Purpose:
To investigate characteristics of community-based issues in nutrition and to assess the effectiveness of a training programme developed to address them.
Design:
The JICA trainee was the chief of the nutrition section of the Nepali Ministry of Health. The project was undertaken after reviewing, in co-operation with JICA, the aims and expected results of the programme. The Nepali trainee alone determined the theme of the programme after considering results of an issue analysis. A programme was then designed to link policy with community realities, incorporating lectures, discussion, and on-site practice. Educational materials employed were those already in use in nutrition programmes both within Japan and in other countries. To create a plan of action, the trainee undertook an analysis of the Nepali communities' institutional and human resources.
Evaluation of the training programme took place on two levels. The trainee self-evaluated her own issues analysis, community resource assessments, and action plan. Additionally, comments made by the trainee during the training period were recorded, categorized and evaluated.
Results:

1. The trainee's analysis of the action plan:

1-1. Community issues were analyzed with support of the Japanese staff. The theme of the training was "Awareness of community resources is an essential part of any nutritional programme".
1-2. Through the analysis of institutional and human resources, the "Tea Shop" was found to be key to the community's nutritional improvement.

2. Staff analysis of the trainee's comments:

2-1. Five stages in the change of the trainee's attitude were observed.
  First stage: Shouldn't the responsibility for resolving nutritional issues be with local workers and organizations?
  Second stage: What are the needs of the local citizens?
  Third stage: What are the responsibilities of the leaders?
  Fourth stage: What is needed for me to fulfill my duties?
  Fifth stage: What is the first thing I should do after returning to my office?

2-2. Support by staff was thought to be effective in making clear the tasks required of the trainee, in providing a framework for understanding the issues from the community viewpoint, identifying methods for establishing links between community and government and making government-produced materials relevant to the community, informing the process of educational materials development, and analyzing community resources.

Older adults tend to lose the opportunities and abilities to pursue hobbies and perform various activities. Club activities provided in the community for old people seem to be beneficial in that the activities prevent them from becoming housebound, and improve overall QOL. In the present study, we conducted a survey by sending out self-answered questionnaire to 424 elder residents in rural areas. We collected information about their life circumstances, the presence or absence of physical pain, activities of Daily Living (ADLs), the degree of enjoyment from activities on the list, the frequency of going out, PGC morale scale and so on. The activities enjoyed frequently by the elderly were bathing, eating and watching TV. The degrees of enjoying eating and bathing showed positive correlations with the PGC morale scale, but the degree of enjoying gambling correlated negatively with the scale. A regression analysis was performed with the PGC morale scale as dependent variables. As a result, a significant model was structured to predict the life sati of the aged by making interpersonal distress, enjoyment derived from gambling, basic ADLs, physical pain and dwelling alone as indepeudent variables. These results will assist us in providing adequate health care to pelple of advanced age.
Morale ; pleasurable emotion ; Academic degree ; Bathing self care ; Activities

For this second report, we divided the efforts of the University of Tsukuba into two parts. In the first part, we introduced the Interprofessional program, an inter-university collaborative educational program between the University of Tsukuba and Ibaraki Prefectural University of Health Sciences. Before the COVID-19 pandemic, this program was conducted using TBL (Team-based learning) in a large conference room. After the pandemic, this was conducted online (using Zoom). The main changes due to the online implementation were the following five points; (1) online faculty meetings, (2) advance distribution of materials, (3) testing using Google Forms, (4) group work using the breakout function, and (5) simultaneous editing using Google Docs. In the future, we would like to examine the possibility of new educational methods while creating innovations that are possible only through online interprofessional educational programs.

In the second part of the second report, we introduce the Care Colloquium, an inter-university collaborative educational program between the University of Tsukuba and the Tokyo University of Science. The Care Colloquium is an interprofessional education program that uses PBL (Problem-based learning). In response to the COVID-19 pandemic, this program was implemented online using Microsoft Teams, with advance preparation including manual maintenance and communication testing. The same learning outcomes were achieved as the face-to-face implementation. Undergraduate interprofessional education tends to be a large-scale program, and the shortage of faculty and classrooms is challenging, but online education could overcome these obstacles. The development of hybrid programs that use the merits of both face-to-face and online education may lead to the promotion of interprofessional education in the future.

It is difficult to implement interprofessional education (IPE) in the classroom due to COVID-19. To share our knowledge of online IPE, we report on how we provided IPE for first-year students at two universities. At Mie University, a class was implemented to use Zoom. Quizzes and chats promoted interactions between instructors and students. At Hokkaido University of Science, an online team medical experience game was conducted via Zoom and a Learning Management System (LMS). The activity promoted interaction between students through gameplay and clear instructions. In both cases, students could successfully develop online IPE based on existing learning methods. Through their experience, it was clear that students are able to understand other professionals’ roles. They were also to commit to membership and/or teamship. On the other hand, students faced challenges with faculty familiarity and time allocation.

Purpose: To determine how nurses perceive the need for advance care planning (ACP) for chronic heart failure with patients and their families. Methods: A questionnaire survey was administered with 427 nurses who were affiliated with implantable cardioverter-defibrillators and resynchronization therapy. The survey included 13 items related to the need for ACP for simulated advanced heart failure cases with patients and their families. Results: Valid Responses were obtained from 207 nurses. On out of all items, the least proprtion of participants (51%) responded “giving predictions about functional prognosis and life expectancy” should be performed with patients. The participants’ perceptions regarding 8 items, which included the items on communication about prognosis, reflected their belief that ACP should be performed with family members rather than the patient. It was found that participants with certification in chronic heart failure nursing were more likely to respond in favor of ACP being performed with the patients in relation to 7 items, which included “ask about what has been important in one’s life”, and being performed with the family in relation to 10 items that included “ask the family what kind of life you want the patient to have hereafter”, as compared to other nurses. Conclusion: Regarding ACP, it is suggested that nurses are careful in discussing prognosis with patients, and certified nurses tend to attach importance to the individualities and values of patients and their families.

Introduction: Research was carried out using a mixed method approach in order to evaluate the educational effects of medical students' visit of an elderly home.Methods: Focus group interviews were conducted with 5 medical students and 5 elderlies. All interviewees had experienced the visitation program more than three times. Self-administrative questionnaires were built based on the results of the focus group interview. The questionnaire was then distributed to medical students and elderlies who participated in the program.Results: A total of 84 medical students and 30 elderlies provided informed consent to participate in the study and returned the questionnaire. Nearly 70 percent of the students answered that they had gotten to know about the life of elderly people and sixty percent of the elderlies answered they had experienced some favorable changes after joining the program. While ninety percent of the elderly were satisfied with the program, only half of the students showed positive comments toward it.Discussion: To help all students participate in this program more actively, more organized planning is necessary so that students can have more chances to build communication skills and clarify their own objectives when visiting the elderly.