Replaced posterior cerebral artery.

PURPOSE: Replaced posterior cerebral artery (PCA), defined as a hyperplastic anterior choroidal artery (AChA) supplying all branches of the PCA, is an extremely rare anatomical variation. To the best of our knowledge, there are only a few reports of replaced PCA. METHODS: Herein, we report a case of replaced PCA diagnosed by digital subtraction angiography. RESULTS: A 76-year-old woman visited a neurosurgical clinic because of headache and vertigo. Magnetic resonance imaging and magnetic resonance angiography incidentally revealed a left internal carotid artery aneurysm. She was referred to our hospital for further examination and treatment of the unruptured intracranial aneurysm. Left internal carotid angiography revealed a paraclinoid aneurysm. We also incidentally found an anomalous hyperplastic AChA distal to the aneurysm. This hyperplastic AChA supplied not only the AChA territory but also the entire PCA territory. No vessels that could be a normal AChA or posterior communicating artery were identified along the left internal carotid artery. Vertebral angiography demonstrated that the left PCA was not visualized. With these findings, we diagnosed anomalous hyperplastic AChoA in this case as replaced PCA. CONCLUSION: Careful imaging assessment is important to identify replaced PCA. Both direct findings of a hyperplastic AChA course and perfusion territory and indirect findings of the absence of the original PCA are useful in the diagnosis of replaced PCA.

[Surgical Techniques for Microvascular Decompression in Hemifacial Spasm].

This study discusses the key microvascular decompression(MVD)techniques for the treatment of hemifacial spasm(HFS). The author's experience is based on their institution's cases, highlighting three critical techniques. (1)Vertebral artery(VA)repositioning: Repositioning the VA is essential in challenging cases. This article focuses on the relocation of the proximal portion of the VA and the importance of careful dissection. (2)Relocating vessels compressing the peripheral branches of the facial nerve: HFS can result from nerve compression at various locations, including the cisternal portion. This study addressed cisternal compression and considered the nearby nerves. (3)Considering the perforating branches during repositioning, cases may involve complex branching of the perforating arteries. This paper describes an approach that carefully repositions the vessels without damaging the perforating branches. The results from 100 VA-involved cases showed excellent outcomes, with 91.2% of patients experiencing T0(excellent)results. This study emphasized the need to adapt the surgical approach to each unique case to ensure the safety and effectiveness of MVD. This study provides insights into the critical MVD techniques for HFS, emphasizing the importance of continuous experience and knowledge accumulation. These techniques can be learned by other neurosurgeons, thereby expanding the availability of safe and successful MVD procedures for HFS.

Objectively-captured Changes in Trigeminal Fibers before and after Microvascular Decompression Using 3D T2-SPACE MRI Might Relate to Eventual Residual Symptoms.

Although microvascular decompression (MVD) is a reliable treatment for trigeminal neuralgia (TN), neurosurgeons sometimes encounter patients whose symptoms do not improve postoperatively or who experience good treatment efficacy but develop other sensory disturbances. This study aims to objectively identify changes in nerve fibers before and after surgery by MRI and to clarify the relationship between the changes and residual postoperative symptoms. We retrospectively analyzed data from 36 consecutive patients who underwent MVD for classical TN at our hospital between November 2019 and November 2020. Cases that fulfilled the diagnostic criteria for multiple sclerosis were excluded. We confirmed the changes on the brainstem side of the trigeminal nerve preoperatively and at seven days postoperatively using 3D T2-SPACE MRI, in which the patients were divided into three groups: preoperative T2 high intensity positive (A), postoperative T2 high intensity positive (B), and no T2 high-intensity region (C). The primary outcome measures were therapeutic efficacy and frequency of postoperative numbness. The results of MVD surgery were evaluated one year postoperatively. The percentage of cases in which treatment outcomes were rated as excellent or good at one year: group A: 0 (0%), group B: 6 (100%), and group C: 25 (96.2%) (p < 0.05); the frequency of numbness: 2 (50%) in group A, 3 (50%) in group B, and 1 (3.8%) in group C, indicating significant differences between the three groups (p < 0.05). 3D T2-SPACE MRI sequences can be used to identify changes in trigeminal nerve fibers before and after MVD, which might correlate with eventual residual symptoms.

