Dietary intake and the indicators of dietary change for females of reproductive age

　The objectives of this study are to understand amount of food consumption and nutrients intake, and changing dietary pattern for females of reproductive age in Lowland of Laos, Lahanam zone in Sonkhon district, Savannakhet province. We randomly selected 113 women aged 19-40 years in 5 villages. The period of the data collection is August to September, 2005. One subjects was visited for 3 days with 4 days interval. The mean of 3 days dietary records was used as the person’s dietary data. The subjects living in Kokphok, where is in most traditional environment and lifestyle, consumed more cereals, other vegetables, mushrooms and sea/river weed than subjects living in other villages in average. The intake levels of fat 13g/day, calcium 406mg/day, iron 13mg/day, and retinal 320mg/day were very low compare with RDA of Thailand and WHO/FAO. The energy density values of protein, fat, carbohydrate in the subjects’ diet, were 13% , 7% , 80% . Fat intake level in energy density (% ) was related sugars, fat & oils, meats, eggs positively, but cereals and other vegetables negatively. It related skinfold thickness positively. High economic status, such as owner of TV/Video, relate fat intake both in crude value and energy density value. These results suggest penetrate of cash economy change dietary pattern, and induce high fat intake and physical fatness

Development and validation of food frequency questionnaire for estimating food and nutrient intakes of people in rural Laos

　Food frequency questionnaire (FFQ) has been developed for estimating food and nutrient intakes at both individual and group levels. The foods listed for FFQ have been chosen based on the data of semi-weighed dietary record (DR) collected in autumn, 2004 from children in Lahanam area, and other qualitative information on the dietary habits of Lao population. The validation study with FFQ and 3-day DR was performed using 113 adult women in Lahanam in summer, 2005. Mean intakes of some food groups were severely overreported in FFQ than in DR although the food list of FFQ almost covered major foods necessary for the assessment of the target population. In order to minimize over/underreporting tendency by food group, the portion sizes in the calculation algorism of FFQ were corrected using the over/underreport ratios of food groups. After this correction, nutrient intakes estimated from FFQ were compared with those assessed with DR at individual and village levels. Mean nutrient intakes of the whole population estimated from FFQ were close to those assessed with DR. However, the correlation coefficients of nutrient intakes between the two methods were null or low (r ranged from -0.14 [ % energy of fat] to 0.21 [niacin]). In contrast, the correlation analysis showed a reasonable reproducibility between the two FFQs assessed one-month apart (r ranged from 0.07 [retinol] to 0.60 [carbohydrate]). Further consideration with careful checking of the collected data may be necessary to develop a reliable and usable FFQ for people in rural Laos

Health Status of Reproductive -age Females in Rural Laos from the Perspective of Anthropometry and Hemoglobin Level.

　The objectives of this study are to elucidate 1) the health status and its’ seasonal variation of reproductive age female villagers in Lahanam zone, Sonkhon district, Savannakhet province of Lao PDR, and 2) the relevant factors in relation to socioeconomic characteristics of their households. Data of the present study were collected in rainy season between 7th and 25th August 2005, and in dry season between 6th and 13th February 2006, based on the authors’ field research in five villages. Randomly selected 113 females, 20 to 40 years old, were studied in 2005; rainy season. Within 113 subjects of rainy season survey, 29 subjects were excluded; the person who were pregnant and breast feeding, moved to other place, thus 84 females were studied in 2006; dry season. Measurements were done for anthropometric variables, hemoglobin level, blood pressure, resting metabolic rate (RMR), and difference between two seasons were calculated. Socioeconomic characteristics of the subjects were obtained by village health volunteers, using structured interviews.　From the results of the anthropometric measurements and hemoglobin level, it can be said that the nutritional statuses of the five villagers were better than that of females in the national survey. Furthermore, the percentages of the overweight (BMI over 25) of the present study (16.8% in rainy season and 22.6% in dry season) were higher than the result of adult females in national survey (10.8 % ). It should be noted that the problems of undernutrition and overnutrition occur in the same village at same time, similarly to a modernizing populations in other developing countries. Among socioeconomic characteristics, the environmental factors such as area of irrigated rice field, and the main sources of the foods played important roles for the health status of the subjects in rural village in the Sonkhon district

