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戦後沖縄文学から読む｢混血児｣表象
Get PDF本博士論文では、これまで、戦後沖縄文学の歴史において繰り返し描かれながらも、テーマとして深く問われることがなかった｢混血児｣表象を論述の対象に研究を行った。序章では、戦後沖縄文学研究における｢混血児｣をめぐる論考と、近年における歴史学や社会学、映像研究などの分野で蓄積がなされている｢混血児｣をめぐる日本・沖縄の研究や記録、文献の整理を行うとともに、本論の方向性との差異について論じた。｢混血児｣｢当事者｣の声を拾い上げようとすることに傾きがちな言論や研究を踏まえつつ、本論では、語られる中で現れてくる｢混血児｣について論述を行うことを目的とすることを述べた。｢混血児｣は、新聞、雑誌、メディア、いかなる場所でも、まず語られる中で登場したからである。語られ方を問うという意味において、そして、文学作品でどのように描かれるのかを読み解くという方法において、本研究は表象研究である。第一章では、1940 年末～1950 年代を分析対象時期に定め、新聞を中心に、｢混血児｣に関する記事を参照しつつ新聞連載小説に現われる｢混血児｣の描かれ方について論じた。第二章では、1950 年代において、米軍との関係に基づいてのみ｢混血児｣が対象化されていく言論によって、戦中における日本軍によるアジアの占領によって生まれた｢混血児｣への言論や問いが後景化していく動きについて、『琉球労働』に掲載された作品を読み解き、批判的に論述を加えた。第三章では、｢復帰｣前後の時期に、｢混血児｣を描く作品が数多く発表されたことについて、批判的に考察を加えるとともに、長堂英吉の『帰りなんいざ』という作品を分析し、｢復帰｣思想を｢混血児｣に関わる言論から問い直した。第四章では、教公二法阻止闘争を記録的に描いた小説、霜多正次『明けもどろ』を分析し、｢混血児｣表象と、｢黒人｣表象について論じた。第五章では、利根川裕『喜屋武マリーの青春』を分析し、｢混血児｣という呼称が｢ハーフ｣へと変容していく際に生じる表象の力学について明らかにした。博士（学術）琉球大
エネルギー安全保障とレジリエンス強化を目指すニジェールの都市部および遠隔地における持続可能なマイクログリッド設計のための最適化と戦略的運用
No full textNiger's energy sector faces critical challenges due to its heavy reliance on electricity imports, particularly from Nigeria. Political tensions and supply disruptions have led to frequent power shortages, increasing dependence on costly and polluting diesel generators (DGs). These energy deficiencies highlight the urgent need for a sustainable and self-sufficient power system. This study develops an optimal microgrid planning framework to enhance energy security, improve system reliability, and ensure economic feasibility in both urban and remote areas of Niger. Using Mixed ·Integer Linear Programming (MILP) and the Transient Search Algorithm (TSA), this thesis evaluates renewable-based microgrid configurations, integrating photovoltaic (PV) panels, wind turbines (WT), battery energy storage systems (BESS), hydrogen energy storage systems (HESS), and DGs. The study explores the trade-offs between cost, reliability, and sustainability to determine the most efficient and resilient energy solutions under different operating conditions. For Niamey, two microgrid configurations are analyzed: PV-BESS and PV-BESS·DG. The results indicate that the PV-BESS·DG system is the most cost-effective, reducing the total life cycle cost (TLCC) by 17.395% compared to the PV·BESS·only system. It achieves a levelized cost of electricity (LCOE) of 0.069/kWh for the fully renewable system. While integrating DGs enhances reliability and reduces costs, it increases carbon emissions, making it less sustainable in the long term. A HESS-based system improves energy resilience but raises costs by 41.3% due to the additional investment in electrolyzers, storage tanks, and fuel cells. A hybrid BESS-HESS system further strengthens,reliability but results in an extra 3.2% cost compared to HESS-only setups and a 45.8% increase compared to the PV-BESS system. Three microgrid configurations are examined for remote Sahara desert areas: PV-BESS, PV·BESS-DG, and a grid-assisted PV·BESS-DG system. The grid-assisted setup in scenario 2 achieves the lowest TLCC, but its implementation is challenging due to site remoteness and infrastructure limitations. Instead, the PV·BESS-DG system emerges as the most viable option, reducing TLCC by 11.19% compared to a standalone PV· BESS system and 5.664% compared to the grid-assisted system in scenario 1. This configuration balances cost efficiency, reliability, and energy independence, making it suitable for off-grid areas. This study provides a comprehensive techno·economic analysis of microgrid feasibility, offering valuable insights for policymakers, energy planners, and stakeholders. By optimizing microgrid configurations, this thesis contributes to enhancing energy security, minimizing costs, and reducing reliance on fossil fuels. The findings support Niger's transition toward a sustainable, resilient, and self· sufficient energy future, ensuring long·term energy stability amid regional uncertainties and evolving energy demands.博士（工学）琉球大学University of the Ryukyu
