Details of a Researcher - Yokoyama, Yoko

Papers - Yokoyama, Yoko

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Sodium ferrous citrate and 5-aminolevulinic acid improve type 2 diabetes by maintaining muscle and mitochondrial health.

Kitamura N, Zhang S, Morel JD, Nagano U, Taworntawat T, Hosoda S, Nakamura A, Ogawa Y, Benegiamo G, Auwerx J, Tsubota K, Yokoyama Y, Watanabe M

Obesity (Silver Spring, Md.) 2023.02

ISSN 1930-7381

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Web-based intervention to improve the evidence-practice gap in minimal intervention dentistry: Findings from a dental practice-based research network

Kakudate N., Yokoyama Y., Sumida F., Matsumoto Y., Takata T., Gordan V.V., Gilbert G.H.

Journal of Dentistry (Journal of Dentistry) 115 103854 2021.12

ISSN 03005712

Objectives: To determine whether: the evidence-practice gap (EPG) in minimal intervention dentistry (MID) can be improved by a tailored web-based intervention, and specific clinical situations might impede implementing MID. Methods: We conducted a before-after intervention study and a qualitative study. Two web-based questionnaire surveys were conducted among 197 Japanese dentists. In the first questionnaire, a baseline EPG was measured using six questionnaire items. Subsequently, feedback material about the EPG was electronically prepared, including results of the first questionnaire, international comparisons with a previous study from the US, and a summary of recent evidence on MID. In the second questionnaire, the EPG was re-measured after participants read the material. The primary outcome was mean overall concordance between published evidence and the dentist's clinical practice for all six questions. During the second questionnaire, we performed qualitative content analysis using free-text responses to a question about difficult situations encountered when conducting MID. Results: Regarding before and after comparisons of concordance between the first and second questionnaires, mean overall concordance improved significantly, from 66% to 89% (p<0.001). Qualitative content analysis identified five difficult situations: “cases where decision making for treatment and prognosis is difficult”, “inadequate practice resources”, “limitations on patient visit and treatment period”, “discrepancy between MID and the patient's values”, and “limitations on health insurance and social understanding”. Conclusions: These results suggest that it is possible to reduce the EPG in MID using a web-based educational intervention among Japanese dentists. Qualitative content analysis revealed five difficult situations that might hinder implementation of MID. Clinical Significance: Although this intervention demonstrated educational effects, perfect concordance was not achieved by all participants. This is possibly associated with the five situations that participants reported facing when conducting MID. Creating an environment to improve these situations may facilitate a reduction in the EPG.

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Iron supplementation regulates the progression of high fat diet induced obesity and hepatic steatosis via mitochondrial signaling pathways

Kitamura N., Yokoyama Y., Taoka H., Nagano U., Hosoda S., Taworntawat T., Nakamura A., Ogawa Y., Tsubota K., Watanabe M.

Scientific Reports (Scientific Reports) 11 ( 1 ) 10753 2021.12

ISSN 2045-2322

Disruption of iron metabolism is closely related to metabolic diseases. Iron deficiency is frequently associated with obesity and hepatic steatosis. However, the effects of iron supplementation on obesity and energy metabolism remain unclear. Here we show that a high-fat diet supplemented with iron reduces body weight gain and hepatic lipid accumulation in mice. Iron supplementation was found to reduce mitochondrial morphological abnormalities and upregulate gene transcription involved in mitochondrial function and beta oxidation in the liver and skeletal muscle. In both these tissues, iron supplementation increased the expression of genes involved in heme or iron–sulfur (Fe–S) cluster synthesis. Heme and Fe–S cluster, which are iron prosthetic groups contained in electron transport chain complex subunits, are essential for mitochondrial respiration. The findings of this study demonstrated that iron regulates mitochondrial signaling pathways—gene transcription of mitochondrial component molecules synthesis and their energy metabolism. Overall, the study elucidates the molecular basis underlying the relationship between iron supplementation and obesity and hepatic steatosis progression, and the role of iron as a signaling molecule.

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Metabolic effects of bee larva-derived protein in mice: Assessment of an alternative protein source

Yokoyama Y., Shinohara K., Kitamura N., Nakamura A., Onoue A., Tanaka K., Hirayama A., Aw W., Nakamura S., Ogawa Y., Fukuda S., Tsubota K., Watanabe M.

Foods (Foods) 10 ( 11 ) 2021.11

ISSN 2304-8158

Food crises caused by growing global population or environmental changes are predicted in the near future; therefore, sustainable solutions are needed. Edible insects, which are rich in protein and can save feed and environmental resources, have the potential to be a sustainable alternative protein source. However, there is limited evidence on the impact on health. In this study, we investigated the biological effects of ingesting bee larva by examining their effects on amino acid, lipid, and glucose metabolism in animal models. In our animal experiments, the replacement of casein as a protein source, with edible insects, did not seem to cause any deficiency in murine amino acid levels in the plasma and liver. Metabolomic analysis of plasma metabolites showed decreased 3-methylhistidine and increased nicotinamide in the bee larva-derived protein-fed mice. Decreased levels of plasma 3-metylhistidine, an indicator of muscle degradation, implies that replacement to bee-larva protein from casein did not cause muscle degradation in vivo. We further investigated effects of increased plasma nicotinamide on peripheral tissue and found an increase in expression levels of genes involved in glucose uptake in muscle and thermogenesis in adipose tissue. These data imply that bee larva is a potential sustainable, safe and healthy alternative protein source.

