検診受診者56324人における大腸がん新規発生率の推定および大腸がん罹患リスクの疫学的検討 : 7年間 retrospective cohort study 研究

内容の要旨 , 審査の要旨広島大学(Hiroshima University)博士(医学)Doctor of Philosophy in Medical Sciencedoctora

Analysis of the learning-targets of the nursing university students during practicum of community health nursing

【目的】本研究の目的は，地域看護学実習において，看護系大学で学ぶ４年次学生がどのような学習目標を持って臨んでいるのかを明らかにすることである． 【方法】地域看護学実習開始１ヵ月前に，実習要項に沿って実習目標および方法について説明を受けた後，学生９２人が考え，記載した学習目標（保健所実習で学びたいこと，市町村実習で学びたいこと）の内容を分類した． 【倫理的配慮】学生には，研究目的を説明したうえで，研究への協力の有無は成績評価とは無関係であること，研究資料としての提供は自由意志であること，協力の諾否により不利益はもたらさないことを説明した．学生の学習目標の内容分類にあたっては，氏名や実習先を伏せ個人を特定できないようにした． 【結果】保健所実習における学習目標は，「保健師の業務や役割の学習」，「保健所の連携機能に注目しての学習」，「健康危機管理についての学習」，「地域の特性を考慮した学習」，「自己の関心に基づく焦点化した課題学習」に分類された．市町村実習における学習目標は，「保健師の業務や役割の学習」，「地域の特性を考慮した学習」，「自己の関心に基づく焦点化した課題学習」に分類された． 【考察】内容は抽象的なものから具体的なレベルのものまであった．市町村の学習目標からは，保健所の場合より地域に密着した保健師活動について学ぼうとする姿勢が窺えた．近年，各市町村が工夫を凝らしたホームページにより詳細な地域情報の提供を行っており，実習地域の事前学習で地域特性をイメージしやすく関心も高まったためと思われる．Purpose : This research is to clarify what learning-targets fourth year nursing university students have during a practicum of community health nursing. Methods : One month prior to the start of the practicum, ９２ students were explained about the practical objectives and methods in line with essential practicum items. The contents of the learning-targets（things they hoped to learn in practical training at healthcare centers and in municipalities）thought up and noted by the students were classified. Ethical Consideration : The students were explained about the research purpose and then the following : the fact that they would not be subject to grade evaluation ; that their provision as a research material was voluntary ; and that whether or not they would cooperate in the research was not to cause any disadvantage to them. In the classification of the learning-targets of the students, their anonymity was secured by concealing their private information such as name and the place of practical training. Results : In the practical training at healthcare centers, the learning-targets were classified as : “Learning of the duty and role of a public health nurse”, “Learning of the collaborative function of healthcare centers as a key focus”, “Learning of health risk management”, “Learning with consideration on community characteristics”, and “Task-oriented learning based on the focus of one’s own interest”. In the practical training in municipalities, the learning-targets were classified as : “Learning of the duty and role of a public health nurse”, “Learning with consideration on community characteristics”, and “Task-oriented learning based on the focus of one’s own interest”. Discussion : The contents of the learning-targets ranged from abstract ones to specific ones. The learning-targets in the practical training in municipalities indicated the active attitude of the students to learn the work of public health nurses which was linked to the community more than healthcare centers were. In recent years, each municipality provides its own regional information through its ingenious homepage. In the prior study on the place for practical training, this is believed to have helped the students image the community characteristics and consequently take a better interest in the place

