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Mental health issues show women bear brunt of Japan monarchy system

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This photo, taken at the Akasaka Estate in Tokyo on July 11, 2021, shows former Princess Mako, rear right, with her family. (Courtesy photo of Imperial Household Agency / Kyodo)

TOKYO (Kyodo) – Former Princess Mako’s diagnosis of post-traumatic stress disorder prior to her controversial marriage in October has again highlighted the severe pressures women face in the Japanese imperial family, with some other members plagued by mental health issues as well.

The former princess, 30, who is a niece of Emperor Naruhito, came into public when it became known that her civil husband’s family, Kei Komuro, was involved in a financial dispute.

Her aunt Empress Masako, 58, has long struggled with a stress-related illness related to the pressure she was under to father a male heir, while former Empress Michiko, 87, the Emperor’s mother, spent months under beatings from the The weekly newspaper couldn’t speak magazines after her husband’s accession to the throne in 1989.

Both the Empress and the former Empress were citizens before their marriage to the then Crown Prince.

Under the Japanese Imperial House Act of 1947, women are not eligible to ascend to the throne, and female members of the imperial family leave the household if they marry a commoner.

While the former princess and Komuro finally married on October 26, more than four years after their relationship was publicized, traditional royal marriage-related ceremonies were not held due to public unease over the money dispute.

“It’s like there are no human rights (within the imperial family),” said clinical psychologist Sayoko Nobuta.

The Imperial Household Agency announced prior to the marriage that the former princess had been diagnosed with complex PTSD caused by mental abuse the couple and their families suffered.

Regarding the mental health of his daughter, Crown Prince Fumihito, the Emperor’s brother, emphasized on the occasion of his 56th birthday.

Although the agency has exposed fake news in the past and exposed some reports on its website since 2007, it does not have a clear policy on how to deal with such matters.

“Even if (former Princess Mako) has been instructed to ignore online bashing or not to engage in it, you can’t help but notice it in your daily life and it will break your heart before you know it,” said Rika Kayama. Psychiatrist and commentator on social issues.

The case of the former princess is only the latest in a history of mental health problems afflicting women in the imperial family.

In 2004, the agency announced that Empress Masako, then Crown Princess, had been diagnosed with adjustment disorder after giving birth to Princess Aiko, the only child between her and the Emperor, in 2001. The previous year, the Empress had canceled her official duties after suffering from herpes zoster.

The Empress, a former diplomat trained at Harvard and Oxford, gave up her career to join the imperial family in 1993 after accepting a marriage proposal from the then Crown Prince after initially turning down the offer.

Many speculated that a major reason for their stress was pressure to father a male heir, since no boys have been born into the imperial family since Crown Prince Fumihito’s birth in 1965.

The situation calmed down after Crown Princess Kiko gave birth to Prince Hisahito, 15, in 2006, who is now second in line to the throne.

But in contrast to ex-emperor Akihito and ex-empress Michiko, who mostly dealt with the public as a couple, the current emperor often carries out official duties alone due to the condition of his wife, although she has gradually expanded her field of activity in recent years .

But even the former empress, who was the first commoner to marry an imperial heir to the throne in 1959, was not exposed to pressure from the imperial family without protection.

After the former emperor’s accession to the throne in January 1989, she became the focus of a backlash in weekly magazines, sparked by his cultivation of a more accessible image compared to his father, Emperor Hirohito, who ascended the throne before World War II when emperors were still considered living gods respected.

On her 59th birthday in October 1993, the former empress collapsed and lost her voice due to psychogenic aphasia.

“The emperor is the symbol of Japan and the monarchy is a symbol of patriarchy, so discrimination against women is most pronounced in the imperial family,” said Nobuta, adding that such an environment makes it difficult for smart women to survive.

Nobuta said the former Princess Mako, who grew up with these events and studied at both Tokyo International Christian University and the UK, felt that the only way to truly live her life was through Japan to leave.

“For former Princess Mako, escape was her main goal and I think she chose Komuro as the man who could help her achieve that goal,” said Nobuta.

The couple left Japan shortly after they got married to start a new life in New York, where Komuro works as a trainee lawyer in a law firm.