ヘラートとカンダハールの旧市街地の構成の比較
Get PDFAfghanistan, situated at the crossroads of Central and South Asia, spans approximately 652,860square kilometers with a population of around 40.5 million. Its prominent cities---:-Kabul, Kandahar,and Herat— are known for their rich historical and cultural legacies. The urban structures of thesecities reflect their historical, cultural, and socio-political evolution. This research compares Heratand Kandahar Old City 's urban structures, focusing on dalans, water supply, and drainage systems.
Herat, an industrial and cultural hub, had 59 dalans identified via aerial imagery in 2016,reflecting a sharp decline over recent decades. The number of dalans in Herat decreased by 27%from 1977-78 to 2005-06 and 54% between 2005-06 and 2019-20. Of the remaining dalans, 16require immediate repairs. Meanwhile, Kandahar, a city with critical historical importance, saw asignificant increase in dalan construction, rising from 26 in 1966 to 121 by 2023. These newerdalans, though often located on dead-end streets, overlap with historical areas (northwest quarter)containing houses over 150 years old, raising concerns about preservation. The total length of dalansin Kandahar (1,118 meters) surpasses Herat's (829 meters), contributing to a more enclosed, compacturban space where the dalans are shorter and narrower.
This study also examines Herat's water supply and drainage systems. The historical water supplynetwork, branching from the Enjil Canal, was essential in providing water to critical public facilities.At the same time, the drainage system, though less well-documented, relied on a natural slope tomanage rainwater and wastewater. Since 2005, with the support of AKTC and the Herat Municipality,modem drainage systems have replaced the traditional ditches, transforming old urban spaces intomore structured areas, such as plazas.
Kandahar's increasing number of dalans contrasts with Herat's decline, but both cities facechallenges in preserving their architectural heritage amidst modernization. The findings emphasizethe need for integrated conservation strategies that balance urban development with protectinghistorical and cultural landmarks.博士（工学）琉球大学University of the Ryukyu
沖縄県小学生を対象とした早朝スポット尿バイオマーカーと体格指数(BMI)の関連性解析と食生活の評価
Get PDFChildhood obesity is rapidly increasing worldwide and is largely the consequence of adoption of unhealthy diets excessive in calories and salt (NaCl) as well as devoid in pivotal micronutrients such as potassium (K) and magnesium (Mg). Educationbased programs aiming to encourage healthy food knowledge and behaviors are crucial at a young age, and for this purpose, convenient ways to assess daily dietary intake are warranted. We therefore attempted to evaluate the dietary intake of Okinawan schoolchildren in Japan by analyzing a series of biomarkers in morning spot urine samples and explore whether these biomarkers correlate with body weight and a series of metabolic parameters. We enrolled 98 third-grade elementary schoolchildren in Okinawa, Japan. Morning spot urine samples were collected and analyzed using high-performance liquid chromatography (HPLC) to assess dietary intake. We found that estimated daily NaCl intake was higher in obese/overweight children as compared to healthy-weight children (p = 0.0001). There was also a significant positive correlation between body mass index (BMI) and NaCl intake (Spearman) (ρ = 0.45, p < 0.0001) and a negative correlation between BMI and Mg/ Cr (ρ = −0.27, p = 0.01). Furthermore, Na/K ratio was higher in samples collected on Monday (weekend) as compared to samples collected on Thursday or Friday (weekday) (p < 0.0001).
