Income Level and Impaired Kidney Function Among Working Adults in Japan

所得と腎機能低下の関連が明らかに --低所得群は高所得群と比べ急な腎機能低下や人工透析開始のリスクが1.7倍--. 京都大学プレスリリース. 2024-03-04.[Importance] Chronic kidney disease (CKD) is a major public health issue, affecting 850 million people worldwide. Although previous studies have shown the association between socioeconomic status and CKD, little is known about whether this association exists in countries such as Japan where universal health coverage has been mostly achieved. [Objective] To identify any association of income-based disparity with development of impaired kidney function among the working population of Japan. [Design, Setting, and Participants] This was a nationwide retrospective cohort study of adults aged 34 to 74 years who were enrolled in the Japan Health Insurance Association insurance program, which covers approximately 40% of the working-age population (30 million enrollees) in Japan. Participants whose estimated glomerular filtration rate (eGFR) had been measured at least twice from 2015 to 2022 were included in the analysis, which was conducted from September 1, 2021, to March 31, 2023. [Exposure] Individual income levels (deciles) in the fiscal year 2015. [Main Outcomes and Measures] Odds ratios were calculated for rapid CKD progression (defined as an annual eGFR decline of more than 5 mL/min/1.73 m2), and hazard ratios, for the initiation of kidney replacement therapy (dialysis or kidney transplant) by income level deciles in the fiscal year 2015. [Results] The study population totaled 5 591 060 individuals (mean [SD] age, 49.2 [9.3] years) of whom 33.4% were female. After adjusting for potential confounders, the lowest income decile (lowest 10th percentile) demonstrated a greater risk of rapid CKD progression (adjusted odds ratio, 1.70; 95% CI, 1.67-1.73) and a greater risk of kidney replacement therapy initiation (adjusted hazard ratio, 1.65; 95% CI, 1.47-1.86) compared with the highest income decile (top 10th percentile). A negative monotonic association was more pronounced among males and individuals without diabetes and was observed in individuals with early (CKD stage 1-2) and advanced (CKD stage 3-5) disease. [Conclusions and Relevance] The findings of this retrospective cohort study suggest that, even in countries with universal health coverage, there may be a large income-based disparity in the risk of rapid CKD progression and initiation of kidney replacement therapy. These findings highlight the importance of adapting CKD prevention and management strategies according to an individual’s socioeconomic status, even when basic health care services are financially guaranteed

Empathy Training Workshop for General Citizens

共感は多くの対人援助職における重要な技能であるが、性的暴行やいじめ問題の防止のために共感訓練の機会が増加している現在の状況を考えると、一般市民にとっても意味のある心の在り方のように思われる。共感訓練はこれまで言語的応答に焦点を当ててきたが、パーソンセンタードの理論からは共感は言語的応答ではなく内的態度であると言われている。共感訓練の必要性とその理論を背景に筆者らは一般市民のための共感訓練ワークショップを2回開催した。本稿はその様子と参加者の感想を紹介し、この経験から筆者らが学んだことを述べるものである。While empathy is an important expertise in many helping professionals, it could also serve as a meaningful attitude for the public given the current increase in training opportunities for the prevention of sexual offense and bullying. Empathy training thus far has emphasized verbal responses, however, it is argued from person-centered theory that empathy is not a set of responses but an internal attitude. In view of such a need for training and its theoretical background, the authors have offered empathy training workshop twice for the public. The paper describes how the two workshops proceeded, how participants felt, and discusses significant points of learning from these experiences

Safety and Efficacy of FIT039 for Verruca Vulgaris: A Placebo-Controlled, Phase I/II Randomized Controlled Trial

