Declines in Physical Activity and Cardiorespiratory Fitness After Implementing new National School Guidelines.

PURPOSE: We examined whether introduction of national guidelines limiting sports club activities at school was associated with adolescents' exercise and cardiorespiratory fitness. METHODS: We conducted interrupted time-series analysis to quantify the changes in prefecture-level aggregated data on exercise or sports activities and 20-m shuttle run (indicator of cardiorespiratory fitness) among adolescents in Japan before (2013-2017) and after (2018-2022) the introduction of the guidelines using data from the National Survey of Physical Fitness, Athletic Performance and Exercise Habits. RESULTS: The introduction of the guidelines was associated with reductions in exercise and sports activities duration (boys, -4.8 [95% CI -5.9, -3.8] min/day; girls, -5.5 [95% CI -6.2, -4.8] min/day) and performance of 20-m shuttle run (boys, -1.2 [95% CI -1.4, -1.0] laps; girls, -2.3 [95% CI -2.5, -2.2] laps). DISCUSSION: After introducing guidelines limiting sports club activities at school, levels of exercise or sports and cardiorespiratory fitness declined among adolescents.

Multicenter observational survey on psychosocial and behavioral impacts of COVID-19 in people living with HIV in Northern Vietnam.

Socially marginalized groups, including people living with HIV/AIDS (PLHIV), could be disproportionately affected by Coronavirus disease 2019 (COVID-19). Following an initial single-center survey conducted in 2020, we conducted a second survey of 11 antiretroviral therapy (ART) sites in Northern Vietnam between June 2021 and January 2022. We tested anti-SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) nucleocapsid IgG antibodies and assessed prevention against COVID-19 and impacts of COVID-19 on access to ART, economic security, risky health behaviors, and mental health using self-reported questionnaires. In total, 7808 PLHIV on ART participated in the second survey. The overall prevalence of SARS-CoV-2 antibody was as low as 1.2%. There was no clear upward trend in COVID-19 infection among PLHIV compared with the rate of infection among the general population. HIV treatment was generally maintained and no increase in risky health behaviors was observed. The economic impacts were significant, with high unemployment rate, poorer economic security, and binge drinking strongly associated with depression. However, the prevalence of depression decreased by 11.2% compared with pre-COVID-19 levels. Social support, including for patients to continue HIV treatment and effective employment/financial assistance, may help to alleviate the negative socioeconomic impacts of COVID-19 and improve mental health among PLHIV.

Quality of life with docetaxel plus cisplatin versus paclitaxel plus carboplatin in patients with completely resected non-small cell lung cancer: quality of life analysis of TORG 0503.

PURPOSE: The TORG0503 study was undertaken to select a preferred platinum-based third-generation regimen for patients with completely resected non-small cell lung cancer (NSCLC). This study aimed to describe the quality of life (QOL) analysis of that study. METHODS: Patients with completely resected NSCLC were randomized to receive three cycles of docetaxel plus cisplatin (DC) or paclitaxel plus carboplatin (PC) on day 1 every 3 weeks. QOL was assessed at three time points (baseline, after two cycles, and after three cycles) using the Functional Assessment of Cancer Therapy-taxane (FACT-Taxane). The adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated by logistic regression analysis that was adjusted for the baseline score in the FACT-Taxane total score and each subscale to evaluate treatment (PC vs. DC) effectiveness. RESULTS: QOL data from 104 patients (DC, n = 56 patients; PC, n = 48) were analyzed. In the FACT-Taxane total score, the baseline-adjusted OR (95% CI) of not worse QOL for the DC group was 3.3 (1.4-8.3) compared with the PC group. In the taxane subscale, the baseline-adjusted OR (95% CI) was 6.2 (2.6-16.0). CONCLUSION: Total QOL was maintained better in the DC group than in the PC group, especially the taxane subscale that consists of neurotoxicity and taxane components in spite of no treatment-related death in both arms between DC and PC. We might recommend DC as the control regimen for the next clinical trial from the viewpoint of QOL, similar to the primary outcomes in TORG0503.

Risk of low birthweight associated with the timing and frequency of antenatal care visits in Lao PDR: a retrospective cohort study.

