先天性心疾患の乳幼児を育てる母親の抱く育児ストレスの概観と支援の展望

目的は，先天性心疾患の乳幼児を育てる親の育児ストレスに着目し，育児ストレスの現状と地域で支えるために必要な支援について示唆を得ることである。方法は，国内外における過去15 年間（2002 年8 月～ 2017 年8 月）の原著，報告，総説，学位論文を対象に，「先天性心疾患」「子ども」「育児ストレス」「ソーシャルサポート」congenital heart disease, child , parenting stress，social support, で検索をし，文献レビューを行った。結果，21 論文を分析対象とし，現状としては日常生活が心臓に及ぼす負荷とそれに伴う日常生活の制限及び精神面・身体面における成長や発達の関係において育児ストレスを抱き，医療従事者のソーシャルサポート（以後，SS という。）の活用が育児ストレスの緩和に繋がっていた

The Perception of Mandarin lexical tones by native Japanese adult listeners with and without Mandarin learning experience

Processing lexical tones is known to be difficult for non-native speakers from various language backgrounds. Perceptual accuracy of six Mandarin tone contrasts (T1–T2, T1–T3, T1–T4, T2–T3, T2–T4, T3–T4) of two groups of Japanese listeners (learners and non-learners) and a control group of Mandarin listeners were compared in Mandarin learning experience, phonetic context, and speaker gender. Both Japanese groups perceived T2–T3 poorly, but the learner group was significantly better than the non-learner group for this and the T1–T2 contrasts. The learners' advantage was observed across various phonetic contexts (initial consonants and tone bearing vowels), suggesting that their tone perception was more stable and resistant to speaker variation. In regard to speaker gender, both Japanese groups perceived the T2–T3 contrast more poorly, and T1–T2 and T1–T4 contrasts more successfully, when produced by female speakers.28 page(s

乳児期の食道内pHモニタリングの胃食道逆流症の評価における胃内pHの影響(東京女子医科大学附属第二病院小児科開局30周年記念論文集)

食道内pHモニタリング(pH検査)は,現在,胃食道逆流症(GER)の評価法として最も信頼度が高いが,乳児では哺乳による影響で胃内pHが高い傾向にあり,GERの評価に影響を及ぼすといわれている.我々はGER症状を有する乳児81例について,日常生活と同じ授乳法でpH検査を施行しGERも評価しているが,その際の胃内pHの影響について検討した.これらの症例には消化管造影,内圧検査も施行した.[結果](1)胃内pH<4の時間率は,乳児期の月齢に従って上昇する.(2)日常生活と同じ授乳法で行ったpH検査のGERの評価は,胃内pHに影響されなかった.(3)胃排出能遅延は,81例中15例に認められたが,胃内pHとの関連は認められなかった.(4)pH検査にてGER陰性であった36例中20例は消化管造影によるGERは陽性,内圧検査にて下部食道括約筋(LES)圧の異常値は24例,食道蠕動異常は18例に認めた.これらの症例には,当科のGERの治療プロトコールに従って治療を行い,全例,症状は軽快した.[結論]乳児では,哺乳により胃内pHは変動するものの,日常生活と同じ授乳法によるpH検査は,そのGERの評価が,胃内pH<4の時間率に関係することなく,乳児におけるGERの評価に有用であった.しかしGERの病態を把握するためには,pH検査のみでなく,内圧検査や放射線学的検査も行い,胃食道機能の全体的な評価をすることが必要であると思われた.Prolonged intraesophageal pH monitoring has become the preferred test to quantify acid gastroesophageal reflux (GER). We have performed this procedure concurrent with a regular feeding schedule as patients experienced symptoms in a similar environment. Hence, milk feedings tended to buffer gastric acidity, we attempted to investigate the influence of gastric pH on the evaluation of esophageal pH monitoring. Gastric and esophageal pH were simultaneously recorded by two separate pH electrodes for more than 20 hours in 81 infants (0～11 months) with GER symptoms. Radiological evaluations of GER and gastric emptying with barium and manometric studies were also performed in these infants. The results of this study indicate that: 1) Percentage of time with gastric pH < 4 increases with age in infancy. 2) Gastric pH is statistically not related to the evaluation of GER on esophageal pH monitoring. 3) Significantly delayed gastric emptying occurred in 15 out of the cases studied, however, gastric pH is not related to the delay. 4) In 36 cases that GER was negative on pH monitoring, GER was documented during radiological study in 20 cases, the abnormalities of lower esophageal sphincter (LES) pressure showed in 24 cases, and esophageal dysmotilities occurred in 18 cases on manometric study. These cases with abnormal findings were successfully treated followed by our treatment protocol for GER. In conclusion, prolonged esophageal pH monitoring with regular feeding is independent of the gastric acidity in infancy, and the method is useful to evaluate pathological GER. However, radiological and manometric studies, in addition to pH monitoring, should be required to evaluate the total gastresophageal function

