Intervention program to promote self-management for prevention of lymphedema after gynecological cancer surgery ― Evaluation of the effectiveness at 12 months after the intervention –

In Japan cancer has been the most common cause of deaths since 1981, and effort has been made to provide countermeasure for cancers. The key to countermeasures is for the general population including cancer patients to know about and overcome cancer. Because the development of cancer is related to lifestyle, it is necessary to work at preventing cancer with attention to the conduct of daily life. The five-year relative survival rate registered in the community from 2006 to 2008 was 62.1%, and this illustrates that there are many cancer survivors leading daily lives after contracting cancer. Uterine cancer was the fifth most common in cancer in 2013. However, it is an important object of the treatment to prevent postoperative complications in gynecologic cancer patients, such as development of lymphedema, because it is reported that the survival rate of uterine cancer is high. The incidence of lymphedema is reported to be between 27.2% and 42% in Japan. Once lymphedema develops, it is difficult to cure, making prevention of the onset an important issue.As a result of the multiple logistic regression analysis performed here using patients where the right femoral circumference increased 2 cm or more as an objective variable, there were differences between the groups analyzed (intervention and control). Compared to the intervention group, 4.46 times more patients in the control group had increases in the right femoral circumference by 2 cm or more. We conducted a randomized controlled trial of an intervention program to promote self-management to prevent lymphedema development after gynecological cancer surgery, and examined the effectiveness at 12 months after the surgery. From the results it can be inferred that observing the lymphedema symptoms including measuring and recording of femoral circumferences and body weight by patients themselves influenced the promotion of self-management. Six months after the surgery, there were significantly more patients who developed lymphedema in the control group, but there were no differences between the groups at 12 months after the surgery. Lymphedema development after gynecological cancer surgery appears about 2.6 months after surgery and chronic lymphedema often appears around 9.7 months after surgery. It can be inferred that this difference is due to the temporary improvement of lymphatic reflux after the improvement of edema. The difference in femoral circumferences is sometimes used as one diagnostic tool for the determination of lymphedema. In this study, we compared the right femoral circumferences before discharge and 12 months after the surgery. Mild lymphedema is defined as larger than 10 mm but smaller than 20 mm in any dimension. In severe cases, a dimension may be larger than 20 mm]. In this study, we performed a multiple logistic regression analysis by defining the patients with lymphedema as patients whose right femoral circumference is increased more than 2 cm. The analysis showed the following as factors influencing the increase in the right femoral circumference by more than 2 cm: group (intervention and control), aerobic exercise, and self-efficacy. Compared to the intervention group, 4.46 times more patients in the control group had increases in the right femoral circumference of more than 2 cm, and this suggests that the intervention program to promote self-management to prevent lymphedema after gynecological cancer surgery is effective at 12 months after the surgery

Práticas alimentares saudáveis: o papel da educação alimentar e nutricionais em adolescentes

Introdução: A adolescência é o período de transição entre a infância e a vida adulta, correspondendo ao período de 10 a 19 anos. Os hábitos alimentares que são vistos mais frequentemente entre adolescentes que em outros grupos etários incluem consumo irregular de refeições, excesso de lanches, comer fora de casa principalmente em locais de fast-food. A Educação Alimentar e Nutricional desenvolve ações e estratégias adequadas às especificidades dos cenários de práticas que contribui para o resultado sinérgico entre as ações. Objetivo: Realizar uma atividade de educação alimentar e nutricional em adolescentes. Metodologia: O presente estudo foi realizado com um grupo de 07 adolescentes estudantes do 7º ano. O trabalho foi dividido em 5 etapas, segundo a metodologia da problematização do Arco de Maguerez. Resultados: Na pergunta “Você considera sua alimentação saudável?” 29% (N=1) responderam “Sim” e 85,71% (N=6) responderam “Não”. Na pergunta Você gostaria de ter uma alimentação saudável?” 100% (N=6) das que deram resposta negativa na questão interior responderam “Sim”. Conclusão: A atividade de EAN contribuiu para o conhecimento aprimorado das adolescentes a respeito de práticas alimentares mais saudáveis, resgatando o interesse pela própria saúde, para uma melhor qualidade de vida das mesmas

Causal Model of Work Engagement among Registered Nurses and Licensed Practical Nurses Working in Long-Term Care Contexts in Japan

The objective of this study was to determine a causal process underlying work engagement, in which individual resources (i.e., resilience) and job resources influence work performance, mediated by work engagement in different types of nurses working in long-term care contexts. We investigated a work engagement causal model in which individual and job resources were set as antecedent factors, work engagement as a mediating factor, and work performance as the outcome, to clarify differences between registered nurses (RNs) and licensed practical nurses (LPNs) working in long-term care contexts. We conducted a questionnaire-based survey with 1,786 Japanese nurses working in long-term care contexts in the Tohoku region. Using 1,269 respondents, we examined the causal model using structural equation modeling (SEM) and multiple population analysis to compare between RNs and LPNs. The results revealed a process whereby individual and job resources influenced work performance, mediated by work engagement, in RNs. In other words, greater individual and job resources enhance pride in work and positive emotion (i.e., work engagement), and greater positive emotion improves work performance. This process was not equivalent in LPNs. In LPNs, the most significant factor affecting work performance was the direct effect of job resources; moreover, the mediating effect of work engagement was not supported. The results demonstrated that in order to improve performance among LPNs working in long-term care contexts, it is important to provide job resource support, as well as to facilitate positive emotion through pride in one’s work

