アドバンス・ケア・プランニング普及啓発プログラムが地域在住高齢参加者に与えた影響

目的： 地域包括支援センターが実施するアドバンス・ケア・プランニング（以下，ACP）普及啓発プログラムが参加者の考え方や行動に与えた影響を明らかにする。方法： 地域包括支援センターの実施するACP普及啓発プログラムに参加した地域在住高齢者5名を対象としてインタビューを実施した。データは質的帰納的に分析した。結果： 本プログラムによって、参加者は【今後の自身の状態や状況のイメージの具体化】、【今後の生き方を選択していくための主体性の獲得】、【今後の生き方についての意向を家族と共有する必要性の認識】、【地域の人々とのつながりを持つことの大切さの実感】、【地域の人々と声を掛け合って暮らしていくことへの自発性の獲得】などの影響を受けていた。結論： 地域の社会資源と連携し、住民同士の対話を取り入れたプログラムは、ACPへの主体的な取り組みを促進するだけでなく、地域における互助を促進する可能性が示唆された。Objectives: This study aimed to clarify the impact of an Advance Care Planning（ACP）dissemination and enlightenment program conducted by a Community General Support Center on the participants’ thoughts and behaviors.Methods: Interviews were conducted with five community-dwelling elderly people who participated in the ACP dissemination and enlightenment program conducted by the Community General Support Center. The data were analyzed qualitatively and inductively.Results: Through this program, participants could［embody the image of their own condition and situation in the future］,［acquire the autonomy to choose their future ways of life］,［become aware of the need to share intentions about the future ways of life with their family］,［realize the importance of connecting with local people］, and［acquire the spontaneity to live while caring for each other in the community］ and so on.Discussions: An ACP dissemination and enlightenment program, conducted by a Community General Support Center that collaborates with the local social resources and incorporates dialogue between residents, not only promotes independent efforts for ACP, but also promotes mutual aid in the community

看護基礎教育における必須の学修内容に関する病院看護師の認識に地域看護学教育が与える影響

目的： 看護基礎教育における地域看護学の学修が、看護基礎教育における必須の学習内容に関する病院看護師の認識に与える影響を明らかにすることを目的とした。方法： 病院に勤務する看護師513名を対象とし、無記名自記式質問紙調査を実施した。地域看護学の学修経験と地域看護学教育の必要性の認識並びに看護基礎教育における必須の学修内容の認識について調査し、地域看護学の学修経験、看護基礎教育における学修内容の必要性認識の関連について分析した。結果： 地域看護学の学修経験を有する者で92.2％、学修経験のない者で72.0％が地域看護学教育を必要と認識していた。また、地域看護学の学習経験は、看護基礎教育における学修内容6項目の必要性に対する認識に独立して影響を与えることが示された。考察： 地域看護学教育は、病院看護師の看護の対象の広がりや、看護師の代弁者としての役割、市民と連携する役割の理解につながることが示唆された。Objective: The purpose of this study was to clarify the effects of community health nursing education on hospital nurses’ perception of essential learning contents in the basic nursing education.Methods: An anonymous self-administered questionnaire survey was conducted on 513 nurses working in a hospital. Learning experience in community health nursing, the perception of the necessity of community health nursing education and the perception of the essential learning contents in the basic nursing education were investigated. Then the relationships between learning experience in community health nursing and nurses’ perception of essential learning contents in the basic nursing education were analyzed.Results: The necessity of community health nursing education was understood by 92.2% nurses in community health nursing learned group. On the other hand, that was understood by 72.0% nurses in community health nursing not-learned group. Moreover, it was shown that the learning experience of community health nursing has an independent influence on the understanding of the necessity of six items of learning contents in the nursing basic education.Discussions: It was suggested that community health nursing education would lead to the hospital nurses’ comprehension of a broad base of clients, their role as advocator, and their role in collaboration with citizens

都道府県別の在宅療養児に対する訪問看護ステーションの需給状況

近年高度な医療的ケアが必要な在宅療養児は増加しており、訪問看護の担う役割は増大しているが、訪問看護ステーションにおける在宅療養児の受け入れは、困難な状況にあることが報告されている。また、訪問看護サービスの需給状況には、地域格差があることが報告されているが、これまで在宅療養児に関する全国レベルの分析はなされていない。そこで本研究では、在宅療養児に訪問看護を行っている訪問看護ステーション数と人口並びに障害者福祉手当受給者数との比をもって在宅療養児に対する訪問看護ステーションの需給状況の指標とし、都道府県レベルでの地域格差が存在するか否かを検討した。結果、20歳未満の人口10万人当たりの20歳未満の在宅療養児への訪問実績のある訪問看護ステーション数には、都道府県間で最大6.3倍の差が存在し、人口10万人当たりの全訪問看護ステーション数の4.2倍に比しても大きい地域間格差が存在することが示唆された。今後は在宅療養児に対する訪問看護ステーション需給状況の良好な都道府県からベストプラクティス事例を収集し、小児訪問看護師の育成や確保に有効な方策を明らかにし、全国に普及可能なプログラムを開発していくことが望まれる