Conclusion: Via the use of morning spot urine analyses, our results show that NaCl intake was associated with obesity, and Mg excretion negatively correlated with BMI in Japanese schoolchildren, highlighting the potential role of these micronutrients in maintaining a healthy body weight.博士（医学）琉球大学University of the Ryukyu
TAKl結合タンパク質2(TAB2)およびTAB3はマクロファージにおいてTLRを介して誘導されるサイトカイン産生に重複して必要である
Get PDFTransforming growth factor-β-activated kinase 1 (TAK1) plays a pivotal role in innate and adaptive immunity. TAK1 is essential for the activation of mitogen-activated protein kinases (MAPKs) and nuclear factor (NF)-κB pathways downstream of diverse immune receptors, including toll-like receptors (TLRs). Upon stimulation with TLR ligands, TAK1 is activated via recruitment to the lysine 63-linked polyubiquitin chain through TAK1-binding protein 2 (TAB2) and TAB3. However, the physiological importance of TAB2 and TAB3 in macrophages is still controversial. A previous study has shown that mouse bone marrow-derived macrophages (BMDMs) isolated from mice double deficient for TAB2 and TAB3 produced tumor necrosis factor (TNF)-α and interleukin (IL)-6 to the similar levels as control wild-type BMDMs in response to TLR ligands such as lipopolysaccharide (LPS) or Pam3CSK4, indicating that TAB2 and TAB3 are dispensable for TLR signaling. In this study, we revisited the role of TAB2 and TAB3 using an improved mouse model. We observed a significant impairment in the production of pro-inflammatory cytokines and chemokine in LPS- or Pam3CSK4-treated BMDMs deficient for both TAB2 and TAB3. Double deficiency of TAB2 and TAB3 resulted in the decreased activation of NF-κB and MAPK pathways as well as the slight decrease in TAK1 activation in response to LPS or Pam3CSK4. Notably, the TLR-mediated expression of inhibitor of NF-κB (IκB)ζ was severely compromised at the protein and messenger RNA (mRNA) levels in the TAB2/TAB3 double-deficient BMDMs, thereby impeding IL-6 production. Our results suggest that TAB2 and TAB3 play a redundant and indispensable role in the TLR signaling pathway.博士（医学）琉球大学University of the Ryukyu
南西太平洋における顕著気象の解析と予測
Get PDF1. Introduction
The Southwestern Pacific (SWP) region consists mainly of small Island nations including the neighbouring continent of Australia. The islands are isolated with some low-lying geographical settings making the region extremely vulnerable to high-impact weather events such as intense tropical cyclones (TCs) and heavy rainfall. The high impacts of extreme winds, storm surges, large waves and related coastal hazards, and heavy rainfall (flooding and landslides) associated with intense TCs, and other heavy rainfall events have tremendously affected the human lives, social infrastructures, and economic activities in the SWP. In terms of disaster prevention and mitigation, the understanding and prediction of those events are critically important. Although many works have been conducted, there remain many topics that have not been resolved or addressed associated with TCs and rainfalls. Two of such topics are the statistical. characteristics of rapidly intensifying tropical cyclones (RI-TCs) around the SWP region and the prediction skill of rainfalls over small island nations with a high-resolution model. These topics have never been investigated according to our knowledge.
