名)、年齢は平均74歳(男性74±3.5歳、女性74.9±2.9歳)。8月17日の1時間森林集団散策時の天候は曇り、気温30℃から32℃、湿度58%から60%、風速0m/secから2m/sec、コントロールは、同じメンバーによる8月21日の田園地域1時間の集団散策とし、非森林浴時の天候は、森林浴時とほぼ同様であった。森林揮発性物質(フィトンチッド)、気分プローフィール(POMS)、血圧、脈拍数、空腹時の血清からNK活性細胞、カテコールアミン(アドレナリン、ノルアドレナリン、ドパミン)、コルチゾール、アディポネクチンを森林浴・非森林浴前後に測定した。川場村における森林浴調査地から森林揮発性物質が検出され、全員で、森林浴前後においてPOMSの総得点、血圧、コルチゾールおよびアドレナリンが有意に低下した。被験者中の3例に森林浴でNK細胞活性の増加を認め、女性1例のみ森林浴および非森林浴の両者でNK細胞活性の増加を認めた。川場村における森林浴研究結果から、POMS、カテコールアミンおよびコルチゾールの血中濃度低下は、森林浴が癒しと健康をもたらす効果をもつ可能性を示唆する所見と考えられた。We performed a physiological research on mind-healing and health-keeping effect of Shinrin-yoku (forest walking) in Kawaba village. Eleven male and 8 female healthy elderly residents in Kawaba village, whose average age was 74.0 ± 3.5 year-old for male and 74.9 ± 2.9 year-old for female, were voluntary to this experiment. All members walked one hour in the Kawaba Forest at 17^, August under cloudy, 30-32℃ temperature, 58-60% humidity, and, 0-2m/sec windy condition and walked again another one hour in the non-forest rural agricultural area at 21st, August under almost same weather condition. Phytoncides in the air, Profile of Mood State (POMS) test, blood pressure (BP), heart rate (HR), fasting levels of serum natural killer cell activity (NK), catecholamine (adrenaline, noradrenalin and dopamine), cortisol, adiponectin were measured before and after the walking of the members. Phytoncides was positively detected in the Forest, all members showed a decrease of POMS total scale, BP, adrenalin and cortisol and 3 of them expressed an increase of NK cell activity after the Forest-walking. A female showed a high NK cell activity after both Forest and non-Forest rural walking. Our experiment on the Forest walking in Kawaba village, revealed its beneficial mind-healing and health-keeping effect, through mental and physical relaxation in the forest fresh air.原著論文departmental bulletin pape
高齢者への援助が免疫機能とストレスに及ぼす影響(第1報) ―通所リハビリテーション施設における入浴とコミュニケーション―
Get PDF本研究の目的は、日常生活において欠かせない入浴およびコミュニケーションによる援助が、高齢者の免疫機能とストレスにどのような影響を及ぼすかについて明らかにすることである。対象者は、通所リハビリテーション施設を利用している認知症を持つ高齢者5名と脳血管障害後遺症を持つ高齢者10名の15名である。方法は、入浴及びコミュニケーションによる援助を提供し、その前後に唾液を採取して平板内単純免疫拡散法(SRID法)により唾液IgAと唾液コルチゾールの値を求めた。結果は、入浴により唾液IgAが7.4mg/dLから11.2mg/dLに上昇し、唾液コルチゾール値が1.1ng/mLから1.05ng/mLにわずかに下降を示した。また、コミュニケーションにより唾液IgAが5.5mg/dLから15.4mg/dLに上昇し、唾液コルチゾール値が0.7ng/mLから0.8Ng/mLと下降を示さなかった。これらのことから、高齢者への入浴とコミュニケーションによる援助は、免疫力を高める効果が早期に発現し、ストレスへの緩和効果は、入浴においてのみわずかに発現される結果であった。また、入浴は、脳血管障害後遺症を持つ高齢者の免疫力を高めにくく、ストレスの緩和効果は得やすい傾向があることが示唆された。The purpose of this study was to clarify the effect of bathing and communication, which are essential functions in daily assistance given to elderly patients, on the immune functions and stress of elderly patients. The subjects in this study were 15 people using an ambulatory rehabilitation facility, comprising 5 elderly dementia patients and 10 elderly vascular dementia patients. As the study method, care was provided in the forms of bathing assistance and communication assistance, saliva was collected from the subjects, saliva IgA and saliva cortisol values were measured by the single radial immunodiffusion (SRID) method before and after care, and the concentrations were calculated. As a result, bathing assistance increased the saliva IgA value of all subjects from 7.4 mg/dL to 11.2 mg/dL and reduced the saliva cortisol value slightly, from 1.0ng/mL to 1.05ng/mL. Communication assistance increased the saliva IgA value of all subjects from 5.5 mg/dL to 15.4 mg/dL but did not cause a decrease in the saliva cortisol value, as the value rose from 0.7ng/mL to 0.8ng/mL. These results showed that bathing and communication assistance of elderly patients have an early effect in improving patients' immunity, and a slight stress relaxation effect is apparent only in bathing assistance. The study also suggested that bathing had little effect in improving the immunity of elderly vascular dementia patients but tended to facilitate the stress relaxation effect.原著論文departmental bulletin pape
群馬県東北部山村住民の腰痛に関連する日常生活要因