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Evidence-practice gap in minimal intervention dentistry: Findings from a dental practice-based research network

Kakudate N., Yokoyama Y., Sumida F., Matsumoto Y., Yamazaki H., Touge T., Fujikawa Y., Gordan V.V., Gilbert G.H.

Journal of Dentistry (Journal of Dentistry) 102 103469 2020.11

ISSN 03005712

Objectives: This study aimed to 1) quantify the evidence-practice gap (EPG) between dental clinical practice and published evidence on Minimal Intervention Dentistry (MID) among dentists in Japan; and 2) examine the hypothesis that dentist characteristics have a significant association with the EPG. Methods: We conducted a cross-sectional study via use of a web-based questionnaire survey of dentists who were affiliated with the Dental Practice-based Research Network Japan (n = 297). To quantify the EPG on MID, we used a questionnaire that included 10 clinical questions or scenarios to assess concordance between dental practice and published evidence on MID. We evaluated concordance by coding responses to each question as consistent or inconsistent with the evidence. An overall concordance was then determined as percent of responses that were consistent with published evidence for 10 questions. Subsequently, multiple logistic regression analysis was conducted to examine the associations between dentist characteristics and higher overall concordance (≥median) with published evidence. Results: Mean and median overall dentist-level concordance were both 60 % (SD: 18, interquartile range: 50–75 %). Logistic regression analysis showed that “gender of dentist”, “city population”, and “frequency of obtaining evidence from the scientific journal articles in English” were significantly associated with high concordance, with odds ratios (95 % CIs) of 2.33 (1.01–5.39), 2.01 (1.02–3.96), and 2.45 (1.08–5.59), respectively. Conclusions: Japanese dentists demonstrated medium concordance with published evidence, indicating that an EPG on MID exists in Japanese dental clinical practices. Dentist-specific characteristics had significant associations with high concordance with published evidence. Clinical Significance: Despite the establishment and dissemination of the concept of MID, the EPG on MID exists in Japanese dental clinical practices. A high concordance was significantly associated with the following dentist characteristics: “female dentist”, “dental clinic location in a government-ordinance-designated city”, and “frequently obtaining evidence from the English-language scientific journal articles”

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Asperuloside Improves Obesity and Type 2 Diabetes through Modulation of Gut Microbiota and Metabolic Signaling

Nakamura A., Yokoyama Y., Tanaka K., Benegiamo G., Hirayama A., Zhu Q., Kitamura N., Sugizaki T., Morimoto K., Itoh H., Fukuda S., Auwerx J., Tsubota K., Watanabe M.

iScience (iScience) 23 ( 9 ) 101522 2020.09

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The regulation of glucose and lipid homeostasis via PLTP as a mediator of BAT–liver communication

Sponton C.H., Hosono T., Taura J., Jedrychowski M.P., Yoneshiro T., Wang Q., Takahashi M., Matsui Y., Ikeda K., Oguri Y., Tajima K., Shinoda K., Pradhan R.N., Chen Y., Brown Z., Roberts L.S., Ward C.C., Taoka H., Yokoyama Y., Watanabe M., Karasawa H., Nomura D.K., Kajimura S.

EMBO Reports (EMBO Reports) 21 ( 9 ) e49828 2020.09

ISSN 1469221X

While brown adipose tissue (BAT) is well-recognized for its ability to dissipate energy in the form of heat, recent studies suggest multifaced roles of BAT in the regulation of glucose and lipid homeostasis beyond stimulating thermogenesis. One of the functions involves interorgan communication with metabolic organs, such as the liver, through BAT-derived secretory factors, a.k.a., batokine. However, the identity and the roles of such mediators remain insufficiently understood. Here, we employed proteomics and transcriptomics in human thermogenic adipocytes and identified previously unappreciated batokines, including phospholipid transfer protein (PLTP). We found that increased circulating levels of PLTP, via systemic or BAT-specific overexpression, significantly improve glucose tolerance and insulin sensitivity, increased energy expenditure, and decrease the circulating levels of cholesterol, phospholipids, and sphingolipids. Such changes were accompanied by increased bile acids in the circulation, which in turn enhances glucose uptake and thermogenesis in BAT. Our data suggest that PLTP is a batokine that contributes to the regulation of systemic glucose and lipid homeostasis as a mediator of BAT-liver interorgan communication.

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A high-salt/high fat diet alters circadian locomotor activity and glucocorticoid synthesis in mice

Yokoyama Y., Nakamura T.J., Yoshimoto K., Ijyuin H., Tachikawa N., Oda H., Shiraishi R., Shinohara K., Kumadaki K., Honda S., Nakamura A., Kitamura N., Tsubota K., Watanabe M.