Therefore, the main objectives of this study are (1) to examine the distribution and
annual changes in RI-TC activity over the 37 years from 1986 to 2022 and (2) to
investigate the characteristics of RI-TCs associated with the large-scale environmental
parameters that influence RI, including both atmospheric and oceanic features. (3) To
assess the performance of rainfall prediction by conducting numerical experiments with
the current Solomon Islands Meteorological Services (SIMS) operational model with 15
km mesh and (4) to discuss the advantages of a high-resolution model (1.875 km mesh)
under the assumption that more computational resources would become available in the
future.
2. Analysis of Tropical Cyclone Rapid Intensification in the Southwest Pacific Region
The high-impact weather events associated with RI of TCs have been investigated. The characteristics of Rls in the SWP region were investigated in 3 7 years from 1986 to 2022. The statistical analysis of RI-TCs around the SWP region have never been investigated according to the authors knowledge. We used the SPEArTC best track data which is a six hourly dataset from 1986 to 2022. We examined the distribution and annual changes in RI-TC activity. Secondly, we investigated the characteristics of RI-TCs associated with large-scale environmental parameters that influence RI including both atmospheric and oceanic ones.
Among 364 TCs, 82 rapidly intensifying TCs (RI-TCs) were defined as TCs that experienced maximum wind speed increase of 3 0 kt (15.4 m s-1) or more in a 24-h period. RI-TCs are frequently observed over the zonally elongated area around Coral Sea, south of Solomon Islands (Solomon Sea), Vanuatu, Fiji, Tuvalu, Tokelau and Samoa, while RITCs were rarely observed in areas of Tasman Sea, Tonga, northern waters of New Zealand, Cook Islands, Niue and French Polynesia. RI-TCs'preferentially occur during the southern hemisphere summer season. The frequency of RI-TC occurrence shows a slowly increasing trend over the 37-year period, which was not statistically significant at the 95% confidence level. In El Nifio years, TCs tend to undergo RI more frequently presumably due to the average genesis to the further north where SST and ocean heat content were high. In contrast, RI-TCs occurred less frequently during La Nifia years. The RI onset typically occurs 0-42 h after TC genesis with a peak frequency observed just after genesis (0-6 h). The RI duration is usually 1-2 days with a peak at 24 hours. The mean lifetime of RI-TCs lifetime was 7.86 days, longer than that of non-rapidly intensifying TCs (NR-TCs) (3.72 days). In terms of average intensity, RI-TCs have significantly lower lifetime central pressure and higher lifetime maximum wind speed than NR-TCs. RI-TCs tend to develop into more severe TCs as a result of formation in environments favourable for TC development such as weak vertical wind shear, deep moist layer, high sea surface temperature and tropical cyclone heat potential.
3. Evaluation of rainfall prediction in the vicinity of Solomon Islands with a high-resolution non-hydrostatic model
The SWP region often encounters extreme climatic events including intense rainfall events. This chapter aimed at evaluating the forecast skill of rainfall around SI in the SWP region. Meteorological authorities in many developing countries refer precipitation predictions from a global model operated by a major centre in developed countries. However, such authorities in the developing countries can benefit from running a regional model simulation optimized for their countries. This study evaluates the prediction skill of rainfall predictions by the SIMS operational model with a grid spacing of 1 S km, Sil 5, based on 219 cases of 36-h forecasts initialized from every five day during 2017-2019. We also conducted runs with a grid spacing of 1.875 km, SIOl, expecting the future availability of numerical resources. The skill was compared with the forecasts of the global spectral model (GSM) operated by Japan Meteorological Agency (JMA), using rain gauge data and satellite-based data. The results indicated that the forecasts by SI15 and SIOl exhibited better performance than the GSM in terms of bias score and threat score, while the forecast skill of SIOl was the best. Additionally, SIOl successfully reproduce the diurnal variation in which precipitation become strong over land in the evening and eastern side of Solomon Islands over the sea in the early morning. There are notable biases detected in Sil 5 in that they have weak bias around the initial time and strong bias after the forecast time of 18 hours.
