認知症高齢者への環境介入 －転居先でその人らしく住み続ける認知症の人の事例分析を通して－

福岡に呼び寄せられた認知症高齢者が、転居先でその人らしく住み続けることができるように地域住民が支援してきた活動を「認知症の人を支える環境づくり」とみなし、そのプロセスを人的・社会的環境介入として考察した。その結果、地域福祉推進の一環としての認知症ケアに関して、認知症の人の環境変化に対応した地域での支援には、生活圏域内の福祉サービス事業所と住民の連携とインフォーマル・サポートが必要であると提言している。Environmental intervention in the elderly people with dementia to support their lives in the relocated community is investigated through a case study in Fukuoka city. In this study, the process of establishment of appropriate environment for the elderly people with dementia is looked upon as human & social environmental intervention. As a result, a network of welfare service institutions cooperated with residents and informal support in the community is necessary to deal with the environmental change of the people with dementia as a part of community social work

中国の宗族社会における高齢者の現状と課題（その１） - 東南地方の農村高齢者の生活実態調査を通して -

近年、中国における農村地域の宗族に関する研究がさまざまな分野で進んでいる。その要因の１つは、経済と社会の転換期にある中国の三農（農業・農民・農村）問題に対する関心が急速に高まってきたことである。三農の中で、特に農民の貧困問題が注目されている。しかしながら、今までの研究業績では、農村生活の貧困、年金、医療・保健などを単に所得保障との関連で論じるものが多く、ソーシャルワークの視点で村落（コミュニティ）を拠点に社会保障・社会福祉（社会的セーフティネット）を推進していく考えはほとんどない。本研究はそれらのことを念頭に置きながら、日本を始め、欧米諸国の先行研究を視野に入れて検討する。その上で、異なるそれぞれの農村地域の歴史、伝統文化、社会環境など具体的な状況に応じて、村民（宗族）自治のあり方を実証性に基づき探求したい。そのため本研究調査は、宗族社会における高齢者の生活現状と課題を明らかにし、宗族社会の変容が高齢者の日常生活に与える影響とその課題を検討することを目的とした。In late years a study about a family of a farm village area in China advances in various fields. One of the factors is that economy and interest for the issue of Chinese agriculture in flatland, bogland and a mountaneous region in a social turning point rose rapidly. In agriculture in flatland, bogland and a mountaneous region, the issue of poverty of a farmer in particular attracts attention. However, by conventional study achievements, as for the thought that merely promotes social security/social welfare (social safety net) in a viewpoint of a social work a lot of things it - affiliated, to lecture on with secured social welfare payment for poverty of farm village life, a pension, medical care/health in a foothold in a village, it is rare. This study founds Japan while taking them into consideration and I put a precedent study of American and European countries in a field of vision and examine. With that in mind, it is based on proof characteristics and, depending on the concrete situation such as the different each farm village local history, traditional culture, social environment, wants to search an ideal method of villager (a family) self-government. Therefore I clarified the life present conditions and a problem of a senior citizen in family society, and this study investigation was aimed at examining influence and the problem that transformation of family society gave everyday life of a senior citizen

離島・過疎地域におけるケアリング・コミュニティ形成に関する研究（その１） - 長崎県西海市崎戸地区におけるインフォーマルサポートの活性化に向けて -

ケアリング・コミュニティ（以下、CC という。）とは、インフォーマル・サポートネットワークの強化を図るための小地域活動が、計画的にシステムとして機能している地域のことである。本研究においては、高齢化率４３.６％を示す長崎県西海市崎戸地区をフィールドとして、とりわけ①家族構成と家族関係、②近隣との付き合い、③生活の継続と地域資源、④日常の生活圏域に注目して CC 形成に関する調査・分析を行なった。その結果次のような特徴的な点が考察された。第１に、崎戸地区が置かれているマイナス要因にもかかわらず、地域住民の郷土への愛着心が極めて強い。第２に、近所付き合いや近隣同士の相互扶助が非常に盛んである。第３に、大島大橋の開通により本島地域が本土と陸続きになったことで日常の行動圏域が広がってきてはいるが、高齢者層と若年層ではその広がりに差がある。以上の考察から論述できることは、強い郷土愛や盛んな近所付き合い、相互扶助のなかにこそ、生活不利条件を跳ね返して CC を形成するエネルギーがあるのではないかということ、である。A caring community is defined as a district that community-based activities for the reinforcement of informal support network function systematically in accordance with a well-established plan. This study is based on an attitude survey in Sakito district in Saikai city, Nagasaki prefecture, where the aged rate is 43.6%. It focuses on : (1) family structure and family relationship, (2) association with neighbors, (3) continuance of stable lives and regional resources and (4) a range of day to day activities. According to the results, the following characteristic points were ascertained. (1) The residents in Sakito district have a strong attachment to their home town in spite of various disadvantaged conditions. (2) The neighbors are getting along well one another and mutual support is active. (3) The range of daily lives of the residents have been gradually expanding after the main island and the mainland were connected by the Oshima bridge, however there is some gap in the extent between younger generation and that of the old. Based of the findings mentioned above, the authors consider that the energy to establish the caring community should exist in the strong attachment and active association within neighbors and mutual support through overcoming the difficulties in depopulation areas as well as isolated islands

