Analysis on the psychological response of clinical front-line nurses in response to public health emergencies / 中国实用护理杂志

Objective:To investigate the psychological state and influencing factors of clinical front-line nurses in response to public health emergencies.Methods:We used stratified cluster random sampling method to survey 1187 front-line clinical nurses from February to March, 2020, using the Psychological Questionnaire for Emergent Events of Public Health.Results:The questionnaire survey showed that the scores for dimensions of depression, neurasthenia, fear, obsessive-anxiety and hypochondria were (0.52±0.02), (0.37±0.01), (0.87±0.02), (0.24±0.01) and (0.25±0.01), respectively. There were statistically significant differences in scores of hypochondriac dimension for clinical nurses at different hospital levels ( F=4.30, P<0.05), and there were statistically significant differences in scores of depression, neurasthenia, obsessive-anxiety and hypochondriac dimension for nurses in different nursing units ( F values were 4.34-11.11, all P<0.05). Multiple linear regression analysis showed that the nursing unit factors had influence on depression, neurasthenia, obsessive-anxiety and hypochondria. Conclusions:Clinical front-line nurses experienced negative psychology such as depression, neurasthenia and fear in public health emergencies. As a manager, it is necessary to strengthen preventive psychological counseling, do a good job in the theory, operation and protection knowledge training for public health emergencies, humanistic care, establish a good organizational atmosphere to maintain the physical and mental health of clinical nurses, and ensure the quality and safety of nursing.

Zika vírus e medidas de intervenção jurídica em saúde pública / Zika virus and measures of legal interventions in public health

The zika virus is an emerging and important world health problem. In public health its harmful effects have stimulated various legal interests. The Federal Government of Brazil recently adopted several social and health surveillance measures, extending the instruments of possibilities to combating the virus transmitter in Brazil. Law No. 13.306/2016 brought incisive determinations about action awareness policies and educational campaigns, and at the same time authorizes the highest authorities of the Unified Health System (SUS) within federal, state, county and municipal governments to establish and implement the necessary measures to control the diseases caused by the virus, i.e. dengue, chikungunya and zika. The published legislation has created a motivating environment for researchers to develop projects aimed at the mosquito that transmits the dengue virus, the chikungunya virus and the zika virus. Therefore, studies on A. aegypti have led to greater scientific knowledge about its habitat, reproduction and development and a description of means to combat it, as a precondition for the fulfilment of the social purposes of Law No. 13.301, of June 27, 2016, mainly if researches about more efficient management models and management of public finances, contributing to unveiling impacts on public health and growth and human development.

O Zika vírus é um importante e emergente problema de saúde no mundo. Na saúde pública, seus efeitos danosos atingem os mais diversos bens jurídicos. O Governo Federal do Brasil adotou recentemente diversas medidas sociais e de vigilância sanitária alargando o instrumental de possibilidades de combate ao transmissor do vírus no território brasileiro. A Lei 13.306/2016 trouxe determinações incisivas sobre as ações de políticas de conscientização e campanhas educativas, bem como autoridades máximas do Sistema Único de Saúde - SUS de âmbito federal, estadual, distrital e municipal foram autorizados a determinar e executar as medidas necessárias ao controle das doenças causadas pelos vírus da dengue, chikungunya e da zika. A partir da legislação publicada, surge um ambiente motivador para pesquisadores desenvolverem projetos de pesquisa para que o mosquito transmissor do Vírus da Dengue, do Vírus Chikungunya e do Vírus da Zika. Por conseguinte, estudos sobre o A. aegypti possibilitaram o maior conhecimento científico sobre as formas de desenvolvimento, habitat, reprodução e descrição quanto às formas de o combater, como um pressuposto para o cumprimento dos fins sociais da Lei nº 13.301, de 27 de junho de 2016, principalmente se surgirem pesquisas sobre modelos de gestão e gerenciamento de finanças públicas de modo mais eficiente, contribuindo para desvelar impactos sobre a saúde pública e crescimento e desenvolvimento humano.

