Nasal glucagon as a viable alternative for treating insulin‐induced hypoglycaemia in Japanese patients with type 1 or type 2 diabetes : A phase 3 randomized crossover study

Aim: To compare nasal glucagon (NG) with intramuscular glucagon (IMG) for the treatment of insulin‐induced hypoglycaemia in Japanese patients with type 1 (T1DM) or type 2 diabetes mellitus (T2DM). Materials and methods: This phase 3, randomized, open‐label, two‐treatment, two‐period crossover non‐inferiority study enrolled Japanese adults with T1DM or T2DM on insulin therapy, with glycated haemoglobin levels ≤86 mmol/mol (≤10%). After ≥8 hours of fasting, hypoglycaemia was induced with human regular insulin (intravenous infusion). Patients received NG 3 mg or IMG 1 mg approximately 5 minutes after insulin termination. The primary endpoint was the proportion of patients achieving treatment success [plasma glucose (PG) increase to ≥3.9 mmol/L (≥70 mg/dL) or ≥1.1 mmol/L (≥20 mg/dL) increase from the PG nadir within 30 minutes of receiving glucagon]. Non‐inferiority was declared if the upper limit of the two‐sided 95% confidence interval (CI) of the mean difference in the percentage of patients achieving treatment success (IMG minus NG) was <10%. Results: Seventy‐five patients with T1DM (n = 34) or T2DM (n = 41) were enrolled; 72 patients (50 men, 22 women) received ≥1 study drug dose (T1DM, n = 33; T2DM, n = 39). Sixty‐eight patients completed the study and were evaluable. All NG‐ and IMG‐treated patients achieved treatment success (treatment arm difference: 0%; upper limit of two‐sided 95% CI 1.47%); NG met prespecified conditions defining non‐inferiority versus IMG. Glucagon was rapidly absorbed after both nasal and intramuscular administration; PG profiles were similar between administration routes during the first 60 minutes post dose. Study drug‐related treatment‐emergent adverse events affecting >2 patients were rhinalgia, increased blood pressure, nausea, ear pain and vomiting in the NG group, and nausea and vomiting in the IMG group. Conclusion: Nasal glucagon was non‐inferior to IMG for successful treatment of insulin‐induced hypoglycaemia in Japanese patients with T1DM/T2DM, supporting use of NG as a rescue treatment for severe hypoglycaemia

フランス都市文化政策の歴史的展開と政策理念の変遷 : 市民から都市へ

学位の種別: 課程博士審査委員会委員 : （主査）東京大学教授 小林 真理, 東京大学教授 木下 直之, 東京大学教授 中村 雄祐, 東京大学教授 月村 辰雄, 高崎経済大学教授 友岡 邦之University of Tokyo(東京大学

Validation of a dietary balance score

This study assessed the validity of dietary balance scores (DBSs) by investigating the association between DBSs and nutrient adequacy (NA) in two Japanese populations. The participants were 65 community-dwelling Japanese from Tokushima Prefecture and 2,330 community-dwelling Japanese from Aichi Prefecture. Based on food frequency questionnaires or 3-day dietary records, we obtained 18 food groups. The NA score integrates nine beneficial nutrients and two nutrients that should be limited. We calculated four different DBSs: DBS1 consisted of five food groups (score range : 0–20), DBS2 consisted of nine food groups (score range : 0–36), DBS3 consisted of eight food groups (score range : 0–32), and DBS4 consisted of 10 food groups (score range : 0–40). Both the Spearman rank correlation coefficient with NA and the area under the receiver operating characteristic curve (AUC-ROC) for the nine beneficial nutrients were then estimated to test the performance of each DBS in predicting nutrient intake. The results showed that DBS1 and DBS4 were positively correlated with NA, while the AUC-ROC showed that DBS4 could moderately discriminate individuals with adequate intake levels of all nine nutrients. These findings suggest DBSs (especially DBS4) are useful in assessing dietary balance in middle-aged and older community-dwelling Japanese

島根県の妊娠初期における妊婦の栄養摂取状況について(第2報) : BMIおよび欠食状況による比較

島根県の低出生体重児の出生割合は高いことが報告されており、児の将来において様々なリスクの可能性がある。　　　我々は、島根県内の妊婦に対して栄養摂取状況の調査を行い、低出生体重児との関連性について検討している。本研究では、妊娠初期における妊婦29 名に食物摂取頻度調査を行い、体格指数（Body Mass Index（BMI））の区分および妊娠後の欠食状況の違いによる栄養素摂取量および食品群別摂取量を算出し検討した。非妊娠時BMI が低い群は、エネルギー、炭水化物、ナトリウム、マンガン、鉄、食物繊維の摂取量が多いことが示唆された。また、妊娠初期の妊婦の44.8％が週一回以上の欠食をし、その結果、栄養素の多くが推奨量に満たないことが示唆された

