ROS induced Cbl-b expression in rat L6 cells

Unloading-mediated muscle atrophy is associated with increased reactive oxygen species (ROS) production. We previously demonstrated that elevated ubiquitin ligase casitas B-lineage lymphoma-b (Cbl-b) resulted in the loss of muscle volume (Nakao R, Hirasaka K, Goto J, Ishidoh K, Yamada C, Ohno A, Okumura Y, Nonaka I, Yasutomo K, Baldwin KM, Kominami E, Higashibata A, Nagano K, Tanaka K, Yasui N, Mills EM, Takeda S, Nikawa T. Mol Cell Biol 29: 4798–4811, 2009). However, the pathological role of ROS production associated with unloading-mediated muscle atrophy still remains unknown. Here, we showed that the ROS-mediated signal transduction caused by microgravity or its simulation contributes to Cbl-b expression. In L6 myotubes, the assessment of redox status revealed that oxidized glutathione was increased under microgravity conditions, and simulated microgravity caused a burst of ROS, implicating ROS as a critical upstream mediator linking to downstream atrophic signaling. ROS generation activated the ERK1/2 early-growth response protein (Egr)1/2-Cbl-b signaling pathway, an established contributing pathway to muscle volume loss. Interestingly, antioxidant treatments such as N-acetylcysteine and TEMPOL, but not catalase, blocked the clinorotation-mediated activation of ERK1/2. The increased ROS induced transcriptional activity of Egr1 and/or Egr2 to stimulate Cbl-b expression through the ERK1/2 pathway in L6 myoblasts, since treatment with Egr1/2 siRNA and an ERK1/2 inhibitor significantly suppressed clinorotation-induced Cbl-b and Egr expression, respectively. Promoter and gel mobility shift assays revealed that Cbl-b was upregulated via an Egr consensus oxidative responsive element at −110 to −60 bp of the Cbl-b promoter. Together, this indicates that under microgravity conditions, elevated ROS may be a crucial mechanotransducer in skeletal muscle cells, regulating muscle mass through Cbl-b expression activated by the ERK-Egr signaling pathway

高齢者の口腔ケア支援に関する相談技術の抽出 : 歯科衛生士が用いている相談技術

地域に根ざした新しい看護提供システムとして「まちの保健室」事業が各地で展開されている。本研究は、この事業の後方支援のために、高齢者の口腔ケア支援に関する相談技術の抽出を行うことを目的として、口腔健康相談を受ける頻度が高いと考えられる歯科衛生上を対象にフォーカスグループインタビューを行い高齢者の口腔ケア支援に関する相談技術の抽出を行った。対象は、研究への同意が得られた歯科衛生上で、カテゴリーが飽和するまで対象者の募集を行った。3～5人を1グループとしてフォーカスグループインタビューを実施し、1)よく受ける相談について、2)うまくいった相談場面、3)相談のとき気をつけている点、工夫している点についてたずねた。得られたデータを質的記述的に分析することによって相談技術を抽出した。7グループと1人、計27人の歯科衛生上のインタビューを行った。参加者の年齢は平均36.8±9.5歳(25～60歳)、全員が女性であった。勤務年数は平均15.4±8.4年(5～36年)、経験したことのある職場は、保健所など多岐に渡っていた。参加者が表現した内容を注意深く読みとり255単位データが抽出された。抽出された技術としては、1)導入部分として、クライエントを「招き入れる」「信頼関係を築く」「機が熟すのを待つ」が抽出された。2)相談部分として、「真の問題を見つける」「問題点を理解してもらう」「できることをいっしょに探す」「行動を引き起こす」「行動の継続を促す」が抽出された。3)今後へ繋ぐ部分として、「次回の予約をする」、「次回までの具体的な目標を決める」が抽出された。インタビューの中では義歯の管理、口腔乾燥などの口腔健康への対応について語られた部分も多かったが、それは別の機会に報告することとし、今回は相談の具体的な技術に焦点をあて抽出した。歯科衛生士が用いている相談技術がそのまま看護職が応用できるとは限らないが、抽出された項目をみると、看護ケアの技術と重なる点がみられ、看護職も参考にでき応用していけるものと考えられた。Walk-in nursing stations are being introduced at several locations as a new system of community nursing in Japan. To assist with this project, our study aimed to investigate oral health consultation skills required for work with elderly people. Focus group interviews were conducted with oral hygienists who agreed to participate in this study. They were recruited until the category was saturated. Three to five people were group-interviewed about 1) common consultation themes and their responses to these, 2) successful consultation and 3) consultation tips. The interviews were taped and each contribution was analyzed and categorized. A total of 27 hygienists were interviewed, making up seven groups and one individual. The average age was 36.8 ± 9.5 years (25-60). All participants were female. Average practice period was 15.4±8.4 years (5-36years). The participants practiced at various sites, including district health centers, visiting dental care units, and similar venues. A total of 225 units of data were extracted from the dialogues and categorized as follows: 1) Introduction: "Inviting clients to a consultation", "building a confidential relationship" and "wait for client to be ready to speak"; 2) The consultation itself: "probing the real problem", "helping the client understand their own problem", "finding a solution together"," bringing about positive health behavior" and "encouraging client to continue positive health behavior"; 3) Closing the session: "making the next appointment" and "setting a goal for the next visit". Participants talked frequently about how to deal with concrete oral problems such as denture management and dry mouth. Management skills of this nature were not felt to be the primary focus of our study and are therefore not discussed here. The consultation skills which were observed in this study might not always apply to nursing consultations. However, many similarities were observed between the skills noted in our findings and those required for nursing care, and these consultation skills are likely to be useful at walk-in nursing stations