Sociodemographic and behavioral factors related to obesity among adults in the Republic of Palau based on the WHO STEPwise approach to NCD risk factor surveillance 2011-2013: A cross-sectional study.

BACKGROUND: Pacific islanders face drastic increase of obesity-related noncommunicable disease (NCD) due to lifestyle shifts of unhealthy diets and physical inactivity. To date, however, obesity related factors have not been well elucidated in Republic of Palau. This study aimed to investigate sociodemographic and behavioral factors related to obesity using the national level data in Palau. METHODS: This is a cross-sectional, population-based study analyzing random sampling data of 2133 adults aged 25-64 years (of 20 thousand national population) from the WHO STEPwise approach to NCD risk factor surveillance (STEPS) implemented between 2011 and 2013. Sociodemographic and behavioral factors were obtained by the STEPS standardized questionnaire for NCD risk factors plus the question on betel nut chewing because of its common behavior in Micronesian countries. Logistic regression analysis was performed to estimate multivariable odds ratio (OR) of general obesity (body mass index ≥30.0 kg/m2) and central obesity (waist circumference ≥90 cm in men and ≥80 cm in women). RESULTS: Means of body mass index, prevalence of general obesity and central obesity were higher in women (29.9 kg/m2, 45.5% and 85.4%) than in men (29.3 kg/m2, 40.4% and 67.6%). After adjusted by other potential factors, native Palauan (OR 4.4, 95% CI, 2.7-7.0 for men and 3.6, 2.3-5.6 for women), betel nut chewing (1.5, 1.1-2.1 for men and 1.6, 1.2-2.3 for women), men who work at government office (1.6, 1.2-2.1), women with higher household income (1.4, 1.0-1.8) were positively associated with general obesity, while frequent vegetable intake were inversely associated with it among women (0.71, 0.54-0.93). Similar associations were observed between the aforementioned factors and central obesity. CONCLUSIONS: Native Palauan, people with betel nut chewing behavior, government employment and higher income appeared to be associated with obesity, while frequent vegetable consumption were inversely associated with obesity. Further interventions for prevention and control of obesity are necessary through the enhancing public relation activities to understand harmful health effects on betel nuts chewing and recommending domestic production of vegetables.

Trends in health and health inequality during the Japanese economic stagnation: Implications for a healthy planet.

Introduction: Human health and wellbeing may depend on economic growth, the implication being that policymakers need to choose between population health and the health of ecosystems. Over two decades of low economic growth, Japan's life expectancy grew. Here we assess the temporal changes of subjective health and health inequality during the long-term low economic growth period. Methods: Eight triennial cross-sectional nationally representative surveys in Japan over the period of economic stagnation from 1992 to 2013 were used (n = 625,262). Health is defined positively as wellbeing, and negatively as poor health, based on self-rated health. We used Slope and Relative Indices of Inequality to model inequalities in self-rated health based on household income. Temporal changes in health and health inequalities over time were examined separately for children/adolescents, working-age adults, young-old and old-old. Results: At the end of the period of economic stagnation (2013), compared to the beginning (1992), the overall prevalence of wellbeing declined slightly in all age groups. However, poor health was stable or declined in the young-old and old-old, respectively, and increased only in working-age adults (Prevalence ratio: 1.14, 95% CI 1.08, 1.20, <0.001). Over time, inequality in wellbeing and poor self-rated health were observed in adults but less consistently for children, but the inequalities did not widen in any age group between the start and end of the stagnation period. Conclusions: Although this study was a case study of one country, Japan, and inference to other countries cannot be made with certainty, the findings provide evidence that low economic growth over two decades did not inevitably translate to unfavourable population health. Japanese health inequalities according to income were stable during the study period. Therefore, this study highlighted the possibility that for high-income countries, low economic growth may be compatible with good population health.

