メンタルヘルス不調者へのセルフマネジメントプログラムの効果に関する研究

本研究の目的は、心療内科に通院するメンタルへルス不調者に、セルフマネジメントプログラムを用いた介入を行い、セルフマネジメント力を高める効果があるかを実証的に検証することである。方法は、「治療のみの変化」「介入による変化」「介入後の持続効果」を比較した群間比較研究である。対象は、うつ・不安障害などで心療内科に通院している患者10 名で、1 回2 時間、3 回からなるプログラムに参加し、その前後と1ヶ月後に質問紙調査を実施した。調査内容は、自己効力感、自己抑制型行動特性、問題解決型行動特性、抑うつ度とした。プログラム内容は、メンタルヘルス不調の心理教育、自己理解、イメージセラピー、エンカウンターグループで構成した。調査の結果、介入前後の比較において、自己抑制型行動特性、問題解決型行動特性に有意差は認められなかった。自己効力感（p＜0.5）、抑うつ（p＜0.1〉で有意な改善が認められた。また、自己効力感の下位因子であるネガティブ因子に有意傾向が認められた（p＜1）。これらの効果は介入1ヵ月後まで維持されていた。さらに、治療のみの期間における尺度の変化は認められなかったことから、介入前後の変化は介入による効果の可能性が高い。セルフマネジメントプログラム実施により、抑うつ気分の改善と自己効力認知の改善が認められ、セルフマネジメントに向けた効果が確認された。自己抑制型行動特性と問題解決型行動特性に変化は認められず、行動変容に至る期間を加味した長期的なフォローアップが必要である。一部の参加者の記述から気分と認知にセルフマネジメントに向けた肯定的な変化があり、統計的分析結果が参加者の主観からも裏付けられた。The purpose of this study is to empirically indicate whether intervention of patientswith mental health disorders, who regularly see doctors, with a self-management program is effective in improving their self-management capabilities.The method used was intergroup research comparing “change only by treatment”,“change by intervention”and“continuing effects after intervention”.Subjects were10patients who regularly saw psychosomatic doctors with the symptoms of depression,anxiety disorder, etc. The program was comprised of three2-hour sessions, and a questionnaire survey was taken before and after those sessions plus one month later.Survey contents included a feeling of self-efficacy,self-restraint behavioral characteristics, problem solving behavioral characteristics,and degree of depression.The program was comprised of psychoeducation of mental health disorders,self-understanding,image therapy, and encounter groups.The results did not show any significance in self-restraint behavioral characteristics or problem solving behavioral characteristics when comparing the before and after intervention, but significant improvement was confirmed on self-efficacy（p<0.5）and depression（p<0.1）.Additionally, a negativefactor, which is the hypostatic factor of self-efficacy, showed a tendency of marginal significance（p<1）.These effects remained1month after intervention. Since the scale didn’t change in the period of only receiving doctor’s treatment, it is highly possible that the intervention was responsible for the effective changes.Improvement in depression and recognition of self-efficacy from the intervention was recognized and the researchers confirmed its effect toward patients’self-management. Some of the written answers from participants stated they had positive changes in their mood and cognition,which confirmed the results of the statistical analysis from the participants’subjective viewpoint

Shifting transcriptional machinery is required for long-term memory maintenance and modification in Drosophila mushroom bodies

Accumulating evidence suggests that transcriptional regulation is required for maintenance of long-term memories (LTMs). Here we characterize global transcriptional and epigenetic changes that occur during LTM storage in the Drosophila mushroom bodies (MBs), structures important for memory. Although LTM formation requires the CREB transcription factor and its coactivator, CBP, subsequent early maintenance requires CREB and a different coactivator, CRTC. Late maintenance becomes CREB independent and instead requires the transcription factor Bx. Bx expression initially depends on CREB/CRTC activity, but later becomes CREB/CRTC independent. The timing of the CREB/CRTC early maintenance phase correlates with the time window for LTM extinction and we identify different subsets of CREB/CRTC target genes that are required for memory maintenance and extinction. Furthermore, we find that prolonging CREB/CRTC-dependent transcription extends the time window for LTM extinction. Our results demonstrate the dynamic nature of stored memory and its regulation by shifting transcription systems in the MBs

The Shared Experience of Nursing care for the Family

年齢も経験も異なる看護師による, 家族ケアに関する事例について, それぞれがどのような体験をしていたのか,その体験の意味づけについて振り返りを行った. ここでは, 担当した事例そのものよりも, 看護師の体験に焦点を当てた. 看護師はそれぞれ経験も年齢も異なるため, 看護学生時代の経験も含めた. 多くの看護師は, 家族ケアに関する認識が高いとはいえなかったが, 少ない情報や経験の中で, 自分のできるケアを提供しようと努力していた. また,家族に向き合うことができず, 家族ケアに消極的にならざるを得なかった事例では, 何が関わりを困難にさせたのかを振り返ることができた.Seven nurses shared anecdotal experiences of caring for their families to compare and attempt to give meaning to their experiences. Rather than looking at the facts of each case, they focused on the experience of nursing. Most of the nurses did not have much knowledge of family care but they wanted to do theirbest within their limited information and experience. We understood cases where they felt difficulty due to their relationships and reluctant to carry out family care. Family care can be promoted through deepening this sort of understanding