Relationship between family support and nutrient intake status in type 2 diabetes mellitus patients

【目的】通院中の2型糖尿病外来患者を対象に、情動的サポート、行動的サポート、また情報的サポートに着目し、家族による支援の有無別に栄養素等摂取状況の検討を行った。【方法】2016年3月～8月、新潟市Ｂ病院の2型糖尿病外来患者42名（年齢中央値68.0歳、男性比率66.7％）を対象に実施した、自記式質問紙調査及び食物摂取頻度調査データを用いた（有効回答率70.0％）。質問紙調査より得た、家族による支援の有無によって対象者を2群に区分した。食物摂取頻度調査より得たデータを用いて、2群のエネルギー及び栄養素等摂取量、食品群別摂取量（密度法によって調整）についてMann-Whitney のU 検定を用いて検討した。【結果】「食事療法を守っていることをほめる」の問いでは、支援あり7名（16.7％）、支援なし35名（83.3％）であった。2群の1000kcal あたりの栄養素等・食品群別摂取量で差がみられた項目はなかった。「同じ時間に食事をする」の問いでは、支援あり32名（76.2％）、支援なし10名（23.8％）であった。支援ありの者で相対的に、たんぱく質（p＝0.045）、豆類（p＝0.022）摂取量が多く、菓子類（p＝0.020）、油脂類（p＝0.039）の摂取量が少なかった。「家族の糖尿病の知識の有無」では、知識ありの者で油脂類のみ摂取量が相対的に多かった（p＝0.013）。また、「家族の食事療法の知識の有無」では、知識ありの者で嗜好飲料のみ摂取量が相対的に多かった（p＝0.028）。【結論】2 型糖尿病外来患者が受ける家族による支援として、「ほめる」という情動的サポートや疾患や食事療法の知識という情報的サポートに比べ、「同じ時間に食事をする」という家族の存在、家族の行動的サポートが栄養素等摂取状況に関連することが示唆された。Objective: To investigate the relationship between family support, specifically emotional, practical, and informational support, and nutrient intake status in type 2 diabetes mellitus (DM) outpatients. Methods: We distributed a self-report questionnaire and food frequency questionnaire to 42 outpatients with type 2 DM (median age: 68.0 years; men: 66.7%) from a community hospital-based registry in Niigata City between March to August 2016. From the self-report questionnaire, the patients were divided into two groups based on whether they received family support or not. Energy and nutrient intake and intake by food groups were compared using Mann-Whitney U test between the two groups.Results: Regarding the item “Praise for complying with medical nutritional therapy,” 7 patients (16.7%) were praised and 35 patients (83.3%) were not. There was no significant difference in nutrient intake or intake by food group between these two groups. For the item “family eating at the same time,” 32 patients (76.2%) responded that they had family meals together versus 10 patients (23.8%) who did not. Regarding energy and nutrient intake and intake by food group, families who ate together had meals with significantly higher protein (p= 0.045) and beans (p= 0.022) content with less confectionary (p= 0.010) and oil and fat (p= 0.039) content compared with families who did not eat together. Fat and oil intake was significantly higher among families with knowledge of DM and intake of beverage was higher among families with knowledge of dietary treatment than among families without such knowledge. Conclusion: For family support, our findings suggested that practical support such as eating at same time was more strongly related to nutrient intake among type 2 DM patients in comparison with emotional support such as praising patients

Dietary intake in Japanese outpatients with type 2 diabetes: 2-year follow up study

