Urawa University

Sub-optimal response in schizophrenia is frequent, warranting augmentation strategies over treatment-as-usual (TAU). We assessed nutraceuticals/phytoceutical augmentation strategies via network meta-analysis. Randomized controlled trials in schizophrenia/schizoaffective disorder were identified via the following databases: PubMed, MEDLINE, EMBASE, Scopus, PsycINFO, CENTRAL, and ClinicalTrials.gov. Change (Standardized Mean Difference=SMD) in total symptomatology and acceptability (Risk Ratio=RR) were co-primary outcomes. Secondary outcomes were positive, negative, cognitive, and depressive symptom changes, general psychopathology, tolerability, and response rates. We conducted subset analyses by disease phase and sensitivity analyses by risk of bias and assessed global/local inconsistency, publication bias, risk of bias, and confidence in the evidence. The systematic review included 49 records documenting 50 studies (n=2,384) documenting 22 interventions. Citicoline (SMD=-1.05,95%CI=-1.85; -.24), L-lysine (SMD=-1.04,95%CI=-1.84;-.25), N-acetylcysteine (SMD=-.87,95%CI=-1.27;-.47) and sarcosine (SMD=-.5,95%CI=-.87-.13) outperformed placebo for total symptomatology. High heterogeneity (tau2=.10, I2=55.9%) and global inconsistency (Q=40.79, df=18, p=.002) emerged without publication bias (Egger's test, p=.42). Sarcosine improved negative symptoms (SMD=-.65, 95%CI=-1.10; -.19). N-acetylcysteine improved negative symptoms (SMD=-.90, 95%CI=-1.42; -.39)/general psychopathology (SMD=-.76, 95%CI=-1.39; -.13). No compound improved total symptomatology within acute phase studies (k=7, n=422). Sarcosine (SMD=-1.26,95%CI=-1.91; -.60), citicoline (SMD=-1.05,95%CI=-1.65;-.44), and N-acetylcysteine (SMD=-.55,95%CI=-.92,-.19) outperformed placebo augmentation in clinically stable participants. Sensitivity analyses removing high-risk-of-bias studies confirmed overall findings in all phases and clinically stable samples. In contrast, the acute phase analysis restricted to low risk-of-bias studies showed a superior effect vs. placebo for N-acetylcysteine (SMD=-1.10,95%CI=-1.75,-.45), L-lysine (SMD=-1.05,95%CI=-1.55,-.19), omega-3 fatty acids (SMD=-.83,95%CI=-1.31,-.34) and withania somnifera (SMD=-.71,95%CI=-1.21,-.22). Citicoline (SMD=-1.05,95%CI=-1.86,-.23), L-lysine (SMD=-1.04,95%CI=-1.84,-.24), N-acetylcysteine (SMD=-.89,95%CI=-1.35,-.43) and sarcosine (SMD=-.61,95%CI=-1.02,-.21) outperformed placebo augmentation of TAU ("any phase"). Drop-out due to any cause or adverse events did not differ between nutraceutical/phytoceutical vs. placebo+TAU. Sarcosine, citicoline, and N-acetylcysteine are promising augmentation interventions in stable patients with schizophrenia, yet the quality of evidence is low to very low. Further high-quality trials in acute phases/specific outcomes/difficult-to-treat schizophrenia are warranted.

Previous studies evaluated the association between eating alone and mental health mainly in older people and adolescents. This study aimed to evaluate the association between dinner frequency with others and psychological distress during the COVID-19 outbreak among the Japanese working population. Data were acquired from a prospective online cohort study (the Employee Cohort Study in the COVID-19 pandemic in Japan) conducted in February 2021 as a cross-sectional design. Dinner frequency with others was categorized into five groups: "almost daily," "4-5 times per week," "2-3 times per week," "once per week," and "less than once per week," setting them as a predictor variable. Modified Poisson regression was performed to calculate the prevalence ratio of psychological distress with multiple imputation for missing data. Global fear and worry about COVID-19 were adjusted as a covariate. A total of 1171 participants completed the questionnaire. Respondents who ate dinner with others "almost daily" had the least psychological distress than those who ate with others "4-5 times," "2-3 times," and "once per week" in the crude model (prevalence ratio (95% CI): 1 [reference], 1.34 [1.08-1.67], 1.40 [1.15-1.69], 1.44 [1.12-1.85], respectively). The association was comparable after adjusting for global fear and worry about COVID-19. Among those who ate dinner with others at least once a week, those who ate with others "almost daily" had the least psychological distress. The association was comparable after adjusting for global fear and worry about COVID-19. Further study is needed on why those who eat with others less than once a week may have a lower prevalence ratio of having mental distress.