All eyes are now on Princess Aiko, who turned 20 in December and is now to take on official duties as an adult member of the imperial family.

The princess would be entitled to the throne if she were a member of the British or Dutch monarchy, both of which enable the monarch’s eldest child to succeed regardless of gender.

A government body tasked with examining ways to ensure a stable Imperial succession proposed on December 22nd that female members who marry commoners can retain their Imperial status.

However, it has been postponed to draw conclusions about whether women or imperial members in the matrilineal line are eligible to take the throne.

In the past, Princess Aiko has sparked public concern and speculation about her prolonged absence from school and severe weight loss at one point, but it remains to be seen whether the mental health problems that affected the female relatives before her will recur.

Hajime Sebata, adjunct professor of modern Japanese history at Ryukoku University, said that building a relationship with citizens through communication, not counter-arguments, is key.

“If (the agency) posts and communicates (information about royals) regularly on social media, the public will trust the imperial family, even if there is criticism,” he said.

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Cleveland Clinic launches largest ever clinical study of neurological disorders | Health

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Updated: Wednesday 19 January 2022 10:03 am

The Cleveland Clinic has launched the largest clinical study to date to better understand why millions of people – about one in six people – around the world suffer from neurological diseases, including Alzheimer’s, Parkinson’s, multiple sclerosis, stroke or epilepsy.

The clinic on Wednesday announced the multi-year longitudinal study, which will collect data from 200,000 neurologically healthy individuals over a 20-year period to identify biomarkers of brain disease and targets to prevent and cure neurological disorders.

“What we’re suggesting here is … there should be some changes – in the blood, in the stool, in the brain, in our ability to think, walk, speak – that could give us if we follow.” [these] different factors over time so we may be able to identify something that will change,” said Dr. Imad Najm, principal investigator of the study and director of the clinic’s epilepsy center. “This will give us the opportunity to use it for pre-disease diagnosis and hopefully to develop new treatment approaches to stop the disease before it occurs.”

Researchers hope to uncover the causes of neurological disorders and figure out what’s happening before the symptoms become apparent — a time known as the “silent phase,” said Dr. Andre Machado, one of the leaders of the study, in a press release.

“Our hope is to change the course of neurodegeneration with the long-term goal of curing diseases in their earliest stages, years before symptoms even appear,” Machado said.

The study, which is funded in part by philanthropic contributions of all magnitudes, started at the hospital’s main Cleveland campus but will expand to other Cleveland Clinic locations over time, according to the press release.

During the first five years of the study, researchers will enroll and thoroughly screen 10,000 volunteers, the press release said. This group includes adults 50 years and older with no known neurological disorder and neurologically healthy adults 20 years and older who have a first-degree relative with multiple sclerosis.

The likelihood of someone developing a neurological condition increases over time, Najm said. Those aged 50 to 55 have a 1 percent chance of developing one, while the risk increases to 14 percent after age 75.

Because of this, researchers believe some of the older participants could develop brain disease within the first five years of the study, and investigators could begin exploring treatments and possible cures in the years that follow, Najm added.

“We think that in the first five years we’re going to have … some results that will hopefully provide a goal or two that we can build on,” he said, “to stop the disease after we understand the risk factor and the cause of it.” have identified disease. We don’t believe we will cure all diseases in five years, but we do believe that we will hopefully contribute to a better understanding of the silent phase before these debilitating disorders emerge.”

You do not have to be a current patient at the Cleveland Clinic to participate in the study. If a participant is diagnosed with a brain disorder at any point during the study, they will either be referred to their primary care physician for treatment or may elect to receive treatment at the Cleveland Clinic, Najm said.

Participants will be evaluated annually and undergo a neurological exam, blood tests, eye retina scans, brain MRIs, EEG and sleep studies, and other cognitive function tests, the clinic said.

The researchers will collect data points from these assessments to look for trend lines that capture genetic risk factors and unseen molecular, structural, neurophysiological and cognitive changes in the brain over time, according to the press release. These “disease fingerprints” can help researchers guide diagnostic and preventative medicine.

