A県内の高齢者向け住まいのサービス提供体制と医療的ケア及び看取りの受け入れ意向との関連

目的：A県の高齢者向け住まいのサービス提供体制と医療的ケア及び看取りの受け入れ意向との関連を明らかにする． 方法：A県の高齢者向け住まい（463か所）に勤務する管理者等を対象とし，入居者の状況，サービス提供体制等の自記式質問紙調査を実施した．サービス提供体制と医療的ケア及び看取りの受け入れ意向の有無との関連について，χ2検定又はFisherの直接確率検定を行った． 結果：有効回答は130施設（有効回答率28.1％）であった．医療的ケアの受け入れ意向では，「施設に看護師が常駐」「夜間ケアを提供する職員の配置」等の11項目，看取りの受け入れ意向では，「施設に常勤の介護職員」「施設に常勤の看護師」「協力医療機関の24時間緊急往診要請への対応」「看取りのマニュアルの整備」等の14項目に関連があった． 結論：高齢者向け住まいにおける医療的ケア及び看取りの受け入れには，看護職員・介護職員の配置及び医療機関等との連携の必要性が示唆された．Objectives: To clarify the relationship between the service provision system of housing for the elderly in A prefecture and the intention to accept medical care and end-of-life care. Method: A self-administered questionnaire survey was conducted on residents’ status and components of the service provision system for managers working in residences for senior citizens in A Prefecture (463 facilities). The χ2 test or Fisher’s exact test was performed on the relationship between the service provision system and the intention to accept medical care and end-of-life care. Results: 130 valid responses were returned (effective response rate 28.1%). For the intention to accept medical care, 11 items were extracted, including “nurse resident in facility” and “allocation of staff providing night care”. For the intention to accept end-of-life care, 14 items were extracted, including“ full-time caregiver at facility”,“ full-time nurse at facility”,“ responding to 24-hour emergency visit requests with cooperating medical institutions” and“ maintenance manual”. Conclusion: It was suggested that the placement of nursing staff and cooperation with medical institutions are necessary for the acceptance of medical care and end-of-life care for the elderly.報

高校生における異文化体験と国際的資質の関連 : 海外研修旅行の効果

本研究の目的は， 日本の高校生を対象に，国際的資質が海外研修旅行における異文化体験へ与える影響を検討することであった。3か国のうち1か国を選択して海外研修旅行を経験した高校生158人に対し，国際的資質および異文化体験を測定する賀問紙調査を実施した。その結呆，旅行後の国際的資質が有意に高まったが，その効果量は低かった。また異文化に対する認識の肯定的変化は，旅行の結果高まったほか，旅行前の国際的資質に強く影響受けることが明らかとなった。教育効果の検証における個人要因導入の必要性について考察された。The purpose of this study was lo examine the impact of international disposition on cross-cultural experiences in an oversea school trip among Japanese high school students. 158 high school students who participated in one in three foreign countries\u27 trip answered the questionnaire regarding international disposition and cross-cultural experiences. The results showed that scores of international disposition significantly increased but the effect sizes were moderate. Positively changes of the realization toward other countries also increased and were positively influenced by international disposition before the trip. Application of individual factors to the examination of the teaching effectiveness was discussed

群馬県訪問看護事業所における医療処置及び人工呼吸療法の事故発生状況，安全対策への取組の実態調査

目的：群馬県訪問看護事業所における医療処置及び人工呼吸器装着者の事故発生状況，安全対策への取組を明らかにし，地域における安全対策の体制整備を検討する． 方法：群馬県の訪問看護事業所の管理者421人を対象に自記式質問紙調査を実施した．有効回答は67人（15.9％），記述統計量を算出し，自由記述は類似性に基づき整理した． 結果：医療処置の事故は訪問看護提供時間内に14件（n＝31），影響度はレベル3以下，人工呼吸療法に関する事故は介護者在宅時が11件（n＝25），影響度はレベル4が1件（4.0％），レベル5が3件（12.0％）であった．発生時の対応は，介護職のケア時間に発生した事故の検討47.4％，地域の多機関で話し合う30.6％であった． 結論：人工呼吸器装着者の安全対策は，介護者のみの時間の療養者・家族が行う対策が重要であり，支援チーム，地域の多機関での事故に関する情報共有・検討が課題である．Purpose: This study examined the development of local safety measure systems by clarifying the incidence of accidents in medical procedures and among users of ventilators, as well as initiatives for safety measures at home-visit nursing stations in Gunma Prefecture. Methods: A self-administered questionnaire was distributed to 421 administrators of home-visit nursing stations in Gunma Prefecture and valid responses were obtained from 67 respondents (15.9％). Each item was subject to descriptive statistics and open-ended answers were organized based on similarities. Results: The respondents reported 14 (45.2％) medical procedure accidents that occurred during home-visit nursing hours with an impact level on patients of 3 or lower, and 11 (44.0％) ventilation therapy accidents that occurred while the caregiver was home, one of which had an impact level of 4 (4.0％) and three of which had an impact level of 5 (12.0％). Measures taken to address accidents were investigations into accidents that occurred during care hours by care workers in 47.4％ of cases and discussions among various local agencies in 30.6％ of cases. Conclusions: Regarding safety measures for users of ventilators, measures carried out by the patient and their family while only the caregiver was home were important. In the future, it is necessary to address the sharing and review of information on accidents among support teams and various local agencies.報

