Search

Current guidelines recommend colonoscopy within 24 h for acute lower gastrointestinal bleeding; however, the evidence in support for colonic diverticular hemorrhage (CDH) indications remains insufficient.To investigate the effectiveness of early colonoscopy on the length of hospital stay for CDH patients.We conducted a single-center retrospective cohort study. Patients who underwent colonoscopy within 24 h of presentation (early group) were compared with those who underwent colonoscopy beyond 24 h of presentation (elective group). The primary outcome was the length of hospital stay, and secondary outcomes were the identification of stigmata of recent hemorrhage (SRH), rebleeding, red blood cell transfusion more than 4 units, and interventional radiology and abdominal surgery after colonoscopy.We identified 574 CDH cases. Patients were divided into the early (Early colonoscopy within 24 h, on arrival for CDH, could not improve the length of hospital stay.

Because generalized pustular psoriasis (GPP) is rare, there are few studies reporting treatments and outcomes for large numbers of patients.To report treatments and outcomes in a large cohort of patients hospitalized with GPP.Using a Japanese national inpatient database, we identified 1516 patients with GPP who required hospitalization between July 2010 and March 2019. We categorized patients into 3 medication groups: biologics (294 patients), oral agents without biologics (948 patients), and systemic corticosteroids only (274 patients). We investigated their characteristics, treatments, and outcomes.Mean age was 66 years (interquartile range: 52-77 years). Fifty patients (3.3%) were admitted to the intensive care unit, 125 (8.2%) required blood pressure support, and 63 (4.2%) died. Patients who received biologics were younger and had fewer comorbidities. In-hospital mortality was lower in the biologics group (1.0% [biologics group] vs 3.7% [oral-agents group] vs 9.1% [corticosteroids-only group]; P .001) as was morbidity (5.4% vs 8.2% vs 12%, respectively; P = .02). Among those who received biologics, IL-17 inhibitor use increased over time, with in-hospital mortality and morbidity comparable to those of tumor necrosis factor inhibitors.Retrospective study design. Some patients received multiple medications.Biologic treatments showed favorable outcomes compared with other treatments.

Objective To examine the associations of 3 major hospital discharge services covered under health insurance (discharge planning, rehabilitation discharge instruction, and coordination with community care) with potentially avoidable readmissions (PARs) within 30 days in older adults after rehabilitation in acute care hospitals in Tokyo, Japan. Design Retrospective cohort study using a large-scale medical claims database of all Tokyo residents aged ≥75 years. Setting Acute care hospitals. Participants Patients who underwent rehabilitation and were discharged to home (N=31,247; mean age in years ± SD, 84.1±5.7) between October 2013 and July 2014. Interventions None. Main Outcome Measure 30-day PAR. Results Among the patients, 883 (2.9%) experienced 30-day PAR. A multivariable logistic generalized estimating equation model (with a logit link function and binominal sampling distribution) that adjusted for patient characteristics and clustering within hospitals showed that the discharge services were not significantly associated with 30-day PAR. The odds ratios were 0.962 (95% confidence interval [CI], 0.805-1.151) for discharge planning, 1.060 (95% CI, 0.916-1.227) for rehabilitation discharge instruction, and 1.118 (95% CI, 0.817-1.529) for coordination with community care. In contrast, the odds of 30-day PAR among patients with home medical care services were 1.431 times higher than those of patients without these services (P Conclusions The insurance-covered discharge services were not associated with 30-day PAR, and the development of comprehensive transitional care programs through the integration of existing discharge services may help to reduce such readmissions.

Background and Aim Intestinal strictures in Crohn's disease (CD) have a high rate of repeated surgery. As alternatives to surgery, endoscopic balloon dilatation (EBD), immunomodulators (IMs), and antitumor necrosis factor alpha (anti‐TNFα) have been proposed. We aimed to assess the effectiveness of the combined therapy with anti‐TNFα and EBD in preventing intestinal stricture recurrence and surgery in patients with CD. Methods This retrospective cohort study included patients from the nationwide administrative database in Japan who were hospitalized and underwent at least one EBD between 1 April 2010 and 31 March 2017. The effectiveness of anti‐TNFα was evaluated by performing survival analysis for the primary outcome. We selected the inverse probability of treatment weighting method for adjustment of covariates. As an exploratory analysis, we evaluated the association of anti‐TNFα initiation timing with intestinal stricture recurrence. Results The anti‐TNFα exposed group had a significantly lower risk of intestinal stricture recurrence than that of the anti‐TNFα nonexposed group (hazard ratio = 0.38, 95% confidence interval 0.31–0.48, P, The combined therapy with anti‐TNFα and EBD could have preventive effects for intestinal stricture recurrence and surgery in hospitalized patients with CD. Particularly, anti‐TNFα initiation may be recommended before or after EBD, not immediately after EBD. With respect to EBD, it is important to clarify the effectiveness of combination therapy with several new medication treatments, such as biologics.

