エチオピア国イルバボール州におけるオンセルカ症に関する研究

Onchocerciasis is a common disease in south-west Ethiopia. Authors undertook field surveys to study this filarial disease in Abdella and Didessa Villages of Ilubabor Province. Two skin snips were taken from the left buttock and calf, respectively, and microfilariae emerged from skin snips were identified as those of Onchocerca volvulus by measurements of the size and the anatomical landmarks. In both villages, fewer females were affected than males, and older age groups showed a higher percentage of onchocerciasis than the younger ones. The microfilarial density of the buttock and calf was almost the same in the similar condition of the skin. Clinical manifestations possibly caused by onchocerciasis were subcutaneous nodule, pruritus, skin changes, enlarged lymph nodes and swollen legs. The skin changes included the pigment changes, hypertrophy and atrophy of skin, and in the legs studied, elephantiasis, mossy skin, nodular skin and edema were involved. In all of 4 patients treated with Hetrazan for 32 days, a remarkable decrease of microfilarial density was observed. Two months later, the patients were free from severe itching.1967年にOomenがエチオピア南西部においてオンコセルカ症の詳細な研究を行なって以来,この地方に於けるオンコセルカ症の重要性が明らかとなった.1971年著者等は同じくエチオピア南西部に位置するイルバボール州のAbdella及びDidessaの両部落に於いてオンコセルカ症に関する疫学的,臨床的なフィールド調査を行なつた.調査方法としてふくらはぎ又は臀部より径2～3mmの皮膚切片をとり,ミクロフィラリアの有無を調べた.得られたミクロフィラリアはその性状及び解剖学的計測値よりOnchocerca volvulusと考えられた.調査を行なったAbdella部落では51.4%,Didessa部落では66.7%とともに高い感染率を示し,特に成年男性においては両部落で80.7%と71.4%という高い感染率を示した.オンコセルカ症によると思われる臨床的所見は主として全身の掻痒感,皮膚における脱色素斑,肥厚及び弛緩,そけい及び大腿リンパ節の肥大,下肢の肥大等がみられた.また,オンコセルカ症が直接の原因であるかどうかは不明であるが,下肢に於ける象皮病も多数みられた.更にこれらの臨床症状をミクロフィラリア密度(MFD)との関係でみると,掻痒感はMFDと相関がなく殆んどの人に存在する.皮膚及び下肢に於ける変化はMFDに比例している.ミクロフィラリア保有者4名を入院させDECを投与してみると副作用としてつよい掻痒感がみられたが,24時間後にはMFDは激減していた

Onchocerca volvulusマイクロフィラリアの皮膚切片からの遊離に関する研究(予報)

ヒトのオンコセルカ症の診断にはskin snip法が広く用いられているが,著者らの経験では従来の方法は必ずしも定量的でないことが明らかとなった.エチオピア国イルバボール州に於いてミクロフィラリア(mf)保有者を用いskin snipからのmf遊離を観察した.患者の臀部より約1cmづつ離れた3つの切片を採取し,細切しないsnipをsnip G,2分したものをsnip M,細切したものをsnip Pとし,スライドグラス上の生食水中で室温(17.5°- 21.5℃)にてincubate し一定時間毎に次のスライドグラスに移し変えることをくりかえし,遊出したmf数をかぞえて集計した結果,細切しないsnipでのmf密度(MFD)が最も高く,かつ長時間にわたりmfが遊出し続けた.細切したものでは短時間内に大部分のmfが遊出完了するがMFDは低い.細切することによりmfが切断,圧迫され活力を失うものと考えられる.著者らは全く細切しないsnipを用いることが実験的な研究のための定量法として最適であると考える

Study of life satisfaction and quality of life of patients receiving home oxygen therapy

An investigation was conducted by mail using a questionnaire regarding the life satisfaction and quality of life (QOL) of patients receiving home oxygen therapy (HOT) to evaluate their support. QOL was evaluated according to 4 scales : (1) activities, (2) state of health and quality of living, (3) physical symptoms, and (4) economic state. The answers of 90 patients (recovery rate : 60%) who responded to the investigation were analyzed, and the following points were clarified. 1. Most of the subjects visited the hospital regularly, and about half the subjects (50.6%) had been treated by hospitalization during the 3 years prior to the investigation. 2. A large majority of the subjects (77.4%) answered they were satisfied with life. 3. Life satisfaction was closely related to the patients’ roles and hobbies, and their activities in their communities and families. 4. The quality of living and the state of health were closely related to mental activity. 5. The economic state was closely related to all items of life satisfaction, quality of living, and state of health. From these results, expansion of the range of activities of patients receiving HOT and providing an economic basis for their living as well as preventing exacerbation of the disease are considered to be important for improving their life satisfaction

