Health Support of Recipients by Welfare Caseworkers : Analysis of a Questionnaire Implemented at Urban Welfare Offices

【目的】生活保護受給者の自立支援の基礎となるのは健康への支援である。生活保護ケースワーカー（以下、CW）による受給者の健康支援を促進する要因と健康支援に関連する認識を明らかにすることを研究目的とした。【方法】3都市10福祉事務所のCW212人に質問紙を配布し、有効回答178人分を分析対象とした。作成した尺度に基づき健康支援得点を算出し、それを目的変数として関連要因を明らかにするために重回帰分析を行った。また、健康支援得点で2群（高群、低群）に分け、重要と考える健康課題、健康支援方策および職場環境整備の必要性についてCWの認識を比較した。【結果】健康支援得点には、CWとしての受給者への姿勢、高い仕事のやりがい感、職場における事例検討が有意に関連していた。重要と考える健康支援の課題は、精神保健と母子保健の領域の課題をあげるものが多く、健康支援得点の高群は低群に比し、児童虐待をあげる割合が有意に高かった。また、健康支援得点の高群は、健康支援方策では保健医療専門職との連携、栄養教室の開催、患者会や当事者グループ等の活用をあげる割合が有意に高く、職場環境の整備では、職場内での助け合い、他部署との友好な連携、支援策の相談と助言、保健医療専門職の配置などの項目すべてでかなり必要であると答える割合が高かった。【結論】CWによる健康支援を促進するには、CWの志気の高さとそれを支える職場内の取り組みが重要である。受給者の健康課題は、精神保健や母子保健の領域に多く認められた。健康支援に積極的に取り組んでいるCWは、健康支援方策についてより多くの方策が必要と考えており、また、職場環境整備の必要性についての意識もより積極的であった。受給者の健康支援では、世帯を担当するCWが受給者の健康状態への気づきやアセスメント力を高め、医療専門職との協働・連携につなげていける職場環境や体制づくりが重要である。[Purpose] Health support is fundamental of various supports for public welfare recipients. This study aimed to clarify promotion factors and awareness related to health support for recipients among welfare caseworkers (CWs). [Methods] Questionnaires were distributed to a total of 212 CWs at ten welfare offices in three different cities, and analysis was conducted on valid answers from 178 respondents. Health support scores were calculated based on a scale created for the study; using the score as the dependent variable, multiple regression analysis was conducted to clarify related factors. In addition, according to the health support score respondents were divided into two groups (the high score group and low score group), and CWs\u27 awareness of the importance of health issues, health support measures, and improvement of workplace environment were compared. [Results] A significant relationship was found between the health support score and the attitudes of CWs toward recipients, a strong sense of the work being worth doing, and case study meetings in the workplace. The health issues that the CWs considered important were those that involved mental health and maternal and child health, and the rate of child abuse being considered important in the high score group was significantly higher than in the low score group. Regarding health support measures, significantly higher rates were shown in the high score group than low score group in terms of cooperation with health professionals, holding nutrition classes, and cooperation with self-help groups. As improvement of workplace environment, the high score group showed higher rates in all of the items, such as helping others within the workplace, favorable cooperation with other sections, consultations and advice for support measures, and placement of health professionals. [Conclusions] For the promotion of health support by CWs, high levels of morale among the CWs themselves and supporting initiatives within the workplace are essential. Many health issues were identified in the areas of mental health and mother and child health. CWs who proactively make efforts for health support thought that larger numbers of health support measures were necessary, and they also had a stronger awareness of the necessity of workplace environment improvement. To promote health support of welfare recipients, it is necessary to enhance CWs\u27 assessment skills toward recipients health need, and workplace environment that assure cooperation with health professions is also important.黒田研二教授退職記念

Factors related to the feeling that their work is worthwhile among caseworkers engaged in livelihood protection programs