Avaliação mediante árvore de decisão da qualidade do atendimento odontológico de pacientes oncológicos pediátricos / Evaluación meiannte árbol de desición de la clidad del tratamiento odontológgica de pacientes oncológicos pediátrioos / Evaluatin of denntal treatment quality o oncology pediatric patients obbtained by decision teee

Objetivo: Conhecer os principais fatores que influenciam na avaliação dos serviços odontológicos ofertados a pacientes oncológicos pediátricos e fornecer aos gestores um meio de apoio às decisões que proporcione melhorias na qualidade do atendimento. Material e métodos: A amostra foi composta por 35 pacientes na faixa etária de 3 a 19 anos, sendo os dados coletados por meio de entrevista semiestruturada com os pacientes ou cuidadores. Para a implementação do modelo de decisão baseado em árvore de decisão, utilizou-se a ferramenta de software Waikato Environment for Knowledge Analysis (WEKA20), versão 3.7.8. Resultados: A variável principal para uma percepção ruim do atendimento foi a ?dificuldade em ter acesso ao serviço odontológico?. Considerando os que não tiveram dificuldade, o ?local do atendimento odontológico? (público, privado ou no próprio hospital) se mostrou determinante para uma boa percepção. Considerações finais: A dificuldade em ter acesso ao atendimento odontológico levou a uma avaliação ruim do serviço, enquanto entre os pacientes que não experienciaram esta dificuldade o local do atendimento proporcionou diferentes percepções, dependendo elas de outras variáveis. Portanto, a árvore de decisão se constitui em um modelo de apoio à decisão que possibilita a redução da subjetividade do gestor nas decisões, maximizando a probabilidade de acerto.

Objetivo: Conocer los principales factores que influyen en la evaluación de los servicios dentales que se ofrecen a los pacientes de oncología pediátrica y proporcionar a los directores herramientas de apoyo a la decisión con el objetivo de mejorar la calidad de la atención. Métodos: La muestra estuvo constituida por 35 pacientes cuyas edades estaban entre 2 a 19 años, y los datos recogidos a través de entrevistas semi-estructuradas con los pacientes o cuidadores. Para poner en práctica la decisión basada en el modelo de árbol de decisión se utilizó la herramienta de software Waikato Medio Ambiente para el Análisis del Conocimiento (WEKA20), versión 3.7.8. Resultados: La variable principal de una mala percepción del servicio fue la ?dificultad de acceso a la atención dental?. Teniendo en cuenta ninguna dificultad, el ?cuidado dental local? (público, privado o en el hospital) resultó decisiva para una buena percepción. Consideraciones finales: La dificultad en el acceso a la atención dental condujo a una mala evaluación del servicio, mientras que entre los pacientes que no experimentaron esta dificultad, el local donde fue efectuado la atención proporciono percepciones diferentes, dependiendo de otras variables. Por lo tanto, el árbol de decisión constituye un modelo de apoyo a la decisión que permite la reducción de la subjetividad del gerente en las decisiones, maximizando las posibilidades de éxito.

Objective: Assess the main factors that influence the evaluation of dental services offered to pediatric oncology patients and provide managers with means for supporting their decisions in order to improve the quality of health care offered. Material and Methods: It was considered a sample composed of 35 patients aged 2?19 in which was collected a set of data through semi-structured interviews with these patients or their caregivers. A decision model based on decision tree was implemented in Waikato Environment for Knowledge Analysis (WEKA20) software tool, version 3.7.8. Results: Takingthe obtained decision model in consideration, the main variable or factor that has been influenced a bad perception of the service from patients was the ?difficulty in accessing the dental care service?. Within those that have accessed the dental care service, the variable ?local dental care (public, private or on the hospital)? has been shown to be decisive for a good perception. Conclusions: The main result of this work was that bad evaluation of health care service offered is caused mainly by due difficulties in accessing the service itself. Beside it, when the patients have access to the service, the service place has provided different user perceptions depending on other variables. As a result, the obtained decision-tree based decision model allows managers to reduce subjectivity in their decisions while maximizing the chances of success of their decisions.

Threats of toxic warfare / 军事医学

In 2002, a research report about toxic warfare launched by the United States Air Force attracted the attentionof the U.S.military and civilian disaster emergency rescue organizations .By reviewing historical events related to the malicioususe of toxic industrial chemicals in the war , this report proposed the concept of Toxic Warfare , and discussed itsimpact on the United States military and homeland security .In this paper, the concept and history of toxic warfare and itsinfluence on American military and homeland security are reviewed , the threats of toxic warfare facing China and counter -measures against toxic warfare are analyzed.

