京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第21962号 / 社医博第93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 中山 健夫, 教授 川上 浩司 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Philosophiae Doctor - PhD / This thesis is concerned with the definition of an inclusive democratic educational theory and practice which mediates the assumed tension between individualism and collectivism, difference and equality, and liberty and equality. In Part 1, I set out the elements of an inclusive theory of democracy and then proceed in Part 2 to examine various aspects of educational practice in the light of this. My main claim is that these assumed tensions can be mediated through the conceptualising of our composite identity in terms of the notion of dual social ontology. This refers to our two-fold identities as universal, common human beings and our multiple subjective positions as particular, different individuating beings. Together, these two aspects of our identity constitute the basis for conceptualising our simultaneous commonality and difference and for an inclusive notion of democracy. I argue further that the key to understanding the intersection of commonality and difference in social relations and institutional practices is the concept of the spheres of social relations and their constitutive meanings. The latter provide the criterion by which we can judge the appropriateness of difference or equality in that sphere or in practices which relate to it. In the light of these concepts, I trace the ideological contestation at the heart of democratic theory between liberalism and socialism. My claim is that the mutual limitations of these theories preclude constructing an inclusive theory of democracy which incorporates collective equality and individual liberty in a non-polarised way. I argue that the tension between individualism and collectivism can be mediated by analysing these cluster concepts into non-polarised simpler elements. My main contention is that only self-interested individualism, which assumes individuals as atomistic self-seekers, is necessarily in conceptual conflict with collectivism. The other two elements of individualism which I identify, namely, individuality, our universal common identity as bearers of rights, and individuation, the process of self-development through the expression of the unique difference, are shown to be compatible with collective concerns and the social view of human identity. Together, I suggest, individuality and individuation constitute our dual social ontology and the foundation for moral regard and an inclusive theory of democracy which accommodates difference and commonality. During the discussion, I draw from several theorists who provide inclusive frameworks in terms of the social, dialogical view of human nature and identity formation and who combine contemporary concerns for pluralism and critical social transformation. I examine the conceptual link between education and democracy through the educative notion of democracy and education for democracy. Critical educational theory is explored as an exemplar of an inclusive democratic educational practice incorporating individual and collective dimensions. The dynamics of commonality and difference are traced in key aspects of the educational process, namely, moral development, learning and the relationship between authority and freedom, and with regard to the democratisation of schooling, the appropriate boundary between the spheres of education and of politics, distributive justice in education and the curriculum. I argue throughout that the discursive tool of dual social ontology, along with the concept of the spheres of social relations and their constitutive meanings, provides the conceptual framework by which these tensions can be mediated and incorporated in an inclusive democratic educational theory and practice.

Background Measuring pain in infants is important but challenging for researchers and health care professionals. The measurement of skin conductance (SC) is considered as a measure of stress and a surrogate indicator of pain. Purpose This dissertation provides insight on the validity of SC for pain measurement in infants and consists of two studies: 1) a scoping review synthesizing the methods and findings of previous studies on validating or using SC for measuring pain in infants; 2) a primary study evaluating the validity of SC for measuring pain in mechanically ventilated infants. Methods Arksey and O’Malley’s framework informed the methods of the scoping review. Nine electronic databases were searched. Data were analyzed and presented descriptively. The primary study used a prospective cross-sectional observational design. Eligible infants were those up to 12 months of age, hospitalized in intensive care units, who were mechanically ventilated, and required painful and non-painful procedures. Results Scoping review: Twenty-eight studies with 1061 infants were included, including 23 cross-sectional observation studies and five interventional studies. The validity evidence of SC was tested in relation to referent pain measures (13 variables), stimuli (13 variables), age (2 variables) and other contextual variables (11 variables). Fifteen studies evaluated the validity evidence in relation to phase of painful procedure, and SC increased significantly during painful procedures in most studies (n=14/15). However, inconsistent findings on other validity evidence and wide variation in methods existed across studies. Primary study: SC showed good validity in relation to the category of procedure, the phase of procedure and the referent pain measures in critically ill mechanically ventilated infants. The findings from diagnostic test accuracy showed that SC had good capacity of detecting moderate to severe pain. However, the values of SC need to be used with caution, due to the imperfect correlations with the referent pain measures and imperfect positive predictive value. Conclusions SC is a promising approach to measuring pain in critically ill infants. Further research testing the validity of SC in relation to pain treatments and advancing the technology of measuring and analyzing SC is needed before it can be recommended for clinical use.

