断酒に至る過程に関する実態調査

断酒に至るまでには，どのような問題があり，その問題に断酒会会員がどのように対処しながら，断酒に至ったかを明らかにすることが目的である．断酒会会員２９４人を調査対象として質問紙および留め置き調査を行った．回収率は５６．８％（１６７名：男性１５０名，女性１７名）であった．調査対象者の平均年齢は５８．６±１１．１（mean±SD）（男性５９．７±１０．５，女性４８±１１．７）歳であった．初回飲酒年齢は平均１８．４±６．３歳であり，１５歳未満の初回飲酒は男性２８名，女性５名であった．飲酒歴は平均２５．４±１１．３年（男性２６．４，女性１６．５年）で，平均断酒期間は１０年１ヵ月±９年６ヵ月（男性１０年７ヵ月，女性４年６ヵ月）であった．調査対象者は飲酒によって家庭や仕事における深刻な問題を引き起こしたため，酒量の調節を試みたが，逆に飲酒量が増し連続飲酒状態に陥り医療機関を受診していた．断酒例会への継続参加により，断酒が可能となり，信用と健康を取り戻し，自信となっていることがあきらかになった．アルコール依存症者が再び社会で正常な日常生活が送れるようになる為には断酒が唯一の方法であることがあらためて確認された．Aim : The purpose of this survey is to clarify alcohol-related problems, the coping methods and how to reach total abstinence in the self-help group members for total abstinence. Method : A mail survey and/or a placement method survey of alcohol dependency were conducted in two prefectures. Subjects were ２９４ recovering alcoholic and they were members of regular meeting for total abstinence. The response rate was５６．８％（１５０males,１７females）. Results : Subjects average age was ５８．６±１１．１ （mean±SD） years （male, ５９．７±１０．５； female, ４８±１１．７ years）. The average of first alcoholic experience of them was at the age of １８．４±６．３. Twenty eight men （１８．６％） and five women （２９．４％） started drinking at the age of less than １５years old. Average duration of drinking was ２５．４±１１．３ years （male, ２６．４； female, １６．５years）, and average abstinence periods were １０．１±９．５years （male, １０．６； female, ４．５years）. They tried to regulate the amount of alcohol because of serious social problems at a home and/or workplace by drinking. However, they could not visit hospitals or clinics until they lapsed into the continuous excessive drinking state. They could quit drinking with continuous participation to regular meeting for total abstinence （Dansyu Reikai） and regained trust, health, and self-confidence. Conclusion : These results suggest that the method to quit drinking is not a self-regulation of amount of alcohol but an attendance of Dansyu Reikai （self-help group participation）

アルコール依存症者の婚姻状況と飲酒関連行動・断酒に関する認識

本研究は，断酒会に入会するまでの飲酒をしていた時のアルコール依存者の行動と現在の状況を調査し，更に婚姻と飲酒による問題に関連した各調査項目および断酒に関する認識との関係を明らかにすることが目的である．調査項目は，①対象者の婚姻の有無別平均年齢・飲酒期間・断酒期間に加えて，②婚姻別断酒会に入会するまでの飲酒をしていた時の状況の９項目，および③断酒会入会後の現在の状況についての４項目の計１３項目である．調査の結果，既婚者で酒の影響による疾患があると回答した人が有意に多かった．断酒歴は既婚者が１１．６±１０．４年，未婚者４．８±６．０年で，既婚者が有意に長かった．要因として考えられることは，①既婚者の平均年齢が高く，飲酒歴が長いことから身体的疾患を抱えている割合が高いこと，②イネイブラーの存在が飲酒行動を助長している可能性があること，③配偶者の存在が治療継続意欲に結びついたことで医療機関への受診に繋がり，④身体合併症の発見率が高くなること，そして，⑤既婚者，未婚者ともに常時再飲酒行動への不安を抱いていることから，断酒継続の動機要因になっていると考えられた．The aim of this paper is to examine the associations between marital status, drinking problems, awareness of alcohol addiction. The questionnaire is composed of １３ items that （１）marital status, average age, average length of alcohol drinking and average length of abstinence（ALA），（２）drinking problems before admission into the group of alcoholics “Danshu-kai” （Japan Sobriety Association, JSA）for total abstinence, and （３）the present situation after admission into the JSA. Statistically significant difference was obtained in alcohol-related health problems in the married group. ALA of the married group （１１．６±１０．４ yrs）shows significantly longer than unmarried group （４．８±６．０ yrs）. These results suggest that： （１）average age of the married group was high, also length of alcohol drinking is long, therefore this group have a high prevalence of physical illness； （２）enabler may be promoting problem drinking； （３） possibility health problems would be discovered by the spouse； （４）the existence of a spouse is related to the motive for abstinence continuation and this has contributed to the successful abstinence； （５）both group have a profound understanding of alcohol dependence, because they worry about alcohol slip

