ダウン症候群児の咀嚼機能獲得に関連する要因の検討

Down syndrome (DS) has the highest prevalence of any chromosomal abnormality identified in newborns. DS children have specific eating and swallowing difficulties such as poor tongue control, mouth opening, swallowing food without chewing, and both facial and occlusal abnormalities. DS children are also at high risk of aspiration, and swallowing food without chewing is considered to be a factor associated with increased risk of aspiration and eating problems. This study aimed to identify factors preventing the acquisition of masticatory function in DS children. The subjects were 75 outpatient DS children (44 males, age range 12 to 36 month-old, mean age 33.0 ± 7.0 month­-old; 31 females, age 12 to 36 month-old, mean age 20.8 ± 8.0 month-old), who had not yet acquired masticatory function, out of 319 who visited the clinic between October 2012 and October 2017. The information necessary for assessment was retrospectively extracted from the medical records of the subjects. The items examined included age, birth weight, nutritional intake, picky eating, tactile hyperesthesia, cognitive development assessed by Ohta stage, gross motor function, occlusal condition by Hellman's dental age, and tongue thrust/lip closure/mastication while eating. The relationships between the acquisition of masticatory function and these items were investigated after one year of rehabilitation. The revealed age, low birth weight, picky eating, and gross motor function to be relevant factors. Among these, gross motor function was found to be the factor most strongly associated with acquisition of masticatory function

Understanding camouflaging, stigma, and mental health for autistic people in Japan Running head: Autism and camouflaging, stigma, and mental health

Background: Camouflaging refers to behaviors in which autistic individuals mask their autistic characteristics and “pass” as non-autistic people. It is postulated that camouflaging is a response to stigma, and preliminary evidence supports this hypothesis. However, research on this topic outside of Western countries is limited. This study replicated and extended previous work in the West that examined the relationships between camouflaging, stigma, and mental health of autistic adults, with a Japanese sample. Methods: Two-hundred eighty-seven autistic people living in Japan (146 men, 120 women, 14 non-binary, 5 other gender identities, 2 preferred not to say; mean age = 37.5 years, standard deviation = 9.8 years) completed an online survey on camouflaging, perceived stigma, coping strategies for stigma, mental well-being, generalized anxiety, social anxiety, and depression. We used hierarchical multiple regression analyses to investigate the relationships between camouflaging and stigma and coping strategies for stigma. Mediation analyses were also employed to examine whether camouflaging mediated the relationships between stigma and autistic people’s mental health. Results: Replicating previous work, we found that higher camouflaging was associated with higher perceived stigma. Both coping strategies of hiding/denying and valuing/embracing stigmatized characteristics were positively related to camouflaging. Camouflaging mediated the association of stigma with depression, generalized anxiety, and social anxiety (but not well-being). Conclusion: Our findings support the hypothesis that camouflaging is closely related to autism-related stigma and can influence the impact of stigma on mental health. More work around social outreach and addressing autism-related stigma would be beneficial to reduce the negative role of camouflaging.Output Status: Forthcomin

Oral hypofunction in the older population : Position paper of the Japanese Society of Gerodontology in 2016

Background: There is growing international interest in identifying the effects of ageing on oral health and on appropriate strategies for managing oral disorders. The Japanese Society of Gerodontology (JSG), as the official representative of researchers and clinicians interested in geriatric dentistry in Japan, makes several recommendations on the concept of “oral hypofunction.” Aims: This study proposes diagnostic criteria and management strategies to reduce the risk of oral hypofunction among older people. Conceptual Framework: We define oral hypofunction as a presentation of 7 oral signs or symptoms: oral uncleanness; oral dryness; decline in occlusal force; decline in motor function of tongue and lips; decline in tongue pressure; decline in chewing function; and decline in swallowing function. The criteria of each symptom were determined based on the data of previous studies, and oral hypofunction was diagnosed if the criteria for 3 or more signs or symptoms were met. Conclusions: We recommend that more evidence should be gathered from clinical studies and trials to clarify our diagnostic criteria and management strategies