According to the press release, modern medicine has learned to deal with some symptoms of brain diseases. However, doctors continue to struggle with predicting who will become ill and how to stop—let alone cure—the progression of these diseases once they are diagnosed.

The study’s leaders hope their research will change that.

“This research will help to understand the mechanisms of brain diseases and lead to the development of preventive treatments for neurological diseases. This is precision medicine at its best,” said Najm. “We’re building a base to screen one person at a time — perhaps with something as routine as a blood test — to immediately diagnose a brain disorder and prevent it from occurring outright.”

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Overcoming Patient Barriers to Chronic Disease Management

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All too often, patients with chronic illnesses feel like a burden to their clinicians or caregivers.

Chronic illnesses don’t make days off—they’re called “chronic” for a reason. Since most patients (and physicians too) are unable to spend all day in an exam room, a large part of day-to-day disease management falls to the patient himself. This heavy responsibility can significantly affect a person’s mental health.

The challenges of disease self-care

To put the challenges of self-management in perspective, this section focuses on a chronic disease that affects 422 million people worldwide and causes 1.5 million deaths annually: diabetes.

Outside the doctor’s office, around-the-clock diabetes care is the patient’s responsibility. Patients must watch what they eat, monitor their blood sugar levels, take their medications, maintain a routine of moderate exercise, and some must self-administer insulin injections multiple times a day. They also need to know what to do in the event of a health emergency, such as: B. a sudden rise or fall in blood sugar levels that can cause dizziness, loss of consciousness, vomiting and other symptoms that can range from bothersome to life-threatening. And the more complex their diabetes is, the more difficult patient adherence becomes.

If they manage their condition well, people with diabetes can lead relatively normal lives. However, everyone has their own unique set of circumstances that are influenced by their underlying physical health, personal history, geographic location, and economic stability—the list goes on. However, there are some issues that are proving to be persistent obstacles to effective diabetes management:

Lack of education and understanding of the condition

To truly understand how to self-manage, patients with complex diabetes and their families or caregivers need educational support about the effects of disease on the body and how medication, exercise, and lifestyle adjustments can counteract these effects. And since most people rely on GPs for their primary health care, they may be missing important, disease-specific training.

Intrinsic barriers to adherence

A patient’s socioeconomic status, age, cultural beliefs, and other health factors can inform how they perceive self-management advice—or make it difficult to access help. Underlying psychological factors such as anxiety, depression, and eating disorders can also exacerbate these problems or act as additional barriers to compliance.

Frustration with the complexity of treatment

When patients find their treatment difficult or complicated, they are less likely to adhere to their recommended self-management. Physicians must ensure that patients do not experience any adverse effects – both physical and psychological – related to taking medication or treatments at home. It is also important for clinicians to understand if patients experience uncomfortable feelings related to medication, such as: B. Fear of injections or difficulty swallowing pills.

Difficulty affording treatment

In countries without universal health coverage, studies have found that out-of-pocket expenses are an important determinant of how likely patients are to adhere to their treatment. Patients with lower incomes are more likely to face economic barriers when it comes to consistently taking their prescribed medications. Patients cannot be expected to overcome their own economic barriers and many GPs are ill-equipped to provide patients with access to more affordable treatment.

If these barriers to successful adherence are not addressed, they can result in patient deterioration, reduced quality of life, development of additional health problems, long-term or re-hospitalization, or death.

Despite these multifaceted challenges, there are steps clinicians and patients can take to improve patient access and experience to disease management.

How to improve care systems for patients

When patients understand and feel involved in their own treatment plans, they are much more likely to adhere to clinical recommendations.

The patient’s relationship with their healthcare provider is one of the most important interactions in healthcare, but it’s only part of a larger support system. Augmenting the patient’s care team with a variety of support specialists—such as health coaches, counselors, care coordinators, and disease educators—can help patients adhere to treatment plans and achieve better health outcomes.

These methods of patient support can greatly improve self-management between doctor visits, making appointments more efficient and productive.

