Issues in the vaccination recommendation for nursing students : consideration from an image research by the Semantic Differential Method

背景：看護学生に対して小児感染症とB型肝炎の免疫抗体価を検査し，免疫を持たない感染症について予防接種の指導を行った．しかし，予防接種が必要であると認識しながらも，実際に予防接種を受けるという行動に結びついた学生は少なかった．そこで，予防接種に対する態度を規定する要因を明らかにするためにイメージ調査を行い，予防接種を推奨する上での課題を明らかにした． 方法：看護学生１０４名を対象とした．集合質問紙調査法により予防接種の指導前後と長期休暇をはさんだ２ヵ月後に予防接種などに関するイメージ調査を行った．イメージ調査にはSD法（Semantic Differential Method）を用い，コンセプトは「予防注射」，「看護師」，「私」，「風疹」，「B型肝炎」の６つとした． 結果：予防注射に対するイメージについて指導前と指導後で比較すると「安い－高い」，「簡便な－面倒な」はマイナスの方向に有意に変化した（p＜０．０１）．「看護師」と「私」のイメージを比較すると，「健康な－病弱な」（p＜０．０１），「抵抗力がある－無防備な」（p＜０．０１）は「看護師」の方が有意にプラスイメージで，逆に「病気にならない－病気になる」（p＜０．０１），「安全な－危険な」は「私」の方が有意にプラスイメージであった．学生は看護師よりも病気にならず安全と感じ，同時に，看護師は学生よりも健康で抵抗力があるが病気になりやすいと矛盾した論理をもっていた．「私」についてのイメージは指導の前後で変化しなかった． 結論：接種率を向上させるためには，受診方法の改善や費用の助成等を行って，予防接種についてのハードルを低くし，環境面からアプローチする必要がある．また，学生は自分が免疫を持たないことを認知しながらも，自己の健康を過信し，自己矛盾を抱えていた．学生が自分自身の健康に対する意識を変え，自己矛盾に気づくよう教育することが今後の課題である．Background : An investigation of immune antibody titer against pediatric infectious diseases and hepatitis B was conducted to nursing students. They were then instructed to vaccinate against communicable diseases they were not yet immunized against. Although they recognized the importance of vaccination, only few actually vaccinated themselves. Consequently, an image research was conducted to find factors determining the attitude toward vaccination. This has clarified issues in vaccination recommendation. Methods : Group questionnaire surveys were conducted to the subjects of 104 nursing students before and after an instruction on vaccination and after 2 months sandwiching vacation. For an image research, the Semantic Differential Method was employed, setting five concepts of : Vaccination, Nurse, Self, Rubella, and Hepatitis B. Results : In the comparison of images to vaccination before and after the instruction, the responses to the questions, “Cheap-Expensive” and “Simple-Complicating,” changed significantly in a negative direction, （p＜ 0.01）after the instruction. Between the concepts of “Nurse” and “Self,” the responses to “Healthy-Sickly” （p ＜0.01）and “Resistant-Vulnerable”,（p＜0.01）were positive in “Nurse”, whereas the responses to “Uneasily sickened-Easily sickened” （p＜0.01） and “Safe-Risky” were positive in “Self.” This represented a contradiction in the subjects’ logic : while the students thought they were uneasily sickened and felt safer than nurses, nurses were seen as healthier and more resistant then the students but easily sickened. Their images toward “Self” did not change from before to after the instruction. Conclusion : The enhancement of vaccination rate requires an environmental approach to the barrier to vaccination, for example, by improving consultation methods and by financial support. Furthermore, the nursing students represented self- contradiction ; although they realized they lacked certain immunity, they were overconfident about their health. What remains to be seen is the education to enable them to change their attitude toward their own health and realize their self- contradiction

Nationwide surveillance of bacterial respiratory pathogens conducted by the surveillance committee of Japanese Society of Chemotherapy, the Japanese Association for Infectious Diseases, and the Japanese Society for Clinical Microbiology in 2010: General view of the pathogens\u27 antibacterial susceptibility

