Choroidal Folds in Acute-Stage Vogt-Koyanagi-Harada Disease Patients with Relatively Short Axial Length

Purpose: To report 2 cases of Vogt-Koyanagi-Harada disease accompanied by remarkable choroidal folds in the acute stage. The early indicator of recurrence in these 2 cases was the identification of choroidal folds by spectral-domain optical coherence tomography (SD-OCT). Case Reports: A 68-year-old woman (Case 1) presented with visual loss in both eyes. Funduscopic examination revealed optic disc swelling and serous retinal detachment in both eyes. SD-OCT revealed remarkable choroidal folds and serous retinal detachment. After the initiation of systemic steroid treatment, choroidal folds disappeared rapidly and the amount of serous retinal detachment reduced remarkably. Choroidal folds observed on SD-OCT were the early indicators of recurrence prior to the emergence of serous retinal detachment. A 62-year-old woman (Case 2) presented with bilateral blurred vision and metamorphopsia. SD-OCT showed remarkable choroidal folds and serous retinal detachment in both eyes. After the initiation of systemic steroid treatment, choroidal folds and serous retinal detachment disappeared. At the time of recurrence, choroidal folds were observed by OCT. Discussion: During monitoring of Vogt-Koyanagi-Harada disease treatment, choroidal folds could be an early sign of recurrence. When choroidal folds are observed and recognized as an early indicator of recurrence, a prompt increase in steroids can improve the patients’ prognosis. Finally, both cases presented here had relatively short axial lengths, and we speculate that a shortened axial length may be a cause of choroidal folds in the acute stage of the disease

Gender differences in HIV testing service visits and its related factors among adults: a cross-sectional study in Homa Bay, Kenya

Introduction: at least 90% of people living with human immunodeficiency virus (HIV) were expected to know their HIV status by 2020. However, only 84% are aware of their status. This study determined the frequency of HIV testing services visits (HTS) and its related factors to HTS visits among adults in Homa Bay County, Kenya. Methods: this was a cross-sectional study. Quantitative and qualitative data were collected. A backward stepwise logistic regression analysis was conducted for quantitative data by gender. Qualitative data were thematically categorised into factors of HTS visits by gender. Results: a total of 645 adults participated in quantitative survey and 17 in qualitative survey. There were no gender differences in the frequency of HTS visits (males=56.3%; females= 58.7%, P=0.785). The frequency of visits was however significantly different between the rural-based (Rachuonyo North=87.5%; Ndhiwa=58.7%) and urban-based (Homa Bay Town=36.8%) facilities at P<0.001. In males, HTS visits were positively associated with ´being in Protestant church´, ´partner´s attitude´, and ´being accompanied by a friend to HTS´. ´Distance to HTS´ was negatively associated with HTS visits in males. For females, 'sexual intercourse in the past 2-5 months´ was positively associated with HTS visits. ´Being in a polygamous marriage´, ´not married´, ´community HIV testing´, and ´affordability of transport cost to HTS centre´ were negatively associated with HTS visits. Conclusion: there were no gender differences in the frequency of HTS visits. Social position for males and position in the family for females are suggested as the factors influencing HTS visits in Homa Bay County

幼児期における刺激の階層構造に対する認識となぞり行動

　3～6歳の幼児76名を対象に，幼児用のNavon図形を作成し，どの階層構造に注目するかを検討した。幼児からの回答の仕方は対刺激に対し，異同判断を求める方法をとった。階層構造のグローバルレベルでは同一であるが，ローカルレベルでは異なっている対に対して「同じ」と反応した場合と，グローバルレベルで異なるがローカルレベルで同一の対に対して「異なる」と反応した場合には，ともにグローバルな反応（W）をしたものとした。またそれら階層構造の対に対して，逆の異・同の反応をした場合にはローカルな反応（P）をしたものとして整理した。更に，グローバル・ローカルの双方のレベルに言及した反応（PW）も区分した。項目分析の結果，幼児期においても全体を同一と認識する刺激項目群と，部分を同一と認識する刺激項目群は，それぞれの等質性が保たれ内的整合性も高いことが確認できた。いずれの年齢群もグローバルな反応（W）が多く次ぎにローカルな反応（P），双方の反応（PW）が続いた。また，なぞり行動はグローバルな反応（W）が他の反応に比べて多く出現することがわかった。幼児期に既にグローバル優位という先行研究を支持する結果を得たといえる。また，グルーバルな知覚となぞり行動とが密接な関係にあることがわかった

Association between Public Assistance and Frequent Emergency Department Visits in Urban Areas of Japan: A Case-Control Study

