Analysis of the risk factors of mortality in elderly patients with hip fracture using a combined database of medical and long-term care insurance claims data.

BACKGROUND: The present study evaluated the risk of mortality in elderly hip fracture, focusing on comorbidities and nursing care levels. METHODS: The present study was an observational cohort study that used a combined database of medical and long-term care insurance (LTCI) claims data from one prefecture in Japan between 2011 and 2016. In total, 6125 patients aged 65 years and older were selected from acute care hospitals with a diagnosis of "hip fracture" between March 2011 and March 2012. The impact of long-term care insurance claim evaluation levels and comorbidities at recruitment time was investigated using this dataset. These patients were followed up monthly until March 2016. Based on this person-month dataset, survival analysis was performed with death as the endpoint. Cases in which receipt data were missing during the middle of the observation period and cases in which the patient survived at the end of the observation period were censored. RESULTS: The number of deaths during the observation period was 635 (10.4%). The impact of comorbidities and nursing care level on mortality were both significant as follows: high nursing care level before the fracture (hazard ratio: 1.09, P < 0.001), comorbidities of malignant diseases (HR: 1.45, P < 0.001), heart disease (hazard ratio: 1.20, P = 0.037), pneumonia (hazard ratio: 1.27, P < 0.001), chronic obstructive pulmonary disease (hazard ratio: 1.28, P = 0.026), renal failure (hazard ratio: 1.44, P < 0.001), and dementia (hazard ratio: 1.27, P = 0.013). CONCLUSION: The results of this study showed that a high level of nursing care and presence of comorbidities such as malignant diseases, heart diseases, pneumonia, chronic obstructive pulmonary disease, renal failure, and dementia increased mortality in elderly patients with hip fracture. Furthermore, this study showed the usefulness of a combined database of medical and LTCI claims data for clinical and health service-related research in the field of orthopedics.

Prospective cohort study of bedroom heating and risk of common cold in children.

BACKGROUND: In countries with mild winter climates and inadequate heating, the relationship between housing conditions and health outcomes in winter have not been well studied. The purpose of the present study was to evaluate the relationship between heater type and temperature factors in the bedroom and incidence of the common cold among children in Japan. METHODS: In this prospective cohort study, we distributed baseline questionnaires and temperature loggers in December 2019 and administered follow-up questionnaires in March 2020. We recruited children under the age of 15 years. We performed Poisson regression analysis and logistic regression analysis. RESULTS: Of 297 participants, air conditioners were the most prevalent (n = 105, 35%), followed by gas or kerosene heaters (n = 50, 17%), and floor heaters (n = 31, 10%). Air-conditioners were associated with higher incidence of all events related to the common cold, especially having a fever (adjusted incidence rate ratio (aIRR) = 1.84, 95% confidence interval (CI): 1.41-2.40). Gas or kerosene and floor heaters showed a lower incidence rate of some events related to the common cold, such as school or nursery school absence (aIRR = 0.55, 95% CI: 0.37-0.82 and aIRR = 0.39, 95% CI: 0.23-0.67, respectively). Bedroom temperature did not show a positive association, but children who always felt cold showed a higher incidence of some events related to the common cold. CONCLUSIONS: Our findings imply that the heating approach and modal thermal comfort, such as location of heating appliances, humidity, airflow, and radiant heat, may be more important for the onset of common cold in children than bedroom temperature itself.

A Prospective Cohort Study of Bedroom Warming With a Heating System and Its Association With Common Infectious Diseases in Children During Winter in Japan.

