Post-Fukushima radiation education for public health nursing students: a case study.

BACKGROUND: The recent Fukushima Nuclear Power Plant accident was one of more than 200 serious nuclear/radiation incidents (accidents and disasters) that occurred worldwide since 1945. The current Fukushima disaster is in the recovery phase with the decreasing levels of radiation in the environment. However, fears and stigma related to the perceived risk of radiation exposure persist among the general population. INTRODUCTION: To improve on students' preparedness for social and public health challenges after a radiation incidence, radiation education was provided for undergraduate public health nursing students. AIM: This case study reports the development and implementation of the first class of radiation education in public health nursing, as well as students' reflections on their class experience. METHODS: We included a 90-min radiation class in an undergraduate public health nursing course in Tokyo, Japan. Lectures/discussion on technical and environmental aspects provided the minimally essential content for basic radiation knowledge. After class, all the 65 students were invited to freely write their reflections on the class. With their consent, 61 students' anonymous written accounts were qualitatively analysed. RESULTS: Five themes emerged: awareness of ignorance about radiation, problems produced by the mass media, becoming knowledgeable about radiation, public health nurses' role, and trustful and enjoyable lecture. DISCUSSION: The class inspired students to consider social, psychological and relational aspects of knowing and not knowing about radiation and their future professional role. CONCLUSION AND IMPLICATIONS FOR NURSING: Once radiation is taught at school, nursing students will emerge as professionals with the belief that radiation is within their professional purview. Education is key to disaster prevention, preparation, response and recovery. Given the ubiquitous nature of health challenges after a radiation incident, radiation education is indispensable for nursing students worldwide.

The relationship of social norms to use of services and caregiver burden in Japan.

PURPOSE: To develop an improved measure of "sekentei" (a social-psychological process that restricts behaviors that do not conform to social norms such as family caregiving) among family caregivers in Japan, and to describe the relationships among sekentei and caregiver's actual use of services, a reluctance to use services, and care burden. DESIGN: Descriptive correlational study. Family caregivers (N = 260) of impaired elders responded to a structured questionnaire. METHODS: Exploratory and confirmatory factor analyses were used to assess the construct validity of the sekentei scale for caregivers (SSC). With the SSC, the relationships among main variables were verified. FINDINGS: The SSC showed satisfactory reliability and validity. Sekentei was significantly correlated with care burden, but not to actual use or reluctance to use services. CONCLUSIONS: Sekentei is an important factor related to caregiver burden in Japan. Further research might include the extent to which sekentei is a factor in care burden in other cultures.

Public health nursing in Japan: new opportunities for health promotion.

Major changes are taking place in public health nursing in Japan. These include significant developments in employment, education, and roles of public health nurses (PHNs). Demographic and economic factors have prompted the Japanese government to focus health service delivery on community-based care, particularly for the growing elderly population. Public health nurses are redefining their roles and are assuming important functions in planning, implementing, and evaluating community health programs for the elderly. Japanese PHNs are using a variety of health promotion strategies to initiate change at the local level. This article presents two case studies to highlight the leadership role of PHNs in creating new services that foster healthy communities.

Long-term care for the elderly in Japan.

This article, using data from the first author's research, presents selected issues in long-term care (LTC) of the elderly in Japan. A brief discussion of historical and cultural factors frame the current realities of LTC. These realities include the vast numbers of elderly people in Japan, changing definitions of the relationship of the individual to the group, and enactment of the new Care Insurance Law for the Elderly to be implemented in the year 2000. Some of the work underway for this implementation is detailed.

The meaning of public health nursing: creating 24 hour care in a community in Japan.

This case study describes the strategies and activities of public health nurses to increase the availability of services in a municipality of 36,000 and to transform community attitudes so that those needing services would feel free to use them. Strategies and activities are seen in the context of Japan, Minakuchi Town and the leadership of the chief public health nurse. Practicing in partnership with members of the community, strategies of public health nurses include technical activities (conducting needs assessment and framing program alternatives) and information sharing and health education (e.g. 75 meetings organized with health promoters for residents in the districts of the town). On the basis of the results of Minakuchi Town, viewed as an example of expert public health nursing practice, a general model for public health nursing practice is presented.

[A study on competencies used by public health nurses in creating new health care systems in the community].

The purpose of this study is to clarify the competencies used by public health nurses in creating new health care systems in the community. The subjects were four public health nurses who were nominated by other public health nurses. As a method a qualitative method was used. Each subject was interviewed using a semistructured questionnaire which was made based on each system she had developed. Each interview was tape recorded and transcribed verbatim. Data were analyzed and divided by the seven domains proposed by Benner. The results showed that public health nurses took roles in six out of the seven domains of Benner. Among them the "Organizational and Work-Role Competencies" domain had a lot of content and was divided into more detailed seven subcategories. All four public health nurses were stimulated to create a new care system by exposure to a serious case and being moved deeply through visits to homes and hospital. The desire to solve the problem of individual clients leads to the establishment a new system in the community, showing the originality of the role of public health nurses who have nursing knowledge and who work in a regional government. In the process of building a health care system each public health nurse secured the budget or created a new measure of the regional government. It shows the significance of the role that public health nurses play in the regional government.

