著者

大串 文隆

出版者

徳島医学会

雑誌

四国医学雑誌 (ISSN:00373699)

巻号頁・発行日

vol.79, no.1.2, pp.25-32, 2023 (Released:2023-07-03)

参考文献数

17

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2019年12月に中国で新型コロナ感染症(COVID-19)患者が発生してから,またたく間に世界的大流行へと拡大し,現在世界では,6億人以上のCOVID-19の感染が確認され600万人以上が死亡している1)。また,わが国においても2000万人以上の感染が確認され4万人以上の死亡が報告されている2)。コロナウイルスも変異を繰り返しα株からデルタ株,そしてオミクロン株,その亜系統と高い感染性を有するウイルスに変化し3)この間新規感染者数は増減を繰り返しながら大きな波を形成し現在は第8波に入ったといわれている。COVID-19の症状はインフルエンザのような発熱,咳,痰,倦怠感などの感冒様症状以外にも嗅覚障害,味覚障害,消化器症状,耳鳴り,脱毛など多様な症状を呈することが分かってきた。また,COVID-19の感染者の大半は回復するが急性期を過ぎた後も症状が遷延する,もしくは新たな症状が出現するなど罹患した一部の患者さんにさまざまな罹患後症状をみとめることも明らかになってきた。これらの症状は「遷延する症状(persistent symptoms,prolonged symptoms)」,「遅発症(late-onset symptom)」,「後遺症(sequelqae)」あるいは「Long COVIDコロナ後遺症,新型コロナ罹患後症状」などさまざまな呼び名がもちいられている。この項ではコロナ後遺症の現状と当院で開設しているコロナ後遺症外来の状況と課題について報告する。

著者

滝川 栄二 江戸 晶子 山本 千穂 難波 和広 松浦 育代 鴨居 弘斉 大森 美季 片岡 睦子 三船 和史 大坂 京子 安原 由子 谷岡 哲也

出版者

徳島医学会

雑誌

四国医学雑誌 = Shikoku acta medica (ISSN:00373699)

巻号頁・発行日

vol.76, no.1, pp.99-106, 2020-04-25

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Patients with mental health problems in long-term hospitalization have severe impairments and disabilities in their daily social life, thereby needing constant assistance. The purpose of this study was to clarify the relationships between the status of the improved duration of participation in occupational therapy activities through active motivation and interdisciplinary collaboration in enhancing mental health and severe physical functional level as evaluated by the Global Assessment of Function(GAF)score. Subjects were175hospitalized patients in psychiatric units at a Psychiatric hospital in Kagawa Prefecture. The duration of participation in the occupational therapy group activities was divided into Groups A-0‐5, B-6‐10, C-11‐15, and D-16‐20times per month. The number of the occupational therapy group activities per month was 20 times in August 2017 and 21 times in March2018, respectively. The number of classified four group participants before and after were calculated by the chi-square test with adjusted residuals. Comparing the number of participants in the four groups before and after 7 months by the active motivation, the number of participants was significantly decreased in group C but was increased in group D(χ2 = 6.82, p <.05). Findings show the number of participants was increased because of the active motivation by interdisciplinary collaboration and enhanced relations. However, the degree of GAF was not related to the duration of participation times. Moreover, it was clearly found that respect for individuality and patient's will were critical motivational factors in effective patient participation.

著者

杉本 博子 安原 由子 谷岡 哲也 郷木 義子 森 健治 冨士 翔子 斎藤 憲

出版者

徳島医学会

雑誌

四国医学雑誌 = Shikoku acta medica (ISSN:00373699)

巻号頁・発行日

vol.72, no.1, pp.43-52, 2016-04-25

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The purpose of this study was to clarify the relationship between sleep-wake rhythms and autonomic nerve activities using actigraphy and heart rate variability(HRV)analysis. Subjects were comprised of six children who were in the fourth to sixth grade levels of elementary school(four boys and two girls). The study was conducted between January and December 2015. The data collection procedure was performed following the Private Information Protection Law, with approval from Tokushima University Hospital Ethics Board(approval number 2021). These subjects were evaluated in an Attentive-Care-Needed stress state based on the PSI(Public Health Research Foundation Type Stress Inventory)and PSQI-J(Pittsburgh Sleep Quality Index, Japanese Version). In analyzing their sleep-wake rhythms, autonomic nervous activities were determined using an actigraph and HRV through RR interval sequence electrocardiography. The results of actigraph data of sleep efficiency in Subject Number 6 was low(76.47%). Regardless, the subject experienced subjective sleep satisfaction. However, Subject Number 2, insisted that she could not easily wake up in the morning because of being sleepy. Low Frequency(LF)/High Frequency(HF)data indicated sympathetic nervous activity showing that all subjects had significantlyhigher LF/HF value during wakefulness than when asleep. HF data indicated parasympatheticactivity of five out of the six children showing significantly higher value during sleep than when awake. Subject number 3 expressed that he was sleepy and could not get up in the morning,and also had trouble going to and maintaining sleep. However, this subject's results of the PSQI-Jindicated that he had no problem expressing subjective sleep satisfaction. Furthermore, in the actigraph and HRV analysis, findings showed that subjects had good sleeping patterns. These findings strongly signify the importance of determining the sleep-wake rhythms of school children based on data from subjective and physiological evaluation methods.