【目的】食事療法は2型糖尿病患者の自己管理に必須であるが、その経年的な実践状況についての検討は不足している。そこで本研究では、2型糖尿病患者における2年間の食事摂取状況の実態把握を行った。【方法】外来に通院する2型糖尿病患者60名 (平均年齢：66.8歳, 男性比率：65.0%) について、食物摂取頻度調査法を用い2014年とその2年後に把握した食品群・栄養素摂取状況を経年的に比較した。【結果】対象者の調査開始時の平均値は、罹病期間：10.2 ± 6.6 年，HbA1c：7.4 ± 1.1 %，BMI（Body Mass Index）：23.6 ± 4.4 kg/m2 であった。2年後は、BMI や血糖、血中脂質に有意差はみられず、収縮期血圧のみ調査開始時より高値であった(137.3 ± 13.6 vs. 132.8 ± 14.7 mmHg, p=0.031)。食事摂取状況は、2年間でエネルギー摂取量に有意差はみられなかったが、脂質エネルギー比が増加し(25.8 ± 5.3 vs. 27.3 ± 6.2 %, p= 0.030)、食物繊維摂取量が低下した(13.8 ± 4.6 vs.12.5 ± 3.6 g, p= 0.030)。食品群別では、野菜総量は摂取量が低下し(280 ± 132 vs. 229 ± 114 g, p=0.004)、肉類摂取量が増加した(45 ± 31 vs. 57 ± 48 g, p= 0.029)。調査開始時のHbA1c 値とBMI による層別解析では、HbA1c＜7%群で食物繊維と野菜類の総量摂取量が2年後に低値となり(p=0.048, 0.001)、HbA1c≧7%群で脂質摂取量が高値であるが( p= 0.042)、脂質エネルギー比でみると有意差は認められなかった。BMI 25kg/m2 未満群では、脂質エネルギー比が2年間で増加し(p= 0.043)、食物繊維と野菜類の総量摂取量が低下し(p= 0.003, 0.003)、乳類の摂取量が増加した(p= 0.022)。BMI 25kg/m2 以上群は、エネルギーや三大栄養素摂取に有意差は認められず、食品群別で、緑黄色野菜のみ2 年後の摂取量が低値となった(p= 0.008)。【結論】外来2型糖尿病患者の2年間の食事摂取状況の変化が明らかとなった。糖尿病療養状況を考慮した、各患者の食事摂取状況の経時的な把握を行う必要性が示唆された。Objective: The dietary intake across the ages of patients with type 2 diabetes is sparse though nutritional therapy is essential for self-managing for diabetes. We aimed to clarify 2-year dietary intake among Japanese individuals with type 2 diabetes from a community hospital-based registry. Methods: This study was analyzed in 60 patients with type 2 diabetes (Men%:65.0%, Age: 66.8y, BMI: 23.6kg/m2, HbA1c:7.4%) using the food frequency questionnaire based on food groups using paired t-test and Wilcoxon signed-rank test. Results: BMI, HbA1c, and serum lipid revels did not show significant difference over 2 years. Systolic blood pressure level in 2 years was significantly high than the value of baseline (137.3±13.6 vs. 132.8±14.7mmHg, p= 0.031). There was no significant difference in mean energy intake and proportions of protein and carbohydrate comprising total energy intake over 2 years. The proportion of fat intake increased (25.8±5.3 vs. 27.3±6.2%, p=0.030) and the fiber intake decreased in the 2 years (13.8±4.6 vs. 12.5±3.6g, p=0.030). As a dietary intake by food groups, vegetable intake was decreased (280±132 vs. 229±114g, p=0.004) and meat intake increased (45±31 vs. 57±48g, p= 0.029) in the 2 years. In addition, among patients who had HbA1c <7%, the intake of fiber and vegetable intakes in 2 years decreased compared with those at baseline (p= 0.048, 0.001), and patients with HbA1c ≥7% had higher fat intake value in 2 years than that of baseline (p= 0.043), though the proportion of fat intake did not show significant difference over 2 years. According to BMI, patients without overweight (BMI< 25kg/m2)raised the proportion of fat intake and milk/milk products intakes (p= 0.043 and 0.022, respectively) and reduced fiber and vegetable intakes (p= 0.003 and 0.003, respectively) in 2 years. The patients with overweight show higher green vegetable intake in 2 years, but the intakes of other nutrients and food group did not significantly changed. Conclusion: Our study clarified the characteristics and change of dietary intake of Japanese outpatients with type 2 diabetes and considering the treatment status would be useful for understanding each dietary intake of each patients with type 2 diabetes

臨地実習を修了した看護学生に対するシミュレーション教育の効果

報告Reports　本稿では、臨地実習を修了した看護学生に対するシミュレーション教育の効果について報告する。本学では8 セメスターに「統合演習」を開講している。この科目は3 フェーズのシミュレーション場面を設定し、状況に応じた情報収集、アセスメント、看護実践をグループで学習する。今回、「統合演習」を受講した4 年次生145 名を対象に、臨地実習修了後の看護技術到達度、各フェーズの学修目標到達度およびARCS 評価、授業前後のシミュレーション教育に関連する看護技術到達度（12 項目）を調査した。その結果、各フェーズで学修目標到達度は4 段階中3 以上、ARCS 評価は6 段階中4 以上と高くなっていた。シミュレーション教育に関連する看護技術到達度は12 項目中バイタルサイン測定を除く11 項目において授業前後で有意に上昇した。臨地実習後のシミュレーション教育は看護技術の習得に有用であることが示唆された

分割型実習で学生が看護過程を展開するための教育方略

その他Miscellaneous　看護学教育の基礎教育課程では、学生が看護を学問として初めて学修し、看護専門職者を目指すものとして知識、態度を育成することが求められる。看護過程を展開する技術は看護実践能力の基盤となる技術として位置づけられ、根拠のある看護実践の基本として修得すべき技術である。2017年度基礎看護学領域において、ディプロマポリシーを踏まえ科目概要を見直すこととなった。そこで、基礎看護学実習Ⅱでは、学生が対象を受け持ち、対象の療養生活を理解し、対象に必要な日常生活援助のための計画を立案することに目標を変更した。学生の学修目標達成のため、教育方略を検討し、実習施設との調整を経て教育方略を変更した経緯を報告する

