東日本大震災に伴う福島第一原子力発電所事故により、2016年3月現在でも避難指定区域外の多くの住民が自主的に避難を続けている。自主避難者の中でも特に、子育て中の母親は経済的な負担や放射線被曝への心配に加え、子育て負担の増加や家族関係の変化、避難先での人間関係の希薄化等よるメンタルヘルスの悪化が指摘されている。本研究では、子どもを持ち自主的に避難を続ける20歳から49歳までの母親241名を対象とし、家族関係及びソーシャル・キャピタルとメンタルヘルスとの関連について明らかにすることを目的とした。同居家族の有無と母親の抑うつ状態(CES-D:26点以上)との関連について多重ロジスティックモデルによる分析を行ったところ、母子のみで生活する母親は家族と同居する母親に比べ2.502倍(95%CI:1.125-5.563)抑うつが疑われる状態にあることが明らかになった。また、近隣住民への信頼感が高い母親に比べ、低い母親は5.434倍(95%CI:1.384-21.339)、地域活動への参加頻度が高い母親に比べて、低い母親は3.244倍(95%CI:1.083-9.718)抑うつが疑われる状態にあることが明らかになった。今後、特に母子のみで避難する母親の支援においては、子育てサークル等の地域で行われるインフォーマルな組織への参加を通して、他者への信頼感や地域活動への参加度を高め、ソーシャル・キャピタルを醸成していくことが重要であると考えられる。(著者抄録)

本研究は、東日本大震災から1年経過した時期および2年経過した時期に、埼玉県内または東京都において避難生活を送る福島県民の世帯に対して行ったアンケート調査の結果である。2011年に発生した東日本大震災は、原子力発電所事故を伴ったことによって、全国に県外避難者を生み出したことが、これまでの自然災害と決定的に異なる特徴である。震災から1年後の2012年調査の結果からは、男性において生活費の心配や失業がストレス反応に影響していることが示され、女性において住宅の被災状況や人間関係、原発に対する賠償問題などがストレス反応に影響していることが示された。一方、2013年調査の結果からは、男女ともに苦しい経済状況、健康状態の悪化、避難者というスティグマ、家族関係や近隣関係、住環境などがストレス反応に影響していることが示され、年月の経過とともに、ストレスが、震災の直接的影響よりも避難生活に起因するものになってきていることが明らかとなった。(著者抄録)

本研究は、東日本大震災に伴って発生した福島原子力発電所事故の2年後に、福島県内の仮設住宅において避難生活を送る住民の心的外傷後ストレス症状と、そのストレスに影響を与える身体・心理・社会的要因を明らかにしたものである。2,425世帯に対して無記名で任意回答のアンケート用紙を配布し、745名(回答率30.7%)の回答を得た。欠損値を除く661名の解析を行ったところ、IES-Rの平均値が34.20±20.56であり、PTSDの可能性に対する高いリスクを示すカットオフ値24/25を超えた者が62.56%であった。PTSDの可能性との関連を多重ロジスティック回帰分析で検討した結果、「経済的困難」(OR:2.34、95%CI:1.30〜4.24)、「賠償の心配」(OR:4.16、95%CI 1.26〜13.76)、「持病の悪化」(OR:2.94、95%CI:1.63〜5.30)、「新疾患の罹患」(OR:2.20、95%CI:1.21〜3.99)、「相談者の不在」(OR:1.92、95%CI:1.07〜3.42)が有意な予測因子として認められた。これまでに世界各地で報告されてきた他の災害と比較しても、原発事故被災者にきわめて高い外傷後ストレス症状が認められた理由として、事故に対する補償や賠償といった問題など、本災害の人為災害としての要素が重要であると考えられた。(著者抄録)

Objective
This study investigated post-traumatic stress symptoms in relation to the population affected by the Fukushima Nuclear Disaster, one year after the disaster. Additionally, we investigated social factors, such as forced displacement, which we hypothesize contributed to the high prevalence of post-traumatic stress. Finally, we report of written narratives that were collected from the impacted population.
Design and Settings
Using the Impact of Event Scale-Revised (IES-R), questionnaires were sent to 2,011 households of those displaced from Fukushima prefecture living temporarily in Saitama prefecture. Of the 490 replies; 350 met the criteria for inclusion in the study. Multiple logistic regression analysis was performed to examine several characteristics and variables of social factors as predictors of probable post-traumatic stress disorder, PTSD.
Results
The mean score of IES-R was 36.15 +/- 21.55, with 59.4% having scores of 30 or higher, thus indicating a probable PTSD. No significant differences in percentages of high-risk subjects were found among sex, age, evacuation area, housing damages, tsunami affected, family split-up, and acquaintance support. By the result of multiple logistic regression analysis, the significant predictors of probable PTSD were chronic physical diseases (OR = 1.97), chronic mental diseases (OR = 6.25), worries about livelihood (OR = 2.27), lost jobs (OR = 1.71), lost social ties (OR = 2.27), and concerns about compensation (OR = 3.74).
Conclusion
Although there are limitations in assuming a diagnosis of PTSD based on self-report IES-R, our findings indicate that there was a high-risk of PTSD strongly related to the nuclear disaster and its consequent evacuation and displacement. Therefore, recovery efforts must focus not only on medical and psychological treatment alone, but also on social and economic issues related to the displacement, as well.

