全国学力・学習状況調査によって明らかとなった，沖縄県の児童生徒の学力問題に対して，沖縄県の児童の学力向上を目指した睡入研究を2012 年度，2015 年度，2017 年度と3 度に亘って実施した。2012 年度は児童のみ，2015 年度及び2017 年度は児童と保護者に対して睡眠の介入を行った。睡眠の介入内容はいずれの年度も，睡眠日誌とクイズ形式の睡眠の授業を，2012 年度は4 ヶ月間，2015 年度，2017 年度は1 ヶ月間行った。2017 年度はWeb アプリケーションを用いて電子化された睡眠日誌とe ラーニングによる睡眠教育を実施した。その結果，2012 年度，2015 年度ともに，介入群は対照群に比べ，睡眠時間や睡眠の質が有意に改善し，国語，算数，理科，社会の学力に有意な向上がみられた。2017 年度は，Web アプリケーションのログインなどの操作性や，睡眠教育への動機づけの低さから，数組の参加に留まる結果となった。学校現場における睡入のポピュレーションアプローチにおいて，直接対面する授業や紙媒体による睡眠日誌の方法が，Web アプリケーションよりも有効であることが示唆された。

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本研究の目的は,生活習慣全般の改善を意図した健康教育への参加ガ,主観的な睡眠の質に与える影響を検討することであった.本研究の対象者は,夜間部の大学1年生男子119名であり,(1)行動変容技法(セルフ・モニタリングと目標設定)を用いる介入群,(2)行動変容技法を用いない対照群という,異なる2つのプログラムの効果を比較検討した.介入群のプログラムは,講義における行動変容技法の教授と,体育の宿題として授業時間外における3種類の課題設定を含んでいた.分散分析の結果,睡眠時間得点(p<0.001),睡眠困難得点(p<0.10),およびPittsburg Sleep Quality Index (PSQl)総合得点(p<0.10)において時間の主効果(またはその傾向)を検出し,両群ともに睡眠の質が悪化していた.その一方で,群の主効果および群×時間の交互作用はみられず,本研究で行った介入プログラムは,睡眠の質の改善に十分な効果をもっていないことガ示された.

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This paper attempts to study the independent life of the severely physically disabled in Nagoya city, Japan, 1992. The life style is analyzed mainly through the time budget approach together with other self-administered questionnaire methods. Some characteristics of the life style are described. Formal and informal networks of care and manifest and latent social service and community care resources are identified. Especially, employment is very important for the independent life. But it is hard to get the normal job for the disabled. Therefore, other types of job are necessary. Accordingly to our research, in the early morning and late night attendant is crucial. In short, independent life of the respondents depend not only on the more effective communityoriented social services, but on the "Sub-culture" of the disability and others.

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　Balancing a career as a microsurgeon and the responsibility of motherhood is challenging but achievable. As the mother of a young child, I have continued to perform surgeries. In our department, which has two full-time physicians, I carried out 33 of 51 reconstructive surgeries involving vascular anastomosis in 2021. On average, I left work at 8:44 p.m. on surgery days. I contributed to housework and childcare on non-operative days as well as 55% of operative days. Nurses were delegated to monitor free flap blood flow; therefore, I was only called in twice in a year. I also took five parental leave days to care for my child during sickness. By performing surgeries efficiently and reliably, avoiding over-scheduling on non-operative days, and delegating the postoperative workload among team members, it is possible for leading microsurgeons in microsurgery to successfully raise a small child and manage housework responsibilities.

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クラブチーム下部組織に所属する競技者は，多忙な生活を送っており睡眠時間の確保には限界がある．また，女性では女性ホルモンが睡眠に影響を及ぼす．このような競技者のコンディショニングに対し，睡眠教育が有用とされている．本研究は，クラブチーム下部組織に所属する女性競技者を対象とし，試合期における睡眠教育が睡眠習慣や体組成，運動パフォーマンスに及ぼす影響を検討した．その結果，睡眠教育により，主観的な睡眠習慣の改善を認めた．また，体組成はタンパク質量を維持しつつ脂肪量が減少した．睡眠教育は，競技者に対して睡眠の認識を高め，コンディショニングに影響する可能性がある．

