切迫早産予測指標としての妊娠前半期における血清中分泌型免疫グロブリンAおよび首尾一貫感覚

取得学位 : 博士（保健学）, 学位授与番号 : 医博甲第2057号 , 学位授与年月日 : 平成21年9月28日, 学位授与大学 : 金沢大学, 審査結果の報告日 : 平成21年8月26

Mother\u27s feelings of distress and related factors resulting from the crying of her one-month-old infants

金沢大学医薬保健研究域保健学

Mother\u27s feelings of distress and related factors resulting from the crying of her one-month-old infants

The purpose of this study was to clarify the nature of mother\u27s distress and its related factors resulting from the crying of her one-month-old infant. Subjects and Methods The subjects were mothers who delivered children in hospitals/maternity clinics in the Hokuriku district and who gave consent to our survey at the time of health examinations for one-month-old infants. The contents of the questionnaire were: characteristics of the infant\u27s crying, states of mother\u27s sleep, feeding and receiving support related to her distress about her infant and its associated factors. Scores were obtained using a 4-point Likert scale. Results Effective responses were obtained from 630 mothers, who consisted of 298 primiparas (47.3%) and 332 multiparas (52.7%). About 50% of the mothers experienced distress because they felt at a loss when their infant cried and when the infant did not stop crying even when being held or lulled. New mothers who had no experience with infants were more likely to indicate distress. The distress was significantly associated with factors such as the way the infant cried and if the infant failed to fall asleep in a timely way. It also was associated with factors in the mother\u27s life such as feeling burdened with childcare and lack of confidence in childcare. Conclusion In order to support mothers having a one-month-old infant, it is important to pay attention to the characteristics of infant\u27s crying, states of mother\u27s fatigue, mother\u27s expression of depression, and to know how mother comprehends childcare and her infant\u27s crying. For screening to be effective it must include both infant and mother factors. 目　的 　生後1 ヶ月児の泣きに対する母親の困難感とその感情に関連する要因を明らかにすることを目的とし た。 対象と方法 　北陸地方の病産院にて出産し，1 ヶ月健診時に調査の同意が得られた母親を対象に，自己記入式質問 紙調査を実施した。調査内容は，児の泣きに対する母親の困難感と，その関連要因として，児の泣きの 性質や母親の睡眠・授乳状況，サポート状況などの質問項目を設定し，各々4段階リカート尺度で点数 化した。 結　果 　有効回答は，初産婦298名（47.3％），経産婦332名（52.7％），合計630名であった。全体の約半数の母親が， 児が泣くと戸惑ったり，抱いたり，あやしても泣きやまない困難な状況を経験していた。困難感を示し た母親は，小さな子どもと接したことのない初産婦に多く，子どもの泣き方が特徴的であったり，なか なか寝入らないなど，子ども側の要因と母親の生活状況，育児に対する負担感や自信感等の母親側の要 因が困難感に関連していた。 結　論 　生後1 ヶ月時の母児の支援には，児側の要因と母親側の要因の双方に着目し，児の泣きの特徴や，母 親の疲労状態，育児に対する気持ち等に注意を向け，母親が児の泣きをどのようにとらえているのかを 知ることが重要であり，これらのスクリーニングの必要性が示唆された

Mother\u27s feelings of distress and related factors resulting from the crying of her one-month-old infants

