博士（健康福祉学）

This study examined the effects of role lettering (RL) on mothers raising their first child in infancy. Mothers raising their first child in infancy experience unique childcare anxiety and are prone to mental instability. The Japanese government has set up support systems for mothers raising children, such as postpartum care programs; however, many of these require mothers to go out to seek support. Considering that mothers raising children are unable to go out easily, it is necessary to consider ways to provide support that are more convenient for mothers. We focused on RL as a method to support this. RL is a role-exchange letter method in which one writes a letter from the perspective of both oneself and others, in this case, the mother and the child, respectively. By conducting this back-and-forth correspondence alone, one encourages self-reflection. Putting oneself in another person's shoes allows one to look at oneself from a new perspective, promotes an understanding of the self and others, and encourages self-acceptance. This study hypothesized that RL could be utilized by mothers raising their first child, and if its effectiveness could be clarified, it could be used as a tool to support child-rearing. This paper consists of four sections. Chapter 1 presents the current situation and issues surrounding mothers raising their first child, a literature review on support for mothers raising their children, a literature review on RL, and the significance and purpose of this study. In Chapter 2, semi-structured interviews were conducted after RL was administered thrice to six mothers raising their first child before preschool. The data obtained were analyzed using the KJ method to structure the effects of RL. We also examined changes in the description of letters in the RL. In Chapter 3, we examine the effects of RL using a randomized controlled trial in a group of 26 mothers raising their first 0-year-old child in a group of three RLs and a control group. We also examined changes in the description of letters in the RL. Chapter 4 provides a comprehensive discussion of the effects of RL on mothers raising their first child during infancy based on the findings in Chapters 2 and 3. In sum, the effects of RL done thrice by mothers raising their first child in infancy are as follows. First, mothers write freely to the child, the letter recipient, without restrictions, thus express their feelings honestly; this naturally allows the mother to affirm her own identity. Second, by writing from the child’s perspective, the mother can think of how the child feels. These activities led to an increase in the mother’s self-esteem and positive feelings toward the child. Such a change in feelings gives the mother of a firstborn child a sense of recognition and confidence in her parenting. The results suggest that such confidence may lead to behavioral changes and willingness to connect with the outside world, such as mothers visiting places for parent-child interaction and consultation with public health nurses.

This study was conducted to investigate the actual contamination of chicken meat with pathogenic microorganisms at each stage of the food chain, to clarify the risk of foodborne diseases, and to examine measures to reduce the risk. The survey at the distribution stage revealed that Campylobacter was isolated from 35.7% of commercial chicken meat in Yamaguchi Prefecture, and that the contamination rate was high in specific parts such as liver and during the summer season. Genotyping of the isolates by the mP-BIT method confirmed the presence of pathogenic genes and a high level of contamination with fluoroquinolone-resistant bacteria, which are feared to make treatment of infectious diseases more difficult. These results suggest that the disinfection of commercial chicken meat distributed in this prefecture is not sufficiently reduced in terms of foodborne diseases risk by the time they reach the distribution stage. Therefore, it is important to prioritize risk reduction measures at the consumption stage of chicken meat, and it is necessary to further educate consumers on the prevention of foodborne diseases. A survey at the chicken slaughtering stage showed that chicken meat shipped from a chicken slaughterhouse in Yamaguchi Prefecture was highly contaminated with Campylobacter, and that the disinfection of chicken meat by the cooling process using sodium hypochlorite at the facility was not sufficient to reduce the risk of foodborne diseases. In the future, it is necessary to improve sanitation management, such as the type of disinfectant, concentration used, and cooling time, in accordance with the actual conditions of the number of broiler processed and equipment at the facility. In addition, it was considered necessary to examine measures to prevent contamination of broiler at each production farm. A survey of several farms at the production stage revealed that the Campylobacter-positive rate was 46.9% in the Chugoku region and 75.0% in the Kyushu region, and the Salmonella-positive rate was 84.4% in the Chugoku region and 89.3% in the Kyushu region. The different characteristics of the contamination status of farms and broiler flocks, the bacterial species and serotypes, genotypes, and the acquisition of drug resistance were observed in the different regions. Therefore, it is important to take regional characteristics into consideration when clarifying the risk of foodborne diseases of chicken meat and considering measures to reduce the risk. The investigation of contamination factors in farms and broiler houses suggested that although the environment inside and outside the broiler house and feed were not factors for Campylobacter invasion and spread, contamination spread to the feeding environment through feces of infected broiler after 5 to 6 weeks of brooding. In addition, continuous contamination of Salmonella was confirmed in the feeding environment, including the bedding material (recycled fermented litter) of the broiler house. The results also suggested the spread of Salmonella through feed and workers. Therefore, it is necessary to strengthen measures to reduce the risk of food poisoning by improving farm broiler feeding hygiene management manuals and introducing hygiene management based on Hazard Analysis and Critical Control Point (HACCP). In particular, it is necessary to establish Critical Control Points for sanitary management of bedding (recycled fermented litter) and to verify fermentation temperatures and times that can completely destroy the bacteria. In order to promote appropriate sanitary management based on HACCP at the chicken slaughtering and production stages, effective foodborne diseases risk reduction measures should be implemented at each stage of the chicken meat food chain based on the knowledge obtained in this study under cross-field collaboration and cooperation among various entities such as government health departments, livestock breeding departments, research institutes, businesses, and consumers. Based on the findings of this study, it is necessary to take effective measures to reduce the risk of foodborne diseases at each stage of the chicken meat food chain to ensure food safety and security.

