A case report of posttraumatic growth from a psychosomatic disorder due to traumatic stress in a 50s woman

【目的】本研究では，トラウマ性ストレスによる心身障害を抱えた50代女性に対する，トラウマ体験を物語ることに焦点を当てた介入の症例から心的外傷後成長（Posttraumatic growth: PTG）の生起過程を考察する。【現病歴】a 市における自然災害死目撃を機に不安，恐怖が持続。薬物治療で回復に向かうも，a 市に帰郷すると体調が増悪するというサイクルを繰り返した。【事例の経過】トラウマ体験を物語ることを目的に，ナラティブ・エクスポージャー・セラピー（Narrative Exposure Therapy: NET）を実施した結果，不安と恐怖が軽減した。その過程の中で夫との親密さが増し，ともにトラウマに立ち向かった結果，症状なくa 市に帰郷できるようになった。【考察】トラウマ体験を物語ることで，PTG に必要な「意図的反芻」，「語りの発展」，「スキーマの変化」を促進し「人間としての強さ」，「他者との関係」の領域においてPTG が生起したと考えられる。【Purpose】 This clinical study is to report the effectiveness of narrative approach for PTG to open up traumatic experiences in a 50s women with psychosomatic disorder due to traumatic stress.【History of present illness】 I anxiety and fear continued after witnessing the death of a natural disaster in a city. The patient recovered with medication. However, she repeated the cycle that his physical condition got worse when he returned to a city.【Progress】 As she described her traumatic experience, her anxiety and fear lessened. In the process, the intimacy with the husband increased, and they faced the trauma together. Two years after intervention, She was back to a city without symptoms.【Disccusion】 It is considered that “intentional rumination”, “development of the narrative”, and “change of the schema”necessary for PTG were promoted by telling the traumatic experience, and PTG arose in the region of “strength as a human” and “relation with others

Association of Health Utility Score with Physical Activity Outcomes in Stroke Survivors

Health-related quality of life (HRQoL) after stroke tends to vary across studies or across stages of stroke. It is useful to use the health utility score to compare HRQoL across studies. Physical activity after stroke also tends to vary similarly. The purpose of the present study was to determine associations between the health utility score and physical activity outcomes in stroke survivors. This cross-sectional study recruited stroke survivors who could ambulate outside, free of assistance. We assessed the health utility score with the EuroQoL 5-Dimension 3-Level questionnaire. The physical activity outcomes were the number of steps taken and duration of moderate-to-vigorous physical activity (MVPA) as measured with an accelerometer. Multiple linear regression analyses were used to determine whether the physical activity outcomes were independently associated with the health utility score. Fifty patients (age: 68.0 years; 40 men, 10 women) were included. Multiple linear regression analysis showed the health utility score to be significantly associated with the number of steps taken (β = 0.304, p = 0.035) but not with MVPA. This is the first study to examine the association between the health utility score and objectively measured physical activity in stroke survivors. Promoting physical activity especially by increasing the number of steps taken might be a priority goal in improving a patient’s health utility score after stroke

Daily steps are associated with walking ability in hospitalized patients with sub-acute stroke

Abstract Increased physical activity is required in patients with stroke that are hospitalized in the rehabilitation unit. This study investigated the association between the daily number of steps and walking independence in order to determine the cutoff value of daily number of steps that can predict walking independence in hospitalized patients with sub-acute stroke. This cross-sectional observational study included 85 stroke patients admitted to the rehabilitation unit. The average daily number of steps was measured using Fitbit One for 4 days starting at 30 days after stroke onset. 6-min walk test, and Fugl-Meyer assessment of the lower extremities were measured The category of walking independence was classified using the Functional Ambulation Category (FAC). The subjects were divided into two groups according to the FAC score: a walking independence group (FAC ≥ 4) and a walking non-independence group (FAC ≤ 3). Logistic regression analysis was conducted to investigate the association of daily number of steps with walking independence and a receiver operating characteristic curve was used to identify the cutoff value of daily number of steps for predicting walking independence. The daily number of steps (per 1000 steps) was independently associated with walking independence (odds ratio (OR); 2.53, 95% confidence interval (CI); 1.40–5.73, p = 0.009). The cutoff value of daily number of steps for predicting independent walking was 4286 steps (area under the curve = 0.914, sensitivity of 0.731, and specificity of 0.949). The daily number of steps was associated with independent walking in hospitalized patients with sub-acute stroke. The daily number of steps may be a useful target in rehabilitation for patients with sub-acute stroke

Objectively measured physical activity was not associated with neighborhood walkability attributes in community-dwelling patients with stroke

Although the built environment may affect physical activity, there is little evidence on how neighborhood walkability attributes influence post-stroke physical activity. This study aimed to explore associations between objectively measured physical activity and neighborhood walkability attributes in community-dwelling patients with stroke. This cross-sectional study recruited patients who could ambulate outside free of assistance. We assessed objectively measured physical activity comprising the number of steps taken and time spent in moderate-to-vigorous physical activity (MVPA) with an accelerometer. Neighborhood walkability attributes were evaluated using the Walk Score. Multiple linear regression analyses were used to determine whether the Walk Score was independently associated with the number of steps taken or MVPA. Eighty participants with a mean age of 65.9 ± 11.1years were included. The participants took an average of 5900.6 ± 2947.3 steps/day and spent an average of 19.7 ± 21.7min/day in MVPA. The mean Walk Score was 71.4 ± 17.2. Multiple linear regression analyses showed that no significant associations were found between the Walk Score and the number of steps taken or MVPA. No associations were found between objectively measured physical activity and neighborhood walkability attributes in community-dwelling patients with stroke in an Asian area