島根県の妊娠初期における妊婦の栄養摂取状況について(第1報) : 分娩歴による比較

島根県における妊娠初期の妊婦の栄養摂取状況を明らかにすることを目的とし、分娩歴による違いがあるかに注目して研究を行った。妊娠10 週から12 週の妊婦29 名に食物摂取頻度調査を行い、初産婦（15名）、経産婦（14 名）の２群に分けて比較した。各種栄養素摂取量および食品群別栄養素摂取量については、２群間で有意な差はみられなかった。食品群別摂取量の「嗜好品飲料類」について、初産婦の摂取量が有意に多かった。栄養素摂取量の多くが２群とも平均必要量に満たないことが明らかになった

一人暮らしの管理栄養士養成課程学生における 食事作り意識・実践の変化と課題の検討

【要旨】A 大学栄養学科 2016 年度入学生を対象に記名自記式質問紙調査を実施し，一人暮らしの者 20 名（女性 17 名，男性 3 名）の回答より 1～2 年次から 4 年次までの食事作りへの意識・実践の変化を分析した。食事作り意識の変化として，何も見ずに作ることができると考える料理が 35 項目中 5 項目有意に増加し（p＜0.05），食事の「栄養バランス」「料理・味付けの組み合わせ」等に気を付けている者が増加した。また各年次で共通して，食品選択で重視していることに「価格」，食事作りで気を付けていることに「作り方が簡単」「短時間で 食事を準備」，料理の参考に「インターネット」「高校までの家庭料理」と回答する者が多く，大学での習得知 識や教科書等を参考とする者は少なかった。食事作り実践の変化として，泡立て器，スケール，おろし器，ゴムベラの調理器具所有者は有意に増加した（p＜0.05）一方，月 1 回以上作る料理の種類は減少が見られた。食事作りを「ほぼ毎日」する者は 5 割，主食・主菜・副菜の揃った食事を「毎食食べる」者は 3 食いずれも 15% 以下と年次による大きな変動はなかった。4 年次までに料理のレパートリーの広がりや食事バランスへの意識 向上が見られた反面，実際の食事作り実践や食事内容へ反映する者は少ないことが課題として示されたことから，学生の生活状況等を考慮し，日常において継続的な食事作りと食事内容の充実に繋がる教育上の工夫が必要と考えられる。Abstract: A self-administered questionnaire survey was conducted on students enrolled in the Department of Nutrition at University A in 2016. On the basis of the answers provided by 20 students living alone (17 women, 3 men), in first and second year and then to the fourth year, we analyzed changes in awareness of and practice around meal preparation. As a change in awareness of meal preparation, the number of students who believe they can cook meals without using a recipe increased significantly for 5 out of 35 dishes (p<0.05), and the number of students paying attention to the "nutrition balance" and "combination of dishes and seasoning" of meals increased. Furthermore, regardless of academic year, many students answered that "price" is important in food selection and mentioned the phrases "easy to make" and "prepare meals in a short time" as considerations when cooking meals, and used the "Internet" and "home cooking up to high school" for reference, while few referred to the knowledge acquired at university and from textbooks. As a change in the practice of meal preparation, the number of those owning whisks, scales, graters, and rubber spatula cookware increased significantly (p <0.05), while the variety of dishes cooked at least once a month decreased. Fifty percent of the students made meals "almost every day," and fewer than 15% of the students "eat every meal" with a staple food, main dish, and side dish in regular meals three times a day, and there was no significant change from year to year. By the fourth year, students’ cooking repertoire had expanded, and awareness of the dietary balance had increased, but this was rarely reflected in students’ actual dietary preparation practice and dietary content. Considering students’ living conditions, educational measures need to be devised that lead to continuous meal preparation and enrichment of meal content in daily life