BACKGROUND: Customarily, bedrooms in Japan are left unheated. Although several studies have reported that the use of a heating system has positive outcomes on respiratory infection and asthma, the preventive effect of heating systems against infectious diseases in children is not well known. METHODS: We conducted a cohort study using two questionnaire surveys, one before the winter season in November, 2018 and the second after winter in March, 2019. Participants were 155 children who did not use a heating system in the bedroom and 156 children who did. RESULTS: Having a heated bedroom with a heating system was associated with decreased odds for the frequency of cold (≥3 times) (adjust odds ratio [AOR] 0.35; 95% confidence interval [CI], 0.19-0.65), duration of fever (≥3 days) (AOR 0.38; 95% CI, 0.22-0.66), duration of medicine for a cold (≥3 days) (AOR 0.91; 95% CI, 0.87-0.95), hospital visit due to cold (≥3 days) (AOR 0.54; 95% CI, 0.31-0.94), absence from school or nursery (≥3 days) (AOR 0.43; 95% CI, 0.27-0.70), influenza infection (AOR 0.43; 95% CI, 0.26-0.71), and gastroenteritis (AOR 0.39; 95% CI, 0.21-0.72). Influenza vaccination reduced the odds of influenza infection (AOR 0.36; 95% CI, 0.22-0.59) and absence from school or nursery (≥3 days) (AOR 0.62; 95% CI, 0.39-0.99). CONCLUSION: This study implies that the heating of bedrooms may have a preventive effect against infections among children. Broader dissemination of this knowledge in Japan will require cultural change through public health awareness.

Effectiveness of regional clinical pathways on postoperative length of stay for hip fracture patients: A retrospective observational study using the Japanese Diagnosis Procedure Combination database.

BACKGROUND: Regional clinical pathways, a new type of clinical pathway, are practiced with the aim of standardizing and optimizing medical care by cooperation among multiple medical institutions in a region. However, current evaluation of the effectiveness of regional clinical pathways for hip fracture, a major health problem requiring hospitalization for orthopedic surgery, is insufficient. This study aimed to determine the association between regional clinical pathways and postoperative hospital length of stay (LOS) among hip fracture patients. In particular, we focused on the variation in postoperative LOS of hip fracture patients among hospitals and the contribution of regional clinical pathways to this variation. METHODS: Using data from the Diagnosis Procedure Combination (DPC) database in Japan from April 2011 to March 2013, patients who were diagnosed with "fracture of head and neck of femur" (ICD10 code S72.0) or "pertrochanteric fracture" (S72.1) and received "bipolar hip arthroplasty" or "open reduction and internal fixation" were extracted. A total of 110,133 patients were included. Associations between regional clinical pathways and postoperative LOS were analyzed using cross-sectional analysis with multilevel regression models. RESULTS: Hospitals that implemented a regional clinical pathway showed a significant reduction (13 days) in the postoperative LOS of hip fracture patients. We found a 16% inter-hospital variation in postoperative LOS, which might be explained by hospital-level implementation of regional clinical pathways. Application of regional clinical pathways at the patient level resulted in a 4-day decrease in postoperative LOS. CONCLUSIONS: Implementation of regional clinical pathways for hip fracture patients at the hospital level was associated with reduced postoperative LOS, regardless of whether or not pathways were implemented at the patient level. This suggests that regional clinical pathways are effective for patient care management in hospitals.

Does the extension of the type of hysterectomy contribute to the local control of endometrial cancer?

OBJECTIVE: To examine the necessity and sufficiency of different types of hysterectomy for the surgical treatment of endometrial cancer. METHODS: This was a multicenter collaborative study conducted by 11 institutions. Among patients with stage I-III endometrial cancer who underwent surgery as the initial treatment (only chemotherapy was provided if adjuvant therapy was needed) from 2001 to 2012, we retrospectively examined the type of hysterectomy, clinicopathological factors, recurrence rate over a maximum period of 5 years, and the site of recurrence. The local recurrence rate was examined by univariate and multivariate analyses. RESULTS: Among 1335 patients, 982 (73.6%) underwent simple hysterectomy (SH) and 353 (26.4%) underwent modified radical hysterectomy (mRH) and were observed for a mean duration of 51.8 months. No significant difference was observed in the rate of local recurrence between the SH and mRH groups (p = 0.928). In multivariate analysis, clinicopathological factors independently associated with localized recurrence included postmenopausal status [hazard ratio (HR) 5.036, 95% confidence interval (CI) 1.506-16.841, p = 0.009], with stages II (HR 3.337, 95% CI 1.701-6.547, p < 0.001) and III (HR 2.445, 95% CI 1.280-4.668, p = 0.007), vs stage I and histological type 2 (HR 1.610, 95% CI 0.938-2.762, p = 0.001). CONCLUSIONS: For endometrial cancer patients requiring surgery, the selection of a more extensive type of hysterectomy did not reduce the rate of local recurrence. Therefore, there is little significance in performing mRH in such cases.

Hospitalization and discharge routes of elderly hip fracture patients with and without dementia: a nationwide cross-sectional exploratory study using the Japanese Diagnostic Procedure Combination database.

PURPOSE: The characteristics of elderly hip fracture patients in acute care hospitals were analyzed based on hospitalization and discharge route and the presence or absence of a dementia diagnosis. METHODS: The study was conducted as a cross-sectional exploratory study using data from the Diagnosis Procedure Combination database in Japan from April 2014 to March 2016. Patients aged 65 years or older who had surgery for a hip fracture were identified. We subsequently extracted patients whose home, medical institution (including convalescent rehabilitation wards), or elderly care facility was both the admission and discharge route. A total of 105 122 patients were included. RESULTS: 19% of patients were diagnosed with dementia. Patients with dementia had a shorter length of acute care hospital stay than those without dementia. The hospitalization route for dementia patients was 51% at home and 40% at a care facility. Dementia patients were discharged to hospital and care facilities at 41% each. Nearly all patients received hospital-based postoperative rehabilitation regardless of dementia but patients with dementia had lower gains in activities of daily living. CONCLUSION: Hip fracture patients with dementia have less opportunity for continuous hospital-based rehabilitation and need an environment that allows for continuous elderly care facility-based and community-based rehabilitation.IMPLICATIONS FOR REHABILITATIONIn Japan, an aging society, one in five elderly patients undergoing hip fracture surgery was diagnosed with dementia.Many hip fracture patients with dementia have a shorter length of hospital stay and may have fewer opportunities to change hospitals to receive rehabilitation.It is necessary to establish an ongoing and proactive community- and elderly care facility-based rehabilitation system for patients with hip fracture with dementia after acute care hospital discharge.

Pre-transplant Rehabilitation to Decrease the Post-transplant Length of Stay for Hematological Malignancy Patients Undergoing Allo-HSCT.

OBJECTIVES: Pre-transplant rehabilitation for hematological malignancy patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) helps improve physical capacity. However, its benefit with respect to post-transplant hospital length of stay (LOS) is unclear. Consequently, the aim of this study was to investigate the effect of pre-transplant rehabilitation on post-transplant LOS for hematological malignancy patients undergoing allo-HSCT. METHODS: Data on patients diagnosed between April 2014 and March 2017 were collected from the Japanese Diagnosis Procedure Combination database. The patients were identified using the ICD-10 codes C81-85, C90-94, C96, and D46. Multilevel linear regression analyses were conducted to identify the effects of pre-transplant rehabilitation on post-transplant LOS (log transformed). RESULTS: In total, 3614 patients were included in the study. Pre-transplant rehabilitation was associated with a significant reduction in post-transplant hospital LOS (ß=-0.134, P<0.001). CONCLUSIONS: Pre-transplant rehabilitation may be an effective strategy for shortening the post-transplant hospital LOS in hematological malignancy patients undergoing allo-HSCT. Consequently, it may be necessary to consider starting rehabilitation before transplantation.

Pain, unhealthy days and poor perceived health among Japanese workers.