看護学的視点による形態機能学教育の再構築

看護教育における形態機能学(解剖生理)は看護活動の基盤をなし、その理論的根拠を与える重要な科目の一つであるが、生活援助や臨床看護の視点に乏しく、実際の臨床の場面での看護ケアの展開につながっていかないのが現状である。そこで、看護学的視点から形態機能学教育を再構築することを最終の目的とし、今回は、形態機能学が、臨床の看護の展開につながらない要因を検討し、形態機能学の看護学教育での位置付けを明らかにし、そのあり方を模索することを目的に、大学および臨床の多様性のあるメンバーからなる討議を重ね分析を試みたので報告する。討議は、病棟管理者1名、病棟新人教育担当看護師1名、若手看護師1名、臨地実習担当教官2名、形態機能学教育に携わる教官3名の計8名(男性2名、女性6名)を構成員とし、計5回実施された。討議の内容はテープに録音され、逐語記録され、カテゴリー化された。形態機能学が看護援助に役立ち必要であることが確認され看護も形態機能学に貢献する可能性があることが示された。形態機能学の深さと広がりとして、a)必須の基礎知識がある、b)形態機能学の知識は全部必要でない、c)看護には詳細なレベルの形態機能学の知識が必要なことがあるというカテゴリーが示された。形態機能学学習のバリアとして、a)形態機能学は看護に特化しにくい、b)知識と実践を統合するのは難しい、c)形態機能学は身につきにくい学問であることが抽出された。打開策として、問題解決型学習法を取り入れたa)事例を入り口として帰納的に学ぶ提案、b)知識習得と実践の繰り返しで学ぶ提案がされ、学習法の工夫として、学生を教える立場にさせる、繰り返し学習する機会をつくる、視覚的に学ぶなどが抽出された。今後は、典型的な事例を用いて看護の場面から問題思考型学習を取り入れた模擬授業を計画し、その効果を学習の到達度、実践への応用、マンパワーや時間の効率について検討を行う必要がある。The structure and function of the human body (integrated anatomy and physiology) is regarded as a subject of fundamental importance in nursing education, providing basic knowledge and evidence of the workings of the human body. However, it contributes little towards developing nursing care, since it appears to focus neither on daily life nor on actual nursing practice. This paper aims to clarify the role of this subject in nursing education and to uncover the barriers preventing its application to nursing practice. The paper also presents break-through proposals that will enable a start to be made in developing the subject further in nursing education. A total of five sessions were held involving eight individuals (two males and six females), including a nursing administrator, a nursing educator and a staff nurse (all working at hospitals) and two teachers in nursing practice as well as three teachers of anatomy and physiology at the college. The sessions were taped and each talk was described and classified into a category. It was confirmed that knowledge of the structure and function of the human body is useful and necessary for nursing practice, and also that nursing practice contributes to the understanding of the human body. Three categories of desirable knowledge emerged: a) a basic knowledge was seen as necessary, b) a detailed knowledge was not generally considered necessary, and c) occasionally detailed knowledge was necessary. Three categories of barriers were also identified, namely a) that the subject was inherently difficult to apply in nursing b) theory and practice were seen as difficult to integrate, and c) the subject was considered inherently difficult. New, break-through ideas were a) learning through case studies and b) refresher courses in both theory and practice. Some learning techniques were suggested, such as letting students teach, running frequent refresher courses, and using audio-visual material. For further study, it is recomended that experimental class should be performed, beginning with a typical case in nursing practice and using problem based learning, in order to evaluate the effect on integration of theory and practice and the efficient use of manpower and time

