付記する学位プログラム名: グローバル生存学大学院連携プログラム / 京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第22151号 / 社医博第99号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 古川 壽亮, 教授 森田 智視, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Although there is a strong body of existing literature on early parental loss, the majority of research is devoted to examining the consequences of parental death in childhood. Less is known about the long-term impact of this early loss. In particular, there is a lack of understanding about what it is like to live with early parental loss in young adulthood. This hermeneutic phenomenological study addresses the question: What is the young adult’s experience of living with early parental loss? An in-depth exploration into the lived meaning of early parental loss was conducted through open-ended interviews with 8 young men and women (20-30 years old) who lost a mother or father in childhood (between the ages of 9-18 years old). Interview data was coded and analyzed using van Manen’s (2014) hermeneutic phenomenological method, including the process of guided existential inquiry. The fundamental existential themes of lived body, lived time, lived space, and lived other were used as a guide to thematic representation of data. Ten identified themes characterize the essential qualities of this phenomenon: (1) The Grief Experience, (2) The Parentless Identity, (3) Body Awareness, (4) The Transition, (5) The Unexpected Visitor, (6) The New World, (7) The Empty Space, (8) Navigating Relationships in New Ways, (9) Continuing Bonds, and (10) The Relationship With Loss. Through rich experiential descriptions, presented findings demonstrate that the early death of a parent has an ‘ever after’ impact and significantly influences many facets of life in young adulthood. Implications for clinical practice and directions for future research are discussed. / Graduate / 2018-10-02

The purpose of this study was to describe and explain participants’ perceptions of Tampa Bay Area Writing Project (TBAWP) influence on professional learning over time. This study explored Writing Project impact on professional learning by accessing the oral histories of three educators who were involved in TBAWP between 1998 and 2004. The research question was: • In what ways, if any, has long-term involvement in the Tampa Bay Area Writing Project impacted the teaching practice, career growth, and professional learning of participating educators? This qualitative study employed constructivism as the theoretical framework. Analysis of study data resulted in specific findings. Educators’ stories revealed Writing Project participation significantly impacted their teaching practice, career growth, and professional learning. The lasting impact of Writing Project involvement was seen in the ways in which educators infused the concept of community into their teaching practice, accepted leadership positions within the profession, and ultimately went on to conduct professional learning experiences for educators. Data analysis generated a conceptual model that examines the lasting impact of educator professional learning. Implications of this finding are significant for longitudinal inquiry of educator professional learning and for impact studies of long-term Writing Project involvement. In addition to providing exemplars of educator stories of practice over time, the study contributed to development of a fuller understanding of effective professional development, educator professional learning, and the lasting impact of Writing Project involvement.