Urbanization and ageing are worldwide issues for healthcare providers. In particular, older adults aged 90 years and older have increased cognitive impairment and lower daily functioning than younger adults. However, the healthcare use of the oldest old remains unclear. This study aimed to describe the healthcare use of the oldest old compared with younger older adults in a city using the ecology of medical care model.We conducted a cross-sectional study. This study targeted all residents aged 75 years and older registered in a city in Japan for one year. We described healthcare use per 1000 inhabitants over a 1-month period and included: outpatient visits, emergency department visits, hospitalizations, home visits, home care services, and facility services. We also compared healthcare use among older adults aged 75-89 years and 90 years and older.We described the healthcare use of 454 366 (male/female: 186 177/268 189) older adults. The numbers of persons per 1000 residents who used healthcare resources at least once in 1 month (75-89 years/90 years and older) were: outpatient clinic visits, 622/570; hospital outpatient visits, 300/263; advanced treatment hospital outpatient visits, 16/6; emergency department visits, 10/27; hospitalizations, 45/96; advanced treatment hospital hospitalizations, 2/1; planned home visits, 36/228; urgent home visits, 6/38; home care services, 173/533; and facility services, 32/178.The results revealed that older adults over 90 years had more hospitalizations, emergency department visits and home visits, and used facility/home care services more compared with older adults aged 75-89 years. The results provide a useful benchmark for healthcare use estimation. Geriatr Gerontol Int 2022; 22: 483-489.

Aim To determine the patterns of concomitant drug use for chronic diseases and examine the risk factors of polypharmacy in older outpatients. Methods Data were extracted from an anonymized health insurance claims database of a public insurance program for older adults in Tokyo, Japan. We analyzed individuals aged ≥75 years who had visited an outpatient clinic, and were regularly prescribed orally administered drugs for chronic diseases for ≥14 days between May and August 2014. The prescription patterns for 16 main drug types were studied using exploratory factor analysis, and the risk factors of polypharmacy, defined as the concomitant prescription of five or more drugs, were identified using multivariate logistic regression models. Results A total of 1 094 199 outpatients were analyzed (mean age 81.8 years, 38.4% men). We identified five prescription patterns that explained almost 40% of all observed variance: edema/heart failure/atrial fibrillation-related drugs, insomnia/anxiety-related drugs, pain-related drugs, lifestyle disease-related drugs and dementia-related drugs. The significant risk factors of polypharmacy included men, octogenarians and nonagenarians, higher number of medical institutions visited, use of physician home visits, and hospitalization during the study period. The main drug types most strongly associated with polypharmacy were analgesics, diuretics and antidiabetics. Conclusions Polypharmacy was found to be prevalent in older outpatients aged ≥75 years in Tokyo. These findings might provide useful evidence that can contribute to the development of practical countermeasures against adverse events associated with polypharmacy in clinical practice. Geriatr Gerontol Int 2020; 20: 304-311.

Background Postoperative respiratory failure is a serious problem in the anaesthetic management of patients with myasthenia gravis who undergo thymectomy. Although the classical recommendation is to avoid neuromuscular blockers, there is no strong evidence to support it. Objectives To evaluate the postoperative outcomes in patients with myasthenia gravis after thymectomy when anaesthetic management included rocuronium reversed with sugammadex. Design A retrospective cohort study. Setting Nationwide acute in-patient care database. Patients A total of 1143 patients with myasthenia gravis who underwent thymectomy were included. Data were collected from the medical insurance claims data of acute care in-patient hospitals. Main outcome measures The postoperative complications when rocuronium reversed with sugammadex was compared against no muscle relaxant use using propensity score matching. The primary outcomes were the rates of in-hospital mortality, plasma exchange following thymectomy and the use of immunoglobulins. The secondary outcomes were the length of stay in the high dependency/ICUs, the total length of hospital stay and the duration and type of respiratory support following thymectomy. Results There were no significant differences between the propensity score matched groups in terms of plasma exchange [relative risk, 0.96; 95% confidence interval (CI), 0.64 to 1.43] and use of immunoglobulins (relative risk, 1.09; 95% CI, 0.60 to 1.97). The length of hospital stay was significantly shorter in patients in whom rocuronium and sugammadex were used: 29.0 vs. 35.4 days, P = 0.035. Conclusions Anaesthetic management with rocuronium reversed by sugammadex was not associated with increased risk of respiratory complications. These findings could help in the anaesthetic management of patients with myasthenia gravis.