著者

仁木 真理子 久保 宜明

出版者

徳島医学会

雑誌

四国医学雑誌 (ISSN:00373699)

巻号頁・発行日

vol.79, no.1.2, pp.33-36, 2023 (Released:2023-07-03)

参考文献数

13

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Coronavirus disease 2019(COVID-19)は2019年12月に中国に端を発した新型コロナウイルス(SARS-CoV-2)による感染症であり,主に呼吸器症状を引き起こすが,それに付随して多彩な皮膚症状を呈することが報告されている。多彩な皮膚症状や皮膚疾患として現れる後遺症に関しては,一定の傾向がみられるが,皮疹とCOVID-19の正確な関係はいまだ不明である。

著者

曽我部 正弘

出版者

徳島医学会

雑誌

四国医学雑誌 (ISSN:00373699)

巻号頁・発行日

vol.79, no.1.2, pp.53-66, 2023 (Released:2023-07-03)

参考文献数

34

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胃食道逆流症(Gastroesophageal Reflux Disease:以下,GERD と略)は胃食道逆流により引き起こされる食道粘膜傷害と煩わしい症状のいずれかまたは両者を引き起こす疾患と定義されている1)。GERDは内視鏡的に食道粘膜傷害を認める「びらん性GERD」と内視鏡的に粘膜傷害を認めず症状のみを認める「非びらん性GERD」に分類される。前者は一般的に逆流性食道炎(Reflux Esophagitis)として,後者はNERD(Non-Erosive Reflux Disease)として広く知られている。 逆流性食道炎を含むGERDの罹患者数は日本や欧米などの先進国では1970~1990年代頃にかけて急激に増加し,経済成長の著しい発展途上国においても近年増加傾向にある2-4)。本邦における逆流性食道炎を含むGERD罹患者数は約1,000~1,500万人で,成人の5人に1人がGERD罹患者と考えられている。逆流性食道炎は粘膜傷害の程度によりロサンゼルス分類(以下,LA分類と略)を用いてgrade Aからgrade Dに分類される5)(重症度:D > C > B > A)(図1)。食道粘膜傷害の主な原因は胃酸の胃食道逆流による食道内への過剰な胃酸曝露であり,その要因は食道裂孔ヘルニアの存在や肥満による腹腔内圧の上昇に伴う下部食道括約筋圧の低下や胃内の空気を排出する際の一過性の下部食道括約筋弛緩であり,食事や喫煙などの生活習慣などが,これらの要因に影響を及ぼしていると考えられている6-14)。また最近では,食道腺癌発症機序の一つに,逆流性食道炎→バレット食道→食道腺癌の経路が明らかとなり,欧米では最近30年間においてHelicobacter pylori(以下,H. pyloriと略)感染率の低下とともにバレット食道からの食道腺癌発生率が数倍になっていることが報告されている15)(図2)。本邦においても肥満者の増加に加え,生活習慣の欧米化やH. pylori非感染者の増加に伴い逆流性食道炎罹患者が増えていることから,今後GERD症状に悩まされる罹患者が増えるだけではなく,バレット食道からの食道腺癌患者の増加に繋がる可能性が懸念されており,食道腺癌発症の観点からも逆流性食道炎の予防は極めて重要な課題である。そこで本稿では,著者らがこれまで行ってきた逆流性食道炎に関する幾つかの研究について紹介させていただく。

著者

中屋 豊 阪上 浩 原田 永勝

出版者

徳島医学会

雑誌

四国医学雑誌 (ISSN:00373699)

巻号頁・発行日

vol.68, no.1, pp.23-28, 2012-04-25

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Refeeding syndrome is a potentially fatal medical condition that may affect malnourished patients in response to an inappropriately rapid overfeeding. This commonly occurs following the institution of nutritional support, especially parenteral or enteral nutrition. The most characteristic pathophysiology of refeeding syndrome relates to the rapid consumption of phosphate after glucose intake and subsequent hypophosphatemia. Refeeding syndrome can manifest as either metabolic changes (hypokalaemia, hypophosphataemia, vitamin B1deficiency, and altered glucose metabolism)or physiological changes(cardiac arrhythmias, unconsciousness, seizures, cardiac or respiratory depression) and potentially death. Preventing refeeding syndrome is the primary goal when initiating nutrition support in severely malnourished patients. Clinicians should be aware of refeeding syndrome when they treat malnourished patients, and most importantly take appropriate steps(careful monitoring)to prevent refeeding syndrome.

