Effects of gastrostomy fee schedule revision on artificial nutrition routes among older people with dementia in Japan: A time series observational study.

AIM: The present study aimed to investigate the effects of the 2014 Japanese fee schedule revision on trends in artificial nutrition routes, including gastrostomy, nasogastric tube and parenteral nutrition, among older people with dementia, using time series analysis. METHODS: The study used claim data in Japan submitted to Fukuoka Late Elders' Health Insurance from fiscal year 2010 to fiscal year 2016. We identified older people with dementia provided for the first time with artificial nutrition via gastrostomy, nasogastric tube or central venous line and aggregated their data by month. Interrupted time series analyses were used to examine trends in artificial nutrition routes over time. RESULTS: The numbers of older people with dementia receiving nutrition via gastrostomy, nasogastric tube and parenterally declined consistently. The slopes for pre-revision trends in gastrostomy, nasogastric tube and parenteral nutrition procedures were all significantly negative in the interrupted time series analyses. The post-revision trends in gastrostomy and parenteral nutrition continuously had significant negative slopes. In contrast, the significant negative trend in nasogastric tube procedures in the pre-revision period had disappeared during the post-revision period. CONCLUSIONS: The study showed that the fee schedule revision had limited impact on gastrostomy and parenteral nutrition. However the trend for nasogastric tube was ambiguous; hence, sustainable surveillance is required for evidence-based health policy. Geriatr Gerontol Int 2018; 18: 1405-1409.

Socioeconomic Status and Knowledge of Cardiovascular Risk Factors: NIPPON DATA2010.

BACKGROUND: The relationship between socioeconomic status (SES) and knowledge of cardiovascular risk factors remains unknown in a general Japanese population. METHODS: Of 8,815 participants from 300 randomly selected areas throughout Japan, 2,467 participants who were free of cardiovascular disease and who provided information on SES in the National Health and Nutrition Survey of Japan 2010 were enrolled in this cross-sectional analysis. SES was classified according to the employment status, length of education, marital and living statuses, and equivalent household expenditure (EHE). Outcomes were ignorance of each cardiovascular risk factor (hypertension, diabetes, hypercholesterolemia, low high-density lipoprotein [HDL] cholesterol, arrhythmia, and smoking) and insufficient knowledge (number of correct answers <4 out of 6). RESULTS: A short education and low EHE were significantly associated with a greater ignorance of most cardiovascular risk factors. A short education (<10 years) was also associated with insufficient knowledge of overall cardiovascular risk factors: age- and sex-adjusted odds ratios (OR) were 1.92 (95% confidence interval [CI], 1.51-2.45) relative to participants with ≥13 years of education. Low EHE was also associated with insufficient knowledge (age- and sex-adjusted OR 1.24; 95% CI, 1.01-1.51 for the lowest quintile vs the upper 4 quintiles). These relationships remained significant, even after further adjustments for regular exercise, smoking, weekly alcohol consumption, body mass index, hypertension, diabetes mellitus, hypercholesterolemia, and low HDL cholesterol. CONCLUSION: Participants with a short education and low EHE were more likely to have less knowledge of cardiovascular risk factors.

[Worker heat disorders at the Fukushima Daiichi nuclear power plant].

OBJECTIVES: Ever since the Fukushima Daiichi nuclear power plant (NPP) accident, every day about 3,000 workers have been working to repair the situation. The frequent occurrence of heat disorders has been a concern for the workers wearing protective clothing with poor ventilation. We have been analyzing the heat disorder problem since the accident in order to come up with a solution to prevent future heat disorder incidents among Fukushima Daiichi NPP accident clean-up workers. METHODS: From March 22 to September 16, 2011, the Fukushima Labor Bureau assessed 43 cases of nuclear power plant workers with heat disorders. Age of subject, month and time of occurrence, temperature, and humidity were examined for each case, as well as the severity of heat disorders. The grade of severity was divided into Grade I and Grade II or higher. Then, age, temperature, and humidity were analyzed using the Mann-Whitney Utest, and age, temperature, humidity, and presence or absence of a cool-vest were analyzed using the χ(2) test and logistic regression analysis. SPSS version 17.0 statistical software was used with a level of significance of p< 0.05. RESULTS: Heat disorders occurred most frequently in subjects in their 40s (30.2%), followed by those in their 30s (25.6%), mostly in July (46.5%) between 7 am and 12 pm (69.8%). Heat disorders occurred most frequently in environments with temperatures more than 25°C (76.7%) and humidity of 70-80% (39.5%). Heat disorders of Grade II or higher occurred in 10 cases, 5 of which were in June. According to statistical analysis, there were no significant differences in difference of severity for all factors. CONCLUSIONS: Heat disorders usually occur in workers aged 45-60; however, cases of heat disorders at the Fukushima Daiichi NPP occurred in clean-up workers at the relatively younger ages of 30-40, suggesting the need for heat disorder prevention measures for these younger workers. Heat disorder cases primarily occurred in the morning, necessitating preventive measures for the early hours of the day. In addition, because heat disorders of Grade II or higher occurred in June in 5 of 10 cases, we believe heat disorder precautions should be implemented from June. The lack of significant difference in severity difference may be attributable to the small number of cases or other factors. We think Fukushima Daiichi NPP accident clean-up workers need heat disorder prevention measures for their safety, based on the results of this study.

An assessment of radiation doses at an educational institution 57.8 km away from the Fukushima Daiichi nuclear power plant 1 month after the nuclear accident.

OBJECTIVES: On 11 March 2011, the Great East Japan Earthquake occurred. Due to this earthquake and subsequent tsunami, malfunctions occurred at the Fukushima Daiichi nuclear power plant. Radioactive material even reached the investigated educational institution despite being 57.8 km away from the power station. With the goal of ensuring the safety of our students, we decided to carry out a risk assessment of the premises of this educational institution by measuring radiation doses at certain locations, making it possible to calculate estimated radiation accumulation. METHODS: Systematic sampling was carried out at measurement points spaced at regular intervals for a total of 24 indoor and outdoor areas, with 137 measurements at heights of 1 cm and 100 cm above the ground surface. Radiation survey meters were used to measure environmental radiation doses. RESULTS: Radiation dose rates and count rates were higher outdoors than indoors, and higher 1 cm above the ground surface than at 100 cm. Radiation doses 1 cm above the ground surface were higher on grass and moss than on asphalt and soil. The estimated radiation exposure for a student spending an average of 11 h on site at this educational institution was 9.80 µSv. CONCLUSIONS: Environmental radiation doses at our educational institution 57.8 km away from the Fukushima Daiichi nuclear power plant 1 month after the accident were lower than the national regulation dose for schools (3.8 µSv/h) at most points. Differences in radiation doses depending on outdoor surface properties are important to note for risk reduction.