Emergency department（ED）crowding due to frequent visitors increases medical costs and endangers the safety of patients who need prompt treatment. Although some studies have examined the social background of frequent visitors to the ED, there are few comprehensive studies of factors related to frequent ED visits in Japan. The present study examined whether public assistance status, age, and underlying conditions are associated with frequent visits to the ED. Subjects in this study were patients over 20 years of age who visited the ED of General Medicine in Showa University Hospital in Tokyo, Japan, from April 1, 2014, to March 31, 2015（n＝6,182）. Information regarding sex, age, public insurance, hypertension, diabetes mellitus, dyslipidemia, chronic obstructive pulmonary disease, cancer, dysuria, bronchial asthma, and chronic kidney disease was collected using a patient database created from medical and hospital records. Based on a previous study, subjects who visited the ED four or more times were defined as frequent visitors, while those who visited the ED less than four times were considered infrequent visitors. Logistic regression analysis was performed to calculate odds ratios（ORs）and 95％ confidence intervals（CIs）for frequent ED visits. Receipt of public assistance significantly increased the OR for frequent visits（4.26, 95％ CI: 1.90-9.56）, even after adjusting for sex, age, and potential confounding factors（OR: 3.89, 95％ CI: 1.62-9.35）. The current study found a significant association between frequent ED visits and the receipt of public assistance. Emergency physicians and medical practitioners need to share information with outpatient physicians and welfare officers and work together with patients to address their specific medical and social vulnerabilities

就学前児の積み木構成における手操作の縦断研究

　手操作の変化をみるために幼児期の縦断研究を行った。4 ～ 6 歳の幼児3 名に積み木を見本と同じ形・方位（0.90,180度）にする課題を行った。手の動かし方が月齢に従いいかに変化するか4 ヶ月間の追跡を行った。結果は，手使用（両手・片手を使用）と手操作（調整・崩壊・はさむ），見比べの計6 カテゴリー３側面に分けて整理した。月齢とともに手使用が減少し手操作が増加する2 名と，わずかな時間で逆転が生じた構成レベルの高い子どもとに分かれた。我々は単純な手の動きから，無駄のない動きへの移行を捉えることが出来た。巧緻性や技巧性の発達と大いに関連すると思われる。子どもの発達において，表象と行為とのあいだには注意と関連した自己制御が大きな役割を果たしているのではないかという議論を行った

看護教育における情報サーバーの構築例 : 臨床看護総論自己学習プログラムの場合

看護教育における情報サーバー構築の一例として、臨床看護総論での学生のレポートをもとに作成した、自己学習プログラムを紹介した。このプログラムは、他の情報サーバーと同様に階層構造を持ち、別のサーバーとの連携の可能性を持つ。コンピュータを介した情報ネットワークは、今後ますますの発展が予想される。このネットワークを、看護においても有効利用していくために、情報学教育の充実と、情報の質の検討、サーバー間の連携の強化が今後の課題として挙げられた

在宅療養に関連する要因の分析

出雲市のT地区の20歳以上を対象に、在宅介護・療養についてのアンケート調査を行い、在宅療養に関連する要因の検討を行った。在宅療養の希望と本人の状況、家族の状況、介護への関心・知識・体験との関連を検討したところ、性別、年齢、入院経験、福祉についての知識において有意の関連がみられた

Need for Flexible Adjustment of the Treatment Schedule for Aprepitant Administration against Erlotinib-Induced Refractory Pruritus and Skin Rush

Common dermatological side-effects associated with erlotinib, epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), include pruritus and skin rash, which are mediated by substance P, leading to the occasional discontinuation of cancer treatment. Aprepitant is an antagonist of neurokinin-1 receptor, through which substance P activates the pruritogens. Thus, aprepitant is expected to offer a promising option for the treatment of erlotinib-induced pruritus. However, the appropriate treatment schedule for aprepitant administration is under consideration. Here, we discuss the need for flexible adjustment of the treatment schedule for aprepitant administration against erlotinib-induced refractory pruritus and skin rush. A 71-year-old female smoker presented with stage IV EGFR-mutated lung adenocarcinoma. She was started on erlotinib at 150 mg/day. However, by 28 days, severe pruritus and acneiform skin rush resistant to standard therapies occurred, resulting in the interruption of erlotinib therapy. After recovery, she was restarted on erlotinib at 100 mg/day. However, severe pruritus and skin rush developed again within 2 weeks. Then, we started the first 3-day dose of aprepitant (125 mg on day 1, 80 mg on day 3, and 80 mg on day 5) based on the results of the previous prospective study, which showed the success rate of 100% with at least the second dose of aprepitant. However, the pruritus and skin rush exacerbated again within 4 weeks. Therefore, we started the second 3-day dose of aprepitant, but in vain. At this point, as the patient-centered medicine, bi-weekly schedule of the 3-day dose of aprepitant was considered and, then, adopted. As the results, the pruritus and skin rush remained well-controlled throughout the subsequent treatment with erlotinib