The nationwide surveillance on antimicrobial susceptibility of bacterial respiratory pathogens from patients in Japan, was conducted by Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases and Japanese Society for Clinical Microbiology in 2010.The isolates were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections during the period from January and April 2010 by three societies. Antimicrobial susceptibility testing was conducted at the central reference laboratory according to the method recommended by Clinical and Laboratory Standard Institutes using maximum 45 antibacterial agents.Susceptibility testing was evaluable with 954 strains (206 Staphylococcus aureus, 189 Streptococcus pneumoniae, 4 Streptococcus pyogenes, 182 Haemophilus influenzae, 74 Moraxella catarrhalis, 139 Klebsiella pneumoniae and 160 Pseudomonas aeruginosa). Ratio of methicillin-resistant S.aureus was as high as 50.5%, and those of penicillin-intermediate and -resistant S.pneumoniae were 1.1% and 0.0%, respectively. Among H.influenzae, 17.6% of them were found to be β-lactamase-non-producing ampicillin (ABPC)-intermediately resistant, 33.5% to be β-lactamase-non-producing ABPC-resistant and 11.0% to be β-lactamase-producing ABPC-resistant strains. Extended spectrum β-lactamase-producing K.pneumoniae and multi-drug resistant P.aeruginosa with metallo β-lactamase were 2.9% and 0.6%, respectively.Continuous national surveillance of antimicrobial susceptibility of respiratory pathogens is crucial in order to monitor changing patterns of susceptibility and to be able to update treatment recommendations on a regular basis

Depolarization controls TRAIL sensitization and tumor-selective killing of cancer cells: crosstalk with ROS

Conventional genotoxic anti-cancer drugs target the proliferative advantage of tumor cells over normal cells. This kind of approach lacks the selectivity of treatment to cancer cells, because most of the targeted pathways are essential for the survival of normal cells. As a result, traditional cancer treatments are often limited by undesirable damage to normal cells (side-effects). Ideal anticancer drugs are expected to be highly effective against malignant tumor cells with minimal cytotoxicity toward normal cells. Such selective killing can be achieved by targeting pathways essential for the survival of cancer cells, but not normal cells. As cancer cells are characterized by their resistance to apoptosis, selective apoptosis induction is a promising approach for selective killing of cancer cells. Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is a promising tumor-selective anticancer drug. However, the congenital and acquired resistance of some cancer cell types, including malignant melanoma cells, currently impedes effective TRAIL therapy, and an innovative approach that can override TRAIL resistance is urgently required. Apoptosis is characterized by cell shrinkage caused by disruption of the maintenance of the normal physiological concentrations of K+ and Na+ and intracellular ion homeostasis. The disrupted ion homeostasis leads to depolarization and apoptosis. Recent evidence suggests that depolarization is an early and prerequisite event during TRAIL-induced apoptosis. Moreover, diverse natural products and synthetic chemicals capable of depolarizing the cell membrane exhibit tumor-selective killing and TRAIL-sensitizing effects. Here, we discuss the role of depolarization in selective killing of cancer cells in connection with the emerging concept that oxidative stress is a critical mediator of mitochondrial and endoplasmic reticulum dysfunctions and serves as a tumor-selective target in cancer treatment

Aspirin Induces Mitochondrial Ca2+ Remodeling in Tumor Cells via ROS‒Depolarization‒Voltage-Gated Ca2+ Entry

Aspirin (acetylsalicylic acid) and its metabolite salicylate, have an anti-melanoma effect by evoking mitochondrial dysfunction through poorly understood mechanisms. Depolarization of the plasma membrane potential leads to voltage-gated Ca2+ entry (VGCE) and caspase-3 activation. In the present study, we investigated the role of depolarization and VGCE in aspirin’s anti-melanoma effect. Aspirin and to a lesser extent, salicylate (≥2.5 mM) induced a rapid (within seconds) depolarization, while they caused comparable levels of depolarization with a lag of 2~4 h. Reactive oxygen species (ROS) generation also occurred in the two-time points, and antioxidants abolished the early ROS generation and depolarization. At the same concentrations, the two drugs induced apoptotic and necrotic cell death in a caspase-independent manner, and antioxidants and Ca2+ channel blockers prevented cell death. Besides ROS generation, reduced mitochondrial Ca2+ (Ca2+m) and mitochondrial membrane potential preceded cell death. Moreover, the cells expressed the Cav1.2 isoform of l-type Ca2+ channel, and knockdown of Cav1.2 abolished the decrease in Ca2+m. Our findings suggest that aspirin and salicylate induce Ca2+m remodeling, mitochondrial dysfunction, and cell death via ROS-dependent depolarization and VGCE activation