婚姻状況と飲酒による問題行動

背景：アルコール依存症では，支えとなる婚姻の有無が，問題行動に大きな影響を与え，それが治療方針や予後を決定する因子となることが多い． 目的：本研究では，婚姻の有無がアルコール依存に関連する問題と断酒継続にどのような影響を与えるかについて検討した． 方法：調査対象者は断酒会会員２９４人を調査対象とした．回収率は５６．８％（１６７名：男性１５０名，女性１７名）であった．調査内容は，婚姻の有無に加え，①飲酒による問題行動（飲酒で喧嘩・警察沙汰になった）の有無，②飲酒による対人関係の崩壊の有無，③アルコール依存症の認知の有無，④現在の節酒の可能性の有無，⑤機会飲酒（冠婚葬祭・会合等）の経験の有無，⑥断酒会に入会する前の断酒の経験の有無，⑦断酒後の生活の変化，⑧スリップ（再飲酒）の経験の有無，⑨飲酒欲求の有無，⑩問題飲酒の経験の有無，⑪断酒会以外への所属状況であった． 結果：飲酒による問題行動（飲酒で喧嘩・警察沙汰になった）（▯２＝３．９８，P＜０．０５），断酒会以外への所属状況（▯２＝４．００，P＜０．０５）では，未婚者が有意に多かった． 結論：既婚者の場合には，配偶者が飲酒による問題行動を警察沙汰にまでしないように制止もしくは緩衝する役割を果たしていると推察された．また未婚者は断酒を日々継続していく生活の工夫として断酒外以外の他の組織にも所属していると推察された．AIM : Alcoholism is a relevant problem in public health. Family intervention is a necessary condition for the complete recovery of the alcoholic and their partners. The family system is a more powerful force than the addiction itself and has great potential for overcoming or sustaining the alcoholism. The purpose of this study was to investigate the relationship between the marriage status and the problem associated with alcohol dependence and abstinence. METHOD : A mail survey and/or a placement method survey of alcohol dependency were conducted in two prefectures. Subjects were ２９４ recovering alcoholic and they were members of “Danshu-kai” （Japan Sobriety Association）for total abstinence. The response rate was ５６．８％ （１５０males，１７females）. Survey contents were a marriage status, problem associated with alcohol dependence, and items related to continue abstinence. RESULTS : In the item of problem behavior（fight or a problems with police）by drinking（▯２＝３．９８，P＜ ０．０５） and belonging to the Danshu-kai and the other group（▯２＝４．００，P＜０．０５），there were many replies of unmarried people significantly compared with married people. CONCLUSION : The findings suggest that alcohol-dependent clients’ partner was repressing or adjusting the alcohol problems in the case of the married person, the unmarried person belonged also to the Danshukai and the other group as a device to continue abstinence

精神科における多職種連携の取り組み

精神科においては精神障害者の生活の質の向上のために退院促進が求められている．そのためにはチームアプローチが不可欠であり，それを実践するためには，各専門職者の持っている能力を統合した活動を展開しなければならない．学際的連携チームケアモデルInterdisciplinary collaborative teamcare model （ICTCM）とは，チームケアを実践するための具体的な方法（教育，理論，実践，研究）を示すものである．そこで，ICTCMを使用して，チームケアサービスの質の改善活動の一環として，看護サービスをレベルアップすることを目的とした多職種参加による看護診断学習会を行ってきた．その結果，チームケア運営体制の整備，職種間の役割理解及び職種間で積極的に情報を共有しようとする姿勢が改善したと考えられた．This article describes workshop on nursing diagnosis that aimed improving an interdisciplinary collaboration in the psychiatric hospital. Psychiatric hospitals are required the promotion of discharge a patients with chronic mental disorders in order to enhance the quality of life of the people with mental disorders. For that purpose, team approach is absolutely imperative. In order to practice team approach, we have to unify the competency of each professional. Interdisciplinary Collaborative Team Care Model （ICTCM）shows the concrete method（education, theory, practice, research）for practicing team care. Our hospitals’ staffs are working based on this model in order to assure continuous improvement of providing efficient and high-quality of team care services. Nursing diagnosis workshop based on this model has been performed which aims to improve nursing services involve the participation of various health care professional. The overall conclusion of the report was that the management system of the team care is well-organized, also understanding of the role of other professions, the active and positive attitude for sharing information between inter-health care providers have improved

