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Abstract Retinopathy of prematurity (ROP) is a major cause of preventable blindness in preterm infants. The association between red blood cell (RBC) parameters and the development of ROP remains unclear. The objectives of the present study were to evaluate the association between RBC parameters and ROP treatment. This single-center, retrospective cohort study included preterm infants born at 117.3 fL at birth (adjusted odds ratio [aOR]:2.3; 95% confidence intervals CI 1.0–5.3). Additionally, on DOL 28, hemoglobin (Hb) values 18.5% (aOR:2.6; 95% CI 1.1–6.2) were associated with ROP treatment. In conclusion, our study indicated that infants born at 117.3 fL at birth, along with Hb 18.5% on DOL 28, had an increased risk of requiring ROP, warranting treatment.

Background: Tobacco exposure during pregnancy is associated with several adverse outcomes in infants. We investigated the association between tobacco exposure during pregnancy (both active and second-hand) and various infections in infants up to 1 year. Methods: This prospective cohort study used a fixed dataset (jecs-an-20180131) from the Japan Environment and Children’s Study of registered births in Japan during 2011–2014 that included 104,065 fetal records from enrolled pregnant women. Based on the participants’ responses to the questionnaire on smoking status, mothers were first divided into “never smoked,” “quit smoking,” and “current smoker” groups and then into “no second-hand smoking (SHS)” and “SHS” groups. Infectious diseases included central nervous system infection, otitis media (OM), upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), gastroenteritis (GI), and urinary tract infection. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated using logistic regression analysis and adjusted for maternal, socioeconomic, and postnatal confounding factors. Results: Among the 73,205 newborns enrolled, multivariable analysis revealed that the aOR of LRTI and GI was 1.20 (95% CI, 1.07–1.33) and 1.18 (95% CI, 1.04–1.35), respectively, for the “current smoker with/without SHS” group compared with the “never smoked without SHS” group. “Quit smoking without SHS” was not associated with the risk of LRTI. SHS was associated with an increased risk of OM, URTI, LRTI, and GI, especially with LRTI and GI. Conclusion: Exposure to tobacco smoke during pregnancy was associated with an increased risk of OM, URTI, LRTI, and GI in infants during their first year of life.

Introduction: Since soy isoflavones compensate for age-related estrogen reduction, adequate intake of soy products may prevent the decline in activities of daily living (ADL) due to estrogen reduction in women. However, it is unclear whether regular soy product intake prevents ADL decline. This study examined the effects of soy product consumption on basic/instrumental ADL (BADL/IADL) in Japanese women 75 years or older for 4 years. Materials and Methods: The subject population consisted of 1289 women aged 75 years or older living in Tokyo who underwent private health examinations in 2008. For 1114 (or 1042) participants without baseline BADL (or IADL) disability, we examined the association between baseline soy product consumption frequency and the BADL (or IADL) disabilities 4 years later using logistic regression analyses. The models were adjusted for baseline age, or further for dietary variety for food groups other than soy products, exercise and sport participation, smoking, pre-existing disease number, and body mass index. Results: Regardless of adjustment for potential confounding factors, less frequent soy product consumption was associated with higher BADL or IADL disability incidence. In the fully adjusted models, the trend toward a higher incidence of disabilities with less frequent soy product consumption was statistically significant for both BADL (p?=?0.001) and IADL (p?=?0.007). Conclusions: Those who consumed soy products more frequently at baseline were less likely to develop BADL and IADL disabilities after 4 years than those who did not. The results show that daily soy product consumption may prevent functional ADL decline in older Japanese women.

BackgroundThere has been a recent decrease in the prevalence of infectious diseases in children worldwide due to the usage of vaccines. However, the association between cesarean delivery and infectious diseases remains unclear. Here, we aimed to clarify the association between cesarean delivery and the development of infectious diseases.MethodsThis study is a cross-sectional study. We used data from the Japan Environment and Children's Study, which is a prospective, nationwide, government-funded birth cohort study. The data of 104,065 records were included. Information about the mode of delivery, central nervous system infection (CNSI), otitis media (OM), upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), gastrointestinal infection (GI), and urinary tract infection (UTI) was obtained from questionnaires and medical records transcripts. Multiple logistic regression analysis was used to assess the association between cesarean delivery and CNSI, OM, URTI, LRTI, GI, and UTI risk.ResultsWe included a total of 74,477 subjects in this study, of which 18.4% underwent cesarean deliveries. After adjusting for the perinatal, socioeconomic, and postnatal confounding factors, children born by cesarean delivery did not have an increased risk of developing CNSI (95% confidence interval [CI] 0.46-1.35), OM (95% CI 0.99-1.12), URTI (95% CI 0.97-1.06), LRTI (95% CI 0.98-1.15), GI (95% CI 0.98-1.11), or UTI (95% CI 0.95-1.45).ConclusionsThis nationwide cohort study did not find an association between cesarean delivery and CNSI, OM, URTI, LRTI, GI, and UTI. However, further studies are needed to evaluate the role of cesarean delivery in the development of infectious diseases.