Aim: Psychotherapy is an effective intervention for depressive cancer patients. However, there are barriers to applying psychotherapy in clinical settings. This study assessed cancer patients’ preferences for psychotherapy using a conjoint analysis.Methods: We conducted a single-center, cross-sectional study using a self-reported questionnaire between March 2018 and March 2020. The questionnaire asked for patients’ preferences for 48 psychotherapy scenarios according to a combination of type, length, price, and frequency. We conducted a conjoint analysis, calculating the relative importance and part worth value of each factor.Results: Cancer patients consider type as the most important factor when deciding whether to undergo psychotherapy (relative importance: 37.5%), followed by frequency (23.4%), price (19.6%), and length (19.5%). Cancer patients value life reviews highly among the four psychotherapy types. Conclusion: Cancer patients consider the type of psychotherapy to be the most important factors when choosing it, although their preferences do depend on their individual characteristics.

We describe the efficacy of high-dose barbiturates and early administration of a parenteral ketogenic diet (KD) as initial treatments for acute status epilepticus (SE) in an 8-year-old girl with febrile infection-related epilepsy syndrome (FIRES). The patient was admitted to our hospital with refractory focal SE. Abundant epileptic discharges over the left frontal region were observed on electroencephalogram (EEG). Treatment with continuous infusion of thiamylal for 4 hours, increased incrementally to 40 mg/kg/h, successfully ended the clinical SE, and induced a burst-suppression coma. The infusion rate was then gradually decreased to 4 mg/kg/h over the next 12 hours. Parenteral KD was administered from days 6 to 21 of illness. Continuous infusion of thiamylal was switched to midazolam on day 10 without causing seizures or EEG exacerbations. The patient has remained seizure free in the 15 months since hospital discharge. The effectiveness of KD for the treatment of FIRES has attracted attention amongst clinicians, but KD treatment may need to last for 2 to 4 days before it can stop SE, a time period that could cause irreversible brain damage. Considering the severity of SE in our patient and the dose of barbiturates needed to treat it, we consider this case to have had a good clinical outcome. The results suggest that rapid termination of seizure using high-dose barbiturates in conjunction with early administration of parenteral KD could reduce the development of chronic epilepsy in patients with FIRES.

Having more than job and physical exhaustion derived from the job demands considerably overload workers and impair their quality of life (QoL). These factors might interfere with the health of this population of workers reflecting as work-related musculoskeletal disorders.To investigate the correlation between musculoskeletal symptoms and QoL among workers at the intensive care unit of a public hospital in Teresina, Piauí, Brazil.Cross-sectional quantitative, observational and analytical study performed with 30 workers at a public hospital ICU. WHOQOL-BREF, the Nordic Musculoskeletal Questionnaire and a sample profile instrument were administered by the investigators during the working hours.86.7% of the sample reported pain in at least one body side, particularly in the knees in the past 7 seven days (23.3%) and in the lower back in the past 12 months (50%). The participants' QoL was reasonable. We found significant moderate correlation between pain and WHOQOL domains physical health (p=0.10) and social relationships (p=0.011) but no correlation with the participants general characteristics.Occurrence of musculoskeletal symptoms might interfere with the QoL, social life and performance at work of ICU workers.O acúmulo de vínculos empregatícios e o desgaste físico causado pelas exigências do trabalho provocam grande sobrecarga nos profissionais, levando ao comprometimento de sua qualidade de vida (QV). Esses fatores podem interferir na saúde desses profissionais, refletindo-se em distúrbios osteomusculares relacionados ao trabalho.Verificar e correlacionar a presença de sintomas osteomusculares e a qualidade de vida dos profissionais de saúde da unidade de terapia intensiva (UTI) de um hospital público de Teresina.Estudo de campo, quantitativo, de caráter observacional, transversal e analítico, realizado com 30 profissionais da UTI de um hospital público, por meio de questionários que foram aplicados pessoalmente e durante o horário de trabalho dos participantes, sendo eles: o questionário de qualidade de vida (WHOQOL-BREF), oDos profissionais, 86,7% sentiam dor em pelo menos uma parte do corpo, de modo que a área mais mencionada nos últimos sete dias foi o joelho (23,3%) e nos últimos 12 meses a coluna lombar (50%). A QV desses profissionais mostrou-se razoável, e, ao correlacionar a dor com os domínios da QV, notou-se correlação moderada e significativa entre ela e os domínios físico (p=0,010) e relações sociais (p=0,011). Não foram encontradas relações entre as características gerais dos participantes com a QV e a presença de dor.O aparecimento de sintomas musculoesqueléticos em profissionais de saúde da UTI pode repercutir na vida deles e interferir no seu aspecto social e no seu desempenho ocupacional.

