大塚 公一郎

[目的]地域ケア実践看護師のコンピテンシーを明らかにする。[方法]研究対象は、A大学で開発した地域ケアスキル・トレーニングプログラムの受講者と看護管理者で同意の得られた者47名に、半構成的面接法を実施した。分析方法は質的内容分析をした。[結果]地域ケア実践看護師のコンピテンシーは、『ICT等による新たな学習方法を通して学習スタイルを拡大し継続する力』『地域で培われた対象者の価値観・関係性を包括的に把握する力』『地域内外の資源を調整し、工夫する力』『対象者が地域で暮らし続けるためのヘルスケアチームづくりおよびチームを育成する力』『医師との協働により隙間のない医療体制を創り上げる力』の5つが生成された。(著者抄録)

自治医科大学附属病院では2003年より腎移植診療を開始しているが、同時期からドナー候補者に対して第三者による意思確認として全例精神科医師による面談が行われ、移植手術の適否についての判断をしてきた。今回われわれは2009年1月から2014年6月の期間に生体腎移植でのドナー候補に対する精神科医による面接116件に関して、当院倫理委員会に提出した「腎移植ドナーの意思決定に関する報告書」を後ろ向きに検討し、ドナーの腎臓提供の動機などの項目を調査し当院での生体腎移植の実際について報告した。レシピエントとドナーの関係の種類や提供の動機などを調査した。夫婦間、親子間などほぼ1親等間による提供で占められており、提供の動機としては「これまでのお礼、恩」や「今後も一緒に生きていきたい」というようなポジティブさを感じさせるものが最も多い一方で、ある種の義務感を感じさせる回答も多かった。臓器移植は臓器を「贈与」す

自治医科大学看護学部の1期生から7期生までの卒業生の動向を知る目的で,卒業生を対象に郵送法による自記式質問紙調査を実施した。本稿では回答の得られた178名を対象に,卒業後の現状と看護職を継続するための要因を探った。その結果,卒業直後よりも現在の方が就業者数は減少しているにも関わらず,保健師職や助産師職の就業者数は増加していた。また,卒業直後の就業先選択理由として,(1)教育研修の充実,(2)実習施設であったが主であった。職場の満足理由として,(1)知識・技術が学べる,(2)職場の人間関係が良い,休みが保障されている,(3)やりがいがある,人の役に立つ等があげられていた。一方,転職経験のあった回答者は約4割で,卒業後3年目までの転職が約7割を占めていた。転職理由の多くは,結婚や他にやりたいことがあったなどであった。今後,へき地での勤務を希望する卒業生の割合は,回答者の約3割を占めていた。今後は同窓会との協力支援体制を強化し,卒業後1年目から3年目を対象とした資格取得や看護職のサポートシステム(活躍している卒業生との交流,資格取得やへき地での勤務に関する情報提供等)を検討する必要性が示唆された。(著者抄録)

Aims: This study aimed to make a comparison of the mental health status between Japanese-Brazilian children in Japan and in Brazil. Methods: A total of 331 Japanese-Brazilian children at five Brazilian schools in Japan (Japanese Group), and 172 Japanese-Brazilian children at one private school in Sao Paulo (Brazilian Group) were enrolled in statistical analyses. The Strength and Difficulties Questionnaire was applied for parents, teachers, and students who were aged over 11 years old. Results: The total comparison of the Strength and Difficulties Questionnaire scores between the two groups demonstrated that all the average symptom scores except prosocial behavior were significantly higher in the Japanese Group by parent report. By teacher report, the average symptom scores of conduct problems, hyperactivity, peer problems and total difficulties were significantly higher in the Japanese Group, while that of the prosocial behavior was significantly higher in the Brazilian Group. Dividing parent and teacher reports into two age ranges, similar results to the total comparison were seen in the parent report in the age range of 4-10-year-olds and both parent and teacher reports in that of 11-16-year-olds, while in the teacher report for 4-10-year-olds, only conduct problems and total difficulties score showed significantly higher average scores in the Japanese Group. By self-report, the average symptom scores of emotional symptoms, peer problems and total difficulties score were significantly higher in the Japanese Group. Conclusion: The results indicate poorer mental health status in the Japanese Group than the Brazilian Group, and suggest the adverse circumstances of the former group both at their homes and schools.

