Regional income inequality in China and Indonesia: A comparative analysis

This study examines the extent and trends of regional income inequality in China and Indonesia, and performs a comparative analysis between these two countries in terms of factors determining regional income inequality. There are a number of studies that have analyzed the relationship between economic development and regional income inequality in China and Indonesia. However, most previous studies employed provincial income and population data to measure regional income inequality and were thus unable to measure inequality within provinces. In order to rectify this drawback, we will use district-level income and population data, rather than provincial data, to measure regional income inequality, and examine not only between-province inequalities but also within-province inequalities by using the two-stage nested Theil decomposition method developed by Akita (2002). China and Indonesia are still at a relatively early stage of economic development; therefore, income-enhancing economic activities tend to have concentrated in a few districts in each province to enjoy agglomeration economies. We will show that a very large regional income inequality exists among the districts of China and Indonesia. This study will also conduct a regression analysis to explore possible determinants of within-province income inequality, in which the following variables are considered: foreign direct investment, economic dualism, and migration.

A type of youth-onset type1 diabates mellitus patients by psychological characteristics in the eating behaviors

取得学位 : 博士（保健学）, 学位授与番号 : 医博甲第1776号, 学位授与年月日 : 平成18年3月22日, 学位授与大学 : 金沢大学, 主査 : 稲垣 美智子, 副査 :泉 キヨ子, 島田 啓

日本人的特性やQOLを考慮した虚血性心疾患患者の行動パターン修正プログラムの作成

虚血性心疾患(以下IHD)患者でタイプA行動パターン(以下タイプA)を示す患者の行動修正を目的に、日本人的特性やQOLを考慮した内容のプログラムを以下の手順で作成し、その過程から当該分野における特徴的な知見を得ることができた。(1)発症前はタイプAであったが発症後にタイプAを修正できた患者とできなかった患者の両方に面接を行い、それぞれの特徴的な点を導き出した。その結果タイプAを修正できなかった患者では、仕事に対して自分自身の徹底した信念をもっており、それが生きる上での支えになっていること、タイプAであり続けることがよくないことはわかっているが、タイプAである自分の存在価値は認めており、だからその行動パターンを変えたくない思いが自分の根底に存在していることが判明した。また患者がタイプAのままでいることが療養生活での必要な行動をとるということによい影響を及ぼしているのではないかとも示唆された。(2)(1)で得られた結果を参考にプログラムを作成した。プログラム作成にあたり、認知療法的アプローチと教育療法的アプローチの両方の利点を取り入れた。さらにストレス緩和を目的として、仕事時間内における有効な余暇の取り入れ方や余暇時間でのリラクゼーション技法の活用方法を取り入れたものとした。(3)(1)のタイプAを修正できなかった患者に外来受診時の待ち時間を利用してプログラム介入した。その際患者自身のタイプAの認識や行動修正できないという思いについての把握、行動修正への意欲および行動修正可能と思う行動の確認等も面接法で実施した。(4)(3)で得られた反応を参考にしながら、今までに行動修正についての指導を受けたことがないタイプAのIHD患者にプログラムに沿って介入し、どんな患者に対しても使用できる内容であるか、また改良すべき部分はどこかについて検討した。今後は作成したプログラムをより多くのIHD患者に使用しさらなる改良を加えることで行動修正の効果的な介入への手だてとしていきたい。For the purpose of the patient modification of type A behavior pattern (type A) in the ischemic heart disease patient (IHD), the program of the content considering Japanese characteristic and QOL was made by following procedures, and it was possible to obtain a characteristic knowledge in the concerned field from the process. 【1!○】In making patient who corrected type A as the result, it was proven to become a bracket as it has the belief in which self it was thorough for the work and as it is effective. And, the existence value of the self which was type A had been recognized, though that being type A, is not good has been proven, and it was proven that so, it did not want to change the behavior pattern, and that the thought exists in the foundation of the self. And, it indicated, even if the good effect be may caused that there is a patient in as of type A taking the necessary behavior in the medical treatment life. 【2!○】In the programming, We took in both cognitive therapy approach a nd educational therapy approach. And the activation method of relaxation technique in work hour in harvest and for the leisure hour in the effective leisure was supposed to be adopted more and more for the purpose of the stress relaxation. 【3!○】Programed to making patient who corrected type A using the queueing time in ambulatory seeking diagnosis and intervened. And, the following were also carried out by the interview technique : Recognition of type A of patient he and grasp on the thought that the behavior can not be modified, volition to the behavior modification and confirmation of the behavior which thinks that it can be modified. 【4!○】Where whether it intervenes in the IHD patient of type A which has not received the guidance on the modification of behavior pattern until now along the program and is the content which can be used for what kind of patient and part to be improved again examined.It wants to make it to be a tool of the behavior modification to the effective intervention by using in future made program for more many IHD patients, and adding further improvement.研究課題/領域番号:12672317, 研究期間(年度):2000-2002出典：「日本人的特性やQOLを考慮した虚血性心疾患患者の行動パターン修正プログラムの作成」研究成果報告書　課題番号12672317 (KAKEN：科学研究費助成事業データベース（国立情報学研究所）)　　　本文データは著者版報告書より作

