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.

　　We report a case of acute renal failure after extraluminal injection of glycerin enema and discuss the side effects of glycerin enema. A woman in her sixties with anal prolapse complained of anal pain after bowel preparation for colonoscopy with administration of 120mL of 50% glycerin enema. She complained of epigastralgia and nausea 2 h after the enema. Brown urine was observed 10 h after the enema, and urine volume was 96mL/day by the next day. Laboratory data revealed evidence of hemolysis and renal dysfunction, and computed tomography showed air and edema around the rectum. Based on these findings, we made a diagnosis of acute renal failure caused by extraluminal injection of glycerin enema. Hemodialysis was performed 6 times over the course of 9 days, and haptoglobin was administered to prevent renal damage from hemolysis. Following this treatment, there was recovery of renal function and this normalized 2 months after the enema.

The current socioeconomic climate has meant more children spend more time alone at home even for dining. This study was performed to characterize modem Korean childrens' food ecology based on mealtime atmosphere. A total of 705 elementary school students, 347 girls and 358 boys took part in the study. They were chosen evenly from the Seoul metropolitan areas, provincial cities, or rural areas, and were asked to fill out a questionnaire. The questionnaire was categorized to determine various factors related to food ecology, life styles, and health related symptoms. The average age of the study subjects was 11.5 years. The average height, weight, body mass index, and Rohrer index were 143.2 cm, 37.6 kg, 18.2 and 127.2 respectively. A significant number of children(39.2%) answered their bed time was between 11 and 12 pm. Only 28.3% answered that the whole family has breakfast together, and 47.7% have dinner together. A considerable number of children, 17.8% for breakfast and 6.9% for dinner, answered they eat alone. Most of the children answered they like to have dinner with the whole family. Half of the children answered they do not feel hungry before having breakfast. Proportions of children for their favorite meal time were 66.8%, and 25.4% and 7.8% for dinner, school lunch, and breakfast respectively. The largest proportions of children, 53.3% and 68.7%, have breakfast and dinner at home. Most of the children(75.2%) never purchase their dinner. Forty two% of the children answered they like school lunch, however, 60% of children answered they leave portions of lunch uneaten occasionally or always. Only 38.0% and 46.2% of the children have nutritionally adequate diet for breakfast and dinner. Children having more meals with the whole family possessed a more positive attitude towards breakfast compared to the children who eat with the whole family less frequently. In conclusion, Korea children are exposed to different health threatening food ecology problems related to changing environments, and consistent concern and support from community nutritionists are required.
Atmosphere ; Body Weight ; Breakfast ; Child* ; Climate ; Diet ; Ecology ; Female ; Humans ; Korea* ; Life Style ; Lunch ; Meals ; Modems ; Nutritionists ; Seoul ; Surveys and Questionnaires