This study explored the association of spousal support and marital satisfaction with the subjective well-being of fathers and mothers using a mediation analysis. Data were gathered from 360 fathers and 338 mothers (aged 25–50 years). Subjective well-being was measured as an outcome using the Japanese version of the World Health Organization-Five Well-Being Index. Marital satisfaction was measured as a mediating variable using the Japanese version of the Marital Relationship Satisfaction Scale. Spousal social support (including instrumental, emotional, and appraisal support) was measured as an independent variable using four-point scales. Control variables were the father’s and mother’s ages, number of children, age of the youngest child, children going to nursery school or kindergarten, use of childcare services, self-evaluated low economic status, and weekday working hours. Among fathers, instrumental and emotional support had significant direct and indirect effects, with the latter mediated by the impact of marital satisfaction on subjective well-being; appraisal support had only significant indirect effects. Among mothers, instrumental support had significant direct and indirect effects; emotional and appraisal support had only significant indirect effects. Our findings indicate that social support from spouses has protective direct and indirect effects on subjective well-being among parents and suggest the need for mutual support between spouses to facilitate effective co-parenting.

Abstract Background Polypharmacy is a serious concern among older adults and is frequently related to adverse outcomes, including health problems, reduced quality of life, and increased medical expenses. Although personality traits are associated with health behaviors and diseases, the effect of polypharmacy on personality traits is unclear. Therefore, we examined the association of personality traits with polypharmacy among community-dwelling older adults. Methods This cross-sectional study analysed data on 836 community-dwelling older adults aged 69–71 years who participated in the Japanese longitudinal cohort study of Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians. Polypharmacy was defined as the intake of ≥ 5 medications concurrently. Personality traits were assessed using the Japanese version of the NEO-Five-Factor Inventory (NEO-FFI). A five-factor model of personality traits, including “neuroticism,” “extraversion,” “openness,” “agreeableness,” and “conscientiousness,” was measured by the NEO-FFI. Results The average number of medications was about 3 in both men and women. Among the participants, polypharmacy was observed in 23.9% of men and 28.0% of women. Multivariable logistic regression analysis showed that neuroticism (adjusted odds ratio [aOR] per 1 point increase = 1.078, 95% confidence interval [CI] = 1.015–1.144) in men and extraversion (aOR = 0.932, 95% CI = 0.884–0.983) in women were associated with polypharmacy. Conclusions Higher neuroticism in men and lower extraversion in women were associated with polypharmacy. This study suggests that personality traits may be involved in the process leading to the development of polypharmacy. Information on individual personality traits may help medical professionals in decision-making regarding medication management for lifestyle-related diseases.

BackgroundJapan's health care system may be providing inpatient care inefficiently with a low number of physicians per hospital bed and a long average length of stay (LOS). The present study examined associations of acute medical care with hospital-level factors, such as the transfer and acceptance rates, and mediation effect of LOS, using medical service fees per day as an outcome measure for the provision of acute medical care in hospitals in a region with limited medical resources.MethodsTo analyze the associations of acute medical care with hospital-level factors, this research used multilevel structural equation modeling (SEM) of a dataset that included 225,203 patients admitted to 99 hospitals in Fukushima, Japan. The characteristics of the patients, medical activities, and hospitals, such as the transfer and acceptance rates, were assumed to have both direct and indirect effects through LOS on medical service fees per day.ResultsThe final analysis used data from 165,413 patients discharged or transferred from 79 hospitals. After separating patient-level effects using multilevel SEM, the results revealed that, at the hospital level, the transfer rate had a significant and positive association with increased medical service fees per day, both directly (standardized coefficient [SC] = 0.215) and indirectly (SC = 0.057) through shortened LOS. The number of first hospitalized patients per physician had a significant and positive association with increased medical service fees per day only indirectly through shortened LOS (SC = 0.063). The acceptance rate had a significant and negative association with medical service fees per day only indirectly through prolonged LOS (SC = -0.078).ConclusionsHospital-level factors, such as enhanced transfer function, reduced acceptance function, and a large number of patients for treatment of acute episodes per physician, had positive associations with increased medical service fees per day, either directly or indirectly through LOS.

