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AIM The present study aimed to investigate the effects of the 2014 Japanese fee schedule revision on trends in artificial nutrition routes, including gastrostomy, nasogastric tube and parenteral nutrition, among older people with dementia, using time series analysis. METHODS The study used claim data in Japan submitted to Fukuoka Late Elders' Health Insurance from fiscal year 2010 to fiscal year 2016. We identified older people with dementia provided for the first time with artificial nutrition via gastrostomy, nasogastric tube or central venous line and aggregated their data by month. Interrupted time series analyses were used to examine trends in artificial nutrition routes over time. RESULTS The numbers of older people with dementia receiving nutrition via gastrostomy, nasogastric tube and parenterally declined consistently. The slopes for pre-revision trends in gastrostomy, nasogastric tube and parenteral nutrition procedures were all significantly negative in the interrupted time series analyses. The post-revision trends in gastrostomy and parenteral nutrition continuously had significant negative slopes. In contrast, the significant negative trend in nasogastric tube procedures in the pre-revision period had disappeared during the post-revision period. CONCLUSIONS The study showed that the fee schedule revision had limited impact on gastrostomy and parenteral nutrition. However the trend for nasogastric tube was ambiguous; hence, sustainable surveillance is required for evidence-based health policy. Geriatr Gerontol Int 2018; 18: 1405-1409.

Objectives: To reveal the effect of age and other factors on perceived anxiety over radiation exposure among decontamination workers in Fukushima Prefecture, Japan. Methods: A survey questionnaire was sent to 1505 workers, with questions regarding age, presence of a written employment contract, previous residence, radiation passbook ownership, presence of close persons for consultation, knowledge of how to access public assistance, and a four-point scale of radiation-related anxiety (1= "Very much," 2= "Somewhat," 3= "A little bit," and 4= "None" ). The relationships between the degree of anxiety and variables were analyzed using the chi-square test and residual analysis. Results: In all, 512 participants responded to the questionnaire. The mean age of participants was 46.2 years (SD: 13.1, range: 18-77). Of them, 50, 233, 168, and 61 workers chose "Very much," "Somewhat," "A little bit," and "None," respectively, on the anxiety scale. Chi-square test showed that participants aged 61 years and over had higher degrees of anxiety (p

OBJECTIVES: The aim of this study was to reveal factors related to heat illness in radiation decontamination workers and determine effective preventive measures. METHODS: A self-administered questionnaire was sent to 1,505 radiation decontamination workers. The questionnaire included age, sex, duration of decontamination work, previous occupation, education provided by employers regarding heat illness, preventive action against heat illness, and subjective symptoms of heat illness during work. We included 528 men, who replied and answered all questions, in the statistical analysis. Subjective symptoms of heat illness were categorized as "no symptoms," "Grade I" and "Grade II" according to severity. A multiple linear regression model was used to determine the factors associated with the severity of heat illness. RESULTS: The mean age of the subjects was 47.6 years old (standard deviation: 13.4). Of the 528 workers, 316 (59.8%) experienced heat illness symptoms (213 at Grade I and 103 at Grade II). The results of the stepwise selection revealed that age, outdoor manual labor, adequate sleep, use of a cool vest, and salt intake were selected as preventive factors, whereas living in a company dormitory or temporary housing, wearing light clothing, and consuming breakfast were selected as risk factors for heat illness. CONCLUSIONS: Both working conditions and living environment are associated with heat illness in radiation decontamination workers. Type of housing and sleep are also strongly related to heat illness during work. Employers should consider not only the working conditions of the employee but also the employee's daily living conditions, in order to prevent heat illness. Language: en

A significant number of patients are diagnosed with "fevers of unknown origin" (FUO) in Shimane Prefecture in Japan where tick-borne diseases are endemic. We conducted molecular surveys for Babesia microti, Ehrlichia species, and Candidatus Neoehrlichia mikurensis in 62 FUO cases and 62 wild rodents from Shimane Prefecture, Japan. PCR using primers specific for the Babesia 18S small-subunit rRNA (rDNA) gene and Anaplasmataceae groESL amplified products from 45% (28/62) and 25.8% (16/62) of captured mice, respectively. Of the 28 18S rDNA PCR positives, 23 and five samples were positive for Hobetsu- and Kobe-type B. microti, respectively. In contrast, of the 16 groESL PCR positives, eight, one and seven samples were positive for Ehrlichia muris, Ehrlichia sp. HF565 and Candidatus N. mikurensis, respectively. Inoculation of selected blood samples into Golden Syrian hamsters indicated the presence of Hobetsu- and Kobe-type B. microti in four and one sample, respectively. Isolation of the latter strain was considered important as previous studies suggested that the distribution of this type was so far confined to Awaji Island in Hyogo Prefecture, where the first case of transfusion-associated human babesiosis originated. DNA samples from 62 FUO human cases tested negative for B. microti 18S rDNA gene, Anaplasmataceae groESL gene, Rickettsia japonica 17K genus-common antigen gene and Orientia tsutsugamushi 56K antigen gene by PCRs. We also conducted seroepidemiological surveys on 62 human sera collected in Shimane Prefecture from the FUO patients who were suspected of carrying tick-borne diseases. However, indirect immunofluorescent antibody tests using B. microti- and E. muris-infected cells detected IgG against E. muris in only a single positive sample. This study demonstrates the presence of several potentially important tick-borne pathogens in Shimane Prefecture and suggests the need for further study on the causative agents of FUOs.

The serovar-specific main antigen (TM antigen) of Leptospira interrogans serovar canicola, which as lipopolysaccharide properties, was treated with 0.1 N sodium hydroxide. This treatment degraded the antigen into two major antigenic components, one of high and one of low molecular weight. The component with the lower molecular weight (approximately 4,000 daltons) consisted mainly of carbohydrates, having lost almost all of the fatty acid and protein components of the original antigen. Although the substance lacked immunoprecipitable activity, it continued to show serovar-specific inhibitory potency in a radioimmunoassay system as well as in a microscopic immunoagglutination reaction of the organisms. The antigenic activity of the compound was also reduced by periodate oxidation as was that of the TM antigen. A component with the same chemical and physicochemical properties was also produced by alkaline treatment from a different serotype TM antigen (serovar kremastos Kyoto), but it showed no antigenic activity.