ショウニカ デ ミラレル シンシンショウ

Many children have undergone stressful experiences, and have been in jeopardy for maladaptation due to a variety of life stresses, including disturbances of parent-child relationship, ineffective peer relation, difficulties in adapting successfully to the school environment. The presence of these cumulative life stresses has been shown to be related to an increase in number of psychosomatic disorders in children. Children with psychosomatic disorder revealed the internalizing behavior problem (e.g., withdrawal, somatic complaints, anxiety-depression), negative self-esteem, ego-overcontrol and the decline in social competence. Psychological supportive intervention was focused on amelioration and remediation of children's vulnerability, and promoted competent adaptation and resilience in response to varying environmental circumstances. As with positive appraisal of oneself and ego-resilience, children cope more adaptively to varying adversity. Utilizing intervention strategies on family dynamics can facilitate the treatment process

セッショク ショウガイジ ノ シャカイ テキオウ エノ シエン

Anorexia nervosa is characterized by extreme weight loss, body-image disturbance, andan intense fear of becoming obese. Personality character includes obsessive traits,interpersonal insecurity, perfectionism, rigid control over impulses and underlying low selfesteem.Anorexic adolescents have felt helpless and ineffective in conducting their ownlives. Other views anorexia nervosa as a family problem, particularly maternal failures toempathy and administration resulted in the child’s overcompliance with maternal wishes.The support for adolescent anorexia nervosa has focused on the psychosocial problemsand the maternal-child relationship, resulted in the improvement of the overall quality of thepatient’s life (school works, daily activities and interpersonal relationships) and the adaptationwithin the familial dynamics

ギャクタイ DV ノ コドモ ノ ココロ エノ エイキョウ ト シエン

Child abuse and domestic violence are both occurring within the privacy of the family. The children, who had suffered abuse and witnessed the domestic violence, have problems with PTSD, disturbance of interpersonal relationship and personality disorders. The Japanese public in general seems to have become aware of the need for child protection system to serve children and their families in a more efficient way. Early detection, intervention and separation from parents were essential to protect the rights of children. We have to collaborate with child guidance office and relevant organizations for rehabilitation of abused children and family reunification

Assessment of Molecular Cytogenetic Methods for the Detection of Chromosomal Abnormalities

Some marker chromosomes and chromosome rearrangements are difficult to identify using G-bands by Giemsa staining after trypsin treatment (G-banding) alone. Molecular cytogenetic techniques, such as spectral karyotyping (SKY) and fluorescence in situ hybridization (FISH), can help to detect chromosomal aberrations precisely. We analyzed the karyotypes in 6 cases of multiple congenital abnormalities and 1 case of spontaneous abortion (case 2). Three cases (cases 1, 6, and 7) had marker chromosomes, and 4 cases (cases 2-5) had chromosomal rearrangements. The karyotypes in cases 1, 2, and 3 were determined using FISH with probes based on the clinical findings and family histories. Spectral karyotyping (SKY) analysis in cases 4-7 showed that this method is useful and saves time. The combination of SKY and FISH analyses defi ned the range of the ring chromosome in case 7. We demonstrated that a combination of G-banding, FISH, and SKY can be applied effectively to the investigation of chromosomal rearrangement and to the detection of marker chromosome origins. We suggest the use of these methods for prenatal diagnosis, in which the inherent time limitations are particularly important

PTSDをきたした患児への箱庭療法

２卵性双生児の妹の死により，外傷後ストレス障害をきたした患児に箱庭療法を行った．患児（７歳１１カ月）は，暗い所には行くことができず，嫌な夢を見ることが多かった．学校では，ささいなことで感情的になり暴力行為に及んでいた．授業にも集中できず，気に入らない課題には取り組まず，担任にだまって早退していた．図工では人の顔が描けなかった．妹が入院していた病棟を見るのを嫌がったため，別の棟で箱庭療法を開始し，約１年半の間に１７回行った．動物の屍骸，恐竜が動物を襲う，弱肉強食など，死をテーマにした作品が多かった．命日の後は，親子の動物を並べた動物園の作品であった．箱庭療法を始めて，学校生活における情緒不安による行動は改善した．箱庭の作品に妹の死を繰り返し表現し，過去のできごととして整理し受け入れていったと思われる．Sandplay therapy was experienced for a seven-year old boy with PTSD caused by the death of his younger fraternal sister who had aplastic anemia. His traumatic symptoms were includes frightening dreams without recognizable content, avoiding dark place, hospital and drawing the face, diminished interest and difficulty concentrating in schoolwork, irritability or outbursts of anger in his classroom. Sandplay therapy can be used as a means to express feelings, clarify grief reactions, and identify needs. Repetitive works on sand occur in which themes or aspects of the trauma expressed. Systematically strategizing recall in a sandplay fashion promotes to exposure the traumatic event, and minimizes cognitive and behavioral avoidance. Sandplay therapy benefits children with PTSD

Daily VMA (vanillyl mandelic acid) variation in urine in relation of fatigue sensation, stress and life stile of nurses on night shift.