PLoS ONE (PLoS ONE) 15 ( 5 ) e0233386 2020.05

ISSN 1932-6203

Salt is an essential nutrient; however, excessive salt intake is a prominent public health concern worldwide. Various physiological functions are associated with circadian rhythms, and disruption of circadian rhythms is a prominent risk factor for cardiovascular diseases, cancer, and immune disease. Certain nutrients are vital regulators of peripheral circadian clocks. However, the role of a high-fat and high-salt (HFS) diet in the regulation of circadian gene expression is unclear. This study aimed to investigate the effect of an HFS diet on rhythms of locomotor activity, caecum glucocorticoid secretion, and clock gene expression in mice. Mice administered an HFS diet displayed reduced locomotor activity under normal light/dark and constant dark conditions in comparison with those administered a normal diet. The diurnal rhythm of caecum glucocorticoid secretion and the expression levels of glucocorticoid-related genes and clock genes in the adrenal gland were disrupted with an HFS diet. These results suggest that an HFS diet alters locomotor activity, disrupts circadian rhythms of glucocorticoid secretion, and downregulates peripheral adrenal gland circadian clock genes.

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Melon GliSODin® prevents diet-induced NASH onset by reducing fat synthesis and improving liver function

Nakamura A., Kitamura N., Yokoyama Y., Uchida S., Kumadaki K., Tsubota K., Watanabe M.

Nutrients (Nutrients) 11 ( 8 ) 2019.08

A high-calorie diet causes fat accumulation and oxidative stress in the liver, leading to fatty liver and eventually non-alcoholic steatohepatitis (NASH). Melon GliSODin® is used as a nutritional supplement because of its antioxidant activity. This study aimed to assess the antioxidant activity of Melon GliSODin® and its effectiveness in preventing NASH, which primarily results from oxidative stress. Furthermore, we verified the protective effect of Melon GliSODin® by administering it to a mouse model of diet-induced NASH. Melon GliSODin® suppressed liver fibrosis and fat accumulation, which is characteristic of the NASH phenotype. Gene expression analysis confirmed the suppression of fat synthesis and activation of antioxidative mechanisms. These results show that Melon GliSODin® mitigates NASH onset at the molecular level, suggesting its potential application as a NASH preventive agent.

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Practice-based research agenda priorities selected by patients: findings from a dental practice-based research network

Kakudate N., Yokoyama Y., Sumida F., Matsumoto Y., Riley J.L., Gordan V.V., Gilbert G.H.

International Dental Journal (International Dental Journal) 69 ( 3 ) 183 - 191 2019.06

ISSN 00206539

Objectives: This study aimed to identify (i) which practice-based research agendas had the highest priority among patients and (ii) whether priorities varied significantly with patient age and gender. Methods: We conducted a cross-sectional questionnaire survey of 482 patients from 11 outpatient dental practices. The patients were shown 31 items concerning practice-based research questions and asked to select the three items in which they were most interested. We generated a rank order of the 31 items. Subsequently, the 31 items were categorised into 10 groups, and we performed subgroup analyses according to age and gender using chi-square tests. Results: “Age-specific care to maintain oral health (n = 86)” was rated as the most interesting research question. When data were analysed according to age, patients less than 40 years old rated “Orthodontic treatment”, “Esthetic dental care” and “Topical fluoride application” as interesting questions significantly more frequently than did patients 40 years old or older (P < 0.01)?, while patients 40 years old or older rated “Regular dental check-ups”, “Dental implant”, “Diet and food” and “Social health insurance” as more interesting than did patients less than 40 years old (P < 0.05). When data were analysed according to gender, female patients rated the questions on aesthetic dental care as more interesting than did male patients (P < 0.01), whereas male patients rated questions on toothbrushing as more interesting than did female patients (P < 0.05). Conclusions: Patients assessed “Age-specific care to maintain oral health” as the highest priority among a broad range of research topics. This study also quantified patient priorities for research agendas according to age and gender group. Designing future research with these priorities in mind will promote patient-centred evidence.

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Dentists’ practice patterns of treatment for deep occlusal caries: Findings from a dental practice-based research network

Kakudate N., Yokoyama Y., Sumida F., Matsumoto Y., Gordan V.V., Gilbert G.H.