Revisión de los casos de dengue en el estado Amazonas, Venezuela, 1995-2008 / Review of dengue cases, Amazonas State, Venezuela, 1995-2008

El dengue se ha ido incrementando significativamente en la región de las Américas e islas del Caribe en las últimas dos décadas. Venezuela ha presentado las mayores tasas de incidencia de DH y el mayor número de fallecidos. En el estado Amazonas se reportan los primeros casos de dengue en el año 1995, siendo el municipio Atures el más afectado. El presente trabajo describe el comportamiento del dengue en el estado Amazonas durante los años 1995 al 2008, mediante la revisión de los registros epidemiológicos y análisis de serotipos del virus DENV. Durante el período 1995-2008 se registró un total de 6209 casos de dengue y 27 con DH, con tres epidemias, quedando demostrada la circulación de los 4 serotipos. Durante las 3 epidemias se hospitalizaron 94 pacientes con Dengue y solo 12 con diagnóstico de DH de 33 con criterios para DH según OPS. En 1995 se registraron 546 casos de dengue, con un solo deceso reportado. La prevalencia anual del Dengue disminuyó en los años 1996-2000 de manera significativa con respecto al año de la epidemia para nuevamente ascender en el año 2001 a cifras de positividad superiores a las del año 1995. Desde el 2003 hasta la fecha el número de casos ha ido en ascenso con presencia significativa de casos de DH. Es necesario que a nivel de la Dirección Regional se estructure un Plan de Control a fin de mantener un Sistema activo de Vigilancia y se revisen periódicamente las pautas de criterios para definir DH.

Dengue fever (DF) has been significantly increasing in the Americas and the Caribbean islands over the past two decades. Venezuela has presented the highest incidence of dengue hemorrhagic fever (DHF) and the largest number of deaths. In Amazonas state the first cases of dengue were reported in 1995, being Atures the most affected municipality. This paper describes the behavior of dengue in the Ama zonas state in the years 1995 to 2008, by reviewing records and epidemiological analysis of DENV virus serotypes. In that period a total of 6209 dengue cases and 27 DHF cases was reported, with three epidemics, proving the movement of the 4 serotypes. During the epidemics 94 pa - tients with dengue were hospitalized, and only 12 were diag nosed with DHF of 33 with PAHO criteria. In 1995 there were 546 dengue cases with one death registered. The an - nual prevalence of dengue significantly declined in the years 1996-2000 compared to the year of the epidemic, but it rose again in 2001 to positive figures higher than 1995. From 2003 until today the number of cases has been increasing with a significant presence of DHF cases. Therefore, it is necessary that in the Regional Health Division a control plan be structured in order to maintain a Monitoring System and periodic reviews of guidelines defining criteria for DHF.

Capacitação do agente comunitário de saúde na prevenção do câncer de colo uterino / Training community health agents in cervical cancer prevention

Atualmente, intensificam-se as discussões a respeito da educação em saúde, principalmente em relação aos agentes comunitários de saúde (ACS), para os quais a capacitação deve ser constante. Este estudo tem como objetivo relatar a experiência de capacitação de ACSs a respeito do tema câncer cérvico-uterino. A escolha do tema abordado baseou-se em sua relevância e na necessidade concreta dos ACSs observados, que não se sentiam empoderados com relação ao assunto. Diante disso, nove acadêmicos de Medicina e Enfermagem, monitores do PET-Saúde da Universidade de Brasília (UnB), realizaram encontros com ACSs dos municípios de Ceres e Santa Isabel (GO), com o intuito de fornecer a esses profissionais mais informações e técnicas para que a abordagem das usuárias em relação ao exame colpocitologico fosse bem-sucedida. A metodologia utilizada foi a integração entre educação bancária e educação dialógica, a fim de que elas se complementassem para alcançar melhores resultados. Foi evidenciado êxito, uma vez que os ACSs demonstraram ter assimilado o conteúdo e ter organizado os conceitos e puderam aplicá-los de forma criativa, envolvendo-se com o aprendizado e acrescentando a ele as suas vivências próprias em relação ao conhecimento aprendido.

Recent years have witnessed increasing discussion on health education, especially for community health workers (CHWs), who should receive continuing training. The aim of this study was to report on an experience with CHWs trained in cervical cancer prevention. The choice of the theme was based on its relevance and the observed need among CHWs, who did not feel empowered to deal with it. Thus, nine undergraduate medical and nursing students, who were monitors in the PET-Saúde project at the University of Brasília (UnB), held meetings with CHWs in the municipalities (counties) of Ceres and Santa Isabel, Goiás State, Brazil, to provide them with information and techniques in order to improve the success of Pap smears for patients. The methodology used a combination of traditional and critical dialogical learning in order to achieve the best results. The training proved successful, since the CHWs assimilated the concepts and were able to apply them creatively, interacting with the learning process and enriching it with their own personal experiences.