The purpose of this study was to clarify the current status of support for children with chronic diseases through interprofessional collaboration and Yogo teachers’ roles in such collaboration. In inclusive education systems, it isimportant to develop various flexible structures that allow the teaching of children with individual educational needs, with a view to promoting their independence and social participation while fulfilling their needs. However, collaborative systems between schools and related institutions are still insufficient, and Yogo teachers’ roles in interprofessional collaboration remain unclear. Therefore, the need for studies to clarify the current status of support through interprofessional collaboration andYogo teachers’ roles in such collaboration was realized. This paper consists of 4 chapters. Chapter 1 specifies the background and objective of the present study, and discusses the current status of support through interprofessional collaboration and Yogo teachers’ challenges to carry out their roles in such collaboration based on policy trends for children with chronic diseases and the related literature. Chapter 2details a hypothetic model on Yogo teachers’ roles in interprofessional collaboration formulated from the quantitative analysis of data obtained from interviews with four institutions. Chapter 3 examines Yogo teachers’ roles that affect the outcomes of interprofessional collaboration based the quantitative analysis of data obtained from a questionnaire survey involving Yogo teachers working at public elementary/junior high schools. Chapter 4 describes the findings regarding Yogo teachers’ roles ininterprofessional collaboration. In the present study, the hypothetic model was evaluated and it was found that [support approaches to fulfill educational needs] lead to [agreement among supporters], and affect the [outcomes of interprofessional collaboration], such as <establishment of trust-based relationships with various other professionals/institutions>,<systems for handover when children are promoted to the next grade or proceed to the next level of education>, <broadened the understanding of children and methods to support them>, and <guarantee of a prosperous life for children with chronic diseases>. [Support approaches to fulfill educational needs] are part of individualized support, provided through <commitments to nurture self-esteem in children>, <perception of changes in physical condition through daily observations of health and analysis of records>, and <support based on characteristics>. [Agreement among supporters] is the step to build support systems through collaboration with teachers and various other professionals,including <information transmission byYogo teachers>, <development ofin-school support systems by information-sharing>, <understanding of Yogo-teachers by principals> and <acquisition of health management methods focusing on child development>, with this last item having the greatest impact. Specifically, Yogo teachers must provide support tailored to each chronically ill child’s characteristics to assist them in the acquisition of health management methods centered on development in conjunction with multiple professionals.But also to provide education that promotes understanding about children with chronic diseases by recognizing that the children around them are also supporters. Yogo teachers are expected to play a role as coordinators in promoting cooperation among multiple professions with shared goals of support and normative integration. Furthermore, they must provide support tailored to the children’s characteristics through daily observation and record analysis, disseminate support content for the educational needs of children with chronic diseases, deepen the understanding of principals and teachers, and develop an environment where the entire school can respond as a team. Above all, it is important to collaborate with multi-professionals to create support that allows children with chronic diseases to acquire their own health management methods as the subject of their own development.

The introduction of the long-term care insurance system and revisions to the Medical Care Act have increased the number of patients with intractable diseases who receive care in home settings. However, dissatisfaction and confusion were reported by patients and their caregivers when managing intractable diseases at home. To address this, a community care system was suggested as a "new system to support intractable diseases." This is in line with the Intractable Diseases Act, which aims to achieve and build collaborative relationships in which both parties and supporters can work together. Thus, in this study, the formation of a system for long-term, home-based, and community-centered care for patients with intractable diseases was composed across four chapters. This project also aims to investigate the feasibility and implementation of a community care system for intractable diseases. Chapter 1 reviews the history and research of community care systems for intractable diseases. It outlines the absence of specific measures for the establishment of a regional community care system, and the challenges of addressing individual cases of intractable diseases as regional issues. It also emphasizes the importance of understanding and addressing drastic changes in medical care of such patients in a timely manner. However, presently, little is known about the actual situation of patients with intractable diseases. Chapter 2 examines how patients with intractable diseases who receive home-based care rebuild their own lives. For these patients to continue their life at home, they must strive for self-management and receive the necessary support to build a lifestyle that adapts to long-term medical care. Building trust with health care providers and their engagement with systemic gaps has a significant impact on patients’ quality of life. Chapter 3 explores the experiences of a patient with an intractable disease who struggles with home-based care, its limitations, and deciding when to visit a health facility. They share that their life is unstable and repeatedly restructured, forcing them to make passive decisions when visiting a health facility, thereby experiencing a loss of autonomy and resulting in feelings of “giving up.” In Chapter 4, we examine the possible implementation of a community care system based on our findings. Such systems for intractable disease patients require a dual structure of common and individual systems, which can complement each other and enable multidisciplinary, professional support for intractable disease patients with a high level of individuality. The establishment of community care systems for patients with intractable diseases can lead to the construction of a more comprehensive healthcare system that addresses a wider range of health concerns.