Understanding camouflaging, stigma, and mental health for autistic people in Japan Running head: Autism and camouflaging, stigma, and mental health

Background: Camouflaging refers to behaviors in which autistic individuals mask their autistic characteristics and “pass” as non-autistic people. It is postulated that camouflaging is a response to stigma, and preliminary evidence supports this hypothesis. However, research on this topic outside of Western countries is limited. This study replicated and extended previous work in the West that examined the relationships between camouflaging, stigma, and mental health of autistic adults, with a Japanese sample. Methods: Two-hundred eighty-seven autistic people living in Japan (146 men, 120 women, 14 non-binary, 5 other gender identities, 2 preferred not to say; mean age = 37.5 years, standard deviation = 9.8 years) completed an online survey on camouflaging, perceived stigma, coping strategies for stigma, mental well-being, generalized anxiety, social anxiety, and depression. We used hierarchical multiple regression analyses to investigate the relationships between camouflaging and stigma and coping strategies for stigma. Mediation analyses were also employed to examine whether camouflaging mediated the relationships between stigma and autistic people’s mental health. Results: Replicating previous work, we found that higher camouflaging was associated with higher perceived stigma. Both coping strategies of hiding/denying and valuing/embracing stigmatized characteristics were positively related to camouflaging. Camouflaging mediated the association of stigma with depression, generalized anxiety, and social anxiety (but not well-being). Conclusion: Our findings support the hypothesis that camouflaging is closely related to autism-related stigma and can influence the impact of stigma on mental health. More work around social outreach and addressing autism-related stigma would be beneficial to reduce the negative role of camouflaging

Survey of suspected dysphagia prevalence in home-dwelling older people using the 10-Item Eating Assessment Tool (EAT-10).

ObjectiveThis study was carried out to determine the prevalence of suspected dysphagia and its features in both independent and dependent older people living at home.Materials and methodsThe 10-Item Eating Assessment Tool (EAT-10) questionnaire was sent to 1,000 independent older people and 2,000 dependent older people living at home in a municipal district of Tokyo, Japan. The participants were selected by stratified randomization according to age and care level. We set the cut-off value of EAT-10 at a score of ≥3. The percentage of participants with an EAT-10 score ≥3 was defined as the prevalence of suspected dysphagia. The chi-square test was used for analyzing prevalence in each group. Analysis of the distribution of EAT-10 scores, and comparisons among items, age groups, and care levels to identify symptom features were performed using the Kruskal-Wallis test and Mann-Whitney U test.ResultsValid responses were received from 510 independent older people aged 65 years or older (mean age 75.0 ± 7.2) and 886 dependent older people (mean age 82.3 ± 6.7). The prevalences of suspected dysphagia were 25.1% and 53.8%, respectively, and showed significant increases with advancing age and care level. In both groups, many older people assigned high scores to the item about coughing, whereas individuals requiring high-level care assigned higher scores to the items about not only coughing but also swallowing of solids and quality of life.ConclusionIn independent people, approximately one in four individuals showed suspected dysphagia and coughing was the most perceivable symptom. In dependent people, approximately one in two individuals showed suspected dysphagia and their specifically perceivable symptoms were coughing, difficulties in swallowing solids and psychological burden

Relationship between Gross Motor Function and Oral Parafunction Habits Relevant to Eating in Children with Down’s Syndrome

