Tokyo College of Welfare

Neurotechnology has the potential to provide high-performance products and services to humans, with its miniaturization and minimally invasiveness of devices, coupled with the development of artificial intelligence (AI) for processing, analyzing, and generating commands based on neural activities. On the other hand, various ethical concerns have been addressed, including the ownership and privacy protection of neural data derived from the brain-machine interface, a fundamental technology to realize the neurotechnology products/services, prevention of misuse, malicious use and unauthorized use. Indeed, various international organizations, national governments and public bodies are advancing the development and publication of recommendations and/or working papers in recent years, with a focus on the impact of neurotechnology on human rights. This study reviews recommendations and their implication effort by Organisation for Economic Co-operation and Development (OECD) and analyzes the trends in international rulemaking. We also examine necessary regulatory frameworks at the national level, based on international rules, as countermeasures to address ethical concerns arising from the societal implementation of neurotechnology.

Since 2017, Japan has been establishing a community-based integrated mental health care system, which includes first-line consultations provided by local authorities (i.e., municipalities). This study aimed to (1) investigate factors related to the challenge municipalities encounter when providing mental health consultations, and (2) identify collaboration patterns between municipalities and public health agencies. Data were obtained from a nationwide municipal survey and publicly available government statistics. Municipal staff difficulty in providing mental health consultations was measured using a four-point scale, and its association with local psychiatric and social care resources and collaboration activities across local institutions was examined by ordinal logistic regression analysis. Latent class analysis was also conducted based on how the municipality collaborated with public health agencies. Lower difficulty providing mental health consultations was associated with the existence of municipally established public health centres (OR 0.22, 95% CI 0.09 to 0.53, p=0.001), which minimises the organisational barrier between the two entities, and frequent meetings with local service providers (OR 0.65, 95% CI 0.44 to 0.96, p=0.032). Variables indicating local psychiatric and social care resources showed no significant associations. Municipalities were classified into four latent classes based on collaboration patterns: Overall frequent (18.1%), Overall infrequent (22.0%), Frequent for individual support (49.1%), and Infrequent for individual support (10.8%). The difficulty faced by local authorities in providing mental health consultations may be reduced by fostering collaboration with other institutions, specifically public health agencies, and by hosting frequent meetings with local service providers.

Background Though nonalcoholic fatty liver disease (NAFLD) is related to chronic kidney disease (CKD), it is unclear whether the hepatic steatosis index (HSI), a screening tool for NAFLD, is related to CKD. The present study investigated the relationship between HSI and CKD among middle-aged individuals in Japan. Methods Subjects were adults (aged 40–64 years) who received an annual health checkup in Japan between April 2013 and March 2014. Height and weight were measured, and venous blood samples were obtained to determine alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatinine levels. HSI was calculated by the following formula: HSI = 8 × ALT/AST ratio + body mass index (+2, if diabetes; +2, if female). CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 and/or urinary protein of ≥ (+). Logistic regression analysis was performed to estimate the odds ratio (OR) and its 95% confidence interval (CI) for CKD. Results Data of 94,893 adults were analyzed. Compared with men with an HSI < 30, men with 30 ≤ HSI ≤ 36 (OR: 1.50, 95% CI: 1.40–1.61) and HSI > 36 (OR: 2.14, 95% CI: 1.99–2.31) had significantly higher ORs for CKD. Moreover, there was a significant dose-response relationship between HSI and CKD (P for trend < 0.001). Even after adjusting for confounders, the significant results persisted. These findings in men were similar to those in women. Conclusions This study showed that the HSI was associated with CKD among middle-aged adults in Japan. Additionally, a dose-response relationship of HSI to CKD was observed. The present study suggested that it might be useful to monitor the HSI among middle-aged individuals to detect CKD at an early stage.

