本学の福祉学生の対人援助における倫理に対する考え方と倫理的支援の捉え方の傾向について

福祉専門職を目指す福祉学生の倫理的取り組みについて､その実情を把握するために調査研究した｡調査は執筆者の演習ｾﾞﾐの中で行った｡結果について､“対ｸﾗｲｴﾝﾄ”は､｢社会資源の提供や就職支援等の生活保障を基盤としたうえで､主体性を高め､一定の制限は加わるが自己実現と福祉向上をなしとげて､利用者の幸福や社会の利益に繋げること｣の考え方がわかった｡また“対ｿｰｼｬﾙﾜｰｶｰ”は､｢これまで以上､専門的技術をもち､個人の理解や尊厳重視等ももって､利用者の支持やｻﾎﾟｰﾄを行いながら､主体性や自己実現を推進するところにｿｰｼｬﾙﾜｰｶｰの存在意義がある｣という捉え方がわかった｡総合的には､｢倫理的な試みには公共の福祉内という社会的制限はあるが､それは自己実現といえる｡そこには専門的技術をもって､個人の理解や尊厳､および主体性を高めたり､また社会資源の提供や就職支援等による生活保障を基盤にしたうえで､福祉向上を成し遂げ､個人の幸福とか社会の利益に繋げるところにｿｰｼｬﾙﾜｰｶｰの存在意義がある｣と､まとめられるものであった｡しかし､教材の｢日本ｿｰｼｬﾙﾜｰｶｰ協会の倫理綱領｣で示されている内容と､さほど変わらないまとめになったことは､良い意味では､倫理綱領の学習理解が図れたといえるものだった｡しかし､否定的に言えば､創造的な話や言葉が出せない福祉学生の､個性の脆弱性問題がここに現れていたといえた｡The study was conducted in order to elucidate the state of ethics initiatives of social work students seeking to become professional social workers. The study was performed as part of the author\u27s seminar. The results indicated that, with respect to clients, the students thought that “Based on a foundation of lifestyle security, such as provision of social resources and employment support, the social worker enhances client independence, and though there are certain restrictions, achieves client self-realization and improvements in welfare for client well-being and social benefit.” And their perception in respect to social workers is that “The significance of the social worker is as someone who brings even greater professional expertise as well as understanding, respect and so on for the individual than before, providing support for the client while promoting client independence and self-realization.” Comprehensively speaking, their views may be summarized as follows: “Though there are certain social restrictions on ethical experimentation, this is a matter of self-realization. The significance of the social worker is as someone who brings professional expertise to such endeavors, understands and respects the individual and enhances the individual\u27s independence, and based on a foundation of lifestyle security such as provision of social resources and employment support, achieves improvements in welfare for individual well-being and social benefit.” The fact that this summary does not differ much from the content of “The Japanese Association of Social Workers Code of Ethics,” a teaching material used in the seminar, means that on the positive side, the students have understood the lessons on the Code of Ethics. Looked at negatively, however, this reveals the characteristic vulnerability of social work students who are unable to engage in creative discussion or make their own statements

雲仙・普賢岳噴火災害の被災者に見られた福祉的援助ニーズの検討 ―深江町丁諏訪名地区の調査を通して―

噴火災害後１２・１３年目に行なった、被災者の福祉的援助ニーズの調査は、その多くが「避難所生活→仮設住宅生活や借家生活→帰宅」の過程をたどったため、これに沿うかたちで調査した。すると、被災者が退去中に接触した、ボランティアや救援物資との関係の把握が問題の中核であることが判った。そこにみられた結果は、自宅からの退去期間が長期になるほど、福祉的援助といえる救援物資や人的社会資源のボランティア活動に対するニーズが高くなり、逆に、その期間が短くなると、そのニーズは低下することが判った。しかし、その間に援助された救援物資等は、生活に必要とされる人に、十分に行き渡たらない面もあった。また集中して援助を受けた人と、受けられなかった人が存在しただけでなく、個人的性格弱者は損をする事例もあったことが、自由文書回答からも判った。今回の調査は、これらの教訓的問題を提示しただけでなく、不公平感を取り払うこと、公的設置の場ばかりでなく、私的・個人的な場での援助の拡大も求めていることが判った。今後は、このニーズを満たす方向での援助の取組みや工夫が必要である