4. Discussion
We also investigated the dependency of RI-TCs on the El Niiio Southern Oscillation (ENSO) phases and MJO phases as well as similarity and differences with other basins. Also, we analysed the six manned stations in-situ daily rainfall measurements from OOUTC to OOUTC by rain gauges over 3 7 years from 1986 to 2022. Generally speaking, the rainfall in many stations has been increasing, while Taro station did not.
5. Conclusion
Firstly, this study statistically investigates the characteristics ofTCs undergoing RI in the SWP and relevant environmental parameters over 3 7 years from 1986 to 2022. Among the 364 TCs investigated, 82 TCs satisfied the criteria of a maximum wind speed increase of 30 kt or more in a 24-hour period. The results of this chapter are meaningful because the general characteristics of RI-TCs around the SWP region were described for the first time and were proved to be consistent with global-scale and/or other basin-scale features.
Secondly, this study aimed at evaluating the prediction skill of heavy rainfall with a 15-km mesh model and a 1.875-km mesh model, compared with a coarse resolution global model. Generally speaking, the forecast skill becomes better with a finer resolution model. Although much work is needed in the future, this research serves as a first step to ensure the benefits and limitations of employing the current SIMS operational model in comparison with a global model, leading to better daily life, water resource management, and disaster prevention in the Solomon Islands. The study also suggests that the use of a fine-mesh model could further enhance the accuracy of these forecasts.
Further analysis of the dependencies on the ENSO and MJO yielded more insight of RI-TCs. Also, additional work on the long-term trend of rainfall observed by rain gauges exhibited the increasing behavior over the last 3 7 years. They underlined the importance of natural variability as well as the climate change.
The results of the present study are meaningful because it contributes to the understanding and prediction of high-impact weather around the SWP region, which consists mainly of small Island nations including the neighbouring continent of Australia. They can pose imminent impacts on the region and its local communities through helping mitigate and prevent disasters.博士（理学）琉球大学University of the Ryukyu
インドネシア、ママサ・トラジャの伝統的集落と家屋の変容
Get PDFThis research project examines the transformation of traditional settlements andhouses in the Indonesian regions of Mamasa and Tana Toraja, with a particular focuson the historical and architectural evolution of the Orobua settlement. The studyaddresses the lack of scientific research on Mamasa's architectural heritage, whichremains comparatively understudied relative to the extensively researched Tana Toraja.
A combination of field surveys, Geographic Information Systems (GIS) mapping,radiocarbon dating, and interviews is utilized to analyze the spatial organization,cultural practices, and construction techniques of these settlements over time.
The findings reveal that the spatial compositions of these settlements are deeplyinfluenced by cultural values and environmental adaptations. Tana Toraja settlementsexhibit structured, linear layouts centered around communal plazas, whereas Mamasasettlements display more organic, curvilinear arrangements that adapt to themountainous terrain. Radiocarbon dating results further underscore the historicalsignificance of the Orobua site, confirming that some traditional houses date back tothe 17th century. The analysis also highlights how modernization has led to significantchanges in construction materials and techniques. While modern elements such ascement and steel are increasingly integrated into. traditional houses, traditionalcraftsmanship continues to thrive in certain areas.
The research is structured in a way that allows for a comprehensive analysis of thefindings, beginning with a comparative exploration of settlement compositions inMamasa and Tana Toraja. It then proceeds to examine the historical development ofthe Orobua settlement, present the results of radiocarbon dating, and undertake astudy of the changing techniques used in its construction. By integrating previousstudies and these elements, the dissertation enhances the understanding of Mamasa'sarchitectural evolution, exploring the interplay between modernization, culturalidentity, and heritage conservation. Each chapter builds upon the preceding one,combining historical, cultural, and environmental perspectives to present a nuancedview of the transformation process.
