Trajectories of distress following the great East Japan earthquake : a multi-wave prospective study

The March 2011 Great East Japan Earthquake, tsunami, and nuclear leak were complex traumas. We examined psychological distress in the years following the earthquake using growth mixture modeling to classify responses from 2,599 linked respondents (2012–2016). We identified four classes of trajectories following the disaster: resilient (76% of respondents), delayed distress (8%), recovery (8%), and chronic distress (7%). Compared with the resilient class, other class members were less likely to be female and had less social support. Survivors in the recovery group were more likely to live in prefabricated housing. Although distress has decreased over time, specific populations continue to require targeted intervention

アルコール依存症と感情障害への支援

アルコール依存症と感情障害の関係性は以前から指摘されている．アルコール依存症とうつ病は，自殺企図者の精神障害の内訳の半数を占め，それらが合併した場合には自殺の危険性を一層高める．また，アルコール依存症治療において，患者がうつ症状を呈している場合，再飲酒のリスクが高くなり治療の継続を妨げる原因となりうる．そのため，うつ病の治療にも注意を払うことが求められる．さらに，家族からの支援はアルコール依存症患者の断酒を継続するなどの治療において重要な役割を果たしている．しかし，患者の断酒の継続に注意を払いすぎるあまり，それがストレスとなり患者の問題飲酒を助長することになったり，家族自身がさまざまな悩みを抱え苦しんだりすることが考えられ，家族への支援もとても重要となる．加えて，親がアルコール依存症である場合，子どもも将来アルコール依存症となる危険性が高くなるなど，子どもに与える影響も大きい．そこで医師，看護師，ソーシャルワーカーが支援に関わることや自助グループを活用することが重要となる．本総説ではアルコール依存症と感情障害の関係と治療方法，アルコール依存症と感情障害を抱える患者とその家族への支援に焦点を当て，包括的な支援のありかたを検討した．The relationship between alcohol dependency and affective disorder has been noted. Alcohol dependence and depression account for approximately half of psychiatric disorders which suicidal persons have, and in case of the combination of them, the risk for suicide would be much higher. Also, in case of patient suffering from alcohol dependence and depression as a complicated disease, it becomes an obstructive factor to provide appropriate alcoholism treatment. Therefore, it is desired to pay attentions to care of depression. In addition, the support from self-help group and patient’s family plays a great role in the alcoholism and depression treatment. However, too much attention of patient’s family to continuation of abstinence becomes a cause of stress for patient. That stress fosters problem drinking. Furthermore, it is conceivable that family has many worries and is plagued with anxiety, so family support is also very important. In this review, we focus on comprehensive support for people with both alcohol dependency and affective disorder, and their families

Phenotypic heterogeneity in a family with FAP due to a TTR Leu58Arg mutation: A clinicopathologic study

金沢大学医学部附属病院神経内科A family with familial amyloid polyneuropathy (FAP) due to a transthyretin (TTR) Leu58Arg mutation was investigated clinicopathologically. The proband presented with sensorimotor-autonomic polyneuropathy and autopsy demonstrated massive amyloid deposition in the peripheral nerves and heart. However, the mother was characterized by carpal tunnel syndrome and ocular vitreous opacities. Thus, there was considerable phenotypic heterogeneity among family members despite the identical TTR genotype. © 2007 Elsevier B.V. All rights reserved

The clinical significance of 5% change in vital capacity in patients with idiopathic pulmonary fibrosis: extended analysis of the pirfenidone trial

<p>Abstract</p> <p>Background</p> <p>Our phase III clinical trial of pirfenidone for patients with idiopathic pulmonary fibrosis (IPF) revealed the efficacy in reducing the decline of vital capacity (VC) and increasing the progression-free survival (PFS) time by pirfenidone. Recently, marginal decline in forced VC (FVC) has been reported to be associated with poor outcome in IPF. We sought to evaluate the efficacy of pirfenidone from the aspects of 5% change in VC.</p> <p>Methods</p> <p>Improvement ratings based on 5% change in absolute VC, i.e., "improved (VC ≥ 5% increase)", "stable (VC < 5% change)", and "worsened (VC ≥ 5% decrease)" at month 3, 6, 9 and 12 were compared between high-dose pirfenidone (1800 mg/day; n = 108) and placebo (n = 104) groups, and (high-dose and low-dose (1200 mg/day; n = 55)) pirfenidone (n = 163) and placebo groups. PFS times with defining the disease progression as death or a ≥ 5% decline in VC were also compared between high-dose pirfenidone and placebo groups, and low-dose pirfenidone and placebo groups. Furthermore, considering "worsened" and "non-worsened (improved and stable)" of the ratings at months 3 and 12 as "positive" and "negative", respectively, and the positive and negative predictive values of the ratings were calculated in each group.</p> <p>Results</p> <p>In the comparison of the improvement ratings, the statistically significant differences were clearly revealed at months 3, 6, 9, and 12 between pirfenidone and placebo groups. Risk reductions by pirfenidone to placebo were approximately 35% over the study period. In the comparison of the PFS times, statistically significant difference was also observed between pirfenidone and placebo groups. The positive/negative predictive values in placebo and pirfenidone groups were 86.1%/50.8% and 87.1%/71.7%, respectively. Further, the baseline characteristics of patients worsened at month 3 had generally severe impairment, and their clinical outcomes including mortality were also significantly worsened after 1 year.</p> <p>Conclusions</p> <p>The efficacy of pirfenidone in Japanese phase III trial was supported by the rating of 5% decline in VC, and the VC changes at month 3 may be used as a prognostic factor of IPF.</p> <p>Trial Registration</p> <p>This clinical trial was registered with the Japan Pharmaceutical Information Center (JAPIC) on September 13^th, 2005 (Registration Number: JAPICCTI-050121).</p