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“Insomnia” has come to a turning point globally. Firstly, a major change has been made to its nosology ; the distinction between “primary insomnia” and “secondary insomnia” has been discarded in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Sleep Disorders (ICSD), and they have been integrated as “insomnia disorder” as an independent diagnostic entity. This is based on the recognition that insomnia can have an independent course even with comorbid conditions, and also has a bidirectional relationship with them. The second major change is the global and ongoing transition of treatment priority from pharmacotherapy to cognitive behavioral therapy for insomnia (CBT–I). The accumulation of the broad range of evidence of CBT–I is striking, and most of the latest guidelines in western countries positioned CBT–I as the first–line treatment. It is also astonishing that it has been suggested that CBT–I can improve not only insomnia but also reduce or even prevent depression. Although its availability is a major issue, digital technology might be one of the solutions. The third major change is regarding the classes of hypnotics. Conventional benzodiazepine receptor agonists (BZRA) have become emphasized to be tapered or discontinued because of dependence and cognitive and motor side effects. Instead, melatonin receptor agonists and orexin receptor antagonists have been developed and focused, as for their reduced side effects like BZRA. The fourth potential major change might be emerged as to the insomnia subtyping. The latest ICSD also discarded conventional subtypes, such as psychophysiological insomnia or idiopathic insomnia, due to lack of stability in their diagnosis. Robust and practical subtyping covering predictability for depression or treatment response would be expected. Accordingly, further knowledge as to the pathophysiology of insomnia would also be needed.

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　The effect of hypnotic intervention for the refractory chronic pain patients was examined along with the process of patients' selection and their psychological characteristics.
　The total 596 visit patients in the first year were statistically examined concerning duration of pain, scores of psychological distress (Hospital Anxiety and Depression Scale) and disability (Pain Disability Assessment Scale) at the initial visit and the treatment outcome at the end of the first year. The duration of chronic pain was significantly related to disability but not to psychological distress at the initial visit. At the end of the first year of multidisciplinary pain treatment, 44% of total patients were under treatment, 19% finished treatment (10% evidently improved and 9% accepted their pain), 12% were referred and 25% dropped out. The group of patients who were evidently improved was not different concerning the duration of pain, but significantly less anxious, less depressed and less disabled at the initial visit than the other groups.
　Among the 261 patients under treatment, 33 patients (5.6% of total patients) were introduced into individual psychological interventions in consideration of 1) poor outcome in pharmacological and physical treatments, 2) unstable treatment relationship and marked pain behaviors, 3) obvious psychological distress, 4) event-related fluctuations in pain. They were significantly more anxious and depressed at the initial visit, than those who were not introduced to psychological intervention. Multiple bio-psycho-social factors were identified; tender points in 21 patients (by physiotherapist), stressful life events around the onset of pain in 26, serious daily conflicts at present in 30, catastrophizing thinking in 21, repressive thinking in 12, avoidance in 2 and perseverative coping in 6. Many of them did not or partly perceive their somatic tension / discomfort. Multiple factors were considered to inhibit the effect of treatment in those patients.
　In individual hypnosis, therapeutic conversation, permissive induction and indirect suggestions were employed. Direct suggestions for analgesia were not applied. Among 33 patients, 25 patients experienced hypnotic analgesia during sessions, 14 of whom finished their sessions with the decreased daily pain level or the enhanced effect of medication until the end of the 3^rd year. Among them, 5 patients evidently improved (one phantom limb pain and 4 other chronic pain). Hypnosis successfully helped 42% of the patients who had failed to respond to multi disciplinary treatment. The psychosomatic resources in patients need to be more attended and utilized in chronic pain treatment.

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Inside the home, it is ordinary for a family member who is unexperienced in giving support to be the main 'helper' for the family member. Under such conditions, it is common for the helper to lose balance while giving support, but however, it is questionable that providing a large space will help to overcome this problem. Instead, a study was conducted to investigate the possibilities of providing a wall that will not get in one's way while giving care, but will serve as a supporting wall, and ensure safety and perhaps ease the difficulties involved in giving care at the same time. The subjects were instructed to lift and move a person from a wheelchair to a toilet basin. The efficiency of the wall used as support was evaluated in terms of differences in sensitivity and posture. The wall proved to be efficient in lifting the person from the wheelchair, and possibilities remain when turning the person around.

