作業療法実践にパーソン・センタード・ケアや認知症ケアマッピングをより良く生かすための考察：作業療法実践・理論とパーソン・センタード・ケアの理念や認知症ケアマッピングの比較検討

研究報告Original Articles　本研究では作業療法の実践理論や評価方法とパーソンセンタードケア（PCC）と認知症ケアマッピング（DCM）の比較検討を通して，作業療法におけるPCC，DCM の適用可能性について考察した．作業療法の実践理論と評価方法については人間作業モデル（MOHO）と運動とプロセス技能の評価（AMPS）を採用した．① MOHO とPCC は，「対象」「個人の意志」「自己の同一性」「能力への着目」「人間理解の方法」「倫理的観点」に着眼し，② AMPS とDCM は，「対象」「目的」「評価内容」「評価ポイント」「活用者」「活用方法」に着眼して比較検討した．本研究の結果，①については，「個人の意志」をMOHO は個人の文脈を重視する一方でPCC は心理的ニーズをあらかじめ想定していること，「社会倫理的観点」をMOHO は持たないがPCC は持っている等の相違点が明らかになった．②については，特に「活用方法」について，AMPS では作業遂行能力の向上のための客観的エビデンスとして活用できるのに対し，DCM はPCC の視点に基づいてケアスタッフ間で合意したエビデンスを活用できる特性の違いが見出された．　In this study, we discussed the applicability of person-centred care (PCC) and dementia care mapping (DCM) in occupational therapy by comparing the theory of occupational therapy and its method of evaluation with PCC and DCM. We adopted the Model of Human Occupation (MOHO) as the theory of occupational therapy practice, and used the Assessment of Motor and Process Skills (AMPS) for the evaluation. 1) MOHO and PCC focused on “object,” “individual will,” “self- identity,” “client’s ability,” “human understanding,” and “ethics.” 2) AMPS and DCM focused on “object,” “purpose,” “evaluation contents,” “evaluation score,” “user,” and “utilization.” Comparison of results of MOHO and PCC showed that MOHO emphasizes the individual context while PCC pre-supposes the psychological needs of the individual and includes “social and ethical viewpoints”, while MOHO does not. Results of comparison of AMPS and DCM indicated that AMPS was able to employ “utilization” as objective evidence for the improvement in occupational ability, while DCM was able to use the evidence agreed upon among staff, based on PCC viewpoints

介護予防を目的とした住民運営の通いの場で支援を行う作業療法士の役割

研究論文Original Articles　目的：介護予防を目的とした住民運営の通いの場で間接的支援を行う作業療法士の役割について明確化すること．対象：A 県B 町憩いのサロンプロジェクトを主導してきたリハビリテーション専門医であるA 氏，サロンのボランティア養成講座の講師を担当してきた作業療法士B 氏．方法：A 氏，B 氏へ個別インタビュー調査を行い，目的に沿って結果を整理した．結果：サロン全体の取り組みと作業療法士が関与する点，ボランティア養成講座を通した作業療法士の支援の視点が明らかになった．考察：作業療法士の役割として，サロンの企画・運営の支援，ボランティア養成講座の企画・講師，サロン実施の際のサポートと振り返りの助言，サロン参加者の評価と行政へのフィードバック，の4点があった．　Purpose: To clarify the role of the occupational therapist who provides indirect support at the place administered by residents in the community, with the aim of preventing nursing care. Participants: Mr. A, a rehabilitation specialist who has led the salon project for Town B in prefecture A; and Mr. B, an occupational therapist who has been in charge of teaching a training course for volunteers in the salon. Methods: Individual interviews were conducted with Mr. A and Mr. B, and the results were arranged according to the purpose. Results: The activities of the entire salon, the involvement of occupational therapists, and the perspective on the support provided by occupational therapists through the volunteer training courses were clarified. Discussion: The occupational therapist had four roles in the salon: (1) to support planning and administration of the salon, (2) to plan and lecture at the volunteer training course, (3) to support the salon conduct and give advice on reflection, and (4) to evaluate participants who come to the salon and give feedback to the administrators