Highlights • We examined links between medical claims and health check-up data for older adults. • Patients receiving pharmacotherapies were more likely to participate in health checkups. • Patients with intensive disease control were more likely to be aged ≥ 90 years. • Linking these databases can improve evaluations of diseases control in older adults., The Japanese government encourages older adults to participate in annual health checkups designed to detect lifestyle diseases such as hypertension, diabetes, and dyslipidemia. However, individuals who are already being treated for these diseases are unlikely to benefit from health checkup participation. This retrospective cohort study of older adults evaluated the associations of pharmacological treatments for these diseases with health checkup participation and identified the disease control factors among patients receiving treatments. Using medical claims data and health checkup data between September 2013 and August 2014 from 820,215 older adults aged ≥ 75 years residing in Tokyo, Japan, we examined the associations between pharmacological treatments and health checkup participation using binary logistic regression analysis. Next, patients receiving pharmacological treatments were categorized into intensive, moderate, or limited disease control based on their blood pressure, hemoglobin A1c levels, and lipid levels; multinomial logistic regression analyses were used to identify the disease control factors. The results showed that patients receiving pharmacological treatments were more likely (odds ratio: 1.374; P

Este estudo tem como objetivo analisar a evolucao clinica de pacientes com aneurisma cerebral internados aguardando neurocirurgia de embolizacao; acompanhar e registrar a evolucao clinica e complicacoes desses pacientes durante a internacao hospitalar; identificar a media de tempo de permanencia de internacao hospitalar na enfermaria neurologica e caracterizar os motivos relacionados com a permanencia hospitalar desses pacientes. Trata-se de uma pesquisa longitudinal, descritiva e prospectiva realizada na Clinica Neurologica de um Hospital Publico, de julho a outubro de 2017 com pacientes diagnosticados com aneurisma cerebral e aguardando microcirurgia de embolizacao. Amostra composta por 51 pacientes, sendo 74,51% do sexo feminino, com idade da amostra variando entre 24 a 77 anos, com idade media de 53,45 anos, ± 11,78. A Hemiplegia foi o deficit motor mais presente na admissao e alta. O desfecho obito esteve presente em 11,76 %. A media de permanencia hospitalar foi de 20,1 dias. A embolizacao demostrou ser uma cirurgia favoravel ao desfecho clinico do paciente, ja que os obitos estiveram mais relacionados com piora clinica antes do procedimento. O tempo de permanencia hospitalar foi maior que o da literatura encontrada e carencia de vaga de UTI foi o motivo mais frequente para permanencia no leito aguardando agendamento e para suspensao de cirurgias ja agendadas interferindo diretamente no tempo de permanencia hospitalar. Palavras-chave : Aneurisma Intracraniano. Embolizacao Terapeutica. Tempo de Permanencia. Evolucao Clinica. CLINICAL EVOLUTION OF PATIENTS WITH CEREBRAL ANEURYSM HOSPITALIZED IN A PUBLIC HOSPITAL ABSTRACT: This study aims to analyze the clinical evolution of patients with cerebral aneurysms hospitalized waiting for neurosurgery of embolization; monitor and record the clinical course and complications of these patients during hospitalization; to identify the average length of hospital stay in the neurological ward and to characterize the reasons related to the hospital stay of these patients. This is a longitudinal, descriptive and prospective study conducted at the Neurological Clinic of a Public Hospital from July to October 2017 with patients diagnosed with cerebral aneurysm and awaiting embolization microsurgery. The sample consisted of 51 patients, 74.51% female, with a sample age ranging from 24 to 77 years, mean age of 53.45 years, ± 11.78. Hemiplegia was the most present motor deficit at admission and discharge. The death outcome was present in 11.76%. The mean hospital stay was 20.1 days. Embolization proved to be favorable surgery for the clinical outcome of the patient, since the deaths were more related to clinical worsening before the procedure. The length of hospital stay was higher than that of the literature found and lack of ICU vacancy was the most frequent reason for stay in bed waiting for scheduling and for suspension of surgeries already scheduled interfering directly in the length of hospital stay. Keywords: Intracranial Aneurysm. Therapeutic Embolization. Lenght of stay. Clinical Evolution.