Mothers involved in child care may be prone to various cognitive failures (e.g., leaving things behind) as a result of being overburdened with maternal duties, with limited attentional capacity for responding to children’s frequent demands. Therefore, this study aimed to explore factors associated with cognitive failure among mothers involved in child care in Japan. The participants were 310 mothers aged 25–45 (155 full-time workers, 155 housewives). The self-reported questionnaire covered cognitive failure (outcome variable), basic demographic characteristics, sociological factors, health status, and personality. Cognitive failure was assessed using the 15-item Japanese version of the Short Inventory of Minor Lapses. The variables evaluated for potential associations with cognitive failure included mother’s age, youngest child’s age, number of children, employment status, daily sleep duration, time spent on leisure activities, fatigue, social support (instrumental and emotional), use of child care services, and the Big Five personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness). Multiple regression analysis showed that number of children, fatigue, emotional support, neuroticism, agreeableness, and conscientiousness were independently and significantly associated with cognitive failure. Our results may help facilitate the development of effective strategies to prevent adverse effects on children’s and parents’ health by preventing cognitive failure among mothers.

The Fukushima Daiichi nuclear power plant accident caused radioactive contamination of the surrounding area. In addition to annual health checkups, a survey of the effects of low-dose radiation exposure on health among Fukushima Prefecture residents after the accident has been conducted. Despite health literacy (HL) being recognized as essential to health, its association with participation in these checkups and the survey remains unknown. We aimed to describe the HL status of the Fukushima Prefecture residents and to verify the hypothesis that HL is associated with participation in both checkup and survey. In a cross-sectional study, a questionnaire was sent to 2000 randomly sampled Fukushima Prefecture residents; data from 770 individuals were analyzed. Communicative and critical HL were measured using a 5-point scale. Factors associated with participation were examined using logistic regression. The survey’s valid response rate was 38.5%. The average HL score was 3.11 ± 0.81. HL was not associated with checkup or survey participation. Checkup participation was negatively associated with radiation anxiety (odds ratio 0.93, 95% confidence interval 0.86–0.99, p = 0.03). The HL of Fukushima Prefecture residents after the accident was relatively lower than that of the Japanese general population, which may be attributed to difference in educational background. The complexities involved in understanding the effects of radiation on the health of residents could explain why no association between HL and participation in a health checkup and survey was observed. Future studies with a longitudinal design should clarify causality between anxiety and checkup participation.

Following the March 2011 accident at Fukushima Daiichi Nuclear Power Plant, many residents of Fukushima have faced anxieties about the health impacts of radiation exposure. Considering that source of information may influence resident anxiety, this study aimed to elucidate the correlation between the two. In addition, a health literacy query was included to examine a possible relationship between anxiety and health literacy skills. A mail survey was conducted in August 2016 among 2000 residents of Fukushima Prefecture aged 20 to 79 years. Survey items included questions about current health anxieties caused by radiation, trusted sources of information about radiation, and media used to obtain information on radiation. The survey valid response rate was 43.4%. Results of multiple linear regression analysis revealed that anxiety was significantly higher for the groups indicating "trust in citizen groups" and "use of internet sites." Anxiety was significantly lower for the groups indicating "trust in government ministries," "trust in local government," and "use of local broadcast television." Also anxiety was significantly lower for groups with higher health literacy. It was found that the significant relationship to anxiety varies depending on the sources of trust and media used. There is a possibility that this was caused by the difference between the contents of each information and media reports. In preparation for any future nuclear accident, government may consider action to improve the media literacy of residents. In addition, improving health literacy of both the recipient and the sender of information can improve access to information and thereby safeguard the health and well-being of the public.

Objective This study examined (1) the current status of posttraumatic growth (PTG) and (2) the relationship between recovery from radiation anxiety and PTG among community dwellers five years after the nuclear disaster in Fukushima. Design This was a cross-sectional study with 796 residents of Fukushima Prefecture (367 men and 429 women). A questionnaire survey assessed PTG with one question (“Have you gained anything through the disaster experience?” [yes/no]), and current and past radiation anxiety on a 5-point Likert-type scale. These two anxiety measures were combined to generate a new item “recovery from radiation anxiety” with three values (“no anxiety,” “recovered,” and “unrecovered”). Results Approximately half of participants experienced PTG (55.4%). Women were more likely to experience PTG than men. Multiple logistic regression showed that individuals who “recovered” from radiation anxiety were more likely to experience PTG (odds ratio (OR) = 1.99, 95% confidence interval (CI): 1.34–2.85), and that higher level of education (OR = 2.12, 95% CI: 1.28–3.49 for secondary education; OR = 3.95, 95% CI: 2.26–6.88 for higher education) and health literacy (OR = 1.34, 95% CI: 1.09–1.63 for one point increase) were also associated with the experience of PTG.Conclusion: Our findings indicate that during the period of recovery from radiation anxiety, a positive psychological adjustment may occur and PTG might emerge as a result; our findings may be practically used to support sufferers of traumatic events in their recovery.