Purpose：The purpose of this study was to clarify the practice of acupuncture and moxibustion in medical institutions with a palliative care unit. Methods：A selfadministered questionnaire was mailed to the physicians in charge of the ward or the chief nurses of 244 medical institutions with a palliative care unit. Results：Responses were obtained from 98 institutions. Among these, it was obvious that acupuncture and moxibustion therapy were performed in six institutions（6.1％）. The conditions of patients treated with acupuncture and moxibustion were pain, fatigue, constipation, and displeasure. Regarding acupuncturists being concerned with a palliative care field, it was described that acupuncturists could have one of the important role in clinical field in palliative care. On the other hand, it was indicated that there were difficulties associated with the practice of acupuncture and moxibustion therapy in a hospital. Conclusion：Although acupuncture and moxibustion therapy are considered to have usefulness as a variety of care, to practice acupuncture and moxibustion therapy in a medical institution, it is necessary to examine create the practice system.

Objectives : We argue for a key concept in "Narrative-Based Medicine" through detailed analysis of interactions in illness narratives. The purpose of this research is to illustrate that practical knowledge based on a patient's lived experience of illness has significant meanings and functions for medical treatments that advocate a holistic medical care. Subjects and method : Subjects of this research are 5 patients placed in the 3^<rd> stage of Four-stage model (1^<st> report). This research adopted the qualitative research method from an anthropological point of view, because it was necessary to mention the influence of a researcher upon subjects. An anthropological research for narrative analysis can deal with interactions among patients, a doctor and a researcher as academic agenda. Results : We examined illness narratives for clarification of a key concept in "Narrative-Based Medicine". It was clarified that illness narratives as "witness" were proving the truth of their illness experience. We found there are 3 aspects on dynamics of witness (Fig. 1); (1) illness narratives as witness of subjects in the 3^<rd> stage, (2) a medical doctor as a witness person for their illness narratives, (3) a researcher or a family member as a second witness person. We found that each interaction among these 3 aspects could be considered indispensable conditions in order to conduct medical treatments based on the dynamics of witness. Significance of illness narratives as witness lies in that subjects will be able to live together with chronic illness through interactions among these 3 aspects. Conclusion : In analysis of illness narratives in this research, it was clarified that the dynamics of witness in the above mentioned 3 aspects could generate medical phenomenon that encouraged patients to live together with chronic illness. We regarded the dynamics of witness as one of the key concepts of "Narrative-Based Medicine". Hence we named this medical phenomenon "Witness-Based Medicine".

Objectives:This research attempts to examine illness narrative as health resource in psychosomatic medical treatment. In clinical process, illness narratives in which explanatory models are implicated show considerable plasticity reflecting doctor-patient relationships. We argue for relevance of Narrative-Based Medicine, through detailed analysis of this plasticity in illness narratives. Subjects and Method:Illness narratives were collected from 20 outpatients at a clinic in Tokyo. From March 2000 to August 2000, we conducted non-structured interview in order to examine illness narratives qualitatively from an anthropological point of view. Results:We found that these illness narratives should be considered as health resources for every patient to cope with various stress-factors in their daily life. We hypothesized four-stage model of clinical process according to the observation on transition of doctor-patient relationship and changing contents of a patient's illness narratives. At the beginning of illness symptom, all patients suffer deeply from not being able to express their mind-body discrepancy verbally. At the first stage, they visit medical facility to seek an orthodox explanatory model of medical science. In the second stage, they begin to ask personal explanatory model of the doctor in charge. Finally, they become able to narrate their illness experience fluently, since they have developed a definition of their health conditions while maintaining mind-body discrepancy in certain degree. In the third stage, patients become an expert of "illness experience", while medical doctors remain as a specialist of "disease". Conclusion:It is clear that to continue narrating illness experience has important meaning and function for a patient's health care. In the third stage, some patients become enable to narrate their feelings and sensations particular to their bodily experience. At the same time, medical doctor respects their knowledge of bodily experience and shows proper attitude as audience in their illness narrative.

The purpose of this study is to evaluate the effects of the Great Hanshin Earthquake in January 1995 on the onset of symptoms of the Posttraumatic Stress Disorder (PTSD) and psychological stress responses systematically. Three to four months after the quake, one hundred twenty eight earthquake victims (males : n-62,Age : Mean : =34.89±12.51,Min.=18,Max.=73; females : n=66,Age : Mean=29.56±11.42,Min.= 19,Max.= 62) were requested to complete a questionnaire, which consists of items from DSM-IV diagnostic criteria for PTSD and Psychological Stress Response Scale (PSRS-18). The rate of. prevalence of PTSD was 12.90% for males, 9.09% for females, and 10.94% for total subjects, suggesting that the prevalence rate of PTSD is almost same as one described in DSM-IV. Victims showed symptoms included DSM-IV criteria category B (persistent reexperience of traumatic events) most frequently (92.97%), followed by category D symptoms (persistent increased arousal : 54.69%), category F symptoms (distress or impairment of social and occupational functioning : 28-91%), and category C symptoms (persistent avoidance of trigger and numbing of responsiveness : 25.00%). Among category B symptoms, 82.03% of victims showed intense psychological distress at exposure to triggers, 69.53% of them showed recurrent and intrusive recollections of the traumatic event and acting or feeling as if the traumatic event were recurring, whereas only 15.63% of victims showed psychological reactivity on exposure to triggers. Among category C symptoms, efforts to avoid activities., places, or people that arouse recollections of the trauma was found in 69.53% of victims and sense of foreshortened future was found in 37.50% of victims. As there were no differences in the occurrence of category D symptoms, 35% to 50% of victims showed each symptom. Regarding to the results of PSRS-18,comparison of PSRS-18 scores between victims and the normative data revealed that victims showed significantly higher scores in all subscales : Depressive-anxious mood, Irritability and anger, and Helplessness. No significant gender difference was found. Further analysis of PSRS-18 scores revealed that victims with PTSD symptoms showed significantly more psychological stress responses than victims without PTSD symptoms in all subscales. These results were discussed with reference to past research data on PTSD caused by quake disaster. The importance of social support system to reduce psychological stress responses and some implications for the intervention of PTSD were discussed.