Diagnostic specificity of the child psychosis-risk screening system with a focus on the differentiation of schizophrenia spectrum disorders and neurodevelopmental disorders

BackgroundResearch on early psychosis has begun to identify psychiatric characteristics of the prodromal period of schizophrenia; however, subclinical characteristics of children in non-psychiatric fields have not been fully investigated. In our previous study, we developed the Child Psychosis-risk Screening System (CPSS).ObjectiveIn the present cross-sectional study, we attempted to identify the risk of developing psychosis in pediatric (n = 216) and psychiatric outpatients (n = 120), aged 6– 18 years, with the CPSS.MethodsAn analysis of variance of CPSS risk was performed in six diagnostic categories to examine specificity for each diagnosis. Receiver operating characteristic (ROC) curve analysis was conducted using the onset of schizophrenia spectrum as the outcome, and the discriminatory power and cut off values of the CPSS were determined. Logistic regression analysis was performed using clinical data to identify factors associated with the risk group (those at high risk of developing psychosis in the future) identified using the CPSS.ResultsThere were significant differences in risk variance among diagnostic categories (p < 0.001), especially between schizophrenia spectrum disorders (SSD) and neurodevelopmental disorders (p = 0.001). CPSS had sufficient discriminatory power for SSD diagnosis [area under the ROC curve = 0.853 (95% confidence interval: 0.774–0.931)]. The cut off value for the risk of SSD was determined to be 98.1%, achieving the best mean of the sum of sensitivity (90.9%) and specificity (84.0%). Cross-sectional logistic regression analysis showed that along with “SSD diagnosis,” “winter birth,” and “maltreatment” were factors associated with the risk group (odds ratio = 38.05 [p = 0.001], 2.30 [p = 0.016], and 0.12 [p = 0.024], respectively).ConclusionCPSS may have potential use in the early detection of psychosis and differentiation from neurodevelopmental disorders, but this study was small and further studies with larger sample sizes and longitudinal study designs are required prior to its use in routine clinical practice

Practical application of cure mixture model for long-term censored survivor data from a withdrawal clinical trial of patients with major depressive disorder

<p>Abstract</p> <p>Background</p> <p>Survival analysis methods such as the Kaplan-Meier method, log-rank test, and Cox proportional hazards regression (Cox regression) are commonly used to analyze data from randomized withdrawal studies in patients with major depressive disorder. However, unfortunately, such common methods may be inappropriate when a long-term censored relapse-free time appears in data as the methods assume that if complete follow-up were possible for all individuals, each would eventually experience the event of interest.</p> <p>Methods</p> <p>In this paper, to analyse data including such a long-term censored relapse-free time, we discuss a semi-parametric cure regression (Cox cure regression), which combines a logistic formulation for the probability of occurrence of an event with a Cox proportional hazards specification for the time of occurrence of the event. In specifying the treatment's effect on disease-free survival, we consider the fraction of long-term survivors and the risks associated with a relapse of the disease. In addition, we develop a tree-based method for the time to event data to identify groups of patients with differing prognoses (cure survival CART). Although analysis methods typically adapt the log-rank statistic for recursive partitioning procedures, the method applied here used a likelihood ratio (LR) test statistic from a fitting of cure survival regression assuming exponential and Weibull distributions for the latency time of relapse.</p> <p>Results</p> <p>The method is illustrated using data from a sertraline randomized withdrawal study in patients with major depressive disorder.</p> <p>Conclusions</p> <p>We concluded that Cox cure regression reveals facts on who may be cured, and how the treatment and other factors effect on the cured incidence and on the relapse time of uncured patients, and that cure survival CART output provides easily understandable and interpretable information, useful both in identifying groups of patients with differing prognoses and in utilizing Cox cure regression models leading to meaningful interpretations.</p

Current status and issues of child developmental support in pediatric wards : A case study on the employment and human resources of childcare workers

小児がんなど長期的あるいは，継続的に入院や治療を受けねばならない子どもが存在する。そのような子どもは，「子どもらしい姿」を表出しにくい環境におかれ，発達期に欠かせない遊びや人間関係形成，義務教育を受けられずにいるという現状がある。本研究では，医療的ケアの必要な子どもを支える専門職としての病棟保育士の職務の実態を明らかにし，子どもや家族を多角的に支える環境づくりに向けて，病棟保育士の職務上の改善点や問題点を確認することを目的とする。調査対象者は，北部九州圏域の病院に勤務する病棟保育士4名を対象とした。アンケートは2019年7月から8月にかけて，インタビューは2019年9月から10月にかけて実施された。これらの調査及びインタビューによって，次のことが示された。病棟保育士はより良い保育環境を整えるために，配置される人員の余裕を望んでいること。そして，単独配置になっている病棟保育士は，一人職場の困難感を感じていることが示された。早急な課題として，病棟保育士の雇用の確保と現場の増員が求められると考えられる

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049