ダウン症候群患者の多くが舌突出や口唇閉鎖不全などの特有の症状を呈する．これらは保護者が発見しやすい症状であるため，摂食指導の主訴となることも多い．舌突出や口唇閉鎖不全は咀嚼や嚥下機能の阻害因子であり，長期化すると歯列や咬合状態にも影響を及ぼし，さらに摂食機能を低下させることが想定される．したがって，ダウン症候群児に特有の症状が習癖化する前にこれらの症状を改善または予防することが重要である． そこで今回，ダウン症候群児の口腔機能や摂食に関する実態を把握し，摂食指導に役立てることを目的に研究を行った． 対象は，経口摂取をしているダウン症候群児51名（男児32名，女児19名）とした．対象者の保護者から，初回の摂食指導受診日にダウン症候群児に関する質問票を記載してもらい，当日回収した．質問票の内容を検討した結果，対象者は，座位以降の粗大運動能の獲得時期が健常児より遅れる傾向にあった．対象者の約7割が摂食指導を受けた経験があったが，その指導内容の大半は食形態の指導であり，間接訓練や直接訓練の指導を受けた者は約2割であった．舌突出の有無は，年齢，歩行，筋訓練，おもちゃしゃぶりとの間に有意な関連が認められた．一方，口唇閉鎖不全の有無は，直接訓練であるかじりとり訓練との間に有意な関連が認められた．以上の結果よりダウン症候群児の舌突出と粗大運動能の発達には関連がみられ，さらに，筋訓練の導入や，一定の時期に行うおもちゃしゃぶりのようなさまざまな感覚入力が有効であることが示唆された．Children with Down’s syndrome generally have specific complications and unique development；most have some oral parafunctional habits, including mouth opening, tongue thrusting, and swallowing food without chewing. These parafunctional activities can be caused by muscle hypotonia and developmental retardation of gross motor function. However, the relationship between the development of gross motor function and oral parafunctional habits remains unclear. The purpose of the present study was to investigate the relationship between gross motor function and oral parafunctional habits in children with Down’s syndrome in order to perform effective dysphagia therapy. The subjects were children with Down’s syndrome receiving dysphagia therapy at the Tama Oral Rehabilitation Clinic at Nippon Dental University from Octber 18, 2012 to January 11, 2014. Fifty-one children（mean age 3.2 ± 1.7 years）who were able to eat orally were enrolled in the study with the consent of their parents. Parents completed a questionnaire about their child’s gross motor function and oral parafunctional habits relevant to eating at their initial clinic visit. Most children had developmental retardation of gross motor function and more than half displayed mouth opening and/or tongue thrusting. The subjects had received prior dysphagia therapy at other clinics, involving many different teaching contents. Most had received information on appropriate food choices；few had received instruction on muscle training. Tongue thrusting was significantly associated with age, development of the gross motor functions of age and walking, experience of muscle exercises, and the oral habit of sucking on toys. On the other hand, there was a significant relationship between mouth opening and biting exercises. We conclude that the development of gross motor function might be an important factor in improving oral parafunctional habits, including mouth opening and tongue thrusting for children with Down’s syndrome. Muscle exercises and sensible stimuli exercises during a specified period should be initiated as part of dysphagia therapy at an appropriate developmental stage in children with Down’s syndrome

COVID-19 Infection-Related Weight Loss Decreases Eating/Swallowing Function in Schizophrenic Patients

Background: In older people with psychoneurological diseases, COVID-19 infection may be associated with a risk of developing or exacerbating dysphagia. The aim of the present study was to examine the relationship between eating/swallowing function and COVID-19 infection. Methods: Subjects were 44 inpatients with confirmed COVID-19 infection being treated for schizophrenia in a psychiatric ward. Eating function was assessed using the Food Intake Level Scale (FILS) before and after infection. We also evaluated age, comorbidities, COVID-19 hospital stay, obesity index, weight loss rate, and chlorpromazine equivalent. Results: Subjects had a mean age of 68.86 years. Pre-infection, 20 subjects had a FILS score of 7–9 (presence of eating/swallowing disorder) and 24 subjects had a score of 10 (normal). Eating function after infection resolution showed decreasing FILS score compared to that before infection in 14 subjects (74.14 years). Six subjects (79.3 years) transitioned from oral feeding to parenteral feeding. A ≥ 10% weight loss during infection treatment was significantly associated with decreased eating function and a transition to parenteral feeding. Chlorpromazine equivalents, comorbidities, and number of days of hospitalization showed no associations with decreased eating function. Conclusions: Preventing malnutrition during treatment for COVID-19 infection is important for improving post-infection life prognosis and maintaining quality of life (QOL)