Microvascular Decompression for Concurrent Trigeminal Neuralgia and Hemi-Laryngopharyngeal Spasm: A Case Report.

BACKGROUND AND IMPORTANCE: Hemi-laryngopharyngeal spasm (HeLPS) may result from vascular compression of the vagus nerve and can be treated using microvascular decompression. We describe the clinical characteristics and surgical treatment in a case of concurrent trigeminal neuralgia (TN) and HeLPS. CLINICAL PRESENTATION: A 44-year-old man presented with a 12-month history of right TN and 8-month history of intermittent episodes of repeated throat contractions associated with a very distressing choking sensation. Preoperative 3-dimensional fusion imaging demonstrated compression of the trigeminal nerve by the superior cerebellar artery and petrosal vein and compression of the vagus nerve by the posterior inferior cerebellar artery and one of its branches. Microvascular decompression was performed by a right standard retrosigmoid approach with enlarged craniotomy. Initially, the compression of the trigeminal nerve was identified by visual inspection. All the offending vessels were wrapped in Teflon felt, transposed away from the trigeminal nerve, and adhered to the tentorial membrane and petrous bone using fibrin glue. Furthermore, observation of the caudal rootlets of the vagus nerve revealed that the posterior inferior cerebellar artery and its branch compressed the ventral side of the nerve. These vessels were displaced antero-caudally with Teflon felt and fibrin glue; no other vessels were found around the trigeminal and vagus nerves. Postoperatively, the patient had immediate and complete resolution of symptoms of TN and HeLPS without recurrence at the 18-month follow-up. CONCLUSION: HeLPS may occur with TN, and neurosurgeons should identify the symptoms suspicious of this disease preoperatively.

Intravenous Fosphenytoin Therapy as an Acute Rescue Treatment for Glossopharyngeal Neuralgia Crisis in Patients Awaiting Neurosurgical Procedures: A Case Series.

INTRODUCTION: Few treatments exist for acute attacks of glossopharyngeal neuralgia (GPN). We investigated the efficacy of intravenous fosphenytoin therapy (IFT) during GPN crisis. CASE PRESENTATION: We evaluated records of 4 consecutive patients with GPN awaiting microvascular decompression (MVD) who received IFT (total, 750 mg). Pain severity was evaluated using a Numerical Rating Scale (NRS). The score was 10 (maximum pain) before treatment. Case 1 (a 52-year-old woman, left GPN): for 12 hours after IFT, pain was eliminated (NRS 0/10); however, severe pain recurred 2 days later. She received MVD 9 days after IFT. Case 2 (a 72-year-old woman, right GPN): pain score reduced to 0/10 immediately after IFT and remained so for 2 days. Severe pain recurred, and she underwent MVD 4 days after IFT. Case 3 (a 69-year-old woman, right GPN): pain was reduced (NRS, 5/10) immediately after IFT and nearly eliminated (1/10) 1 hour later. After 6 hours, severe pain recurred; she received a second IFT 3 days later, and pain score dropped to 1/10. She was pain-free for 24 hours but intermediate pain recurred in 2 days. Microvascular decompression was performed 9 days after the second IFT. Case 4 (a 32-year-old woman, right GPN): Pain score reduced to 0/10 immediately after IFT and remained so for 4 days. She underwent MVD 4 days after IFT. No evidence of recurrence was found throughout the 24-, 22-, 20-, and 5-month follow-ups. CONCLUSIONS: These results provide new insights into the innovative therapeutic option of intravenous fosphenytoin and contribute to advancements in treating acute GPN crisis.

[Emergency Superficial Temporal Artery-Middle Cerebral Artery Bypass for Atherosclerotic Ischemic Stroke].