疤痕效應(Scarring Effect)所指的當一個人的就業歷程出現失業，失業將會對往後的就業歷程產生長期性的影響，且影響的範圍相當廣，包含收入、就業狀況、身心健康等等。然而，在所有年齡層中，青年是最容易失業且待在勞動市場中時間最長的群體。 　　本研究將在疤痕效應的理論基礎上探討：台灣青年在失業後是否會影響終生的就業歷程、造成長期性工作貧窮的現象。本研究試著從青年找不到適得其所的工作時，其實際工作狀況和生活來理解失業的成因及長期性影響。 　　本研究採取多元方法的研究設計，透過「人力運用擬-追蹤調查資料庫」以及「華人家庭動態資料庫」比較15-29歲有失業經驗的青年及無失業經驗青年，往後薪資及就業狀況，觀察失業的短期性及長期性的影響。並以深度訪談的方式，訪談七位不同背景且在15-29歲期間有3個月以上失業經驗的受訪者，透過訪談青年失業理解連續性脈絡，藉此理解疤痕效應的成因及疤痕效應造成影響的詳細情形。 　　實證結果發現不論觀察期長短，有失業經驗的青年的收入漲幅普遍會低於沒有失業經驗的青年，失業確實會對收入水準造成長期影響。就業情形的差異上，有失業經驗青年陷入再度失業的機率普偏高於無失業經驗青年陷入失業的機率。 　　訪談結果發現疤痕效應的原因有(一)工作經驗不足，無法進入職場；(二)雇主對過短工作經驗的負面評價；(三)人力資本難以積累；(四)社會關係封閉，難以向外得到援助；(五)工作經驗的中斷。 　　本研究透過疤痕效應的理論，指出失業對青年所造成的長期性影響。藉由實證數據及訪談結果，深入理解青年失業所造成的長期性影響及成因，作為解決青年失業問題及工作貧窮上的政策參考。 / The “Scarring Effect” means the unemployment of a person's career path, which will have a long-term impact on the future career path, and have the influence of a wide range, including income, employment status, physical and mental health and so on. However, youth have the highest unemployment rate in all ages and have the longest time in the labor market. 　　This study will explore the theory of scarring effect: whether unemployment will affect Taiwanese youth’s lifetime career path after unemployment, resulting in long-term poverty. This study tries to understand the causes and long-term effects of unemployment from the time when youth find jobs that are not suitable for them. 　　This study is based on a multimethod research approach to compare youth from 15 to 29 years old with unemployed experience and young people with no unemployment experience. Through "Manpower Utilization Quasi-longitudinal Survey" and the “Panel Study of Family Dynamics" in subsequent earnings and employment status, we observe the short-term and long-term effects of unemployment. And through deep-interviews with seven different backgrounds and those who had more than three months of unemployment experience during the 15-29 year old period, we understand the continuity of unemployment, the causes of scar effects and the details of the impact. 　　The empirical results show that regardless of the length of the observation period, the income growth of youth with unemployed experience is generally lower than which of those without unemployed experience. Unemployment will indeed have a long-term impact on income levels. The difference in employment status, the re-unemployment rate of the youth with unemployment experience is higher than which of youth without unemployment experience. 　　The results of interviews finds that the cause of scarring effects are contributed to (1)Lack of working experiences to get work. (2)Employer have negative impression on short working experience.(3)The difficulty of accumulating human capital.(4) Closed social relationships, which is difficult to get assistance from others. (5)Interruption of work experience. 　　This study, through the theory of scarring, points out the long-term effects of unemployment on youth. Through empirical data and interviews, we will understand the long-term impact and causes of youth unemployment as a policy reference to solve the problem of youth unemployment and working poverty.

Current research studies on the success of peer-based outreach programs for adolescent suicide prevention are inconclusive (Mann et al. 2005; Gould et al. 2003). Fewer still have measured the feelings and experiences of the peers who are responsible for reaching out to suicidal friends within such a program. This exploratory research study examines the experiences and perspectives of past participants of an adolescent peer-based outreach program, Hope4Utah. Findings from this mixed-method study of Hope4Utah support that peer-outreach suicide prevention programs have far-reaching benefits, on both the participants and their surrounding communities, which extend into adulthood. Themes that emerged from analysis of interviews are consistent with literature on school communities, adolescent alienation, stigma reduction, compassion fatigue, and formation of social roles and mental health beliefs through the social interactionist framework. Finally, this paper explores promising avenues for future research.

Les oxydants infusés avec la nutrition parentéral (NP) néonatale induisent une modification du métabolisme des lipides et du glucose, donnant lieu à l’âge adulte à un phénotype de carence énergétique (faible poids, baisse de l’activité physique). L’hypothèse qu’une diète précoce riche en glucose prévient ces symptômes plus tard dans la vie, fut évalué chez le cobaye par un ANOVA en plan factoriel complet à deux facteurs (p < 0:05) : NP du jour 3 à 7, suivit d’une nourriture régulière (chow) (NP+) vs. chow à partir du 3ième jour (NP-), combiné avec une eau de consommation enrichie en glucose (G+) ou non (G-) à partir de la 3ième semaine. Les paramètres suivant ont été mesurés à l’âge de 9 semaine: taux de croissance, activité physique, activité de phosphofructokinase-1 et glucokinase (GK), niveau hépatique de glucose-6-phosphate (G6P), glycogène, pyruvate et potentiel redox du glutathion, poids du foie, glycémie, tolérance au glucose, concentrations hépatiques et plasmatiques en triacylglycérides (TG) et cholestérol. Le groupe G+ (vs. G-) avait un taux de croissance plus bas, une activité de GK et une concentration en G6P plus élevée, et un potentiel redox plus bas (moins oxydé). Le niveau plasmatique de TG était moins élevé dans le groupe NP+ (vs. NP-). Les traitements n’eurent aucun effet sur les autres paramètres. Ces résultats suggèrent qu’indépendamment de la NP, une alimentation riche en glucose stimule la glycolyse et déplace l’état redox vers un statut plus réduit, mais ne surmonte pas les effets de la NP sur le phénotype physique de carence énergétique. / Neonatal exposure to oxidant molecules from total parenteral nutrition (TPN) alters future lipid and glucose metabolism, resulting in an energy deficient phenotype characterized by lower body weight and physical activity. Using a guinea-pig model, the hypothesis that early diet supplementation with glucose could overcome such symptoms at week 9 of age was tested in a two-factor full-factorial ANOVA design (p<0:05): TPN day 3-7, chow thereafter (TPN+) vs: chow from day 3 (TPN-), combined with glucose-enriched diet from week 3 (G+) vs: plain chow throughout (G-). The growth rate, physical activity, phosphofructose kinase-1 and glucose kinase (GK) activities, glucose-6-phosphate (G6P), glycogen and pyruvate concentrations, relative liver weight, fasting blood glucose, glucose tolerance, hepatic and plasma triacylglyceride and cholesterol levels, individual glutathione levels and GSH/GSSG-based redox potential were determined at 9 weeks. Glucose supplementation (vs: the lack thereof) resulted in a lower growth rate, higher GK activity, and higher G6P concentration at week 9. Plasma triacylglycerides at week 9 were lower in TPN+ (vs: TPN-) subjects. Hepatic GSH=GSSG-derived redox potential shifted to a more reduced state in G+ (vs: G-) subjects. No other parameters showed significant differences. Independently of TPN, an early glucose-rich diet stimulated the glycolysis pathway, shifted the redox potential towards a more reduced status ; however, it did not overcome the effects of TPN on future physical and metabolic phenotype.