Journal of Dentistry (Journal of Dentistry) 84 76 - 80 2019.05

ISSN 03005712

Objectives: This study quantified and compared practice patterns of treatment for deep occlusal carious lesions among Japanese dentists, and tested the hypothesis that dentist characteristics are significantly associated with the decision to choose an indirect pulp capping (IPC), a form of selective carious tissue removal that involves leaving a thin layer of demineralized tissue over the pulp, that is then covered with a protective liner. Methods: This cross-sectional study was conducted using a questionnaire survey of dentists affiliated with the Dental Practice-based Research Network Japan (n = 297). Dentists were asked to indicate what percentage of time they use three treatment options when treating patients with deep occlusal caries and possible mild pulpitis on a posterior tooth. Response options were “1. Stop before removing all caries and perform an IPC”, “2. Remove all caries and proceed with a direct pulp cap”, and “3. Remove all caries and proceed with endodontic-related procedures”. Percentages of options 1–3 were compared by multiple comparison. Associations between dentist characteristics and a higher percentage of IPC provision (option 1) were analyzed via logistic regression. Results: Responses were obtained from 206 dentists. Median percentages (interquartile ranges) of options 1, 2 and 3 were 30% (10–59%), 10% (0–30%), and 40% (19–80%), respectively. The differences between option 3 and options 1 and 2 were significant (p < 0.001). In logistic regression analysis, a higher frequency of obtaining evidence from English-language scientific articles was significantly associated with a higher percentage of IPC, with an odds ratio of 2.28 (95%CI: 1.14–4.54). Conclusions: Endodontic-related procedures remain the most frequent treatment option for deep occlusal caries. Frequent use of evidence-based information in English-language scientific articles was associated with Japanese dentists’ preference toward IPC. Clinical Significance: Japanese dentists would most frequently choose endodontic-related procedures, followed by IPC and direct pulp capping for treatment of patients with deep occlusal caries with possible mild pulpitis on posterior teeth. Significant association was identified between use of evidence-based information in the English-language scientific literature and Japanese dentists’ preference for IPC.

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Agaricus brasiliensis KA21 May Prevent Diet-Induced Nash through Its Antioxidant, Anti-Inflammatory, and Anti-Fibrotic Activities in the Liver

Nakamura A., Zhu Q., Yokoyama Y., Kitamura N., Uchida S., Kumadaki K., Tsubota K., Watanabe M.

Foods (Foods) 8 ( 11 ) 2019

Non-alcoholic steatohepatitis (NASH) is a progressive disease that occurs in the liver. As the number of people with NASH has increased, effective prevention and treatment strategies are needed. Agaricus brasiliensis KA21 (AGA) is a mushroom native to Brazil and is considered a healthy food because of its purported health benefits, including its antioxidant properties. In this study, we focused on the oxidative stress that accompanies the onset of NASH and examined whether AGA can prevent NASH development through its antioxidant activity. We used a mouse model of NASH in which pathogenesis was promoted by dietary induction. Supplementation with AGA attenuated the development of hepatic fibrosis, which is a characteristic feature of late-stage NASH. This effect appeared to be mechanistically linked to an AGA-promoted reduction in hepatic oxidative stress. These results demonstrate a novel role for AGA in NASH prevention.

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Dentist's distress in the management of chronic pain control

Yokoyama Y., Kakudate N., Sumida F., Matsumoto Y., Gordan V.V., Gilbert G.H.

Medicine (United States) (Medicine (United States)) 97 ( 1 ) e9553 2018.01

ISSN 00257974

We aimed to obtain greater understanding of dentists' distress when they diagnose and treat patients with temporomandibular disorders (TMD), and to explore ways in which TMD can be better treated. We conducted a cross-sectional study based on a questionnaire survey of dentists (n = 148). Dentists were queried using an open-ended questionnaire about distress they experienced when treating patients with TMD. Survey responses were analyzed using mixed methods. Associations between specific dentist and patient characteristics and types of distress were analyzed by one way analysis of variance and residual analysis. One hundred thirteen clinicians responded to the questionnaire, giving a 76% response rate. Thematic analysis identified 6 major themes: difficulty in predicting therapeutic effect and prognosis; difficulty in diagnosis; difficulty in the decision about whether to do occlusal adjustment; difficulty in specifying a cause; difficulty in communicating with patients and mental factors; and health insurance system barriers. Clinicians who reported difficulty in deciding whether to do occlusal adjustment saw significantly more patients who experienced shoulder stiffness and headache (P = .008 and P = .022, respectively). Dentists' knowledge of TMD guidelines was associated with a lower percentage of difficulty in predicting therapeutic effect and prognosis (residual analysis; P = .010). These findings provide important insights into clinician's perception of difficulties with patients experiencing TMD-related pain. Knowledge of the existence of TMD clinical practice guidelines may lower dentist distress, particularly with regard to prognosis. Further studies are needed to decrease dentist's distress and to overcome the evidence-practice gap in TMD treatment.

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Association between plant-based diets and plasma lipids: a systematic review and meta-analysis.

Yokoyama Y, Levin SM, Barnard ND

Nutrition reviews 75 ( 9 ) 683 - 698 2017.09

ISSN 0029-6643

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Use of clinical practice guidelines by dentists: findings from the Japanese dental practice-based research network.

Kakudate N, Yokoyama Y, Sumida F, Matsumoto Y, Gordan VV, Gilbert GH

Journal of evaluation in clinical practice 23 ( 1 ) 96 - 101 2017.02

ISSN 1356-1294

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Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis.

Yokoyama Y, Barnard ND, Levin SM, Watanabe M

Cardiovascular diagnosis and therapy 4 ( 5 ) 373 - 82 2014.10

ISSN 2223-3652

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Vegetarian diets and blood pressure: a meta-analysis.

Yokoyama Y, Nishimura K, Barnard ND, Takegami M, Watanabe M, Sekikawa A, Okamura T, Miyamoto Y

JAMA internal medicine 174 ( 4 ) 577 - 87 2014.04

ISSN 2168-6106

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Dentists' practice patterns regarding caries prevention: results from a dental practice-based research network.