虚血性心疾患患者の行動パターン修正へのアプローチ方法の検討

金沢大学医薬保健研究域医学系虚血性心疾患患者の行動パターンおよび行動パターンの変化が、患者のクオリティ・オブ・ライフ(以下QOLとする)とどのように関係しているかについて検討した。対象は金沢大学医学部附属病院第2内科循環器外来に定期的に通院している虚血性心疾患患者62名とした。対象の条件は、診断の定義に該当し、急性期を脱して半年以上経過しており、調査時に社会復帰している者で、研究についての説明は外来主治医の協力を得た研究に対する同意が得られた者とした。方法は発症前と現在の対象のタイプAを知るために、前田の作成した「A型傾向判別表」(30点満点)を使用し、合計得点17点以上をタイプA、16点以下をタイプBと判定し、発症前後での行動パターンの変化を見た。また患者のQOLを測定するために「病気をもちながらの生活管理」の質問紙(以下「病」の質問紙とする)の再検討された項目のものを使用し、総得点によってQOLの程度を評価した。その結果、1.行動パターンを変容することによる総得点からみたQOLの変化はみられなかった。2.発症前にタイプAであり現在タイプBに行動修正した者(A-B群)と発症前も現在もタイプAのままの者(A-A群)の間で「病」の質問紙の平均得点に有意差を認めた1項目の内容は「社会的な地位や置かれている立場を考えると、多少無理をしても、仕事(あるいは家事等)はおろそかにできない」でありA-B群の得点の方が高かった。3.有意差を認めることはなかったものの、A-B群がA-A群よりも「病」の質問紙において高得点を示す項目が多かった。したがってタイプAを修正することでQOLを低下させることはなく、むしろタイプAのままでいることの方がQOL上望ましいことではないといえた。今後は、行動修正についての患者の理解内容や考え方、意欲についても検討していきたい。研究課題/領域番号:09772083, 研究期間(年度):1997 – 1998出典：「虚血性心疾患患者の行動パターン修正へのアプローチ方法の検討」研究成果報告書　課題番号09772083（KAKEN：科学研究費助成事業データベース（国立情報学研究所））（https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-09772083/)を加工して作