BACKGROUND: Antenatal care (ANC) plays an important role in preventing low birthweight (LBW). Whereas the government of Lao People's Democratic Republic (Lao PDR) has committed to increasing the usage of ANC, little attention has been given to the early initiation of ANC. The present study assessed the influence of delayed and fewer ANC visits on LBW in the country. METHODS: This is a retrospective cohort study conducted at Salavan Provincial Hospital. Study participants were all pregnant women who gave birth at the hospital between 1 August 2016 and 31 July 31 2017. Data were collected from medical records. Logistic regression analyses were performed to quantify the relationship between ANC visits and LBW. We also investigated factors associated with inadequate ANC visits: first ANC visit after the first trimester or < 4 ANC visits. RESULTS: The mean birth weight was 2808.7 g [standard deviation: SD 455.6]. Among 1804 participants, 350 (19.4%) had babies with LBW, and 147 (8.2%) had inadequate ANC visits. In multivariate analyses, compared to participants with adequate ANC visits, those with ≥ 4 ANC visits and the first ANC visit after the second trimester, those with < 4 ANC visits, and those with no ANC visits had higher odds ratios (ORs) of LBW: 3.77 (95% confidence interval: CI = 1.66-8.57), 2.39 (95% CI = 1.18-4.83) and 2.22 (95% CI = 1.08-4.56), respectively. Younger maternal age (OR 1.42; 95% CI = 1.07-1.89), government subsidisation (OR 2.69; 95% CI = 1.97-3.68) and ethnic minority (OR 1.88; 95% CI = 1.50-2.34) were associated with increased risk of insufficient number of ANC visits after adjusting for covariates. CONCLUSIONS: Frequent and early initiation of ANC was associated with a reduction in LBW in Lao PDR. Encouraging childbearing-aged women to receive sufficient ANC at proper timing may lead to a reduction in LBW and improvement in short- and long-term health outcomes of neonates. Special attention will be needed for ethnic minorities and women in lower socioeconomic classes.

Regional variation of pediatric interhospital critical care transport in Japan.

BACKGROUND: An in-depth understanding of the epidemiology of ill or injured children transported between hospitals is crucial in building regional medical transport services in public health. Although the epidemiological situation varies by nation and region, it has not been well documented in Japan. In this report we described the number of pediatric interhospital transportations and examined the regional variations and trends in the recent decade. METHODS: We performed repeated, cross-sectional analyses of children (<15 years) undergoing interhospital transportation in 2010, 2013, and 2016-19, using the national database of public ambulances of the Fire and Disaster Management Agency in Japan. We stratified the cases into critical care transport (CCT) or non-critical care transport (NonCCT) by the illness/injury severity of the transported children. We calculated the national population-adjusted number of CCTs and described prefectural variations in CCT numbers with analytical thinking. RESULTS: There were 23,506 CCTs and 138,347 NonCCTs. The national average of population-adjusted CCT numbers was 255 per 1,000,000 person-years. The statistics varied by prefectures, ranging from 25-536 per 1,000,000 person-years. The annual trends were also diverse across prefectures, increasing in nine, decreasing in six, and static in 31 prefectures. In analytical thinking of regional variations, potential contributing factors included available interhospital transport services and the threshold of direct admission and referral to tertiary-care hospitals, whereas regional variations were not well associated with geographical patterns or population size. CONCLUSIONS: Public ambulance services were substantially used for CCTs and NonCCTs in Japan. Regional variations should be taken into account for the future policymaking on pediatric interhospital transportation.

Effects of 'SPRAT' programme for dietary and lifestyle education to improve psychosomatic symptoms and dietary habits among adolescents: a cluster randomised controlled trial.