Endovascular recanalization is the primary strategy for the treatment of acute embolic stroke. However, atherosclerotic occlusions are often challenging to recanalize, and only medical therapy can be performed. In these cases, even the best medical treatment may not be effective, and the cerebral infarction progressively worsens. We believe that an emergency superficial temporal artery-middle cerebral artery(STA-MCA)bypass could be effective in these situations, after careful case selection. We use the following eligibility criteria: (1)atherosclerotic infarction; (2)cerebral ischemia with blood flow < 70% of the contralateral side; (3)progressively worsening symptoms or widening of the subcortical infarction despite medical treatment; and(4)surgery availability < 72 h from symptom onset. Among the 35 patients who underwent urgent STA-MCA bypass from 2014 to 2020, 27(77.1%)gained gait independence, and the National Institutes of Health Stroke Scale(NIHSS)scores improved from a preoperative median of 8 to 3 at discharge. The modified Rankin score(mRS)improved from a preoperative median of 5 to 2 at discharge. No intracerebral hemorrhages occurred due to hyper-perfusion syndrome. When we match it with other reports, this emergency surgery allows 76-90% of patients with progressive stroke to achieve gait independency.

Lateral Supracerebellar Infratentorial Approach for Superior Oblique Myokymia: A Case Series.

BACKGROUND: Few reports have shown that superior oblique myokymia (SOM) may result from vascular compression of the trochlear nerve and may be curable using microvascular decompression (MVD). OBJECTIVE: To report the clinical characteristics and surgical treatment of 2 cases of SOM and provide a review of the related literature. METHODS: Two patients with SOM were treated using MVD with the lateral supracerebellar infratentorial approach. The patients underwent diagnostic magnetic resonance imaging and three-dimensional fusion imaging preoperatively. A lateral suboccipital craniotomy was performed in the park-bench position. The trochlear nerve and branches of the superior cerebellar artery were confirmed after opening the cerebellomesencephalic fissure over the tentorial surface of the cerebellum. The vessel, which compressed the root exit zone of the trochlear nerve, was transposed far from the nerve and attached to the surface of the midbrain using Teflon felt and fibrin glue. RESULTS: The first case showed compression on both the ventral and rostral sides of the trochlear nerve root exit zone, and the second showed compression only on the ventral side. Large bridging veins on the tentorial surface of the cerebellum complicated the approach in the second case. Postoperatively, both patients had immediate and complete resolution of symptoms without recurrence at the 24-mo and 17-mo follow-ups, respectively. Five previous reports described the complete resolution of SOM after MVD. CONCLUSION: A presentation of an intermittent fluttering ocular sensation should prompt magnetic resonance imaging for ipsilateral trochlear nerve compression. The lateral supracerebellar infratentorial approach allows safe and efficacious MVD for SOM.

The Association Between Informal Caregiving and Poor Self-rated Health Among Ever-married Women in Japan: A Nationally Representative Survey.

BACKGROUND: The number of people providing informal caregiving, including dual care, which is the combination of child and nursing care, is increasing. Due to the burden of multiple responsibility, dual care could negatively affect the health of informal caregivers. Previous research has not studied the effects of combining different types of informal caregiving. Therefore, we examined, among Japanese women, 1) the association between types of informal caregiving and self-rated health (SRH), and 2) difference in this association according to caregivers' socio-economic conditions. METHODS: We analyzed the nationally representative 2013 Comprehensive Survey of Living Conditions data of 104,171 women aged 20-59 years. The odds ratios (ORs) for poor SRH by type of informal caregiving (no care, childcare, nursing care, and dual care) were estimated using logistic regression. We also conducted sub-group analyses by socio-economic conditions (equivalent monthly household expenditure and educational attainment). RESULTS: Compared to the no care group, the adjusted ORs for poor SRH of the childcare, nursing-care, and dual care groups were 0.92 (95% confidence interval [CI], 0.88-0.97), 1.33 (95% CI, 1.21-1.47), and 1.42 (95% CI, 1.23-1.64), respectively. There was no extra risk arisen from combining childcare and nursing care. The sub-group analyses indicated that neither household expenditure nor educational attainment affected the association between caregiving type and poor SRH. CONCLUSION: Our study found that informal nursing care and dual care impose a health burden on female caregivers, regardless of their socio-economic conditions. This highlights the importance of addressing the effects of informal caregiving on the health of women.

