目的：侵襲的人工呼吸器（TPPV）を装着した筋萎縮性側索硬化症（ALS）患者のライフ経験について，ライフ・ライン・メソッドを用いたCOVID19感染拡大期も含めた14年間の心理的状態の変化と関連要因から縦断的に明らかにすることを目的とした．

方法：前回調査後14年後に実施した．本研究に参加同意の得られた3名のTPPV装着ALS患者を対象に，半構造化面接と質問紙票調査を実施した．

結果：心理的状態は，2名は現在に向けて回復していたが，1名は悪化していた．心理的状態が悪化中の者は，回復中の者と比べて概ね，身体的自覚症状とHopeレベルの悪化，現在の心の支えとなる人と楽しみの数の少なさ，現在のレジリエンスの獲得的要因の占める割合の低さが見られた．心理的状態の悪化要因と回復要因の記述的内容として，それぞれ，「身体症状・身体障害」を主軸とする「病への適応」「対人面」「生活面」「コロナ渦」の5領域と，12個のカテゴリーが抽出された．「コロナ渦」領域のカテゴリーは，「対人面」と「生活面」領域のカテゴリーとの関連が見られ，平時からの介護体制や人間関係構築が非常に重要であった．

結論：ALS患者のライフ経験を長期的な視点から捉えた研究はこれまでに殆ど見られなかった．そのような中、本研究では，重症度の高いTPPV装着ALS患者を対象に，COVID-19感染拡大期を含む長期にわたるライフ経験を，先行研究の限られる中でその一端を明らかにすることができた．病状の進行や新興感染症の世界的大流行という困難な状況においても，心理的状態は健常な人と同等のレベルまで回復し得ること，また心理的状態に影響を及ぼす要因の中でも，「コロナ渦」特有の要因は，平時からの人間関係や介護体制のあり方と深く関連していることが示された．これらの知見から，患者理解と支援のあり方を具体的に提案した．

[Objective] We quantitatively analyzed age and cause of death structure of the decline in age-adjusted mortality rates in recent years, especially since 2000, to understand future public health issues.

[Methods] We calculated age adjusted mortality rates by cause of death were nationwide from 2000 to 2015. The reference population was set as “Japanese 2015 model population”.

[Results] The age-adjusted mortality rate (per 100,000) for all causes was 1,781.3 for males and 990.6 for females in 2000, but decreased to 1,442.2 for males and 792.5 for females in 2015.

By cause of death, “malignant neoplasm”, “cardiac disease (excluding hypertension)”, “pneumonia”, and “cerebrovascular disease” contributed greatly. On the other hand, the age-adjusted mortality rate of “senility” increased, showing a negative contribution of －6.0% for males and －13.7% for females to the decrease in all-cause mortality.

[Discussion] The decline in the all-cause age-adjusted mortality rate was largely due to the fact that “cerebrovascular disease” was almost halved. In addition, the two causes of death, “cerebral infarction” and “acute myocardial infarction”, accounted for about 40% of the overall decline.

Among diseases other than “selected causes of death” (A classification of 34 causes of death that are of great social interest), “vascular and unspecified dementia,” “Parkinson’s disease,” and “Alzheimer’s disease” increased. In addition, “other respiratory diseases” classified as “aspiration pneumonia”, also increased during this period.

Although the age-adjusted mortality rate for all causes of death decreased significantly, the contribution of “cerebral infarction” and “acute myocardial infarction” should decrease, and we need to clarify the causes and take measures for these trends.

Purpose: This study seeks to clarify the presence or absence of cold sensitivity, lifestyle habits considered as factors for cold sensitivity, and accompanying symptoms in elderly men.

Method: The study enrolled men aged 65 years or elderly living in A region, Japan. The participants were asked about their basic attributes, lifestyle habits, presence or absence of accompanying symptoms, the Terasawa Hiesho Questionnaire, and body parts with cold sensation and its degree.

Results: Of 234 participants, 55 (23.5%) were diagnosed with cold sensitivity.

The elderly individuals with cold sensitivity tended to weigh less than those without. In terms of lifestyle habits, elderly men with cold sensitivity were significantly associated with having “many likes and dislikes” and “bathing only once a week or taking showers.” There were significant differences in nine accompanying symptoms, including “fatigue,” “tiredness,” “dizziness and lightheadedness,” “constipation tendency,” “frequent urination,” and “light sleep.”

Conclusion: Cold sensitivity was present in 20% of elderly male participants. Accompanying symptoms appear to affect their daily activities. Information provision about the occurrence of cold sensitivity in men and coping strategies should be considered.