Distance to G14.33-0.64 in the Sagittarius Spiral Arm: H2O Maser Trigonometric Parallax with VERA

We report on trigonometric parallax measurements for the Galactic star forming region G14.33-0.64 toward the Sagittarius spiral arm. We conducted multi-epoch phase-referencing observations of an H2O maser source in G14.33-0.64 with the Japanese VLBI array VERA. We successfully detected a parallax of 0.893+/-0.101 mas, corresponding to a source distance of 1.12+/-0.13 kpc, which is less than half of the kinematic distance for G14.33-0.64. Our new distance measurement demonstrates that the Sagittarius arm lies at a closer distance of ~1 kpc, instead of previously assumed ~2-3 kpc from kinematic distances. The previously suggested deviation of the Sagittarius arm toward the Galactic center from the symmetrically fitted model (Taylor & Cordes 1993) is likely due to large errors of kinematic distances at low galactic longitudes. G14.33-0.64 most likely traces the near side of the Sagittarius arm. We attempted fitting the pitch angle of the arm with other parallax measurements along the arm, which yielded two possible pitch angles of i=34.7+/-2.7 degrees and i=11.2+/-10.5 degrees. Our proper motion measurements suggest G14.33-0.64 has no significant peculiar motion relative to the differential rotation of the Galaxy (assumed to be in a circular orbit), indicating that the source motion is in good agreement with the Galactic rotation.Comment: 14 pages, 7 figures, to appear in PASJ Vol. 62, No.

Experiences of romantic relationships and desires to marry and have children among youth in a low-fertility society.

Introduction: This study aims to explore experiences of romantic relationships and to examine determinants of desires to marry and have children in the future among Japanese university students. Methods: A cross-sectional study was conducted among undergraduate students of A University, located in the capital city of a Japanese prefecture, using an anonymous self-administered and structured questionnaire developed by an online survey software. Results: A total of 815 respondents with complete data were analyzed by logistic regression analysis. Over 80% of males and females expressed the desire to marry and have children in the future. It was found that for both female and male respondents, the "desire to marry" was associated with currently being in a romantic relationship or having experience of sexual intercourse. On the contrary, the "desire to have children" was associated with currently being in a romantic relationship or having experience of sexual intercourse only among male respondents, and no significant association was observed among female respondents. Conclusion: "Currently being in a romantic relationship" and "having experience of sexual intercourse" were associated with wanting to marry and have children in the future among male university students. This suggests that these may be important factors in providing a positive perception regarding having children when they attain childbearing age

Development of a multiparticulate system containing enteric-release mini-tablets of omeprazole

O presente trabalho teve como objetivo desenvolver e avaliar um sistema multiparticulado de liberação modificada, composto por mini-comprimidos revestidos com polímero de liberação pH-dependente, utilizando como fármaco modelo o omeprazol. Os mini-comprimidos (diâmetro de 2,5 mm) foram obtidos em máquina de compresssão excêntrica, revestidos em leito fluidizado com hidroxipropilmetilcelulose/Eudragit(r)L30D55 e, em seguida, acondicionados em cápsulas gelatinosas duras. A partir dos resultados obtidos no perfil de dissolução foi possível demonstrar a liberação gastro-resistente e comportamento cinético de ordem zero. A formulação contendo lactose como diluente, com revestimento de 12% de polímero, demonstrou semelhança com o medicamento referência.The main aim of this study was to develop a multiparticulate system containing mini-tablets of omeprazole formulated with an enteric polymer with pH-dependent solubility. Pre-formulation studies showed good flow and compaction capacity, leading to the production ofhigh quality mini-tablets. The mini-tablets were coated in a fluidized bed with hydroxypropylmethylcellulose /Eudragit(r) L30D55 and packed into hard gelatin capsules. The dissolution profile showed gastro-resistance and zero-order kinetics. The dissolution profile for the formulation containing lactose as the diluent and coated with 12% (tablet weight gain) of polymer was similar to that ofthe reference drug

審査論文 社会福祉を学ぶ学生が感じる楽しさ、難しさと学び方に基づいた授業の工夫の必要性に関する研究

本研究は、本学生活環境学類においてコース選択を終え、社会福祉士国家試験受験資格取得を目指すことが推定される２年生を対象に、社会福祉に対する関心や感じている楽しさや難しさ、学び方をはじめ、社会福祉の現場や相談援助等のイメージづくりに寄与するための授業の工夫の必要性を探ることを目的とした。質問紙法を用いて、特にKJ法による質的データの分析に重点を置いた。　本学類の学生が福祉に関心を持ったきっかけは、半数強が大学の講義や演習であり、福祉の仕事への関心も高かった。福祉を学ぶ｢楽しさ｣には、｢知識としての社会福祉｣と｢生活としての生活の中の社会福祉｣において、新たな知識の獲得や実践的な学びが挙げられた。｢難しさ｣には、｢社会福祉と近接領域の専門知識を習得すること｣と｢相談援助の多様性やそれへの対応方法･技術の理解や習得｣が挙げられ、学生が感じる理論と実践のギャップを埋める支援の必要性が考えられた。｢福祉の学び方｣には、｢授業内容を整理する方法、ツール｣、｢学んだ知識･技術を実践的に理解する方法｣が求められていた。　分析結果から、｢実践的あるいは体験的な学び｣によって社会福祉を理解できるような仕掛けが重要であることが明らかになった。講義や演習それぞれの特徴や限界もあるが、上述の学び方は学生の関心や意欲を刺激する可能性が高いことも推察された。以上を意識した授業の工夫が必要であると考えられた