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我々は介護度を、要介護者への直接処遇の介護業務における関わり度・困難度・必要度により数量化し、保健福祉機関職種別の介護専門性を比較検討した。1995年12月に配票調査を行い、保健福祉職種別の要介護者事例1208名から介護度を数量化し分析した。介護支援業務総計80項目を基に、6種類(生命、生活、情報、医療、末期、在宅)の主業務にまとめた。関わり度と必要度は、相関係数0.77(偏相関0.49)と非常に高く、困難度は関わり度とは0.57(-0.27)、必要度とは0.67(-0.02)とその偏相関係数は低かった。今回、その関係から、介護度=困難度×(関わり度+必要度)/2として数量化した。介護度は、職種別には、特養寮母が生命、特養看護が医療、特養指導員は情報、老健介護は生命、老健看護が医療、ホームヘルパーと訪問看護とデイケアはともに情報が一番高値であった。特養寮母と老健介護職員の相関係数(0.845)と老健介護職員と老健看護が相関係数(0.883)と非常に高値となった。介護度により保健福祉分野での介護専門性の比較検討ができることが示唆された。

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(OBJECTIVE) The change in the secretion of stress-related bio-chemical substances, which are cortisol, immunoglobulin A (sIgA), and alpha-amylase, while asleep was regarded. As for the sample collection, we developed and proposed a saliva collection technique as a non-invasive and non-disturbing manner of sample collection while asleep, whereas the blood collection should impose greater psycho-physiological stresses to subjects. (METHOD) Subjects, 10 male university students, were instructed to take a 6-hour of sleep from 0:00 of the midnight to 6:00 in the morning at the environmental controlled room, where electrocardiogram (ECG) and blood pressure (BP) were measured, and saliva collection was made continuously in the time series. (RESULT) Salivary sIgA and alpha-amylase concentration obtained by saliva samples depicted a similar profile in the time series, i. e. gradually increase while subjects were asleep, and dropped to the initial level right after awakening. Meanwhile cortisol remained the same level while asleep and got started to increase right after awakening and reached at a peak around 40 minutes later. (CONCLUSION) We developed and proposed our own saliva collection technique for the purpose of non-invasive sample collection while asleep. As a developing result, the distinctive difference in the secretion of stress-related substances was illustrated;which might be derived from the difference in the stress-reaction pathways in our body.

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児童福祉施設の移転に伴う養有体制の改善により, 入所児の発達が移転前と移転後でどう変化したかを検討した。移転に伴う養育改善の要点は家庭的で小グループの落ち着いた雰囲気の中で, 養育担当者との深い継続的な愛着関係を確立して, 乳児期初期からの養育者と乳児との非言語的コミュニケーションを保証することにより, 全面的な発達を向上させることにあった。その結果, 移転前に入所した児と移転後の入所児における発達指標は次のように変化した。まず, 初語発現は約1か月半早く, 移転後では平均10か月5日となり, 2語文発現は約3か月早まり, 平均1歳7か月になった。また, 人見知りは移転後では約1か月早くなり, 平均6か月19日となった。そして, 事例で示されているように, 今日では子どもと担当者との絆が深まっており, 深い人間関係が形成されていた。施設という集団養育の場で, 交替制勤務や複数養育者体制から生じる問題が多く残されているものの, 諸発達は明らかに良くなっていた。以上の結果から, 施設の養育環境を改善すれば, 平均的家庭児に劣らない発達を示すことが, 本実践研究によって明確に示された。

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目的　職場における睡眠教育と睡眠を可視化できるウェアラブル端末を組み合わせ，睡眠の状態，日中の眠気，睡眠習慣行動に与える影響，効果について検討することを目的とした。

方法　本研究は，建設会社3社の従業員を対象に，教育群（睡眠教育と睡眠メモによるモニタリング）および端末群（睡眠教育とウェアラブル端末による総睡眠時間等のモニタリング）に割り付けた比較研究である。2週間後に，ピッツバーグ睡眠質問票日本語版（PSQI-J）などの質問票により睡眠の質，生活習慣，プロセス評価について両群間の比較検討を行い，睡眠データについては各群内の経時的変化の検討を行った。一社ごとに男女別々に層別し，サイコロを用いて割り付けを行った。ベースライン（BL）と2週間後の変化量（改善の程度）について，群間比較では t 検定，マン・ホイットニーの U 検定，群内比較では反復測定分散分析を行った。