国外での作業的公正における作業療法士の介入と規範に関する文献レビュー

総説Review articles　背景：1993 年より促進された社会的公正の理論の作業療法への適応と，その後概念化された作業的公正について，どちらも日本で広まりつつあるが，文献は少なく，日本での作業的公正に関する概念は議論途上である．　目的：国外の作業療法士が作業的公正という概念のもと行なっている調査研究を経年的に調べ介入と規範の具体例と傾向を明らかにすること．　方法：PubMed にてOccupational Justice で検索した．検索された論文のうち調査研究を分析対象とし，作業的公正，不公正の実例を抜き出した．さらに調査研究の目的・方法・OT の介入や規範についてレビューマトリックスを用いてまとめた．　結果と考察：作業的公正，作業的不公正の実例は日本の作業療法で対象とならない事例が多かった．作業的公正についての調査研究で述べられた作業療法士の規範をまとめると，対象者個人の作業を通した社会参加の支援に加え，作業療法士の社会への関わりの必要性が示された．国外文献の調査と，それらを障害の社会モデルの視点を取り入れて慎重かつ丁寧に分析すること，そして国内での発展が望まれる．　Background：Adaptation to occupational therapy of social justicewas promoted in 1993, and the occupational justice that was conceptualized afterward is spreading out in Japan. However, there are only a few documents that have discussed the concept of occupational justice in Japan.　Object：The aim of this study is to clarify the intervention by citing specific examples and the tendency of the model by checking overseas occupational therapists’ research on the occupational justice concept with age.　Methods：The PubMed database was used to search articles on the keyword “Occupational Justice.” The search was targeted on scientific research works that have analyzed occupational justice and occupational injustice. In addition, we have divided it into purposes, methods, interventions, and norms.　Results and Implications：With respect to the examples for occupational justice, most of the research studies did not seem to be applicable for Japanese occupational therapy. The written norms supported the social participation through the occupation. In addition, it was said that occupational therapists should associate with society. Future studies should investigate overseas documents and adopt the viewpoint of the social model of the obstacles carefully

GWAS for Japanese CSC

PURPOSE. Central serous chorioretinopathy (CSC) is a retinal disorder that often affects the vision of middle-aged people yet the molecular mechanisms of CSC remain unknown. This study was conducted to identify genetic factors influencing individual differences in susceptibility to CSC. METHODS. A two-stage genome-wide association study (GWAS) was conducted with a total of 320 unrelated Japanese idiopathic CSC cases and 3245 population-based controls. In a discovery stage, 137 unrelated Japanese idiopathic CSC cases and 1174 population-based controls were subjected to GWAS, followed by a replication study using an additional 183 individuals with idiopathic CSC and 2071 population-based volunteers. The results of the discovery and replication stages were combined to conduct a meta-analysis. RESULTS. In the two-stage GWAS, rs11865049 located at SLC7A5 in chromosome 16q24.2 was identified as a novel disease susceptibility locus for CSC, as evident from the discovery and replication results using meta-analysis (combined P = 9.71 × 10−9, odds ratio = 2.10). CONCLUSIONS. The results of the present study demonstrated that SLC7A5 might be the potential candidate gene associated with CSC, indicating a previously unidentified molecular mechanism of CSC

重度失語症者にとっての旅行の意味付けと旅行後の生活への影響 : 作業療法における旅行の活用方法についての一考察

実践報告Practical reports　目的：海外旅行に参加した夫婦にインタビュー調査を行い，重度失語症者にとっての本旅行の意味付けと旅行後の生活への影響を考察することで，作業療法における旅行の活用方法について示唆を得ることである．対象と方法：失語症のある人の中から，配偶者が調査時に同席可能であり，旅行後の生活において事故などの旅行とは無関係なイベントのない4 名を対象とし，「発障前の生活」「発症後の生活」「旅行後の生活」「本旅行への関心」「本旅行に対する満足・不満足」「また旅行に行きたいか」について聴取した。結果・考察：本旅行への意味付けと，参加態度，満足度，旅行前後の生活変容の状況を事例毎に整理した．結果より，主体的な旅行参加はその後の生活にも肯定的影響を与える可能性がある，旅行への参加態度は本人の抱く旅行への意味付けの能動性が影響する，旅行に対する満足度の高低と旅行後の生活活性化の有無は関係しない傾向がある，の3 点が考察された．　Objectives: The purpose of the current study was to investigate the meaning of traveling and how traveling affected the subsequent lives of patients with severe aphasia, by conducting interviews with couples that participated in international traveling. We hoped to gain insights about how traveling can be utilized in occupational therapy. Participants and Method: We enrolled 4 individuals with aphasia who had not had any events unrelated to traveling (e.g., accidents) in their post-travel lives, whose spouses were also available to attend the interviews. We gathered information about “life before aphasia,” “life after the onset of aphasia,” “life after the travel,” “interest in the travel,” “satisfaction/dissatisfaction of the travel,” and whether the patient would like to go to travel again. Results and Discussion: We organized the patients’ report on the meaning of the travel, their attitude about participating, degrees of satisfaction, and changes in their life pre- to post-traveling. The results suggested the possibility that the patients’ voluntary participation in the travel had positive effects on their lives after traveling. The patient’s attitude about participation in the travel was impacted by how actively the patient put a meaning to this travel. Lastly, the degrees of satisfaction of the travel were not associated with revitalization of life after the travel