Intravenous fosphenytoin therapy for rescue of acute trigeminal neuralgia crisis in patients awaiting neurosurgical procedures: A cross-sectional study.

Few treatments exist for acute attacks of trigeminal neuralgia. Therefore, this study aimed to investigate the efficacy and safety of an intravenous fosphenytoin therapy protocol in a trigeminal neuralgia crisis. We conducted a single-center, retrospective, observational study of the records of 20 patients with trigeminal neuralgia who received intravenous fosphenytoin therapy (15 mg/mL in normal saline at 50 mg/min for 15 min, total 750 mg) during hospitalization between September 2015 and August 2020. Serum phenytoin concentration was measured 30 min post-infusion. Pain severity was evaluated using a numerical rating scale and was analyzed for statistical significance. The mean age of the patients was 67.5 years (female, 50.0%). The median numerical rating scale score (interquartile range) of pain severity was 2.35 (0-10), 0.65 (0-5), 0.15 (0-1), 2.00 (0-8), and 4.30 (0-10) at 15, 30, and 60 min, and 12 and 24 h, respectively (p < .001); the numerical rating scale score was 10 before treatment. Reduction in pain 24 h following treatment was significant. The mean phenytoin concentration was 12.8 µg/mL 30 min post-treatment. While mild dizziness occurred in four patients, all could walk independently within 60 min. The mean age and weight of patients with mild dizziness were significantly higher and lower, respectively (p < .001), than those of other patients. These results may provide physicians with new insights into the innovative therapeutic option of intravenous fosphenytoin and contribute to advancements in treating acute trigeminal neuralgia crisis.

[Maternal occupation and infant mortality in Japan: Insights from the Vital Statistics (Occupational and Industrial Aspects)].

Objectives　The proportion of Japanese women who maintain their employment during pregnancy and after delivery has been increasing. Previous studies from Western countries showed an association between the mother's occupation and birth outcomes; however, to the best of our knowledge, no epidemiological study has analyzed this association in Japan. Therefore, data from the national Vital Statistics: Occupational and Industrial Aspects were used to examine the association between the mother's occupation and (1) the risk of stillbirth at or after 12 weeks of gestation, and (2) the risk of infant death under 1 year of age after livebirth.Methods　Data from the Vital Statistics: Occupational and Industrial Aspects (Live Birth Form, and Foetal Death Form) for fiscal years (FYs) 1995, 2000, 2005, 2010, and 2015 and Vital Statistics data files (Death Form) from FYs 1995-96, 2000-01, 2005-06, 2010-11, and 2015-16 were analyzed. The study population consisted of (1) 5,355,881 infants who were born during the survey period, with (2) 5,290,808 live birth excluding still birth during the same period. The odds ratios (ORs) were estimated for (1) stillbirth (without stillbirth = livebirth) and (2) infant death (without infant death = alive at 1 year of age) by mother's occupation (managers/specialist/technical workers, clerical workers, sales workers, service workers, blue collar workers, and not employed) using logistic regression. Blue collar workers included workers in security, agriculture/forestry/fishing, manufacturing process, transport, and machine operation. The population attributable risk (PAR) for stillbirth attributed to mother's occupation among employed mothers was also calculated.Results　There were 61,179 (1.1%) stillbirths in the study population and 12,789 (0.2%) infant deaths among 5,290,808 live birth. Compared to managers/specialist/technical workers, the adjusted ORs (95% confidence interval) for stillbirth among clerical workers, sales workers, service workers, blue collar workers and not employed women were 1.24 (1.20-1.29), 1.48 (1.41-1.56), 1.76 (1.69-1.83), 1.54 (1.46-1.61), and 0.95 (0.92-0.98), respectively. There was no association between the mother's occupation and infant deaths. The PAR values for stillbirth among mothers employed as clerical workers and service workers were 7.4% and 12.3%.Conclusion　The risk of stillbirth differed according to the mother's occupation in our study. The OR and PAR of stillbirth were the highest for service workers. Mother's occupation was not associated with the risk of infant death; therefore, the mothers' occupation is likely to affect the children's condition only during pregnancy. Our study suggests the importance of understanding the causal linkage between pregnant women's occupation and birth outcomes.

