Intraoperative Changes in Idiopathic Macular Holes by Spectral-Domain Optical Coherence Tomography

Purpose: To examine anatomical changes in idiopathic macular holes during surgery using handheld spectral-domain optical coherence tomography (SD-OCT). Methods: Five eyes of 5 patients who underwent surgery for the repair of idiopathic macular holes were examined. The surgery included standard 25-gauge, 3-port pars plana vitrectomy, removal of the internal limiting membrane (ILM), fluid-air exchange, and 20% sulfur hexafluoride tamponade. Intraoperative SD-OCT images of the macular holes were obtained after ILM removal and under fluid-air exchange using a handheld SD-OCT. From SD-OCT images, the macular hole base diameter (MHBD) was measured and compared. Results: All macular holes were successfully closed after the primary surgery. The mean MHBD under fluid-air exchange was significantly smaller than the mean MHBD after ILM removal and the preoperative mean MHBD. In 1 eye with a stage 3 macular hole, SD-OCT images revealed that the inner edges of the macular hole touched each other under fluid-air exchange. Conclusion: Fluid-air exchange significantly reduced MHBD during surgery to repair macular holes. Fluid-air exchange may be an important step for macular hole closure as it reduces the base diameter of the macular hole

医療扶助受給者を医療保険の被保険者へ : 「普遍的医療給付」制度化に見るフランスの健康権実現への思想と過程

フランスの"皆保険"体制は1999年7 月27日法で創設された「普遍的医療給付」（Couverturemédicale universelle : CMU）制度によって2000年1月1日から施行された。日本の"皆保険"体制が1961年からであるから、日本と比較すれば40年も遅れたことになるが、その"皆保険"の構造は日本のそれとは大いに異なる。フランスに3か月以上、安定して正規に居住するすべての人は（他の制度による現物医療給付を受けられる人を除き、）基礎的医療保険制度加入が義務付けられ、低所得者の保険料を無料にする（CMU de base 基礎給付）。さらに一定の所得条件の下で受診時の自己負担分が免除されるように、民間の補足医療保険への加入も規定し、その保険料を無料にする（CMU-C 補足給付）という制度なのである。「普遍的医療給付」制度の創設で県医療扶助、および任意で加入する個人保険は廃止された。ただし、非正規に滞在中の外国人、および居住者ではない外国人への医療措置として、所得条件の下で国の医療扶助を規定した。　「普遍的医療給付」は1946年の第Ⅳ共和制憲法の前文（前文は現行の第Ⅴ共和制憲法に引き継がれる）の精神の具現化であり、さらにはフランス革命時に国民国家として初めて社会権を認めた1793年の憲法の精神を引き継ぐものである。しかしながら、1999年の法律一つで一挙に「普遍的医療給付」が創設されたわけではない。第二次世界大戦後、国は社会保険方式による社会保障制度の一般化を目指すも、職業によって分立する社会保険制度の谷間に置かれ公的医療保険でカバーされない低所得の人々を医療につなげた医療扶助が果たした役割は重要であった。さらに、医療扶助の負担によって任意の自主保険、続いて個人保険への加入も実現させてきた。1893年の無料医療救済法の成立からおよそ100年にわたった医療扶助の機能とその変遷を解説しながら、フランスにおける健康権の思想とその実現過程を概観しつつ、普遍的医療給付のポイントをまとめる。Universal coverage' in Japan started in 1961. In France, 'universal coverage' was realized in January 1st 2000, when 'La Couverture Médicale Universelle' came into effect, having been established in the July 27 Act, 1999. It would appear that 'universal coverage' had been implemented 40 years earlier in Japan than it was in France. However, the meaning of 'universal coverage' differs in these countries. One of the primary objectives for 'La Couverture Médicale Universelle' in France was to abolish the 100 yearold system of medical aid （conversely, making provisions for illegal residents of other nationalities to receive national medical aid）, and to include those who did not have medical insurance and who could not pay insurance premiums due to low-income in a free basic medical insurance plan, so that all people legally residing in France could have medical insurance. Under the medical insurance system, there is often an insurance fee （or tax） payment for the insured, and a further self-payment involved at the time of diagnosis. Another objective of 'La Couverture Médicale Universelle' was to include individuals for whom this self-payment is difficult on account of a low income in a supplementary insurance plan, in order to provide them with free treatment or to lessen the burden. The thorough universalization of medical insurance has secured health rights as they were defined in the 1946 Constitution. In Japan, the medical insurance system and public assistance's medical aid coexist. The National Health Insurance Act, in force since January 1st 1959, exempts households on public assistance （National Health Insurance Act, Article 6, Paragraph 9）, and medical aid is administered by the local government. This paper argues Japan's current system, in which entitlement to medical care is distinguished according to the amount of income. With that in its center of discussion, this paper will attempt to uncover what kind of concepts and administrative and financial reforms preceded the realization of 'universal coverage' in France