This study contributes to a broader understanding of how modernization affectstraditional architecture while preserving cultural identity. It advocates for sustainableconservation efforts that balance heritage preservation with modernization, ensuringthe continuation of traditional building practices and the protection of these livinghistorical landscapes.博士（工学）琉球大学University of the Ryukyu
Digitalization of Proprioception for Enhancing Education and Support in Rehabilitation
No full textSociety 5.0 は、医療や介護分野にも大きな変革をもたらすことが期待されている。特にリハビリテーションにおいては、従来の対面型治療及び教育に加え、ウェアラプルデバイスや人工知能、拡張現実技術を活用により、生体情報の取得や解析が高度化し、物理的制約を超えた柔軟で安全な支援環境が整いつつある。
リハビリテーションは、身体の適切な機能水準の回復を目指し、小児から高齢者までの広範な対象に対して医療、予防、健康増進、スポーツ、地域活動など多領域で展開されている。その実践において、感覚的な技能、特に関節や筋肉、腱周囲の受容器から得られる固有感覚は、身体の姿勢、運動、力加減などの調整に不可欠であり、日常生活動作の遂行や身体活動の質に深く関与している。これは、患者支援のみならず、理学療法士、作業療法士、言語聴覚士などの職種における技術習得や教育支援においても重要な指標となる。
しかし、リハビリテーション分野においてリアルタイムでの固有感覚のデジタル化、コンピュータヘの固有感覚情報の入力、国有感覚情報の可視化および分析、さらにはVirtualReality空間内への展開によるリハビリテーションの実戦的な展開は未だ限定的である。そのため、固有感覚のデジタル化と分析手法の確立は、現代のリハビリテーション教育における重要な課題の一つとして挙げられている。
本論文では、体表に装着した筋変位センサを用いて固有感覚情報を取得し、そのデジタル化手法、ならびにコンピュータヘの情報入力、可視化および分析手法の構築を目的とする。さらに、取得した固有感覚の時系列データを機械学習で分類し、技術レベルの客観的指標構築を目指す。また、熟練者の教示データを基にした初学者への学習支援アプリケーションの開発を目指す。加えて、これらの固有感覚のデジタル化手法と分析手法を、Virtual Reality空間において固有感覚情報を入力および提示技術を開発し、没入的な体験を提供することで、技能教育への応用可能性を探る。さらに応用として言語聴覚士教育における囃下練習支援やスポーツ領域を含めた他分野にも応用し、リハビリテーション職種横断的な教育支援基盤の実現可能性を示す。
本論文の成果として、リハビリテーションに関連する固有感覚情報のデジタル化や分析の体系化により、質の高い技術指導および技術伝承にも寄与する教育的支援手法の提案が可能となる。今後は、患者を含む多様な対象や分野において固有感覚情報の収集を進め、アルゴリズムの比較検証、推定手法の確立、ならびにデータベースの構築を図る。また、Virtual Reality空間内でリアルタイム性の高い固有感覚の入出力技術を開発し、場所や時間に依存しない個別性の高いリハビリテーションプログラムの提供を目指す。博士（工学）琉球大学University of the Ryukyu
アスリートの足関節前方インピンジメントにおける骨棘の形態と軟骨病変との関連：横断的研究
Get PDFBackground: The present study aimed to describe the frequency and severity of tram-track lesions in anterior ankle impingement in athletes and to evaluate the association between osteophyte morphology and severity of tram-track lesions, the distinctive cartilage lesions associated with tibial osteophytes in anterior ankle impingement syndrome.
Methods: We evaluated 34 athletes who underwent arthroscopic osteophyte resection for anterior ankle impingement between January 2017 and March 2021.