Yokoyama Y, Kakudate N, Sumida F, Matsumoto Y, Gilbert GH, Gordan VV

BMJ open 3 ( 9 ) e003227 2013.09

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Men who have Sex with Men(MSM)におけるHIV感染予防行動を妨げる認知に関する検討

松高由佳, 古谷野淳子, 桑野真澄, 橋本充代, 本間隆之, 山崎浩司, 横山葉子, 日高庸晴

日本エイズ学会誌 ((一社)日本エイズ学会) 15 ( 2 ) 134 - 140 2013.05

ISSN 1344-9478

Men who have Sex with Men(MSM)向けHIV予防介入・教育に寄与するため、我が国のMSMのセイファーセックスを妨げるセルフトークのタイプについて検討した。方法は2009年に実施されたMSM対象のインターネットHIV予防介入プログラムにおいてUnprotected anal intercourese(UAI)を許容する認知(セルフトーク)のリスト30項目を提示し、回答を求めた。この236名分のデータを使用し結果、1)年齢層は20〜30代が約8割を占め、居住地は東京都54名(22.9%)、神奈川県27名(11.3%)、大阪府23名(9.7%)の順に多かった。2)因子分析は3つの因子構造であることが示唆された。第1因子は「安全神話」、第2因子は「あきらめ・開き直り」、第3因子は「セックスへの意味づけ」を表す因子と命名した。以上、このようにタイプが分類化されることは認知の傾向をより意識しやすくなり、予防介入場面で個人がセックスに求めている個別のニーズを把握でき、セイファーセックスを実現していく道を模索する上で研究の成果に活かすことができると考えられた。

A novel Internet-based blended learning programme providing core competency in clinical research.

Tsugihashi Y, Kakudate N, Yokoyama Y, Yamamoto Y, Mishina H, Fukumori N, Nakamura F, Takegami M, Ohno S, Wakita T, Watanabe K, Yamaguchi T, Fukuhara S

Journal of evaluation in clinical practice 19 ( 2 ) 250 - 5 2013.04

ISSN 1356-1294

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Interpersonal psychosocial factors associated with underreported dietary energy intake in hemodialysis patients.

Yokoyama Y, Sasaki S, Suzukamo Y, Yamazaki S, Takegami M, Kakudate N, Hasegawa T, Haga M, Kawaguchi T, Moriya T, Hotta O, Fukuhara S, Dialysis Nutrition Research Group.

Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation 23 ( 1 ) 37 - 44 2013.01

ISSN 1051-2276

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Dentists' dietary perception and practice patterns in a dental practice-based research network.

Yokoyama Y, Kakudate N, Sumida F, Matsumoto Y, Gilbert GH, Gordan VV

PloS one 8 ( 3 ) e59615 2013

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臨床研究に関するブレンデッド型遠隔学習プログラムの教育効果測定の試み

角舘直樹, 次橋幸男, 横山葉子, 山本洋介, 三品浩基, 中村文明, 福森則男, 竹上未紗, 大野慎也, 佐藤恵子, 脇田貴文, 渡部一宏, 山口拓洋, 福原俊一

医学教育 ((一社)日本医学教育学会) 43 ( 3 ) 205 - 210 2012.06

Lead author, Last author, Corresponding author, Accepted, ISSN 0386-9644

我が国では臨床研究のデザインから解析までの基礎知識(臨床研究コア・コンピテンシー)を理解する医療者は少ない。我々は、臨床現場で働く多忙な医療者が、臨床研究コア・コンピテンシーを学ぶための対面授業と遠隔学習システムを組み合わせたブレンデッド型遠隔学習プログラムを開発した。今回は、本プログラムの教育効果について報告する。1)本プログラム終了から4ヵ月経過時点で、対象者の64%が臨床研究に取り組み始めていた。2)本プログラムは、臨床研究について議論できる仲間の数を増やすことにも寄与している可能性が示唆された。3)本プログラムは、受講者の臨床研究に対する自信(自己効力感)を高めている可能性が示唆された。(著者抄録)

臨床研究教育におけるメンタリングの促進・阻害因子の探索的研究　メンティーのインタビュー調査から

三品浩基, 横山葉子, Feldman Mitchell D., 角舘直樹, 福原俊一

医学教育 ((一社)日本医学教育学会) 42 ( 2 ) 75 - 80 2011.04

Lead author, Last author, Corresponding author, Accepted, ISSN 0386-9644

欧米では、メンター制度が医学領域の研究成果の達成のみならずキャリア形成、研究資金獲得にとって有用な教育システムとして認められている。わが国の医学研究教育においてもメンター制度を活用するにあたり、その試行経験から、メンタリングの促進因子と阻害因子を検討することが重要と考える。1)メンター制度下で臨床研究の実施経験がある医師12人を対象として、メンタリングの促進因子および阻害因子を探索するインタビュー調査を行った。2)インタビューの逐語録を質的に分析し、メンタリングの促進因子と阻害因子を抽出した。3)促進因子として、メンティーのレベルの適切な評価、メンティーの考えているキャリアパスの把握、コミュニケーションの双方向性、身近な先輩研究者の存在が抽出された。4)阻害因子として、メンターの忙しさ、相談内容のレベルの低さについてのメンティーの不安、メンター・メンティー間の上下関係が抽出された。5)施設におけるメンタリングの評価制度、およびメンターの教育制度がメンタリングの促進に必要な対策として期待された。(著者抄録)