Autonomic dysfunction and anemia in neurologic disorders.

The effect of autonomic dysfunctions on anemia in various neurological disorders, such as familial amyloidotic polyneuropathy (FAP) Type I, pandysautonomia, and Shy-Drager syndrome was examined. As a control, hemograms of patients with amyotrophic lateral sclerosis (ALS), which is known to be free from autonomic dysfunction, was compared with patients with the above neurological disorders. FAP and pandysautonomia patients showed significant anemia comparable with the severity of the autonomic dysfunctions. Shy-Drager patients exhibited mild anemia. However, in ALS patients, no such anemia was recognized at all even in the end stage of this disease. In pandysautonomia patients, hypoplastic bone marrow was recognized, which was quite consistent with the data previously reported in FAP patients. Human recombinant erythropoietin improved orthostatic hypotension as well as anemia in 4 FAP patients. These results suggest that autonomic dysfunction may be deeply connected with erythropoiesis.

[Relationship of 'sekentei' to utilization of health, social and nursing services by the elderly].

The purpose of this study was to determine if a relationship exists between 'sekentei' and utilization of health, social and nursing services. 'Sekentei' is the level of a person's self-consciousness of others observing one's behavior and endeavoring to meet the perceived norms of behavior. A questionnaire assessing 'sekentei' was developed and utilized in a survey with 1,294 persons responding to the questionnaires. The results of this study were as follows: (1) 'Sekentei' was related to the place of birth, former occupation and education of persons. (2) Respondents who had a higher 'sekentei' score showed a tendency to have a sense of resistance concerning the use of services. (3) There was a significant relationship between 'sekentei' and utilization of services. These results show the importance of considering individual consciousness of 'sekentei' and characteristics of a community to facilitate use of services and remove the stigma related to social services in a community.

Atypical peritracheobronchial vasculitis and an effective treatment.

We report an interesting case of vasculitis in which the inflammatory lesion was limited to the peritracheobronchus. This case showed positive antineutrophil cytoplasmic antibodies, diffuse peritracheobronchial swelling, and vasculitis in its histology. Steroid therapy was effective for both roentgenological and serological findings. Although the biopsy specimen shows only inflammation and does not satisfy the WHO criteria of Wegener's granulomatosis (WG), a possible diagnosis of WG should not be disregarded.

[A field assessment of a community 'rehabilitation class' for home handicapped persons--focusing on participant social network].

The purpose of this study is to evaluate a community 'Rehabilitation class' for its effectiveness. A function of the 'Rehabilitation class' is the expansion of a participant's social network, and the following hypothesis was formulated: the reciprocal relationships of participant and class or staff members bring about psychological effectiveness and a change of their awareness, resulting in the expansion of social networks. Actual class activity, psychological aspects and social networks of twenty-six participants and twenty care takers, who responded to a questionnaire survey, were examined with respect to the above hypothesis. Those reporting having changed were compared to those reporting no change. The results were as follows: (1) Class activity was directed at developing relationships among participants, and while most of them were changed positively, it appeared that staff members were not sufficiently involved. (2) There were 23 participants in the 'changed' group. Most of their care takers and family were changed positively. Eleven reported receiving significant emotional support from other 'Rehabilitation class' members, and therefore their social networks appeared to have expanded generally. (3) The 'non changed' group consisted of 3 participants whose social networks did not appear to have expanded. (4) Social networks outside the home were not expanded for all participants, probably due to their reported receiving little social support from others outside family members, and because they had few social roles outside the home. Based on the above results, it is concluded that effective classes involve participants individually, and encourage the independent activity of participants, and that it is necessary to have networking with other organizations in community, and the 'Rehabilitation class' should be provided to smaller local regions.

Secondary hypoplastic anemia in patients with familial amyloidotic polyneuropathy.

The anemia of patients with familial amyloidotic polyneuropathy (FAP) was evaluated. Anemia was seen in 32 (91%) of the 35 FAP patients, more often with progression of the disease. The incidence of macrocytic hypochromic anemia was the most common type (40%). In 14 autopsied and 2 biopsied cases, no amyloid deposition was detected in the bone marrow. Thirteen (81%) of the 16 FAP patients showed hypoplastic bone marrow. Bone marrow aspiration of 2 patients revealed a decreased ratio of erythrocytic/myelocytic cells. The plasma levels of vitamin B12 and folate were within normal ranges. Neither oral nor intravenous administration of iron had any effect on the anemia of FAP patients. Intravenous erythropoietin elevated blood hemoglobin levels and blood pressure in 2 patients. Orthostatic hypotension, one of the most common symptoms of FAP, was unexpectedly improved. Secondary hypoplastic anemia is common in FAP, but treatment of anemia in this disease using erythropoietin is promising.

