title: A Report on the Positive Response to an Outdoor Nature Challenge of a Snow Camp for Young Liver Transplant Patients.
abstract: OBJECTIVE
  More than two decades have passed since the first living donor liver transplantation was performed in Japan in 1989. There are many reports about problems in adherence to taking medication and medical follow-ups in children who received liver transplants, because there is no transition strategy for those children and parents or guardians. The objective of this study is to measure the effect of nature and outdoor activity to improve children's medical adherence.
  
  
  METHODS
  We recruited participants from 9-year-old children who are attending the outpatient liver transplant clinic in a stable condition (no event such as rejection or surgical procedure within 6 months). We took participants to a snow camp and measured its effect by using the IKIRU CHIKARA (IKR) tool, which contain 28 items divided into 3 categories: psychosocial ability, moral fitness, and physical ability. Children were tested on three occasions, before, just after, and 1 month after the camp.
  
  
  RESULTS
  Eight patients participated in the snow camp and 7 patients were eligible for the study. The average age was 12.6 with a range 10 to 17 years. There were 3 girls and 4 boys. The average IKR scores before, just after, and 1 month after the camp were 127.9, 131.5, and 126.6, respectively.
  
  
  CONCLUSIONS
  An outdoor activity such as a snow camp can be safely conducted, and it is an acceptable option to incorporate within a pediatric liver transplant program. There were no significant changes in IKR scores during this short observation. Longer observation is needed to measure the effect of nature and outdoor activities.
authors.affiliation: Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan. Electronic address: soeda@sfc.keio.ac.jp.
authors.forename: E
authors.initials: E
authors.lastname: Soeda
authors.affiliation: School of Medicine, Keio University, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Hoshino
authors.affiliation: Department of Nursing, Keio University Hospital, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Izawa
authors.affiliation: Department of Nursing, Keio University Hospital, Tokyo, Japan.
authors.forename: C
authors.initials: C
authors.lastname: Takaoka
authors.affiliation: School of Nursing, Shibuya Medical Association, Tokyo, Japan.
authors.forename: C
authors.initials: C
authors.lastname: Isobe
authors.affiliation: Miyahara Kids Clinic, Saitama, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Takahashi
authors.affiliation: School of Medicine, Keio University, Tokyo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: School of Medicine, Keio University, Tokyo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Shimojima
authors.affiliation: School of Medicine, Keio University, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Fujino
authors.affiliation: School of Medicine, Keio University, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Shinoda
authors.affiliation: School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kitagawa
authors.affiliation: Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Tanabe
authors.affiliation: Faculty of Health and Sports Science, Juntendo University, Chiba, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Nakamaru
authors.affiliation: Faculty of Educatoin, Shinshu University, Nagano, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Taki
authors.affiliation: Japanese Center for Research on Women in Sports, Juntendo University, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Sekiguchi
authors.affiliation: Tanagokoro, Saitama, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Nakazawa
authors.affiliation: Tanagokoro, Saitama, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Turukawa
authors.affiliation: School of Medicine, Keio University, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kuroda
mesh_terms: D000293:Adolescent; D002648:Child; D015444:Exercise; D005260:Female; D006801:Humans; D007564:Japan; D008099:Liver; D016031:Liver Transplantation / Q000379:methods / Q000534:rehabilitation*; D008297:Male; D010290:Parents; D010349:Patient Compliance / Q000523:psychology; D012449:Safety; D012914:Snow