薬剤師のニーズに合致した臨床研究教育ワークショップの立案・実施・評価

渡部一宏, 横山葉子, 大野慎也, 川井朋子, 倉田洋子, 網岡克雄, 関根祐子, 井関健, 福原俊一

薬局薬学 ((一社)日本薬局学会) 2 ( 1 ) 44 - 52 2010.09

Lead author, Last author, Corresponding author, Accepted, ISSN 1884-3077

薬剤師のニーズに合致した臨床研究に関する知識やスキルを育成する目的で、臨床研究ワークショップ(WS)を立案・実施し、その教育的効果を評価した。本WSは学会開催中に実施した計3時間の教育プログラムで、「レクチャー」「小グループ実習」および「グループ発表会」から構成されている。本WS参加者の学習効果と、参加者によるプログラム評価を行う目的で、自記式質問紙調査を行った。その結果、学習内容の事前および事後に実施した理解度テストでは、スコアに大幅な改善が見られ、本WSの難易度が適切であり、知的好奇心を高めるのに役立ったことが分かった。本WSは一定の教育効果や評価が得られ、薬剤師のニーズに合致した教育プログラムであることが示唆された。

臨床研究医の現状　診療現場で臨床研究を実現するための課題　京都大学臨床研究者養成コース(MCRコース)の履修生の実態調査から見えてきたこと

有村保次, 西田俊彦, 南麻弥, 横山葉子, 三品浩基, 山崎新, 石崎達郎, 川上浩司, 中山健夫, 今中雄一, 川村孝, 福原俊一

医学教育 ((一社)日本医学教育学会) 41 ( 4 ) 259 - 265 2010.08

Lead author, Last author, Corresponding author, Accepted, ISSN 0386-9644

我が国の臨床研究の推進には,臨床と研究手法に精通した臨床研究医(clinical investigator)の養成が必要である.我が国初の臨床研究の系統的な教育を行う臨床研究者養成(MCR)コースが京都大学に開設された.今回,本コースの卒業生が臨床研究を実施する上で直面している問題点を調査し,今後の改善策を検討した.1)MCRコース3期生までの全履修者28名を対象に,履修後の臨床研究実施に関する現状や将来像等について自己記入式質問紙調査を行った.2)回答者24名中(回収率86%),臨床研究を行う上で,「時間がない」,あるいは,「研究協力者がいない」といった問題を挙げる者は,それぞれ40%程度いた.3)「臨床研究を進めるために職場や周囲への働きかけ」を行った者は20名(83%)いたが,職場において臨床研究の支援が得られたのは1名のみであった.4)このような状況下,自らの10年後の将来像として「病院で臨床研究を行う臨床医」と回答した者が半数以上いた(54%).また,「臨床研究を行う医師のキャリアパスを想像できる」と回答した者は42%であった.5)MCRコースは改善の余地があるものの人材育成の具体的なモデルを呈示した.臨床研究のさらなる発展のため,医療現場における支援体制や人的・物的インフラ整備の必要性が示唆された.(著者抄録)

【未破裂脳動脈瘤】未破裂脳動脈瘤の治療選択における意思決定支援ツールの開発と評価

横山葉子, 野崎和彦, 中山健夫, 福原俊一

脳卒中の外科 ((一社)日本脳卒中の外科学会) 38 ( 3 ) 142 - 147 2010.05

Lead author, Last author, Corresponding author, Accepted, ISSN 0914-5508

著者らは未破裂脳動脈瘤患者に対する意思決定支援システム:u-SHAREおよび治療方針を説明したDVDを試作した。今回、u-SHAREの有用性を検討するために、病院毎にクラスター割付けでu-SHAREを使用して説明するとともにDVDを視聴した33例(介入群)とu-SHARE非使用でDVDのみ視聴した17例(非介入群)に分け、比較した。その結果、1)日本版DCS尺度の得点は両群とも介入後に改善する傾向にあったが、両群間で有意差はなかった。2)ユーザビリティ評価に関しては医師の評価と患者の評価に乖離がみられた。また、医師のu-SHAREへのユーザビリティ評価は高く、特に治療方針の理解、状況によって治療法が変わる可能性の理解、意思決定に影響する重要な条件の理解、診察時間において、u-SHAREの活用が有用であることが示唆された。尚、これらの医師の評価に反して、患者は介入群よりも非介入群で高いユーザビリティ評価をする傾向が強かった。3)DVDに関しては、DVD視聴が意思決定に有用であるとした患者が大半を占めており、医師からの説明に加えて用いるべきツール形態の1つであると思われた。