Statistic Observation of Marriages, Births, and Children in Multi-cultural Families and Policy Perspectives in Korea / 대한주산의학회잡지

PURPOSE: Recently, the trend of multi-cultural families is rising in number due to increasing marriage-based immigrants in Korea. We evaluated statistic changes of characteristics in international marriage, births, and off-springs for the past 20 years in Korea. METHODS: The annual report of national population from Statistics Korea, the survey results about the present status of resident foreigners from Korea Ministry of Health and Welfare, Korea Ministry of Public Administration and Security, and editorials from Health and Welfare Forum and other related reports of Korea Institute for Health and Social Affairs and Korea Ministry of Health and Welfare were used. RESULTS: There were 35,098 (10.8%) international marriages among total 326,104 marriages in 2010 in Korea. The regional distribution of the international marriage was the highest in Gyeonggi (18.5%), and the lowest in Jeju (1.1%). The metropolitan area Seoul (15.4%), Incheon (4.5%) and Gyeonggi (18.3%) comprised one third of the entire international marriage. The number of childbirths was 13,443 (2.9%) in 2008, 19,024 (4.3%) in 2009, and 20,312 (4.3%) in 2010 with increasing trend. The number of off-springs was 44,258 in 2007, 58,007 in 2008, 99,684 in 2009 and 105,502 in 2010. Children less than 18 years old was 93.1%. We expected 1.5 times of increase over the next coming 10 years in the number of multi-cultural international marriage and off-springs compared with 2011. CONCLUSION: When we evaluated the characteristics of multi-cultural marriages, childbirths, and off-springs, systemic nationwide care seemed to be necessary in the aspect of health problems such as perinatology, obstetrics, neonatology, and pediatrics. We expect our results to be utilized for the basic health data.

Psychiatry disorders and dengue: Is there a relationship? / Transtornos psiquiátricos e dengue: existe uma correlação?

OBJECTIVE: The aim of this study was to examine the relationship of compulsive hoarding with dengue. METHOD: Fifty two adults notified by health vigilance authorities because of inappropriate trash accumulation in vacant lots in Goiânia, Central Brazil, completed a questionnaire regarding the presence and severity of hoarding behavior (Hoarding Rating Scale-Interview HRS-I). Five dimensions of hoarding are evaluated with this instrument: difficulty using spaces due to clutter, difficulty discarding possessions, excessive acquisition of objects, emotional distress and functional impairment due to hoarding behaviors. RESULTS: The sample was primarily male, with an average age of 49 years. Eighty six percent of the sample scored 14 or greater on the HRS-I, indicating pathological hoarding. The medias of the five HRS-I domains were high, indicating severeness of all dimentions of pathological hoarding. CONCLUSION: These results highlight the relationship between psychiatric disorder and actions upon environmental conditions that favors dengue, as well as its associated public health burden.

OBJETIVO: O objetivo deste estudo foi examinar a relação entre colecionismo compulsivo e a dengue. MÉTODO: Cinquenta e dois adultos notificados pelas autoridades de vigilância sanitária por causa do acúmulo inadequado de lixo em lotes vagos em Goiânia, no Brasil Central, completaram um questionário sobre a presença e gravidade de comportamentos de colecionismo (Hoarding Rating Scale - Interview - HRS-I). Cinco dimensões de colecionismo são avaliadas com esse instrumento: a dificuldade de utilização do espaço devido à intensa desorganização, dificuldade de descartar pertences sem função, aquisição excessiva de objetos, distúrbios emocionais e comprometimento funcional devido a comportamentos de colecionismo. RESULTADOS: A amostra foi predominantemente do sexo masculino, com idade média de 49 anos. Oitenta e seis por cento da amostra atingiu 14 pontos ou mais na HRS-I, indicando colecionismo patológico. As médias dos cinco domínios do HRS-I foram altas, indicando gravidade de todas as dimensões de colecionismo patológico. CONCLUSÃO: Estes resultados ressaltam a relação entre transtorno psiquiátrico e as ações sobre as condições ambientais que favorecem a disseminação da dengue, bem como o problema de saúde pública associado.