Sequential Change of Facial Nerve Motor Function after Microvascular Decompression for Hemifacial Spasm: An Electrophysiological Study.

Hemifacial spasm (HFS) patients occasionally present with preoperative facial weakness (PFW) or develop delayed facial palsy (DFP) after microvascular decompression (MVD). This study is aimed to evaluate the neurophysiology underlying facial nerve motor dysfunction in HFS patients preoperatively and postoperatively. In all, 54 HFS patients without prior botulinum toxin injection who underwent MVD were retrospectively reviewed. The compound muscle action potential (CMAP) amplitude ratios of the affected and unaffected facial nerves, measured at 4 time points from preoperation to 1 year post-surgery, were aggregated. Clinical outcomes and the CMAP amplitude ratios were evaluated. Six patients (11.1%) presented with PFW, which correlated with advanced age (p = 0.007) and symptom duration (p = 0.001). The average duration to achieve PFW relief was 2.67 months postoperatively. The preoperative CMAP amplitude ratios of PFW patients were lower than those of patients without PFW (85.3% vs 95.7%). The ratios showed the lowest value at 1-week post-surgery in both groups (70.3% vs 90.9%), had a tendency toward improvement at 1 month, and finally recovered to almost the same level as that before the surgery at 1 year. Three patients (5.6%), whose CMAP ratios showed a persistent decrease from 1 week (56.5%) to 1 month (31%) after MVD, developed DFP. This study illustrates PFW in HFS patients reflects facial nerve axonal stress. MVD is effective in resolving spasm and PFW, without long-term damage to the facial nerve in most patients. In DFP patients, the direct and subsequent secondary axonal disorder develops on the postoperative facial nerve.

Association between maternal employment status during pregnancy and risk of depressive symptomatology 1 month after childbirth: the Japan Environment and Children's Study.

BACKGROUND: Previous studies, which examined the association between employment status and postpartum depression, were limited by binary or ternary employment status measures (employed/unemployed or full-time/part-time/unemployed). This study examined the association between detailed employment status during pregnancy and risk of depressive symptomatology 1 month after childbirth, and the effect modification by one's perceived level of social support and household equivalent income. METHODS: Our study examined 76 822 participants in the Japan Environment and Children's Study. The exposure included maternal employment status during pregnancy (regular workers, dispatched workers, part-time workers, self-employed workers, non-employed and others), and the outcome was depressive symptomatology 1 month after childbirth: Edinburgh Postnatal Depression Scale (EPDS scores ≥9 and ≥13). Adjusted ORs and 95% CIs of depressive symptomatology associated with employment status were calculated by multivariable logistic regression. Subgroup analyses by perceived level of social support and household equivalent income were conducted. RESULTS: Compared with regular workers, the risk of depressive symptomatology (EPDS score ≥9) was higher for non-employed and others, and that (EPDS score ≥13) was so for part-time workers. There was no significant interaction by perceived level of social support and household equivalent income in the associations. However, part-time workers and non-employed had excess risk of depressive symptomatology among women with lower perceived level of social support, but not among those with the higher one. CONCLUSION: Compared with regular workers, part-time workers and non-employed had an increased risk of depressive symptomatology, which was confined to women with lower perceived level of social support.

Determinants of alcohol consumption and marijuana use among young adults in the Republic of Palau.