結果　参加同意者48人のうち，分析対象は42人（端末群 n=22，教育群 n=20）であった。年齢の中央値は端末群39（20–62）歳，教育群42（21–63）歳，男女比は端末群17：5，教育群15：5であった。PSQI-J総合得点は，端末群より教育群が有意に改善された（P=.017）。このことは，PSQI-JのBL値が改善の程度に，有意な影響を与えていたためであった（P<.001）。日本語版エプワース眠気尺度では，2群間に有意な変化はみられなかった。就床時刻は端末群が約12分前倒し，教育群が約11分後ろ倒しの有意な変化がみられた（P=.023）。総睡眠時間は両群ともに，BLに比べ1週目・2週目が有意に増加した（端末群 P=.015，教育群 P=.017）。睡眠習慣行動のうち「就寝2時間前の間，コンビニなどの明るいところへ外出しない」という項目のみ，端末群の達成度が有意に上昇した（P=.006）。

結論　睡眠教育単独の支援では主観的な睡眠の質の改善，ウェアラブル端末を加えた支援では主に睡眠の量的な変化（就床時刻の前倒し，睡眠時間の延長）が認められたが，それらの効果は部分的であった。しかしながら，本研究は，職場における睡眠支援計画立案の一つの参考資料として有用であるといえよう。

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The long term goal of our research is to develop an in-car health screening instrument, based on a novel approach for physiological measurement, in order to contribute to much-needed efforts aimed at achieving safer driving. We describe here a feasibility study in which a system was constructed to derive cardiac indices non-invasively and simultaneously using a finger cuff. Specifically, the instrument measures blood pressure (BP), pulse rate (PR), normalized pulse volume (NPV) reflecting alpha-adrenergic sympathetic activity, and finger-artery elasticity index (FEI). The instrument's measurement process has two phases:firstly, cuff pressure is maintained at 30 mmHg to measure the NPV and PR;secondly, whilst applying a gradual change in counter-pressure, the BP and FEI are measured by application of the volume-oscillometric method. We tested a prototype instrument in 5 healthy male and female volunteers (age 21, 22, 36, 37, 49 years) during two weeks day-to-day living, including a 33-hour period of total sleep deprivation as physiological challenge. The results indicated that with sleep deprivation there appear to be relatively large physiological changes. In conclusion, the prototype system we have developed has allowed the periodic collection of physiological data in a convenient and expeditious way without any failure, demonstrating the possibility to detect an adverse effect on health. Further investigations will be needed in a larger group of subjects with a variety of real environmental conditions.

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目的：脳卒中後疲労に関する研究の動向，疲労の特定方法，実態，介入方法を明らかにする。方法：PubMedと医学中央雑誌から抽出した324文献を分類，記述した。結果：過去およそ20年間で実態調査等が行われ，薬物療法は過去15年間，非薬物療法は過去10年間で知見が積み重ねられていた。脳卒中後疲労の特定方法は主観的評価であった。疲労にはパーソナリティ特性，脳卒中，身体・心理・社会・行動・環境要因が関連し，高い割合で持続性疲労を有し，機能低下，QOL低下，死亡リスクを招いていた。薬物療法，認知行動療法，マインドフルネス，運動療法，教育，照明・光療法等で疲労改善が期待できるが，エビデンスは十分に構築されていなかった。結論：脳卒中後疲労は主観的評価で特定され，持続性疲労が重篤な結果を招いていた。薬物療法のほか非薬物療法でも疲労改善が期待できるが，非薬物療法のエビデンスは十分に構築されておらず，介入の開発が求められる。

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Energy balance in human body undergoes constant change, leading to a change in the weight and body composition throughout life. Energy balance at a particular time point is influenced by the psychological, physiological, sociological, and environmental factors of that moment. In addition, the regulation of homeostasis continuously monitors and maintains the energy balance; however, it complicates the identification of factors influencing the energy balance. For understanding these factors, creating a model with comprehensive factors and testing it among a substantial number of individuals for dynamic changes in the energy balance may be warranted. However, till date, to the best of our knowledge, no studies report on comprehensive modeling, including homeostasis and the other factors. Thus, at this moment, summarizing previous studies for further research is required. Accordingly, this review summarizes 1) the basic factor of energy expenditure and intake; 2) interactive relationship between energy expenditure and intake; and 3) energy expenditure and intake during dynamic changes in the body weight caused by events such as overfeeding, underfeeding, growth and aging, and pregnancy.

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