【目的】鍼灸師養成施設教員の臨床及び教育における銀鍼に対する意識調査を実施した。 【対象と方法】全国の鍼灸師養成施設 （専門学校） 87校の教員を対象に無記名式アンケート調査を郵送法により実施し、各施設につき2名の回答者を依頼した。回収データの統計解析としてFisherの直接確率検定及び単純集計を実施した。 【結果】調査票回収率は67.8%であり回答者数は118名であった。臨床で銀鍼を使用する者は35名 （29.7%） であり、そのうちディスポーザブル鍼のみを使用する者が28名 （80.0%） と最多であった。臨床での銀鍼の使用状況と治療法 （P＜0.01） との間に有意な関連性が認められた。使用理由の最多は、気などの概念を用いた 「東洋医学」 によるものであった。一方、使用しない理由で最多は 「経済面」 であった。銀鍼の教育の必要性を認識している者は93名 （80.9%） であった。必要とする理由は技術向上によるものが最多であった。必要としない理由は、臨床での銀鍼の必要性が低いことによるものが最多であった。 【考察】銀鍼使用者のうち、ディスポーザブル鍼の使用者が多かったのは、銀鍼特有の衛生管理の困難さによると考えられる。銀鍼の使用理由は、「気」 など東洋医学的概念によるものが最多であることから、銀鍼の使用状況と治療法との間に関連性が認められた可能性がある。銀鍼の欠点として認識されている 「経済面」 等の要因が臨床における銀鍼の使用低下につながっていることが示唆された。一方で技術向上の為、銀鍼教育の必要性を認識している者が多かったものの反対意見もあり、銀鍼教育の実態調査が課題であると考える。 【結論】調査の結果、臨床において銀鍼を使用している者は少ないが、銀鍼教育の必要性を認識している者は多いことが明らかとなった。今後、教育現場における銀鍼教育の実態を明らかにする必要がある。

The aim of this open-label study was to investigate the long-term safety and efficacy of selegiline as monotherapy in Japanese patients with early Parkinson disease (PD). We conducted a 56-week prospective study in patients with early PD (N = 134) who had previously completed the randomized, double-blind, placebo-controlled phase III trial of selegiline monotherapy for 12 weeks. In the present study, dosing was titrated from 2.5 to 10 mg/d in increments of 2.5 mg/d for 2 weeks. From the seventh week, the dosage was maintained at 10 mg/d until week 56. The primary outcome was any change in the total Unified Parkinson's Disease Rating Scale (UPDRS) score (part I + II + III) from baseline. Secondary outcomes, including changes in the UPDRS subscores and safety profile, were also evaluated. Ninety-one (67.9%) patients completed the 56-week study. Treatment with selegiline significantly reduced total UPDRS score from week 4 (mean ± SD, -2.62 ± 3.83; P < 0.0001) to week 56 (-3.39 ± 9.27; P < 0.01). The peak effect was seen at week 20 (-5.79 ± 5.57; P < 0.0001). In addition, we found similar improvements in the UPDRS parts II and III scores. The incidence rate of adverse drug reactions was 44.3% (58 patients) and did not increase during the period of 10 mg selegiline administration. Long-term monotherapy with selegiline (10 mg/d) was effective and well tolerated in patients with early PD in this 56-week study.

With the revision of the Services and Supports for Persons with Disabilities Act in 2013 to provide welfare service to patients with Intractable Diseases (IDs) and the enactment of a new act for these patients in 2015, employment support (ES) service for them has become an important issue in Japan because of the chronicity of many of the diseases. The objective of this research is to examine utilization of the ES welfare services, and to identify care expected from ES service providers and their current efforts. A questionnaire was mailed to every registered provider in Japan (12,483 locations). Among 6,053 respondents, 16 percent reported patients with IDs using their services, and that among them, 74 percent had a certificate of person of disabilities, which is not required under the current Act. As for the reasons for reporting non-utilization, the percentage of “absence of inquiry” was 77 percent, while that of “needed medical care,” “insufficient staff/facilities” and “lack of appropriate work” were all less than 3 percent. The result shows that dissemination of the ES service is still insufficient, and patients with IDs, their families, support providers and medical professionals need to be familiarized with the service in details. Article DOI: https://dx.doi.org/10.20319/lijshls.2015.s11.172179 This work is licensed under the Creative Commons Attribution-Non-commercial 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc/4.0/ or send a letter to Creative Commons, PO Box 1866, Mountain View, CA 94042, USA.