BACKGROUND: This study aimed to describe the status of alcohol consumption and drug use among young adults as well as their determinants. METHODS: We conducted a cross-sectional study of 356 young adults (aged 18 to 24 years) living in Palau in 2013. The prevalence of self-reported alcohol and marijuana usage were compared within and between sexes, age groups, ethnicities, and education levels. RESULTS: The proportion of current drinking was higher in people aged 21-24 than in those aged 18-20 (73.2% vs. 60.9%, p = 0.09 in men and 48.3% vs. 30.0%, p = 0.02 in women), while that of marijuana use did not differ between the age groups. The proportions of current drinking and marijuana use were higher in Palauan than in other ethnicities (current drinking: 70.6% vs. 40.6%, p = 0.005 in men and 38.8% vs. 16.6%, p = 0.04 in women; lifetime marijuana use: 80.0% vs. 52.9%, p = 0.02 in men and 56.1% vs. 30.6%, p = 0.09 in women). The proportion of frequent (3 times or more) marijuana users was higher for the lower educated than for the higher educated (62.5% vs. 32.1%, p < 0.001 in men and 33.9% vs. 24.4%, p = 0.12 in women). CONCLUSIONS: Sex, age, ethnicity, and education were significant determinants of alcohol and marijuana use.

Associations Between Broader Autism Phenotype and Dietary Intake: A Cross-Sectional Study (Japan Environment & Children's Study).

The purpose of the present study was to investigate associations of dietary intake including vitamin D, folate, and n-3 and n-6 polyunsaturated fatty acids (PUFA) in pregnant women with broad autism phenotype (BAP). The Japan Environment and Children's Study is a government-funded birth cohort study. All complete data of 92,011 were analyzed. The Japanese version of the Autism Spectrum Quotient was used to assess mothers' BAP level, and a food frequency questionnaire was used to estimate their dietary intake. Mothers with BAP consumed less vegetables, fruits, and fish and shellfish, and they consumed lower folate, vitamin C, vitamin D, and n-3 PUFA than their counterparts. Dietary intervention should be considered for pregnant women with high BAP scores.

Cross-Sectional Association Between Employment Status and Self-Rated Health Among Middle-Aged Japanese Women: The Influence of Socioeconomic Conditions and Work-Life Conflict.

BACKGROUND: Few studies examining the impact for women of employment status on health have considered domestic duties and responsibilities as well as household socioeconomic conditions. Moreover, to our knowledge, no studies have explored the influence of work-family conflict on the association between employment status and health. This research aimed to investigate the cross-sectional associations between employment status (regular employee, non-regular employee, or self-employed) with self-rated health among Japanese middle-aged working women. METHODS: Self-report data were obtained from 21,450 working women aged 40-59 years enrolled in the Japan Public Health Center-based Prospective Study for the Next Generation (JPHC-NEXT Study) in 2011-2016. Multivariate odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for poor self-rated health ('poor' or 'not very good') by employment status. Sub-group analyses by household income and marital status, as well as mediation analysis for work-family conflict, were also conducted. RESULTS: Adjusted ORs for the poor self-rated health of non-regular employees and self-employed workers were 0.90 (95% CI, 0.83-0.98) and 0.84 (95% CI, 0.75-0.94), respectively, compared with regular employees. The identified association of non-regular employment was explained by work-family conflict. Subgroup analysis indicated no statistically significant modifying effects by household income and marital status. CONCLUSION: Among middle-aged working Japanese women, employment status was associated with self-rated health; non-regular employees and self-employed workers were less likely to report poor self-rated health, compared with regular employees. Lowered OR of poor self-rated health among non-regular employees may be explained by their reduced work-family conflict.

Impact of intention and feeling toward being pregnant on postpartum depression: the Japan Environment and Children's Study (JECS).