TRIAL DESIGN: Human papillomavirus infection causes verruca vulgaris. CDK9 inhibitor FIT039 inhibits DNA virus proliferation in animal models. We conducted a multicenter, single-blind, placebo-controlled, randomized phase I/II clinical trial evaluating the safety and efficacy of FIT039 against verruca vulgaris. METHODS: Target lesions were treated with liquid nitrogen once, and a FIT039 patch or placebo patch was applied for 14 days. The primary endpoint was lesion disappearance. The secondary endpoints were safety and changes in dimension, cross-sectional area, and the number of petechial lesions. RESULTS: A total of 24 participants were randomly allocated to the FIT039 (n = 13, median age, 54 years) and placebo (n = 11, median age, 62 years) groups. Verruca vulgaris did not disappear. FIT039 decreased the dimension to 76% of the initial value on day 29, followed by an increase to 98% on day 57. Placebo showed a monotonic increase to 107% on day 57. Changes in the cross-sectional area and petechiae number were comparable between the groups. CONCLUSIONS: No drug-related adverse reactions occurred. FIT039 efficacy was not determined in this study

Community Clinical Psychological Support of an Evening High School (IV) : providing the revised model of support activities

ある定時制高校の支援要請に対する地域臨床的な支援活動も、筆者らで4年目を迎えた。今年度の支援活動は、昨年度の報告で提示された「支援モデル」（山見・細見・吉川ら，2013）を引き継ぐ形で活動方針を立て、さらに中島・津田・中條ら（2013）が挙げた「今後の課題」を受け、さまざまな改良・改善を加えた。今年度は、昨年度同様、校内支援委員会の開催やグループワークの実施など、定時制高校の先生方との関係性を維持することができた。また、校内巡回や学校行事などへの参加によって、今まで以上に生徒や先生方とのつながりを感じる機会も多かった1年である。そこで、本稿ではまず今年度の支援活動経過を活動内容別に項目立てて報告する。次に、その報告を「支援モデル」の6つの構成要素別に考察する。そして最後に、各構成要素を抽出・羅列するにとどまっていた昨年度の「支援モデル」に対して、各構成要素の関係性や位置関係を明らかにし、新たな改訂版支援モデルとして提示する。For the past three years, the authors have been continuing to provide psychological support to an evening high school. We formed our support activity schemes based on an initial support model (Yamami, Hosomi, Yoshikawa et al., 2013) . Over the year, we gradually made some additions and improvements to that model, taking into consideration the future tasks suggested by Nakajima, Tsuda, Chujo et al. (2013) . We feel that the relationship with the teachers was strengthened through continuous contact and more involvement in school events. The purpose of this article is threefold. First, we report on details of our support activities. Second, we discuss them from the viewpoint of each of the six elements of the support model (Yamami, Hosomi, Yoshikawa et al., 2013) . Finally, we clarify the relationship between the elements of the model, and provide a revised version

Survey Interviews on How Teachers and Students Recognize our Community Clinical Psychological Support Activities for an Evening High School

これまで筆者らは、ある定時制高校において相談室の開室やグループワークなどの支援活動を続け、その報告を行ってきた。しかし、ユーザーである先生方や生徒らからどのように認識されているのかは明らかになっていなかった。そこで今回、校内支援委員会の先生方と相談室を利用していた生徒を対象にインタビューを実施し、活動がどのように認識されており、どのようなニーズがあるのかについて調査した。その結果、筆者らの活動が、生徒らにとって“安心して話せる居場所”を提供していたことと、生徒同士や、先生と生徒という関係とは異なる「斜めの関係」（平井，1997；文部科学省）で生徒とつながっていることなど、筆者らならではの意義が示された。また、支援活動へのニーズとして、①先生方との情報共有、②学習支援、③就職・キャリア支援の3 点が明らかとなった。今後の課題は①校内支援委員会の機会を持ったり、共有ノートを活用していくこと、②筆者らの専門性を活かしながら関係づくりを行い、生徒らの登校意欲や学習意欲向上につなげること、③筆者らの体験談を生徒に語ることで、生徒らの進路について共に考えていく場を作っていくことなどが考えられた。さらに、相談室をより親しみのあるものにしていくため、「相談室」という名称を見直していく必要性についても考察された。The authors have been reporting on our activities to provide community clinical psychological support for an evening high school. However, thus far, the issue of how teachers and students recognize our activities, have not been addressed. Hence, interviews were conducted. The interviews found that our activities have been offering some space for students to feel safe in a "diagonal" relationship that has a different quality from that between students and teachers. It also became apparent from the interviews that we are expected to: 1) share information with the teachers; 2) assist students for learning in class; and 3) engage further in students\u27 career development. We are hoping to: 1) have a meeting together and share a notebook with teachers; 2) motivate students to attend school and study with our own expertise; and 3) offer some opportunities for students to consider career and academic development by disclosing our own personal experiences. In addition, the possibility of changing the name of the room from "consulting room" to something else in order to make it more accessible for students was discussed