AIM To improve preventive strategies for readmission within 30 days after discharge among older patients receiving home medical care services, we examined the associations between readmission within 30 days and the medical institute factors among patients over 75 years of age. METHODS All patients over 75 years of age receiving home medical care services and who had been admitted to hospital or clinic and discharged between September 2013 and July 2014 in Tokyo, Japan, were participants of this study (n=7,213). The primary outcome was readmission within 30 days after discharge. We performed generalized estimating equations (GEEs) using a model with logit link and binominal sampling distribution to examine the associations of sociodemographic variables, the prevalence of chronic diseases and medical institute factors with readmission within 30 days. RESULTS Approximately 11.2% of the patients receiving home medical care services who had been discharged were readmitted within 30 days after discharge. Men, cancer patients, and emergency admission were positively associated with readmission within 30 days according to the GEEs. The rate of readmission within 30 days was lower in patients receiving home medical care services at home care support clinics/hospitals after discharge (adjusted odds ratio [aOR] = 0.205, p value < 0.001) and in patients discharged from hospitals with over 200 beds (aOR = 0.447, p value < 0.001, vs. clinics) than in others. CONCLUSION Home care support clinics/hospitals, which can provide home medical care services around the clock, may help reduce the rate of readmission within 30 days.

Background Military police officers are a distinct population group given they deal everyday with violence and crime. For this reason they are more susceptible to develop burnout syndrome, resulting in significant decrease of productivity and changes in the quality of sleep. Objective To analyze the correlation between burnout syndrome and sleep quality relative among military police officers. Method Cross-sectional, descriptive and quantitative study conducted with 32 military police officers of the military police battalion of Teresina, Piaui, Brazil. Data collection was performed through administration of a questionnaire for sociodemographic data, the Masliach Burnout Inventory and the Pittsburgh Sleep Quality Index. Pearson's correlation was used for statistical analysis. Results The sample comprised 32 male military police officers, with average age 44.35±5.63 years old. Sleep duration exhibited highly significant, inverse and moderate correlation with emotional exhaustion (p=0.0003). Emotional exhaustion exhibited significant moderate correlation with sleep quality (p=0.004). Depersonalization exhibited significant, albeit weak correlation with sleep quality (p=0.03). Conclusion Burnout syndrome domains emotional exhaustion and depersonalization exhibited significant correlation with sleep quality.

PurposeTo evaluate the prescribing patterns of psychotropic polypharmacy for inpatients of acute care hospitals in Japan.MethodsAdministrative data on 2,639,885 patients admitted to acute care hospitals in Japan between July and December of 2008 were analyzed retrospectively. We defined psychotropic medications as antipsychotics, antidepressants, benzodiazepines, and other sedatives/hypnotics and studied their prescription patterns during the hospitalization of patients with stroke, acute cardiac infarction, cancer, and diabetes mellitus.ResultsAt least one psychotropic drug was prescribed in 35.9% of all cases. Two-drug combinations of antipsychotic drugs were prescribed for stroke patients in 14,615 cases (1.4%), more than 2 in 3,132 cases (0.3%), and 22.4% of cases were prescribed 2 or more psychotropic drugs in addition to antipsychotic drugs. Amongst upper gastrointestinal cancer patients, 7.7% were prescribed a combination of 2 or more drugs, including benzodiazepines. Of the upper gastrointestinal cancer patients who were prescribed benzodiazepines, 20.3% were also prescribed 2 or more psychotropic drugs. Amongst stroke and upper gastrointestinal cancer patients, 36.6% and 35.6%, respectively, were treated with combination therapy using drugs of this class and others.ConclusionThere is a pattern of polypharmacy that combines benzodiazepines and other sedatives/hypnotics with antidepressants or antipsychotic drugs, and this study provides a detailed analysis of this within acute care hospitals. Our results indicate the need for additional research into the efficacy of polypharmacy for inpatients in non-psychiatric settings.