乳児期の食道内pHモニタリングの胃食道逆流症の評価における胃内pHの影響(東京女子医科大学附属第二病院小児科開局30周年記念論文集)

食道内pHモニタリング(pH検査)は,現在,胃食道逆流症(GER)の評価法として最も信頼度が高いが,乳児では哺乳による影響で胃内pHが高い傾向にあり,GERの評価に影響を及ぼすといわれている.我々はGER症状を有する乳児81例について,日常生活と同じ授乳法でpH検査を施行しGERも評価しているが,その際の胃内pHの影響について検討した.これらの症例には消化管造影,内圧検査も施行した.[結果](1)胃内pH<4の時間率は,乳児期の月齢に従って上昇する.(2)日常生活と同じ授乳法で行ったpH検査のGERの評価は,胃内pHに影響されなかった.(3)胃排出能遅延は,81例中15例に認められたが,胃内pHとの関連は認められなかった.(4)pH検査にてGER陰性であった36例中20例は消化管造影によるGERは陽性,内圧検査にて下部食道括約筋(LES)圧の異常値は24例,食道蠕動異常は18例に認めた.これらの症例には,当科のGERの治療プロトコールに従って治療を行い,全例,症状は軽快した.[結論]乳児では,哺乳により胃内pHは変動するものの,日常生活と同じ授乳法によるpH検査は,そのGERの評価が,胃内pH<4の時間率に関係することなく,乳児におけるGERの評価に有用であった.しかしGERの病態を把握するためには,pH検査のみでなく,内圧検査や放射線学的検査も行い,胃食道機能の全体的な評価をすることが必要であると思われた.Prolonged intraesophageal pH monitoring has become the preferred test to quantify acid gastroesophageal reflux (GER). We have performed this procedure concurrent with a regular feeding schedule as patients experienced symptoms in a similar environment. Hence, milk feedings tended to buffer gastric acidity, we attempted to investigate the influence of gastric pH on the evaluation of esophageal pH monitoring. Gastric and esophageal pH were simultaneously recorded by two separate pH electrodes for more than 20 hours in 81 infants (0～11 months) with GER symptoms. Radiological evaluations of GER and gastric emptying with barium and manometric studies were also performed in these infants. The results of this study indicate that: 1) Percentage of time with gastric pH < 4 increases with age in infancy. 2) Gastric pH is statistically not related to the evaluation of GER on esophageal pH monitoring. 3) Significantly delayed gastric emptying occurred in 15 out of the cases studied, however, gastric pH is not related to the delay. 4) In 36 cases that GER was negative on pH monitoring, GER was documented during radiological study in 20 cases, the abnormalities of lower esophageal sphincter (LES) pressure showed in 24 cases, and esophageal dysmotilities occurred in 18 cases on manometric study. These cases with abnormal findings were successfully treated followed by our treatment protocol for GER. In conclusion, prolonged esophageal pH monitoring with regular feeding is independent of the gastric acidity in infancy, and the method is useful to evaluate pathological GER. However, radiological and manometric studies, in addition to pH monitoring, should be required to evaluate the total gastresophageal function.東京女子医科大学附属第二病院小児科開局30周年記念論文