Is Blood Pressure Lowering in the Very Elderly With Previous Stroke Associated With a Higher Risk of Adverse Events?

BACKGROUND: We investigated whether blood pressure lowering for secondary prevention is associated with a reduction in recurrent stroke risk and/or a higher risk of adverse events in very elderly compared with younger trial participants. METHODS AND RESULTS: This is a random effects meta-analysis of randomized controlled trials of blood pressure lowering for secondary stroke prevention to evaluate age-stratified (<80, ≥80 years) risk of adverse events. Ovid-MEDLINE was searched for trials between 1970 and 2020. Summary-level data were acquired including outcomes of stroke, cardiovascular events, mortality, and adverse events. Seven trials were included comprising 38 596 participants, of whom 2336 (6.1%) were aged ≥80 years. There was an overall reduction in stroke risk in the intervention group compared with controls (risk ratio [RR], 0.90 [95% CI, 0.80, 0.98], I 2=49%), and the magnitude of risk reduction did not differ by age subgroup (<80, ≥80 years). There was no increase in the risk of hypotensive symptoms in the intervention group for patients aged <80 years (RR, 1.19 [95% CI, 0.99], 1.44, I 2=0%), but there was an increased risk in those ≥80 years (RR, 2.17 [95% CI, 1.22], 3.86, I 2=0%). No increase was observed in the risk of falls, syncope, study withdrawal, or falls in either age subgroup. CONCLUSIONS: Very elderly people in secondary prevention trials of blood pressure lowering have an increased risk of hypoten-sive symptoms, but with no statistical increase in the risk of falls, syncope, or mortality. However, evidence is lacking for frail elderly with multiple comorbidities who may be more vulnerable to adverse effects of blood pressure lowering

児童虐待と親のメンタルヘルス問題の接点 : 先行研究にみるその実態

本研究では，児童虐待と親のメンタルヘルス問題との接点に着目する。虐待をした親に「精神障害」がみられる事例（以下，当該事例）の多さが頻繁に指摘されるが，その実態については不明確な点も多く，「精神障害」と児童虐待との因果関係や虐待発生機序についても十分に議論されているとは言えない。児童福祉施設入所児童への家庭復帰支援の促進が図られる中，当該事例においては親のメンタルヘルス状態の安定や地域生活支援体制の提供など支援上の課題がより多岐に亘らざるを得ず，その支援に困難感を抱く相談援助職者も多い。その特性に応じた支援方策に関する議論も乏しいことから，当該事例の実態および支援方策について検討することには重要な意義があると考える。本稿は当該事例への家庭復帰支援方策に関する研究の端緒に位置するものであり，とくにその実態について実証的に論じた先行研究の概観を通して，児童虐待と親のメンタルヘルス問題の接点に関する知見を整理することを目的としている。The focus of this research is the relationship of child abuse and parents' mental health problems. The frequency of the cases where mental health problems are seen is often pointed out in parents who abused. However, there are many unclear points about the actual situation. Moreover, the causal mechanism of the relationship between parents' mental health and child abuse has not been sufficiently discussed.At the present time, the government is seeking to promote family reintegration for children who have entered child welfare institutions. However, more support is needed, in particular with regard to the stability of parents' mental health and assisted living. There are many support professionals who experience difficulty, and discussion of methods is rare. Therefore，investigation of the actual situation and of support methods is urgently needed. The purpose of this paper is to begin preliminary research on support methods for family re-integration in cases where children have been abused by parents with mental health problems, by reviewing previous knowledge about the relationship of child abuse and parents' mental health.資料Data Report

子どもとの接触体験からみた看護学生の子どもイメージ

本研究の目的は,入学したばかりで小児看護学受講前の学生は,子どもとの接触体験をどの程度持っているのか,またどのような子どもイメージを持っているのか,子どもとの接触体験は,イメージの形成にどのように影響するのかを明らかにすることであった。対象者は,研究の目的に同意が得られた2大学の1年生143名である。結果は,接触体験で最も多い項目は,「赤ちゃんを抱く」や「子どもとの遊び相手」で世話に関する体験は少なかった。接触体験やきょうだい数が多いほど,子どもの『行動特性』からくるイメージは肯定的となっていた。他のイメージの側面には影響がみられなかった。また接触体験の多さは,子どもへの関心とも関連がなかった。むしろ接触体験が多いと苦手意識になることも示唆された。学生は,子どもへの関心は高いが,そのイメージは,子どもとの浅い関わりや外観から得られるイメージであることがわかった。The purpose of this research was to examine the relation between the students' image of children before attending the lectures on child nursing and their previous experience of contact with children. The subjects of the research were 143 nursing students who agreed to the research at two universities. The measurement of the image of children involved a questionnaire consisting of 47 adjectives vs. four factors. And the measurement of experience of previous contact with children involved a questionnaire composed of 18 items concerning experience of contact with babies to children. The most common items checked in experience of contact were "holding a baby" and "being a child's playmate". Experience of other contacts was limited. A positive image of children's behavioral features appeared to be linked to the number of the subjects' siblings and the amount of experience of contact. Apart from this, no other relations emerged as image factors. Moreover, there was no relationship between experience of contact and interest and concern for children. Rather, it seemed that a large amount of previous contact with children was connected to the awareness of difficulties. Although it became clear that students had a high level of interest and concern, their image of children came from shallow and superficial relations.報告Report国立情報学研究所で電子

ヨウソウ ヨウサイ ノ フキュウ ト ワフク 1950ネンダイ ニオケル チョクセンダチ ノ イミ

アジア太平洋戦争敗戦後の1950年前後の日本において, 洋裁・洋装の普及過程で注目された「直線裁ち」は, 洋服地と洋裁技術のないままに, 「和服」地と和裁の技術をもって洋服を身につける, という困難な課題に対する解決策であった。またそこに西洋の洋服とは違う, 「日本人に合った洋服」が求められることにもなった。本研究では, この時期に, 多くの服飾関係者や一般の人々が, 「日本人にとって洋服とは」という疑問につきあたり, 「和服」と洋服との折衷とも言える「直線裁ち」に活路を見出そうとしていたということ, また, 洋服に「和服」の手法を取り入れるという方向と, 「和服」に洋服の手法を取り入れるという方向との双方向があったことを明らかにした。加えて, 和服がほぼ儀礼服と化した現在と異なり, 1950年前後の時期は, 「日本人にふさわしい衣服」についての議論が活発であり, 「和服」と洋服のあり方や両者の関係についてもとらえ方が流動的であることを明らかにした