精神保健福祉士のあり方を考える: 帯広・十勝圏域の精神保健医療福祉実践から学ぶこと

本稿の目的と関心は，全国的にも高い評価を受ける北海道帯広・十勝圏域の精神保健医療福祉実践を概観するとともに，その歴史的事項の整理を行いながらわが国の精神保健福祉士のあり様について試論を述べることにある。この実践を検討する際には，諸家が「オープンシステム」を評価していることに注目するべきである。それは，「どこの病院の患者であろうと利用できる。誰が創ろうと地域に創られた資源は，医療機関も同様に住民が自由に活用できることが当たり前であり，社会資源は社会の共有資源であることを基本として相互に利用しあうこととなった」というものである。諸家の記録を検討すると，これらの実践では，当事者が置かれている環境へのきわめて素朴な疑問から関係者が様々な連携・協働の下にシステムを構築してきたことが明らかであった。この点の重要性を精神保健福祉士は再認識すべきであると考えられた。This study has the objective and interest of outlining mental health welfare practices in Obihiro and Tokachi districts of Hokkaido, which are highly esteemed nationwide, with presentation of the author’s opinions of how psychiatric welfare workers should fulfill their duties by summarizing related historical information. In examining this practice, it is noteworthy that many experts appreciate the “open system.” According to the system, “Any patient of any hospital can use it. No matter who creates it, the resource created at a community, including healthcare facilities, should be used naturally and freely by residents. Therefore, social resources have been used communally on the premise that they should be shared as social resources.” Examination of records by the experts revealed that the people involved have created a system with various cooperation and collaboration from simple problem consciousness they have of the environment in which patients are placed. The author infers that psychiatric social workers should recognize the importance of this point

発達障害学生の学修支援に関する試論 : ソーシャルワーカーの立場から

【要旨】本稿では，近年増加する発達障害や発達障害が疑われる学生の増加に鑑み，概況を把握するとともに学修支援の実践例やありようについて諸家の知見を整理し，本学での学修支援システム構築に資する基礎資料を作成することを試みた。日本学生支援機構によれば，大学，短期大学及び高等専門学校に在籍する障害学生数は33,812人でそのうち，「発達障害(診断書有)」6,047人であった。このうち支援障害学生は4,325人であったが，これに加えて発達障害(診断書無・配慮有)の支援障害学生3,105人の存在もある。発達障害のみならず，障害を持つ学生支援は全国的に質・量とも追求される時勢であるが，殊に発達障害学生について各大学の取り組みを概観するとともに，「学生支援体制づくり」「援助希求のない学生への支援」について筆者の私心を述べた。Abstract: In recent years, the number of students who have and who are suspected of having developmental disorders has been increasing. Given this fact, the analysis described herein was conducted to grasp the overall situation of students with developmental disorders. The results are expected to yield source materials to develop a learning support system at Nayoro City University through organization of practical examples of learning support and various researchers’ knowledge of how the support should be administered. According to the Japan Student Services Organization (JASSO), the number of students with disorders currently attending universities, junior colleges, and technical colleges is 33,812. Of those, 6,047 students have “developmental disorders (with a medical certificate),” which includes 4,325 students with disorders receiving support. There are 3,105 other students with developmental disorders (without a medical certificate but with educational considerations) receiving support. These days, support for students with disorders, not limited to developmental disorders, is pursued both qualitatively and quantitatively nationwide. However, the author particularly surveys universities’ efforts to support students with developmental disorders and presents views of “the development of a student support system” and “support for students not seeking assistance.

精神障害者のリカバリーと地域精神保健福祉活動に関する試論 : ヤングケアラーに関わる諸課題も含めて

本稿の目的と関心は、精神障害者のリカバリーの概念について諸家の知見を整理するとともに、筆者が日頃親交のある当事者やその家族との交流の中から 、リカバリーやあわせて精神障害者の家族支援についていくつかの試論を述べることにある。リカバリーの概念はソーシャルワーク領域も含め精神保健福祉領域では以前から盛んに用いられている。そして、リカバリーを考えるなかでは、家族支援を取り巻く課題にも目を向ける必要がある。リカバリーを促進させるためには、地域精神保健福祉活動のありようも検討していく必要があり、支援や土壌づくりは多くの人々が様々な視点を持って関わることが求められる。その点においては、 社会福祉学科のみならず、栄養学科、看護学科、社会保育学科を擁す大学に課せられる使命は決して小さくはないことを再確認する。The purpose and goal of this paper are organization of the researechers\u27 information related to the concept of recovery for persons with mental disabilities. From the author\u27s experience of freindship with the parties concerned and interaction with their families, their recovery and family support are discussed. The recovery concept has been used frequently since long ago in the fleld of mental health welfare, including that in the fleld of social work.Consideration of recovery necessitates a shift of our focus from difficulties surrounding their families\u27 support system. Acceleration of recovery requires examination of the conditions of regional mental health welfare activity. Moreover to ensure support and the building of a public consensus, many pcople with diverse perspectives are necessarily involved. Given this point of view, we reconflrm that the mission of the universities having social welfaredepartment is deflnitely not small, including nutritional seicnce, social welfare, nursing, and social nursery