Background: The care for patients with mental disorders have changed and this has led to higher demands on nurses. Research is conducted globally within the subject and studies have shown that nurses enquire more theoretical knowledge and practical training. In the Gambia, nursing education is conducted by five different schools and the country has one psychiatric hospital. Purpose: To explore nurses’ experiences and challenges while caring for patients with mental disorders in the Gambia. Method: The study was conducted using a quantitative cross-sectional design. Result: The result showed that the respondents enquire more education, that the work is challenging and that the majority of respondents have experience of working with patients with mental disorders. Conclusions:  There is a need for internal education for nurses on their workplaces and more research within the subject.

This research exercise aimed to replicate use of the instrument (“Vygotsky’s Blocks”) of Vygotsky and Sakharov (1928-1934) in combination with the 22 wooden blocks and the later adaptations and scoring framework of Hanfmann and Kasanin (1937; 1942). This procedure – the functional method of double stimulation – examined new concept formation from early childhood to adulthood (N=60 subjects, aged three- to 76-years-old) to establish whether contemporary adults and children produced the same or similar patterns as those described by Vygotsky (1986). The study found a developmental trend consistent with Vygotsky’s (1986) writings on the ontogenesis of concept formation. The path from the syncretic, to the concrete and factual, to the intermediate phase before true conceptual thought becomes possible was reflected in a positive correlation between the age of the subjects and their modes of thinking. This verified Vygotsky’s assertion that true conceptual thinking only becomes possible in adolescence. This study aimed to encourage further research with this procedure to confirm the trends found by this study and to validate the adapted scoring method of Hanfmann and Kasanin (1942) for the purposes of cross-sectional use.

Research on the Advanced Placement (AP) program generally shows that students scoring 4s and 5s on AP exams outperform their non-AP peers in subsequent college courses. However, faculty often advise students with AP credit to repeat prerequisite courses in college before attempting advanced coursework, and there are few studies that provide empirical evidence about outcomes related to the use of AP credit. I compared grades of 26,843 students in 34 STEM courses using two-level cross-sectional multilevel modeling and found that students with AP credit in biology, calculus, chemistry, or physics significantly outperformed non-AP students after controlling for high school GPA and SAT Math scores, whether they used their AP credit to fulfill course pre-requisites or not. Additionally, I investigated outcomes of 10,152 students who had earned AP credit for course pre-requisites, depending on whether or not they chose to use their AP credit or repeat it at the college level prior to taking subsequent courses. I found that contextual factors, such as the specific target course and the student’s home college, were highly influential in determining the propensity to use AP credit. Measures of prior academic achievement also influenced the propensity to use AP credit, but most demographic factors did not. After applying propensity weights, I found no causal effect of using AP credit on subsequent course grades. The use of two-level cross-sectional multilevel modeling showed that the effect of using AP credit on subsequent course grades varied significantly across courses. The results of this study show that students who use AP credit to move directly into subsequent college STEM courses do not earn lower grades in those courses as a result of their decision to use AP credit.