Introduction Although the mental health of Japanese-Brazilian children in Japan has become a matter of concern, few studies have employed a psychological approach and no research of these children's mental health has previously been performed at Brazilian schools in Japan. Methods The present study used a sample of 241 children aged 4 to 10 years at five Brazilian schools in Japan. The Strength and Difficulties Questionnaire was applied for their guardians and teachers to detect the probable cases of mental disorders. Demographic data of the children were also collected from their guardians and a further analysis was made to determine the risk factors of the probable cases of conduct disorders. Results The proportion of probable cases was 0.8% for emotional disorders, 9.1% for conduct disorders, 2.1% for hyperactivity disorders, and 10.0% for any psychiatric disorder. The detected risk factors of conduct disorders were male sex, 8 to 10 years of age, living without a father, and not talking often with their teacher. Discussion The proportions of probable cases of mental disorders were not as high compared to general prevalence ranges or earlier studies. Considering the school and home situation of the children, living without a father seemed to be the foremost risk factor of conduct disorders.

Few studies have investigated the long-term course of patients with acute polymorphic psychotic disorder, despite the clinical relevance. The present study focused on the frequency of acute polymorphic psychotic disorder without symptoms of schizophrenia (F23.0) and the prognosis of patients with the disorder over a long period. A total of 388 inpatients with nonaffective psychosis were examined and cases with F23.0 were retrospectively investigated regarding clinical course over 12 years with reference to clinical charts. A total of 16 cases were diagnosed with F23.0 according to first episode. After 12 years, five cases were rediagnosed with schizophrenia, and one case with borderline-type emotionally unstable personality disorder, although the diagnosis of F23.0 was not changed in 10 older patients. Of the four cases with > 2 repeated episodes of F23.0, the same clinical picture as in the first episode was observed in three, while one case showed continuous residual symptoms. F23.0 does not represent a homogeneous clinical entity. In some cases, diagnosis changes to schizophrenia, but others display repeated episodes of F23.0.

The aim of the present study was to assess the mental health status of Japanese-Brazilians living in Kiyoharadai, Japan and compare the findings with the Japanese-Brazilians living in Bauru, Brazil. A comparative community-based mental health survey was conducted from November 1997 to April 1999 on a randomly selected sample of Brazilians of Japanese descent living in Bauru, Brazil (n=213) and on the entire Brazilian community of Kiyoharadai, Utsunomiya, Japan (n=158), using the self-reporting questionnaire (SRQ-20). Analysis was done by chi(2) Fisher and multiple logistic regression. Scores indicating probable cases of minor psychiatric disorders, were found in 3.2% of the community in Bauru city and 17.8% (OR=7.01) of the community in Kiyoharadai. The sociodemographic data indicated that those with high SRQ-20 scores were most likely to be female (OR=2.98), smokers (OR=2.76). and those whose former occupation was student when living in Brazil (OR=9.57). The mental health status of the Japanese-Brazilians living in Kiyoharadai, Japan is significantly worse than that of the community living in Bauru, Brazil, particularly among women, smokers and those who were students when living in Brazil. Further research concerning the mental health of this community is necessary and assistance provided.

The comparatively high salaries made in Japan are attractive to many Japanese-Brazilians. The number of individuals from this ethnic group being treated in Japanese mental hospitals has increased. We hypothesized that Japanese-Brazilian patients with panic disorders adjusted better to Japanese society and culture than those with other mental disorders. The subjects in the present study are 40 Japanese-Brazilian patients undergoing treatment at the Department of Psychiatry at Jichi Medical School, Japan, from May 1990 to September 1998. Patients were divided into a panic disorder group, a schizophrenic group, a mood disorder group and a neurosis group. Demographic data (Japanese language ability, duration of residence in Japan etc.) were collected. A comparison was made among the four groups. Patients in the panic disorder group showed a significant tendency to be fluent speakers of Japanese. Patients in the panic disorder group also had been in Japan for a significantly longer period of time than those in the other three groups. Japanese ability and length of residence in Japan rule out exacerbating factors due to a foreign living environment. Panic disorder patients usually have resolved the problems inherent in living and working in a foreign country. In general, Japanese-Brazilians are more comfortable both financially and socially in Japan than other foreign laborers because of their cultural and family background. The emotional conflict experienced by such patients may result from concern over whether to live in Brazil or Japan in the future. Their ethnic and cultural identity may be confused, fluctuating between identifying with Brazil and with Japan, and this may cause vague feelings of anxiety.

Carbamazepine-induced pitch perception shifts have rarely been described. Two cases of shifted pitch perception developing during medication with carbamazepine are described. Case 1 possessed absolute pitch. Her pitch perception shift disappeared with the discontinuance of carbamazepine. Case 2 did not have absolute pitch. Even though he experienced a pitch perception shift, he developed a tolerance to the shift. We concluded that carbamazepine was the cause of the pitch perception shift in the first case, while the second case probably became attuned to the change in pitch perception because he did not possess absolute pitch.