タイワ ト コウリュウ ノ バ ズクリ カラ ハジメル マチ ズクリ ノ アリカタ ニカンスル イチコウサツ

参加や協働によるまちづくりという言葉は， 広く一般的に使われており， 全国各地で様々な実践が行われてきた． 今後， 「まちづくり」 の実践や展開においては， 「自分たちで意思決定を行い， 自分たちで実行できるシステムを作り」， また， 「多様な関係主体が， 地域の中で様々な関係性を構築し， 組織や活動を生み出していく （選び取る）」 ことが重要になっていくだろう． そして， この実践・実行のためには， 相互作用や関係変容を促す対話と交流の 「場」 の形成が不可欠になる． そこで， 本稿では， 対話と交流の場づくりから始めるまちづくりに関して， その意義を示すとともに， 具体的な実践事例を通じてその可能性を示す

Reframing 'resident-led' through the concept of 'enjoyment': Through a literature review in the field of community welfare and community development

地域福祉とまちづくりの分野で議論される住民の主体性の醸成に関連する概念の一つに，「楽しさ」がある．この「楽しさ」について，議論のあり方とその概念を整理し，その理論的到達段階を確認することと，今後の理論構築に向けた課題を明らかにすることを目的に文献レビュー及びその分析を行った． 　分析の結果，地域福祉分野で「楽しさ」が求められるようになった背景には，1990年以降の我が国の地域福祉政策の変化と，それに伴う「共助」概念の出現を契機とする，参加のあり方の変化があると捉えられた．また，「楽しさ」の内容，生成・醸成される場面，「楽しさ」に対する問題提起の内容を確認できた． 　「楽しさ」の構成要素には，「担い手や仕掛人に遊び心があること」，「『正しさ』や目的から始まらない『きっかけ』の多様性」，「差異を認めて互いに承認できること」，「新しいことに取り組むこと」，「活動をとおして興味・関心が高まり夢中になること」，「目的を志向しすぎないこと」の 6 点があることを考察した．我が国の今後の地域福祉分野において，住民の主体性に基づく「住民主体」を期待するならば，これまでの「正しさ」を基調としたものだけではなく，「楽しさ」という視点から捉えなおすことが，地域福祉推進の一つの切り口になり得る可能性がある．「楽しさ」が生成・醸成されるプロセスや，価値観同士の結節点としての「楽しさ」の可能性，「正しさ」の中に「楽しさ」を見出す可能性を明らかにしていくことと，個別事例の確認が今後の課題である．departmental bulletin pape

Cardioversion in patients with newly diagnosed non-valvular atrial fibrillation: observational study using prospectively collected registry data

OBJECTIVE To investigate the clinical outcomes of patients who underwent cardioversion compared with those who did not have cardioverson in a large dataset of patients with recent onset non-valvular atrial fibrillation. DESIGN Observational study using prospectively collected registry data (Global Anticoagulant Registry in the FIELD-AF-GARFIELD-AF). SETTING 1317 participating sites in 35 countries. PARTICIPANTS 52 057 patients aged 18 years and older with newly diagnosed atrial fibrillation (up to six weeks' duration) and at least one investigator determined stroke risk factor. MAIN OUTCOME MEASURES Comparisons were made between patients who received cardioversion and those who had no cardioversion at baseline, and between patients who received direct current cardioversion and those who had pharmacological cardioversion. Overlap propensity weighting with Cox proportional hazards models was used to evaluate the effect of cardioversion on clinical endpoints (all cause mortality, non-haemorrhagic stroke or systemic embolism, and major bleeding), adjusting for baseline risk and patient selection. RESULTS 44 201 patients were included in the analysis comparing cardioversion and no cardioversion, and of these, 6595 (14.9%) underwent cardioversion at baseline. The propensity score weighted hazard ratio for all cause mortality in the cardioversion group was 0.74 (95% confidence interval 0.63 to 0.86) from baseline to one year follow-up and 0.77 (0.64 to 0.93) from one year to two year follow-up. Of the 6595 patients who had cardioversion at baseline, 299 had a follow-up cardioversion more than 48 days after enrolment. 7175 patients were assessed in the analysis comparing type of cardioversion: 2427 (33.8%) received pharmacological cardioversion and 4748 (66.2%) had direct current cardioversion. During one year follow-up, event rates (per 100 patient years) for all cause mortality in patients who received direct current and pharmacological cardioversion were 1.36 (1.13 to 1.64) and 1.70 (1.35 to 2.14), respectively. OBJECTIVE To investigate the clinical outcomes of patients who underwent cardioversion compared with those who did not have cardioverson in a large dataset of patients with recent onset non-valvular atrial fibrillation. DESIGN Observational study using prospectively collected registry data (Global Anticoagulant Registry in the FIELD-AF-GARFIELD-AF). SETTING 1317 participating sites in 35 countries. PARTICIPANTS 52 057 patients aged 18 years and older with newly diagnosed atrial fibrillation (up to six weeks' duration) and at least one investigator determined stroke risk factor. MAIN OUTCOME MEASURES Comparisons were made between patients who received cardioversion and those who had no cardioversion at baseline, and between patients who received direct current cardioversion and those who had pharmacological cardioversion. Overlap propensity weighting with Cox proportional hazards models was used to evaluate the effect of cardioversion on clinical endpoints (all cause mortality, non-haemorrhagic stroke or systemic embolism, and major bleeding), adjusting for baseline risk and patient selection. RESULTS 44 201 patients were included in the analysis comparing cardioversion and no cardioversion, and of these, 6595 (14.9%) underwent cardioversion at baseline. The propensity score weighted hazard ratio for all cause mortality in the cardioversion group was 0.74 (95% confidence interval 0.63 to 0.86) from baseline to one year follow-up and 0.77 (0.64 to 0.93) from one year to two year follow-up.Of the 6595 patients who had cardioversion at baseline, 299 had a follow-up cardioversion more than 48 days after enrolment. 7175 patients were assessed in the analysis comparing type of cardioversion: 2427 (33.8%) received pharmacological cardioversion and 4748 (66.2%) had direct current cardioversion. During one year follow-up, event rates (per 100 patient years) for all cause mortality in patients who received direct current and pharmacological cardioversion were 1.36 (1.13 to 1.64) and 1.70 (1.35 to 2.14), respectively. CONCLUSION In this large dataset of patients with recent onset non-valvular atrial fibrillation, a small proportion were treated with cardioversion. Direct current cardioversion was performed twice as often as pharmacological cardioversion, and there appeared to be no major difference in outcome events for these two cardioversion modalities. For the overall cardioversion group, after adjustments for confounders, a significantly lower risk of mortality was found in patients who received early cardioversion compared with those who did not receive early cardioversion. STUDY REGISTRATION ClinicalTrials.gov NCT01090362