Introduction Multimorbidity, the co-occurrence of 2 or more disorders in a patient, can complicate treatment planning and affect health outcomes. Improvements in prevention and management strategies for patients with 3 or more or more co-occurring chronic diseases requires an understanding of the epidemiology of common 3-way disease patterns and their interactions. Our study aimed to describe these common 3-way disease patterns and examine the factors associated with the co-occurrence of 3 or more diseases in elderly Japanese patients. Methods We included all Japanese citizens aged 75 or older living in Tokyo who used medical care between September 2013 and August 2014 (N = 1,311,116) in our analysis. The 15 most common 3-way patterns of 22 target diseases according to sex and age were identified from among all possible combinations by using an anonymized medical claims database. We examined the associations of sociodemographic characteristics and health care use with the presence of 1 or 2 co-occurring diseases and 3 or more co-occurring diseases by using multinomial logistic regression. Results Approximately 65% of patients had 3 or more co-occurring diseases. The most common 3-way pattern was hypertension, coronary heart disease, and peptic ulcer disease in men (12.4%) and hypertension, dyslipidemia, and peptic ulcer disease in women (12.8%). The prevalence of 3 or more diseases was positively associated with men, patients aged 85 to 90, the use of home medical care services, the number of outpatient facilities visited, and hospital admissions. Conclusion The common 3-way disease patterns and multimorbidity factors identified in our study may facilitate the recognition of high-risk patients and support the development of clinical guidelines for multimorbidity.

Military police officers are a distinct population group given they deal everyday with violence and crime. For this reason they are more susceptible to develop burnout syndrome, resulting in significant decrease of productivity and changes in the quality of sleep.To analyze the correlation between burnout syndrome and sleep quality relative among military police officers.Cross-sectional, descriptive and quantitative study conducted with 32 military police officers of the military police battalion of Teresina, Piaui, Brazil. Data collection was performed through administration of a questionnaire for sociodemographic data, the Masliach Burnout Inventory and the Pittsburgh Sleep Quality Index. Pearson's correlation was used for statistical analysis.The sample comprised 32 male military police officers, with average age 44.35±5.63 years old. Sleep duration exhibited highly significant, inverse and moderate correlation with emotional exhaustion (p=0.0003). Emotional exhaustion exhibited significant moderate correlation with sleep quality (p=0.004). Depersonalization exhibited significant, albeit weak correlation with sleep quality (p=0.03).Burnout syndrome domains emotional exhaustion and depersonalization exhibited significant correlation with sleep quality.Os policiais militares fazem parte de um grupo distinto da população por estarem lidando, no seu cotidiano, com a violência e a criminalidade, tornando-se mais suscetíveis a desenvolverem a síndrome deCorrelacionar a síndrome deEstudo descritivo, transversal e quantitativo, com 32 policiais militares pertencentes ao batalhão de polícia militar da cidade de Teresina, Piauí. A coleta de dados ocorreu por meio de um formulário contendo informações sociodemográficas e dois questionários:A amostra foi composta de 32 policiais militares do sexo masculino com idade média de 44,34±5,63 anos. A duração do sono demonstrou correlação moderada extremamente significativa e inversamente proporcional à dimensão exaustão emocional (p=0,0003), correlação moderada e altamente significativa entre exaustão emocional e qualidade do sono (p=0,004) e fraca correlação significativa entre despersonalização e qualidade do sono (p=0,03).Por meio dos resultados obtidos, conclui-se que as dimensões exaustão emocional e des-personalização apresentam correlação significativa com a qualidade do sono.