日仏比較の視点から見る : フランスの介護職と人材育成政策

介護職の社会における立ち位置は、その国の福祉政策や労働政策、教育制度や雇用状況など、さまざまな要素が絡み合って成り立っている。日本では介護職の需要に対して、なり手が不足し離職率も高い。国家資格　介護福祉士取得者の約7割は実務経験3年以上が取得条件で受験し合格した。だが、2007（平成19）年度の法改正では、2012（平成24）年度からさらに6ヵ月以上（600時間以上）の研修も受験要件に加わる。ところが、現場の介護職や介護サービス事業者は長い研修は「実現不可能」だという。2010（平成22）年春に厚生労働省が実施したこのような調査結果から、受験要件の変更実施は延期される見込みである。なぜ、このような方針転換をせざるを得ないのか。働きながら学ぶ継続職業教育の公的政策が、日本では未発達だからである。そこで本稿では、前半では介護政策の大枠・介護職の国家資格などの日仏比較をする。後半ではフランスの介護職の人材育成方法を紹介する。具体的には、フランスの国家資格介護職の養成方法、労働法に規定された継続職業教育支援策、労働協約・取り決めによる研修計画とその財政措置などである。The social standing of nursing care workers in each country is determined by numerous factors, including national welfare and labour policy, education systems and the national employment situation. In Japan, the demand for nursing care workers far exceeds the number of people willing to take on such work and the turnover rate is high. With regards to the various eligibility criteria for the government-issued qualification as a certified care worker, just under seventy percent of people who obtained certification did so by having three years' nursing care work experience rather than specialist academic qualifications. However, a revision of the applicable law means that those seeking to become certified care workers will need a further training period of at least six months （at least 600 hours） in order to become qualified. Front-line nursing care workers and business owners say that long-term training is unfeasible because Japan's public policy regarding ongoing vocational training remains underdeveloped. This report provides qualifications of nursing care workers in Japan and France, and an overview of French methods of training and developing nursing care workers

先進諸国における訪問介護サービスの変容と今後の課題 : 日本、フランス、ドイツ、オランダを中心に

2013年現在、日本では2015年の介護保険制度改正にむけて、厚生労働省が打ち出した改正案の中に、軽度な自立喪失兆候を示す要支援者に対する訪問介護サービス給付の変更がある。現在の要支援者に対する訪問介護サービスは介護保険の法定給付であるが、改正案では市町村の裁量による新しい地域支援事業の中に組み入まれる。市町村の方針や状況に合わせて、地域のNPOやボランティア団体、企業などを活用して、介護予防、配食、見守りなどの生活支援サービスを提供するという方向性である。しかしながら、要支援者が最も利用してきたのは訪問介護サービスであることから、改正案はその縮小である、という見方ができる。さらに現在ではまだ見えにくいが、介護保険や行政サービスによる準市場ではない、自由市場における家事・介護に関連する生活支援サービス振興の狙いにも気付かされる。そこで本稿では先進諸国の公的介護制度の中で、訪問介護サービスはどのような動向を示しているのかを見る。その上で、社会福祉の訪問介護サービスを市場の対人サービスに包摂したフランスにおける高齢者援助政策の推移を見る。At present, in 2013, there are changes in provision of visiting care services for people requiring care showing signs of loss of autonomy in the reform proposed by the Ministry of Health, Labour and Welfare, as Japan moves toward the 2015 revision of the Nursing Care insurance system. Currently, visiting care services are a statutory benefit of Nursing Care Insurance, but in the proposed revision, they will be incorporated into new community support projects implemented at the discretion of the city, town or village. The trend is for community NPOs, volunteer groups and businesses to be used to provide daily living support services such as prevention of the need for care, meals services and monitoring visits in line with the policies and situation of the city, town or village. However, judging by the fact that it is visiting care services that have been most used by people requiring care, there is a view that the proposed revision means cutbacks in these services. Furthermore, although it is still not clear, one is made aware of the aim of promoting home help and care services as a free market rather than quasi-market through nursing care insurance and public services. Within this context, this paper examines the kinds of trends evident in visiting care services in public care systems in developed countries. Based on this, the situation of visiting care service market policies in France, where visiting care services consume a large part financially in the care system for elderly people, is introduced

