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BACKGROUND: This study aimed to examine postoperative recurrence after curative pancreatic resection following neoadjuvant chemoradiotherapy (NACRT) in patients with resectable (R-) and borderline resectable (BR-) pancreatic ductal adenocarcinoma (PDAC), focusing on its relationship with the standardized uptake value (SUV) on 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET). METHOD: The postoperative initial recurrence patterns were examined in patients with R- and BR-PDAC who underwent NACRT followed by curative pancreatic resection. Data collected from three prospective clinical trials were retrospectively analysed. RESULTS: After a median follow-up of 29 months, 91 (60 %) of 151 patients experienced postoperative recurrence. The median recurrence-free survival (RFS) for all patients was 18 months. The sites of first recurrence were lung-only in 24 (26 %) patients, liver-only in 23 (25 %), local-only in 11 (12 %), peritoneum-only in 10 (11 %), other single site in 5 (5 %), and multiple sites in 19 (21 %) patients. Multivariate analysis identified the maximum standardized uptake value (SUVmax) on FDG-PET at diagnoses ≥5.40 (hazard ratio [HR], 1.62; 95 % confidence interval [CI], 1.01-2.61; p = 0.045) and node-positive pathology (HR, 2.01; 95 % CI, 1.32-3.08; p = 0.001) as significant predictors of RFS. Furthermore, the SUVmax at initial diagnosis and after NACRT correlated with liver metastasis. CONCLUSION: R- and BR-PDACs with high SUV on FDG-PET at diagnosis are risk factors for postoperative recurrence. Among patients who undergo surgery after NACRT, those with a high SUVmax at diagnosis or post-NACRT require careful attention for postoperative liver recurrence.
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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.
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Contaminantes Atmosféricos , COVID-19 , Diabetes Mellitus , Contaminantes Ambientales , Enfermedades Metabólicas , Humanos , Anciano , Contaminantes Atmosféricos/efectos adversos , Contaminantes Atmosféricos/análisis , Años de Vida Ajustados por Discapacidad , Contaminantes Ambientales/análisis , Pandemias , COVID-19/epidemiología , Enfermedades Metabólicas/epidemiología , Material Particulado/efectos adversos , Material Particulado/análisis , Diabetes Mellitus/epidemiologíaRESUMEN
A spinal cord injury (SCI) can cause severe lifelong functional disability and profoundly affect an individual's daily life. We investigated the prediction of patients' post-SCI functional outcomes by evaluating sensory scores rather than motor scores, as the latter's association with functional outcomes is well established. We examined patients' responses to a light touch (LT) and pin prick (PP) at admission and the response data's usefulness as predictors of functional outcomes (i.e., ability to perform activities of daily living) at discharge. This exploratory observational study used data from the Japanese National Spinal Cord Injury Database (SCI-J). Data from 3,676 patients who met the inclusion criteria and were admitted for an SCI between 1997 and 2020 were analyzed. The motor score of the Functional Independence Measure (mFIM) at discharge was used as an index of functional outcome. A multiple regression analysis revealed that the mFIM was associated with both the LT response (ß=0.07 (0.01), p<0.001) and the PP response (ß=0.07 (0.01), p<0.001) at admission. The false discovery rate log-worth values for LT and PP were 6.6 and 8.5, respectively. Our findings demonstrate that LT and PP scores at admission can help predict patients' functional outcomes after an SCI, although the magnitude of their contributions is not high.
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Actividades Cotidianas , Traumatismos de la Médula Espinal , Humanos , Traumatismos de la Médula Espinal/fisiopatología , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , Tacto , Recuperación de la Función , Adulto JovenRESUMEN
BACKGROUND: Identifying malignant transformation in pancreatic branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) remains challenging, but the standardized uptake value (SUV) obtained from 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT has the potential to become a valuable parameter for differentiation. This study aimed to assess the effectiveness of SUV of FDG-PET/CT in distinguishing low-grade dysplasia (LGD), high-grade dysplasia (HGD), and intraductal papillary mucinous carcinoma (IPMC) within BD-IPMNs. METHODS: We assessed 58 patients with confirmed BD-IPMN undergoing surgery between 2008 and 2022. Receiver operating characteristic curves were plotted using the tumor-to-blood pool ratio (TBR) of FDG-PET/CT in two scenarios: one considering HGD + IPMC as positive and the other considering only IPMC as positive. RESULTS: In the cohort of 58 cases, there were 39 females, and the median age was 71 years. The median TBR value was 1.45 (range, 0.35-25.44). The TBRs exhibited a significant correlation with each histopathology (p < 0.001). Furthermore, in the multivariate analysis, TBR was independently significant in both scenarios, with HGD + IPMC defined as malignant (p = 0.001) and with only IPMC defined as malignant (p = 0.024). CONCLUSIONS: TBR might have the potential to serve as a valuable parameter for indicating malignant transformation in pancreatic BD-IPMNs.