Objective: This study aimed to provide a psychometric evaluation of the Japanese version of the Ten-Item Personality Inventory (TIPI-J), and was conducted to confirm the concurrent validity, internal consistency, and test–retest reliability of the measure. Methods: A total of 520 middle-aged (40–64 years old) and 312 older adults (65–79 years old) participated in this study. Participants were registered research volunteers with an internet research company. The TIPI-J assesses the Big Five personality traits (Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness). The NEO-Five-Factor Inventory (NEO-FFI) was used to test concurrent validity. Results: Correlations of corresponding trait measures for the TIPI-J and NEO-FFI ranged from 0.45 (Openness) to 0.70 (Extraversion) for middle-aged, and from 0.33 (Openness) to 0.67 (Neuroticism) for older adults. The correlation values of Openness between the two scales were similar to those for the correlation between TIPI-J Openness and NEO-FFI Extraversion for both middle-aged and older adults, and that for the correlation between TIPI-J Openness and NEO-FFI Conscientiousness for older adults. The relationships between TIPI-J personality scores measured at a two-week interval ranged from 0.74 (Agreeableness) to 0.84 (Extraversion) for middle-aged and from 0.67 (Openness) to 0.78 (Neuroticism and Extraversion) for older adults. Conclusion: The TIPI-J has relatively acceptable concurrent validity, with the exception of Openness, which was considerably weaker than the other traits. The scale has relatively acceptable test–retest reliability. Thus, TIPI-J would be a useful instrument, roughly speaking, for assessing the Big Five personality traits among middle-aged and older adults.

For healthy longevity, according to the theoretical framework of “successful aging,” it is not only essential to avoid disease and disability, and to keep high levels of mental and physical functioning, but also to engage with life. Thus, satisfactory leisure activity is important for the aged. We examined actual conditions of leisure activity among older adults in Japan, which can contribute to the development of a standardized leisure activity scale. Participants were 843 community-dwellers (390 men and 453 women, 70.5 ± 6.9 years old) who completed 58 draft leisure activity items. Three procedures (including item selection, factor analyses, and correlation analyses) were conducted to finalize the leisure activity list and evaluate its psychometric properties. Through item selection procedures, 15 items were regarded as inappropriate and were omitted from the analysis. The factor analyses resulted in an 11-factor solution with 43 items. Correlation analysis revealed that Factors 2 (social-public), 5 (social-private), 7 (technology use), 8 (travel), and 10 (developmental activity) had relationships with health outcomes (including functional capacity, social network, subjective well-being, and health literacy). A standardized leisure activity list among modern middle-aged and elderly people was developed, and was associated in part with health outcomes.

We investigated the psychometric properties of the Japanese version of the Posttraumatic Stress Disorder Checklist–Stressor Specific Version (PCL-S) using baseline data from the Fukushima Health Management Survey. A total of 26,332 men and 33,516 women aged 16 and above participated in this study. Participants lived in the Fukushima evacuation zone in Japan and experienced the Great East Japan Earthquake and nuclear power plant (NPP) incident. The PCL-S was used to assess participants’ posttraumatic stress disorder (PTSD) symptoms. In addition, we described participants and tested the validity of the PCL-S by administering the Kessler Six-item Screening Scale for Psychological Distress (K6) and assessing education; employment; self-rated health; sleep satisfaction; experiencing the earthquake, tsunami, and NPP incident; and bereavement as a result of the disaster. PCL-S scores exhibited a positively skewed, slightly leptokurtic distribution. Confirmatory factor analysis revealed that the five-factor model was a better fit than were the three- or four-factor models. The PCL-S and its subscales had high Cronbach’s alpha coefficients. The PCL-S scores had weak-to-moderate correlations with history of mental illness, bereavement, experiencing the tsunami, experiencing the NPP incident, self-rated health, and sleep satisfaction, as well as a strong correlation with psychological distress. There were significant gender and age differences in PCL-S scores. Overall, this study confirmed the psychometric properties of the PCL-S, including the score distribution, factor structure, reliability, validity, and gender and age differences. Thus, the Japanese version of the PCL-S would be a useful instrument for assessing the PTSD symptoms of community dwellers who have experienced traumatic events.