Alteration of Concanavalin A Binding Glycoproteins in Cerebrospinal Fluid and Serum of Alzheimer's Disease Patients

Alzheimer’s disease (AD) is the most common cause of dementia in the elderly. It is characterized pathologically by the formation of senile plaques and neurofibrilly tangles in the brain. Diagnostic markers for detecting earlier stages of AD are needed. We measured the intensity of concanavalin A (Con A) binding activities of glycoproteins of the cerebrospinal fluid (CSF) and serum of subjects to clarify the modification of core mannose since we expected that aberrant glycosylation of glycoproteins might be useful as a new biomarker for detecting AD. CSF samples were collected from 15 patients with probable AD (AD group), 5 patients with probable dementia with Lewy bodies (DLB) (DLB group) and 8 controls without dementia (control group), whereas serum samples from 20 patients with probable AD and 20 controls without dementia were also collected. Glycoproteins in the CSF and serum were detected by lectin blotting using Con A. In the CSF of the AD group, 2 Con A binding glycoproteins were significantly higher compared with the control group. Furthermore, using analysis of variance, 3 Con A binding glycoproteins detected from the CSF of the AD group showed significant differences among the 3 groups. The levels of 3 Con A binding glycoproteins were significantly lower than in non-dementia controls in the serum. These changes in Con A binding activities did not depend on the amount of proteins. Therefore, the data indicate that the aberrance of protein glycosylation relates to the pathology of AD, and has some promise as a new biomarker for the diagnosis of AD

Effects of Kurozu concentrated liquid on adipocyte size in rats

<p>Abstract</p> <p>Background</p> <p>Kurozu concentrated liquid (KCL) is used as a health-promoting supplement for the treatment of disorders such as cancer, hyperlipidemia, and hypertension in Japan. We investigated the possible anti-obesity effects of KCL in rats.</p> <p>Methods</p> <p>Male Sprague Dawley rats were fed American Institute of Nutrition 76 formula diet and were orally administrated KCL or acetic acid at a dose of 100 mg/kg body weight or deionized water for 4 weeks. Adipocyte size, DNA content in subcutaneous adipose tissue, lipid levels in the serum and liver, and the rate of fatty acid excretion were determined. Effects of KCL on pancreatic lipase activity and 3T3-L1 preadipocyte differentiation were investigated <it>in vitro</it>.</p> <p>Results</p> <p>In the KCL group, the average adipocyte size in subcutaneous and perirenal adipose tissues was significantly reduced. The KCL-administered rats displayed greater numbers of small adipocytes in the subcutaneous, perirenal and mesenteric adipose tissues than did rats from the other groups. In the KCL group, the DNA content in subcutaneous adipose tissue was significantly increased. The rate of fatty acid excretion was significantly increased in the KCL group. Furthermore, KCL significantly inhibited pancreatic lipase activity <it>in vitro</it>, and also significantly inhibited fat accumulation and mRNA expression of fatty acid binding protein 2 (aP2) and peroxisome proliferator-activated γ (PPARγ) in 3T3-L1 preadipocyte. The levels of serum and liver lipids, the concentration of serum glucose, and the levels of adiponectin were similar among the 3 groups.</p> <p>Conclusion</p> <p>Oral administration of KCL decreases the adipocyte size <it>via </it>inhibition of dietary fat absorption and reductions of PPARγ and aP2 mRNA expression levels in adipocytes.</p

社会福祉に関する日仏用語の研究(2)

　日仏の社会福祉においては、理念、制度体系、社会福祉従事者の活動等に大きな相違がある。したがってフランスの社会福祉に関する用語を日本語にする場合には、制度づくりの発想の違い、社会保険と社会福祉の関係、公私組織の違いをふまえて訳すことが必要である。　本研究では、フランスの社会福祉の特色を表す5つの用語（action sociale, aide sociale, solidarité，insertion, économie sociale）をとりあげて、その内容を示した。続く研究（3）では、選定した用語の日本語訳を検討し、確定する手続きを提示する予定である

Clinical Incidence of Sacroiliac Joint Arthritis and Pain after Sacropelvic Fixation for Spinal Deformity

∙ The authors have no financial conflicts of interest. © Copyright: Yonsei University College of Medicine 2012 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial Licens