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京都大学 / 新制・課程博士 / 博士(医学) / 甲第23795号 / 医博第4841号 / 新制||医||1058(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 石見 拓, 教授 湊谷 謙司, 教授 山本 洋介 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

The purpose of this study was to investigate time commitment, self-efficacy and social environment as it relates to physical activity in a selected sample of hypertensive African Americans. In addition, this study focused on identifying additional research areas in regards to hypertensive African Americans. This study utilized a quantitative method for data collection. The survey instrument utilized contained the following subtopics: (1) demographics;(2)hypertension risk factors;(3) prevention and treatment;(4)hypertension knowledge, and (5)physical activity participation. Data collected did not support the hypotheses or information contained in the review of literature. It was revealed from data collection that 69% of the respondents (n=90) disagreed with the survey statement that "exercise takes too much of my time (time commitment)." Fifty-two percent of the respondents (n=68) either disagreed or strongly disagreed with the statement "exercise tires me (self-efficacy belief)." Forty-three percent of the respondents (n=56) disagreed with the statement "my spouse (or significant other) does not encourage exercise." There is a need for future investigation to examine how additional barriers to physical effect activity African Americans individually, and is there a culmination of specific barriers to physical activity that work in conjunction to inhibit African Americans to engage in physical activity. / Ph. D.

Yes / The most commonly reported symptom of hyperthyroidism is weight loss; successful treatment increases weight. Weight gain faced by patients with hyperthyroidism is widely considered a simple reaccumulation of premorbid weight, whereas many patients feel there is a significant weight “overshoot” attributable to the treatment. We aimed to establish if weight gain seen following treatment for hyperthyroidism represents replenishment of premorbid weight or “overshoot” beyond expected regain and, if there is excessive weight gain, whether this is associated with the applied treatment modality. Methods: We calculated the risk of becoming obese (body mass index [BMI] >30 kg/m2) following treatment for hyperthyroidism by comparing BMI of 1373 patients with overt hyperthyroidism seen in a secondary care setting with the age- and sex-matched population (Health Survey for England, 2007–2009). Next, we investigated the effect of treatment with an antithyroid drug (ATD) alone in regard to ATD with radioactive iodine (131I) therapy. We modeled the longitudinal weight data in relation to the treatment pathway to thyroid function and the need for long-term thyroxine replacement. Results: During treatment of hyperthyroidism, men gained 8.0 kg (standard deviation ±7.5) and women 5.5 kg (±6.8). At discharge, there was a significantly increased risk of obesity in male (odds ratio = 1.7 [95% confidence interval 1.3–2.2], p < 0.001) and female (1.3, 1.2–1.5, p < 0.001) patients with hyperthyroidism compared with the population. Treatment with 131I was associated with additional weight gain (0.6 kg, 0.4–0.8, p < 0.001), compared with ATD treatment alone. More weight gain was seen if serum thyrotropin (TSH) was markedly increased (TSH >10 mIU/L; 0.5 kg, 0.3–0.7, p < 0.001) or free thyroxine (fT4) was reduced (fT4 ≤ 10 pmol/L (0.8 ng/dL); 0.3 kg, 0.1–0.4, p < 0.001) during follow-up. Initiation of levothyroxine was associated with further weight gain (0.4 kg, 0.2–0.6, p < 0.001) and the predicted excess weight gain in 131I-induced hypothyroidism was 1.8 kg. Conclusions: Treatment for hyperthyroidism is associated with significant risks of becoming obese. 131I treatment and subsequent development of hypothyroidism were associated with small but significant amounts of excess weight gain compared with ATD alone. We advocate that the discussion over the weight “overshoot” risk forms part of the individualized treatment decision-making process.

Obesity is associated with structural and functional alterations in brain areas that are often functionally distinct and anatomically distant. This suggests that obesity is associated with differences in functional connectivity of regions distributed across the brain. However, studies addressing whole brain functional connectivity in obesity remain scarce. Here, we compared voxel-wise degree centrality and eigenvector centrality between participants with obesity (n=20) and normal-weight controls (n=21). We analyzed resting state and task-related fMRI data acquired from the same individuals. Relative to normal-weight controls, participants with obesity exhibited reduced degree centrality in the right middle frontal gyrus in the resting-state condition. During the task fMRI condition, obese participants exhibited less degree centrality in the left middle frontal gyrus and the lateral occipital cortex along with reduced eigenvector centrality in the lateral occipital cortex and occipital pole. Our results highlight the central role of the middle frontal gyrus in the pathophysiology of obesity, a structure involved in several brain circuits signaling attention, executive functions and motor functions. Additionally, our analysis suggests the existence of task-dependent reduced centrality in occipital areas; regions with a role in perceptual processes and that are profoundly modulated by attention.

