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Background: After-hours house call (AHHC) medical services have been implemented in Japan to reduce ambulance use, as well as overcrowding at the emergency department (ED). Examining the pre-and post-home visit behaviors of those using AHHC medical services will provide insights into the usefulness of these services and help develop strategies to reduce ED visits and ambulance use further., Methods: This questionnaire-based study used data from anonymized medical records and internet-based questionnaires completed by patients who used AHHC medical services in Tokyo, Japan, between January 1 and December 31, 2019. The questionnaire comprised two questions: (1) What action would the patient have taken in the absence of AHHC services and (2) what action was taken within 3 days following the use of the AHHC services. In addition, following home consultations, AHHC doctors classified the patient's illness severity as mild (treatable with over-the-counter medications), moderate (requires hospital or clinic visit), or severe (requires ambulance transportation)., Results: Of the 15,787 patients who used AHHC medical services during the study period, 2128 completed the questionnaire (13.5% response rate). Individuals aged ≤15 years and 16-64 years were the most common users of AHHC services (≤15 years, 71.4%; 16-64 years, 26.8%). Before using the AHHC service, 46.4% of the total respondents reported that they would have visited an ED had AHHC services not been available (≤15 years, 47.8%; 16-64 years, 42.8%; ≥65 years, 43.6%). The proportion of patients originally planning to call an ambulance was higher among those in the older age groups (≤15 years, 1.1%; 16-64 years, 6.0%; ≥65 years, 20.5%). After using the AHHC services, most patients (68.1%) did not visit a hospital within 3 days; however, the proportion of patients who visited an ED and called an ambulance within 3 days increased with the severity of illness., Conclusions: Increasing AHHC medical services awareness among older adults and patients assessed as having severe illnesses regularly availing of AHHC services may help reduce ED visits and ambulance use., (© 2021. The Author(s).)

Objective The present study analyzed the psychological status of healthcare workers in Japan and the influencing factors during the 2019 coronavirus disease pandemic. Methods An online survey was conducted from July 22 to August 21, 2020. A total of 328 of the 1,029 medical staff members in our university hospital participated in the study. Their mental health was assessed using the 12-item General Health Questionnaire. A multivariate regression analysis was performed to identify the factors associated with the mental health outcomes. Results Of the respondents, 78.0% reported psychological distress. Overall, we found that women, non-physicians, those who lived alone, and younger respondents had significantly greater psychological distress than their counterparts. The multivariate regression analysis showed that four factors were extracted as independent 12-item General Health Questionnaire-related factors: the lack of a sense of mission as a medical professional, the burden of the change in the quality of work, the lack of understanding about virus infectivity, and a strong sense of duty. Conclusion In summary, we found a high prevalence of psychological distress among healthcare workers during the 2019 coronavirus disease outbreak in Japan. Independent risk factors for psychological distress were the burden of the change in the quality of work, the lack of understanding about virus infectivity, a sense of responsibility, and the lack of a strong motivation and drive to help.

We present two cases of severely calcified thoracoabdominal aortic aneurysm treated by means of endografting with a retrograde aortomesenteric bifurcated bypass graft reconstructing the celiac axis and superior mesenteric artery. To avoid spinal ischemia, we monitored evoked spinal cord potential and performed an occlusion test of the intercostal arteries using a retrievable stentgraft. No change in evoked spinal cord potential was noted, and no endoleaks or complications, including paraplegia, were observed. This procedure is a feasible and less-invasive treatment for severely calcified thoracoabdominal aortic aneurysms.

We investigated the incidence rates of cerebral palsy, severe mental and motor retardation, and Down syndrome in the City of Kokubunji in suburban Tokyo with a total population of about 100,000. The number of liveborn babies during 1985-1989 was 5,475. The number of children with cerebral palsy (CP) was 11 and the incidence rate was 2.01/1,000, which was equal to the rates in reports from several countries and was higher than those of the previous reports from Japan. Two out of 10 patients with CP had mild motor handicaps and were expected to "outgrow" their handicaps. The number of children with "severe mental and motor retardation" (SMMR) was 6 and the incidence rate was 1.10/1,000. Prenatal brain damage played a major role in the pathogenesis of CP and SMMR. The number of children with Down syndrome (DS) was 11 and the incidence rate was 2.01/1,000 which was higher than the previous rates. Incidence rates of CP, SMMR, and DS still remain high and further strategy to prevent pediatric neurological diseases is necessary.