目的 保育所のデイリープログラムに合わせた生活場面を取り上げ，子どもが不快感情を表出する際に，保育士がどのように対応するかに焦点化し，保育者の方略と感情表出の関連を明らかにする。方法 2018～2019年に公立保育所に勤務する保育士1511名に留置法で質問紙調査を実施した。保育者の属性，子どもへの対応，子ども評価を尋ねた。結果と考察 保育園児が不快感情を表出する場面は，生活場面の切り替えを要因とし，保育士は対応の難しさを感じていた。年齢が高いほど一人ひとりの子どもの気持ちを理解し，落ち着くまで寄り添うことが難しいと感じており，集団内の対人関係を踏まえて感情調整を促す必要を感じていることが示唆された。乳幼児期に感情調整の発達を促す保育者の役割は重要であろう。

【背景・目的】臓器移植はメディアの報道を通じての啓発も重要であるため，メディア関係者の報道判断に影響を与える要素を検討することを目的とした。【方法】予備調査①はメディア関係者7名を対象にヒアリング調査を行い，移植の報道判断に影響を与える要素を抽出した。予備調査②ではメディア関係者10名を対象に半構造化面接を行い，臓器移植法20年の啓発イベント（1）（2）の報道発表資料を提示し，影響を与える要素を分類した。本調査では，全国750社のメディア関係者を対象に報道資料（1）（2）を用いて質問紙調査を行い（回答130社，回収率17.3％），報道に影響を与える要素を独立変数に，報道判断（意欲）を従属変数に重回帰分析を行った。【結果】報道判断に影響を与える要素は，社会的背景，メッセージ，タイミング，新奇性，独創性，公共性等が抽出された。報道資料に対しては，「法施行20年の節目」「専門家によるレクチャー」が正の影響，「移植にニュースバリューがない」「イベントのインパクトが弱い」が負の影響を与えていた。【考察】タイミング，移植の専門情報，ニュースバリュー，インパクト等の要素を考慮することが移植の報道および啓発につながると考えられる。

Abstract Background: Almost 1% of Canadians are hepatitis C (HCV)-infected. The liver-specific complications of HCV are established but the extra-hepatic comorbidity, multimorbidity, and its relationship with HCV treatment, is less well known. We describe the morbidity burden for people with HCV and the relationship between multimorbidity and HCV treatment uptake and cure in the pre- and post-direct acting antiviral (DAA) era. Methods: We linked adults with HCV at The Ottawa Hospital Viral Hepatitis Program as of April 1, 2017 to provincial health administrative data and matched on age and sex to 5 Ottawa-area residents for comparison. We used validated algorithms to identify the prevalence of mental and physical health comorbidities, as well as multimorbidity (2+ comorbidities). We calculated direct age- and sex-standardized rates of comorbidity and comparisons were made by interferon-based and interferon-free, DAA HCV treatments. Results: The mean age of the study population was 54.5 years (SD 11.4), 65% were male. Among those with HCV, 4% were HIV co-infected, 26% had liver cirrhosis, 47% received DAA treatment, and 57% were cured of HCV. After accounting for age and sex differences, the HCV group had greater multimorbidity (prevalence ratio (PR) 1.38, 95% confidence interval (CI) 1.20 to 1.58) and physical-mental health multimorbidity (PR 2.71, 95% CI 2.29 – 3.20) compared to the general population. Specifically, prevalence ratios for people with HCV were significantly higher for diabetes, renal failure, cancer, asthma, chronic obstructive pulmonary disease, substance use disorder, mood and anxiety disorders and liver failure. HCV treatment and cure were not associated with multimorbidity, but treatment prevalence was significantly lower among middle-aged individuals with substance use disorders despite no differences in prevalence of cure among those treated. Conclusion: People with HCV have a higher prevalence of comorbidity and multimorbidity compared to the general population. While HCV treatment was not associated with multimorbidity, people with substance use disorder were less likely to be treated. Our results point to the need for integrated, comprehensive models of care delivery for people with HCV.

