Atrial fibrillation and mortality after ischemic stroke: An observational study using an insurance claim database.

OBJECTIVES: In this study, we aimed to examine the association between atrial fibrillation and mortality after ischemic stroke and evaluate the use of anticoagulation therapy for atrial fibrillation before stroke onset in patients who experienced stroke. METHODS: In this retrospective observational study, we used a combined database of medical and long-term care insurance claims data from one prefecture in Japan. The data of 25,352 patients aged ≥ 65 years who were hospitalized in acute care hospitals with a diagnosis of ischemic stroke between April 2012 and March 2015 were extracted. Cox proportional hazard modeling, with adjustment for age, sex, comorbidities, and long-term care dependency level (based on the activities of daily living), was performed to evaluate the relationship between mortality and atrial fibrillation. RESULTS: The prevalence of atrial fibrillation was 21.8% in the study population. A significant association was noted between mortality and atrial fibrillation (adjusted hazard ratio: 1.28, 95% confidence interval: 1.16-1.41, p < 0.001). Anticoagulant drugs were used in 32.2% of the patients with atrial fibrillation. CONCLUSIONS: These results indicate that atrial fibrillation is associated with mortality after stroke; however, the use of anticoagulation therapy for atrial fibrillation is unsatisfactory. Efforts to improve the use of atrial fibrillation therapy are required in Japan.

Relationship between financial distress and mistreatment of workers regarding the COVID-19 prevention measures: A 1-year prospective cohort study.

OBJECTIVE: A substantial number of workers' experience mistreatment in the workplace, impacting workers' health and companies' functioning. Vulnerability of those with lower income has been reported, yet little is known about mistreatment during COVID-19. This study aims to examine whether workers in financial distress are particularly prone to mistreatment at the workplace with reference to pandemic-related infection prevention measures. METHODS: An internet-based, year-long prospective cohort study was conducted from 2020 to 2021. Participants were recruited from workers aged 20 and 65 years and currently employed at baseline. In total, 27 036 were included in the analysis and 18 170 responded to the follow-up survey. The odds ratio (OR) of mistreatment at the workplace regarding COVID-19 associated with the financial condition at baseline was estimated using multilevel logistic regression analysis nested by participant residence. RESULTS: Compared with workers in a comfortable financial condition, those under financial stress showed significantly higher ORs of mistreatment (age- and sex-adjusted model: 2.08, 95% confidence interval [CI] 1.75-2.47, P < .001, model adjusted for socioeconomic factors: 2.14, 95% CI 1.79-2.55, P < .001). CONCLUSION: Workers in financial distress were shown to be vulnerable to mistreatment at work regarding infection prevention measures in the COVID-19 pandemic, underscoring a double burden of poverty and mistreatment. The perspective of vulnerable groups needs to be taken into account when implementing countermeasures against emerging infectious diseases, such as COVID-19. As unfair treatment in the workplace might distort vulnerable employees' reactions to infection control (e.g., hiding infection), financial deprivation should be considered a public health issue.

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.

Effectiveness of workplace exercise supervised by a physical therapist among nurses conducting shift work: A randomized controlled trial.

OBJECTIVES: This study aimed to evaluate the effectiveness of supervised exercise among nurses conducting shift work for health promotion. METHODS: A total of 30 healthy female nurses conducting shift work participated in this study and they were randomly assigned to one of the following 2 groups: The supervised exercise group (SG; participants exercised under the supervision of a physical therapist (PT)) and the voluntary exercise group (VG; participants exercised without supervision). The study participants were asked to exercise twice/week for 12 weeks for 24 sessions. The primary outcome was aerobic fitness, and the secondary outcomes were muscle strength, anthropometric data, biochemical parameters, and mental health. We compared all the outcomes before and after the intervention within each group and between both groups at follow-up. RESULTS: Aerobic fitness increased in the SG whereas it decreased in the VG, but these changes were not statistically significant (p=0.053 and 0.073, respectively). However, the between-group difference was significant in the intervention effect (p=0.010). Muscle strength, high-density lipoprotein cholesterol and metabolic profile (high-molecular weight adiponectin), and depressive symptom significantly improved in the SG over time, even though the SG exercised less as compared with the VG. Moreover, significant differences in muscle strength, and low-density lipoprotein cholesterol and reactive oxygen metabolite levels were observed between both groups, and these parameters were better in the SG than in the VG. CONCLUSIONS: Our data-suggest the effectiveness of exercise supervised by a PT at the workplace of nurses conducting shift work for health promotion.