〈短報〉発達障害がある子の保護者が我が子の小学校期に持った支援ニーズに関する面接調査

本研究では成人した発達障害のある子を持つ母親5名に面按を行い、我が子の小学校期を想起して当時担任や学校に対しどのような支援ニーズを持っていたのかを明らかにした。その結呆、第1に母親らは子どもが直面している困難に対し教員が速やかに適切な支援をしてくれることを望んでいた。また保護者が相談しやすい休制を校内に整え、学校内外の各種相談窓口を紹介して欲しいと考えていた。第2に本人の発達障害に起因する特性を教員が理解し、保護者が悩む気持ちに共感して欲しいと考えていた。学校生活におけるさまざまな困難について、医師・教員と母親・本人の考えには乖離があり、保護者の支援ニーズを教員に理解してもらうのは難しかったことが示された。第3に母親は直面している困難への支援のことだけではなく、本人の将来のことも考慮して支援策を検討して欲しいと考えていた。これら3点は子どもが成人した今も保護者が重要だと考えている支援である。In this study, interviews were conducted with five mothers of grown children with developmental disabilities. The mothers reflected on their children\u27s elementary school period and clarified what support they needed from the teachers and the school at that time. Primary study results were threefold: first, mothers hoped their children\u27s teachers would promptly provide appropriate support for the difficulties their children faced. These mothers also would have appreciated a system for easy consultations at school and would have welcomed the introduction of various consultation offices both at school and off campus. Second, they wanted teachers to understaod the characteristics caused by their child\u27s developmental disabilities and desired sympathy for their troubles as parents. This suggests that there is a gap between doctors\u27/teachers\u27 views and mothers\u27/children\u27s regarding the various difficulties during school life and that it is difficult for teachers to understand guardians\u27 support needs. Third, the mothers wanted schools to consider support measures keeping in mind the children\u27s future as well as immediate difficulties. These three areas of support are still important to guardians even after their children have become adults

Left-right axis formation in the dorsalized or ventralized Xenopus laevis embryos : Does dorsal-midline development affect the left-right orientation of visceral organs?

Yostら(1995)は、ツメガエル受精卵の表層回転を阻害することで頭部組織を欠損させた胚や、卵割期の背側割球にXwnt-8 mRNAを微量注射することで頭部組織を欠損させた胚において、心臓逆位が高率に生じることを発見した。彼らはその理由について「頭部中軸組織は内臓の左右軸の決定に関与する因子を放出するので、頭部が欠けると内臓が左右軸の手がかりを失い内臓逆位が生じる」とした。筆者らは、彼らとは異なる以下の3つの処理方法を用いて頭部欠損症状を持った胚を人工的に作出し、それらの心臓や腸管の左右非対称性の正位/逆位を調べた。頭部欠損の程度と内臓逆位の出現率とが相関するか否かを解析することで、Yostらの仮説の検証を試みた。胚の頭部形成を阻害することが知られるレチノイン酸で短時間暴露処理(パルス処理)したツメガエル胞胚∿神経胚の内臓逆位の出現率について調べた。1-10μMレチノイン酸処理胚は著しい頭部欠損症状を示したにもかかわらず、それらの内臓逆位出現率は1%(3/263)と、無処理胚における逆位の自然発生率と同レベルであった。カルシウムイオノフォアA23187のパルス処理によって、発生段階依存的に頭部欠損胚または尾部欠損胚が得られる(後藤ら, 1994)が、その場合の内臓逆位出現率について調べた。後藤らの報告では、初期卵割期の処理では胴尾部欠損胚が得られ、卵割後期∿胞胚期の処理では頭部欠損胚が得られるとあるが、我々の実験結果はそれと正反対のものであった。初期卵割期の処理では頭部欠損が見られ、後期胞胚∿原腸胚期の処理では胴尾部欠損(特に尾部欠損)が観察された。原腸胚期にA23187処理を行った胚の63%(15/24)が内臓逆位を示した。処理によって尾部を欠損した胚の多くは内臓逆位胚であった。塩化リチウム処理で内臓逆位が生じることが、高谷(1949)によって明らかにされており、一方、品川ら(1989)により胞胚期∿原腸胚期のリチウム処理で頭部欠損胚が得られることが報告されている。そこで、リチウム処理による頭部欠損の程度と内臓逆位の出現との相関について調べた。原腸胚期のリチウム処理で、11%(8/72)の個体に内臓逆位が生じた。同じ処理群の中に頭部が欠損した胚も多数得られ、頭尾軸欠損指標Dorso-Anterior Index (Kao & Elinson, 1988)の平均は4.35であった(n=72)。しかしながら、個々の胚について頭部欠損の程度と逆位発生との相関を調べると、逆位胚の75%はDAI 5の頭尾軸は正常な胚であり、頭部欠損の度合いと内臓逆位出現率とは相関がなかった。以上の結果から、「胞胚期以降の胚においては、内臓の左右性に関連する位置情報はすでに心臓や腸管の予定細胞群自身が獲得していて、それらの左右軸は、頭部組織の有無に影響を受けない程度には決定されている。」と考えられる