ナラティヴアプローチを基盤とした看護実践によるうつ病高齢者の語りの変化に関する研究

This practical research study sought to clarify the treatment effect of, and means of a narrative approach toward, the depressed elderly that could by applied in nursing care with the hope of contributing to the development of a nursing-specific treatment approach that can help to alleviate depression among the elderly. Five hospitalized elderly patients with depression, aged 65 or older, participated in individual interviews based on a narrative approach that were conducted by the nurse researcher. Changes that occurred in the patients’ discourses and the researcher’s nursing practice over time were recorded and subjected to qualitative inductive analysis. In addition, the process of reciprocal interaction between the patients and researcher were examined with reference to Travelbee’s “human-to-human relationship model”. In the initial phase of the encounters between the patients and researcher, the patients’ discourses focused mainly on their physical suffering. The researcher attempted to build mutual trust by accompanying their mental and physical suffering, and through the mutual trust that developed the researcher prompted them to share their experiences without anxiety. Through this relationship, a coidentity emerged between the two parties. As the interviews progressed, the patients’ discourses changed to express their suffering in an intrapsychic world. A deepening of relationship and changes in it occurred between the patients and researcher, and the researcher had “opportunities to reach the heart of the depressed elderly through mutual identification” and listen to their psychological suffering. When their relationship progressed from identification to empathy, the patients told the researcher of their psychological suffering and life history : the discourses now contained previously untold stories, details of the times in which they lived, meaning in their life, and sociality. The discourses finally developed to express self-insights and hopes. This is when the patients and the researcher shared vividly that they now had a connection and rapport was established. The researcher supported the reestablishment of positives in the patients’ discourses by “wishing for their recovery and actualizing their hopes”, while also accepting their feelings of hopelessness that their depression would never be cured. The continuous narrative approach provided as part of nursing practice enabled the elderly patients who had been experiencing depressive feelings due to physical and intrapsychic suffering to alleviate their depression.本研究は、うつ病高齢者に対するナラティヴアプローチの治療的効果とその実践方法に ついて明らかにすることを目的とした実践研究である。 　入院治療を受けているうつ病高齢者５名に対して、ナラティヴアプローチを行い、研究 参加者の語りの変化と研究者の看護実践をデータとして質的帰納的に分析を行った。また、 ナラティヴアプローチの実践によって、参加者と研究者の相互作用が進展していくプロセ スをTravelbee13) の理論に則って捉えた。 　研究参加者の語りは、初期の出会いの位相では《身体の苦悩を基軸とした語り》が中心 であった。研究者は、『うつ病高齢者の心身のつらさに添いながら相互信頼を構築する』か かわりを基盤とし、参加者が研究者とともに安心して自己の体験を語ることができるよう に配慮していた。そのようなかかわりによって、両者の間に同一性が出現した。面接の経 過を経るに従い語りの内容は変化し、参加者は《精神内界の苦悩を表出》するようになっ た。研究者は、参加者との関係性の深まりや変化をみながら、状況に応じて『相互に一体 感をもちうつ病高齢者の琴線に触れる』かかわりを行い、精神的な苦悩を傾聴していた。 参加者と研究者の相互関係は同一化から共感の位相に進展したことによって、精神的な苦 悩や生活史が語られるようになり、そこには各参加者のいまだ語られていなかった物語や 生きられた時間、意味性、社会性が表現されていた。そして、同感の位相を経て、最終的 に参加者の語りは《自己洞察と希望の表出》という形に展開した。ここには、参加者と研 究者の間に、お互いが結ばれているという生き生きとした体験が基盤にあり、ラポールが 構築された。研究者は、参加者の抑うつ感情や「病気が治ることはない」という絶望感に 添い、受容しながらも、『回復や希望の実現を願う』ことで参加者の語りがポジティブに再 構築されるように支援していた。これまで、身体の苦悩や抱え込んでいた精神内界の苦悩 によって抑うつを体験していた参加者は、継続したナラティヴアプローチによって、抑う つを緩和することができていた

Healthy Campus Trial: a multiphase optimization strategy (MOST) fully factorial trial to optimize the smartphone cognitive behavioral therapy (CBT) app for mental health promotion among university students: study protocol for a randomized controlled trial.

BACKGROUND: Youth in general and college life in particular are characterized by new educational, vocational, and interpersonal challenges, opportunities, and substantial stress. It is estimated that 30-50% of university students meet criteria for some mental disorder, especially depression, in any given year. The university has traditionally provided many channels to promote students' mental health, but until now only a minority have sought such help, possibly owing to lack of time and/or to stigma related to mental illness. Smartphone-delivered cognitive behavioral therapy (CBT) shows promise for its accessibility and effectiveness. However, its most effective components and for whom it is more (or less) effective are not known. METHODS/DESIGN: Based on the multiphase optimization strategy framework, this study is a parallel-group, multicenter, open, fully factorial trial examining five smartphone-delivered CBT components (self-monitoring, cognitive restructuring, behavioral activation, assertion training, and problem solving) among university students with elevated distress, defined as scoring 5 or more on the Patient Health Questionnaire-9 (PHQ-9). The primary outcome is change in PHQ-9 scores from baseline to week 8. We will estimate specific efficacy of the five components and their interactions through the mixed-effects repeated-measures analysis and propose the most effective and efficacious combinations of components. Effect modification by selected baseline characteristics will be examined in exploratory analyses. DISCUSSION: The highly efficient experimental design will allow identification of the most effective components and the most efficient combinations thereof among the five components of smartphone CBT for university students. Pragmatically, the findings will help make the most efficacious CBT package accessible to a large number of distressed university students at reduced cost; theoretically, they will shed light on the underlying mechanisms of CBT and help further advance CBT for depression. TRIAL REGISTRATION: UMIN, CTR-000031307 . Registered on February 14, 2018