In this study, we examined subgroups of adolescents based on their levels of psychopathic traits and ADHD symptoms. Participants were 982 adolescents from a community sample, with a mean age of 14.28 (SD= .94) years. We used youths’ self-reports of psychopathic traits and their legal guardians’ reports of the adolescent’s ADHD symptoms to identify distinct subgroups of youths. We identified four groups that varied in levels of psychopathic traits and ADHD by using the Hierarchical clustering analysis. One group was characterized by high levels of psychopathic traits and high levels of ADHD (high combination group). The subgroups differed significantly from each other in several theoretically meaningful ways. The high combination group reported higher levels of psychopathic traits, impulsivity and hyperactivity, as well as higher levels on external variables such as aggression, delinquency and violence compared to the other subgroups. The high combination group also differed in terms of anxiety levels from the subgroup with high psychopathic traits only. These findings are in line with previous research and confirms that the construct of psychopathy is heterogenous. We identified an especially vulnerable subgroup that resembles the characteristics of the secondary psychopath.

The block periodization training paradigm has been shown to produce enhanced gains in strength and power. The purpose of this study is to assess resistance training induced alterations in lean body mass and cross-sectional area using a block periodization training model among individuals (n = 15) of three differing strength levels (high, moderate and low) based on one repetition maximum back squat relative to body weight. A 3 × 5 mixed-design ANOVA was used to examine within-and between-subject changes in cross-sectional area (CSA), lean body mass (LBM), lean body mass adjusted (LBMadjusted) and total body water (TBW) over an 11-week resistance training program. LBMadjusted is total body water subtracted from lean body mass. The ANOVA revealed no statistically significant between-group differences in any independent variable (p > 0.05). Within-group effects showed statistically significant increases in cross-sectional area (p < 0.001), lean body mass (p < 0.001), lean body mass adjusted (p < 0.001) and total body water (p < 0.001) from baseline to post intervention: CSA: 32.7 cm2 ± 8.6; 36.3 cm2 ± 7.2, LBM: 68.0 kg ± 9.5; 70.6 kg ± 9.4, LBMadjusted: 20.4 kg ± 3.1; 21.0 kg ± 3.3 and TBW: 49.8 kg ± 6.9; 51.7 kg ± 6.9. In conclusion, the results of this study suggest subjects experienced an increase in both lean body mass and total body water, regardless of strength level, over the course of the 11-week block periodized program. Gains in lean body mass and cross-sectional area may be due to edema at the early onset of training.

Background: Inflammation is proposed to play a role in the development of Alzheimer's disease, and may also be involved in the pathogenesis of mild cognitive impairment (MCI). This study examined the association of inflammatory markers in serum or plasma with prevalent MCI and MCI subtypes in a population-based sample. Methods: Olmsted County, MN, residents aged 70-89 years on October 1, 2004, were evaluated using the Clinical Dementia Rating Scale, a neurological evaluation, and neuropsychological testing. Information ascertained for each participant was reviewed by an expert panel of neuropsychologists, physicians, and nurses, and a diagnosis of normal cognition, MCI, or dementia was made by consensus. C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis alpha (TNFα), and adiponectin were measured at baseline. Results: Among 313 subjects with MCI and 1570 cognitively normal subjects, a CRP level in the upper quartile (>3.3 mg/L) was significantly associated with MCI (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.00-2.01) and with nonamnestic MCI (OR, 2.05; 95% CI, 1.12-3.78) after adjusting for age, sex, and years of education. However, there was no association with amnestic MCI (OR, 1.21; 95% CI, 0.81-1.82). No association was observed with the other inflammatory markers. Conclusions: Plasma CRP is associated with prevalent MCI and with nonamnestic MCI in elderly, nondemented persons in a population-based setting. These findings suggest the involvement of inflammation in the pathogenesis of MCI.

Desired performance-related characteristics for entry-level managers are studied from the perspective of 106 Portuguese executives. The results indicate that soft characteristics and skills, such us leadership, entrepreneurship and organisational learning skills, appear to be more important than technical skills. While these skills and characteristics are valued by today's business organisations, the educational system does not appear to be preparing its graduates accordingly. The resulting educational gaps have important performance-related implications to both the business organisations and the higher education institutions.