目的：本研究は、生活保護現業員の仕事のやりがい感に関連する要因を明らかにし、やりがい感を支援する方策を検討することを目的とした。方法：政令指定都市、中核市、特例市である3つの市の10か所の福祉事務所の生活保護現業員全数212人を対象に自記式質問紙調査を行った(有効回答数178人、有効回答率85.6％)。調査内容に含まれる項目のうち、仕事のやりがい感(5件法で質問し回答に1点～5点を付与)を従属変数とした。回答者の属性、職場内の事例検討等の実施、受給者への健康支援の対応、受給者に対する支援関係の基本姿勢、他部門・他機関・他職種等との連携から独立変数を設定して分析を行った。まず、2変数間の関係をt検定、分散分析、相関係数により調べ、仕事のやりがい感に有意に関連を示す変数を見い出し、次にそれらを独立変数としたステップワイズ(漸増法)の重回帰分析を行った。結果：2変数間の関係の分析の結果、仕事のやりがい感と回答者の所属自治体、専門職資格の有無、職場での支援困難事例の相談・検討、定期的な事例検討、健康支援得点、支援関係得点、行政内連携、および医療・介護との連携との間に、有意な関連が見出された。所属自治体を除く7変数を独立変数とする重回帰分析により、仕事のやりがい感に対し、健康支援得点、支援困難事例の相談・検討、行政内連携が有意な関連を示した。結論：生活保護現業員の仕事のやりがい感を支援するには、受給者との関係で健康支援の観点を重視すること、支援困難事例の検討等のスーパーバイズを重視した職場環境づくり、さらに関係部門・機関との連携を図ることが重要である。支援者自らが仕事のやりがい感を感じることは、受給者のQOLの向上を図る上においても重要であろう。[Objective] This study aims to clarify factors affecting the feeling that their work is worthwhile among caseworkers engaged in livelihood protection programs and to identify measures to promote this feeling. [Method] A questionnaire survey was conducted at 10 welfare offices in 3 municipalities. The survey participants were 212 caseworkers, of whom 208 returned questionnaires. Statistical analyses were performed for 178 questionnaires, as the valid response rate was 85.6%. The caseworkers\u27 feeling that their work was worthwhile was evaluated using a five-point scale to obtain the worthwhile work score (WWS). In the statistical analyses, WWS was used as the dependent variable, and the relationship between WWS and each independent variable was analyzed using t-test, analysis of variance, and correlation coefficients to identify statistically significant variables. A multiple regression analysis was then conducted using significant independent variables. [Results] The following variables exhibited a statistically significant relationship to WWS: municipalities, professional qualifications, consultation regarding difficult cases, regular case study meetings, health support score, helping relation score, collaboration within the local government, and collaboration with medical and long-term care. The multiple regression analysis using seven variables as independent variables excluding municipalities revealed that health support score, consultation regarding difficult cases, and collaboration within the local government were significantly related to WWS. [Conclusion] To promote the feeling that their work is worthwhile among caseworkers, it is important for them to develop an attitude of respect for the health and well-being of their recipients. In addition, job environments that ensure supervision and consultation, and increased collaboration with the relevant government department and facilities are important. Promoting the feeling that their work is worthwhile among caseworkers will also contribute toward the improvement of recipients\u27 QOL

Health support for recipients of livelihood protection : A review of the needs and consideration of a support system

本研究は、健康格差の縮小に向けて生活保護受給者の健康支援ニーズを明らかにし、その支援体制を検討することを目的とする。方法は、健康政策並びに学術論文、行政統計資料から健康支援ニーズを整理し、今後の支援体制について検討する。その結果、生活保護受給者の健康支援ニーズを概観すると、貧困そのものが社会的ハイリスクとなり、健康に負の影響をもたらしていた。また、低い健診受診率、精神疾患と自殺、生活習慣病が課題となる。さらに、介護や看取りにおける意思決定支援等も課題である。受給者の健康支援ニーズに対応すべく支援体制としては、第1に、自立支援、生活支援をすすめる際に、健康支援を基礎にした包括的支援という視点をもち、ヘルスリテラシーを高める支援を開発することが必要である。第2に、ケースワークをより専門的に実践していく力を高めるため生活保護部門においてコーディネート機能（生活支援および健康支援におけるコーディネート機能）の強化が必要である。第3に、保健・医療・福祉・教育における行政分野間政策連携（行政部門間、行政主体間の連携）とともに、公民連携による地域包括支援体制を構築していくことが求められる。This study aims to clarify the health support needs of welfare recipients in order to narrow the gap of health status disparity, and examine the support system. The study not only classifies health support needs based on health policies, academic papers, and administrative statistics material but also considers the future support system. The review of the health support needs of welfare recipients revealed that poverty is a high social risk and has a negative influence on health. Low participation rates in health examinations, mental disorders and suicide rates, and lifestyle-related diseases are relevant issues; decision-making support, such as that for long-term care and end-of-life care, has also become a concern. For a support system that responds to the health support needs of welfare recipients, firstly, it is necessary to develop support for enhancing health literacy with a viewpoint of comprehensive support on which health support is based. Secondly, it is necessary to strengthen a coordination (particularly between livelihood and health support), reinforcing the ability to professionally execute activities in case work. Finally, a community-based integrated support system must be built through public-private partnership as well as policy collaborations in administrative fields, such as health, medical care, welfare, and education