Similarities and differences between obesity and addiction are a prominent topic of ongoing research. We conducted an activation likelihood estimation meta-analysis on 87 studies in order to map the functional magnetic resonance imaging (fMRI) response to reward in participants with obesity, substance addiction and non-substance (or behavioural) addiction, and to identify commonalities and differences between them. Our study confirms the existence of alterations during reward processing in obesity, non-substance addiction and substance addiction. Specifically, participants with obesity or with addictions differed from controls in several brain regions including prefrontal areas, subcortical structures and sensory areas. Additionally, participants with obesity and substance addictions exhibited similar blood-oxygen-level-dependent fMRI hyperactivity in the amygdala and striatum when processing either general rewarding stimuli or the problematic stimuli (food and drug-related stimuli, respectively). We propose that these similarities may be associated with an enhanced focus on reward – especially with regard to food or drug-related stimuli – in obesity and substance addiction. Ultimately, this enhancement of reward processes may facilitate the presence of compulsive-like behaviour in some individuals or under some specific circumstances. We hope that increasing knowledge about the neurobehavioural correlates of obesity and addictions will lead to practical strategies that target the high prevalence of these central public health challenges.

Low cholesterol concentrations and cholesterol-lowering therapies have been suggested to be associated with increased suicidality. This article examined the association of cholesterol, triglycerides, and body-mass index (BMI) with suicidal ideation and suicide attempts. Findings are based on a nationally representative community sample of n = 4,181 subjects (18–65 years) examined with a standardized diagnostic interview (CIDI) for (DSM-IV) mental disorders. Controlling for age and gender the study revealed a moderate positive association between cholesterol, triglycerides, BMI, and suicide attempts in subjects with depressive symptoms during the past 12 months (n = 1,205). The results of this study are compatible with two recent epidemiological cohort studies showing a positive association between cholesterol and completed suicide.

Bakgrund: Sömnens påverkan på viktkontroll har större betydelse än vad forskarna tidigare trott. God sömn innebär återhämtning av livsnödvändiga funktioner och är en grund för god hälsa. Studier visar att människor sover mindre idag jämfört med tidigare. Sömnens påverkan på viktkontrollen behöver lyftas fram i sjuksköterskans hälsopreventiva arbete för att främja hälsa. Syfte: Att belysa sömnens relevans för viktkontroll hos medelålders vuxna. Metod: En allmän litteraturstudie gjordes där elva kvantitativa vetenskapliga artiklar ligger till grund för resultatet. Resultat: Kort sömnlängd ger ökad sannolikhet för fetma vilket kan ge rubbad hormonbalans med förändrad aptitreglering och viktökning som följd. Osammanhängande sömn är förenat med högre body mass index och ökad risk för fetma. Mest gynnsam sömnlängd för optimal viktkontroll är sju till åtta timmar. Slutsats: Fler studier behövs för att förstå sambandet mellan sömn och viktkontroll. Kvalitativa studier där patienternas upplevelser belyses är önskvärda. Sjuksköterskan har en viktig roll i att försöka skapa ett bra möte och samtal om sömnens betydelse för viktkontroll. Ett förtroendefullt samtal där öppenhet och lyhördhet är grundpelare. Under samtalet kan sjuksköterskan inta en stödjande och rådgivande roll där ett gemensamt beslut kan resultera i en förståelse för sambandet mellan sömn och viktkontroll. / Background: The effects of sleep on weight control is more important than researchers previously believed. Good sleep means recovery of essential life functions and is a foundation for good health. Studies show that less time is spent sleeping today than before. Therefore the importance of sleep needs to be raised in the health preventive work of the nurse to promote health. Aim: To illuminate the relevance of sleep in weight control in middle-aged adults. Method: A literature review was done where eleven quantitative scholarly articles form the foundation for the result. Result: Short sleep duration will lead to an increased likelihood of obesity which can lead to disorder in the hormone balance with changed appetite regulation and an increase in body weight as a result. Fragmented sleep is related to increased body mass index and a higher risk of obesity. The most favourable sleep duration for optimal weight control is seven to eight hours. Conclusion: More studies are needed to understand the relationship between sleep and weight control. Qualitative studies where the patients ́ own experiences are illuminated. The nurse has an important role to create a good meeting and a dialogue where openness and sensitivity are essential pillars. The nurse can take a supportive and advisory role, where a common decision can result in an understanding in the association between sleep and weight control.