Home nursing skills of the registered visiting nursing stations

本研究の目的は，T県内の訪問看護ステーション（以下ステーション）に所属する看護師が実施している看護技術の実態を明らかにすることである．研究対象は，T県において登録されているステーション５７ヵ所の管理者であった．調査票の郵送により４段階の選択肢による回答を求め，以下のことが明らかになった． １）回答のあった４１ヵ所のステーションで１ヵ月に１度以上実施していた項目は「日常生活援助技術」では，関節可動域訓練，歩行介助，移動の介助，寝衣交換などの衣生活援助であった．「適切な医療ケアを支援する技術」ではバイタルサインの観察であった．「安全・安楽援助技術」では適切な体位の保持であった． ２）「日常生活援助技術」では，回答のあったステーションの９０％以上が１ヵ月に１度以上実施していた項目は，療養生活環境調整，排便を促す援助，オムツ交換，体位変換，移乗の介助，部分浴，入浴介助，清拭，陰部ケア，整容，洗髪，口腔ケアであった． ３）「適切な医療ケアを支援する技術」では，８０％以上のステーションが１ヵ月に１度以上実施していた項目は褥瘡ケア（予防も含む），創傷処置，経口薬の服薬方法の説明，外用薬の使用方法の説明，パルスオキシメータであった． ４）「安全・安楽援助技術」では，８０％以上のステーションが１ヵ月に１度以上実施していた項目は療養生活の安全確保，転倒・転落・外傷予防，マッサージであった． ５）救命・救急に関する項目については実施頻度が低かった． 教育上の課題としては，実施頻度が高い項目においては，訪問先の状況に応じた実施ができるように学内演習を進める必要がある．また，臨地での経験が困難と予測される項目や救急時の技術，高度な医療技術項目については視聴覚機器を活用し，知識面での理解を深める必要があると考えられた．Purpose : The purpose of this study was to investigate the study items of home nursing skills of the registered Visiting Nursing Stations（VNS）. Method : The questionnaire survey was mailed to fifty seven managers of registered VNS in T prefecture. Results : The effective answer rate was ７１．９％（n＝４１）．The nursing skills in the three domains that were carried out at least once or more in a month by nurses who belong to all VNS are as follows : １）In the domain of daily life support skills, four items of “range of motion exercises”，“walking assistance”， “assistance of transferring”, and “changing night clothes” were identified. ２）In the domain of skills for helping effective medical care，“check-up of vital signs” was identified. ３）In the domain of skills for safety/ comfort， “maintaining comfortable positions” was identified. And nursing skills that were required in emergency medical care/treatments were observed in a very low frequency in the same domain. Discussion : The nursing faculty should provide exercises in the university settings for the students to acquire these fundamental nursing skills, so that they can perform adequate nursing care at the time of home visits. In addition, it might be necessary for the faculty to utilize an audiovisual aid effectively in order to promote a better understanding of the students on the nursing skills/knowledge that would be rarely experienced during their clinical training, such as emergency clinical care and advanced therapeutic technologies. In order to build the effective study support system for the nursing students, we need to develop a collaborative education system between the University and the VNS

Duration of blood feeding of Simulium ochraceum in relation to intake of Onchocerca volvulus microfilariae

