民族衛生
Online ISSN : 1882-868X
Print ISSN : 0368-9395
81 巻 , 5 号
選択された号の論文の3件中1~3を表示しています
巻頭言
原著
  • 平野 優子, 山崎 喜比古
    2015 年 81 巻 5 号 p. 143-158
    発行日: 2015/09/30
    公開日: 2015/10/30
    ジャーナル フリー
    It is well documented that amyotrophic lateral sclerosis (ALS) patients experience significant suffering upon loss of motor function; however, there has been hardly any study of how such patients face their disease and cope with it. The life-line method is a useful non-verbal, visual interview method for retrospectively assessing life experience over time. The goal of this study is to elucidate the factors governing coping and life re-structuring of ALS patients under tracheotomy invasive positive pressure ventilation (TPPV). We studied changes in and correlations among psychological well-being, demographic characteristics, and physical or psychosocial factors at three time points: pre-onset, psychological nadir, and time of study. Questionnaires were sent to 47 patients selected in a manner to ensure varied background factors, followed by semi-structured interviews at their residences based on questionnaire answers.
    Results may be summarized as follows. First, psychological wellbeing dramatically worsened for all participants after onset, and although recovery is possible significant recovery is difficult. Second, while the psychological nadir was the period of physical and care-based uncertainty surrounding TPPV placement, the physical nadir was the time of the study, at which point patientsʼ physical function was lowest albeit stable, and with a stable care environment. Third, although the point of psychological nadir was marked by increasing physical subjective symptoms, decreasing sources of joy, decreasing hope, worsening of family economic status, and more people providing psychological support, at the time of the study subjective physical symptoms, hope and family economic status improved, together with more people providing psychological support. Fourth, at the time of the study there was a correlation between psychological wellbeing and use of Internet, email, and computer-assisted communication, hope, and sources of joy. Finally, subjects whose life-lines belonged to the groups of “No recovery,” “Recovery followed by second exacerbation,” or “Recovered but remained within negative range (limited recovery),” exhibited physical and psychosocial levels of wellbeing no better at the time of the study than during their nadir.
    Our study suggests that assisting ALS patients in coping with their disease and re-constructing their lives consists of first attenuating factors impeding psychosocial recovery. At the same time, the factors we identify which can help promote recovery suggest concrete directions for patient support.
  • Takafumi MONMA, Fumi TAKEDA, Kenji TSUNODA, Naruki KITANO, Shuko HOTOG ...
    2015 年 81 巻 5 号 p. 159-169
    発行日: 2015/09/30
    公開日: 2015/10/30
    ジャーナル フリー
    目的:地域在住高齢者における身体活動(余暇活動,家庭内活動,仕事関連活動)とストレス対処力(sense of coherence; SOC)との関連を性・年齢層別に検討した.
    方法:2011年および2012年の7~8月に茨城県笠間市に在住する65~85歳の地域在住高齢者のうち,体力テストに参加意思を表明した508名に記名自記式調査を実施した.調査票は体力テスト参加日に回収し,欠損回答のない394名(男性194名,女性200名:有効回答率77.6%)を分析対象とした.調査項目は属性(性,年齢,教育年数,世帯構成,既往症の有無),身体活動(Physical Activity Scale for the Elderly日本版;余暇活動,家庭内活動,仕事関連活動の各実施量),SOC(13項目5件法版Sense of Coherence Scale),ソーシャルネットワーク(家族,友人)であった.身体活動とSOCとの関連を,教育年数,世帯構成,既往症の有無,ソーシャルネットワークを統制した重回帰分析により検討した.分析は,性別,年齢層別(前期高齢者:65~74歳,後期高齢者:75~85歳)に分けて実施した.
    結果:前期高齢者の男性では,余暇活動量とSOCとの間に有意な正の関連を認めた(β=0.233, p<0.05).また,後期高齢者の男性において仕事関連活動量がSOCと有意な正の関連(β=0.273, p<0.05)を認めた一方,前期高齢者の女性では,仕事関連活動量とSOCとの間に有意な負の関連(β=-0.285, p<0.01)を認めた.
    結論:比較的健康な地域在住高齢者において,身体活動とSOCとの関連性は性や年齢層によって異なり,男性では,前期高齢者は余暇活動が,後期高齢者は仕事関連活動が多いほどSOCが高い一方,女性では年齢層に関わらずSOCを高める身体活動はなかった.本研究は,地域在住高齢者に対する一次予防として有効な身体活動の内容を具体的に示した点で,重要な意義をもつと考えられる.
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