Pregnancy intention is reported to be associated with the risk of postpartum depression (PPD), but the impact of feelings toward being pregnant on PPD is unknown. We aimed to examine whether feelings toward being pregnant are associated with PPD at 1 month after childbirth. In our nationwide study between 2011 and 2014 in Japan, we used multivariate logistic regression analyses to examine the associations between pregnancy intention and feelings toward being pregnant with PPD [Edinburgh Postnatal Depression Scale (EPDS score > 9 or > 12)] among Japanese women. Among 92,431 women, 14.0 and 5.4% had PPD with EPDS scores > 9 and > 12, respectively. Compared with women who felt very happy to be pregnant, those whose pregnancy was unintended but happy, unintended and confused, those who felt troubled, and those who felt no emotion toward being pregnant had increased risks of PPD [multivariable odds ratios (95% confidence intervals (CIs)) = 1.17 (1.11-1.22), 1.39 (1.29-1.49), 1.74 (1.42-2.14), and 1.58 (1.22-2.02), respectively, for EPDS score > 9]. Those associations were more evident without antenatal possible mental illness (K6 score < 13). Women whose pregnancy was unintended should be regarded as targets for the early detection and prevention of PPD irrespective of whether they felt happy or confused.

Diet Quality Affects the Association between Census-Based Neighborhood Deprivation and All-Cause Mortality in Japanese Men and Women: The Japan Public Health Center-Based Prospective Study.

BACKGROUND: Individuals residing in more deprived areas with a lower diet quality might have a higher mortality risk. We aimed to examine the association between deprivation within an area and all-cause mortality risk according to diet quality. METHODS: We conducted a population-based prospective study on 27,994 men and 33,273 women aged 45-75 years. Neighborhood deprivation was assessed using the Japanese areal deprivation index (ADI). Dietary intakes were assessed using a validated 147-item food frequency questionnaire. RESULTS: Individuals residing in the most deprived area had the lowest dietary scores. During the 16.7-year follow-up, compared to individuals with a high quality diet residing in the least deprived area, individuals with a low quality diet had a higher risk of mortality according to increment of ADI (p trend = 0.03); the multivariate-adjusted hazard ratio (95% confidence interval) was 1.09 (0.999-1.19), 1.17 (1.08-1.27), and 1.19 (1.08-1.32) in those residing in the lowest through the highest third of ADI, respectively. However, individuals with a high quality diet had no significant association between ADI and mortality. CONCLUSION: A well-balanced diet may prevent early death associated with neighborhood socioeconomic status among those residing in highly deprived areas.

[Preventing Crying after Revascularization Surgery in Pediatric Patients with Moyamoya Disease:Sedation with Dexmedetomidine].

BACKGROUND: Hyperventilation is a well-known risk factor of ischemic events in pediatric patients with moyamoya disease. For young children, it is important to avoid crying to prevent ischemic events because of their unstable postoperative hemodynamics. To prevent crying in pediatric patients, we used dexmedetomidine(DEX)for sedation immediately after revascularization surgery. OBJECTIVE: We investigated the effects of postoperative DEX use on hemodynamic changes and the avoidance of crying and hypocapnia in pediatric patients with moyamoya disease. CASE: Ten consecutive patients(5 boys and 5 girls)who underwent surgical revascularization were enrolled, and 16 hemispheres(8 boys and 8 girls)were sedated with DEX postoperatively between August 2011 and August 2016. METHODS: During extubation after revascularization, DEX was started at 0.4µg/kg/hr under spontaneous breathing and its dose was increased depending on the degree of consciousness, to maintain sedation of at least 3 on the Ramsay scale. DEX administration was terminated the next morning. RESULTS: Sedation was maintained well in all patients without hypocapnia, and no ischemic complications were observed. One patient cried and needed additional intravenous DEX injections and was immediately re-sedated;no hypocapnia developed. Respiratory depression did not occur and changes in respiratory rate and decreases in SpO2 were not observed. No significant changes in systolic blood pressure and heart rate were observed. CONCLUSION: Dexmedetomidine is safe and useful for postoperative sedation in children with moyamoya disease.