[Study on the relationship between toddler temperament and development (second report)--the relationship between toddler temperament and developmental delay].

The purpose of this study is to clarify the relationship between toddler temperament and developmental delay, and to examine whether the result could be adapted to the health practice of mother and child. As the conceptual framework, we used A. J. Sameroff's transactional model. Questionnaires concerning toddler temperament, rearing environment and toddler development were sent to mothers whose children were scheduled to receive 1 year and 6 months child health examinations, and collected 306 responses. We assessed the developmental status of 41 children among the 306 by means of the Japanese edition of the Denver Developmental Screening Test. All 306 children were classified into either the developmental delayed group (30) or the normal group (275). The data analyses were conducted both quantitatively and qualitatively with the following results. Compared with normal children, developmentally delayed children showed these characteristics: (1) The temperamental category scores of adaptability and persistence were higher, indicating low adaptability and persistence. The prevalence of difficult child, slow to warm up (STWU) child and intermediate high child was relatively higher, with STWU child the highest. (2) The score for the rearing environment was lower. (3) There were cases where disagreement between a child's temperament and the mother's rearing behavior had an influence on the child's development. As a conclusion, these results indicate that a child's temperament must be considered developmental and child-rearing counseling in child health examinations.

[Study on the relationship between toddler temperament and development (first report)--the correlation among toddler temperament, maternal perception and rearing environment].

The purpose of this study is to clarify how a child's temperament and maternal perception influences the rearing environment. As the conceptual framework, we used A.J. Sameroff's transactional model and Miyake's conceptual model of mother and child. The following process was hypothesized: toddler temperament influences maternal perception, which in turn influences rearing environment under which children are developing. Questionnaires concerning toddler temperament, maternal perception and rearing environment were sent to mothers whose children were scheduled to receive 1 year and 6 months child health examinations, and results from 306 mothers and children who answered the questionnaires were analyzed. The results were as follows: (1) Child temperament showed a tendency to accord with maternal perception of how easy it is to handle him/her. (2) Maternal perception was related to rearing environment. (3) Temperamental characteristics were related to rearing environment. (4) While the influence of child temperament and maternal perception on the rearing environment was not shown to be strong, the hypothesized process of this study was supported to a certain degree. From these results, it appears that it is important to pay attention to a child's temperament as a contributing factor in the health practice of mother and child.

Stability of human insulin in solutions containing sodium bisulfite.

The stabilities of human insulin (HI) in aqueous solutions were investigated in the pH range of 4.0-7.0 in the presence (1.0-3.0 x 10(-3) M) and absence of sodium bisulfite (SBS) both in the dark and under scattered light (1000 lux) using high performance liquid chromatography. Increasing concentrations of SBS tended to degrade HI. In the presence of SBS, with an increase in the pH value, the stability of HI decreased in the pH range of 4.0-7.0. There was a partial difference in the stability of HI in the presence of SBS in the dark and that under scattered light. HI was stabilized by glucose in the presence of SBS in the dark, and the stability of HI was revealed to depend on the concentration of free SBS. The reason for this phenomenon was postulated to be the formation of bisulfite-glucose adduct.

Stability of urokinase in solutions containing sodium bisulfite.

The stabilities of urokinase (UK) in aqueous solution were investigated at pH 5.0-8.0 in the presence (1.0-3.0 x 10(-3) M) and absence of sodium bisulfite (SBS) both under scattered light (1000 lux) and in the dark using the fluorogenic substrate method. Increasing concentrations of SBS tended to increase the inactivation of UK. In the presence of SBS, with the increase in the pH value, UK gained in stability in the pH range of 5.0-8.0. The stability of UK in the presence of SBS in the dark was larger than that under scattered light, especially at pH 5.0. Therefore, it was suggested that the difference in the residual activities of UK between under light and in the dark was due to free radicals formed during the autooxidation of bisulfite under scattered light. UK was stabilized by glucose in the presence of SBS both under scattered light and in the dark. One reason for this phenomenon was postulated to be the formation of inactive bisulfite-glucose addition compound. The degradation products of UK during storage in a solution containing SBS were investigated by sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis. UK was revealed to be split into M.W. 36000 form and M.W. 20000 form by SBS.

Stability prediction of nafamostat mesilate in an intravenous admixture containing sodium bisulfite.

The hydrolysis of nafamostat mesilate (NM) in aqueous solution was found to be accelerated by sodium bisulfite (SBS) using high-performance liquid chromatographic assay. The hydrolysis of NM catalyzed by SBS was pseudo-first-order and was considered to be a reaction between nafamostat cation (N+) and sulfite ion. The effects of SBS concentration and temperature on the hydrolysis of NM in buffer solution were examined. From the findings obtained, we estimated the compatible pH range of the intravenous admixture (mixed infusion) of NM after a constant storage time at a constant SBS concentration and temperature employing a simulated pH-profile for the mixed infusion. In order to evaluate the compatibility of the prescribed mixed infusion, the method of pH estimation for the mixed infusion was also investigated using the pH titration curve of each preparation.