BACKGROUND: Dietary and lifestyle modifications to reduce subjective psychosomatic symptoms (SPS) have become an important topic worldwide. We developed a school-based dietary and lifestyle education programme that involved parents/guardians in reducing SPS in adolescents (SPRAT). The programme encouraged parents/guardians to participate in adolescents' healthy dietary and lifestyle modifications to reduce SPS, increase enjoyment of school life, and foster appropriate dietary intake. This study evaluated the effectiveness of SPRAT in reducing SPS and in altering dietary behaviour among adolescents. METHODS: A 6-month cluster randomised controlled trial using SPRAT and the usual school programme (control) was performed. Participants were middle school students in Japan who provided informed consent. Outcomes were SPS scores assessed at baseline and 2, 4, and 6 months after baseline and the proportions of dietary and lifestyle factors achieved such as enjoyment of school life and dietary intakes assessed by FFQW82. Change from baseline (CFB) at 6 months was the primary endpoint. A linear mixed-effects model was applied. As for dietary intake, the treatment effect was estimated as an interaction term between baseline and treatment "baseline*treatment". RESULTS: The intention-to treat analysis included 951 (94.7%) and 1035 (89.8%) individuals in the SPRAT and control groups, respectively. The CFB in the 6-month SPS score adjusted for baseline was lower in the SPRAT group (-0.29) than in the control group (0.62), but the difference was not statistically significant -0.91 (p = 0.093). CONCLUSIONS: Although the primary endpoint tended to denote improvement in the SPRAT group compared to the control group, the improvement was not significant. Favourable effects were observed in some secondary outcomes and statistically significant treatment*baseline interactions were observed for several dietary intakes. These results imply that CFBs of dietary intake were increased or decreased in a favourable direction depending on the baseline intake, especially in the SPRAT group. TRIAL REGISTRATION: UMIN000026715. (27/03/2017).

Cost-effectiveness analysis of sedation and general anesthesia regimens for children undergoing magnetic resonance imaging in Japan.

PURPOSE: The anesthesiologist-directed sedation service has not been well established in Japan partly due to reimbursement issue. In this study, we compared the cost-effectiveness of sedation by non-anesthesiologists with that of sedation or general anesthesia by anesthesiologists under the Japanese medical fee schedule. METHODS: We conducted a single-center observational study with patients who required sedation or general anesthesia for magnetic resonance imaging (MRI) during a 12-month period. Costs per patient and failure rates of imaging were modeled in a decision analysis tree with sensitivity analysis. Costs were estimated from the health-care sector perspective. RESULTS: A total of 1546 patients were analyzed. The failure rate of sedation by non-anesthesiologists was 17.5% (264 out of 1506), whereas all the sedation and general anesthesia by anesthesiologists were successful. The cost-effectiveness analysis with setting successful sedation as outcomes showed that the mean cost per patient was 84.2 USD for sedation by anesthesiologists, followed by 74.2-92.7 USD for intravenous sedation by non-anesthesiologists, 112.1-458.3 USD for oral or rectal sedation by non-anesthesiologists, and 605.4 USD for general anesthesia by anesthesiologists. The one-way sensitivity analysis demonstrated that the cost per patient of sedation by a non-anesthesiologist would remain higher than that of sedation by an anesthesiologist, provided that the failure rate is over 11.3% for sedation via oral or rectal route, or over 3.6% for intravenous route, respectively. CONCLUSIONS: Anesthesia-directed sedation would be more cost-effective than oral or rectal sedation by non-anesthesiologists for children undergoing MRI in the Japanese medical fee schedule.

Effects of a Self-Monitoring Quality of Life Intervention in Outpatients with Breast Cancer: A Preliminary Report of A Randomized Controlled Trial.

OBJECTIVE: This preliminary report used data from a randomized controlled clinical trial to investigate the beneficial effects of a self-monitoring quality of life (SMQOL) intervention on communication, medical care and patient outcomes in Japanese women with breast cancer. METHODS: This study compared a SMQOL intervention group with a control group that received usual care after 4 months on self-efficacy aspects of patient-physician communication among outpatients with breast cancer in Japan using the Perceived Efficacy in Patient-Physician Interactions (PEPPI) questionnaire. Patients were randomly assigned to the intervention and control groups using permuted-block randomization. The intervention groups were asked to complete a paper-based quality-of-life (QOL) questionnaire in addition to the usual care provided in the control group. Analysis of covariance was used to assess the difference in PEPPI scores between the intervention and control groups. Additionally, subgroup analyses were performed for outpatients with breast cancer accompanied by depression or anxiety. RESULTS: In total, 232 patients were eligible for this study and randomized. Seven patients did not answer the PEPPI questionnaire at baseline after group allocation, leaving 225 patients for inclusion in the analyses. The modified intention-to-treat ITT analysis showed the SMQOL intervention had no significant effect on PEPPI total score (P = 0.226). We found a significant between-group difference in PEPPI total score in the anxiety group (P = 0.045), namely, the self-efficacy aspects of patient-physician communication of those with anxiety in the intervention group were better than for those in the control group after 4 months. CONCLUSION: Use of the SMQOL had beneficial effects on communication self-efficacy between patients and physicians for outpatients with breast cancer, those with anxiety.

