Food Service Issues Relating to Food Allergies in Residential Nurseries and Children\u27s Care Homes : A Study Based on the Comments of Dieticians and Registered Dieticians with Regard to Their Use of Food Allergy Guidelines

乳児院・児童養護施設を対象におこなった食物アレルギーの給食対応に関する調査の自由記述欄の内容を分析し、食物アレルギーの給食対応に関して両施設にみられる課題およびガイドラインの有無別にみられる特徴を検討することを目的とした。自記式質問紙調査の自由記述欄に記入があり、ガイドラインによる取り組みに回答のあった施設のうち栄養士・管理栄養士が回答した乳児院30施設と児童養護施設71施設を分析対象とした。社会的養護に特徴的な課題として《施設体制》の【入所時のアレルギー情報把握】の欠如による〈緊急入所・情報不足による食事提供への不安〉、【小規模化における課題】が示された。ガイドラインの有無別にみると、乳児院での〈初発のリスクへの不安〉、児童養護施設での〈事故対応に対する不安〉〈重症児対応に対する不安〉といった不安感はガイドラインがない施設に見出された。ガイドラインがある乳児院の栄養士は《給食業務》の〈献立例〉の心配は少なく、《施設内連携》の〈情報共有・共通理解の重要性〉や〈職員間の認識差〉を課題ととらえていた。また、ガイドラインがある児童養護施設の栄養士は《食事場面》での【食事指導】や【児童の心理面への配慮】などの課題は少なく、施設外の情報交換を求めていた。以上のことから、ガイドラインがない施設の栄養士は、献立や食事指導の仕方などの児童に対しての直接的な支援が課題であると認識していたが、ガイドラインがある場合は、施設内連携・施設外連携などの児童を取り巻く職員間・部署間の情報共有や、他施設との関係を課題ととらえていることが推察された。The aim of this study was to analyze comments provided in our survey on the provision of allergy-appropriate food services in residential nurseries and children\u27s care homes, to examine the issues identified, and to compare facilities that used food allergy guidelines with those that did not. The facilities analyzed were 30 residential nurseries and 71 children\u27s care homes where dietitians responded through comments in self-administered questionnaires. Characteristic concerns with children\u27s social care related to problems with food services during an emergency admission due to lack of allergy information at the time of admission. Among dietitians that did not use food allergy guidelines, concerns such as anxiety around the risk of allergy onset were found at residential nurseries, and concerns about appropriate responses to accidents and to children with severe conditions were found among dietitians at children\u27s care homes. Dietitians that did use food allergy guidelines had little concern about using specific menus, but raised the importance of information sharing, having a common understanding, and recognizing differences in food allergy awareness among staff. Dietitians at children\u27s care homes that used food allergy guidelines had few issues with dietary guidance and less need for consideration of children\u27s psychological state, but sought additional information outside of the facilities. As indicated above, comments made by dietitians working at facilities without any food allergy guidelines acknowledged problems in providing adequate menus and dietary guidance. Where guidelines were used, challenges such as information sharing between staff and departments surrounding the children (including cooperation within and outside of facilities), and maintaining relationships with other facilities, were expressed.本研究はJSPS 科学研究費（課題番号16K12745）の助成を受けたものです

Age-related changes in a patient with Pelizaeus-Merzbacher disease by repeated 1H-MRS

Purpose: In this report, we describe a patient with Pelizaeus-Merzbacher disease (PMD) who underwent repeated evaluations by 1H-Magnetic resonance spectroscopy (MRS). Subject: The patient was given a definitive diagnosis of PMD based on genetic testing, which showed overlap of the proteolipid protein 1 (PLP1) gene. The control subjects for 1H-MRS consisted of healthy age-matched children. Methods: All measurements were performed with a clinical 3-tesla magnetic resonance imaging (MRI) system. For 1H-MRS, the center of a voxel was positioned in the right parietal lobe. 1H-MRS was performed when the patient was 2, 6, 14, and 25 months old. Results: The concentration of GABA in early childhood (2 months 1.72 mM, 6 months 2.15 mM) was increased compared with that in normal controls. However, his GABA concentration was normalized at 14 and 25 months. The concentrations of Ins were increased after 6 months. No remarkable changes were seen in the concentration of Cho at any time. Conclusion These results suggest that the changes in metabolite concentrations during growth may reflect the pathological state of PMD. Furthermore, the lack of a change in the Cho concentration may be useful for differentiating PMD from other demyelinating diseases