島嶼地域高齢者の主観的健康感とその関連要因 : ソーシャル・サポート・ネットワークと社会関連性を中心に

本研究の目的と関心は,1)自立度が高いとされる島嶼地域高齢者の主観的健康感の状況とその関連要因について検討すること,2)島嶼地域のコミュニティについて概観し,健康福祉政策策定の基礎資料を作成することの2つに集約できる.本研究では,島嶼地域に居住する高齢者を対象に,ソーシャル・サポート・ネットワークや社会関連性について訪問面接調査を実施した.その結果,235人から回答を得ることができた(回収率:87.0%).主観的健康感の分布は,一般的な知見と概ね同様であった.主観的健康感の関連要因の検討では,基本属性において「同居家族」,ソーシャル・サポート・ネットワークの状況において,「心配事を聞いてくれる人」「元気づけてくれる人」,社会関連性において,「役割の遂行」「規則的な生活」の計5項目を独立性の高い変数として検出した.本研究の結果から,島嶼地域の高齢者は"生涯現役的"生活・思考を持っていることが示唆された.今後は,それらを尊重しながら島民の健康を支える保健医療福祉施策のあり方を模索する必要があろう.The investigational targets of this study can be summarized as the following two points : 1) Examining self-rated health condition and its associated factors among elderly persons living in island communities whose degree of autonomy is considered to be high. 2) Surveying communities in island regions to gain many accounts of developments there and to produce a basic dataset for health and welfare policy development. Subjects of the study were 270 persons aged 65 years or over living in island communities. After conducting a visitation interview survey, we received 235 responses from them (response rate, 87.0%). Survey contents of the study were items related to : (1) base attributes, (2) social interaction, (3) ADL, (4) social support network situation, and (5) health and living habits. Main results of the study were the following. Distribution of self-rated health : 32 (13.6%) answered "Very healthy" ; 145 (61.7%) answered "Sufficiently healthy" ; 52 (22.1%) answered "Not so healthy" ; and six (2.6%) answered "Not healthy at all". Logistic-regression analyses of factors associated with self-rated health identified the following five items as variables with high influence. In items related to base attributes, the OR of "Yes" was 4.29 as to "family who lives together". In items related to social support network situation, the OR of "Yes" was 6.49 as to "person who hears anxiety". The OR of "Yes" was 6.99 as to "person cheering you up". In items related to social interaction, the OR of "Yes" was 5.96 as to "achieving your roles". The OR of "Yes" was 4.72 as to "regular life". Results of this study indicate that elderly persons in island communities have "lifelong active" way of life and thought. For the future, in that respect, we must seek ideal methods of health, medicine and welfare to support islanders\u27 health

Regulation of Pancreatic β Cell Mass by Cross-Interaction between CCAAT Enhancer Binding Protein β Induced by Endoplasmic Reticulum Stress and AMP-Activated Protein Kinase Activity

During the development of type 2 diabetes, endoplasmic reticulum (ER) stress leads to not only insulin resistance but also to pancreatic beta cell failure. Conversely, cell function under various stressed conditions can be restored by reducing ER stress by activating AMP-activated protein kinase (AMPK). However, the details of this mechanism are still obscure. Therefore, the current study aims to elucidate the role of AMPK activity during ER stress-associated pancreatic beta cell failure. MIN6 cells were loaded with 5-amino-1-ϐ-D-ribofuranosyl-imidazole-4-carboxamide (AICAR) and metformin to assess the relationship between AMPK activity and CCAAT enhancer binding protein ϐ (C/EBPϐ) expression levels. The effect of C/EBPϐ phosphorylation on expression levels was also investigated. Vildagliptin and metformin were administered to pancreatic beta cell-specific C/EBPϐ transgenic mice to investigate the relationship between C/EBPϐ expression levels and AMPK activity in the pancreatic islets. When pancreatic beta cells are exposed to ER stress, the accumulation of the transcription factor C/EBPϐ lowers the AMP/ATP ratio, thereby decreasing AMPK activity. In an opposite manner, incubation of MIN6 cells with AICAR or metformin activated AMPK, which suppressed C/EBPϐ expression. In addition, administration of the dipeptidyl peptidase-4 inhibitor vildagliptin and metformin to pancreatic beta cell-specific C/EBPϐ transgenic mice decreased C/EBPϐ expression levels and enhanced pancreatic beta cell mass in proportion to the recovery of AMPK activity. Enhanced C/EBPϐ expression and decreased AMPK activity act synergistically to induce ER stress-associated pancreatic beta cell failure

Importance of rostral ventrolateral medulla neurons in determining efferent sympathetic nerve activity and blood pressure

Accentuated sympathetic nerve activity (SNA) is a risk factor for cardiovascular events. In this review, we investigate our working hypothesis that potentiated activity of neurons in the rostral ventrolateral medulla (RVLM) is the primary cause of experimental and essential hypertension. Over the past decade, we have examined how RVLM neurons regulate peripheral SNA, how the sympathetic and renin-angiotensin systems are correlated and how the sympathetic system can be suppressed to prevent cardiovascular events in patients. Based on results of whole-cell patch-clamp studies, we report that angiotensin II (Ang II) potentiated the activity of RVLM neurons, a sympathetic nervous center, whereas Ang II receptor blocker (ARB) reduced RVLM activities. Our optical imaging demonstrated that a longitudinal rostrocaudal column, including the RVLM and the caudal end of ventrolateral medulla, acts as a sympathetic center. By organizing and analyzing these data, we hope to develop therapies for reducing SNA in our patients. Recently, 2-year depressor effects were obtained by a single procedure of renal nerve ablation in patients with essential hypertension. The ablation injured not only the efferent renal sympathetic nerves but also the afferent renal nerves and led to reduced activities of the hypothalamus, RVLM neurons and efferent systemic sympathetic nerves. These clinical results stress the importance of the RVLM neurons in blood pressure regulation. We expect renal nerve ablation to be an effective treatment for congestive heart failure and chronic kidney disease, such as diabetic nephropathy