Improvement in the health of older people and changes in their lifestyles necessitate a scale that can better measure their competence at a higher level. This study describes the development process of the Japan Science and Technology Agency Index of Competence (JST-IC) by (a) refining conceptual definitions and developing preliminary items and (b) examining the basic properties of the items. Participants were 1,253 septuagenarians (539 men and 714 women) living in communities, who were asked to judge whether they were independent via 88 items. To examine the basic properties of the preliminary items, five different analyses were conducted. Thirty-four items were considered as inappropriate (6 overlapped between the analyses): (a) 9 due to very high or low ratios of responders who answered “yes,” (b) 4 due to gender or regional differences, (c) 5 due to their weak association with health status, (d) 9 due to low communalities in factor analysis, and (e) 13 due to redundancy of meaning with other items. Conceptual definitions and preliminary items were developed, and the basic properties of the items were examined to create the JST-IC. The next step would be to screen the remaining 54 items to create the final version of the scale.

Unhappiness at school is one of the main reasons for truancy among adolescents. In order to assess this problem more thoroughly in the context of Japanese adolescents, the present study examined the associations between feelings of unhappiness at school and lifestyle habits, school life realities, and mental health status.This study was designed as a cross-sectional survey. A self-administered questionnaire was provided to students enrolled in randomly selected junior and senior high schools throughout Japan. We calculated the percentages of both junior and senior high school students who felt unhappy at school based on factors related to school life, lifestyle habits, and mental health status. Multiple logistic regression analyses were performed in order to examine the associations between those factors and students' feelings of unhappiness at school.A total of 98,867 valid responses were analysed, 7.9% (Boys: 8.4%, Girls: 7.4%) of which came from students who responded that they felt unhappy at school. For both junior and senior high school students, the percentages of those who felt unhappy at school were significantly higher among those who had not yet decided on their future life course, who did not participate in extracurricular activities, did not eat breakfast every day, went to bed late, had used tobacco or alcohol in the previous 30 days, and had poor mental health compared with others. The results of multiple logistic regression analyses indicated that the adjusted odds ratios for feeling unhappy at school with regard to the above-mentioned factors were significantly high for both junior and senior high school students.The present results suggest that school employees and administrators must provide health guidance to students, considering that irregular lifestyle habits, lower school engagement, smoking, drinking alcohol, and poor mental health status are all associated with maladaptation to school among adolescents.

Abstract It has been postulated that being breastfed in infancy affects not only health status in childhood but also disease risk in adulthood. To investigate the association of being breastfed with the risks of adult colorectal cancer and benign tumor, we conducted a case–control study including 1190 colorectal cancer and 1585 benign tumor cases and 5301 controls, admitted to a single hospital in Miyagi Prefecture, Japan, between 1997 and 2013. History of having been breastfed was assessed using a self-administered questionnaire, and odds ratios (ORs) were estimated using unconditional logistic regression. There was no association between being breastfed and colorectal cancer risk (breastfed versus formula-only fed, OR = 1.21; 95% CI 0.87–1.67). There was also no association with the risk of benign tumor (OR = 1.04). On the other hand, analyses stratified by sex and birth year found heterogeneous associations. Women born after 1950 who had been breastfed tended to have increased risks of colorectal cancer (OR = 1.58) and benign tumor (OR = 1.51) relative to those who had been formula-only fed, although not statistically significant. In men born after 1950, being breastfed was associated with a significantly decreased risk of benign tumor (OR = 0.57; 95% CI 0.33–0.98).

In Japan, outcome measures for maternal and child health measures such as maternal, perinatal, and infant mortality have consistently shown a trend toward improvement. On the other hand, the problems of the declining birth rate, child abuse, and domestic violence have become evident since the 1990s. In terms of Japan's maternal and child health, it is necessary to take measures to preserve mental health of mothers and children, and also to respond to family issues such as abuse and violence. The services needed such as comprehensive support centers for families with children and new postpartum care programs have been established. It is necessary to further improve the competence of doctors, public health nurses, and midwives working in the maternal and child health field and to promptly construct a cooperation system in the community. J. Med. Invest. 69: 159-164, August, 2022. [ABSTRACT FROM AUTHOR]

The Great East Japan Earthquake severely damaged the Tohoku and Kanto districts, and Fukushima Prefecture faced a subsequent nuclear disaster. Few studies have reported the effects of socioeconomic stressors on individuals' mental status following disasters. We analyzed the responses of 60,704 adult residents of a designated restricted area to the PTSD Checklist-Stressor-Specific Version (PCL-S). The relationships between the PCL-S scores and demographic, socioeconomic, and damage-related variables were analyzed using regression analysis to predict participants' severity of PTSD symptoms. Approximately 14.1% of evacuees had severe PTSD symptoms (PCL-S ≥50) eighteen months post-earthquake. The PCL-S scores were higher among women, older adults, less educated people, those with a history of mental illness, and those living outside Fukushima Prefecture. The PCL-S scores increased with participants' scores on the Kessler Psychological Distress Scale. The number of trauma-exposure stressors and socioeconomic stressors were associated with 1.52 and 3.77 increases in the PCL-S score, respectively. Furthermore, psychological distress, unemployment, decreased income, house damage, tsunami experience, nuclear power plant accident experience, and loss of someone close due to the disaster were associated with the prevalence of severe PTSD symptoms. The complex triple disaster of a major earthquake, tsunami, and nuclear accident created significant socioeconomic changes that may be important determinants of PTSD among residents of restricted access areas in Fukushima. [ABSTRACT FROM AUTHOR]