金沢大学留学生センターグアテマラにおけるオンコセルカ症の主要媒介種Simulium ochraceumのOnchocerca volvulus仔虫のとりこみに関して実験を行った。仔虫のとりこみは, ブユが体表にとまってから30秒で始まった。3∿4分後には65%のブユが吸血を完了し, とりこまれる仔虫数が最高に達した。それ以後は吸血時間がのびても, とりこみ量は増加しなかった。仔虫密度が皮膚10(mm)^2あたり55∿116匹の中程度に感染した人にあっては, とりこまれる仔虫の数は皮膚中の仔虫の密度と関連していた。しかし仔虫密度が1.8と非常に低い人の場合に, 異常に高い仔虫のとりこみが観察された。このことは, 皮膚中の仔虫密度が低い場合には, 仔虫がブユの吸血時に誘引あるいは何らかの刺激を受けることを示唆するものかもしれない。 Intake of microfilariae of Onchocerca volvulus by Simulium ochraceum, the main vector of onchocerciasis in Guatemala, was studied. The initiation of intake of microfilariae was around 30sec after landing. Thereafter, the number of microfilariae taken by flies increased as the feeding time increased. After 3 to 4min of landing, 69% of flies finished their blood meal, and the intake of microfilariae reached the highest. Thereafter, increase of feeding time did not increase the intake. With the volunteers of moderate density of microfilariae (55-116 Mf per 10(mm)^2), the number of microfilariae taken by the flies was correlated with the density of microfilariae in human skin. With a volunteer of very low density (1.8 Mf per 10(mm)^2), however, an extraordinarily high intake of microfilariae was observed. This suggested the possibility of the flies attracting or stimulating the microfilariae in the skin of low density carriers

Development of Onchocerca volvulus Larvae in Simulium pintoi in the Amazonas Region of Venezuela

The intake and development of Onchocerca volvulus in Simulium pintoi from the Parima mountain region of the Federal Territory of Amazonas in Venezuela, were studied experimentally. When wild females fed on the lower half of the legs and lower third of the back of an onchocerciasis patient harboring 23 and 264 microfilariae per skin snip, respectively, at each site, an average (median) of 14 (range, 1?77) and 245 (range, 58?495) microfilariae was ingested. However, within 24 hours of microfilarial ingestion a mortality of 47% (16/34 flies) was observed in the group of flies which fed on the back, as compared with 2% (2/101 flies) in the other group which fed on the legs. At a temperature varying between 16°C and 24°C, the development of O. volvulus larvae in S. pintoi was synchronous and orderly; no abnormal nor deformed larvae were observed. Third-stage larvae were first seen in the head of flies dying between 8 and 9 days after microfilarial ingestion, and 98 of 100 larvae recovered from days 10?16 were in the third stage. The proportions of females harboring third-stage larvae among flies which lived through day 8 in the two groups which fed on the legs and back, respectively, were 55% (21/38 flies) and 63% (5/8 flies). Although only two of five positive flies in the latter group contained third-stage larvae in the head (1 and 12, respectively), 71% (15/21 positive flies) of the former group had an average of 2.7 third-stage larvae in the head (range, 1?10). In conclusion, it is suggested that S. pintoi is an efficient vector of O. volvulus due to its high susceptibility, in spite of the high mortality caused by an excessive intake of microfilariae

Onchocercomas in Guatemala, with Special Reference to Appearance of New Nodules and Parasite Content

To determine the rate of appearance of new nodules during a specified period, a follow-up study on onchocercomas that had been removed was carried out in San Vicente Pacaya, Guatemala, between June 1976 and April 1977. Incidence rate, or rate of nodules appearing in initially negative subjects, was studied in relation to the degree of endemicity. Rates in a period of 7?8 months in high, medium, and low endemic areas were 0.231, 0.083, and 0.022, respectively. The rate of nodule appearance in persons nodulectomized, or rate of nodules appearing in subjects who were surgically rendered negative during the first survey, was 45.3%, 36.4%, and 4.5% in those areas. The highest rate of nodule appearance was observed in patients with microfilariae in both the skin and nodules, followed by patients with either microfilariae or nodules. In highly endemic areas, new nodules appeared in 13.2% of persons without microfilariae or nodules, while in low endemic areas even patients with nodules earlier were less likely to have developed new ones. The performance of the nodulectomy teams (brigadas) was evaluated by confirming the worms in nodules. By gross examination alone, about 6% of nodules removed by brigadas did not contain worms. Nodules containing worms were examined for microfilariae to clarify their role as a source of microfilariae. Microfilariae were not detected in some of these nodules, especially in small ones. In contrast, microfilariae emerged from 80% of those larger than 10 mm. Number of worms per nodule, their sex, and the fecundity of female worms were examined by a collagenase technique. The average number of worms per nodule was 0.6 males and 1.2 females. The highest burden in any one nodule was seven worms, four females and three males. Most nodules had one female and either one male worm or none. Intrauterine microfilariae were found in most females from nodules shared with a male, while solitary females were not gravid. Solitary females were likely to be found in small nodules and large nodules were more likely to include both sexes