看護師の学士課程教育における地域看護診断演習の効果

目的：看護師の学士課程教育における地域看護診断演習の効果について明らかにする。方法： 2019年度にA 大学の看護師教育課程の科目「地域看護学援助演習」を受講した3年生のうち、研究に同意した87名を対象とした。演習のレポートから学修内容についての記述を抽出し質的帰納的に分析した。結果： 地域看護診断演習によって、学生は【地域の健康課題を分析していく視点と方法の獲得】、【地域の健康課題に対する支援を検討していく視点の獲得】、【地域看護の特質への理解の深まり】、【地域看護への関心と視野の広がり】、【効果的なチームワークについての理解の深まり】を学修していた。結論： 学生は、地域や人々の生活状況を踏まえて支援すること、地域看護への関心と地域を支える一員として自覚をもつこと、チームワークについて学んでいた。以上から、本演習は今後の保健医療を担う看護師に必要とされる力の獲得に効果があったといえる。Objective: The purpose of this research is to clarify the effects of education program for community health nursing diagnosis in the bachelor level course for nursing.Method: The subjects were 87 of third grade students of bachelor nursing course in A University that took “an education program for community health nursing diagnosis” in 2019 and gave consent. Text related to learning outcomes of the program were abstracted from the assignment report and qualitative-inductive analysis was conducted.Results: The effects of an education program for community health nursing diagnosis were shown to be consisted of followings; “Gaining perspectives and methods for analyzing community health issues”, “Gaining perspectives to consider support to community health issues”, “Deepening their understanding of the characteristics of community health nursing”, “Increase in interest and widening of perspectives towards community health nursing”, and “Deepening their understanding of effective teamwork”.Conclusion: Through this program, students learned about support based on local characteristics and people’s living conditions, and about teamwork. The students also became interested in community health nursing and aware as members of the community. Therefore, it is considered that this program was effective in acquiring the competence required for nurses useful in future health care system

Evaluating Public Health Nurse Curriculum of A University Using Student Self-Evaluation

目的：保健師教育課程修了時の公衆衛生看護学実習において、学生の自己評価を用いて保健師教育評価の指標の到達度を明らかにし、A大学の保健師教育課程の評価を行う。 方法：保健師教育課程を履修し、2022年度に公衆衛生看護学実習を行ったA大学4年次学生20人を対象とした。公衆衛生看護学実習経験記録表、保健師教育評価の指標（62項目）を用いて、学生の自己評価の状況を分析し、目標到達者の人数をカウントし、その割合を算出した。 結果：保健師教育評価の指標の目標到達者割合の平均は72.4％であり、目標到達割合が100％の項目は5項目であり、80％以上の項目は26項目、50％未満の項目は8項目であった。 考察：保健師教育評価の指標の目標到達割合を勘案すると、到達状況は良好であった。目標到達者の割合が低い項目に関する授業・実習内容については、今後、再考する必要性が示唆された。departmental bulletin pape

The whole blood transcriptional regulation landscape in 465 COVID-19 infected samples from Japan COVID-19 Task Force

「コロナ制圧タスクフォース」COVID-19患者由来の血液細胞における遺伝子発現の網羅的解析 --重症度に応じた遺伝子発現の変化には、ヒトゲノム配列の個人差が影響する--. 京都大学プレスリリース. 2022-08-23.Coronavirus disease 2019 (COVID-19) is a recently-emerged infectious disease that has caused millions of deaths, where comprehensive understanding of disease mechanisms is still unestablished. In particular, studies of gene expression dynamics and regulation landscape in COVID-19 infected individuals are limited. Here, we report on a thorough analysis of whole blood RNA-seq data from 465 genotyped samples from the Japan COVID-19 Task Force, including 359 severe and 106 non-severe COVID-19 cases. We discover 1169 putative causal expression quantitative trait loci (eQTLs) including 34 possible colocalizations with biobank fine-mapping results of hematopoietic traits in a Japanese population, 1549 putative causal splice QTLs (sQTLs; e.g. two independent sQTLs at TOR1AIP1), as well as biologically interpretable trans-eQTL examples (e.g., REST and STING1), all fine-mapped at single variant resolution. We perform differential gene expression analysis to elucidate 198 genes with increased expression in severe COVID-19 cases and enriched for innate immune-related functions. Finally, we evaluate the limited but non-zero effect of COVID-19 phenotype on eQTL discovery, and highlight the presence of COVID-19 severity-interaction eQTLs (ieQTLs; e.g., CLEC4C and MYBL2). Our study provides a comprehensive catalog of whole blood regulatory variants in Japanese, as well as a reference for transcriptional landscapes in response to COVID-19 infection