As Japan's population continues to age rapidly, the national government has implemented several measures to improve the efficiency of healthcare services and to control rising medical expenses for older patients. One such measure was the revision of the medical fee schedule for physician home visits in April 2014, in which eligibility for these visits was restricted to patients who are unable to visit outpatient clinics without assistance. Through an investigation of patients who were receiving physician home visits in Tokyo, this study examines whether this fee schedule revision resulted in an increase in patients who transitioned from home visits to outpatient care. In a retrospective analysis of health insurance claims data, we examined 80,914 Tokyo residents aged 75 years or older who had received at least one physician home visit between January and May 2014. The study period was divided into four periods (January-February, February-March, March-April, and April-May), and we examined the number of patients receiving home visits in the index month of each period who subsequently transitioned to outpatient care in the following month. Potential factors associated with this transition to outpatient care were examined using a generalised estimating equation. The March-April period that included the fee schedule revision was significantly associated with a higher number of patients who transitioned from home visits in the index month to outpatient care in the following month (odds ratio: 4.46, p < 0.001) than the other periods. In addition, patients receiving home visits at residential facilities were more likely to transition to outpatient care (odds ratio: 10.40, p < 0.001). These findings indicate that the fee schedule revision resulted in an increase in patients who ceased physician home visits and began visiting outpatient clinics for treatment.

In Japan, an “Integrated Community Care” model has been introduced into the public long-term care insurance (LTCI) system to help persons ageing in place. The aim of the present study was to examine the association between the development of an Integrated Community Care system and the number of nursing home placements under the LTCI program among municipal governments in Japan. Development of the Integrated Community Care system was assessed by a paper questionnaire distributed to each municipality. The annual number of elderly nursing home placements was obtained from published national statistics data over a 10-year period from 2001 to 2010. The sample consisted of 612 municipalities (35.1 % of all municipalities) that responded to the questionnaire. A multilevel linear regression analysis for panel data revealed significantly smaller annual numbers of nursing home placements per 1000 elderly persons among municipalities that had larger number of agencies joining in multiple service networks of the Integrated Community Care system. A significantly greater number of nursing home placements was also observed among municipalities that had a larger elderly population rate, lower annual number of elderly individuals in intermediate care per 1000 elderly persons, and smaller number of elderly individuals in congregate housings per 1000 elderly persons. The national “ageing in place” policy should explore a revised model of the Integrated Community Care system that is applicable for areas with limited resources.

Adult-onset Still’s disease (AOSD) is a rare disease, and large epidemiological studies of this disease are limited. Furthermore, it has been difficult to show the incidence and characteristics of severe AOSD complications due to the rarity of this disease. The aim of our study was to describe the demographics of AOSD and the incidence and characteristics of severe complications. Using a large Japanese administrative database, we identified hospitalized patients with AOSD and described the demographics. We also calculated the incidence of severe complications (i.e., macrophage activation syndrome [MAS] and disseminated intravascular coagulation [DIC]) and in-hospital mortality in AOSD patients, and then analyzed the age-controlled difference between men and women. We identified 513 patients with AOSD (mean age: 53.1 years; women 64.1 %). According to the age distribution, there was no distinct peak age. The thirties and the sixties were relatively large age groups. There were 76 patients of AOSD with MAS or DIC observed in this study. The incidence of severe complications was 14.8 %, 95 % CI [11.9, 18.2]. Women were more likely to have severe complications than men after controlling for age (odds ratio: 2.07; [1.14, 3.73]; p = 0.014). AOSD does not predominantly affect young adults in our study population. Elderly AOSD patients can be observed more than before due to global population aging. Severe complications are more likely to occur in women than in men.

Objectives This study aimed to describe the clinical and procedural characteristics of drug poisoning, to examine procedural differences between drug poisoning repeaters and non-repeaters, and to estimate the costs of drug poisoning. Methods A retrospective cohort study of a nationally representative sample of 6585 inpatients with drug poisoning was conducted, using the administrative database of the Diagnosis Procedure Combination/Per-Diem Payment System in 2008. Results Although only 3% of patients required surgery and 65% were discharged from the hospitals within 3 days, greater than 30% were admitted to tertiary emergency care (i.e., high-level emergency care) centers that provide care to severely ill and trauma patients who require intensive care. Only 30% of patients received psychiatric consultation during hospitalization. In addition, repeaters were less likely to be admitted to hospitals by ambulance (67% vs. 76%) and more likely to be discharged within 3 days (77% vs. 65%) than non-repeaters. The annual economic burden of drug poisoning in Japan was $66 million (¥7.7 billion), with the population aged 20–39 years accounting for 50% of these costs. Conclusion This study highlights the need for optimally allocating resources and improving prevention strategies.