OBJECTIVES: The current research aimed to study the relationship between health-related quality of life (poor perceived health/unhealthy days) and workers' pain. METHODS: This cross-sectional study was conducted among 1360 Japanese workers of a Japanese company in Kyushu. Health-related quality of life was measured by HRQOL-4 tool developed by Centers for Disease Control and Prevention of the USA. Pain was assessed by numeric rating scale with 0-10 points. Regression analysis was conducted to identify the relationship between health-related quality of life and pain. RESULTS: Participants who reported pain had significantly greater odds of having poor health compared to those with no pain (AOR = 3.99, 95% CI = 3.82-4.18, P < .0001). In general, participants who had a higher frequency and intensity of pain had significantly greater odds of having poor health compared to those with no pain. Compared to those with no pain, participants with pain had an average of 2.85 (95% CI = 2.07-3.63, P < .0001), 2.25 (95% CI = 1.52-2.99, P < .0001), 4.41 (95% CI = 3.39-5, P < .0001), and 1.9 (95% CI = 1.30-2.50, P < .0001) more physically unhealthy days, mentally unhealthy days, total unhealthy days, and days with activity limitation, respectively. Headache causes many more unhealthy days and more poor health than any other pain, including back pain, shoulder/neck pain, and joint pain. CONCLUSION: Poor health status and the number of unhealthy days among Japanese workers are strongly associated with the presence of pain and increases with the intensity and frequency of pain.

The Interaction Between Pain Intensity and Pain Self-Efficacy in Work Functioning Impairment: A Cross-Sectional Study in Japanese Construction Workers.

OBJECTIVE: To examine the pain intensity and pain self-efficacy interaction in workers' work functioning impairment. METHODS: A cross-sectional study using a self-reporting survey. Of 6657 Japanese construction company employees, 5129 (77.0%) valid responses were analyzed for work functioning impairment. Further analysis using current pain intensity and pain self-efficacy was performed on 1622 employees who experienced physical pain in the past 12 months. RESULTS: Pain intensity showed a dose-response relationship with work functioning impairment. Further analysis showed an interaction between pain intensity and pain self-efficacy for work functioning impairment. Stratification by pain self-efficacy showed that high pain self-efficacy was not associated with an increase in work functioning impairment, even in those with severe pain (odds ratio = 1.79; 95% confidence interval = 0.69 to 4.68). CONCLUSIONS: Pain self-efficacy may be a key determinant for work functioning impairment in workers with pain.

Validation of the Japanese version of the CDC HRQOL-4 in workers.

BACKGROUND: We set out to investigate the reliability and validity of the Japanese version of the CDC core healthy day measures assessing health-related quality of life (CDC HRQOL-4) in Japanese workers. METHODS: This cross-sectional study was conducted among 1360 Japanese workers of one Japanese company located in Kyushu. Cronbach's alpha was calculated to evaluate the internal consistency of CDC HRQOL-4 items. The concurrent validity was tested by assessing whether the CDC HRQOL-4 items correlated well with the corresponding domains of the SF-8 and the overall WFun score. The construct validity was tested by assessing the ability of the CDC HRQOL-4 to discriminate groups with and without any current disease, pain, mental problem, and sleeping disorder. RESULTS: Cronbach's alpha for three of the four CDC HRQOL-4 items was 0.80, which is greater than the minimal standard (0.70) recommended for internal consistency reliability. Correlation coefficients ranging from 0.25 to 0.67 were obtained between CDC HRQOL-4 items and the SF-8 domains and WFun score. Workers with any current disease, mental problem, pain or sleeping disorder reported higher numbers of unhealthy days, and a higher odd of poor health than those without such problems. Japanese version of the CDC HRQOL-4 shows a good concurrent validity with the SF-8 and the WFun tool and good construct validity among Japanese workers in the current study. CONCLUSIONS: Japanese version of the CDC HRQOL-4 is a reliable and valid instrument that may be used to assess overall health and physically and mentally unhealthy days in Japanese workers.