高齢者口腔保健行動に関する認知的変数測定のための質問票作成

高齢者の口腔保健行動を推進する効果的な介入プログラムを開発するためには、高齢者個人の考え方や物事の受け止め方(以下、認知的変数と呼ぶ)が、保健行動にどのように関連するのかを明らかにすることが重要である。そこで、本研究では、高齢者の口腔保健行動に関する認知的変数を測定する質問票を開発したので報告する。A高齢者大学で行われた口腔健康調査へ参加した60歳以上の高齢者93名を対象とし、口腔の健康のために行っていることや気をつけていることについて面接を行い、口腔保健行動の理由を分析した。その結果に基づき、自記式質問票を作成し、専門家らによって検討が行われた。作成された質問票を用い、口腔健康調査へ参加した60歳以上の高齢者215名を対象とし、質問票の試行と構成因子についての調査を実施した。保健行動を起こす理由としては、「信念や規範」「辛い体験の回避」「直面している問題への対処」「効果の実感」「周囲の助言」「習慣」、行動をとらない理由としては、「口腔健康への関心の低さ」「信念や規範」「継続の困難さ」が抽出された。次にこれらの結果をふまえ、「口腔健康への関心」「信念や規範」「辛い体験への脅威」「直面している問題の存在」「効果の実感」「周囲の助言」のカテゴリーをもとに質問項目を作成した。因子分析の結果、【ポジティブな信念や規範】、【口腔の問題-周囲の助言】、【口腔健康へのあきらめ】、【効果の実感】、【口の健康に対する自信】の5因子が抽出された。以上の結果、認知的変数として考えられる5因子22項目からなる認知行動的変数の測定質問票が構成された。本研究で得られた項目は高齢者の面接調査から収集され、その後、専門家による項目検討が行われていることから、内容的妥当性を有しているといえる。また、因子分析の結果、高齢者口腔保健行動にみられる認知的諸因子が得られたことから、本質問は適切な因子的妥当性を有していると考えられた。今後、これらの因子と実際の保健行動との関連や口腔の健康問題との関連を検討していくことで、さらに質問票を洗練させていくことが可能であると考える。We engaged in a project to develop a questionnaire to measure cognitive variables in oral health behavior among the elderly. When developing an effective program of oral health promotion for elderly people, it is very important to understand how their cognitive activity affects their health behavior. This study was aimed at discerning cognitive patterns which might affect health behavior and developing a questionnaire for measuring cognitive variables. The first study had 93 participants who had enrolled in an oral health check program at a community College for Senior Students, and who agreed to take part in the research. The participants were questioned about their approach to oral health, and their answers were then analyzed qualitatively. Based on the results, a self-reported questionnaire was designed, and specialists consulted. The questionnaire was then submitted to 215 persons over 60 years old, in order to evaluate the constituent factors. Facilitators of oral health behavior were categorized as follows: Underpinning belief and norm, avoiding painful experiences, dealing with the problem faced, feeling of effects, following advice, and habits. Barriers to positive oral health behavior were categorized as: Lack of concern about oral health, belief and norm, and difficulty with continuation. Based on the results, the data were grouped under overall headings, namely concern about oral health, underpinning belief and norm, fear of painful experiences, facing the existence of the problem, feelings of effects and following advice. The questionnaire had a total of 24 questions using a 5-point Likert-type scale. After an explanatory factor analysis, five factors with 22 items were indicated to be the best fitting model. These were: Positive underpinning belief and norm, following advice on oral problems, resignation regarding oral health, feelings of effects, and confidence in oral health. Though the questionnaire was drawn up to measure the cognitive variables effecting the health behaviors of elderly people, further studies would be needed to uncover the relationship between the cognitivefactors found through our study and actual health behavior