地域包括ケアシステムにおける訪問看護ステーションの経営状況と事業所特性及び地域特性，経営管理との関連―全国と群馬県の比較―

目的：全国及び群馬県の訪問看護ステーション（以下，ST）の経営状況と事業所特性及び地域特性，経営管理との関連を明らかにし，比較検討する． 方法：全国2,000人及び群馬県163人のST管理者を対象とし，自記式質問紙調査を実施した．有効回答は全国473人，群馬県55人で，経営状況と各項目との関連はχ2検定及びKruskal-Wallis検定を，さらに経営状況を目的変数とするロジスティック回帰分析を行った． 結果：全国では，看護師常勤・看護師非常勤・事務職員非常勤の従業者数，1人1日平均訪問回数，北海道・東北地域，収支のモニタリングが黒字に関連していた．群馬県では関連がみられず，全国に比して赤字のST割合が多く，経営管理の得点が低かった． 結論：経営状況の改善には，ST規模の拡大やST管理者の収支のモニタリングに焦点を当てた行動の有効性が示唆された．群馬県では，経営管理に関する分析の強化が必要である．Objectives: The financial status of home-visit nursing stations (STs) was analyzed in relation to business office characteristics, local community characteristics and business management, and the results between Gunma Prefecture and all prefectures in Japan were compared. Methods: A self-administered questionnaire survey was completed by 163 ST managers in Gunma Prefecture and 2000 ST managers from all over Japan. Valid responses were collected from 55 managers from Gunma Prefecture and 473 managers from all over Japan. The association between management status with each variable was analyzed by the chisquare test and Kruskal-Wallis test. In addition, logistic regression analysis was carried out with the status of management as the dependent variable. Results: For STs all prefectures in Japan, profitable business (black-ink balance) was associated with the number of employees (full-time nurses, part-time nurses and part-time clerical staff), the mean number of care receiver homes visited daily by each nurse, the district (Hokkaido/Tohoku) and revenue/expenditure balance monitoring. In Gunma Prefecture, the percentage of red-ink operation STs was higher and the score for business management was lower than in all prefectures in Japan. Conclusions: These results suggest that management actions focusing on expansion of the scale of STs and on revenue/ expenditure balance monitoring by ST managers are effective in improving the status of management. In Gunma Prefecture, reinforcement of how to analyze business management is needed.原

Data from: Relationships between resprouting ability, species traits, and resource allocation patterns in woody species in a temperate forest

Many woody plants resprout to restore above-ground biomass after disturbances or to survive in stressful environments. Resprouting requires carbohydrate storage, but the general relationship between resource allocation patterns and resprouting ability remains unclear because it can be influenced by the disturbance regime to which species have adapted. We studied deciduous broadleaved trees that coexist in a Japanese cool-temperate forest to investigate the relationships among the biomass and total non-structural carbohydrate (TNC) allocation patterns of saplings, resprouting ability and functional traits. The study species comprised 16 single-stemmed species that only resprout when above-ground biomass loss occurs and eight multi-stemmed species that resprout regardless of whether above-ground damage occurs or not. Single-stemmed species with better juvenile resprouting ability had larger roots, whereas multi-stemmed species with better juvenile resprouting ability did not necessarily depend on below-ground reserves. Species that retain their ability to resprout until a larger size had a higher root TNC content as saplings, suggesting that they can survive major disturbances such as fire and coppicing by resprouting supported by TNC stored in their roots. Species with shade-tolerant traits (i.e. low foliar nitrogen indicating low photosynthetic capacity, high wood density indicating high defensive investment) had small below-ground TNC reserves irrespective of resprouting types. On the other hand, multi-stemmed species with high wood density and high LMA (indicating high photosynthetic capacity) had small above-ground TNC reserves. Contrary to our hypothesis, a species’ maximum size did not relate to the size of its below-ground reserves. By considering the differences in resprouting types, we suggest more complex control of resprouting than was formerly proposed. Variation in the resprouting ability of single-stemmed species was based on a trade-off between below-ground reserves for resprouting and shade-tolerant traits. However, multi-stemmed species can vigorously resprout irrespective of the size of its below-ground reserves. Their multi-stemmed architecture, well-defended wood, high photosynthetic capacity or large above-ground carbohydrate reserves seem to respectively contribute to their persistence. Such variation in the resprouting strategy based on a trade-off between shade tolerance and resource storage would promote species coexistence under a range of disturbance regimes and light environments

FEShibataDataForAnalyses

FEShibataDataForAnalyse

Appendix E. Evaluation of the starvation at the pre-dispersal predation.

Evaluation of the starvation at the pre-dispersal predation