Abstract Background Palpitations due to Graves’ disease are often caused by supraventricular arrhythmia. However, in rare cases, the background of coronary artery disease, genetic abnormalities, or channel abnormalities can cause ventricular fibrillation, which is a lethal arrhythmia. Here, we report a case of ventricular fibrillation after administration of beta-blockers early in the course of treatment for Graves’ disease coexisting with atypical angina and long QT syndrome. Case presentation A 48-year-old man consulted a local general physician for chest discomfort and palpitations for approximately 2 weeks. He was diagnosed with Graves’ disease and treated with thiamazole 15 mg, bisoprolol 1.25 mg, and nitroglycerin 0.3 mg. The patient continued to experience chest discomfort the next day and visited our hospital. The patient was treated with landiolol 0.125 mg/kg/min for heart rate control, and 20 min later, electrocardiography showed a change from the R-on-T phenomenon to ventricular fibrillation. After cardiopulmonary resumption and improvement of thyroid function, a stress test was performed, which revealed coronary angina and long QT syndrome. An implantable cardioverter defibrillator (ICD) was implanted in the patient for secondary prevention. Since then, no fatal arrhythmia has been observed to date. Conclusions When beta-blockers are administered to patients with Graves’ disease who have severe chest symptoms, fatal arrhythmias are possible. ICD implantation should be considered for the secondary prevention of fatal arrhythmias.

Abstract Background The AF-201P, a new electromyography (EMG)-based neuromuscular monitor has been developed recently. The aim of this clinical study was to compare two ulnar nerve innervated muscles: the adductor pollicis (AP) muscle and the abductor digiti minimi (ADM) muscle during the recovery from rocuronium-induced neuromuscular block by using EMG AF-201P. Methods Twenty patients undergoing surgery with general anesthesia were enrolled in the study. During total intravenous general anesthesia, train-of-four (TOF) and post-tetanic counts (PTC) responses following 0.9 mg/kg rocuronium administration were concurrently monitored at the AP and the ADM muscles with EMG AF-201P on the opposite arms. At the end of the surgery, sugammadex 2 mg/kg was administered when TOF counts of 2 (TOFC2) was observed at both muscles. The primary outcome of the study was time from administration of rocuronium to first appearance of PTC response (first PTC). The secondary outcomes of the study were time from administration of rocuronium to TOF count of 1 (TOFC1), time from first PTC to TOFC1 (PTC-TOF time), time to TOFC2, and time from administration of sugammadex to TOF ratio ≥ 0.9. Agreement between the two muscles was assessed using the Bland–Altman analysis. Data are expressed as mean ± standard deviation. Results Nineteen patients were included in the analysis. Time to first PTC was significantly faster at the ADM muscle than the AP muscle (24.4 ± 11.4 min vs 32.4 ± 13.1 min, p = 0.006). PTC-TOF time was significantly longer with the ADM muscle than the AP muscle (19.4 ± 7.3 min vs 12.4 ± 10.6 min, p = 0.019). There were no significant differences in time to TOFC2 and sugammadex-facilitated recovery between the two muscles. Bland–Altman analyses showed acceptable ranges of bias and limits of agreement of the two muscles. Conclusions The ADM muscle showed a good agreement with the AP muscle during rocuronium-induced neuromuscular block but faster recovery of PTC response when using EMG. Trial registration UMIN-CTR (Registration No. UMIN000044904 ). Registered 19 July 2021 -Retrospectively registered, https://center6.umin.ac.jp/cgi-bin/ctr_e/ctr_view.cgi?recptno=R000051290 .

Purpose This study examined the incidence of depression and associated factors among elderly persons from Iitate village after the March 2011 earthquake. Method This was a prospective cohort study. As a baseline survey, in May 2010 a self-assessment Basic Checklist (BCL) was distributed to 1611 elderly villagers, of which 1277 responded. Of these respondents, 885 without a tendency to depression (69.3%) were given a follow-up survey in May 2013. The BCL was used to assess depression tendency, instrumental activities of daily living (IADL), physical function, nutritional status, oral function, homeboundness, cognitive function and social activities. Univariate analysis was used to examine differences in risk between those with a presence of depression tendency (PDT) and those without (non-PDT) depending on demographic and BCL variables. Variables found to be significant were analysed by Poisson regression analysis. Results Of the 438 respondents in the second survey, 163 (37.2%) showed depression tendency. PDT risk was significantly increased by female gender, age, history of diabetes and cognitive disorder. It was significantly reduced by increased IADL. Engagement in social activities decreased PDT risk in rental accommodation. Discussion Renters faced a higher risk of PDT than persons evacuated in groups to purpose-built housing. The inclusion of social activities in the multivariate Poisson regression analysis weakened this effect. Female gender, a history of diabetes, reduced IADL and a tendency to cognitive disorder each independently affected PDT risk. These findings may inform future responses to earthquakes and the technical disasters that may accompany them. [ABSTRACT FROM AUTHOR]