One-Step Detection of the 2009 Pandemic Influenza A(H1N1) Virus by the RT-SmartAmp Assay and Its Clinical Validation

<div><h3>Background</h3><p>In 2009, a pandemic (pdm) influenza A(H1N1) virus infection quickly circulated globally resulting in about 18,000 deaths around the world. In Japan, infected patients accounted for 16% of the total population. The possibility of human-to-human transmission of highly pathogenic novel influenza viruses is becoming a fear for human health and society.</p> <h3>Methodology</h3><p>To address the clinical need for rapid diagnosis, we have developed a new method, the “RT-SmartAmp assay”, to rapidly detect the 2009 pandemic influenza A(H1N1) virus from patient swab samples. The RT-SmartAmp assay comprises both reverse transcriptase (RT) and isothermal DNA amplification reactions in one step, where RNA extraction and PCR reaction are not required. We used an exciton-controlled hybridization-sensitive fluorescent primer to specifically detect the HA segment of the 2009 pdm influenza A(H1N1) virus within 40 minutes without cross-reacting with the seasonal A(H1N1), A(H3N2), or B-type (Victoria) viruses.</p> <h3>Results and Conclusions</h3><p>We evaluated the RT-SmartAmp method in clinical research carried out in Japan during a pandemic period of October 2009 to January 2010. A total of 255 swab samples were collected from outpatients with influenza-like illness at three hospitals and eleven clinics located in the Tokyo and Chiba areas in Japan. The 2009 pdm influenza A(H1N1) virus was detected by the RT-SmartAmp assay, and the detection results were subsequently compared with data of current influenza diagnostic tests (lateral flow immuno-chromatographic tests) and viral genome sequence analysis. In conclusion, by the RT-SmartAmp assay we could detect the 2009 pdm influenza A(H1N1) virus in patients' swab samples even in early stages after the initial onset of influenza symptoms. Thus, the RT-SmartAmp assay is considered to provide a simple and practical tool to rapidly detect the 2009 pdm influenza A(H1N1) virus.</p> </div

Yokukansan, a Kampo medicine, prevents the development of morphine tolerance through the inhibition of spinal glial cell activation in rats

Background: Animal models have shown that glial cells (microglia and astrocytes) in the spinal cord undergo activation following peripheral injury associated with chronic pain, suggesting the involvement of these cells in pain diseases. We have previously reported that Yokukansan (YKS), a Japanese traditional herbal (Kampo) medicine, is effective against chronic pain through the suppression of spinal glial cell activation. Morphine is a widely-used opioid analgesic for relieving severe pain, but its repeated administration leads to the development of antinociceptive tolerance. The development of morphine tolerance is also reported to be caused by spinal glial cells activation. In the present study, we investigated the inhibitory effects of YKS on the development of morphine tolerance and the activation of the spinal microglia and astrocytes using a rat model. Methods: Male Wistar rats received a subcutaneous injection of morphine hydrochloride (10 mg/kg/d) for 7 days, and the withdrawal latency to thermal stimulation was measured daily using a hot plate test. Thereafter, the appearance of activated microglia and astrocyte in the spinal cord (L5) was examined by immunofluorescence staining. Ionized calcium binding adapter molecule-1 (Iba-1) staining was used to label microglia and glial fibrillary acidic protein (GFAP) staining was performed to label astrocytes. YKS was administered mixed with powdered rodent chow at a concentration of 3%. Results: The preadministration of YKS (started 3 d before the morphine injection) prevented the development of morphine tolerance. The repeated administration of morphine increased Iba-1 and GFAP immune reactivities in the spinal cord; however, these activations were inhibited by the preadministration of YKS. Conclusion: These results suggest that the preadministration of YKS attenuates the development of antinociceptive morphine tolerance, and the suppression of spinal glial cell activation may be one mechanism underlying this phenomenon