Risk assessment of assisted reproductive technology and parental age at childbirth for the development of uniparental disomy-mediated imprinting disorders caused by aneuploid gametes

Abstract Background Our previous study suggested that assisted reproductive technology (ART) may be a possible risk factor for the development of epimutation-mediated imprinting disorders (epi-IDs) for mothers aged ≥ 30 years. However, whether ART or advanced parental age facilitates the development of uniparental disomy-mediated IDs (UPD-IDs) has not yet been investigated. Results We enrolled 130 patients with aneuploid UPD-IDs including various IDs confirmed by molecular studies and obtained ART data of the general population and patients with epi-IDs from a robust nationwide database and our previous report, respectively. We compared the proportion of ART-conceived livebirths and maternal childbearing age between patients with UPD-IDs and the general population or patients with epi-IDs. The proportion of ART-conceived livebirths in patients with aneuploid UPD-IDs was consistent with that in the general population of maternal age ≥ 30 years and was lower than that in the patients with epi-IDs, although there was no significant difference. The maternal childbearing age of patients with aneuploid UPD-IDs was skewed to the increased ages with several cases exceeding the 97.5th percentile of maternal childbearing age of the general population and significantly higher than that of patients with epi-IDs (P < 0.001). In addition, we compared the proportion of ART-conceived livebirths and parental age at childbirth between patients with UPD-IDs caused by aneuploid oocytes (oUPD-IDs) and that by aneuploid sperm (sUPD-IDs). Almost all ART-conceived livebirths were identified in patients with oUPD-IDs, and both maternal age and paternal age at childbirth were significantly higher in patients with oUPD-IDs than in patients with sUPD-IDs. Because maternal age and paternal age were strongly correlated (r s  = 0.637, P < 0.001), higher paternal age in oUPD-IDs was explained by the higher maternal age in this group. Conclusions Different from the case of epi-IDs, ART itself is not likely to facilitate the development of aneuploid UPD-IDs. We demonstrated that advanced maternal age can be a risk factor for the development of aneuploid UPD-IDs, particularly oUPD-IDs

Sustained endocrine profiles of a girl with WAGR syndrome

Abstract Background Wilms tumor, aniridia, genitourinary anomalies and mental retardation (WAGR) syndrome is a rare genetic disorder caused by heterozygous deletions of WT1 and PAX6 at chromosome 11p13. Deletion of BDNF is known eto be associated with hyperphagia and obesity in both humans and animal models; however, neuroendocrine and epigenetic profiles of individuals with WAGR syndrome remain to be determined. Case presentation We report a 5-year-old girl with the typical phenotype of WAGR syndrome. She showed profound delays in physical growth, motor and cognitive development without signs of obesity. Array comparative genome hybridization (CGH) revealed that she carried a 14.4 Mb deletion at 11p14.3p12, encompassing the WT1, PAX6 and BDNF genes. She experienced recurrent hypoglycemic episodes at 5 years of age. Insulin tolerance and hormonal loading tests showed normal hypothalamic responses to the hypoglycemic condition and other stimulations. Methylation analysis for freshly prepared DNA from peripheral lymphocytes using the pyro-sequencing-based system showed normal patterns of methylation at known imprinting control regions. Conclusions Children with WAGR syndrome may manifest profound delay in postnatal growth through unknown mechanisms. Epigenetic factors and growth-associated genes in WAGR syndrome remain to be characterized

Carcinogenesis vol.19 no.3 pp.425–431, 1998 Chemoprevention of 4-nitroquinoline 1-oxide-induced oral carcinogenesis by citrus auraptene in rats

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