Therapeutic Research

第86 回日本循環器学会学術集会会長講演（2022 年3 月11 日）で，伊藤浩氏は自らの臨床および研究でOriginality を目指してきたこと，それを裏付けるデータの精度，大阪大学，桜橋渡辺病院で積み重ねてきた多くの経験の重要性を語った。さらに岡山大学での新たな取り組み，多施設臨床試験，地域医療モデル，日本循環器連合の立ち上げなどを紹介し，循環器領域の臨床と研究の進展に向けてSomething new，Something special，All for the Patients の必要性を指摘した。

The pneumococcal vaccine is currently recommended as national immunization program（NIP）to children under 5 years of age, adults aged 60‒64 years with high‒risk conditions, and the elderly aged 65 years and over in Japan. In the case of NIP, vaccines’cost‒effectiveness and preventive effects have been evaluated in the fact sheets prior to the recommendation. However, the evidence on the cost‒effectiveness of vaccinations is still very limited especially for the adults with underlying medical conditions. 　　A recent study analysed the cost‒effectiveness of PCV13 in adults aged 60 years and over with underlying medical conditions compared to PPV23 and no vaccination using a Markov model with a lifetime horizon and a 1‒year cycle. The expected costs, quality‒adjusted life‒years （QALYs）, and prevented cases and deaths were estimated from public payer’s and societal perspectives. The cost per QALY gained from a public payer’s perspective for PCV13 vs PPV23 and no vaccination were estimated at 500,255JPY/QALY and 1,139,438JPY/QALY, respectively. PCV13 was shown to be cost‒effective in all scenarios compared with PPV23 and no vaccination. 　　In adults aged 60 years and over with underlying medical conditions, PCV13 was shown to be a more cost‒effective alternative to PPV23. It is important to validate these results using the latest available data, since the distribution of serotypes may change over time due to the COVID‒19 impact and the introduction of new vaccines.

もの忘れ健診を受診した。北海道樺戸郡浦臼町の高齢地域住民121 名（女性81 人，年齢78.3±6.0 歳；65～95 歳）に，ToCA‒MCI，MMSE，HDS‒R，時計描画試験，MoCA‒J，睡眠障害と抑うつ，5 m 歩行速度，握力，ロコモティブ症候群，サルコペニア，フレイル，baPWV/ABI の総合的機能評価を実施。ICD‒10 の認知症診断基準に基づいて健常群と軽度認知障害（MCI）群に分類し，認知症への進行の有無を2380日間追跡調査した。健常群87 名とMCI 群34 名の認知症発症頻度はおのおの，8.1％と29.4％であった（p＝0.0024）。ToCA‒MCI（カットオフ値18）を実施すれば感度88.2％，特異度88.5％でMCIを検出できること，カットオフ値が18を下回る住民は高頻度に認知症に進行すること（Cox‒Mantel test，p＝0.0038），カットオフ値18 を下回る40名の地域住民のうち14名に毎週火曜日，2 時間の歩行訓練を主眼とする生活治療を12 ヵ月間以上実施すると，認知症への進行が予防できること（Cox‒Mantel test，p＝0.0105）が観察された。専門医がいなくとも，たとえば保健師が中心となってToCA‒MCIを実施すれば，カットオフ値18 で認知症予備群の早期発見が可能であり，生活治療介入により認知症への進行が予防できることが期待される。

Background: In Japan, combination therapy is recommended for the treatment of mild and moderate ulcerative colitis（ UC）, when treatment of oral therapy with 5 –aminosalicylic acid（ OT5ASA）or topical therapy（ TT） is ineffectve. However, the actual situation of the combination therapy for UC is unclear. Objective: We evaluated combination proportion of OT5ASA and TT, trend to be withdrawal from combination therapy and continuation proportion of OT5ASA. Methods: We conducted a retrospective cohort study using Japanese Claims Data （JMDC）. We included subjects who was diagnosed with UC and prescribed therapeutic medicines from June 1, 2017, to June 30, 2020, in the study. Study subjects were also categorized into cohort 1（OT5ASA only）, 2 （TT only） and 3 （combination OT5ASA and TT） at the first of prescribing. We analized proportion of combination OT5ASA and TT tended to be withdrew from combination therapy and continuation proportion of OT5ASA from prescription initiation to 180 days, and the differences between cohorts and therapeutic medicines. Results: The combination proportion of OT5ASA and TT from prescription initiation were 21.5％ and 21.6％ in cohorts 1 and 2, respectively, with no differences between cohorts and therapeutic medicines. For the proportion of subjects, which prescribing initiation was OT5ASA, with less than 25％ of TT combinations, proportion of time–dependent, pH–dependent and MMX was 28.4, 28.1 and 42.9％ , respectively, and also OT5ASA continuation proportion were 46.9, 44.9 and 65.9％ , respectively. Conclusion: The proportion of patients who changed to the combination therapy from OT5ASA or TT as single agent was both about 1/5 of the total, and there was no difference betweem cohorts and formulations. MMX formulations tended to be more withdrew from combination therapy and maintained OT5ASA continuation compared to other OT5ASA at initiate treatment of OT5ASA.

Background：After the outbreak of COVID‒19, the infection was soon declared a pandemic and remains active after two years. First‒year students entering college in 2020 faced added challenges in adjusting to a new environment during the pandemic. 　　Purpose：Through a qualitative research design using focus group interviews, this study explores their experiences of adjusting to college life. 　　Methods：The participants comprised 14 college students who entered a Korean nursing school in 2020 and had completed their first year. Data were collected from January to February 2021 and analyzed using the phenomenological methodology proposed by Colaizzi. 　　Results：The exploratory research results were classified into five categories：stressed about a new experience, feeling helpless in an unresolvable situation, feeling depressed from severed communications, growth by overcoming challenge, and desiring a normal college life. 　　Conclusions：The findings highlight the need for systematic education at the college and departmental levels and virtual student interaction programs to help first‒year students adjust well to changed college life due to COVID‒19. It is also important to monitor first‒year students’ level of stress and depression and to provide psychological support and special attention.