DOCK2 is involved in the host genetics and biology of severe COVID-19

「コロナ制圧タスクフォース」COVID-19疾患感受性遺伝子DOCK2の重症化機序を解明 --アジア最大のバイオレポジトリーでCOVID-19の治療標的を発見--. 京都大学プレスリリース. 2022-08-10.Identifying the host genetic factors underlying severe COVID-19 is an emerging challenge. Here we conducted a genome-wide association study (GWAS) involving 2, 393 cases of COVID-19 in a cohort of Japanese individuals collected during the initial waves of the pandemic, with 3, 289 unaffected controls. We identified a variant on chromosome 5 at 5q35 (rs60200309-A), close to the dedicator of cytokinesis 2 gene (DOCK2), which was associated with severe COVID-19 in patients less than 65 years of age. This risk allele was prevalent in East Asian individuals but rare in Europeans, highlighting the value of genome-wide association studies in non-European populations. RNA-sequencing analysis of 473 bulk peripheral blood samples identified decreased expression of DOCK2 associated with the risk allele in these younger patients. DOCK2 expression was suppressed in patients with severe cases of COVID-19. Single-cell RNA-sequencing analysis (n = 61 individuals) identified cell-type-specific downregulation of DOCK2 and a COVID-19-specific decreasing effect of the risk allele on DOCK2 expression in non-classical monocytes. Immunohistochemistry of lung specimens from patients with severe COVID-19 pneumonia showed suppressed DOCK2 expression. Moreover, inhibition of DOCK2 function with CPYPP increased the severity of pneumonia in a Syrian hamster model of SARS-CoV-2 infection, characterized by weight loss, lung oedema, enhanced viral loads, impaired macrophage recruitment and dysregulated type I interferon responses. We conclude that DOCK2 has an important role in the host immune response to SARS-CoV-2 infection and the development of severe COVID-19, and could be further explored as a potential biomarker and/or therapeutic target

The Constrained Maximal Expression Level Owing to Haploidy Shapes Gene Content on the Mammalian X Chromosome.

X chromosomes are unusual in many regards, not least of which is their nonrandom gene content. The causes of this bias are commonly discussed in the context of sexual antagonism and the avoidance of activity in the male germline. Here, we examine the notion that, at least in some taxa, functionally biased gene content may more profoundly be shaped by limits imposed on gene expression owing to haploid expression of the X chromosome. Notably, if the X, as in primates, is transcribed at rates comparable to the ancestral rate (per promoter) prior to the X chromosome formation, then the X is not a tolerable environment for genes with very high maximal net levels of expression, owing to transcriptional traffic jams. We test this hypothesis using The Encyclopedia of DNA Elements (ENCODE) and data from the Functional Annotation of the Mammalian Genome (FANTOM5) project. As predicted, the maximal expression of human X-linked genes is much lower than that of genes on autosomes: on average, maximal expression is three times lower on the X chromosome than on autosomes. Similarly, autosome-to-X retroposition events are associated with lower maximal expression of retrogenes on the X than seen for X-to-autosome retrogenes on autosomes. Also as expected, X-linked genes have a lesser degree of increase in gene expression than autosomal ones (compared to the human/Chimpanzee common ancestor) if highly expressed, but not if lowly expressed. The traffic jam model also explains the known lower breadth of expression for genes on the X (and the Z of birds), as genes with broad expression are, on average, those with high maximal expression. As then further predicted, highly expressed tissue-specific genes are also rare on the X and broadly expressed genes on the X tend to be lowly expressed, both indicating that the trend is shaped by the maximal expression level not the breadth of expression per se. Importantly, a limit to the maximal expression level explains biased tissue of expression profiles of X-linked genes. Tissues whose tissue-specific genes are very highly expressed (e.g., secretory tissues, tissues abundant in structural proteins) are also tissues in which gene expression is relatively rare on the X chromosome. These trends cannot be fully accounted for in terms of alternative models of biased expression. In conclusion, the notion that it is hard for genes on the Therian X to be highly expressed, owing to transcriptional traffic jams, provides a simple yet robustly supported rationale of many peculiar features of X's gene content, gene expression, and evolution