石舘 美弥子

慣れない環境に順応することが難しい発達障害児にとって、医療機関の受診は容易ではない。診察室内の装飾が気になり、じっとしていられない、特定の音に強い苦痛を感じパニックになる、など、感覚過敏に伴う対処が上手くなされず引き起こされる行動要因に物理的環境因子がある。本研究は、発達障害児が安心して受診できる物理的環境を明らかにし、適切な環境づくりについて示唆を得ることを目的とした。日本小児神経学会のHP上で、発達障害児の診療医師、小児専門医として登録されている医師が勤務する292施設の医師・看護師ら876名を対象に、郵送法による自記式質問紙調査を行った。日本全国の各地から221部（回収率25.2％）の返送があり、そのうち欠損値のある１名を除外した220名（有効回答率99.5％）を分析に供した。統計解析はText Mining Studio ver.7.1.2を使用し、数量的データは単純集計を行い、記述データは係り受け頻度分析、注目分析を行った。対象者の年齢は、50歳代以上100名（45.5％）、40歳代80名（36.4％）の順であった。職種は、看護師138名（62.7％）、医師78名（35.5％）でほとんどを占めた。分析の結果、発達障害児が安心して受診できる物理的環境は、1．寝転ぶことができ、玩具で遊べる、待合室と診察室を融合した一定程度のフロアスペースであること、2．発達障害児に共通する視覚情報の提供として、入室から退室までの見通しがもてるような「スケジュール」、「絵カード」、「パンフレット」を室内に準備すること、3．音や声を制限した静かな空間に、受容的な遊びの絵本や図鑑などを揃え、必要時利用できる個室を整備する、といった内容が明らかとなり、集団環境における標準化の方向性が示唆された。

This study aimed to investigate sleep problems during staying at home due to the coronavirus disease 2019 (COVID-19) pandemic and after returning to campus among university nursing students. We analyzed data from self-reported sleep surveys conducted during a nursing course at a university in Tokyo between 2019 and 2021. During staying at home due to COVID-19, we observed delayed sleep-wake rhythm, prolonged sleep duration on weekdays, a decreased sleep debt, improved daytime sleepiness, and worsened insomnia, especially in terms of difficulty initiating sleep (Study 1; 18 paired data). After returning to campus, we found advanced wake-up time, shortened sleep duration, increased sleep debt, worsened insomnia, and increased daytime sleepiness (Study 2; 91 paired data). The association between advanced midpoint of sleep and commute time over an hour (aOR, 3.29; 95%CI: 1.24-8.72) was confirmed. Furthermore, sleep paralysis and nightmares were more prevalent among nursing students with an advanced midpoint of sleep, whereas nursing students whose midpoint of sleep was delayed had higher daytime sleepiness after returning to campus. To maintain regular sleep-wake rhythms and sufficient sleep duration, the educational environment surrounding nursing university students (e.g., curriculum, class schedule, style of class) should be established considering their age-dependent biological rhythm in addition to sleep hygiene education for students.

The first objective in this study was to identify the errors of incidents and accidents that occurred in general and mobile X-ray examinations. Based on the analysis of results, the second purpose in this study was to propose useful measures to prevent such errors. As much as 553 radiological technologists in the Gunma Prefecture were surveyed on their experience with errors related to general and mobile X-ray examinations. The questionnaire asked for descriptions of errors experienced during examinations and the responses given (multiple answers possible), and evaluations of the degree of busyness on a five-point scale. A total of 115 questionnaires were returned. Analysis revealed that there was no significant relationship between errors and degree of busyness for either general or mobile examinations. The most frequent error both in general and in mobile examinations was to X-ray a patient mistakenly, the cause of which was cited as failure to confirm the patient's name. After the use of solution priority number to evaluate proposed preventive measures, such as finger-pointing and call, independent double-checks, and verbal self-confirmation would be the simplest and most easily implemented countermeasure.