Les oxydants infusés avec la nutrition parentéral (NP) néonatale induisent une modification du métabolisme des lipides et du glucose, donnant lieu à l’âge adulte à un phénotype de carence énergétique (faible poids, baisse de l’activité physique). L’hypothèse qu’une diète précoce riche en glucose prévient ces symptômes plus tard dans la vie, fut évalué chez le cobaye par un ANOVA en plan factoriel complet à deux facteurs (p < 0:05) : NP du jour 3 à 7, suivit d’une nourriture régulière (chow) (NP+) vs. chow à partir du 3ième jour (NP-), combiné avec une eau de consommation enrichie en glucose (G+) ou non (G-) à partir de la 3ième semaine. Les paramètres suivant ont été mesurés à l’âge de 9 semaine: taux de croissance, activité physique, activité de phosphofructokinase-1 et glucokinase (GK), niveau hépatique de glucose-6-phosphate (G6P), glycogène, pyruvate et potentiel redox du glutathion, poids du foie, glycémie, tolérance au glucose, concentrations hépatiques et plasmatiques en triacylglycérides (TG) et cholestérol. Le groupe G+ (vs. G-) avait un taux de croissance plus bas, une activité de GK et une concentration en G6P plus élevée, et un potentiel redox plus bas (moins oxydé). Le niveau plasmatique de TG était moins élevé dans le groupe NP+ (vs. NP-). Les traitements n’eurent aucun effet sur les autres paramètres. Ces résultats suggèrent qu’indépendamment de la NP, une alimentation riche en glucose stimule la glycolyse et déplace l’état redox vers un statut plus réduit, mais ne surmonte pas les effets de la NP sur le phénotype physique de carence énergétique. / Neonatal exposure to oxidant molecules from total parenteral nutrition (TPN) alters future lipid and glucose metabolism, resulting in an energy deficient phenotype characterized by lower body weight and physical activity. Using a guinea-pig model, the hypothesis that early diet supplementation with glucose could overcome such symptoms at week 9 of age was tested in a two-factor full-factorial ANOVA design (p<0:05): TPN day 3-7, chow thereafter (TPN+) vs: chow from day 3 (TPN-), combined with glucose-enriched diet from week 3 (G+) vs: plain chow throughout (G-). The growth rate, physical activity, phosphofructose kinase-1 and glucose kinase (GK) activities, glucose-6-phosphate (G6P), glycogen and pyruvate concentrations, relative liver weight, fasting blood glucose, glucose tolerance, hepatic and plasma triacylglyceride and cholesterol levels, individual glutathione levels and GSH/GSSG-based redox potential were determined at 9 weeks. Glucose supplementation (vs: the lack thereof) resulted in a lower growth rate, higher GK activity, and higher G6P concentration at week 9. Plasma triacylglycerides at week 9 were lower in TPN+ (vs: TPN-) subjects. Hepatic GSH=GSSG-derived redox potential shifted to a more reduced state in G+ (vs: G-) subjects. No other parameters showed significant differences. Independently of TPN, an early glucose-rich diet stimulated the glycolysis pathway, shifted the redox potential towards a more reduced status ; however, it did not overcome the effects of TPN on future physical and metabolic phenotype.