Descriptive epidemiologic study that aimed to analyze the typical occupational accidents notified by employees of a university hospital in the South of Brazil from 1997 to 2002, and to estimate their risk indicators. A total of 717 accidents were registered; 86% of them (616) were typical and presented an annual average risk coefficient of 6.0 per 100 employees. The groups that presented more risks for accidents were cooks, woodworkers and nursing auxiliaries, while hands were the most affected area. Regarding the accidents nature, the greatest risks involved biological material. Hence, it is necessary to orient personnel about the legal aspects of occupational accidents and review work processes, especially those related to employees who perform activities at greater risk of transmissible diseases like AIDS and hepatitis B and C.Se trata de un estudio epidemiológico descriptivo que tuvo como objetivo analizar los accidentes de trabajo típicos notificados por los trabajadores de un hospital universitario de la región sur de Brasil, de 1997 a 2002 y estimar indicadores de riesgo. Fueron notificados 717 accidentes, siendo 86% (616) típicos, cuyo Coeficiente de Riesgo Promedio Anual fue igual a 6,0 accidentes a cada 100 trabajadores. Los equipos que corrieron los mayores riesgos de sufrir tales accidentes fueron los de los cocineros, carpinteros y auxiliares de enfermería, siendo las manos la parte del cuerpo más afectada. En cuanto a la naturaleza de los accidentes, los de mayor riesgo fueron los relacionados a materiales biológicos. Se constató la necesidad de orientar al personal sobre los aspectos legales de los accidentes y revisar los procesos de trabajo desarrollados, especialmente para los que actúan en funciones cuyos riesgos son mayores de contraer enfermedades graves como SIDA y Hepatitis B y C.Estudo epidemiológico descritivo objetivou analisar os acidentes de trabalho típicos notificados pelos trabalhadores de um hospital universitário da Região Sul do Brasil, de 1997 a 2002, e estimar indicadores de risco. Foram notificados 717 acidentes, sendo 86% (616) típicos, cujo coeficiente de risco médio anual foi igual a 6,0 acidentes a cada 100 trabalhadores. As equipes que correram os maiores riscos de sofrer tais acidentes foram as de cozinheiros, marceneiros e auxiliares de enfermagem, sendo as mãos a parte do corpo mais atingida. Quanto à natureza dos acidentes, aqueles de maior risco foram os que envolveram materiais biológicos. Constatou-se a necessidade de orientação do pessoal sobre os aspectos legais dos acidentes e revisão dos processos de trabalho desenvolvidos, especialmente para os que atuam em funções cujos riscos são maiores para contrair doenças graves como AIDS e hepatite B e C.

Background Little is known about the use of multiple prescribers for benzodiazepines, which might reflect fragmented patient care and increases the risk of hospital admission for drug dependence or poisoning. Therefore, we aimed to identify the prevalence, prescribed quantities, and trajectory of multiple prescriber episodes for benzodiazepines. Methods We conducted a 2-year cohort study of 1178,361 recipients aged 0–74 years using a large health insurance claims database in Japan. We quantified multiple prescriber episodes for benzodiazepines occurring in ambulatory care settings in a baseline and subsequent year by (1) counting the number of unique providers within a 12-month period, (2) calculating the maximum number of unique providers within a single month, and (3) identifying consecutive overlapping prescriptions of over 30 days duration. Results Among 58,314 patients with a benzodiazepine prescription during the baseline year, 282 (0.5%) filled prescriptions from four or more providers within a 12-month period, 439 (0.8%) filled prescriptions from three or more providers within a single month, and 757 (1.3%) filled consecutive overlapping prescriptions. The odds for multiple prescriber episodes were significantly higher among patients with multiple chronic conditions. Consecutive overlapping prescriptions had the best accuracy to detect patients with potentially questionable prescribed quantities as well as to predict those with multiple prescriber episodes in the subsequent year. Conclusions These results highlight the need for pharmacists to increase their involvement in prescription oversight and for health insurance agencies to implement a prescription monitoring program to screen for patients with multiple prescriber episodes for benzodiazepines.