Perceptions of Japanese and Dutch women with early breast cancer about monitoring their quality of life.

OBJECTIVE: Monitoring quality of life (QoL) in patients with cancer can provide insight into functional, psychological and social consequences associated with illness and its treatment. The primary objective of this study is to examine the influence of cultural factors on the communication between the patient and the health care provider and the perceived QoL in women with breast cancer in Japan and the Netherlands. METHODS: In Japanese and Dutch women with early breast cancer, the number, content and frequency of QoL-related issues discussed at the medical encounter were studied. Patients completed questionnaires regarding QoL and evaluation of communication with the CareNoteBook. RESULTS: The total number, frequency and content of QoL-related issues discussed differed between the two countries. Japanese women (n = 134) were significantly more reticent in discussing QoL-issues than the Dutch women (n = 70) (p < .001). Furthermore, Dutch patients perceived the CareNoteBook methodology significantly more positively than the Japanese patients (p < .001). Both groups supported the regular assessment via a CareNoteBook methodology. CONCLUSIONS: Japanese women are more reluctant in expressing their problems with the illness, its treatment and patient-physician communication than Dutch women.

Effectiveness of polypharmacy reduction policy in Japan: nationwide retrospective observational study.

Background Polypharmacy is an important global health issue. In Japan, an amended policy has been implemented since April 2016 to offer incentives that allow claiming a payment of approximately 22.5 US$ per patient to hospitals and clinics that succeed to reduce two or more medications. However, there is no evidence on the nationwide effectiveness of polypharmacy reduction policy. Aim To evaluate the effectiveness of the polypharmacy reduction policy in Japan using nationwide outpatient prescription fee reimbursement claims data in Open Data of the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Method This nationwide retrospective observational study was conducted over 3 years (April 2015 to March 2018). The primary outcome was the polypharmacy reduction ratio calculated by the polypharmacy proportion. Factors associated with policy effectiveness were identified by performing a multiple linear regression analysis using independent variables. Results After implementing the new policy, a 7.3 % polypharmacy reduction ratio was observed, particularly in the elderly (8.2 %). Multiple linear regression analysis revealed that the proportion of elderly residents (aged ≥65 years), number of hospitals per 100,000 residents, and number of clinics per 100,000 residents were statistically significantly associated with this reduction. Conclusion The polypharmacy reduction policy indicated an association with polypharmacy reduction in Japan. The proportion of elderly residents and availability of hospitals and clinics are important factors to enhance the effectiveness of the polypharmacy reduction policy.

Evaluation of an educational programme for people who have difficulty decluttering and organising: A randomised controlled trial in Japan.

Home clutter can adversely affect work performance, health and well-being. Clinical-level hoarding disorders usually manifest during early adolescence, so early detection and prevention of subclinical hoarding tendencies are essential. This study aimed to evaluate a community-based programme for individuals with poor organising and decluttering skills who volunteered to receive education on how to organise their homes. We conducted an open-label randomised controlled trial beginning in January 2016 in Tokyo. We enrolled 61 volunteers aged 12-55 years with problems with organising and decluttering. A workshop and home visit group (n = 30) attended four workshop sessions on organising skills and received a visit from a home organiser. The home visit only group (n = 31) only received the home organiser visit. The primary outcome was Saving Inventory-Revised (SI-R; Japanese version) scores. The secondary outcomes were Clutter Image Rating Scale and Rosenberg Self-Esteem Scale (Japanese version) scores. Between-group changes from baseline to 7 months were analysed using a general linear model. At follow-up, the SI-R scores of both groups had improved. The mean change from baseline in SI-R scores was -20.8 (standard deviation = 9.8) and -13.1 (standard deviation = 14.3) in the workshop and home visit and home visit only groups, respectively. The estimated between-group difference in SI-R score changes from baseline (adjusted for baseline SI-R score) was non-significant at -5.7 (95% confidence interval, -12.4 to 0.9; p = .089). However, the difference was significant in the univariate model: -7.2 (95% confidence interval, -13.7 to -0.8; p = .029). Although both groups improved, after adjusting for baseline values and participant characteristics, there was no significant difference between the groups. Our results suggest that a workshop-style educational intervention and assistance and advice from professional organisers may help to improve the living conditions of people with hoarding tendencies.