Results: We found tram-track lesions in 26 athletes (76.5%). Arthroscopic findings revealed the distribution of the International Cartilage Repair Society grades of tram-track lesions (grade 0, eight; grade 1, seven; grade 2, ten; grade 3, nine; grade 4, zero). These findings indicate that athletes with anterior ankle impingement syndrome may have more severe cartilage lesions than non-athletes. There was a positive correlation between the International Cartilage Repair Society grade and osteophyte size (r = 0.393, p = 0.021). We divided athletes into two groups according to the presence or absence of osteophyte protrusion into the joint space. Osteophyte protrusion was present in 14 athletes (41.2%). All athletes in the protrusion-type group had tram-track lesions; seven (50%) had International Cartilage Repair Society grade 3. The protrusion-type group’s International Cartilage Repair Society grade was significantly higher than that of the non-protrusion-type group (p = 0.008). The osteophyte sizes in the two groups were not significantly different (p = 0.341).
Conclusions: Based on these findings, osteophyte protrusion should be assessed when an indication of arthroscopic treatment for anterior ankle impingement syndrome is considered, particularly in athletes.博士（医学）琉球大学University of the Ryukyu
沖縄県中小事業所における健康管理担当者の有無と高血圧
Get PDF【背景／目的】循環器系疾患予防において、定期的な健康診査(健診)で循環器系危険因子有病者を同定し医療により重症化を防ぐことは重要な戦略の一つであるが、本邦において健診後要受診者の未受診は重要な課題である。産業保健関連有資格者による保健指導や受診勧奨は健診後の受診を高めることが報告されているが、有資格者の確保が困難な中小事業所では、本来の職務や資格の有無に関わらずに従業員の健康管理を担当する者（本研究で健康管理担当者と定義）を配置することが現実的な代替戦略として期待される。しかし、中小事業所における健康管理担当者と健診後受診行動の関連を見た研究はない。そこで我々は最大の循環器系危険因子である高血圧に注目し、リアルワールドデータを用いて中小事業所に配置された健康管理担当者が健診で新規に指摘された高血圧者においてその治療を目的とする医療機関の受診を高めるか否かを明らかにすることを目的とした。
【方法】2019年に全国健康保険協会沖縄支部が管轄する沖縄県内の民間中小事業所（5,923事業所）に勤務する35~59歳の従業員(72,839人)を対象に、事業所の特性、従業員の健康および健康保険(レセプト)等の既存情報を活用する疫学研究を実施した。うち、前年度の健診で高血圧(収縮期血圧≥140mmHg、拡張期血圧≥90mmHgまたは降圧薬服用あり)がなく、当年度の健診で新規に指摘された未治療の高血圧者(2,906人、1,366事業所）を目的の縦断解析の対象とした。追跡期間は健診後6ヶ月間とし、事業所の健康管理担当者の有無の間で医療機関受診の累積発生率を比較した。マルチレベル･ロジスティック回帰モデルを用いて健康管理者の非配置群に対する配置群の受診に関するオッズ比および95%信頼区間を算出した。軽度の高血圧者は受診を控える傾向があるため、新規高血圧者を収縮期血圧140-149mmHgかつ拡張期血圧90-94mmHgと収縮期血圧≥150mmHgまたは拡張期血圧≥95mmHgに層別化して同様な解析を行った。
【結果】健診での新規高血圧者(2,906人、1,366事業所)で健診後翌月末までの受診率は健康管理者の配置群で2.97%、非配置群で2.00%であり、配置群の受診に関する調整オッズ比は1.74(95%信頼区間0.94-3.22)であった。しかし、それ以降の各月末までの受診率の群間差は漸減した。収縮期血圧≥150mmHgまたは拡張期血圧≥95mmHgの高血圧者では健診後翌月末までの受診率は配置群で4.97%、非配置群で2.29%であり、配置群の受診に関する調整オッズ比は3.05(1.12-8.29)であったが、それ以降の各月末までの受診率の群間差は漸減した。
【結論】中小事業所において健康管理担当者の存在が健診での新規高血圧者における早期の医療機関受診率の増加と関連した。健康管理担当者を配置し役割を規定することは中小事業所における現実的かつ効果的な循環器系疾患予防戦略であることが示唆された。博士（医学）琉球大学University of the Ryukyu