[研究ノート] 高齢者集落における社会的紐帯と健康状態の関連への文化人類学からのアプローチ：秋田県男鹿市A地区B集落での予備調査から

要旨：保健分野のソーシャル・キャピタル研究では、ソーシャル・キャピタルの内実が地域毎に異なるにも関わらずその内実が解明されず、またソーシャル・キャピタルと健康の因果関係が明らかにされないという２つの問題点がある。本研究では、対象社会の社会構造の特徴を精査した上で、それが集団レベルの健康状態と結びつくメカニズムの解明を目指す文化人類学の手法を構想した。2015年４月から秋田県男鹿市Ａ地区の住民を対象に行った現在までの予備調査では、対象地域住民の間で社会的紐帯が強く、その背景に親族組織や農事勉強会などの社会組織が関連するという手がかりを得た。本稿では現在までに得た予備調査データを参照しつつ本研究の構想を示す。Abstract：Many studies have been conducted using the concept of social capital in the fi eld of health recently. These studies typically have two problems. The first is that they do not pay close attention to the actual situation of social capital, although there are real diff erences amongst communities. The second is that they do not discuss causation between social capital and health status. Thus, in this study, we utilize a cultural anthropological approach to investigate the relationship between the social structure and the health status of a given group, based on a survey of the characteristics of social structure in the subject community. The participants are located in the (A) district of Ogacity, Akita, where we have been conducting fieldwork since April, 2015. According to our preliminary fieldwork, we have discovered results, which suggest that the connection amongst the people was strong in the subject community, which has a relationship with social organizations such as a kin group, agricultural study meeting, and so on. In this article, we present our research framework based on data from our preliminary fieldwork

アキタケン シミン ノ ガン イリョウ ニ タイスル アンシンカン ノ ジッタイ ト アンシンカン ニ エイキョウ ヲ アタエル キョジュウ チイキ ノ トクチョウ

秋田県内3地域(秋田市、横手市、湯沢市)に居住する一般市民のがん医療に対する安心感の実態と、安心感に影響を与える居住地域の特徴について明らかにすることを目的に、1200名に対して質問紙調査を行った。437名(有効回答率36.6% )から回答を得た。その結果、居住地域でのがん医療に対して、59.2%の回答者は安心して治療や介護を受けられるとは思っていなかった。特に自宅療養に関する安心感は低く、「地域で安心して自宅療養できる」と思っていた回答者は20.4%であった。また、7割以上の回答者が「冬を乗り切ることは『安心感』を考える上で大切である」「地域での療養は『安心感』を考える上で大切である」と思っていた。地域別の特徴では、がん拠点病院や緩和ケア施設をもたず、特別豪雪地域である湯沢市の安心感が低く、医療圏での差が生じていた。がん医療に対する安心感を高める居住地域の特徴は「近くにすぐかかれる医療機関があって安心であること」「冬季にも自宅療養することが可能であること」「地域の在宅療養の体制を知ること」であった。本研究の結果、一般市民のがん医療に対する安心感を高めるには、身近な医療機関の充実やがん医療に関する情報支援システムなどの対策の必要性が示されたと言える。また、冬季での自宅療養を可能にするために、除雪サービス等の具体的な福祉や生活支援の検討も必要である。Questionnaire concerning feelings of support and security regarding cancer care were administered to 1200 residents from three regions in Akita prefecture (Akita, Yokote, and Yuzawa cities), to elucidate the characteristics of these residential areas as it aff ects their sense of security. We received 437 responses (response rate: 36.6% ). The results of the survey revealed that 59.2% of the respondents did not believe that they could receive cancer treatment or nursing care without anxiety in their residential areas. A sense of security concerning home care services was especially low: only 20.4% of the respondents thought that they "can receive home care services in their local area without anxiety." Moreover, 70% or more of the respondents thought that "to get through the winter" or "to receive eff ective treatment in the local community" were important with reference to their own sense of security. The characteristics analyzed by each region revealed diff erences between the healthcare zones in which the areas were located. Thus a sense of security among residents of Yuzawa city was low, possibly because the city has no core hospitals or palliative care facilities being in an area that receives particularly heavy snowfall. The characteristics of these residential areas that increase a sense of security concerning cancer care were as follows: "there is a medicalinstitution nearby that can be immediately consulted when necessary," "residents can receive medical care at home even during winter," and "residents know about the system for home medical care in the local community." These results show that in order to increase a sense of security for ordinary citizens with reference to cancer care, it is necessary to examine strategies to enhance local medical institutions and information support systems concerning cancer care. Also to develop specific welfare and livelihood support such as snow-removal services are needed to enable home medical treatment during winter

