Published papers

従来清潔行動の研究蓄積の少ない産科病棟に焦点を当て,新生児ケアに直接関与する看護職の清潔行動を検討した.質問紙調査では看護職は新生児入室や新生児ケアなど新生児に関する手洗いの必要性は認識していることが示唆されたが,観察法では先行研究と同様,看護職の清潔行動への過大評価が伺え,全体的に効果的な清潔行動が行われておらず,特に速乾式手指消毒ではその値が低かった

産後1ヵ月前後の褥婦20名の搾母乳を試料とし、冷凍で1ヵ月保存した後、「流水解凍」「電子レンジ解凍」「湯温解凍」という3通りの方法で解凍を行い、搾乳直後と比較して母乳中の[IgA活性][リパーゼ][グルコース][総蛋白質][総脂質][総コレステロール]がどのように変化しているか、解凍法別に検討した。結果、IgA活性は搾乳直後の中央値に比べて「流水解凍」と「電子レンジ解凍」で低下傾向を示し、「湯温解凍」では有意に上昇していた。リパーゼは搾乳直後に比べて全ての解凍法で減少し、特に「電子レンジ解凍」と「湯温解凍」では有意に減少していた。グルコースは全ての解凍法で有意な変化なく、総蛋白質は「電子レンジ解凍」と「湯温解凍」で有意に増加し、総脂質は「湯温解凍」で有意に減少、総コレステロールは「電子レンジ解凍」と「湯温解凍」で有意に減少していた。

QATQSは1998年に公衆衛生活動の実践をサポートするエビデンスとして質の高いシステマティックレビューを提供するために作成され、研究者の評価の手助けとしてユーザーマニュアルが添付されている。また欧米では量的研究のレビューを行うための尺度が作成されているが、本邦では日本語で使用できる一般的な尺度がこれまでなかったことから、今回J-QATQSを作成し、その信頼性(評価者間信頼性)について検討した。既存のQATQSは、「選択バイアス」「研究デザイン」「交絡因子」「盲検化」「データ収集方法」「対象の脱落率」の6項目について、2〜4つの質問と、QATQSとは別のユーザーマニュアルから検証しなければならず、説明文書が長いことから使いにくい問題があった。また項目によっては結果がSTRONGともMODERATEとも取れる揺らぎのある割り付けがある場合があった。そのためJ-QATQSは使用者の利便性を考慮し、ユーザーマニュアルをJ-QATQSの中に入れ込み、項目ごとに2〜3の質問で構成し、STRONG、MODERATE、WEAKのいずれかに集約される形のステップ・チャートを作成した。このJ-QATQSをQATQSの原著者に見てもらい、QATQSとの等価性に問題はないことを確認した。評価者間信頼性も高いことが確認され、論文を客観的に評価できる可能性が示唆された。

産婦人科の病棟・外来を利用している妊産婦,授乳婦計50名とその児及び産婦人科病棟の医療従事者30名を対象に黄色ブドウ球菌の保有状況や伝播経路などを検討した.その結果から妊産婦や新生児の病院利用には黄色ブドウ球菌感染のリスクがあることが示唆された.病棟看護職23名に対して清潔行動に必要な知識や看護場面別手洗い時間などを問うアンケート調査を行ったところ,清潔行動の知識はあるものの実際には有効な行動がとられていないことが明らかになった

ポリエチレングリコール処理静注用ヒト免疫グロブリン(PEG処理IVIG)のα-hemolysinに対する中和作用と臨床分離MRSAの産生する溶血毒に対する中和作用について検討した.その結果,ヒツジ血液を溶血した臨床分離MRSAの297株中153株(51.5%)に確認され,PEG処理IVIGの効果を精製されたα-hemolysinに対する検討では,その溶血を完全に阻害する中和効果が確認され,さらにMRSA培養液中に産生されるhemolysinの中和効果も確認された.MRSAの培養液中に産生されるhemolysin様活性物質の主な溶血はα-,β-hemolysinによるものであり,PEG処理IVIGはこれを中和したために溶血を阻害したものと考えられた.その中和力は菌株によって異なり,PEG処理IVIGを64倍から512倍まで希釈した範囲で溶血を阻害していた.以上より,PEG処理IVIGはMRSA産生の菌体外毒素のTSST-1やenterotoxinの中和ばかりでなく,hemolysinに対する中和効果も認められた

We report here an outbreak of beta-lactam-induced vancomycin-resistant methicillin-resistant Staphylococcus aureus (MRSA; BIVR) at one of the Cancer-Institute-affiliated hospitals in Tokyo. We examined a total of 500 strains (100 per year) of clinically isolated MRSA from 1998 to 2002. The detection rates of BIVR in the years 1998, 1999, 2000, 2001, and 2002 were 10%, 9%, 49%, 15%, and 19%, respectively. To investigate the cause of the high incidence of BIVR detection in the year 2000, we carried out pulsed-field gel electrophoresis (PFGE) of the SmaI-digested chromosomal DNA of BIVR and MRSA. The results showed that 96% of the BIVR strains isolated in 2000 were classified as an identical DNA type "A", while only 47% of the MRSA strains were classified as this type. We concluded, based on these results, that this hospital had a nosocomial infection of BIVR in the year 2000. An important message given by this study would be that nosocomial BIVR infection could occur in any hospital where MRSA infection is treated with vancomycin and beta-lactam antibiotics.