Get PDF群馬県泉北部山村住民の腰痛発症の現状とそれに関連している日常生活要因について検討することを目的に、群馬県K村在住の40歳～69歳の全住民2,373人を対象に質問紙調査を行った。保健推進員56名がアンケートの配布・回収を行い、1,638人より有効回答が得られた(回収率69.0%)。その結果、612人(37.4%)に腰痛がみとめられた。そのうち腰痛を引き起こす内臓疾患のある者、交通事故やけがで腰を痛めた者を除いた1,489人について、腰痛発症と日常生活要因との関係を調べた。対象の背景、職業経験、日常生活動作、普段よくする姿勢、日常生活習慣に関する要因の項目間で腰痛ありの割合に有意差がみられたのは、「年齢階層」、「急性腰痛の経験」、「ストレス」、「長時間腰をかがめる仕事の経験」、「重量物の取扱い、運搬〔仕事〕」、「重量物の取扱い、運搬〔日常生活動作〕」、「横座りをする」、「足を組んで座る」、「猫背である」、「横向きに寝ながらテレビ雑誌を見る」であった。また、多重ロジスティック回帰モデルでは、「腰痛あり」の関連因子として、「急性腰痛の経験」、「ストレス」「年齢(40歳～49歳)」「長時間腰をかがめる仕事の経験」、「重量物の取扱い、運搬〔日常生活動作〕」の5因子が抽出された。 40歳台は他の年代と比べて腰痛ありの者が多く(37.5%)、農業や屋根の雪下ろしなど、K村に特徴的な就労や日常生活の場面で腰に負担をかけていることが予測された。また、急性腰痛のエピソードやストレスと、腰痛との関連が認められたことから、地域保健と産業保健の領域が連携し、住民ならびに特定の職業従事者のための腰痛対策が必要である。また横座りなどの姿勢と腰痛との関連がみとめられたことなどから、保健センターや住民の自主的な活動による地域住民を対象とした腰痛予防のための知識の普及が期待される。Purposes: The purposes of this study are to identify the prevalence of low back pain among residents living in a mountain village in northeastern Gunma Prefecture and to consider the factors affecting low back pain. Methods: A survey was conducting using questionnaires distributed to 2,373 residents with ages between 40 and 69 living in two adjacent districts in K Village, Gunma Prefecture, Japan. The district health promotion leaders distributed and collected the questionnaires. A total of 1,638 (69.0%) residents gave valid responses to the questionnaire. Among these, persons who indicated histories of disease associated with low back pain, traffic accidents, or back injuries, as well as those without answers, were excluded. The remaining 1,489 responses were analyzed. Results : At the time of the survey, 37.4% of the responders reported having low back pain. Related variables in the prevalence of low back pain included age, stress, episodes of acute low back pain, experience of work involving stooping for extended periods of time, experience of work involving handling or carrying heavy objects, handling or carrying heavy objects in daily life, posture sitting sideways on the floor, posture sitting on a chair with crossed legs, humpback, and posture lying on one side while watching TV or reading. In the multiple logistic regression model, those for "low back pain" included age (high prevalence in the 40-49 year age group), stress, episodes of acute low back pain, work involving stooping for extended periods, and handling or carrying heavy objects. Conclusion : The 40-49 year age group had the highest prevalence of low back pain (by age: 40-49/37.5%, 50-59/29.4%, 60-69/26.0%). Work requiring stooping, such as farming, and handling or carrying heavy objects, such as removing snow from roads, are characteristics of the lifestyle of residents in K village. Because episodes of acute low back pain and stress are related to low back pain, it is urgent that public health nurses in the district work in cooperation with those in industry to take preventive measures against low back pain for people engaged in specific types of work. In addition, because many people placed loads on their backs by bad posture, it is hoped that the public health center and residents' association will cooperate in education on behavioral changes to prevent or reduce low back pain.原著論文departmental bulletin pape
日本における外国人看護師の保健医療活動への適応実態 ―医療現場という視点から―
Get PDF本研究は、日本の医療機関に勤務している外国人看護師が医療現場でどのような看護現状を体験し、かつどのように日本社会での生活、医療や看護の現状へ適応していくのか、その適応実態を明らかにすることを目的とした。医療機関に勤務している外国人看護師6名を対象に適応実態に関する半構成面接を実施し、質的帰納的に分析した。分析の結果、【施設のサポートの要因】【文化価値観の影響】【看護役割への影響】【風習への理解】【言葉の対応の困難さ】という5つのカテゴリーが抽出された。本研究では異国で人、特に病気という時期にある人と深く関わる外国人看護師の適応過程において、自分の文化を捨てて相手の文化に染まることではなく、既に身に付いていた自国文化と新しく接触した文化の両者をとけ込ませ、自国・他国の違いを越えた一人の人間としての生き方、考え方、価値観、世界観を作りあげることであると考えられる。日本の看護師資格を持つ外国人看護師雇用には雇用側での日本社会での生活、医療や看護の現状の理解を深めるなど、外国人看護師のためのサポート体制の整備も不可欠であると考える。The objectives of this research are to describe how foreign nurses working at Japanese health service facilities experience real nursing activities at the clinical site and how they adapt to the actual status of their life and health service and nursing activities in Japanese society, and then to clarify the actual condition of their adaptation. We conducted semi-structured interviews with six foreign nurses and analyzed the results of the interviews by qualitative and inductive methods. Five categories were extracted from the results of the analysis, these being "factors of support by the nurse's health facility," "influence of cultural values," "influence on the nursing role," "understanding of customs," and "linguistic difficulties." For foreign nurses who are deeply concerned with people, particularly people during a period of disease, it is a distinctive feature of adaptation that emic factors such as "support by the nurse's health facility," "cultural values," "influence on the nursing role," "understanding of customs," and "linguistic difficulties" are extracted. This suggests that the provision of a support system, including understanding of the foreign nurse's everyday life and the actual condition of health service and nursing activities in Japanese society on the part of the employer, is essential for employment of foreign nurses who have Japanese nursing licenses.原著論文departmental bulletin pape