Clinical impact of implementing humidified high-flow nasal cannula on interhospital transport among children admitted to a PICU with respiratory distress: a cohort study.

BACKGROUND: There is a limited evidence for humidified high-flow nasal cannula (HHFNC) use on inter-hospital transport. Despite this, its use during transport is increasing in children with respiratory distress worldwide. In 2015 HHFNC was implemented on a specialized pediatric retrieval team serving for Victoria. The aim of this study is to investigate the effect of the HHFNC implementation on the retrieval team on the paediatric intensive care unit (PICU) length of stay and respiratory support use. METHODS: We performed a cohort study using a comparative interrupted time-series approach controlling for patient and temporal covariates, and population-adjusted analysis. We studied 3022 children admitted to a PICU in Victoria with respiratory distress January 2010-December 2019. Patients were divided in pre-intervention era (2010-2014) and post-intervention era (2015-2019). RESULTS: 1006 children following interhospital transport and 2016 non-transport children were included. Median (IQR) age was 1.4 (0.7-4.5) years. Pneumonia (39.1%) and bronchiolitis (34.3%) were common. On retrieval, HHFNC was used in 5.0% (21/420) and 45.9% (269/586) in pre- and post-intervention era. In an unadjusted model, median (IQR) PICU length of stay was 2.2 (1.1-4.2) and 1.7 (0.9-3.2) days in the pre- and post-intervention era in transported children while the figures were 2.4 (1.3-4.9) and 2.1 (1.2-4.5) days in non-transport children. In the multivariable regression model, the intervention was associated with the reduced PICU length of stay (ratio 0.64, 95% confidential interval 0.49-0.83, p = 0.001) with the predicted reduction of PICU length of stay being - 10.6 h (95% confidential interval - 16.9 to - 4.3 h), and decreased respiratory support use (- 25.1 h, 95% confidential interval - 47.9 to - 2.3 h, p = 0.03). Sensitivity analyses including a model excluding less severe children showed similar results. In population-adjusted analyses, respiratory support use decreased from 4837 to 3477 person-hour per year in transported children over the study era, while the reduction was 594 (from 9553 to 8959) person-hour per year in non-transport children. With regard to the safety, there were no escalations of respiratory support mode during interhospital transport. CONCLUSIONS: The implementation of HHFNC on interhospital transport was associated with the reduced PICU length of stay and respiratory support use among PICU admissions with respiratory distress.

Effectiveness of self-managed continuous monitoring for maintaining high-quality early essential newborn care compared to supervision visit in Lao PDR: a cluster randomised controlled trial.

BACKGROUND: Thousands of neonatal deaths are expected to be averted by introducing the Early Essential Newborn Care (EENC) in the Western Pacific Region. In Lao People's Democratic Republic (Lao PDR), the government adopted the EENC programme and expanded it to district hospitals. With the expansion, maintaining the quality of EENC has become difficult for the government. METHODS: A cluster randomised controlled trial with four strata based on province and history of EENC coaching was implemented to evaluate the effectiveness of self-managed continuous monitoring compared with supervisory visit in Lao PDR between 20 July 2017 and 2 April 2019. Health workers who were routinely involved in maternity care were recruited from 15 district hospitals in Huaphanh (HP) and Xiangkhouang (XK) provinces. The primary endpoint was the score on the determinants of EENC performance measured by the Theory of Planned Behaviour (TPB). Secondary endpoints were set as the knowledge and skill scores. A linear mixed-effects model was applied to test the effects of intervention over time on the endpoints. RESULTS: Among 198 recruited health workers, 46 (23.2%) did not complete the final evaluation. TPB scores were 180.9 [Standard Deviation: SD 38.6] and 182.5 [SD 37.7] at baseline and 192.3 [SD 30.1] and 192.3 [SD 28.4] at the final evaluation in the intervention and control groups, respectively. There was no significant difference in changes between the groups in the adjusted model (2.4, p = 0.650). Interviews with participants revealed that district hospitals in HP regularly conducted peer reviews and feedback meetings, while few hospitals did in XK. Accordingly, in stratified analyses, the TPB score in the intervention group significantly increased in HP (15.5, p = 0.017) but largely declined in XK (- 17.7, p = 0.047) compared to the control group after adjusting for covariates. Skill scores declined sharper in the intervention group in XK (- 8.78, p = 0.026), particularly in the practice of managing nonbreathing babies. CONCLUSIONS: The study indicates that self-managed continuous monitoring is effective in improving behaviour among district health workers; however, additional measures are necessary to support its proper implementation. To maintain resuscitation skills, repeated practice is necessary. TRIAL REGISTRATION: This trial was registered at UMIN Clinical Trials Registry on 15/6/2017. Registration number is UMIN000027794 .