Broad targeting of resistance to apoptosis in cancer

Apoptosis or programmed cell death is natural way of removing aged cells from the body. Most of the anti-cancer therapies trigger apoptosis induction and related cell death networks to eliminate malignant cells. However, in cancer, de-regulated apoptotic signaling, particularly the activation of an anti-apoptotic systems, allows cancer cells to escape this program leading to uncontrolled proliferation resulting in tumor survival, therapeutic resistance and recurrence of cancer. This resistance is a complicated phenomenon that emanates from the interactions of various molecules and signaling pathways. In this comprehensive review we discuss the various factors contributing to apoptosis resistance in cancers. The key resistance targets that are discussed include (1) Bcl-2 and Mcl-1 proteins; (2) autophagy processes; (3) necrosis and necroptosis; (4) heat shock protein signaling; (5) the proteasome pathway; (6) epigenetic mechanisms; and (7) aberrant nuclear export signaling. The shortcomings of current therapeutic modalities are highlighted and a broad spectrum strategy using approaches including (a) gossypol; (b) epigallocatechin-3-gallate; (c) UMI-77 (d) triptolide and (e) selinexor that can be used to overcome cell death resistance is presented. This review provides a roadmap for the design of successful anti-cancer strategies that overcome resistance to apoptosis for better therapeutic outcome in patients with cancer

Yolk sac cell atlas reveals multiorgan functions during human early development

The extraembryonic yolk sac (YS) ensures delivery of nutritional support and oxygen to the developing embryo but remains ill-defined in humans. We therefore assembled a comprehensive multiomic reference of the human YS from 3 to 8 postconception weeks by integrating single-cell protein and gene expression data. Beyond its recognized role as a site of hematopoiesis, we highlight roles in metabolism, coagulation, vascular development, and hematopoietic regulation. We reconstructed the emergence and decline of YS hematopoietic stem and progenitor cells from hemogenic endothelium and revealed a YS-specific accelerated route to macrophage production that seeds developing organs. The multiorgan functions of the YS are superseded as intraembryonic organs develop, effecting a multifaceted relay of vital functions as pregnancy proceeds

Community Clinical Psychological Support of an Evening High School (III)

筆者らは今年度もある定時制高校への心理臨床的な支援を行ってきた。今年は高校の先生方が筆者らを校内支援委員会に招いたり、生徒の情報を積極的に提供してくださったりするなど、筆者らの支援活動の意義が先生方に確かに認められていることを感じる年であった。そこで、本稿はいつものように、本年度1年間の活動経過を記述のうえで、先生方との連携が強くなっていることを示す2つの事例を描写する。そして、このような高校支援のあり方に関するモデルを提示する。For the past two years, the authors have been continuing to provide psychological support to an evening high school. Some changes have occurred; school teachers invited us to attend an in-school committee and constantly shared information about students in difficult situations. It implies that our activity and its significance have been recognized among the teachers. In this article, the details of our activity is reported with two cases which show growth in our coalition with the teachers. A model for providing psychological support to high schools is also introduced