山間地域に住む高齢者の保健行動

【目的】本研究の目的は山間地域で主体的に運営する産業に従事している高齢者の保健行動を明らかにすることである． 【方法】対象者：産業に従事している高齢者（以下A 群）８４人と従事していない高齢者（以下B群）８１人である．データ収集方法：集合法で自記式アンケート調査を行った．期間：２００９年５月から９月に行った．調査項目：基本情報・生きがい・生活習慣・生活活動能力・疲労蓄積度（厚生労働省）で構成し，５２項目を設定し選択式回答とした．分析：回答者のうち，６５歳未満を除いた１４４人（８７．３％）について分析を行った．A群とB群の保健行動について，生きがい，生活習慣，生活活動能力に関する質問項目を記述集計およびクロス集計によって統計学的に分析した．倫理的配慮：所属機関の臨床研究倫理審査委員会の審査を受けた． 【結果】A 群はB群に比べて高齢者の集まりに入会している人の割合が有意に少なく（p＜０．０１），活動している人の割合も有意に（p＜０．０１）少なかった．A群の方がB群に比べて現病歴のある人の割合が少ない傾向（p＝０．０５４）が認められた．生活に対する意識について，「不満」「非常に不満」と回答したのは，A群に多く，両群間に有意な差（p＜０．０１）が認められた．疲労蓄積度の自覚症状の平均値は，A群では８．８±５．７点，B群は６．１±４．８点であった．A群では，疲労の自覚症状が３９点中１１～２０点であったのは１７人（２９．７％），それ以上は２人（３．４％）であったのに比べ，B群では前者が１６人（２２．２％），後者はおらず有意な差（p＜０．０５）があった． 【考察】A群は疲労蓄積度が高く，高齢者の集まりに参加している人が少なかったことから，A群は余暇活動をする時間がないほどに仕事に力を注いでいると考えられた．それにもかかわらずA群は現病歴のある人の割合が少なく，主体的な産業に従事できる程の健康状態を維持していることが示唆された．【Aim】This study aims to clarify the health behavior of the elderly who were managing profit-earning works in mountainous areas. 【Methods】The elderly aged more than ６５ year-old in the areas in T Prefecture were targeted. The elderly who were managing profit-earning works named Group A, and the elderly who were not named Group B. A questionnaire was conducted to the participants at local regular meetings from May to September, ２００９. The questionnaire consisted in five sections, such as, living habits, abilities of daily activities and the degree of fatigue accumulation１４）. The data was analyzed a comparison between two groups. This study was reviewed by the clinical ethic board of the institution to which the authors belong. 【Results】The total of １４４ participants were analyzed. The number of Group A was ６３, and Group B was ８１. There was a significant difference in average age between two groups. Regarding abilities daily activities, the admission of a public meeting for elderly of Group A in the areas was significantly lower than that of Group B. Group A was significantly lower the rate of present illness than that of Group B. Regarding fatigue accumulation, the difference between Group A and Group B were significant（p＝０．０３１）. 【Discussion】Group A seemed to favor their own profit-earning activities more than the admission of the activities for the elderly by public. Group A, however, felt more being fatigue than that of Group B. In addition, Group A seemed to have less present illness than Group B. Group A seemed to maintain their health and their work and life balance. Therefore, we considered to clarify that health behavior that consisted in the five sections was well maintained by the elderly who manage profit-earning activities

Health behavior of elderly people engaged in agriculture in conjunction with information communication technology

The aim of this study is to clarify the health behavior of elderly people engaged in agriculture and information communication technology (ICT). The participants were 61 people engaged in agriculture in conjunction with ICT systems (group A), and 49 people not engaged in this (group B) from among the people aged 65 years or over in village C, both living located in a mountain areas. Data were collected from August 2009 to June 2011 in two stages : interviews to members of group A through home visits, and a group survey of groups A and B through questionnaires. The results of the study were as follows : 1) members of group A lived with feelings of attachment to the land to which they were accustomed and showed gratitude to their ancestors ; 2) in group A, the desire of participants to continue their life was sufficient motivation to look after their own health and maintain independence ; and 3) they provided a new challenge and a sense of achievement. The results suggest that the health behavior in group A was behavior adopted voluntarily in order to maintain an independent lifestyle supported by working, and it is likely to be linked to the preservation of health

Visiting Nurses’ Awareness of the Current State of Clinical Practicum and Guidance