Diese Dissertation befasst sich mit den möglichen Folgen einer Kolonisation mit Helicobacter pylori (H. pylori) im Kindesalter. Von besonderem Interesse ist dabei die Entwicklung des Body-Mass-Index (BMI). Dazu werden die Daten einer populationsbezogenen Querschnittsstudie, welche 1998 und 2006 unter Leipziger Schulanfängern bzw. Achtklässlern durchgeführt wurde, analysiert. Insgesamt konnten 1349 bzw. 1161 Kinder, deren H. pylori-Status mittels 13C‑Harnstoff-Atemtest untersucht wurde, in die Untersuchung inkludiert werden. Dabei bestätigte sich, dass die Besiedlung mit H. pylori u.a. signifikant mit einem geringeren sozialen Status und einer geringeren Körpergröße der Kinder assoziiert ist. Der BMI der untersuchten Kinder unterscheidet sich jedoch nicht signifikant in Abhängigkeit von einer Kolonisation mit H. pylori. Auf diesen Ergebnissen basierend werden zwei Hypothesen diskutiert. Zum einen wird analysiert, inwieweit ein Einfluss einer Infektion mit dem Erreger auf den BMI der Kinder nicht sicher auszuschließen ist und dieser eventuell aufgrund der Komplexität der Gewichtsentwicklung in den Ergebnissen dieser Untersuchung nicht erkennbar ist. Zum anderen wird die geringere Körpergröße H. pylori‑besiedelter Kinder nicht auf mit der Infektion in Verbindung stehende Ernährungsstörungen in Zusammenhang gebracht, da sonst vor einer entscheidenden Größenminderung das Gewicht bzw. der BMI der Studienteilnehmer zurück bleiben müsste.

Introduktion Övervikt och fetma är ett växande folkhälsoproblem i stora delar av världen, problemet kryper dessutom allt längre ner i åldrarna. Övervikt hos barn ger en betydligt ökad risk att som vuxen drabbas av tillstånd som diabetes, hjärt- och kärlsjukdomar, vissa cancersjukdomar samt en ökad risk att dö i förtid. Syfte Syftet med studien var att undersöka om det föreligger skillnader i kroppssammansättning, energiomsättning, substratutnyttjande och insulinkänslighet mellan könen hos barn med övervikt och fetma i åldrarna 10-13 år, samt om det fanns några skillnader inom könen utifrån kategorisering efter BMI för övervikt (25-29,9) respektive fetma (≥30).   Metod Datainsamlingen skedde genom inhämtning av resultat från mätningar av kroppssammansättning, energiomsättning, substratutnyttjande och insulinkänslighet utförda på ett universitetsjukhus i Mellansverige under åren 2008-2014. Resultatet hämtades från 26 flickor och 29 pojkar med övervikt och fetma i åldrarna 10-13 år.   Resultat Det förelåg ingen signifikant skillnad avseende något av mätvärdena mellan könen. Det kunde dock ses en signifikant skillnad avseende insulinkänslighet mellan de med övervikt och fetma hos båda könen, hos pojkarna fanns det även en signifikant skillnad i energiomsättning (p=&lt;0,05). Det kunde ses att flickorna var mindre insulinkänsliga än pojkarna, även de med fetma var mindre känsliga för insulin än de med övervikt i respektive könsgrupp.   Slutsats Studien visade att det förelåg större skillnader avseende mätvärdena utifrån kategorisering i BMI inom respektive kön än mellan könen. Det kunde påvisas en signifikant skillnad mellan de med övervikt och fetma gällande flera resultat, med hänsyn till urvalets storlek krävs dock fler och större studier för att uppnå generaliserbarhet. / Introduction Overweight and obesity is a growing public health problem in many parts of the world. More concerningly, children are getting increasingly affected by this problem. Childhood obesity results in a significantly higher risk of developing conditions such as diabetes, cardiovascular disease and certain cancers later in life. It also increases the risk of dying prematurely.   Objective The aim of this study was to examine sex characteristics in body composition, energy metabolism, substrate utilization and insulin sensitivity in children (10-13 years) with overweight and obesity, and differences within each sex based on categorization of BMI for overweight (25-29,9) and obesity (≥30).   Method 26 girls and 29 boys (10-13 years) were included in the study. Data was collected from medical records of previous tests measuring body composition, energy metabolism and substrate utilization and insulin sensitivity conducted in a university hospital in central Sweden during the years 2008-2014.   Results There were no significant differences in any of the measured values between the sexes. There was a significant difference in energy metabolism between the boys with overweight and obesity, as well as insulin sensitivity between the groups in both sexes (p=&lt;0,05). The girls were less insulin sensitive than the boys. Those with BMI overweight were less sensitive to insulin than those with obesity within in each sex.   Conclusion The study showed more pronounced differences regarding categorization by BMI within each sex than between the sexes. There were several significant differences between those with overweight and obesity, however, with consideration to the limited sample size more research is required to achieve generalizability.