金沢大学医薬保健研究域　保健学

妊婦の心理社会的ストレスと早産発生率の関連: 神経内分泌免疫学の観点から

金沢大学医薬保健研究域医学系[研究概要]平成17年度までの調査において,神経内分泌免疫学の観点からストレス対処能力と妊娠経過に何らかの関連がある可能性が示唆された。そこで平成18年度はストレス対処能力と妊娠経過との関連をさらに追及した。ストレス対処能力の指標にはSense of Coherence(以下SOC)を用い,妊娠前期,妊娠後期において同一対象者に調査を行った。[結果・考察]70名の妊婦に依頼したところ全員から同意が得られた。妊娠前期,妊娠後期において継続調査が可能であった対象者のうち,早産リスク因子のある妊婦を除外した55名を分析対象とした。妊娠36週までの経過において早産であった者(早産群)は2名,切迫早産の治療を受けた者(切迫群)は15名であり,妊娠経過に異常がなかった者(正常群)は38名であった。SOCは時期別で有意差はなく強い正相関があった(r=0.78,p<0.01)。そこで妊娠経過別に妊娠前期のSOCを比較したところ,正常群143.2±16.8に比較し切迫群および早産群では128.6±16.8であり,SOC得点が有意に低かった(p<0.01)。さらにSOCカットオフポイントで妊娠経過を比較した結果,SOCが低い群では高い群に比べ切迫早産や早産の割合が高かった(p<0.05)。つまりストレス対処能力が低いことが妊娠経過に影響している可能性が示唆され,SOCが低い妊婦に対するストレス軽減ケアの重要性が示された。また,平成17年度までの結果におけるSOCとストレス関連物質との関連から,生体侵襲のない方法として,SOCによりストレス対処能力が低い妊婦をスクリーニングできる可能性も示唆された。[結論]SOCが低い群では高い群に比べ切迫早産や早産の割合が高く,心理社会的ストレス反応に影響するストレス対処能力と妊娠経過との関連が明らかとなった。研究課題/領域番号:16791379, 研究期間(年度):2004 – 2006出典：「妊婦の心理社会的ストレスと早産発生率の関連-神経内分泌免疫学の観点から-」研究成果報告書　課題番号16791379（KAKEN：科学研究費助成事業データベース（国立情報学研究所））（https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-16791379/)を加工して作

Breakfast Skipping in Female College Students Is a Potential and Preventable Predictor of Gynecologic Disorders at Health Service Centers

Inadequate dietary habits in youth are known to increase the risk of onset of various diseases in adulthood. Previously, we found that female college students who skipped breakfast had higher incidences of dysmenorrhea, suggesting that breakfast skipping interferes with ovarian and uterine functions. Since dietary habits can be managed by education, it is preferable to establish a convenient screening system for meal skipping that is associated with dysmenorrhea as part of routine services of health service centers. In this study, we recruited 3172 female students aged from 18 to 25 at Kanazawa University and carried out an annual survey of the status of students’ health and lifestyle in 2019, by a questionnaire. We obtained complete responses from 3110 students and analyzed the relationship between dietary habits, such as meal skipping and history of dieting, and menstrual disorders, such as troubles or worries with menstruation, menstrual irregularity, menstrual pain, and use of oral contraceptives. The incidence of troubles or worries with menstruation was significantly higher in those with breakfast skipping (p p p < 0.001), indicating that this simple screening test is suitable for picking up breakfast skippers who are more prone to gynecologic disorders. In conclusions, since dysmenorrhea is one of the important clinical signs, breakfast skipping may become an effective marker to predict the subsequent onset of gynecological diseases at health service centers. Considering educational correction of meal skipping, breakfast skipping is a potential and preventable predictor that will contribute to managing menstrual disorders from a preventive standpoint in the future

The Circadian Clock, Nutritional Signals and Reproduction: A Close Relationship

The circadian rhythm, which is necessary for reproduction, is controlled by clock genes. In the mouse uterus, the oscillation of the circadian clock gene has been observed. The transcription of the core clock gene period (Per) and cryptochrome (Cry) is activated by the heterodimer of the transcription factor circadian locomotor output cycles kaput (Clock) and brain and muscle Arnt-like protein-1 (Bmal1). By binding to E-box sequences in the promoters of Per1/2 and Cry1/2 genes, the CLOCK-BMAL1 heterodimer promotes the transcription of these genes. Per1/2 and Cry1/2 form a complex with the Clock/Bmal1 heterodimer and inactivate its transcriptional activities. Endometrial BMAL1 expression levels are lower in human recurrent-miscarriage sufferers. Additionally, it was shown that the presence of BMAL1-depleted decidual cells prevents trophoblast invasion, highlighting the importance of the endometrial clock throughout pregnancy. It is widely known that hormone synthesis is disturbed and sterility develops in Bmal1-deficient mice. Recently, we discovered that animals with uterus-specific Bmal1 loss also had poor placental development, and these mice also had intrauterine fetal death. Furthermore, it was shown that time-restricted feeding controlled the uterine clock’s circadian rhythm. The uterine clock system may be a possibility for pregnancy complications, according to these results. We summarize the most recent research on the close connection between the circadian clock and reproduction in this review