Association of Health Utility Score with Physical Activity Outcomes in Stroke Survivors

Health-related quality of life (HRQoL) after stroke tends to vary across studies or across stages of stroke. It is useful to use the health utility score to compare HRQoL across studies. Physical activity after stroke also tends to vary similarly. The purpose of the present study was to determine associations between the health utility score and physical activity outcomes in stroke survivors. This cross-sectional study recruited stroke survivors who could ambulate outside, free of assistance. We assessed the health utility score with the EuroQoL 5-Dimension 3-Level questionnaire. The physical activity outcomes were the number of steps taken and duration of moderate-to-vigorous physical activity (MVPA) as measured with an accelerometer. Multiple linear regression analyses were used to determine whether the physical activity outcomes were independently associated with the health utility score. Fifty patients (age: 68.0 years; 40 men, 10 women) were included. Multiple linear regression analysis showed the health utility score to be significantly associated with the number of steps taken (β = 0.304, p = 0.035) but not with MVPA. This is the first study to examine the association between the health utility score and objectively measured physical activity in stroke survivors. Promoting physical activity especially by increasing the number of steps taken might be a priority goal in improving a patient's health utility score after stroke

Experimental and Theoretical Analyses of Azulene Synthesis from Tropones and Active Methylene Compounds: Reaction of 2-Methoxytropone and Malononitrile

A representative azulene formation from an active troponoid precursor (2-methoxytropone) and an active methylene compound (malononitrile) has been analyzed both experimentally and theoretically. ²H-Tracer experiments using 2-methoxy­[3,5,7-²H₃]­tropone (<b>2</b>-<i>d</i>₃) and malononitrile anion give 2-amino-1,3-dicyano­[4,6,8-²H₃]­azulene (<b>1</b>-<i>d</i>₃) in quantitative yield. New and stable ²H-incorporated reaction intermediates have been isolated, and main intermediates have been detected by careful low-temperature NMR measurements. The detection has been guided by mechanistic considerations and B3LYP/6-31­(+)­G­(d) calculations. The facile and quantitative one-pot formation of azulene <b>1</b> has been found to consist of a number of consecutive elementary processes: (a) The troponoid substrate, 2-methoxytropone (<b>2</b>), is subject to a nucleophilic substitution by the attack of malononitrile anion (HC­(CN)₂^–) to form a Meisenheimer-type complex <b>3</b>, which is rapidly converted to 2-troponylmalononitrile anion (<b>5</b>). (b) The anion <b>5</b> is converted to an isolable intermediate, 2-imino-2<i>H</i>-cyclohepta­[<i>b</i>]­furan-3-carbonitrile (<b>6</b>), by the first ring closure in the reaction. (c) A nucleophilic addition of the second HC­(CN)₂^– toward the imine <b>6</b> at the C-8a position produces the second Meisenheimer-type adduct <b>7</b>. (d) The second ring closure leads to 1-carbamoyl-1,3-dicyano-2-imino-2,3-dihydroazulene (<b>11</b>). A base attacks the imine <b>11</b>, which results in generation of a conjugate base <b>12</b> of the final product, azulene <b>1</b>

Experimental and Theoretical Analyses of Azulene Synthesis from Tropones and Active Methylene Compounds: Reaction of 2-Methoxytropone and Malononitrile

A representative azulene formation from an active troponoid precursor (2-methoxytropone) and an active methylene compound (malononitrile) has been analyzed both experimentally and theoretically. ²H-Tracer experiments using 2-methoxy­[3,5,7-²H₃]­tropone (<b>2</b>-<i>d</i>₃) and malononitrile anion give 2-amino-1,3-dicyano­[4,6,8-²H₃]­azulene (<b>1</b>-<i>d</i>₃) in quantitative yield. New and stable ²H-incorporated reaction intermediates have been isolated, and main intermediates have been detected by careful low-temperature NMR measurements. The detection has been guided by mechanistic considerations and B3LYP/6-31­(+)­G­(d) calculations. The facile and quantitative one-pot formation of azulene <b>1</b> has been found to consist of a number of consecutive elementary processes: (a) The troponoid substrate, 2-methoxytropone (<b>2</b>), is subject to a nucleophilic substitution by the attack of malononitrile anion (HC­(CN)₂^–) to form a Meisenheimer-type complex <b>3</b>, which is rapidly converted to 2-troponylmalononitrile anion (<b>5</b>). (b) The anion <b>5</b> is converted to an isolable intermediate, 2-imino-2<i>H</i>-cyclohepta­[<i>b</i>]­furan-3-carbonitrile (<b>6</b>), by the first ring closure in the reaction. (c) A nucleophilic addition of the second HC­(CN)₂^– toward the imine <b>6</b> at the C-8a position produces the second Meisenheimer-type adduct <b>7</b>. (d) The second ring closure leads to 1-carbamoyl-1,3-dicyano-2-imino-2,3-dihydroazulene (<b>11</b>). A base attacks the imine <b>11</b>, which results in generation of a conjugate base <b>12</b> of the final product, azulene <b>1</b>