管理栄養士養成課程学生における切砕技術の変容と課題

【要旨】管理栄養士養成課程学生を対象として調理技能調査および質問紙調査を実施し，4年間の切砕技術の変容を調査した。調理技能調査の結果，1，2 年次には制限時間内に切り終わらない学生もいたが，4年次では全員が制限時間内に切り終えていた。切断物の評価は，どの年次でも「やや不揃い」，「不揃い」の学生が多かった。4 年間通して一人暮らしであった学生のうち半数以上が週 3～4 回以上食事作りをしていた。自炊を始めたことにより自身の切砕技術が向上したと考えている学生が多かった。日常の食事で「野菜そのものを買う」学生が多く，野菜を切るときに速さや均一さを「意識していない」学生が多かった。キャベツのせん切りをするときの包丁の持ち方は，全握式を選択した学生が多かった。均一さを備えた技術の習得には，切り方に応じた包丁の持ち方の指導，日常の食事作りにおいても速さや均一さの意識を持たせること，家庭で繰り返し練習させる課題の工夫が必要と考える。Abstract: Students from a registered dietitian training program were administered questionnaires and cooking skills examinations to determine changes in their knife skills over the course of their four-year program. Examination of cooking skills revealed that, while all fourth-year students were able to complete a chopping task within the designated time limit, some first and second-year students were unable to do so. Evaluations of the chopped items found many students’ work to be “unevenness” or “a little unevenness,” regardless of year group. Of those students who lived alone during the four-year program, more than half cooked meals at least three or four times a week. Many students believed that their knife skills had improved as a result of them starting to cook for themselves. Many reported buying unprocessed vegetables for everyday meals, while a high number stated that they did not pay attention to speed or evenness when chopping vegetables. When choosing a knife grip for julienning cabbage, many students selected whole grip style. To allow students to master the skills needed to chop evenly, we must provide guidance on the knife grips appropriate to each cutting technique; encourage their awareness of the speed and evenness of their chopping, even in the preparation of their own daily meals; and devise tasks that will allow them to practice through repetition at home

管理栄養士養成課程学生の切砕技術と意識 : 技術向上に及ぼす要因の検討

管理栄養士養成施設であるA大学2年生を対象として調理技能調査および質問紙調査を行い,切砕技術に及ぼす要因を検討した。調理技能調査は,きゅうりの輸切り,だいこんのせん切りおよびキャベツのせん切りを課題とし,所要時間の計測と切断物の評価(調査者評価および自己評価)を行った。切断物の調査者評価はいずれも約9割の学生が「やや不揃い」「不揃い」であった。一方,自己評価は調査者評価より高い傾向にあり,学生と調査者が考える技術レベルに違いがあることが推察された。切砕操作における意識は,調査時では「揃えて切ること」,日常生活では「特に意識していない」「速く切ること」「速く揃えて切ること」を回答した学生が多かった。今後は食事提供に携わる職を目指す学生に求められる技術レベルを理解させ,日常生活の切砕操作においても均一さを意識するよう促す指導が必要である。To investigate influential factors, a knife skills survey and questionnaire were conducted among second‐year students at a university running a registered dietitian training course. The skills for slicing cucumber, Japanese radish, and cabbage were examined by both investigators and students assessing the time taken and the slices produced. For all three items, about 90% of the investigators\u27 evaluations recorded "unevenness" or “a little unevenness. "On the other hand, the self-evaluations tended to be more positive, suggesting a difference between the perceptions of students and investigators. Many students reported that they remained conscious during the survey “ to cut same-sized slices. "In response to the questionnaire item about cutting same‐sized slices on an everyday basis, many students reported that they: "were not particularly conscious," "cut quickiy," or "cut same-sized slices quickly.“ In future, therefore, lt is essential to educate students about the level of knife skills required of those wishing to work in catering and encourage an awareness of cutting food evenly in everyday life

川崎医科大学におけるブース形式診療科別説明会の学内開催

川崎医科大学は,中核市の倉敷市内と政令指定都市の岡山市内に二つの附属病院を有している。両病院の卒後臨床研修プログラムは独立しているが,研修は両方の病院の診療科から選択することが可能である。平成27年7月,初めて川崎医科大学生を対象にした大学附属病院診療科の説明会をブース形式で学内開催した。研修プログラム説明会とは趣を異にし,各診療科の特徴や業務内容を広報することを目的とした。1年生から6年生までの学生が参加し,アンケート調査に回答した52名全員が将来の研修病院の選択に役に立ったと答え,うち27%は非常に役立ったと高い満足度を示した。また,研修医だけで計画した学生向けのミニシンポジウムも同時に開催し,来場した約70%の学生が参加し貴重な情報収集の場となった。次年度以降も改善を加えながら,学生が身近に附属病院スタッフや先輩研修医と交流できるイベントとして育てていきたい。Kawasaki Medical School has one hospital in Kurashiki City, a core city, and another in Okayama City, an ordinance-designated city. These hospitals have independent postgraduate clinical training programs. However, departments of both hospitals can be selected for training. In July 2015, a boothtype meeting regarding Kawasaki Medical School Hospital departments was held for Kawasaki Medical School students for the first time. The intent of the meeting differed from that of other training program meetings, and its goal was to provide information on the characteristics and tasks of each department. First- to sixth-year students participated in the meeting. All 52 students who responded to a questionnaire survey answered that the meeting was useful in helping them select a hospital for their future training, and 27% of them reported that the meeting was very useful and showed high levels of satisfaction. A mini symposium for students planned only by residents was also held at the same time. About 70% of visiting students participated in the symposium and were given a valuable opportunity to gather information. By making improvements, we will cultivate the meeting as an event in which students can have contact with hospital staff and junior residents from the next year