Self-Esteem, Socioeconomic Status and Social Participation of Persons with Disabilities Living in Areas Affected by Armed Conflict in Colombia.

This cross-sectional study explored the association between self-esteem and social participation of persons with disabilities living in two municipalities affected by armed conflict in Colombia. We studied the socioeconomic status, communication level, social participation, and self-esteem of the participants. The Rosenberg Self-Esteem Scale (RSES) was used to evaluate the level of self-esteem. We performed bivariate analysis and multiple regression analysis to identify the determinants of higher self-esteem in the target populations. In total, there were 579 participants in the study. The mean RSES score was 28.8 (SD = 4.5). Self-esteem was associated with monthly household income (ß = 0.45, p = 0.028), education level (ß = 0.65, p = 0.048), current job (ß = 1.00, p = 0.017), type of disability (ß = -1.17, p = 0.002), frequency of communication with neighbors or friends (ß = 0.53, p = 0.013), and participation in community organization activities (ß = 0.89, p = 0.019). Frequent communication with their own community, higher levels of school education, and having a job were determinants of higher self-esteem in persons with disabilities. We suggest the importance of an active inclusive reconstruction program to support persons with disabilities in local municipalities affected by armed conflict in developing countries.

Overall health information exposure, its barriers and impacts on attitude toward healthcare among cancer patients. The long-term aftermath of the 2011 triple disaster in Fukushima, Japan: A single institution cross-sectional study.

Disasters can hinder access to health information among cancer patients. However, little is known regarding overall health information exposure (HIE), its barriers and its impacts on attitudes toward healthcare among cancer patients in the long-term aftermath of disasters. The aims of this study were threefold: assess the extent of HIE; identify associations between family composition and a non-engagement with HIE; and examine the effects of HIE on attitudes toward healthcare among local cancer patients-5 years after the 2011 triple disaster (earthquake, tsunami, and nuclear disaster) in Fukushima, Japan. We conducted self-administered surveys with all cancer and non-cancer surgery department outpatients at Minamisoma Municipal General Hospital (MMGH), Minamisoma City, from October 2016 to January 2017. In total, 404 patients (263 cancer patients and 141 non-cancer patients) voluntarily participated in the study. The results revealed that a regular level of HIE occurred among 90.5% of the cancer patients. In cancer patients, family composition was not significantly associated with HIE, and HIE was not associated with attitude toward healthcare. In conclusion, most cancer patients visiting the MMGH surgical department were regularly engaged in HIE.

Analysis of intraoperative modifiable factors to prevent acute kidney injury after elective noncardiac surgery: intraoperative hypotension and crystalloid administration related to acute kidney injury.

BACKGROUND: The optimal intraoperative blood pressure range and crystalloid administration protocol for the prevention of acute kidney injury (AKI) after elective noncardiac surgery remain unknown. METHODS: This single-center retrospective cohort study included 6296 patients aged ≥ 50 years who had undergone elective noncardiac surgery under general anesthesia. We evaluated the relationship between duration of intraoperative hypotension and AKI. To assess whether the effects of crystalloid administration differed according to baseline estimated glomerular filtration rate (eGFR), we examined the interaction between intraoperative crystalloid administration and eGFR. We calculated univariable and multivariable adjusted odds ratios (ORs) and their 95% confidence intervals (95% CIs) for the prevalence of AKI. RESULTS: AKI occurred in 431 (6.8%) patients and was associated with intraoperative hypotension. Effects of intraoperative crystalloid administration differed significantly according to baseline eGFR. Increased risk of AKI was noted in patients with eGFR ≤45 ml min-1 1.73m-2 who were managed with restrictive or liberal crystalloid administration [OR 4.79 (95% CI 3.10 to 7.32) and 6.43 (95% CI 2.23 to 16.03), respectively] as opposed to those with eGFR >45 ml min-1 1.73m-2 who were managed with moderately restrictive crystalloid administration. CONCLUSIONS: Our findings suggest that anesthesiologists should avoid intraoperative hypotension as well as either restrictive or liberal (as opposed to moderately restrictive) crystalloid administration in patients with decreased eGFR. Intraoperative blood pressure and crystalloid administration protocol are major modifiable factors that must be optimized to prevent postoperative AKI.