Handling rich turn-taking in spoken dialogue systems

ABSTRACT This paper discusses how to build a system that can engage in a mixed-initiative human-machine spoken dialogue in which system utterances sometimes overlap with user utterances and vice versa. In the method, a module that incrementally understands user utterances and another module that incrementally generates system utterances work in parallel, and the timing of taking and releasing the dialogue initiative is decided according to the understanding of user utterances and the content of the system utterances. This method enables the system to respond when the user holds the dialogue initiative and is speaking, and enables the system to react to the user&apos;s barge-ins when it holds the initiative and is speaking. An experimental system called DUG-1 is also presented

退院支援施設入所後の神障害者の生活能力

研究目的は，退院促進支援により退院し，退院支援施設で生活した精神障害者の生活能力を明らかにし，看護のあり方を検討することである．調査対象者は，施設入所後１年が経過した長期入院であった精神障害者１７名（男性１２名，女性５名）で，平均年齢は，５２．５歳，平均入院期間は１１．３年であった．データ収集は，調査対象者一人ずつに約２０分程度の半構成的面接を行った．その結果，逐語録から２５５のラベルが得られ，１１のサブカテゴリーに分類された．これらから「自分自身のペースに合わせた生活リズムの獲得」，「病気を悪化させないための自己管理」，「施設退所後の生活のための心の準備」，「良好な対人関係の構築」という４つのカテゴリーが抽出された．これらの結果から，施設利用者は自分なりのペースで社会復帰に向けての準備をしながら，着実に生活能力を身につけていることが示唆された．The aim of this survey is to describe the life ability of people with mental disorders who entered the Discharge Support Center for People with Mental Disorders（DSC）, also to examine how best to help them. Participants were １７ people who had been long-term patients（１２ men and ５ females）living in the DSC for about a year. Their average ages were ５２．５ years old, and the average length of hospital stay was １１．３ years. Semi-structured interviews were conducted approximately１２months after discharged from the psychiatric hospital, transcribed verbatim and analyzed according to qualitative content analysis. Sentences of ２５５ were obtained, and they were classified into １１ subcategories. Finally, ４ categories were identified from these subcategories : “Acquisition of life rhythm matched to self-pace”, “Self-care to prevent aggravation of disease”, “Mental preparedness for social life after discharge from the DSC”, and “Creation of good interpersonal relationship”. From these results, it was suggested that people with mental disorders had social ability for social living by preparing with their own pace

Comparison of 19-gauge conventional and Franseen needles for the diagnosis of lymphadenopathy and classification of malignant lymphoma using endoscopic ultrasound fine-needle aspiration

Background/Aims Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) using a 19-gauge needle is an efficient sampling method for the diagnosis of lymphadenopathy. This study compared 19-gauge conventional and Franseen needles for the diagnosis of lymphadenopathy and classification of malignant lymphoma (ML). Methods Patient characteristics, number of needle passes, puncture route, sensitivity, specificity, and accuracy of cytology/histology for lymphadenopathy were analyzed in patients diagnosed with lymphadenopathy by EUS-FNA using conventional or Franseen needles. Results Between 2012 and 2022, 146 patients met the inclusion criteria (conventional [n=70] and Franseen [n=76]). The median number of needle passes was significantly lower in the conventional group than in the Franseen group (3 [1–6] vs. 4 [1–6], p=0.023). There were no significant differences in cytological/histological diagnoses between the two groups. For ML, the immunohistochemical evaluation rate, sensitivity of flow cytometry, and cytogenetic assessment were not significantly different in either group. Bleeding as adverse events (AEs) were observed in three patients in the Franseen group. Conclusions Both the 19-gauge conventional and Franseen needles showed high accuracy in lymphadenopathy and ML classification. Considering sufficient tissue collection and the avoidance of AEs, the use of 19-gauge conventional needles seems to be a good option for the diagnosis of lymphadenopathy

Subjective assessment of participants in education programs on clinical practice guidelines in the field of psychiatry

The Effectiveness of Guidelines for Dissemination and Education in psychiatric treatment (EGUIDE) project, which is a nationwide dissemination and implementation program for clinical practice guidelines (CPGs) in the field of psychiatry, is currently ongoing. In the current study, a subjective assessment of the participants in the EGUIDE programs was assessed using a questionnaire. Then, the relationships between the subjective assessment, the characteristics of the participants, and the clinical knowledge of the CPGs were evaluated. More than 90% of the participants gave a high rating for the components of content, recommendation, knowledge, skill, and adherence, but not for the component of confidence. A positive correlation was found between years of professional experience and the score of confidence. These results suggest that it may be necessary to apply the knowledge and skills of CPGs obtained in the education programs into practice to increase confidence in the proper use of psychiatric therapies based on CPGs