DSpace コレクション: 2015年度博士論文
http://hdl.handle.net/10564/3021
2015年度博士論文
2024-03-19T06:39:56Z
-
Smoking bans in mental health hospitals in Japan: barriers to implementation.
http://hdl.handle.net/10564/3202
タイトル: Smoking bans in mental health hospitals in Japan: barriers to implementation.
著者: Hashimoto, Kazumichi; Makinodan, Manabu; Matsuda, Yasuhiro; Morimoto, Tsubasa; Ueda, Shotaro; Kishimoto, Toshifumi; 橋本, 和典; 牧之段, 学; 松田, 康裕; 盛本, 翼; 上田, 昇太郎; 岸本, 年史
抄録: BACKGROUND: A number of studies have reported that smoking rates are higher and smoking cessation rates are lower in patients with mental disorders than in the general population. Despite the harmful effects of smoking, implementing total smoking bans in mental health hospitals is difficult. We investigate the status of smoking bans and the barriers to the implementation of total smoking bans in Japanese mental health hospitals. METHODS: A questionnaire survey was administered to the directors of 1242 Japanese mental health hospitals in March 2013. RESULTS: Forty-nine percent (n = 612) of the hospital directors responded. Of these, 24 % implemented total smoking bans and 14 % limited the bans to hospital buildings. In 66 and 68 % of the remaining hospitals, smoking rooms were located in open and closed wards, respectively, and completely separate from nonsmoking areas. Hospitals that had not implemented total smoking bans were concerned that introducing a total ban would exacerbate patients' psychiatric symptoms (46 %) or increase the incidence of surreptitious smoking (65 %). However, of the hospitals that had implemented total smoking bans, only 2 and 30 % identified "aggravation of psychiatric symptoms" and "increased surreptitious smoking" as disadvantages, respectively. The other concerns regarding the implementation of total smoking bans were staff opposition (21 %) and incidence of smoking around hospital grounds (46 %). These concerns were overcome by educating staff about smoking and cleaning the area around the hospital. CONCLUSIONS: There are some barriers to implementing total smoking bans in Japanese mental health hospitals. However, our study indicates that implementation of total smoking bans in mental health hospitals was minimally problematic and that barriers to the implementation of smoking bans could be overcome. As the current number of hospitals that have implemented total smoking bans is low in Japan, more hospitals should introduce total smoking bans.
内容記述: 博士(医学)・乙第1376号・平成28年3月15日; Copyright © 2015 Hashimoto et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,
provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/
publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
2015-10-28T15:00:00Z
-
Sequential screening to predict symptomatic pulmonary thromboembolism after gynecologic surgery in Nara, Japan.
http://hdl.handle.net/10564/3199
タイトル: Sequential screening to predict symptomatic pulmonary thromboembolism after gynecologic surgery in Nara, Japan.
著者: Haruta, Shoji; Kawaguchi, Ryuji; Hirai, Toshiko; Kobayashi, Hiroshi
抄録: OBJECTIVE: To evaluate a sequential screening method's efficacy in predicting symptomatic pulmonary thromboembolism (PTE) after gynecologic surgery. METHODS: A prospective study employing a two-stage screening process was conducted among consecutive asymptomatic adults who underwent outpatient evaluation for gynecologic surgery at Nara Medical University Hospital, Japan, between April 1, 2004, and December 31, 2013. Patients with a preoperative plasma D-dimer level greater than or equal to 1.0μg/mL underwent compression ultrasonography of the lower extremities. The primary outcome measure was postoperative detection of symptomatic PTE. RESULTS: Overall, 1729 patients were included. The mean D-dimer level was 1.7±3.3μg/mL. Compression ultrasonography was conducted among 470 (27.1%) patients with positive D-dimer test results; symptomatic deep vein thrombosis (DVT) was preoperatively detected among 94 (20.0%) of them. Patients with DVT (n=94) had higher D-dimer levels than patients (n=1635) without (7.8±12.8μg/mL vs 1.1±1.8μg/mL; P<0.001). Despite anticoagulant therapy, symptomatic PTE was detected postoperatively among two of these 94 patients. Symptomatic PTE was also detected among four of 376 patients with positive D-dimer test results but no evidence of DVT by ultrasonography. No clinical onset of postoperative PTE was observed among 1259 patients with D-dimer levels below the cut-off value. CONCLUSION: The PROVEN screening strategy (Preoperative surveillance using a sequential strategy) was ineffective at predicting postoperative symptomatic PTE.
内容記述: 博士(医学)・乙第1375号・平成28年3月15日; Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
2015-12-31T15:00:00Z
-
Adolescent Scoliosis Screening in Nara City Schools: A 23-Year Retrospective Cross-Sectional Study.
http://hdl.handle.net/10564/3198
タイトル: Adolescent Scoliosis Screening in Nara City Schools: A 23-Year Retrospective Cross-Sectional Study.