AimIntentional or unintentional acute drug poisoning occurs even in elderly people, but little is known about the factors influencing the intention to poisoning. A retrospective study was undertaken to describe the characteristics of acute drug poisoning in elderly people according to whether the poisoning was intentional or unintentional and the responsible agents.MethodsThe study was carried out in a single tertiary hospital in Japan. A total of 145 patients aged ≥65 years who were transferred by an ambulance service and were diagnosed with acute drug poisoning were included. Medical records were used to collect information on the intention behind poisoning and the responsible agents. Patients were divided into two groups according to whether they experienced intentional or unintentional poisoning and were further classified according to the responsible agent. Multivariable logistic regression models were used to estimate the association between hospitalization for acute drug poisoning and the use of benzodiazepine receptor agonists (BzRAs).ResultsPoisoning was unintentional in 102 (70.3%) patients and intentional in 43 (29.7%) patients. In total, 65 (44.8%) patients required hospitalization. Among patients in the unintentional poisoning group, those using non‐BzRAs were more likely to be hospitalized than those using BzRAs (odds ratio, 6.64; 95% confidence interval, 2.56–17.22). The length of hospital stay was significantly longer in the unintentional poisoning group than in the intentional poisoning group (13.9 vs. 6.2 days; P = 0.013).ConclusionsThe proportion of unintentional poisoning in the elderly is high, and particularly with respect to poisoning with non‐BzRAs, the hospitalization rates are high.

PURPOSE: Stair climbing can be a strenuous task and stair accidents/injury are common among older adults. We evaluated the effectiveness of daily stair climbing on leg muscle strength in older adults participating in weekly community physical activity programs for 6 months. METHODS: Seventy-four healthy older adults (50 women, 24 men, mean age, 73.5 ± 5 years) were recruited. Participants attended weekly physical activity programs at their community center and recorded their daily walking and stair climbing steps using a pedometer, Omron, HJA-403C, which detects both types of steps. Prior to and after the 6-month study period, height, weight, and leg strength (i.e., abductor muscle strength, adductor muscle strength, and knee extensor strength) were measured. During the study period, the instructors encouraged participants to engage in stair climbing by explaining the health benefits, providing information on locations of stairs nearby, and listening to participants’ experiences on routine stair use. A paired t-test was used to determine the changes in steps and leg strength before and after the 6-month study period, and Pearson correlation analysis was used to identify correlations between the stair climbing steps and leg strength. RESULTS: Forty-nine participants (34 women, 15 men) completed the study. At the baseline, the participants recorded an average of 120 stair steps per day, which was approximately 2% of their daily total walking steps. After the 6-month study period, the mean walking steps (6,607 ± 3,235 steps vs. 7,556 ± 2,715 steps) and stair steps (119 ± 90 steps vs. 166 ± 123 steps) increased significantly (p ≤ 0.01). There were no significant changes in leg muscle strength (Pre-test vs. Post-test: Adductor, 0.35±0.11 vs. 0.35±0.10kg/kg, Abductor 0.41±0.11 vs. 0.44±0.10kg/kg). However, in men the correlation coefficient between the stair steps and abductor muscle strength was observed (Pre-test: r=0.428, p=0.04, Post-test: r=0.556, p=0.03). CONCLUSIONS: Stair-use campaigns increased routine daily stair use (about 50 steps) in older adults. This did not significantly change leg muscle strength, however in men the relationship between the stair steps and abductor muscle strength was observed. In a future study, cross-sectional evaluations of stair steps and leg muscle strength will be examined.