Ocorrência de parasitas e comensais intestinais em crianças da comunidade da Vila Inglesa, em São Paulo-SP, Brasil / Occurrence of intestinal parasites and commensals among children of Vila Inglesa, community of São Paulo, State of São Paulo, Brazil

O objetivo deste estudo foi avaliar a ocorrência de parasitas em crianças da Comunidade da Vila Inglesa em São Paulo, SP, Brasil. Os exames coproparasitológicos realizados em amostras coletadas de 66 crianças evidenciaram resultados positivos em 69,7% em que os mais prevalentes foram Endolimax nana (48,4%), Entamoeba coli (40,9%) e Giardia lamblia (10,7%). Observou-se que 25,8% das crianças estavam infectadas por mais de um protozoário. Esses achados mostram que as enteroparasitoses ainda representam um sério problema de saúde pública em determinadas comunidades e que há necessidade de programas de saúde para orientar a população a respeito de educação sanitária para a prevenção de doenças.

This study aimed at investigating the enteroparasitosis occurrence in children of the Vila Inglesa community in São Paulo, SP, Brazil. Coproparasitological analyses performed in samples collected from 66 children revealed that 69.7% were infected with protozoa, being Endolimax nana (48.4%), Entamoeba coli (40.9%) and Giardia lamblia (10.7%) the mostly prevalent. It was also observed that 25.8% of the analyzed children were infected with more than one protozoa species. These findings show that enteroparasitosis remains to be a serious problem of public heath in certain communities, and that a health program needs to beimplemented for guiding the population on how the sanitation education can help for preventing diseases.

A produção intelectual em saúde coletiva no âmbito do Estado do Rio de Janeiro: uma trajetória de 1960 a 2007 / The intellectual production in public health on Rio de Janeiro State, Brazil: from 1960 to 2007

Este artigo tem como foco a produção intelectual em Saúde Coletiva nos níveis de mestrado e doutorado cujo tema está no âmbito do Estado do Rio de Janeiro. A pesquisa considerou o período compreendido entre 1960 e 15 de julho de 2007. No subperíodo entre 1960 e 1990, foi encontrado apenas um trabalho no campo da Saúde Coletiva cujo tema foi o Estado do Rio de Janeiro. No subperíodo compreendido entre 1991 e 15 de julho de 2007, foram encontrados 48 trabalhos no campo da Saúde Coletiva referentes a esse estado. A produção foi classificada inicialmente em oito áreas temáticas; Políticas; Epidemiologia; Saúde e Sociedade; Recursos Humanos; Formação Profissional; Modelos de Atenção e de Gestão; Sistemas de Informação e História da Saúde Pública. A área temática Políticas, que lidera a produção, concentrando 22 trabalhos, foi então dividida em duas subcategorias: Políticas do SUS, com 20 por cento, e Políticas Específicas, com 25 por cento. A área temática Epidemiologia, na qual foram encontrados 11 trabalhos (23 por cento), representa outro polo de concentração importante. A produção intelectual total esteve concentrada tanto em dissertações de mestrado (78 por cento) como institucionalmente: a FIOCRUZ lidera a produção de dissertações de mestrado, enquanto o IMS/UERJ lidera a de teses de doutoramento. A despeito da importância do Estado do Rio de Janeiro no Brasil, a pesquisa conclui que a produção intelectual no campo da Saúde Coletiva referente a esse estado é baixa e concentrada em poucas áreas temáticas.

This text focuses on the intellectual production in public health studies expressed through master's degree dissertations and doctoral thesis whose theme was Rio de Janeiro State, Brazil. The research considered the period from 1960 to July 15th, 2007. From 1960 to 1990 there was only one work on the Rio de Janeiro State, and from 1991 to July 15th, 2007, we found 48 works on public health studies concerning Rio de Janeiro State. The intellectual production was classified in eight thematic areas: Policies; Epidemiology; Human Resources; Professional Education and Training; Health and Society; Assistance Models and Management; Information Systems and Public Health History. The theme area named Policies is the production leader with 22 works (and it was divided in two: National Health System Policies (20 percent) and Specific Health Policies (20 percent). The theme area named Epidemiology, with 11 works (23 percent), is another important concentration pole. The intellectual production as a whole had been concentrated both in master's degree dissertations (78 percent) as in a few number of educational and research institutions such as Fiocruz - the leader in terms of master's degree dissertations - and IMS-UERJ, which holds the leadership in terms of doctoral thesis. In spite of the great importance of Rio de Janeiro State in relation to Brazil, we conclude that the intellectual production is reduced and concentrated in a few theme areas.

