{"created":"2021-12-10T04:07:29.234673+00:00","id":2000145,"links":{},"metadata":{"_buckets":{"deposit":"8c5c6519-517d-44d9-8225-2f04197d2cdb"},"_deposit":{"id":"2000145","owners":[1],"pid":{"revision_id":0,"type":"depid","value":"2000145"},"status":"published"},"_oai":{"id":"oai:niigata-u.repo.nii.ac.jp:02000145","sets":["453:456","471:537:538:1639104999452"]},"author_link":[],"item_1627361970403":{"attribute_name":"出版タイプ","attribute_value_mlt":[{"subitem_version_resource":"http://purl.org/coar/version/c_970fb48d4fbd8a85","subitem_version_type":"VoR"}]},"item_7_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2020-06","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"6","bibliographicPageEnd":"191","bibliographicPageStart":"187","bibliographicVolumeNumber":"134","bibliographic_titles":[{"bibliographic_title":"新潟医学会雑誌","bibliographic_titleLang":"ja"}]}]},"item_7_description_4":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"Background: concerning the adult cases those are alive without assistance by others in activities of daily living (ADL) and seem to be relatively juvenile, healthy, the causes of sudden death of them are mainly induced by cerebrovascular diseases including brain and heart. This phenomena often happens in winter rather than in summer. It is possible to due to the rapid change of the blood pressure (rising) especially in winter. On other hand, it is considered that the bed-ridden patients in the terminal stage those complicated chronic and prolonged states of multi-organ failure (MOF) due to senile decay, cerbrovascular diseases, pneumonia die of the of other mechanism. The pattern of these patients is one as if they may go down a slope slowly deteriorating with synergistic effects of several systemic complications. Purpose: In order to investigate when those bed-ridden patients in the terminal stage die of these chronic disorders seasonally at Nagaoka city in Niigata prefecture. Then, we would tried to perform intensive care of those patients at that season. Results: The mortality rate of the bed-ridden patients in the terminal stage was most high in January (in winter) at Nagaoka city. In conclusion: recently, the heating system including the gas stove and the airtight in general houses surprisingly developed compared with the initial decades of the last century. Then, Kitajima et al designated the rate of mortality in winter versus that in summer. In the area of seaside of Japan sea in Hokkaido, Touhoku, Hokuriku area, this rate was high in the first half in the 20^<th> century, but it decreased in the middle century. They designated this phenomena as the slack of seasonal changing of the mortality rate. It is suggested that the heating system and the airtight in general houses cause this phenomena. Regardless of these development, no decrease of mortality rate of the bed-ridden patients in the terminal stage was not identified in Nagaoka city Niigata prefecture, especially at our hospital. We speculated that the high mortality rate of those patients is associated with the location of Nagaoka city is in inland compared with Niigata city which is located in the seaside in the Niigata prefecture. The low rate of mortality in Niigata city is considered to be due to the little temperature difference because the sea decrease the difference. Since Nagaoka is located in inland, it is difficult to be influenced by sea.","subitem_description_language":"en","subitem_description_type":"Abstract"},{"subitem_description":"背景：比較的若い健常者の突然死による死亡率は，冬季に多く，夏季に少ない．そして，その原因は，心疾患および脳血管疾患が主体となり，悪性新生物の死亡率に季節的変動は見られないという．これに対し，慢性化した心疾患，脳血管疾患，肺炎，老衰による多臓器不全などの疾患を合併し，終日臥床の著しく進行した認知症症例(以下，終末期症例)も，季節的変動に伴い，高い死亡率を示す時期があると推測した．