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Adenocarcinoma Mucinoso , Carcinoma Ductal Pancreático , Neoplasias Intraductales Pancreáticas , Neoplasias Pancreáticas , Femenino , Humanos , Anciano , Fluorodesoxiglucosa F18 , Neoplasias Intraductales Pancreáticas/diagnóstico por imagen , Neoplasias Intraductales Pancreáticas/cirugía , Neoplasias Intraductales Pancreáticas/patología , Carcinoma Ductal Pancreático/diagnóstico por imagen , Carcinoma Ductal Pancreático/cirugía , Carcinoma Ductal Pancreático/patología , Tomografía Computarizada por Rayos X , Estudios Retrospectivos , Tomografía Computarizada por Tomografía de Emisión de Positrones , Sensibilidad y Especificidad , Adenocarcinoma Mucinoso/patología , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/cirugía , Neoplasias Pancreáticas/patología , Tomografía de Emisión de PositronesRESUMEN
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.
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COVID-19 , Salud Pública , Humanos , COVID-19/epidemiología , COVID-19/prevención & control , Japón/epidemiologíaRESUMEN
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.
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Pueblos del Este de Asia , Neoplasias , Humanos , Renta , Empleo , Encuestas y Cuestionarios , Neoplasias/diagnóstico , Neoplasias/epidemiologíaRESUMEN
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.
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Médicos , Investigación , Anciano , Humanos , Japón , Cuidados Críticos , Análisis de DatosRESUMEN
An unhealthy diet can lead to the development of metabolic disorders. C-reactive protein (CRP) has been reported to be an inflammatory component of metabolic disorders. Additionally, reduced adiponectin (APN) levels is known as a predictor of metabolic disorders. We report on the beneficial effects of NBF1, an algal fiber-rich formula, on CRP, APN, and diabetes markers. Additionally, associations between dietary nutrients, CRP, and APN were investigated. A dietary survey that used a brief self-administered diet history questionnaire, a validated 58-item fixed-portion-type questionnaire, and a 4-week placebo-controlled dietary intervention were carried out. The latter consisted of a twice daily intake of 3 g of sujiaonori alga-based powder as a supplement (NBF1, n = 16), whereas the placebo group received the same amount of corn starch powder (n = 15). CRP and APN levels were assayed by ELISA. Clinical cases comprising three subjects with metabolic disorders treated with NBF1, including two type 2 diabetes mellitus patients and one subject with hypercholesterolemia, are also reported. They received 2.1g NBF1 once daily for 12 weeks. Intakes of algal fiber and n-3 PUFA were positively associated with the increase of APN, and n-3PUFA intake was inversely associated with CRP. All cases had improved metabolic health profile.
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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.
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Desequilibrio Ácido-Base , Hiperuricemia , Masculino , Adolescente , Femenino , Humanos , Niño , Hiperuricemia/epidemiología , Estudios Transversales , Ácido Úrico , Prevalencia , Sobrepeso , Japón/epidemiología , HDL-Colesterol , LDL-Colesterol , Factores de RiesgoRESUMEN
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.
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COVID-19 , Anciano , Humanos , Estados Unidos , COVID-19/epidemiología , Pandemias , Organización para la Cooperación y el Desarrollo Económico , Sobrepeso , Estado de SaludRESUMEN
Health state utilities are global measurements of quality of life and have been used to evaluate health outcomes for the cost-utility analysis. This study aimed to estimate the health state utilities of patients with hepatitis B (HB), hepatitis C (HC), and hepatitis-related diseases in Japan. We distributed a self-administered questionnaire, including the EuroQol 5-Dimension 5-Level (EQ-5D-5L), to 9,952 outpatients with several clinical conditions caused by HB or HC virus infection (such as asymptomatic chronic hepatitis, chronic hepatitis, compensated cirrhosis, and decompensated cirrhosis) and estimated the condition-specific utilities of patients with HB or HC. In patients with more severe conditions (patients with acute hepatitis, fulminant hepatitis, and hepatocellular carcinoma and patients undergoing post-liver transplantation), the utilities of these severe conditions were estimated by three hepatitis experts using the EQ-5D-5L. The means of the utilities for acute hepatitis, fulminant hepatitis, asymptomatic chronic hepatitis, chronic hepatitis, compensated cirrhosis, compensated cirrhosis, hepatocellular carcinoma stage I/II, hepatocellular carcinoma stage III/IV, and post-liver transplantation were 0.529, - 0.111, 0.904, 0.868, 0.845, 0.722, 0,675, 0,428, and 0.651 and 0.876, 0.821, 0.737, 0.671, 0.675, 0.428, and 0.651 in HB and HC, respectively. To the best of our knowledge, this is the first study that comprehensively assessed the health state utilities of patients with HB, HC and hepatitis-related conditions from a nationwide survey in Japan using the EQ-5D-5L.