被爆２・３世者の健康への意識について - 特に原爆による遺伝との関連における自己意識の現状について -

今日の被爆２・３世者は、生活習慣病を発症しやすい壮年期に突入したこともあり、健康不安を増大させていると世間では取り沙汰している。これに関する科学的裏付けを得たく、今回はパイロットスタディを行って、次回の本研究へ向けての指針探りを行った。ここでの調査では、被爆３世のサンプルが少なかったため、２・３世者を合わせて被爆子孫と称して分析作業を行った。すると、被爆子孫の方々の身体的健康面に関連する不安は、被爆子孫であろうと無かろうと、また男女別でも相違性は見られず、一般の人々のレベルで考えられている事柄と何ら変わりないことが再認識させられた。しかしながら被爆に伴う遺伝的影響面に関する不安については、元来から子孫に影響が出るはずだと意識していた人、ならびに自分では判断できないと思っていた人の場合では、自らが病気に罹患した場合には、その病気を原爆に関連させて「不安」になるところが認められた。しかし間接被爆者の子孫には、「自分には心配するようなことは起こらないだろう」という意識が感じ取れた。以上のように、被爆２・３世者である被爆子孫には、原爆による遺伝的影響面に関する不安、言い換えると心的・精神的な面で、不安と向かい合いながら、社会的に生存しているような可能性がわかった。そのためこの対策としては、次の本格的な研究でより解明できるまでは、とりあえずこの可能性をふまえて対処すべきである。そのため相談事業はもちろん、原爆医療の正しい知識を被爆子孫へ普及させて、少しでも不安から解放されるように対策を講じるべきである。同時に、一般の人にも原爆 (放射線) 医療の正しい知識の普及を図って被爆者や被爆子孫への理解を向上させるべきであると考えた。It is rumored that 2nd and 3rd generation Hibakusha descendants of Atomic Bomb victims are concerned about their health as they become adults where health problems are more prevalent. In order to obtain scientific proof on this matter a pilot program was performed and I reviewed one indicator during this study. The pilot program had very few descendants to properly evaluate from those evaluated we found that descendants had no difference in health condition than the originally victims in their health conditions regardless of sex. However, hereditary influence on their descendants is unknown and causes much concern about physical and mental health effects. I fully endorse and highly recommend that a full-fledged research project be initiated based on the pilot program findings. All measures possible should be research and investigated to relieve these descendants of long range health concerns and if the research reveals that long range health effects can be past from generation to generation measures should be implemented to ease the burden on all effected. We have a moral responsibility to do this research and obtain all the knowledge and facts associated with Atomic Bomb Radiation and provide this information to those affected

東日本大震災のｶﾞﾚｷ受け入れに関する一部長崎市民の意識

2011年の東日本大震災は､地震や津波および原子力発電所爆発事故まで引き起こしたため､この被災地からでる“ｶﾞﾚｷ”は､放射能汚染と結びついて受けとめられた2)｡国からの広域処理の要請で､受け入れの検討が行われた長崎市においては､同市内の被爆者団体は意見が分かれることもあった4)が､受入反対の意思表示を行なった3)5)｡そこで､部分的ではあるが市民の意向を一定の範囲で把握すべく､一部長崎市民を対象に調査したところ､統計学的に有意差を見出せなかったが､“震災ｶﾞﾚｷ”を長崎で受け入れるべきだとする人は78.49%存在していた｡その中で､特に50～69歳代者には､積極的な受け入れ姿勢がみられた｡40歳代や70歳代者も受け入れ姿勢は高く見られたものの､難色や拒否する人は他の年代者よりも2～3倍存在していた｡これは､自らの子や孫への放射能による影響不安があったがためと考えられた｡70歳代者は受け入れ拒否は低かったが､積極的でもなく中位だった｡放射能からの影響不安では80歳代者も高かったため､高齢になるほど変化や不安から遠ざかり安泰な生活を望む傾向から来ていると推察された｡しかし､もう一つの視点である､被爆者と一般市民との“ｶﾞﾚｷ”受け入れ意識の差は見られなかった｡尚､2012年7月26日､長崎市長は､“ｶﾞﾚｷ”の受け入れの検討作業を中止すると発表した6)｡The Great East Japan Earthquake and subsequent tsunami of 2011 led to explosions at a nuclear power station, and this resulted in perceptions linking“debris”from the affected area with radioactive contamination. In response to a request for regional waste management from the government, the city of Nagasaki considered accepting debris, and although opinions within atomic bomb victim groups were divided, they ultimately decided to refuse. Therefore, a survey of Nagasaki residents was conducted in order to gain a better understanding of their views in relation to this decision. While statistically significant differences were not seen, 78.49% of Nagasaki residents thought that“disaster debris”should have been accepted. Of these, 50-69 year olds were particularly positive about acceptance. People in their 40s and 70s also showed high levels of positivity toward acceptance, but the number of people in these age groups expressing reluctance or refusal was 2-3 times that of other age groups. This may be due to concern regarding the effects of radioactivity on their own children or grandchildren. Respondents in their 70s tended to be neither strongly for nor strongly against“debris”acceptance. People in their 80s were anxious about the effects of radioactivity, which may be due to a tendency to want an untroubled life free from change and anxiety in later years. From another perspective, no gap was observed between the views of atomic bomb victims and ordinary residents concerning“debris”acceptance. On 26 July 2012, the Mayor of Nagasaki announced that the review of“debris”acceptance was to be discontinued