目的：上記推測に従い，新潟県長岡市において，終末期患者は，終末期において，四季の内，一体，何時，死亡しやすいのかの検討を行い，その死亡時期を見極めることである．そこで，その時期を見極め，死亡率を低下させるべく，集学的治療(肺炎における喀痰の十分な吸引，強力な抗生剤による化学療法など)を行うことである．対象と方法：具体的には，1993年1月から2011年10月まで，特定医療法人楽山会三島病院にて入院，加療，死亡に至った1,423症例である．年齢は，45歳から，107歳まで(平均83.87±6.29歳)男性567名，女性856名であり，対象症例の死因となる全身的合併症は，種々の認知症を基礎疾患とし，心疾患，脳血管疾患，肺炎，老衰など多岐にわたるが，これらの疾患単独に罹患している症例ならびに複数の疾患を合併している症例であり，疾患ごとの明確な区分はできなかった．結果：健常者と同様に，終末期患者も，一年の内でも最も寒冷な厳冬期である1月に，突出して高い死亡率(167例)を示した．結論：当院における終日臥床の終末期患者は，高齢である場合が多く，また，慢性疾患として，心疾患，脳血管疾患，肺炎(常在菌が原因となる日和見感染を含む)および老衰に伴う多臓器不全を呈している場合が多く，これら合併疾患が原因となり，厳冬期の1月に死亡し易い事がわかった．近年，北島が，冬季に夏季の何倍の死亡数があるのかを，「死亡数の冬夏季比」と定義しており，男女とも，北海道，東北地方の日本海側から北陸地方にかけて，この比が20世紀前半には，大きかったが，同世紀半ばからは，小さくなったとは報告している(冬季の死亡者数が減少し，夏季に近づいた)．これを死亡率の季節的変動の緩慢化している．これらの地域を含む寒冷地域の冬季の死亡率が減少したのは，種々の暖房器具の普及と家屋の気密性の向上であると考えられる．しかし，我々の新潟県長岡市における検討結果は，冬夏比の縮小には該当せず，現在も，冬季には，依然として終末期患者の冬季死亡率が高い．これは，新潟県長岡市と比較し，沿岸部に位置するこれらの地方では，海に近接しているために，冬夏季の寒暖差が，緩和されるものと考えられる．冬季，特に寒冷なな新潟県長岡地区においては，沿岸にある冬夏季比の小さいことが想定される新潟市などと比べ，夏の猛暑と冬の高度な寒冷，豪雪等による寒暖差の激しい特有な気候を無視することはできないと考えられた．","subitem_description_language":"ja","subitem_description_type":"Abstract"}]},"item_7_publisher_7":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"新潟医学会","subitem_publisher_language":"ja"}]},"item_7_source_id_11":{"attribute_name":"書誌レコードID","attribute_value_mlt":[{"subitem_source_identifier":"AN00182415","subitem_source_identifier_type":"NCID"}]},"item_7_source_id_9":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"0029-0440","subitem_source_identifier_type":"PISSN"}]},"item_access_right":{"attribute_name":"アクセス権","attribute_value_mlt":[{"subitem_access_right":"open access","subitem_access_right_uri":"http://purl.org/coar/access_right/c_abf2"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"今井, 邦英","creatorNameLang":"ja"},{"creatorName":"Imai, Kunihide","creatorNameLang":"en"}]},{"creatorNames":[{"creatorName":"田中, 弘","creatorNameLang":"ja"},{"creatorName":"Tanaka, Koh","creatorNameLang":"en"}]},{"creatorNames":[{"creatorName":"田中, 政春","creatorNameLang":"ja"},{"creatorName":"Tanaka, Masaharu","creatorNameLang":"en"}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_access","date":[{"dateType":"Available","dateValue":"2021-12-10"}],"displaytype":"detail","filename":"134(6)_187-191.pdf","filesize":[{"value":"3.57MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"objectType":"fulltext","url":"https://niigata-u.repo.nii.ac.jp/record/2000145/files/134(6)_187-191.pdf"},"version_id":"536691ae-7539-4414-8989-0b6353a2c970"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"終末期患者","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"死亡率","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"季節的変動","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"死亡時期集中の緩慢化","subitem_subject_language":"ja","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"departmental bulletin paper","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"新潟県長岡市における終日臥床．高度認知症患者の終末期における死亡時期の季節的変動の検討","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"新潟県長岡市における終日臥床．高度認知症患者の終末期における死亡時期の季節的変動の検討","subitem_title_language":"ja"},{"subitem_title":"Investigation of the Seasonal Changing of the Mortality Rate of the Bed-ridden Patients in the Terminal Stage in Nagaoka City","subitem_title_language":"en"}]},"item_type_id":"7","owner":"1","path":["456","1639104999452"],"pubdate":{"attribute_name":"PubDate","attribute_value":"2021-12-10"},"publish_date":"2021-12-10","publish_status":"0","recid":"2000145","relation_version_is_last":true,"title":["新潟県長岡市における終日臥床．高度認知症患者の終末期における死亡時期の季節的変動の検討"],"weko_creator_id":"1","weko_shared_id":-1},"updated":"2022-12-15T04:35:35.640788+00:00"}