  • Use additional support programs
  • Approach communication from a patient-centric perspective
  • Provide multiple communication touchpoints

How to help patients overcome adherence barriers

While it may feel contradictory to a clinician, the key to overcoming patient non-compliance is this: Healthcare professionals must position the patient as the primary decision-maker in their own care and actively support the patient’s efforts to meet their care goals.

Doctors can embody this approach by asking the patient questions such as:

“What would you like to take away from today’s visit?”

“What is most important to you?”

“How can I help you achieve your goals?”

“What do you find difficult?”

“What confuses, troubles or scares you?”

“Need help identifying less complicated treatment options?”

“Need help finding cheaper treatment options?”

Integrating activities such as goal setting and problem solving into routine appointments will help facilitate patient-physician communication beyond mere status updates. Additionally, connecting patients with health coaches gives them the opportunity to easily ask questions and share self-management updates between appointments.

Alicia Warnock, MD, is Chief Operating Officer of Stability Health, a diabetes management company.

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Mental disorders remain significant global burden on health

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January 18, 2022

2 minutes read

Source/Disclosures

Disclosure:
Ferrari does not report any relevant financial disclosures. All other relevant financial information can be found in the study.

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According to a 30-year global systematic analysis published in The Lancet Psychiatry, the prevalence of mental disorders has increased and remains a leading contributor to the global burden of disease.

“Mental disorders are increasingly recognized as a major contributor to the burden of disease. In order to meet the mental health needs of individual countries in a way that prioritizes health systems transformation, an in-depth understanding of the magnitude of the impact of these disorders, including their distribution in the population, the health burden imposed and their wider health outcomes, is essential “, Alize Ferrari, PhD, from the Queensland Center for Mental Health Research at the University of Queensland and colleagues.

Infographic data derived from: Ferrari A, et al. Lancet Psychiatry. 2022;doi/10.1016/S2215-0366(22)00002-5.

Ferrari and colleagues attempted to measure the impact and incidence of 12 mental disorders between 1990 and 2019 at global, regional, and national levels using multiple quality of life metrics: disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs).

Researchers evaluated estimates of prevalence and burden in males and females in 23 different age groups in 204 countries and territories worldwide. They estimated DALYs as the sum of YLDs and YLLs up to premature mortality. In addition, they included information analyzed from multiple databases for prevalence, incidence, remission, duration, severity, and excess mortality for individual mental disorders. They performed Bayesian meta-regression analysis to estimate frequency by disorder, age, sex, year, and location.

The results showed that mental disorders accounted for an estimated 654.8 million cases in 1990 and 970.1 million cases in 2019, an increase of 48.1 percent. Australasia, tropical Latin America, and high-income North America had the highest prevalence of mental disorders across all measurements.

The prevalence of depressive disorders was high in sub-Saharan Africa, North Africa and the Middle East, as well as in Australasia, tropical Latin America, and high-income North America. The frequency of bipolar disorder and schizophrenia varied to a lesser extent in all regions.

Depressive disorders ranked highest among all age groups in the study except those from birth to age 14, for whom behavioral problems were the main cause of distress.

A sharp increase in the global number of DALYs due to mental disorders over the course of the study was noted, from 80.8 million in 1990 to 125.3 million in 2019, and an increase in the percentage of resulting DALYs to 3.1% in 1990 and 4.9% in 2019.

The highest DALY rates were observed in the US, Australia, New Zealand, Brazil, Western Europe, Sub-Saharan Africa, North Africa and the Middle East. The lowest DALY rates were observed in Southeast Asia, East Asia, high-income Asia-Pacific and Central Asia.

Women and girls were found to carry a greater burden of depressive disorders, anxiety disorders and eating disorders than men and boys, while the opposite was true for autism spectrum disorders and ADHD. At the end of the study, 80.6% of the burden of mental disorders was in those of working age (16 to 65 years), with 9.2% of the remaining burden being in those under 16 years of age.

“The GBD 2019 results underscore the large proportion of the global burden of disease attributable to mental disorders and the global disparities in this burden,” Ferrari and colleagues wrote. Furthermore, there has been no evidence of a global reduction in exposure since 1990, despite evidence-based interventions that can reduce exposure across age, gender, and geographic locations.”

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