Relationship between social cohesion and the care burden of primary family caregivers in central Tokyo, Japan.

OBJECTIVES: To clarify how the care burden of primary family caregivers is associated with social cohesion in an urban area of Tokyo, Japan. STUDY DESIGN: Cross-sectional study. METHODS: A questionnaire survey of primary family caregivers was conducted in Tokyo in 2015. Social cohesion was examined using the social capital indicators of Kondo et al, and the care burden of primary family caregivers was assessed by the Zarit Care Burden Interview Scale in Japanese short version (J-ZBI_8). Data were analyzed by multiple regression models. Ethics approval was obtained to carry out this research. RESULTS: Seventy-nine caregivers responded to the questionnaires. After excluding 6 caregivers who did not respond appropriately to the questionnaire, 73 caregivers were included in the analyses. The average age of the primary family caregivers was 68.9 ± 12.7 years old, and that of the patients receiving care was 83.1 ± 10.0 years old. "Receipt of instrumental support" was significantly associated with reduced burden of care for family caregivers as assessed by the J-ZBI_8 score (P = .027). CONCLUSION: This study suggested that social cohesion was significantly associated with reduced burden of care for primary family caregivers. Especially, the results suggested that "social support: receipt of instrumental support" was associated with a lower burden of care after adjustment for confounding factors. It is important to understand family structure and social community differences such as informal social support for future policy making.

Perceptions and Attitudes Toward Telemedicine by Clinicians and Patients in Japan During the COVID-19 Pandemic.

Background: Coronavirus disease 2019 (COVID-19) has spread rapidly worldwide. In Japan, the spread of COVID-19 was recognized and a state of emergency declared in April 2020. In response, public health interventions, such as discouraging people from leaving their homes unnecessarily, were enacted across the country. Under these circumstances, telemedicine has received a great deal of social attention, and it has become necessary to identify the perceptions of and attitudes toward telemedicine by clinicians and patients and to clarify the problems and advantages. Materials and Methods: Ten clinicians and 10 family members (if the patient was pediatric or elderly, a caregiver was included) were invited to participate in individual private interviews in 2020. All interviews were conducted from October to December 2020 using a semistructured interview guide. All transcripts were coded using thematic content analysis. Results: Four categories from clinicians and five from patients were identified as perceptions of and attitudes toward telemedicine. Both evaluated the usefulness and convenience of telemedicine in the same manner, but there was a large gap in the content under the safety and problem categories. Discussion: It is necessary to disseminate information about the communication techniques unique to telemedicine to doctors and to improve the "operation and introduction" and "communication environment and device settings" when starting or using telemedicine for all patients. Conclusions: The perceptions and attitudes identified in this study will be useful for establishing and developing a telemedicine system in Japan.

Associations Between Social Support and Subjective Symptoms in Disaster-Stricken Ishinomaki, Japan.

OBJECTIVES: Natural disasters affect long-term health by directly disrupting or destroying health-care systems and social support. We examined the associations between social support and subjective symptoms (SS) among disaster victims living in their homes approximately 1-2 years after the Great East Japan Earthquake and tsunami on March 11, 2011, which devastated the northeastern Japan seaboard and far inland, focusing on Ishinomaki, Miyagi Prefecture. METHODS: The Health and Life Revival Council of Ishinomaki District conducted door-to-door household surveys between April 2012 and January 2013. Replies to 12 questions regarding social support, specifically emotional, informational, and instrumental, were investigated. SS prevalence was calculated as the proportion of those having any of 8 predetermined symptoms including back pain, neck stiffness, sleep difficulty, dizziness, heart palpitations, poor appetite, or stomachache. Logistic regression analysis by sex was used to obtain crude and adjusted odds ratios for the association between SS prevalence and forms of social support. RESULTS: From 4023 households, self-reported data on 2593 individuals from 1709 households were obtained. SS prevalence was 29.1%. Adjusted logistic regression analysis revealed that instrumental support with others and emotional support with personal and others were specific associated with SS in men and women, respectively. CONCLUSIONS: Our findings suggest that providing social support depending on needs is potentially effective in preventing SS in disaster areas.