Aplicação do método de análise hierárquica MAH, visando a utilização de poços com alto teor natural de ion fluoreto, quando única fonte de água para consumo humano

A Portaria nº 518, de 25 de março de 2004, do Ministério da Saúde,estabelece os Procedimentos e Responsabilidades Relativas ao Controle e Vigilância da Qualidade da Água para Consumo Humano e seu Padrão de Potabilidade. O Valor Máximo Permitido(VMP) para a concentração de íons fluoreto deve observar a legislação específica respeitando o VMP da Tabela (1,5mg/l). No Brasil, diversas regiões apresentam águas subterrâneas com concentração natural de fluoretos superior ao VMP, contribuindo para o agravamento da saúde daqueles que as consomem podendo acarretar a fluorose dentária. Este estudo foi baseado na revisão de literatura de alternativas (processos, técnicas) de desfluoretação, sobre as quais se procurou construir um modelo de decisão para a escolha de uma delas, visando o tratamento da água obtida de manancial subterrâneo, quando única fonte hídrica, em comunidades em zonas rurais, cuja análise química apresenta concentração natural de íons fluoreto superior ao permitido pela legislação vigente. O modelo de decisão utilizado foi baseado no Método de Análise Hierárquica (MAH) ou Analytic Hierarchy Process (AHP), que é uma ferramenta de auxílio à tomada de decisão por múltiplos critérios desenvolvida por Thomas L. Saaty no final dos anos 70. Foram considerados os seguintes critérios: (i) características físicoquímicas da água bruta, com ênfase na concentração de íons fluoreto e quantidade a ser tratada; (ii) características físico-químicas da água tratada com ênfase na VII concentração ótima final de íons fluoreto; (iii) custo de implantação, e (iv) custo de produção e de operação e manutenção...

The Regulation N. 518, from March 24 of 2004, by the State Departmentof Health, settles the Proceedings and Responsibilities Relating to Control andSurveillance of Water Quality for Human Ingestion and it’s Potability Standard.The Maximum Contaminant Level (MCL) for the fluoride ion concentration mustfulfil the specific legislation according to the MCL from the Chart (1,5 mg/l).In Brazil, many regions present underground water with a natural fluoride concentration higher than the MAV, aggrieving the health of those who drink it, possibly causing Dental Fluorosis. This study was based on the revisal of defluoridation alternatives/proceedings/techniques literature, over which was attempted to build a decision model for the choice of one of them, aiming at the treatment of the water obtained from underground fountainhead, when it’s the only water source at rural areas and whose chemical analysis presents a natural fluoride ion concentration superior than the allowed by the present legislation.The decision model used was based on the Analytic Hierarchy Process(AHP), which is a supporting tool to the decision making by multiple criteria,developed by Thomas L. Saaty at the late 70’s. The following criteria were considered: (i) physical-chemicalcharacteristics of raw water, emphasizing the fluoride ion concentration and theamount to be treated; (ii) physical-chemical characteristics of the treated water, emphasizing the optimal final fluoride ion concentration; (iii) implementation expenses; and (iv) production, operation and maintenance expenses. From the many defluoridation alternatives analyzed, the bone coal and the activated alumina were considered excellent adsorbents and the most frequently used. However, the operation monitorament was considered too onerous...

Case Study of International Cooperative Activities in Community by Public Health Nurses: Key Challenges in Carrying Out Their Responsibilities / 国際保健医療

 The opportunity for the community health nursing profession to engage in international cooperative activities is increasing in recent years. Many challenges are anticipated for developing the cooperative activities, since the basic situations in each country regarding the environment, the cultural background or the health system are quite different. However analysis of the challenges is not enough, we must also understand limitations based on individual personal experiences. The purpose of this report is to describe the challenges that interrupt the development of cooperative activities.<br> The target group was sixteen public health nurses who were sent to developing countries as JOCV (Japan Overseas Cooperative Volunteers) from June1997 to March 1999. The research was conducted for two years. Data were collected from each participant using five semi-structured questionnaires and analyzed using qualitative methods for the following areas: (1) challenges, (2) changes in viewpoints about the language learning, and (3) changes in participants' health conditions.<br> Fifteen participants returned the questionnaires. Results showed wide variation in the challenges described, and the challenges changed during the period of assignment. During the beginning period, there were many descriptions about difficulties based on daily life and cultural adaptation. Afterward, challenges based on the cooperative activities became the core of issues to resolve. Some challenges involved a lack of information for planning the cooperative activities, lack of funds, a too-short time frame, local staff's resistance to the out-reach activities. Also some issues were very difficult solely on the basis of the personal effort required <br> When we carry out cooperative activities in developing countries, there will inevitably be various challenges. However, there are two types of challenges, challenges able to be resolved by personal effort and challenges in need of system responsiveness. To develop effective cooperative activities in a limited period, it is necessary to understand the possible challenges that will happen and take measures to prevent avoidable situations.