Cost-effectiveness of gargling for the prevention of upper respiratory tract infections

<p>Abstract</p> <p>Background</p> <p>In Japan, gargling is a generally accepted way of preventing upper respiratory tract infection (URTI). The effectiveness of gargling for preventing URTI has been shown in a randomized controlled trial that compared incidences of URTI between gargling and control groups. From the perspective of the third-party payer, gargling is dominant due to the fact that the costs of gargling are borne by the participant. However, the cost-effectiveness of gargling from a societal perspective should be considered. In this study, economic evaluation alongside a randomized controlled trial was performed to evaluate the cost-effectiveness of gargling for preventing URTI from a societal perspective.</p> <p>Methods</p> <p>Among participants in the gargling trial, 122 water-gargling and 130 control subjects were involved in the economic analysis. Sixty-day cumulative follow-up costs and effectiveness measured by quality-adjusted life days (QALD) were compared between groups on an intention-to-treat basis. Incremental cost-effectiveness ratio (ICER) was converted to dollars per quality-adjusted life years (QALY). The 95% confidence interval (95%CI) and probability of gargling being cost-effective were estimated by bootstrapping.</p> <p>Results</p> <p>After 60 days, QALD was increased by 0.43 and costs were $37.1 higher in the gargling group than in the control group. ICER of the gargling group was$31,800/QALY (95%CI, $1,900–$248,100). Although this resembles many acceptable forms of medical intervention, including URTI preventive measures such as influenza vaccination, the broad confidence interval indicates uncertainty surrounding our results. In addition, one-way sensitivity analysis also indicated that careful evaluation is required for the cost of gargling and the utility of moderate URTI. The major limitation of this study was that this trial was conducted in winter, at a time when URTI is prevalent. Care must be taken when applying the results to a season when URTI is not prevalent, since the ICER will increase due to decreases in incidence.</p> <p>Conclusion</p> <p>This study suggests gargling as a cost-effective preventive strategy for URTI that is acceptable from perspectives of both the third-party payer and society.</p

DOCK2 is involved in the host genetics and biology of severe COVID-19

「コロナ制圧タスクフォース」COVID-19疾患感受性遺伝子DOCK2の重症化機序を解明 --アジア最大のバイオレポジトリーでCOVID-19の治療標的を発見--. 京都大学プレスリリース. 2022-08-10.Identifying the host genetic factors underlying severe COVID-19 is an emerging challenge. Here we conducted a genome-wide association study (GWAS) involving 2, 393 cases of COVID-19 in a cohort of Japanese individuals collected during the initial waves of the pandemic, with 3, 289 unaffected controls. We identified a variant on chromosome 5 at 5q35 (rs60200309-A), close to the dedicator of cytokinesis 2 gene (DOCK2), which was associated with severe COVID-19 in patients less than 65 years of age. This risk allele was prevalent in East Asian individuals but rare in Europeans, highlighting the value of genome-wide association studies in non-European populations. RNA-sequencing analysis of 473 bulk peripheral blood samples identified decreased expression of DOCK2 associated with the risk allele in these younger patients. DOCK2 expression was suppressed in patients with severe cases of COVID-19. Single-cell RNA-sequencing analysis (n = 61 individuals) identified cell-type-specific downregulation of DOCK2 and a COVID-19-specific decreasing effect of the risk allele on DOCK2 expression in non-classical monocytes. Immunohistochemistry of lung specimens from patients with severe COVID-19 pneumonia showed suppressed DOCK2 expression. Moreover, inhibition of DOCK2 function with CPYPP increased the severity of pneumonia in a Syrian hamster model of SARS-CoV-2 infection, characterized by weight loss, lung oedema, enhanced viral loads, impaired macrophage recruitment and dysregulated type I interferon responses. We conclude that DOCK2 has an important role in the host immune response to SARS-CoV-2 infection and the development of severe COVID-19, and could be further explored as a potential biomarker and/or therapeutic target

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo