COVID-19 fatality and DALYs, and associated metabolic disorders and ambient air pollutants in pre-Omicron era of the pandemic: an international comparative study.

BACKGROUND: Air pollution and a number of metabolic disorders have been reported to increase the risk of severe COVID-19 outcomes. This study explored the association between severe COVID-19 outcomes, metabolic disorders and environmental air pollutants, at regional level, across 38 countries. METHODS: We conducted an ecological study using COVID-19 data related to countries of the Organization for Economic Cooperation and Development (OECD), with an estimated population of 1.4 billion. They were divided into 3 regions: 1. Europe & Middle east; 2. Americas (north, central & south America); 3. East-Asia & West Pacific. The outcome variables were: COVID-19 case-fatality rate (CFR) and disability-adjusted life years (DALYs) at regional level. Freely accessible datasets related to regional DALYs, demographics and other environmental pollutants were obtained from OECD, WHO and the World in Data websites. Generalized linear model (GLM) was performed to determine the regional determinants of COVID-19 CFR and DALYs using the aggregate epidemiologic data (Dec. 2019-Dec. 2021). RESULTS: Overall cumulative deaths were 65,000 per million, for mean CFR and DALYs of 1.31 (1.2)% and 17.35 (2.3) years, respectively. Globally, GLM analysis with adjustment for elderly population rate, showed that COVID-19 CFR was positively associated with atmospheric PM2.5 level (beta = 0.64(0.0), 95%CI: 0.06-1.35; p < 0.05), diabetes prevalence (beta = 0.26(0.1), 95%CI: 0.12-0.41; p < 0.001). For COVID-19 DALYs, positive associations were observed with atmospheric NOx level (beta = 0.06(0.0), 95%CI: 0.02-0.82; p < 0.05) and diabetes prevalence (beta = 0.32(0.2), 95%CI: 0.04-0.69; p < 0.05). At regional level, adjusted GLM analysis showed that COVID-19 CFR was associated with atmospheric PM2.5 level in the Americas and East-Asia & Western Pacific region; it was associated with diabetes prevalence for countries of Europe & Middle east and East-Asia & Western Pacific region. Furthermore, COVID-19 DALYs were positively associated with atmospheric PM2.5 and diabetes prevalence for countries of the Americas only. CONCLUSION: These findings confirm that diabetes and air pollution increase the risk of disability and fatality due to COVID-19, with disparities in terms of their impact. They suggest that efficient preventive and management programs for diabetes and air pollution countermeasures would have curtailed severe COVID-19 outcome rates.

A Comparison of Sleep Duration Accuracy Between Questionnaire and Accelerometer in Middle Childhood.

Purpose Healthy sleep is vital to children's well-being, and assessing sleep efficiently and accurately can help understand children's lifestyles. Due to the difficulty in objectively measuring sleep duration using wearable sensors in large-scale surveys of children, self-administered questionnaires are often used in Japan; however, their accuracy is uncertain. We evaluated and compared the accuracy of questionnaire-based sleep times to those of wearable sensors. Methods This observational study was conducted between November 2019 and January 2020. A self-administered questionnaire on lifestyle habits and ActiGraph GT3X+ (ActiGraph, Inc., Pensacola, USA) accelerometer data were collected from 40 fourth-grade elementary school students in Kagawa Prefecture, Japan. We analyzed measurements for 256 days out of 280 days (40 persons × 7 days) after excluding days when the rate of wearing the accelerometer was < 90%. Results The median sleep duration per accelerometry was 453 minutes, and the median time in bed was 519 minutes. Questionnaire-based time in bed was 11 minutes longer, with relatively high inter-individual variability. The difference in bedtime was 26 minutes earlier, and wake-up time was 12 minutes earlier for the questionnaire. The average sleep efficiency was 87.4%, and one-third of the children had sleep efficiency < 85%. Conclusion The difference in sleep duration by questionnaire compared to accelerometry was approximately 10 minutes, suggesting the questionnaire may determine sleep duration with accuracy.

The number of physicians is related to the number of nighttime emergency surgeries in Japan: An ecological study.

PURPOSE: Increasing the number of physicians per population may improve the quality of medical services, but there are few reports on this aspect in the field of surgery. This study aimed to examine whether the number of physicians is associated with the number of nighttime emergency surgeries, which may be one of the indicators of the quality of medical services in the field of surgery. METHODS: This was a prefecture-based ecological study utilizing open data from Japanese government surveys conducted between 2015 and 2019. The relationship between the number of physicians and the number of nighttime emergency surgeries in 47 prefectures of Japan was evaluated by correlation analysis and panel data regression analysis. The correlation analysis was conducted between the number of physicians per 100,000 population and the number of nighttime emergency surgeries per 100,000 population per year in each prefecture in Japan. In the panel data regression analysis, panel data of the prefectures in Japan from 2015 to 2019 were created. We evaluated whether the number of physicians was related to the number of nighttime emergency surgeries, independent of the number of acute care beds per 100,000 population, population density, and the elderly population ratio. RESULTS: From the correlation analysis, the correlation coefficient between the number of physicians per 100,000 population and the number of nighttime emergency surgeries per 100,000 population was 0.533 (P < 0.001). In the panel data regression analysis, there was a significant association between the number of physicians per 100,000 population and the number of nighttime emergency surgeries per 100,000 population (P < 0.001). The regression coefficient (95% confidence interval) for the number of physicians per 100,000 population was 0.246 (0.113-0.378). CONCLUSION: The number of physicians is associated with the number of nighttime emergency surgeries.

Income Change One Year after Confirmed Cancer Diagnosis and Its Associated Factors in Japanese Patients.

The number of patients who survive for a long time after cancer diagnosis is rapidly increasing; however, such patients experience major problems such as returning to work and changes in their income. This study aimed to determine the extent of income changes of cancer patients during the first year after cancer diagnosis and identify the influencing factors. From November 2019 through January 2020, we conducted a multicenter, self-administered anonymous survey of cancer patients in Kagawa Prefecture, Japan. The number of questionnaires collected was 483 (recovery rate 60.4%), and the number of participants who met the inclusion criteria was 72. Mean year-on-year income level one year since cancer diagnosis was 66% (SD: 32%; median: 70%). Cancer stage (p = 0.016), employment status at diagnosis (p = 0.006), and continued employment at the same workplace (p = 0.001) were associated with income change. Findings from this study showed that cancer patients lost one-thirds of their income one year after their diagnosis. It was related to the stage of their illness, employment status, and continued employment at their workplace just before the diagnosis. Employers should provide cancer patients with the support they need to keep them employed.

Prevalence and factors related to hypouricemia and hyperuricemia in schoolchildren: results of a large-scale cross-sectional population-based study conducted in Japan.

Hypouricemia in children including renal hypouricemia, which is a major cause of exercise-induced acute renal injury (EIAKI), is an important clinical problem, in addition to hyperuricemia. However, no large-scale studies of serum uric acid (UA) concentrations in the general pre-adolescent population have been carried out. We conducted a population-based cross-sectional study to measure the prevalences of hypouricemia and hyperuricemia and identify the associated factors. We analyzed 31,822 (16,205 boys and 15,617 girls) 9-10-year-old children who underwent pediatric health check-ups in Kagawa prefecture between 2014 and 2018. Hypouricemia and hyperuricemia were defined using serum UA concentrations of ≤ 2.0 mg/dL and ≥ 6.0 mg/dL, respectively. The prevalence of hypouricemia was 0.38% in both 9- and 10-year-old boys and girls, and was not significantly associated with age, sex, or environmental factors, including overweight. The prevalence of hyperuricemia was significantly higher in boys (2.7%) than in girls (1.9%), and was significantly associated with age, overweight, future diabetes risk, hypertriglyceridemia, low high-density lipoprotein-cholesterol, and liver damage, but not with high low-density lipoprotein cholesterol. Therefore, some pre-adolescent children in the general population in Japan showed hypouricemia. A means of identifying children with hypouricemia and lifestyle guidance measures for the prevention of EIAKI should be established.

Country-level and regional COVID-19 burden and determinants across OECD member states and partner countries.

BACKGROUND: COVID-19 pandemic is tremendously impacted by socioeconomic and health determinants worldwide. This study aimed to determine factors associated with COVID-19 fatality among member states and partner countries of the Organization for Economic Cooperation and Development (OECD). METHODS: An ecological study was conducted using COVID-19 data of 48 countries for the period between 31 December 2019-31 December 2021. The outcome variables were COVID-19 case fatality rate (CFR) and years of life lost to COVID-19 (YLLs). Countries' sociodemographics and COVID-19-related data were extracted from OECD website, Our World in Data, John Hopkins Coronavirus Resource Center, Economist Intelligence Unit (EIU) and WHO. RESULTS: In the first year of the pandemic (December 2019-January 2021), highest CFR was observed in Mexico, 8.51%, followed by China, 5.17% and Bulgaria, 4.12%), and highest YLLs was observed in Mexico, 2,055 per 100,000. At regional level, highest CFR was observed in North & central America, 4.25 (3.71) %, followed by South America (2.5 (0.1) %); whereas highest YLLs was observed in South America region 1457.5 (274.8) per 100,000, followed by North & central America, 1207.3 (908.1) per 100,000. As of 31 December 2021, Mexico (7.52%) and Bulgaria (4.78%) had highest CFR; on the other hand, highest YLLs was observed in England, 26.5 per 1,000, followed by the United States, 25.9 per 1,000. At regional level, highest CFR (3.37(3.19) %) and YLLs (16.7 (13) per 1,000) were both observed in North & central America. Globally, the analysis of the 2-year cumulative data showed inverse correlation between CFR and nurse per 10,000 (R = -0.48; p < 0.05) and GDP per capita (R = -0.54; p < 0.001), whereas positive correlation was observed between YLLs and elderly population rate (R = 0.66; p < 0.05) and overweight/obese population rates (R = 0.55; p < 0.05). CONCLUSION: This study provides insights on COVID-19 burden among OECD states and partner countries. GDP per capita, overweight/obesity and the rate of elderly population emerged as major social and health determinants of COVID-19 related burden and fatality. Findings suggest that a robust economy and interventions designed to promote healthy longevity and prevent weight gain in at-risk individuals might reduce COVID-19 burden and fatality among OECD states and partner countries.

The Association between Preoperative Blood Pressure Elevations and Postoperative Adverse Outcomes after Non-cardiac Surgery: A Single-center Retrospective Observational Study.

Blood pressure (BP) often rises before surgery. This study investigated whether BP elevation immediately before surgery was associated with adverse outcomes. Medical records of 11,732 patients (average age: 61 years; male: 47.4%) who underwent non-cardiac elective inpatient surgery under general anesthesia at Kagawa University Hospital between January 2011 and June 2019 were reviewed. Differences between the first BP values measured on the day before surgery and the first BP values in the operating room were defined as Δ systolic BP (ΔSBP) and Δ diastolic BP (ΔDBP). The relationships between ΔSBP/ΔDBP and 30-day mortality, 30-day readmission, and over-the-standard length of hospital stay (OSLOS) were assessed. OSLOS was defined as a hospital stay longer than mean+2 standard deviations and was calculated using the Japanese Diagnosis Procedure Combination data. In univariate analysis, the differences in ΔSBP and ΔDBP between the OSLOS and standard LOS groups were both 2 mmHg. In multivariate logistic regression analysis, only ΔDBP was associated with OSLOS. The adjusted odds ratio (95% confidence interval) for the largest quartile was 1.31 (1.02-1.69) (p<0.05). ΔDBP was associated with OSLOS; however, there may be little need to worry about large ΔSBPs and ΔDBPs in clinical practice.

COVID-19 outbreak trends in South Africa: A comparison of Omicron (B.1.1.529), Delta (B.1.617.2), and Beta (B.1.351) variants outbreak periods.

OBJECTIVES: We provided COVID-19 outbreak trends in South Africa during the Omicron (B.1.1.529), Delta (B.1.617.2), and Beta (B.1.351) variants outbreak periods from November 2020 to March 2022. METHODS: We used the time series summary data of the COVID-19 outbreak for South Africa available in the COVID-19 data repository created by the Center for System and Science and Engineering at Johns Hopkins University and the Our World in Data database by the University of Oxford from January 2020 to March 2022. We used the joinpoint regression model with a data-driven Bayesian information criterion method for analyzing the outbreak trends. In addition, we used density ellipses and partition modeling on the outbreak data. RESULTS: During the Omicron outbreak period, COVID-19 cases in South Africa significantly jumped by 4.7 times from December 01 to December 08, 2021. The average daily growth rate of incidence peaked at 23,000 cases/day until December 16, 2021, which was 18.6 % higher than the peak growth during the Delta outbreak period. South Africa experienced peak growth in COVID-19 cases with 18,611 cases/day (January 04 to January 14, 2021) during the Beta outbreak period and with 19,395 cases/day (July 01 to July 11, 2021) during the Delta outbreak period. Density ellipsoid showed a significant correlation between daily cases and daily death count during the Beta and Delta outbreak period which was not prominent in the Omicron outbreak period. Comparatively higher daily death tolls were reported in days with a recovery rate of less than 89.1 % and 91.9 % in the Beta and Delta outbreak period respectively. The backlog counts may be one of the reasons for the significant increase in daily death tolls during the Omicron period. CONCLUSIONS: During the Omicron period, COVID-19 cases peaked growth was 18.6 % higher than the peak growth during the Delta outbreak period. Despite that fact, growth in death trends in the Omicron outbreak period was found low which might be due to the low mortality rate and case fatality proportion. The emergence of the Omicron variant once again reminds us that- "no one is safe until everyone is safe".

Trends in per Capita Food and Protein Availability at the National Level of the Southeast Asian Countries: An Analysis of the FAO's Food Balance Sheet Data from 1961 to 2018.

We aimed to analyze the temporal trends in the per capita food (kcal/day/person) and protein (g/day/person) availability at the national level in the Southeast Asian (SEA) countries from 1961 to 2018. To avoid intercountry variations and errors, we used a dataset derived from the FAO's old and new food balance sheets. We used the joinpoint model and the jump model to analyze the temporal trends. The annual percentage change (APC) was computed for each segment of the trends. Per capita food and protein availability in the SEA countries increased significantly by 0.8% per year (54.0%) and 1.1% per year (85.1%), respectively, from 1961 to 2018. During the 1960s, 1970s, and 1980s the per capita food availability in mainland SEA did not change significantly and was less than 2200 kcal/person/day. Since the early 1990s, food availability increased appreciably in the mainland SEA countries, except for Cambodia, which has experienced the increasing trend from the late 1990s. Distinct from the mainland, maritime SEA countries showed an up-down-up growth trend in their per-capita food availability from 1961 to 2018. Food-availability growth slowed down for Brunei (since the mid-1980s) and Malaysia (since mid-the 1990s) whereas it increased for Indonesia (1.5% per year), Timor-Leste (0.9% per year), and the Philippines (0.8% per year). Per capita protein availability trends in the mainland SEA countries were similar to the countries' per capita food availability trends. Since the late 1980s, Thailand and since the late 1990s, other mainland SEA countries experienced a significant growth in their per capita protein availability. Since the late 1990s, per capita protein availability in Vietnam increased markedly and reached the highest available amount in the SEA region, following Brunei and Myanmar. Per capita protein availability increased almost continuously among the maritime SEA countries, except for Timor-Leste. Marked inequality did exist between maritime and mainland SEA countries in per capita food-availability growth till the mid-1990s. Considerable increases in per capita food availability have occurred in most of the SEA countries, but growth is inadequate for Timor-Leste and Cambodia.

Relationship between Willingness and Psychological Characteristics of Suicide Prevention Telephone Counselors: A Retrospective Observational Study.

Suicide is a major public health issue worldwide, and telephone counseling is an important preventive measure. As the number of telephone counselors is insufficient in Japan, public needs cannot be fully met. Willingness is important for securing telephone counselors, but few studies have examined the willingness to engage in telephone counseling activities. Therefore, we investigated the relationship between telephone counselors' willingness to perform their activities and their psychological characteristics, health status, and received social support. In this study, a questionnaire survey was conducted by mail among telephone counselors belonging to the Federation of Inochi No Denwa in Japan. The total number of valid responses was 709 (recovery rate: 50.4%). Following an exploratory factor analysis, three factors were extracted: (1) willingness to engage in telephone counseling activities, (2) sense of being burdened by telephone counseling activities, and (3) sense of difficulty in coping. Structural equation modeling, using all the factors, showed that social support and grit were directly related to the willingness to engage in telephone counseling activities, while physical health, mental health, and general self-efficacy were indirectly related to it. The findings obtained may be useful in devising concrete measures for telephone counselors to continue their activities.

Quality of Life and Mental Health Status of Japanese Older People Living in Chiang Mai, Thailand.

This study aimed to establish the quality of life and mental health status among older Japanese people living in Chiang Mai, Thailand. We conducted a questionnaire survey among Japanese retired people aged 50 years or over who had been living in Thailand. The questionnaire covered socio-demographic variables including health status and ability to communicate in Thai. We measured mental health status using the Japanese version of the General Health Questionnaire-28 (GHQ-28) and quality of life using the Japanese version of EuroQOL-5D-3L. We explored the factors associated with poor mental health and quality of life using logistic regression analysis. In total, 96 (89.7%)participants provided complete responses. Overall, quality of life was generally good, although those with one or more chronic diseases reported significantly lower quality of life. Having one or more chronic diseases and being aged 70-79 were significantly associated with poorer mental health. In total, 21 (21.8%) respondents had a possible neurosis, which was defined as a total GHQ-28 score of more than 6. The logistic regression analysis showed a significant association between possible neurosis and the presence of chronic diseases (adjusted odds ratio: 11.7 1). Quality of life among older Japanese people living in Chiang Mai was generally good, but there was a high level of possible neurosis, especially among those with one or more chronic diseases.

Trends in COVID-19 Outbreak in Tokyo and Osaka from January 25 to May 6, 2020: a Joinpoint Regression Analysis of the Outbreak Data.

We analyzed the trends of the coronavirus disease 2019 (COVID-19) outbreak in Tokyo and Osaka from January 25 to May 6, 2020. To analyze the trends and identify significant changes in them, we performed a joinpoint regression analysis. From the last week of March, the number of COVID-19 cases soared in Tokyo (ß = 103.51) and Osaka (ß = 28.07). During the 2nd and 3rd weeks of April, both Tokyo (ß = 157.53) and Osaka (ß = 60.96) experienced peak growth in COVID-19 cases. Since almost 14 days after the state of emergency declaration, the number of cases showed a containment trend in Osaka, but continued to increase at a concerning rate in Tokyo (ß = 90.66).

Temporal Trends in Apparent Energy and Macronutrient Intakes in the Diet in Bangladesh: A Joinpoint Regression Analysis of the FAO's Food Balance Sheet Data from 1961 to 2017.

We analyzed the temporal trends and significant changes in apparent energy and macronutrient intakes in the Bangladeshi diet from 1961 to 2017. Due to the lack of a long-running national dietary intake dataset, this study used the Food and Agriculture Organization (FAO)'s old and new food balance sheet dataset. We used the joinpoint regression model and jump model to analyze the temporal trends in apparent energy and macronutrient intakes. The annual percentage change (APC) was computed for each segment of the trends. Bangladesh has experienced a late energy revolution in their dietary history. During the 1960s, 1970s, 1980s, and 1990s, Bangladesh was suffering from substantive calorie deficits, where in apparent energy intake was less than 2200 kcal/day/person. Since the late 1990s, Bangladesh has made significant progress in raising the apparent energy consumption in the diet. Since the late 1970s, apparent fat intake started to increase significantly at a marked rate (APC = 2.16), whereas since the early 1990s, protein intake increased significantly by 1.33% per year. Plant sources have mostly governed the protein and fat intake trends in the Bangladeshi diet since 1960, whereas animal sources began to contribute significantly in protein intake since 1990 (APC = 3.43) and in fat intake since 2000 (APC = 2.88). Bangladesh overcame the substantive calorie deficit condition in the diet from the late 1990s. Excessive carbohydrate intake along with imbalanced and low-quality protein and fat intakes have been the central features in the diet in Bangladesh.

Face-to-Face Exercises Performed by Instructors to Improve the Mental Health of Japanese in the Community-A Randomized Control Trial.

Background and objectives: The purpose of this study is to clarify the effects on the mental health of face-to-face exercise performed by an instructor (lesson-style Group: Group L) and exercise using machines (program-style Group: Group P) by randomized control trial. Materials and Methods: Among 120 subjects, 117 subjects were allocated to two groups with stratified randomization by sex (Group P: 58 subjects; Group L: 59 subjects). A 60-min health exercise class was held once per week for 12 consecutive weeks. The measurement items were mental health as a primary evaluation item and self-efficacy as a secondary evaluation item. Physical fitness was also measured using a new physical fitness test used in Japan. The 12-item general health questionnaire (GHQ-12) was used to measure mental health and the general self-efficacy scale (GSES) was used to measure self-efficacy. Results: After the intervention, 102 subjects were analyzed. The changes in mental health evaluated by GHQ-12 scores were significantly lower in Group L -0.7 (95% CI, -1.2 to -0.3) than Group P -0.1 (95% CI, -0.4 to 0.2) (p = 0.03). The changes in self-efficacy evaluated by GSES scores were significantly higher in Group P 5.3 (95% CI, 3.1 to 7.5) than Group L 1.3 (95% CI, -0.4 to 3.1) (p < 0.01). Conclusions: Compared with program exercises mainly using machines, face-to-face exercises performed by instructors improved mental health.

Occupational COVID-19 Prevention among Congolese Healthcare Workers: Knowledge, Practices, PPE Compliance, and Safety Imperatives.

The SARS-CoV-2 (COVID-19) pandemic has had a tremendous impact on the functionality of health systems and world affairs. We assessed knowledge, attitudes, and practices (KAPs) of healthcare workers (HCWs) in the Democratic Republic of the Congo (DRC). This was a cross-sectional study conducted in 23 referral hospitals located in three towns of the DRC (Lubumbashi, Kamina, Mbuji-Mayi). In total, 613 HCWs were surveyed using the World Health Organization's (WHO's) "Exposure Risk Assessment in the Context of COVID-19" questionnaire. Participants included medical doctors (27.2%) and other categories of HCWs (72.8%). The mean age was 40.3 ± 11.7 years. Over 80% (range: 83-96%) of respondents had sufficient knowledge on each of the three domains: COVID-19 symptoms, disease transmission, and patient care approach. However, attitudes and practices scores were relatively low. Only 27.7% of HCWs were willing to receive a COVID-19 vaccine when it is available, whereas 55% of HCWs complied with good practices; 49.4% wore masks consistently and, surprisingly, only 54.9% used personal protective equipment (PPE) consistently at work and during contact with patients. Knowledge level was positively associated with the use of social media as a primary source of COVID-19-related information and the category of residence, with HCWs from towns already affected by the COVID-19 epidemic being more likely to have positive attitudes (adjusted OR, 1.64; 95%CI, 1.32-2.20) and comply with good practices (aOR, 2.79; 95%CI, 1.93-4.06). This study showed that most Congolese HCWs had sufficient knowledge on COVID-19, whereas the majority did not comply with consistent PPE use. The government of the DRC should urgently take major steps in capacity building for HCWs in outbreak preparedness and supplying hospitals with PPE.

Temporal Trends in Apparent Food Consumption in Bangladesh: A Joinpoint Regression Analysis of FAO's Food Balance Sheet Data from 1961 to 2013.

We analyzed the temporal trends and significant changes in apparent food consumption or availabilityin Bangladesh from 1961 to 2013. Due to the lack of a long-term national dietary intake dataset, this study used data derived from the FAO's food balance sheets. We used joinpoint regression analysis to identify significant changes in the temporal trends. The annual percent change (APC) was computed for each segment of the trends. Apparent intake of starchy roots, eggs, fish, vegetables, milk, and vegetable oils significantly has increased (p < 0.05) in the Bangladeshi diet since 1961; whereas cereals changed by merely 4.65%. Bangladesh has been experiencing three structural changes in their dietary history after the Liberation War, though the intake level has been grossly inadequate. Initially, since the late-1970s, apparent vegetable oils intake increased at a market rate (APC = 7.53). Subsequently, since the early-1990s, the real force behind the structural change in the diet has been the increasing trends in the apparent intake of fish (APC = 5.05), eggs (APC = 4.65), and meat (APC = 1.54). Lastly, since the early 2000s, apparent intakes of fruits (APC = 20.44), vegetables (APC = 10.58), and milk (APC = 3.55) increased significantly (p <0.05). This study result reveals and quantifies the significant secular changes in the dietary history of Bangladesh from 1961 to 2013. Bangladesh has experienced inadequate but significant structural changes in the diet in the late-1970s, early-1990s, and early-2000s. Overabundance of cereals and inadequate structural changes in the diet may have caused the increasing prevalence of overweightness and emergence of diet-related, non-communicable diseases in Bangladesh.

Quality of dying and death desired by residents of Kagawa Prefecture, Japan: a qualitative study.

BACKGROUND: Achieving a desirable death is an urgent aging-related problem in Japan. However, measures of the quality of death and dying in Japan are lacking. This study aimed to identify components of a desirable death in the residents of Kagawa prefecture, Japan, through focus group interviews. METHODS: A group interview was conducted with 30 residents aged 20-80 (Mage = 50.9, SD = 22.1 years; 43.3% ≥ 65 years; 40.0% unemployed) who had experienced the death of a closely associated person. Participants were grouped into four generations with diverse characteristics (e.g., age, sex, occupation). The interview lasted 1-2 h and involved one interviewer, one observer, and one recorder. The interview theme was "What is a desirable death?" Participants were asked "What do you want to achieve before you die?" or "What would a close friend want to experience when death is near?" We then extracted important items related to "desirable death" using serialization and observation records, while also consulting three analysts. The analysis results of the four generations were ultimately integrated into final categories. RESULTS: The most common experience of a familiar death was that of parents, followed by grandparents. Half of participants had witnessed the death. Through category analysis, eight important categories related to desirable death were ultimately extracted. Nine items were identified as common to all generations. While the elderly generation had wide-ranging opinions, the younger generations' opinions tended to concentrate on satisfaction with life and family relations. CONCLUSION: Eight concepts were extracted as important factors of a desirable death from the residents of Kagawa prefecture, Japan.

Behavior problems and dysfunctional parenting: Cross-sectional study in Japan.

BACKGROUND: The Japanese government has established a law encouraging early detection and treatment of developmental disorders in children. Child behavior problems (CBP) tend to be recognized at school as a result of developmental disorders. The aim of this study was to identify factors associated with CBP in Japan. We hypothesized that factors other than developmental disorders are important in explaining CBP. METHODS: The study was conducted between February and March 2015. Parents of 3,515 children aged 2-5 years attending one of 34 public nursery schools in Takamatsu, Kagawa, Japan received self-administered questionnaires addressing parental socioeconomic factors, mental health, parenting style (i.e. hostile, overreactive, or lax), developmental disorders in children, and CBP. A multiple regression analysis was applied to explore associations between CBP and possible factors. RESULTS: Overall, 1,410 mothers were eligible to participate in the study. Children diagnosed with developmental disorders accounted for 7.8% of the sample, while on the Eyberg Child Behavior Inventory 17% of children had behavior problems needing clinical intervention. After adjustment for confounding factors, as well as for the diagnosis of developmental disorders, poor mental status and all three dysfunctional parenting styles had strong associations with CBP, and hostile, overreactive, and lax parenting had standardized ß-values (ß) of 0.29, 0.28, and 0.15, respectively (P < 0.01). A problematic relationship between the parents was also significantly associated with CBP (ß = -0.29, P < 0.01). CONCLUSION: When CBP are identified, parenting skills, mental health status and parental relationships should be considered along with the possibility of developmental disorders in the development of interventions.

Long-term effects of low-intensity training with slow movement on motor function of elderly patients: a prospective observational study.

BACKGROUND: Slow-motion training, which comprises exercising using extremely slow-movements, yields a training effect like that of high-intensity training, even when the applied load is small. We developed a slow-training exercise program that allows elderly people to safely use their own body weight without a machine. Previously, it was confirmed that functional gait and lower limb muscle strength were improved by low-intensity training using bodyweight training for 3 months. This study evaluated the long-term effects of low-intensity training using body weight with slow-movements on the motor function of frail, elderly patients. METHODS: Ninety-six elderly men and women aged 65 years or older whose level of nursing care was classified as either support required (1 and 2) or long-term care required (care levels 1 and 2) volunteered to participate. Two facilities were used. Participants at the first facility used low-intensity training using body weight with slow-movements (low-stress training [LST] group, n = 65), and participants at another facility used machine training (MT group, n = 31). Exercise interventions were conducted for 12 months, once or twice per week, depending on the required level of nursing care. Changes in motor function were examined. RESULTS: Post-intervention measurements based on the results of the chair-stand test after 12 months showed significant improvements from pre-intervention levels (P < 0.0001) in the LST group and MT group. Although the ability of performing the Timed Up & Go test and the ability to stand on one leg with eyes open improved in both groups, no significant change was observed. When changes after 12 months were compared between the two groups, no significant difference was observed for any variables. CONCLUSIONS: Slow body weight training for 12 months without a machine improved the lower limb muscle strength. Therefore, it could have the same effects as training using a machine. TRIAL REGISTRATION: UMIN000030853 . Registered 17 January 2018 (retrospectively registered).

Lung-thorax compliance measured during a spontaneous breathing trial is a good index of extubation failure in the surgical intensive care unit: a retrospective cohort study.

BACKGROUND: Extubation failure is associated with mortality and morbidity in the intensive care unit. Ventilator weaning protocols have been introduced, and extubation is conducted based on the results of a spontaneous breathing trial. Room for improvement still exists in extubation management, and additional objective indices may improve the safety of the weaning and extubation process. Static lung-thorax compliance reflects lung expansion difficulty that is caused by several conditions, such as atelectasis, fibrosis, and pleural effusion. Nevertheless, it is not used commonly in the weaning and extubation process. In this study, we investigated whether lung-thorax compliance is a good index of extubation failure in adults even when patients pass a spontaneous breathing trial. METHODS: In a single-center, retrospective cohort study, patients over 18 years of age were mechanically ventilated, weaned with proportional assist ventilation, and underwent a spontaneous breathing trial process in surgical intensive care units of Kagawa University Hospital from July 2014 to June 2016. Extubation failure was the outcome measure of the study. We defined extubation failures as when patients were reintubated or underwent non-invasive positive-pressure ventilation within 24 h after extubation. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the clinical involvement of several parameters. The area under the curve (AUC) was calculated to assess the discriminative power of the parameters. RESULTS: We analyzed 173 patients and compared the success and failure groups. Most patients (162, 93.6%) were extubated successfully, and extubation failed in 11 patients (6.4%). The averages of lung-thorax compliance values in the success and failure groups were 71.9 ± 23.0 and 43.3 ± 14.6 mL/cmH2O, respectively, and were significantly different (p < 0.0001). In the ROC curve analysis, the AUC was highest for lung-thorax compliance (0.862), followed by the respiratory rate (0.821), rapid shallow breathing index (0.781), Acute Physiology and Chronic Health Evaluation II score (0.72), heart rate (0.715), and tidal volume (0.695). CONCLUSIONS: Lung-thorax compliance measured during a spontaneous breathing trial is a potential indicator of extubation failure in postoperative patients.