聖隷クリストファー大学リハビリテーション学部における授業開放週間（オープンウィーク）とピアレビューの試み

実践報告Practical repor

日本における認知症ケアマッピングに関する研究の動向

研究報告Original Articles　本研究では、日本におけるDCMを用いた研究の様相を探り、研究活用の意義とDCMを用いた研究の今後の方向性について考察を行った。対象文献を内容の類似性でカテゴリ化したところ6つのカテゴリが生成された。【ケアの変化】【ケアする人の意識の変化】【単独介入への適用】【普及方法の模索】【内在的検討】【その他】である。結果より、今後はDCMに関する研究水準の向上、特定介入に対する効果検証、ケア実践者が結果を受け止めやすいフィードバック方法の検討、単独介入への適用について効果検証を行った事例数の蓄積、施設や人の壁をブレークスルーできる普及方法の開発で研究の進展が期待されると考えた。The paper explored the status of studies on dementia care mapping (DCM) in Japan and their significance, as well as future trends of DCM. When the papers were categorized based on the similarity of the contents, six categories were constructed: “change of care”, “awareness of change in caregivers”, “application of independent intervention”, “exploration of distribution methods”, internal discussion” and “other”. As a result, research development was expected by improvement in research levels on DCM, verification of the effect of special intervention, investigation of a feedback method for caregivers to easily obtain results, accumulation of cases to explore the effect of application of independent intervention, and methods to diffuse development of distribution methods to break through the obstacles of institutions and humans

Development of early neutropenic fever, with or without bacterial infection, is still a significant complication after reduced-intensity stem cell transplantation

AbstractLittle information is available on the clinical characteristics of infectious complications that occur in the early period after reduced-intensity stem cell transplantation (RIST). We retrospectively investigated the clinical features of neutropenic fever and infectious episodes within 30 days after RIST in 76 patients who had received fluoroquinolones as part of their antibacterial prophylaxis. Preparative regimens included cladribine 0.66 mg/kg or fludarabine 180 mg/m2 plus busulfan 8 mg/kg. All but 1 patient survived 30 days after transplantation, and 75 patients (99%) became neutropenic within a median duration of 9 days. Neutropenic fever was observed in 29 patients (38%), and bacterial infection was confirmed in 15 (20%) of these, including bacteremia (n = 13), bacteremia plus pneumonia (n = 1), and urinary tract infection (n = 1). The causative organisms were gram-positive (n = 9) and gram-negative organisms (n = 7), with a mortality rate of 6%. Neither viral nor fungal infection was documented. Multivariate analysis showed that the presence of neutropenia at the initiation of preparative regimens was an independent risk factor for subsequent documented bacterial infections (P = .026; 95% confidence interval, 1.25–35.1). We conclude that neutropenic fever and bacteremia remain common complications in RIST

ヘルスプロモーションを目指した介護予防における作業療法士の間接的支援の支援構造 : 住民運営通いの場への参加促進要因についての作業科学の視点からの一考察

研究論文Original Articles　目的：本研究では，住民運営通いの場への参加促進要因を質的，帰納的分析により抽出し，その結果から，間接的支援のための支援構造を考察することを目的とした．対象と方法：個別インタビューはサロンの立ち上げに関与したA 氏に行い，フォーカス・グループ・インタビューは，サロン研究やそれに類似する高齢者介護研究を実施してきた研究者4 名に行い，結果を，帰納的に分析し，カテゴリ化を行い，カテゴリを説明する概念を付した．また先行研究を参考にし，さらに作業科学の知見を基にテーマを設定した．結果：people に関わる要因とplace に関わる要因に分類された．People に関わる要因は，作業的存在としてのbelonging とdoing に分けられた．考察：人を作業的存在として捉えたとき，サロンは，健康志向性を持った，高齢者の誰をも受け入れるbelonging を用意し，ソーシャルキャピタルを育成するdoing を提供しているplace であると整理できた．　Aims: This study aims to extract factors that promote participation in a community-based social program in a local senior salon via qualitative and inductive analyses and discuss a structure for occupational therapists to provide indirect support. Subjects and methods: An interview was conducted with Mr. A, who was involved in the launch of a local senior salon, and a focus group interview was conducted with four researchers who have studied the role of senior care centers among the elderly and elderly care. An inductive analysis was conducted. The results were categorized, and a concept explaining each category was assigned. Additionally, a theme was set based on the knowledge of occupational science. Results: Factors were classified into those related to people and those related to place. Factors related to people were further divided into “belonging” and “doing” in terms of the human as an occupational being. Discussion: When an elderly person is deemed as an occupational being, a local senior salon was a place that accepts all elderly people, provides elderly people with a sense of belonging, and provides them with a sense of doing while cultivating social capital