The disaster at the Fukushima Daiichi Nuclear Power Plant after the Great East Japan Earthquake on March 11, 2011, might have affected the mental health status of children. To assess the mental health status, we measured the Strengths and Difficulties Questionnaire (SDQ) in 15 274 children (aged 4-15 years). The proportions of those who scored above the cutoff (≥16) of SDQ, reflecting the clinical range of the mental health status, were 25.0% (aged 4-6 years), 22.0% (aged 7-12 years, and 16.3% (aged 13-15 years), which were higher than that in the usual state (9.5%). We also explored the possibility that the distribution on the Fukushima prefectural map of the proportions of those who scored above the cutoff (≥16) of SDQ might correspond with the environmental radiation levels, but there was no significant correlation. [ABSTRACT FROM AUTHOR]

Abstract Background Several neuraxial techniques have demonstrated effective post-cesarean section analgesia. According to previous reports, it is likely that patient-controlled epidural analgesia (PCEA) without opioids is inferior to intrathecal morphine (IM) alone for post-cesarean section analgesia. However, little is known whether adding PCEA to IM is effective or not. The aim of this study was to compare post-cesarean section analgesia between IM with PCEA and IM alone. Methods Fifty patients undergoing elective cesarean section were enrolled in this prospective randomized study. Patients were randomized to one of two groups: IM group and IM + PCEA group. All patients received spinal anesthesia with 12 mg of 0.5% hyperbaric bupivacaine, 10 μg of fentanyl, and 150 μg of morphine. Patients in IM + PCEA group received epidural catheterization through Th11–12 or Th12-L1 before spinal anesthesia and PCEA (basal 0.167% levobupivacaine infusion rate of 6 mL/h, bolus dose of 3 mL in lockout interval of 30 min) was commenced at the end of surgery. A numerical rating scale (NRS) at rest and on movement at 4,8,12,24,48 h after the intrathecal administration of morphine were recorded. In addition, we recorded the incidence of delayed ambulation and the number of patients who requested rescue analgesics. We examined NRS using Bonferroni’s multiple comparison test following repeated measures analysis of variance; p

Background: Relocation following a disaster can impact the psychological well-being of evacuees. This study investigated the associations between residence-related factors and psychological distress among evacuees living in temporary housing after the Fukushima Daiichi Nuclear Power Plant accident. Methods: Data from 525 participants living in temporary housing were collected. Associations between residence-related factors (frequent relocation, dissatisfaction with the residence, and plan to move to permanent housing) and psychological distress were measured. The psychological distress of evacuees was measured using the Japanese version of the 6-item Kessler scale (K6). We used a cut-off score of five to identify cases with psychological distress, the basis of Kessler's 6 items for psychological distress. Results: Multivariate logistic regression analysis (n = 418) showed that frequent relocation (OR = 2.05, 95% CI: 1.14-3.66, p = 0.016) and dissatisfaction with the residence (OR = 2.48, 95% CI: 1.60-3.83, p < 0.001) was significantly associated with psychological distress. After stratifying by gender, dissatisfaction with the residence was associated with psychological distress, and a plan to move to permanent housing was significantly associated with psychological distress in women (OR = 1.93, 95% CI: 1.03-3.63, p = 0.041). Conclusions: Frequent relocation and dissatisfaction with the residence were associated with psychological distress among evacuees following the Fukushima nuclear disaster. Evacuees should be provided with comfortable living spaces, and steps should be taken to reduce repeated relocation of evacuees. Thus, particular attention should be paid to women with a plan to move to permanent housing within this context. [ABSTRACT FROM AUTHOR]

The objectives of this study were to explore how health information sources vary by functional health literacy levels and the relationship between health literacy and health behaviors among the old-old, community-dwelling adults. A cross-sectional study was used. The sample included 620 participants from a rural community in northern Japan. We used structured questionnaires to gather demographic information and assess health-related behaviors, information sources utilized, and functional health literacy. Functional health literacy scores were categorized into three groups, namely, low, middle, and high literacy. Individuals with limited health literacy were more likely to drink less alcohol, were less physically active, had less dietary variety, and had a low rate of medical check-ups. They were also less likely to use printed media, organization or medical procedure, electronic media, and accessed fewer health-related information sources. This study highlights the necessity of information tools that facilitate better access to information among older adults with limited health literacy. [ABSTRACT FROM AUTHOR]