アキタケン ニオケル タンキ ニュウショ セイカツ カイゴ ショートステイ ノ シセツ トクセイ ノ ジッタイ ト チョウキ リヨウ ニ カンレン シタ ヨウイン

介護保険制度の短期宿泊サービスであるショートステイは施設形態、運営する法人が多様である。また30日を超えてショートステイを利用する長期利用者が存在する。本研究の目的は、ショートステイの施設特性の実態と長期利用率「長期利用者数/(長期利用者数+短期利用者数)」に関連する要因を明らかにし、今後地域包括ケアシステムの中で担うべき機能について探ることである。秋田県内全域の280事業所のショートステイ管理者を対象とした質問紙調査を行い、108事業所より回答を得た。施設形態は単独型で小規模であり営利法人の運営が多かった。平均の「長期利用率」は単独型、営利法人で割合が高かった。サービス提供状況では職員配置が充実しているショートステイでは、サービスの質の向上に関わる加算が算定される傾向があった。また、全体の傾向として常時医療職の関与が必要な医療ニーズの高い利用者を断っており、個別の機能訓練を実施している割合は低かった。秋田県は高齢化でショートステイの利用需要が高まり、営利法人が単独型ショートステイの運営へ参画している。今後医療機関から在宅へ戻る際に重要な役割を果たすショートステイは機能訓練や医療ニーズへの対応が機能として求められる。しかし単独型ショートステイでは経営面からサービスの質向上よりも利用者確保が優先されやすい。単独型ショートステイでも経営が安定するような介護報酬請求の仕組みが必要である。A short-stay, a short-term stay service of the nursing-care insurance system, is characterized by diverse facility forms and the managing corporate bodies. In addition, there are long-term facility users who remain consecutively in a short-stay service for 30 days or longer. The objective of this study was to clarify the relationship between the realities of short-stay facility characteristics and the long-term usage rate (the number of long-term facility users)/ (the number of long-term facility users + the number of short-term facility users) and to explore the functions that such facilities should bear in the future as part of a regional comprehensive care system. A questionnaire was conducted with the managers of 280 short-stay operations within Akita prefecture, with 108 of these operations responding. The most common facility format was a single-operation type, small in size, and run by a for-profit corporation. The average long-term usage rate was higher in the single-operation type, for-profit corporations. Regarding the state of service provision, short stay operations with sufficient personnel allocation, showed a tendency for an additional charge connected with an improvement in service quality to be included. Furthermore, as an overall trend, facilities rejected facility users with high medical needs that constantly required involvement of health care professionals. Furthermore, the percentage of facilities that conduct functional training for individuals was low. The demand for short-stay services has increased in Akita prefecture due to the aging of the population. Thus, profit-making corporations are participating in the management of single-operation type shortstay facilities. In the future, short-stay facilities will be required to provide functions such as provision of functional training for those who can address medical needs since such facilities play an important role for elderly patients when returning to their respective homes after being discharged from medical facilities. However, single-operation short stay facilities tend to prioritize the securing of facility users rather than improving the overall service quality due to managerial reasons. A claim system for nursing-care benefits that will help stabilize management even for singleoperation type short-stay facilities is required