Factors responsible for elevated plasma B-type natriuretic peptide levels in severe aortic stenosis: Comparison between elderly and younger patients

AbstractBackgroundElevated plasma B-type natriuretic peptide (BNP) is a predictor of outcome and helpful for risk stratification in aortic stenosis (AS). However, left ventricular (LV) diastolic dysfunction progresses with aging and may also influence plasma BNP levels in elderly patients. We hypothesized that plasma BNP levels may be influenced by age in severe AS, and that factors that affect the elevation of plasma BNP levels may be different between elderly and younger patients with AS.MethodsWe performed echocardiography in 341 patients with severe AS [aortic valve area (AVA)<1.0cm2] and classified them into two groups by age (elderly ≥75 years old, n=201; younger patients <75 years old, n=140). We used multivariate linear regression analysis to assess the factors that determine plasma BNP levels in both groups.ResultsAge was found to be one of the independent determinants of plasma BNP levels in all patients (β=0.135, p=0.005). Although AVA was similar in the two groups, plasma BNP levels and E/e′ were significantly higher in elderly than younger patients [133.0 (IQR, 73.3–329.7)pg/dl vs 92.8 (IQR, 40.6–171.8)pg/dl, p<0.01; 20±8 vs 16±6, p<0.01, respectively). In multivariate stepwise linear regression analysis, AVA index, LV ejection fraction, mass index, E/e′, estimated systolic pulmonary artery pressure (eSPAS), and the presence of atrial fibrillation were independent determinants of plasma BNP levels in younger patients. In contrast, the independent determinants of plasma BNP levels in elderly patients were LV ejection fraction, mass index, E/e′, eSPAS, the presence of atrial fibrillation, age, and hemoglobin levels, but not AVA index.ConclusionsThere may be differences in the factors that influence plasma BNP levels between elderly and younger patients with severe AS. In elderly patients, plasma BNP levels may be influenced more by these factors than AS severity compared with younger patients

Prediction of functional recovery after revascularization using quantitative gated myocardial perfusion SPECT: a multi-center cohort study in Japan

金沢大学医薬保健研究域医学系Backgrounds: Prediction of left ventricular functional recovery is important after myocardial infarction. The impact of quantitative perfusion and motion analyses with gated single-photon emission computed tomography (SPECT) on predictive ability has not been clearly defined in multi-center studies. Methods: A total of 252 patients with recent myocardial infarction (n = 74) and old myocardial infarction (n = 175) were registered from 25 institutions. All patients underwent resting gated SPECT using 99mTc-hexakis-2-methoxy-isobutyl isonitrile (MIBI) and repeated the study after revascularization after an average follow-up period of 132 ± 81 days. Visual and quantitative assessment of perfusion and wall motion were performed in 5,040 segments. Results: Non-gated segmental percent uptake and end-systolic (ES) percent uptake were good predictors of wall motion recovery and significantly differed between improved and non-improved groups (66 ± 17% and 55 ± 18%, p < 0.0001 for non-gated; 64 ± 16% and 51 ± 17% for ES percent uptake, p < 0.0001). The area under the curve of receiver operating characteristics curve for non-gated percent uptake, ES percent uptake, end-diastolic percent uptake and visual perfusion defect score was 0.70, 0.71, 0.61, and 0.56, respectively. Sensitivity and specificity of percent uptake were 68% and 64% for non-gated map and 80% and 52% for ES percent uptake map. An optimal threshold for predicting segmental improvement was 63% for non-gated and 52% for ES percent uptake values. Conclusion: Segmental 99mTc-MIBI uptake provided a useful predictor of wall motion improvement. Application of quantitative approach with non-gated and ES percent uptake enhanced predictive accuracy over visual analysis particularly in a multi-center study. © 2008 Springer-Verlag