Recently, beta-lactam antibiotic induced vancomycin-resistant MRSA (BIVR) has been reported increasingly in Japan. Between 1998 and 2002, we tried to detect BIVR from 500 strains of MRSA in a cancer hospital. And the difference of the detection rate under condition of pre-culture with or without ceftizoxime was compared. The detection rate of BIVR under condition of pre-culture with 1.0 mg/L of ceftizoxime was 20.4% (102/500), and without ceftizoxime was 9% (45/500). That of preculture with 1.0 mg/L of ceftizoxime was higher than those without ceftizoxime with the significant difference. (p < 0.001; McNemar-t examination). In comparing each department, the detection rate of BIVR from Chemotherapy, Head & Neck, and Urology department was 33.3%, 27.0%, and 20.0%, respectively. These results mean that addition of beta-lactam as ceftizoxime in pre-culture induces the ability of resistance to vancomycin for MRSA having a capacity as BIVR.

Abstract In Japan, many fathers consider their spouse to be their children’s primary parent while casting themselves in a supporting role. Yet, in the majority of reported child maltreatment cases in Japan, the child’s father is recorded as the perpetrator. This may seem somewhat puzzling, given that primary caregivers are recorded as the perpetrator of maltreatment in other cultures. This study qualitatively analyses the parenting experience of 11 Japanese fathers and their reflections on child maltreatment risks. Semi-structured interviews were conducted with fathers of pre-school aged children from middle-class families who had no reported history of child maltreatment. Using qualitative content analysis through a process of condensing, coding and categorising, we arrived at the following theme: fathers aspire to be an active parent, while respecting and supporting their spouses, but anxiety and stress trigger impatience and frustration during parenting. The fathers reported that they are more likely to maltreat their children, especially boys, in situations which triggered anxiety and frustration. Anxiety is particularly heightened when they feared public embarrassment. These findings are discussed with reference to the Japanese social and cultural context, and contrasted with previous research into the parenting experiences of Japanese mothers. The findings indicate that fathers may benefit from tailored support programmes which strengthen their self-efficacy before building resilience for the challenging situations they may encounter as fathers.

Methicillin-resistant Staphylococcus aureus (MRSA) has been defined as S. aureus having the mecA gene or showing a minimum inhibitory concentration (MIC) of oxacillin higher than 4 mg/l. However, some clinical isolates are mecA-positive and oxacillin-susceptible. Therefore, we surveyed the occurrence of S. aureus having the mecA gene and an MIC of oxacillin of less than 2 mg/l (oxacillin-susceptible MRSA; OS-MRSA) in a total of 480 strains of S. aureus collected from 11 hospitals in different location in Japan isolated from 2003 through 2005. We found 6 strains matching the criteria for OS-MRSA. All 6 strains were staphylococcal cassette chromosome (SCC) mec-positive, without exception, and 4 strains showed the SCCmec type III-variant, which is unique in Japan. These OS-MRSAs were least resistant to oxacillin among the MRSAs tested and they were within the susceptible range to seven other beta-lactam antibiotics tested. Thus, OS-MRSA may become a high-resistant MRSA upon the treatment of patients with beta-lactam antibiotics. To characterize whether these OS-MRSAs were hospital-acquired or community-acquired MRSAs, we tested for the presence of the genes encoding toxins. Genes encoding hemolysin, exfoliative toxin, enterotoxin, toxic shock syndrome toxin-1, and Panton-Valentine leukocidin were found in 6, 4, 0, 0, and 0 strains, respectively. These results revealed that OS-MRSAs could be classified as a new type of MRSA that exhibits properties distinguishable from either hospital- or community-acquired MRSA. Coagulase typing of the OS-MRSAs supported the above conclusion. In this study, the occurrence of OS-MRSA at a certain frequency was noted; precautions are called for in the classification of oxacillin-resistant S. aureus and in the treatment of OS-MRSA infection.

We could not detect hetero-vancomycin-intermediate resistant Staphylococcus aureus (hetero-VISA), according to the definition of hetero-VISA, from the clinical isolates of 140 methicillin-resistant S. aureus (MRSA) strains. However, 15 beta-lactam antibiotic-induced vancomycin-resistant MRSA (BIVR) strains were detected from the same strains. We screened 1882 MRSA clinical isolates obtained in 2002 from 21 institutes throughout Japan. The detection rate of blood-isolated BIVR was 12.6% (19/151), and that of nonblood-isolated BIVR was 4.9% (85/1731; P < 0.001; chi2 test). Uridine-diphosphate-N-acetylmuramyl-L: -alanyl-D: -isoglutamyl-L: -lysine, used as the peptidoglycan material of S. aureus, showed the same results as beta-lactam antibiotics in BIVR.