Daily VMA variation in urine in relation of fatigue sensation, stress and life stile of nurses on night shift. To evaluate exhaustion objectively in hospital nurses, daily variation of urinaly VMA (vanillyl mandelic acid) excretion was measured in hospital nurses working in daytime and nighttime and it's correlation with the data from Psychological Stress Response Scale (PSRS) test, the burn-out scale, quality and quantity of sleep and daily life stile recorded throughout 24 hours were studied. VMA level in urine showed circadian rhythmic movement, higher in daytime and lower in nighttime. During night shift, VMA in urine in nighttime showed slightly higher level than during day shift but in the subsequent daytime after night shift, VMA level was stillkeeping normal circadian rhythm, resuling flatness of daily fluctuation of VMA level. Dissatisfaction of sleep during daily fluctation of VMA level. Dissatisfaction of sleep during daytime was noticed. Correlation between VMA level in urine and sense of tiredness, stresses or burn-out scale were not carfied in this study because of shortage of samples but working conditions might affect biologicalresponse of exhaustion

The relationship between parents with a history of childhood problems and incidence of consequent child abuse

The purpose of this study was to determine the factors related to the need for cooperation with child guidance centers with a focus on the presence or absence of a history of childhood problems in at-risk parents receiving support from their municipality. Among the 1890 parents who received child care support from public health nurses in the municipalities, 164 parents (8.7%) had a history of childhood problems. Among these, 50 parents (30.5%) received support from child guidance centers. The parents with a history of childhood problems had a higher incidence rate for receiving support from child guidance centers than other parents. Multiple logistic regression analysis showed that “marital strife or domestic violence”, and “financial problems” were associated with consultations with child guidance centers among parents with a history of childhood problems. The results showed that family situations of parents who had a history of childhood problems may, in time, become more severe, even if they have received support from public health nurses in the municipalities. Therefore, parents with a history of childhood problems need support as early as possible. In addition, those parents with “marital strife or domestic violence” and “financial problems” also need guidance and early nursing care interventions

Effects of primary prevention of child abuse that begins during pregnancy and immediately after childbirth

Objective : To improve primary prevention of child maltreatment, the association between at-risk parents identified by maternity hospitals and local health centers and intervention outcomes was investigated. Methods : A screening program for primary prevention of child maltreatment has been implemented for parents with children aged<3 years in A Prefecture. At-risk parents are identified at maternity hospitals and local health centers. Public health nurses provide intervention to promote positive parenting through home visits, and referred to child protective centers when they suspect child maltreatment. Results : Between 2009 and 2014, a total of 2,252 new at-risk parents were identified, 956 from maternity hospitals and 1,296 from local health centers. Among these at-risk parents, 356 (15.8%) were referred to child protective centers for possible child maltreatment, 88 of which came from maternity hospitals and 268 from local health centers. The rate of referral from maternity hospitals was significantly lower than that from local health centers (9.2% vs. 20.7%, p<0.001). Conclusions : Identification of at-risk parents during pregnancy and early intervention resulted in a decrease in the rate of referrals to child protective centers. The specific risk factors of “perceived lack of social support”, “mental illness” and “teen pregnancy” may be mitigated by early intervention

糖尿病を合併した神経性大食症例

インスリン依存性糖尿病を合併した神経性大食症例で，糖尿病治療にコンプライアンス不良を示す１７歳女子例を経験した．両親は言い争いが絶えず，姉は神経性無食欲症になり，母親は姉の治療に心労を費やした．患児は幼少からさびしい思いをし，家族と信頼関係が育まれない環境で育った．離婚を契機に過食・嘔吐が始まった．患児の親権者は父親であったが，父親との生活もストレスを感じた．母親と生活をともにする日を作ったが，姉との関係も悪く満足できなかった．友人や部活動にも気を遣う学校生活から不登校になり，将来への絶望感が高まった． 離婚１年後にインスリン依存性糖尿病を発症したが，コンプライアンスは不良であり，糖尿病は悪化し白内障を合併した．家族関係障害に起因するアイデンティティ確立への葛藤や，母親をコントロールしようとする気持ちが，糖尿病治療のコンプライアンスに影響していると考えられる．A 17-year old girl of bulimia nervosa with diabetes mellitus was reported. Family history showed that the quarrel occurred frequently between father and mother, and elder sister suffered from anorexia nervosa. She have lived with father after divorce of her parents, and begun to vomit after overeating. She has suffered from diabetes mellitus after 1 year of divorce, but has been noted to have poor compliance for glycemic control. The development of interpersonal confidence and identification was impaired through the reciprocal interaction within the family. She was exhausted from the inability to expression of emotion, sensation and thoughts in her school life and stay away from school. The disturbance of interfamilial relation resulted in the impaired development of identification may lead to poor treatment compliance for diabetes mellitus

スキー実習におけるグループ・ローテーション指導の効果について(2) : 中級グループでの試み

The purpose of this study was to make clear the effect of the Group Rotation Teaching in the medium grade class of Ski Intensive Course. Results are summarized as follows: 1) Through the Group Rotation Teaching, students have received more various helpful advice than the beginner\u27s class. Students are content with the Group Rotation Teaching, because they meet many teaching methods and teachers in this class. But their skill of skiing isn\u27t superior to the beginner. 2) For teachers, the Group Rotation Teaching is valuable to exchange their views and information about teaching skiing. Through the meeting about Group Rotation Teaching, They talk about not only teaching skiing, but about themselves