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Carcinoma Hepatocelular , Hepatitis A , Hepatitis B , Hepatitis C , Neoplasias Hepáticas , Necrosis Hepática Masiva , Estado de Salud , Hepatitis B/complicaciones , Humanos , Japón , Cirrosis Hepática , Calidad de Vida , Encuestas y CuestionariosRESUMEN
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.
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Anestesia General , Presión Sanguínea , Procedimientos Quirúrgicos Operativos , Anestesia General/efectos adversos , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Periodo Preoperatorio , Estudios RetrospectivosRESUMEN
BACKGROUND: The number of total pancreatectomy cases have increased worldwide, expanding the need for new insulin products and high-titer pancrelipases. However, the current data that is focused on hypoglycemic events after a total pancreatectomy from large nationwide series are still lacking. This study is aimed to assess the risk factors associated with hypoglycemic events after a total pancreatectomy. METHODS: Data were prospectively collected from 216 consecutive patients who underwent total pancreatectomies between August 2015 and December 2017 from 68 Japanese centers. Of the 216 patients, 166 with a follow-up period of 1 year were analyzed. The risk factors for hypoglycemic events at 6 and 12 months (postoperative months 6 and 12) were investigated based on the results of a nationwide multicenter prospective study. RESULTS: Of the 166 patients, 57 (34%) and 70 (42%) experienced moderate or severe hypoglycemic events or hypoglycemia unawareness on a monthly basis at postoperative months 6 and 12, respectively. Multivariate analysis revealed that body weight loss after surgery ≥0.3 kg and total cholesterol level ≤136 mg/dL at postoperative month 6, and glycated hemoglobin level ≤8.9% and rapid-acting insulin use at postoperative month 12 were independent risk factors for hypoglycemic events after a total pancreatectomy. There were different independent risk factors depending on the postoperative period. CONCLUSION: Patients with body weight loss after surgery, low total cholesterol level, strict glycemic control, and using rapid-acting insulin should be aware of the occurrence of hypoglycemic events after their total pancreatectomy. In order to prevent hypoglycemic events after a total pancreatectomy, we need to consider optimal nutritional and glycemic control according to the postoperative period.
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Hipoglucemiantes , Pancreatectomía , Glucemia/análisis , Colesterol , Hemoglobina Glucada/análisis , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Insulina de Acción Corta , Japón/epidemiología , Pancreatectomía/efectos adversos , Pancreatectomía/métodos , Estudios Prospectivos , Factores de Riesgo , Pérdida de PesoRESUMEN
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".
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COVID-19 , SARS-CoV-2 , Teorema de Bayes , COVID-19/epidemiología , Brotes de Enfermedades , Humanos , Sudáfrica/epidemiologíaRESUMEN
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.
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Estados Financieros , Alimentos , Asia Sudoriental , Cambodia , Abastecimiento de Alimentos , HumanosRESUMEN
AIM: Familial hypercholesterolemia (FH) is an underdiagnosed autosomal dominant genetic disorder characterized by high levels of plasma low-density lipoprotein cholesterol (LDL-C) from birth. This study aimed to assess the genetic identification of FH in children with high LDL-C levels who are identified in a universal pediatric FH screening in Kagawa, Japan. METHOD: In 2018 and 2019, 15,665 children aged 9 or 10 years underwent the universal lipid screening as part of the annual health checkups for the prevention of lifestyle-related diseases in the Kagawa prefecture. After excluding secondary hyper-LDL cholesterolemia at the local medical institutions, 67 children with LDL-C levels of ≥ 140 mg/dL underwent genetic testing to detect FH causative mutations at four designated hospitals. RESULTS: The LDL-C levels of 140 and 180 mg/dL in 15,665 children corresponded to the 96.3 and 99.7 percentile values, respectively. Among 67 children who underwent genetic testing, 41 had FH causative mutations (36 in the LDL-receptor, 4 in proprotein convertase subtilisin/kexin type 9, and 1 in apolipoprotein B). The area under the curve of receiver operating characteristic curve predicting the presence of FH causative mutation by LDL-C level was 0.705, and FH causative mutations were found in all children with LDL-C levels of ≥ 250 mg/dL. CONCLUSION: FH causative mutations were confirmed in almost 60% of the referred children, who were identified through the combination of the lipid universal screening as a part of the health checkup system and the exclusion of secondary hyper-LDL cholesterolemia at the local medical institutions.