ObjectivesTo examine the association between self-reported eating rate and metabolic syndrome.DesignCross-sectional study.SettingAnnual health checkup at a health check service centre in Japan.ParticipantsA total of 56 865 participants (41 820 male and 15 045 female) who attended a health checkup in 2011 and reported no history of coronary heart disease or stroke.Main outcome measureMetabolic syndrome was defined by the joint of interim statement of the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute.ResultsIn multiple logistic regression models, eating rate was significantly and positively associated with metabolic syndrome. The multivariable-adjusted ORs (95% CI) for slow, normal and fast were 0.70 (0.62 to 0.79), 1.00 (reference) and 1.61 (1.53 to 1.70), respectively, in men (p for trend <0.001), and 0.74 (0.60 to 0.91), 1.00 (reference) and 1.27 (1.13 to 1.43), respectively, in women (p for trend <0.001). Of metabolic syndrome components, abdominal obesity showed the strongest association with eating rate. The associations of eating rate and metabolic syndrome and its components were largely attenuated after further adjustment for body mass index; however, the association of slow eating with lower odds of high blood pressure (men and women) and hyperglycaemia (men) and that of fast eating with higher odds of lipid abnormality (men) remained statistically significant.ConclusionsResults suggest that eating rate is associated with the presence of metabolic syndrome and that this association is largely accounted for by the difference in body mass according to eating rate.

The safety of a new technique, designated "transcatheter arterial embolization (TAE) with aspiration via a balloon-occluded renal drainage vein" (TAE-ABOD), for the management of large renal cell carcinomas (RCCs). The subjects were 25 patients with RCC who underwent a total of 27 sessions of TAE-ABOD. This TAE-ABOD technique incorporates two procedures: balloon occlusion of renal drainage vein and infusion of absolute ethanol into the tumor-feeding arteries during aspiration of blood via a balloon catheter, thereby reducing leakage of absolute ethanol into the systemic circulation. Our primary endpoint was to establish a safe regimen for high-dose ethanol injection therapy, and our secondary endpoint was to assess global survival of the patients. The administered dose of ethanol ranged from 0.2 to 0.5 ml/kg [median: 0.34 (SD: 0.10) ml/kg], increased in a stepwise manner. The systemic ethanol concentration was measurable in 14 patients, and was less than 0.1 mg/ml in 12 and from 0.1 to less than 0.2 mg/ml in two. There were no major complications such as renal failure or renal abscess. TAE-ABOD can safely deliver a high dose of absolute ethanol for the treatment of large RCCs.

聴覚障害発症年齢の異なる (幼年期・青年期) 中途失聴者2例の人工内耳装用効果について, 述後2年半までの臨床場面の対話 (narrative) 分析により質的検討を加えた。特に日常生活場面で装用者自身に主観的に感じられる人工内耳装用の効果を中心に検討を行った。その結果, 以下の点が明らかとなった。1. 中途失聴成人の人工内耳装用においては, 音声コミュニケーションにおける音韻の聴取改善に留まらず発話者の「情動」の伝播, 理解とそれに伴う「メタコミュニケーション (発話における真の命題)」理解に改善効果が認められた。またそれには, 発話の超分節的要素 [リズム, アクセント, 間 (ま), 有声休止など] の理解改善が大きく貢献していることが示唆された。2. 自然環境音の聴取改善により,「生命の躍動感」や「情緒性」とも結びついた社会文化的な聴覚経験 (「うぐいすの声」で春の訪れを感じるなど) の回復を招き, 装用者のQOLの向上に役立つことが示唆された。3. 難聴発症年齢の差異が過去の聴覚概念の形成に影響し, 人工内耳装用後の聴取回復過程に質的影響を及ぼす可能性が示唆された。