新人看護師の看護基本技術習得に向けた統合型評価システムの有用性の検討

目的：看護基本技術習得に向けた統合型評価システムが，新人看護師の技術習得と課題の明確化につながっているかを明らかにし，システムの有用性を検討する． 方法：①システムを使用した新人看護師（以下システム使用後）14名とシステムを使用していない新人看護師20名のチェックリストの得点を統計学的に分析した．②システム使用後14名の課題を表す「整理シート」の記述を内容分析した．③システム使用後14名の知覚をインタビューし内容分析した． 結果：①入職1か月，6か月，1年でシステム使用後の得点が有意に高かった．②整理シートの課題は，自己学習や日常生活援助などが多く時期の経過とともに内容も変化した．③システム使用後14名の知覚は，【システムの使用で課題が明確になった】，【チェックリストが目標となり取り組めた】など，12カテゴリを形成した． 結論：システムの活用は，技術習得，課題の明確化，目標設定などを促進し有用性を示唆した．Objectives: To clarify whether an integrated evaluation system for novice nurses will contribute to the acquisition of skills and clarify nursing tasks [Does this reflect your intended meaning here and below?], and to evaluate the effectiveness of that system. Methods: We compared checklist scores of 14 novice nurses who used the system and 20 novice nurses who did not use the system by statistical analysis. “Summary sheets” that described problems with nursing tasks experienced by nurses who used the system were analyzed. In addition, we interviewed the nurses who used the system to obtain their impression of the system. Results: The scores of nurses who used the system were significantly higher at 1, 6, and 12 months after beginning their jobs. Most of the tasks observed on the summary sheets were related to self-learning and daily living care for patients; however, the tasks listed on the summary sheets changed over time as the nurses gained more experience [Is this addition ok?]. Nurses' impressions of system were classified into 12 categories, such as [use of the system helped to clarify tasks] and [ability to concentrate on completing the checklist as a goal]. Conclusions: The introduction of this system promoted the effective acquisition of skills, identification of problems, and setting of goals.報

Prevalence of and risk factors for post-intensive care syndrome: Multicenter study of patients living at home after treatment in 12 Japanese intensive care units, SMAP-HoPe study

Few studies have examined the epidemiology of post-intensive care syndrome in Japan. This study investigated the mental health and quality of life of patients living at home in Japan after intensive care unit (ICU) discharge. Additionally, we examined whether unplanned admission to the ICU was associated with more severe post-traumatic stress disorder (PTSD), anxiety, and depressive symptoms. An ambidirectional cohort study was conducted at 12 ICUs in Japan. Patients who stayed in the ICU for > 3 nights and were living at home for 1 year afterward were included. One year after ICU discharge, we retrospectively screened patients and performed a mail survey on a monthly basis, including the Impact of Event Scale—Revised (IER-S), the Hospital Anxiety Depression Scale (HADS), and the EuroQOL—5 Dimension (EQ-5D-L) questionnaires. Patients’ characteristics, delirium and coma status, drugs used, and ICU and hospital length of stay were assessed from medical records. Descriptive statistics and multilevel linear regression modeling were used to examine our hypothesis. Among 7,030 discharged patients, 854 patients were surveyed by mail. Of these, 778 patients responded (response rate = 91.1%). The data from 754 patients were analyzed. The median IES-R score was 3 (interquartile range [IQR] = 1‒9), and the prevalence of suspected PTSD was 6.0%. The median HADS anxiety score was 4.00 (IQR = 1.17‒6.00), and the prevalence of anxiety was 16.6%. The median HADS depression score was 5 (IQR = 2‒8), and the prevalence of depression was 28.1%. EQ-5D-L scores were lower in our participants than in the sex- and age-matched Japanese population. Unplanned admission was an independent risk factor for more severe PTSD, anxiety, and depressive symptoms. Approximately one-third of patients in the general ICU population experienced mental health issues one year after ICU discharge. Unplanned admission was an independent predictor for more severe PTSD symptoms

Employment status and its associated factors for patients 12 months after intensive care: Secondary analysis of the SMAP-HoPe study

BackgroundReturning to work is a serious issue that affects patients who are discharged from the intensive care unit (ICU). This study aimed to clarify the employment status and the perceived household financial status of ICU patients 12 months following ICU discharge. Additionally, we evaluated whether there exists an association between depressive symptoms and subsequent unemployment status.MethodsThis study was a subgroup analysis of the published Survey of Multicenter Assessment with Postal questionnaire for Post-Intensive Care Syndrome for Home Living Patients (the SMAP-HoPe study) in Japan. Eligible patients were those who were employed before ICU admission, stayed in the ICU for at least three nights between October 2019 and July 2020, and lived at home for 12 months after discharge. We assessed the employment status, subjective cognitive functions, household financial status, Hospital Anxiety and Depression Scale, and EuroQOL-5 dimensions of physical function at 12 months following intensive care.ResultsThis study included 328 patients, with a median age of 64 (interquartile range [IQR], 52–72) years. Of these, 79 (24%) were unemployed 12 months after ICU discharge. The number of patients who reported worsened financial status was significantly higher in the unemployed group (p<0.01) than in the employed group. Multivariable analysis showed that higher age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.03–1.08]) and greater severity of depressive symptoms (OR, 1.13 [95% CI, 1.05–1.23]) were independent factors for unemployment status at 12 months after ICU discharge.ConclusionsWe found that 24.1% of our patients who had been employed prior to ICU admission were subsequently unemployed following ICU discharge and that depressive symptoms were associated with unemployment status. The government and the local municipalities should provide medical and financial support to such patients. Additionally, community and workplace support for such patients are warranted