Effective treatment of a 13-year-old boy with steroid-dependent ocular myasthenia gravis using tacrolimus

Over the past several years, tacrolimus has attracted attention as a new therapeutic drug for myasthenia gravis (MG), but few reports have considered its use for MG in pediatric patients, and most of these have focused on severe systemic MG. In this case report, we used tacrolimus to successfully treat a 13-year-old boy with ocular MG who had suffered from severe steroid complications, including a failure of thrive and osteoporosis. He first showed symptoms of ocular MG at age 2 years 3 months. At age 13 years, he was receiving PSL (3.75 mg/day), but the symptoms of ocular MG recurred. We increased the dosage of oral PSL up to 30 mg/day, and three courses of mPSL pulse therapy were applied, but these therapies had only limited effect, and his symptoms worsened. Tacrolimus was started at 0.4mg/day (0.011mg/kg/day), and every two weeks the dose was gradually increased by 0.2mg/day. His symptoms of MG began to improve three weeks after the initial administration of tacrolimus. Approximately three months after the start of tacrolimus administration, PSL was discontinued. Currently, at one year and four months after the start of tacrolimus administration, while slight ptosis is observed in the evening, it does not influence his daily life, and his condition remains comparable to that when he stopped taking PSL. No adverse effects of tacrolimus have been recognized. In pediatric patients with steroid-dependent ocular MG without thymectomy, tacrolimus may be a safe and effective alternative to steroid and thymectomy

ジヘイショウ ノ ノウガゾウ ケンキュウ

Brothers proposed a network of neural regions that comprise the “social brain”, which includes the amygdala, the orbito-frontal cortex, and the superior temporal sulcus and gyrus. Since the psychiatric condition of autism involves deficits in “social intelligence”, it is plausible that autism may be caused by an abnormality of these regions. We measured chemical metabolites in the left amygdala and the bilateral orbito-frontal cortex, which are the main components of the social brain. We also examined the association between these metabolic findings and social abilities in subjects with autism. The study group included 77 autistic patients and age-matched 31 normal children. Conventional proton magnetic resonance spectra were obtained using the STEAM sequence with parameters of TR＝5 sec and TE＝15 msec by a 1.5-tesla clinical MRI system. We analyzed the concentrations of N-acetylaspartate （NAA）, creatine/phosphocreatine （Cr）, and choline-containing compounds （Cho） using LCModel （Ver.6.1）. The concentrations of NAA in the left amygdala and the bilateral orbito-frontal cortex in autistic patients were significantly decreased compared to those in the control group. In the autistic patients, the NAA concentrations in these regions correlated with their social quotient. These findings suggest the presence of neuronal dysfunction in the amygdala and orbito-frontal cortex in autism. The amygdala is thought to play a central role in associating sensory cues with their motivational and emotional significance. Schoenbaum et al. proposed models of amygdala-frontal interaction in which motivational and emotional significance, coded by the amygdala, is conveyed to the orbito-frontal cortex for the control of action. Dysfunction in the amygdala and orbito-frontal cortex may contribute to the pathogenesis of autism

Usefulness of NIRS for medication adherence

The symptoms of attention deficit hyperactivity disorder (ADHD) are inattention, hyperactivity, and impulsiveness. Physicians often prescribe methylphenidate (MPH) for children with ADHD for long periods of time. The purpose of the present study was to investigate the usefulness of near-infrared spectroscopy (NIRS) for evaluating drug effects and improvements in medication adherence in children with ADHD. Subjects were 10 male children diagnosed with ADHD : average age, 9.3 years, and 10 boys with typical development : average age 9.5 years. Children with intellectual disability, autism, and obvious depressive symptoms were excluded. The present study revealed that in the ADHD group, oxy-Hb concentrations in the left and right lateral prefrontal cortex significantly increased during the execution of the Stroop color-word test in both channels when taking MPH. This method was considered to be useful for assessing drug effects on ADHD because NIRS is an objective indicator for evaluating ADHD executive dysfunction and visualizes the activation of frontal lobe function by MPH. A pediatric neurologist explained the results of NIRS while presenting images to the ADHD group, and medication adherence and the drug-taking ratio both markedly improved. Therefore, this therapeutic explanation is an effective strategy for improving medication compliance and adherence among patients