チイキ ノ ソーシャル キャピタル ト ジュウミン ノ ケンコウ シンサ ガン ケンシン ジュシン コウドウ トノ カンレン

日本では健康診査やがん検診(以下、健・検診と記す)の受診率の低迷が課題となっている。そこで、社会的環境因子として健康行動との関連で成果が期待されているソーシャル・キャピタル(以下S.C.と記す)に注目した。本研究はS.C.およびその構成要素と、健・検診受診行動との関連について明らかにし、そこから健・検診の受診率向上への手がかりを検討することを目的とした。2013年に秋田県男鹿市の住民台帳から地域、性、年代別(40～69歳までの10歳毎)に無作為抽出のうえ、1192名を対象に自記式質問紙の郵送法による調査を行った。協力が得られた住民326名(有効回答率27.3%)のデータを分析した結果、S・Cおよびその構成要素である「ネットワーク」と地区行事への参加で計算される「規範」は、住民の健・検診受診と関連があることが明らかになった。現在住んでいる土地に愛着のある人がない人よりも健・検診を受けていたことからも、地区行事活性化と行事への自主的な参加が健・検診受診率向上への糸口になりえることが示唆された。住民は健診に関する知識や認識は高いが、行動に移せていない段階であり、禁煙や運動教室などでのセルフケア能力向上を手がかりに、近い将来、健診受診に結びつけていくような段階的な取り組みが有効だと思われる。また、経済状況によって健・検診受診状況に有意な差がみられたため、経済的理由からの未受診者対策をさらにすすめる必要があることがわかった。The consultation rates for basic medical examinations and cancer screening have hovered at low levels in Japan. To hunt for clues for improving the consultation rate, we took note of the positive relationship between social capital( S.C.) as the social environmental parameter and healthy action in recent studies. The aim of this study was to clarify the association between S.C. and health consultation action of residents in a provincial area of Japan. In 2013, data were collected in a population-based cross-sectional questionnaire survey in Oga city, Japan. A stratified random sampling approach based on area, sex and age( 40-69-year-old) was used to select 1192 inhabitants from 4 areas. The result of having analyzed the data of 326 (27.3% of effective answer rates) showed that the S.C. and its components "Network( participation in voluntary groups)" and "Norms of reciprocity( participation in community events)" were related to the consultation behavior of the inhabitants. As shown in the relationship between passion for their residential areas and positive behavior of medical checkups and cancer screening, local community festivals and events activation along with voluntary participation in such events could become steps to move forward. Subjects\u27 knowledge and recognition about medical examinations were high but they were at a stage of preparation wherein people turn knowledge into action. To improve the consultation rate, a step-by-step approach with a course of healthy lifestyle that covers not only smoking cessation and fitness habits but for improving selfcare ability proves to be quite useful. In addition, the consultation behavior patterns differed by income and economic conditions; strengthening of countermeasures against the economic non-consultation is needed

カンゴ カンリシャ ノ ショク セイカツ ノ ジッタイ ト ショク ヘノ エンジョ ノ カンゴ カンリ

看護管理者の食生活の実態と、患者の食への援助の看護管理の実態を明らかにするため、100床以上の全国の一般病院(108施設)の看護管理者を対象に食意識・食行動・食への援助に関する自記式質問紙と簡易型自記式食事歴法質問票(BDHQ)を用いた調査を行った。調査に協力が得られた看護部長89人(回収率82.4%)、看護師長554人(回収率60.9%)のデータを分析した結果、看護部長と看護師長は、ともに食意識が高く、食意識は食行動や食物摂取にも関連していることが明らかになった。患者の食への援助では、看護部長・看護師長ともに食への援助の意識が高く、食が患者の健康や疾病治癒に及ぼす影響を認識していた。看護師長の入院患者に対する食への援助では、患者個々に見合った食事指導の確認や、食に関する勉強会や研修会開催への働きかけ、看護師が行う食事準備・食事介助・後始末の確認の実施割合が低いことが分かった。一方、食意識と食への援助とは関連が見られ、良好な食生活を送っていると自負している看護師長は、食への援助の看護管理に積極的な傾向が見られた。本研究では、看護管理者が自分自身の食生活を整えることが患者の食への援助に関する看護管理にも好影響を与えることが示唆された。十分とは言えなかった食への援助に関する看護管理をどのように日常業務の中に組みこんでいくかが今後の課題である。The aim of the research is to investigate the patterns and the degree of dietary awareness of nursing administrators. The target nursing administrators included directors of nursing and head nurses from 108 hospitals with more than 100 beds for the general patient population. The survey was conducted using a questionnaire of attributed information; the way of thinking about food, dietary behavior, and a brief-type self-administered diet history questionnaire (BDHQ) for food and nutritional intake. The number and rate of responding were 89 (82.4%) for directors of nursing and 554 (60.9%) for head nurses. The result showed that nursing administrators had high levels of dietary awareness which also significantly supports the correlation between their higher standards of dietary/eating habits and behaviors. Regarding the patients nutritional assistance, it is clear that nursing administrators were aware that diet is deeply related to the patients\u27 overall health and recovery. Although nursing administrators recognize the importance of dietary/nutritional assistance, "unsatisfactory performance in the supervision of actual dietary intervention by nurses for the patients", "inadequate number of training workshops on diets", and "poorly-supervised meal services and assistance/cleanups by nurses" have been observed. On the one hand, those who had higher awareness levels of their own eating habits and dietary routines, showed that they also tend to have good dietary habits, and better attitudes and were more diligent toward the management of a nursing practice of diets. The research suggests that, by revising the dietary habits of the nursing administrators, it will create a more positive impact on patient dietary support. It should now be our future objective to engage in adequate dietary support within daily nursing administrative routines