著者

片岡 三佳 谷岡 哲也

出版者

徳島医学会

雑誌

四国医学雑誌 (ISSN:00373699)

巻号頁・発行日

vol.75, no.3, pp.113-120, 2019-08-25

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The purpose of this study was to compare the strengths-oriented attitude among psychiatric nurses(PNs), psychiatric social workers(PSWs)and occupational therapists(OTs)working at psychiatric hospitals using principal component analysis. Survey subjects were 899 PNs, 100 PSWs and 90 OTs employed at 17 psychiatric hospitals in Japan who consented to participate in the study. The self-administered questionnaire was mailed and returned between from October 2013 to January 2014. The subjects' strengths-oriented attitude was evaluated using the Strengths-Oriented Attitude Inventory(SOAI)developed by the authors based on the work by Rapp and Goscha. The loading of the primary ingredient of the SOAI was compared by Principal Component analysis among occupations. A common strengths-oriented attitude of PNs, PSWs, and OTs was the assessment for psychiatric inpatients' social life, the ability to perform activities of daily life (ADL), mental status, and taking care and therapeutic intervention. Especially, in the differences of characteristics depending on the specialty, PNs focus on physical health, PSWs emphasize economics and housing, and OTs emphasis on functional recovery of their ADL. Differences in strength-oriented attitudes have shown the commonality and specialty of each healthcare provider.

著者

八木 恵子 廣瀬 久美子 曽我 哲朗 手束 典子 手束 昭胤 湯浅 哲也 佐藤 浩充 遠藤 雅充 株式会社トーカイ

出版者

徳島医学会

雑誌

四国医学雑誌 = Shikoku acta medica (ISSN:00373699)

巻号頁・発行日

vol.69, no.3, pp.145-150, 2013-08-25

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We report on a new mat experimentally developed by us for changing the position of the body (named i-mat), based on an idea of a floating body. [Method] At first,4, approximately 70cm long, belts were attached to both the right and left side of the pad for tying to the beds. For a lateral position with a 30-degree tilt to the right side, the belt attached on the left side is fixed to the right bed fence and the length of the belt is adjusted so that the patient's position becomes lateral with a 30-degree tilt. The body pressure levels (mmHg) at sites of bone were measured after position changes by using a simple body pressure-measuring device (PREDIA®) in 10 patients with an independence degree of daily living rating of C2 (group i) in whom the i-mat was used, and compared with the levels measured after position changes in patients where a mat made of urethane (Nasentpat®) was used (group N). [Results] The pressure levels in the sacral region and occipital region could be significantly lowered in group i as compared with that in group N. We also measured and compared the pressures at the major trochanter, acrominon, and iliac regions, because the high-pressure loaded region shifted to these regions on the side facing the bed in the lateral position. No significant differences in the pressure levels at the major trochanter and acrominon were found between the i and N groups. The pressure level in the iliac region in the i group was significantly higher than that that in the N group. [Conclusion] Use of this experimentally produced i-mat can significantly lower the pressure load at the sacral and occipital regions when the patient is placed in the lateral position of either side with a 30-degree tilt, as compared to that of Nasentpat®. But it appears that caution should be exercised to prevent the occurrence of bedsores in the iliac region.

著者

四宮 加容

出版者

徳島医学会

雑誌

四国医学雑誌 (ISSN:00373699)

巻号頁・発行日

vol.62, no.3, pp.120-122, 2006-08-25

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IT stands for information technology, and the chance to use IT equipments such as personal computers and game machines has been increasing dramatically. IT eye syndromes are referred to unpleasant symptoms of the eye because of these. They are mainly due to asthenopia by ocular movement and accommodation, and dry eye.It is important to take a proper rest in computer-aided works, and to put the display on an appropriate position for the prevention of IT eye syndrome. When glasses or contact lens are used, it is necessary to check whether they are appropriate or not. It is preferable to review working environment, and person who engage in personal computer works for a long time should receive regular health screenings for the prevention of IT eye syndrome.

著者

松岡 優 吉村 栄子 伊勢 正夫 久保 雅宏 山下 和子

出版者

徳島医学会

雑誌

四国医学雑誌 (ISSN:00373699)

巻号頁・発行日

vol.59, no.4-5, pp.244-249, 2003-10-25

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We studied the onset of allergic diseases and allergy march in 1,029 children aged from 3 months-old to 18-years old.A clinical study showed the close relationship between atopic dermatitis and asthma,and between asthma and allergic rhinitis. Specific IgE to house dust, mites, pets and pollen was recognized to be positive in early infants aged 4- or 5 months-old.This finding is earlier than the previous report, indicate the recent increase of allergic disease. Allergy to food allergens, inhalanted allergens and contact allergens are linked each other, and tend to be IgE-mediated sensitization to multiallergen.