著者: Yamamoto, Satoshi; Shigematsu, Hideki; Kadono, Fumihiko; Tanaka, Yukihiro; Tatematsu, Masataka; Okuda, Akinori; Iwata, Eiichiro; Koizumi, Munehisa; Tanaka, Yasuhito
抄録: STUDY DESIGN: Retrospective cross-sectional study. PURPOSE: To determine the prevalence of idiopathic scoliosis, define the distribution of the curve magnitude, evaluate the accuracy of Moiré topography as a screening tool, and investigate the cost-effectiveness of our screening system. OVERVIEW OF LITERATURE: Early detection of idiopathic scoliosis provides the opportunity for conservative treatment before the deformity is noticeable. We believe that scoliosis screening in schools is useful for detection; however, screening programs are controversial owing to over referral of students who do not require further testing or follow-up. In Japan, school scoliosis screening programs are mandated by law with individual policies determined by local educational committees. We selected Moiré topography as the scoliosis screening tool for schools in Nara City. METHODS: We selected Moiré topography as the scoliosis screening tool for schools in Nara City. We screened boys and girls aged 11-14 years and reviewed the school scoliosis screening results from 1990 to 2012. RESULTS: A total of 195,149 children aged 11-14 years were screened. The prevalence of scoliosis (defined as ≥10° curvature) was 0.057%, 0.010%, and 0.059% in fifth, sixth, and seventh grade boys and 0.337%, 0.369%, and 0.727% in fifth, sixth, and seventh grade girls, respectively. The false-positive rate of our Moiré topography was 66.7%. The minimum cost incurred for scoliosis detection in one student was 2,000 USD. CONCLUSIONS: The overall prevalence of scoliosis was low in the students of Nara City schools. Over 23 years, the prevalence of scoliosis in girls increased compared to that in the first decade of the study.
内容記述: 博士(医学)・乙第1374号・平成28年3月15日; Copyright Ⓒ 2015 by Korean Society of Spine Surgery; This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/)
which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
2015-05-31T15:00:00Z
-
von Willebrand Factor-Rich Platelet Thrombi in the Liver Cause Sinusoidal Obstruction Syndrome following Oxaliplatin-Based Chemotherapy.
http://hdl.handle.net/10564/3196
タイトル: von Willebrand Factor-Rich Platelet Thrombi in the Liver Cause Sinusoidal Obstruction Syndrome following Oxaliplatin-Based Chemotherapy.
著者: Nishigori, Naoto; Matsumoto, Masanori; Koyama, Fumikazu; Hayakawa, Masaki; Hatakeyama, Kinta; Hatakeyama, Kinta; Ko, Saiho; Fujimura, Yoshihiro; Nakajima, Yoshiyuki
抄録: Oxaliplatin-based chemotherapy is widely used to treat advanced colorectal cancer (CRC). Sinusoidal obstruction syndrome (SOS) due to oxaliplatin is a serious type of chemotherapy-associated liver injury (CALI) in CRC patients. SOS is thought to be caused by the sinusoidal endothelial cell damage, which results in the release of unusually-large von Willebrand factor multimers (UL-VWFMs) from endothelial cells. To investigate the pathophysiology of CALI after oxaliplatin-based chemotherapy, we analyzed plasma concentration of von Willebrand factor (VWF) and the distribution of VWFMs in CRC patients. Twenty-three patients with advanced CRC who received oxaliplatin-based chemotherapy with (n = 6) and without (n = 17) bevacizumab were analyzed. CALI (n = 6) and splenomegaly (n = 9) were found only in patients who did not treated with bevacizumab. Plasma VWF antigen (VWF:Ag) and serum aspartate aminotransferase (AST) levels increased after chemotherapy only in patients without bevacizumab. VWFM analysis in patients who did not receive bevacizumab showed the presence of UL-VWFMs and absence of high molecular weight VWFMs during chemotherapy, especially in those with CALI. In addition, plasma VWF:Ag and AST levels increased after chemotherapy in patients with splenomegaly (n = 9), but not in patients without splenomegaly (n = 14). Histological findings in the liver tissue of patients who did not receive bevacizumab included sinusoidal dilatation and microthrombi in the sinusoids. Many microthrombi were positive for both anti-IIb/IIIa and anti-VWF antibodies. Plasma UL-VWFM levels might be increased by damage to endothelial cells as a result of oxaliplatin-based chemotherapy. Bevacizumab could prevent CALI and splenomegaly through inhibition of VWF-rich platelet thrombus formation.
内容記述: 博士(医学)・乙第1373号・平成28年3月15日; Copyright: © 2015 Nishigori et al. This is an open access article distributed under the terms of the Creative Commons Attribution License(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
2015-11-17T15:00:00Z