Qualidade da água utilizada para equipamentos de hemodiálise em Unidade de Terapia Intensiva

There are rules and regulations for assessment of water quality services in ambulatory care unit and specific recommendations for the procedures performed in intensive care units (ICU) services. An exploratory study was conducted at hemodialysis equipment in ICU in a Southern Brazil city. Water samples were directly collected from the network public supply and from post-reverse osmosis associated with hemodialysis equipaments, monthly from January to June 2011. Mass spectrometry technique (quadrupolar type), associated with a source of inductive coupling plasma (ICP/MS) was applied to measure water trace metals levels. Bacteriological analyzes were performed to search for he-terotrophic bacteria. Data showed that the metal concentrations in the purified water of hemodialysis centers did not exceed legal standards. The bacteriological analysis of water for hemodialysis systems resulted as &lt; 200 CFU/mL, according to legal limits in all evaluated months, with an exception on February. The results corroborate the fact that maintenance and precaution with the hemodialysis water are being effective. The avoidance of complications arising from chemical or microbiologic water contaminants, in ICU requires a constant attention, since patients conditions are different from those found in outpatient care.Existem critérios e regulamentos para a avaliação da qualidade da água em serviços de unidade de terapia ambulatorial e recomendações específicas para os procedimentos realizados em unidades de terapia intensiva (UTI). Um estudo exploratório foi conduzido em equipamentos de hemodiálise em UTI, em uma cidade do Sul do Brasil. Amostras de água foram coletadas da rede de abastecimento público e pós-osmose reversa associa-da a dois aparelhos de hemodiálise, entre janeiro e junho de 2011. Espectrometria de emissão óptica com fonte de plasma indutivamente acoplado (ICP OES) foi utilizada para análise de metais em níveis de traços. Análises bacteriológicas foram realizadas para pesquisa de bactérias heterotróficas. Os dados obtidos mostraram que as concentrações dos metais não excederam os limites estabelecidos pela legislação. A análise bacterioló-gica da água para hemodiálise resultou em contagem inferior a 200 UFC/mL, em todos os meses avaliados, com exceção do mês de fevereiro. Os resultados obtidos corroboram o fato de que a manutenção e os cuidados necessários com a água para o tratamento dialítico têm sido efetivos. A prevenção de complicações decorrentes de contaminantes químicos ou microbiológicos na água para hemodiálise em UTI requer uma atenção constante, uma vez que as condições dos pacientes são diferentes daquelas encontradas em atendimento ambulatorial

The effects of beta-blockers on dobutamine-atropine stress echocardiography: early protocol versus standard protocol

BACKGROUND: To study the effects of Beta-blockers during Dobutamine Stress Echocardiography (DSE) comparing the hemodynamic benefits of an early administration of atropine in patients taking or not Beta-blockers. METHODS: One hundred and twenty-one patients were submitted to dobutamine stress echocardiography for the investigation of myocardial ischemia. The administration of atropine was randomized into two groups: A or B (early protocol when atropine was administered at 10 and 20 mcg/kg/min of dobutamine, respectively) and C (standard protocol with atropine at 40 mcg/kg/min of dobutamine). Analysis of the effects of Beta-blockers was done regarding the behavior pattern of heart rate and blood pressure, test time, number of conclusive and inconclusive (negative sub-maximum test) results, total doses of atropine and dobutamine, and general complications. RESULTS: Beta-blocked patients who received early atropine (Group A&B) had a significantly lower double product (p = 0.008), a higher mean test time (p = 0.010) and required a higher dose of atropine (p = 0.0005) when compared to the patients in this group who were not Beta-blocked. The same findings occurred in the standard protocol (Group C), however the early administration of atropine reduced test time both in the presence and absence of this therapy (p = 0.0001). The patients with Beta-blockers in Group A&B had a lower rate of inconclusive tests (26%) compared to those in Group C (40%). Complications were similar in both groups. CONCLUSION: The chronotropic response during dobutamine stress echocardiography was significantly reduced with the use of Beta-blockers. The early administration of atropine optimized the hemodynamic response, reduced test time in patients with or without Beta-blockers and reduced the number of inconclusive tests in the early protocol