Abstract Sugammadex, a modified gamma-cyclodextrin, has changed clinical practice of neuromuscular reversal dramatically. With the introduction of this selective relaxant binding agent, rapid and reliable neuromuscular reversal from any depth of block became possible. Sugammadex can reverse neuromuscular blockade without the muscarinic side effects typically associated with the administration of acetylcholinesterase inhibitors. However, what remained unchanged is the incidence of residual neuromuscular blockade. It is known that sugammadex cannot always prevent its occurrence, if appropriate dosing is not chosen based on the level of neuromuscular paralysis prior to administration determined by objective neuromuscular monitoring. Alternatively, excessive doses of sugammadex administered in an attempt to ensure full and sustained reversal may affect the effectiveness of rocuronium in case of immediate reoperation or reintubation. In such emergent scenarios that require onset of rapid and reliable neuromuscular blockade, the summary of product characteristics (package insert) recommends using benzylisoquinolinium neuromuscular blocking agents or a depolarizing agent. However, if rapid intubation is required, succinylcholine has a significant number of side effects, and benzylisoquinolinium agents may not have the rapid onset required. Therefore, prior administration of sugammadex introduces a new set of potential problems that require new solutions. This novel reversal agent thus presents new challenges and anesthesiologists must familiarize themselves with specific issues with its use (e.g., bleeding risk, hypermagnesemia, hypothermia). This review will address sugammadex administration in such special clinical situations.

We report a rare case of primary hepatic gastrinoma. A 77-year-old woman exhibited continuous watery diarrhea for 8 months and weight loss. Bacterial cultures of the stools were negative and colonoscopy revealed no abnormalities. Esophagogastroduodenoscopy showed severe reflux esophagitis and multiple duodenal erosions. Computed tomography and magnetic resonance imaging detected two solid masses measuring 2 receptor antagonist and proton pump inhibitor administrations. Based on an arterial stimulation and venous sampling test, the patient was diagnosed as primary gastrinoma of the liver. Our findings demonstrated the presence of Zollinger-Ellison syndrome in a patient who was subsequently cured by surgical resection of the liver tumors.

The objective of this study was to determine the point after sugammadex administration at which sufficient or insufficient dose could be determined, using first twitch height of train-of-four (T1 height) or train-of-four ratio (TOFR) as indicators. Groups A and B received 1 mg/kg and 0.5 mg/kg of sugammadex, respectively, as a first dose when the second twitch reappeared in train-of-four stimulation, and Groups C and D received 1 mg/kg and 0.5 mg/kg of sugammadex, respectively, as the first dose at posttetanic counts 1–3. Five minutes after the first dose, an additional 1 mg/kg of sugammadex was administered and changes in T1 height and TOFR were observed. Patients were divided into a recovered group and a partly recovered group, based on percentage changes in T1 height after additional dosing. T1 height and TOFR during the 5 min after first dose were then compared. In the recovered group, TOFR exceeded 90% in all patients at 3 min after sugammadex administration. In the partly recovered group, none of the patients had a TOFR above 90% at 3 min after sugammadex administration. An additional dose of sugammadex can be considered unnecessary if the train-of-four ratio is ≥90% at 3 min after sugammadex administration. This trial is registered with UMIN000007245.

Purpose. Hypoglossal nerve palsy after use of the laryngeal mask airway (LMA) is an exceptionally rare complication. We present the first case of unilateral hypoglossal nerve palsy after use of the LMA Supreme. Clinical Features. A healthy 67-year-old female was scheduled for a hallux valgus correction under general anesthesia combined with femoral and sciatic nerve blocks. A size 4 LMA Supreme was inserted successfully at the first attempt and the cuff was inflated with air at an intracuff pressure of 60 cmH2O using cuff pressure gauge. Anesthesia was maintained with oxygen, nitrous oxide (67%), and sevoflurane under spontaneous breathing. The surgery was uneventful and the duration of anesthesia was two hours. The LMA was removed as the patient woke and there were no immediate postoperative complications. The next morning, the patient complained of dysarthria and dysphasia. These symptoms were considered to be caused by the LMA compressing the nerve against the hyoid bone. Conservative treatment was chosen and the paralysis recovered completely after 5 months. Conclusion. Hypoglossal nerve injury may occur despite correct positioning of the LMA under the appropriate intracuff pressure. A follow-up period of at least 6 months should be taken into account for the recovery.