2019 年度看護学部教育課程の改定について

紀要委員会企画Special Articles　本稿は、本学看護学部の2019 年度教育課程改定における活動内容の概要を記した。2012 年に教育課程変更を行って５年が経過したことや、教育職員免許法の改正により養護教諭課程の再課程認定に伴い、2019 年度に向けて看護学部教育課程の改定を行うことになった。2017 年度からカリキュラム検討委員会を中心に教育課程の検討を行い、２年間に渡って教育課程改定に向けて活動した内容をまとめた。2019 年度新教育課程としては、地域包括ケアシステムの推進に基づく社会の変遷にあわせた教育課程へと発展させるための学修内容の追加、本学の強みである充実した実習環境をもとに行われている臨地看護学実習を通して「生命の尊厳と隣人愛」に基づく教育理念を継続的に意識づけられるような教育課程を策定することができた。指定規則改正に伴う次の教育課程の改定に向けて、今回のプロセスが参考となることを期待する

Long-term oral administration of cows' milk improves insulin sensitivity in rats fed a high-sucrose diet

We evaluated the effects of long-term daily cows' milk (CM) administration on insulin resistance induced by a high-sucrose diet. F344 rats, aged 3 weeks, were divided into two groups according to diet (dextrin-fed v. sucrose-fed). These groups were further divided into two groups receiving either CM or artificial milk (AM; isoenergetic emulsion of egg white protein, maltose, lard and minerals). Rats were fed a sucrose- or dextrin-based diet for 7 weeks and orally administered CM or AM at 25 ml/kg following an 8 h fast on a daily basis. Insulin sensitivity was evaluated via postprandial changes in serum glucose and insulin, oral glucose tolerance tests, and fasting serum insulin and fructosamine concentrations. The sucrose-fed rats showed an overall decrease in insulin sensitivity, but postprandial insulin levels were lower in the CM-treated subgroup than in the AM-treated subgroup. Peak serum glucose and insulin concentrations were highest in the sucrose-fed rats, but CM administration reduced peak glucose and insulin values in comparison with AM administration. By area under the curve analysis, insulin levels after feeding and glucose loads were significantly lower in the CM-treated groups than in the AM-treated groups. The CM-treated groups also demonstrated lower fasting insulin and fructosamine levels than the AM-treated groups. Improved insulin sensitivity due to CM administration seemed to be associated with reduced duodenal GLUT2 mRNA levels and increased propionate production within the caecum

Geometric and dosimetric impact of 3D generative adversarial network-based metal artifact reduction algorithm on VMAT and IMPT for the head and neck region

Abstract Background We investigated the geometric and dosimetric impact of three-dimensional (3D) generative adversarial network (GAN)-based metal artifact reduction (MAR) algorithms on volumetric-modulated arc therapy (VMAT) and intensity-modulated proton therapy (IMPT) for the head and neck region, based on artifact-free computed tomography (CT) volumes with dental fillings. Methods Thirteen metal-free CT volumes of the head and neck regions were obtained from The Cancer Imaging Archive. To simulate metal artifacts on CT volumes, we defined 3D regions of the teeth for pseudo-dental fillings from the metal-free CT volumes. HU values of 4000 HU were assigned to the selected teeth region of interest. Two different CT volumes, one with four (m4) and the other with eight (m8) pseudo-dental fillings, were generated for each case. These CT volumes were used as the Reference. CT volumes with metal artifacts were then generated from the Reference CT volumes (Artifacts). On the Artifacts CT volumes, metal artifacts were manually corrected for using the water density override method with a value of 1.0 g/cm3 (Water). By contrast, the CT volumes with reduced metal artifacts using 3D GAN model extension of CycleGAN were also generated (GAN-MAR). The structural similarity (SSIM) index within the planning target volume was calculated as quantitative error metric between the Reference CT volumes and the other volumes. After creating VMAT and IMPT plans on the Reference CT volumes, the reference plans were recalculated for the remaining CT volumes. Results The time required to generate a single GAN-MAR CT volume was approximately 30 s. The median SSIMs were lower in the m8 group than those in the m4 group, and ANOVA showed a significant difference in the SSIM for the m8 group (p < 0.05). Although the median differences in D98%, D50% and D2% were larger in the m8 group than the m4 group, those from the reference plans were within 3% for VMAT and 1% for IMPT. Conclusions The GAN-MAR CT volumes generated in a short time were closer to the Reference CT volumes than the Water and Artifacts CT volumes. The observed dosimetric differences compared to the reference plan were clinically acceptable