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Hiperlipoproteinemia Tipo II , Apolipoproteínas B/genética , Niño , LDL-Colesterol , Humanos , Hiperlipoproteinemia Tipo II/diagnóstico , Hiperlipoproteinemia Tipo II/epidemiología , Hiperlipoproteinemia Tipo II/genética , Japón/epidemiología , Mutación , Proproteína Convertasa 9/genéticaRESUMEN
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.
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Consejeros , Prevención del Suicidio , Consejo , Humanos , Encuestas y Cuestionarios , TeléfonoRESUMEN
Both voluntary in-hospital reporting and mandatory national-level reporting systems for patient safety issues need to work well to develop a patient safety learning system that is effective in preventing the recurrence of adverse events. Some of the hospital systems and activities may increase voluntary in-hospital reporting and mandatory national-level reporting. This study aimed to identify the hospital systems and activities that increase voluntary in-hospital reporting and mandatory national-level reporting for patient safety issues. An anonymous mail survey of hospitals in Japan was conducted in 2017. The hospitals were selected by stratified random sampling according to number of beds. The survey examined the annual number of reported events in the voluntary in-hospital reporting system for patient safety and experience of reporting unexpected patient deaths possibly due to medical interventions to the mandatory national-level reporting system in the last 2 years. The relationship of the answer to the questions with the patient safety management systems and activities at each hospital was analyzed. The response rate was 18.8% (603/3,215). The number of in-hospital reports per bed was positively related to identifying events by referring complaints or questions of patients or family members, using root cause analysis for analyzing reported events, and developing manuals or case studies based on reported events, and negatively related to the unification and standardization of medical devices and equipment. The experience with mandatory national-level reporting of serious adverse events was positively related to identifying problematic cases by a person in charge of patient safety management from the in-hospital reporting system of complications and accidental symptoms. Enhanced feedback for reporters may promote voluntary in-hospital reporting of minor cases with low litigation risks. Developing an in-hospital mechanism that examines all serious complications and accidental symptoms may promote mandatory national-level reporting of serious adverse events with high litigation risks.
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Seguridad del Paciente/normas , Administración de la Seguridad/organización & administración , Estudios Transversales , Hospitales/normas , Humanos , Japón , Notificación Obligatoria , Seguridad del Paciente/legislación & jurisprudencia , Administración de la Seguridad/métodosRESUMEN
AIM: To evaluate the cost-effectiveness of therapeutic strategies initiated at different stages of liver fibrosis using three direct-acting antivirals (DAAs), sofosbuvir-ledipasvir (SL), glecaprevir-pibrentasvir (GP), and elbasvir plus grazoprevir (E/G), for Japanese patients with chronic hepatitis C (CHC) genotype 1. METHODS: We created an analytical decision model reflecting the progression of liver fibrosis stages to evaluate the cost-effectiveness of alternative therapeutic strategies applied at different fibrosis stages. We compared six treatment strategies: treating all patients regardless of fibrosis stage (TA), treating individual patients with one of four treatments starting at four respective stages of liver fibrosis progression (F1S: withholding treatment at stage F0 and starting treatment from stage F1 or higher, and three successive options, F2S, F3S, and F4S), and administering no antiviral treatment (NoRx). We adopted a lifetime horizon and Japanese health insurance payers' perspective. RESULTS: The base case analysis showed that the incremental quality-adjusted life years (QALY) gain of TA by SL, GP, and E/G compared with the strategies of starting treatments for patients with the advanced fibrosis stage, F2S, varied from 0.32 to 0.33, and the incremental cost-effectiveness ratios (ICERs) were US$24,320, US$18,160 and US$17,410 per QALY, respectively. On the cost-effectiveness acceptability curve, TA was most likely to be cost-effective, with the three DAAs at the willingness to pay thresholds of US$50,000. CONCLUSIONS: Our results suggested that administration of DAA treatment for all Japanese patients with genotype 1 CHC regardless of their liver fibrosis stage would be cost-effective under ordinary conditions.