臨床薬剤師を対象とした臨床研究への関心度とその教育学的解析

渡部一宏, 横山葉子, 佐藤恵子, 竹上未紗, 関根祐子, 網岡克雄, 大西良浩, 福原俊一

医療薬学 ((一社)日本医療薬学会) 36 ( 4 ) 277 - 283 2010.04

Lead author, Last author, Corresponding author, Accepted, ISSN 1346-342X

臨床薬剤師の臨床研究への関心や臨床研究者養成のための具体的な教育ニーズを把握することを目的としてアンケートを行った。調査依頼者240例中、有効回答数は204例であった。所属・勤務先は、病院薬剤部・薬局が67.2%、保険調剤薬局23.5%、その他9.3%であった。臨床研究に関心がある理由は、「日常業務の疑問・問題の解決のため」が58.8%と最も多く、「研究したいテーマがある」が38.7%、「医療の進歩に貢献したい」が23.5%などであった。臨床研究に関わる際どのような立場を希望しているのかの質問に対し、「研究参加者の一人として参加を希望する」が43.1%と最も多かった。臨床研究に関する知識・スキルの全項目において大部分の回答者は重要と考えていた。臨床研究に関する知識・スキルのうち、「臨床研究を行うにあたっての倫理的配慮ができる」以外の項目において大部分の回答者は達成できていないと考えていた。

臨床研究および臨床研究者養成のための教育への病院上層部の関心　病院特性による比較

横山葉子, 三品浩基, 松村理司, 郡義明, 名郷直樹, 渡部一宏, 福原俊一

医学教育 ((一社)日本医学教育学会) 40 ( 5 ) 333 - 340 2009.10

Lead author, Last author, Corresponding author, Accepted, ISSN 0386-9644

臨床研究に対する臨床医の関心は高いことが先行研究から明らかにされているが、わが国の臨床医学分野における臨床研究は基礎医学分野に比べると立ち遅れており、臨床研究実施に伴う障害を明らかにすることが急務である。1)病院上層部を対象に、臨床研究実施に対する関心や障害、臨床研究者養成のための教育に対するニーズを明らかにすることを目的とし郵送調査を行った。2)臨床研修病院810施設に対して、質問票を郵送し調査を行った。有効回答数は、301(37.2%)であった。3)臨床研究実施への関心は、大学病院・ナショナルセンター(以下NCとする)の方がそれ以外の病院より高い傾向にあった。4)大学病院・NCの上層部60.6%、それ以外の上層部18.8%が臨床研究を専門にする医師を雇用する必要があると回答した。公的な研究費から雇用するリサーチ・レジデントの場合、いずれも約50%が雇用したいと回答した。5)臨床研究実施の障害となっている時間・人手・専門家の不足に対する方策は十分に立てられていない可能性が示唆された。今後、臨床研究実施の障害を解消する具体的な方策を推進する必要がある。(著者抄録)

Dialysis staff encouragement and fluid control adherence in patients on hemodialysis.

Yokoyama Y, Suzukamo Y, Hotta O, Yamazaki S, Kawaguchi T, Hasegawa T, Chiba S, Moriya T, Abe E, Sasaki S, Haga M, Fukuhara S

Nephrology nursing journal : journal of the American Nephrology Nurses' Association 36 ( 3 ) 289 - 97 2009.05

Lead author, Last author, Corresponding author, Accepted, ISSN 1526-744X

臨床医を対象とした臨床研究への関心および教育のあり方についての調査　中堅臨床医の臨床研究への関心は高いか?

三品浩基, 横山葉子, 川上浩司, 福原俊一

医学教育 ((一社)日本医学教育学会) 40 ( 2 ) 105 - 112 2009.04

Lead author, Last author, Corresponding author, Accepted, ISSN 0386-9644

【背景】わが国の臨床研究者の不足は深刻であり、臨床研究を実施できる臨床医の育成は医学教育の重要課題である。臨床研究基盤整備を目的とした臨床研究者養成のための教育が始められつつあるが、臨床研究の中心的役割を担うべき臨床医の臨床研究実施への関心度および教育へのニーズはこれまで明らかにされていない。1)臨床研究の実施および教育に対する臨床医の関心度を調査することを目的とし、インターネット上での横断的アンケート調査を行った。2)30歳以上45歳未満の臨床医2176人に調査依頼メールを送付し310人(回答割合14.6%)より回答を得た。回答者のうち臨床研究実施に関心をもつ臨床医は85%、教育の受講希望者は78%であった。3)教育は臨床研修修了後に教育セミナーや研修の受講生として受講したいとの意見が多く、ある程度の臨床経験を得た後、臨床医の仕事を中断することなく学べる教育環境が望まれている。4)学位(博士)取得希望者に教育の受講希望が多い(90%)傾向であったが、学位取得に興味がない医師の受講希望も76%と多く、また既に学位がある医師の受講希望も74%と多かった。5)臨床研究の教育は大学院教育を軸に、学位取得希望が無い臨床医にも教育プログラムが柔軟に提供される教育システムが臨床医にとって望ましいと考える。(著者抄録)

Impact of early referral to nephrologist on mental health among hemodialysis patients: a Dialysis Outcomes and Practice Patterns Study (DOPPS).