本研究は，訪問看護師への質問紙調査から，看護学生に対する訪問看護師の実習指導の現状と実習指導についての意識を知ることを目的に実施した．対象は，A県で在宅看護実習を受け入れている訪問看護ステーションの訪問看護師１９８名であった．質問は，実習指導の現状（２０項目）と実習指導の意識（１０項目）に，「当てはまる（５点）」から「全く当てはまらない（１点）」の５段階で回答を求めた．その結果，実習指導の現状では「学生の利用者や家族への理解が深まるように情報を提供している」「学生が連携について理解が深まるように助言している」「学生に指導するときは言葉や伝え方に配慮している」の３項目が４．４０と高かった．実習指導についての意識では，「指導することを通して自分の成長につながる」「指導することで学びなおす機会となる」の２項目が４．１７と高かった．また，実習指導の際に心がけていることや信念への自由記載から，【対象全体を捉えやすくする】【思いや基本を伝える】【対象の尊重と支援の方法を伝える】【共に学ぶ存在として学生をとらえる】の４カテゴリが抽出された．以上のことから，訪問看護師は学生に対して，マニュアルに頼らず，利用者や連携についての情報提供や助言をしており，個々に合わせた指導をしている現状がわかった．また，訪問看護師は学生が緊張しないように，言葉や伝え方に配慮をして学生に関わっていることが明らかになった．訪問看護師経験の長い者の方が，実習指導を，自分自身の学び直す機会や自分の成長につながる経験であると捉えており，実習指導についての意義を見いだしていると思われた．また，雇用形態によって，実習要項の確認や記録への助言，反省会への参加などに差があり，訪問看護師間における情報伝達や指導方法についての工夫が必要である．This research aimed to study clinical practicum provided by visiting nurses to nursing students and awareness of the practicum. The participants were １９８ visiting nurses at visiting nurses’ stations in Prefecture A. They responded to questions on the actual state of clinical practicum （２０items） and on their awareness of practicum （１０items） by choosing one of the items of a ５-point Likert scale, where ５ was “Applicable” and１ “Not Applicable at All”. Regarding the actual state of practicum, three items received a high score of ４．４０: “Providing information to enhance the students’ understanding of service-users and users’ families” ; “Helping the students improve their understanding of cooperation” : and “Being considerate of the ways of communication when giving guidance”. Regarding their awareness of practicum, two items received a high score of４．１７ : “Giving guidance leads to my own growth” and “Giving guidance is an opportunity to relearn”. Further, four categories were extracted from their free descriptions : Easier to grasp the entirety of care targets ; Communicating thoughts and basics ; Teaching the way to respect and support care targets ; and Seeing the students as co-learners. The findings indicate that the visiting nurses tailored their guidance according to the students’ individuality, and did not rely on manuals in providing the students with advice and information about clients and cooperation. Furthermore, they were considerate of their words and ways of communication to avoid putting the students under pressure. In addition to grasping the the real significance of a practicum, those experienced visiting nurses tended to consider practicum as an opportunity to relearn, and improve themselves. There were differences between visiting nurses with regard to their employment statuses, their advice on checking and reporting of practicum requirements, and to their participation in evaluation meetings. Finally, the results of the present study underscore the need to improve the capacity of visiting nurses to communicate information and give guidance

Development of diffuse large B-cell lymphoma in a patient with Waldenström's macroglobulinemia/lymphoplasmacytic lymphoma: clonal identity between two B-cell neoplasms

Waldenström's macroglobulinemia (WM)/ lymphoplasmacytic lymphoma (LPL) is an indolent mature B-cell neoplasm. In rare cases of WM/LPL, diffuse large B-cell lymphoma (DLBCL) develops as a result of histologic transformation. In this report, we present a case of DLBCL developing in a patient with WM/LPL. Combination chemotherapy for DLBCL was effective and complete remission was eventually achieved. We attempted to determine the clonal relatedness between WM/LPL and DLBCL in the patient by analyzing complementarity-determining region 3 (CDR3) in the immunoglobulin heavy chain gene. A common CDR3 sequence was found in tumor cells of DLBCL and those of WM/LPL, indicating that tumor cells of DLBCL are clonally identical to those of WM/LPL. Therefore, in the present case, DLBCL is developed from WM/LPL cells by clonal evolution