Yokoyama Y, Yamazaki S, Hasegawa T, Wakita T, Hayashino Y, Takegami M, Akiba T, Akizawa T, Asano Y, Saito A, Kurokawa K, Fukuhara S

Nephron. Clinical practice 113 ( 3 ) c191 - 7 2009

Lead author, Last author, Corresponding author, Accepted, ISSN 1660-8151

Access to Document (DOI)

Shared Decision Making成立の促進要因　小児アトピー性皮膚炎患児の親の事例から

横山葉子

保健医療社会学論集 (日本保健医療社会学会) 19 ( 1 ) 38 - 50 2008.08

ISSN 1343-0203

近年増加しているといわれる小児アトピー性皮膚炎(Atopic Dermatitis:AD)は治療法が複数存在し、専門家の間でも治療法に対して複数の意見が存在している。そのため、実際に治療選択を行う患児の親が、治療選択に迷うような状況にある。英国における研究では、AD患児の親は医師と患児の親双方が治療選択に関わるShared Decision Making(SDM)を希望しているが、実際の治療選択では患児の親が単独で治療選択に関わっている傾向にあるという。そしてこの希望と実際の乖離の要因のひとつとして、医師からの特定の内容の情報提供が不足していることが指摘されてきた。本研究では、特定の内容の情報提供以外にSDM成立の促進要因があるかを検討した。その結果、患児の親のステロイド忌避はSDM成立の阻害要因のひとつとなっているが、個別の経過に応じた情報提供がSDM成立の促進要因となりうることが示唆された。(著者抄録)

未破裂脳動脈瘤患者に対するDVD意思決定サポートツールの有効性評価(Examination of the Effectiveness of DVD Decision Support Tools for Patients With Unruptured Cerebral Aneurysms)

Nozaki Kazuhiko, Okubo Chie, Yokoyama Yoko, Morita Akio, Akamatsu Rie, Nakayama Takeo, Fukuhara Shun-ichi, Hashimoto Nobuo

Neurologia medico-chirurgica ((一社)日本脳神経外科学会) 47 ( 12 ) 531 - 536 2007.12

Lead author, Last author, Corresponding author, Accepted, ISSN 0470-8105

未破裂脳動脈瘤患者47名(平均63.8±10.2歳)を対象に、未破裂脳動脈瘤の診断および治療に関するマルチメディアDVDをみせ、患者の意思決定に及ぼす影響を評価した。アンケート調査を行った結果、平均知識スコアはDVD視聴前8.72/15点、視聴後12.4点、3ヵ月後10.34点であった。治療法に関する知識もDVD視聴後に増加した。DVD視聴前の治療決定に満足した患者は63.2%であったが、視聴後の意思決定に満足したものは69.6%であった。全ての患者がマルチメディアイメージの使用により治療選択が理解しやすくなり、詳細な情報を得た上での決断がしやすくなったと回答した。DVDは未破裂脳動脈瘤患者の意思決定サポートツールとして有用であり、患者の知識を効果的に増加させた。

Examination of the effectiveness of DVD decision support tools for patients with unruptured cerebral aneurysms.

Nozaki K, Okubo C, Yokoyama Y, Morita A, Akamatsu R, Nakayama T, Fukuhara S, Hashimoto N

Neurologia medico-chirurgica 47 ( 12 ) 531 - 6; discussion 536 2007.12

Lead author, Last author, Corresponding author, Accepted, ISSN 0470-8105

Access to Document (DOI)

MPCポリマー加工肌着・ペバックス繊維肌着が小児アトピー性皮膚炎の症状・生理指標に及ぼす影響についての検討

横山葉子, 木俣肇, 御手洗幸子, 平野昌一, 矢野詩織, 三谷元宏, 山口公一, 白川太郎

日本小児アレルギー学会誌 ((一社)日本小児アレルギー学会) 21 ( 5 ) 657 - 668 2007.12

ISSN 0914-2649

[目的]MPC(2-メタクリロイルオキシエチルホスホリルコリン)ポリマー加工をした生体適合性を持つ肌着と汗処理・透湿性・吸湿性に優れるペバックス繊維肌着が小児アトピー性皮膚炎(AD)の症状・生理指標に及ぼす影響について検討した。[方法]53名の小児AD患者をMPC群(19名)、ペバックス群(17名)、レギュラー群(17名)に割り付けた4週間の二重マスク化ランダム化比較試験を行い、ADの重症度(SCORAD)、角質水分量・水分蒸散量、成長ホルモン、コルチゾール、s-IgAの測定を行った。[結果]AD重症度は、ペバックス群(p=0.008)・レギュラー群(p=0.003)で統計学的に有意な改善がみられ、MPC群でも改善の傾向がみられた。さらに、成長ホルモンはMPC群でレギュラー群と比較して有意な増加が認められた(p=0.009)。角質水分量はペバックス繊維肌着の小児ADに対する長期着用の安全性が得られたと考えられた。また、肌着の繊維の違いが生理指標に影響を与える可能性が示唆された。(著者抄録)

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