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2.
Clin Interv Aging ; 13: 895-901, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29780243

RESUMEN

Purpose: The aim of this study was to investigate whether the day of starting oral intake affects the clinical course of patients with aspiration pneumonia. Results: We conducted a retrospective cohort study of 392 patients who were hospitalized for aspiration pneumonia but tolerated oral intake. Patients were divided into two groups according to the day of starting oral intake: Monday to Friday (midweek group) and Saturday or Sunday (weekend group). Underlying diseases, severity of pneumonia, time to oral intake, hospital duration, discontinuation of oral intake, and death during hospitalization were compared between the groups. Multivariate analysis was performed using hospital duration and discontinuation of oral intake due to aspiration as the dependent variables. Results: The cohort comprised 244 men and 148 women with a mean age of 79.3 ± 13.1 years. The weekend (n = 98) and midweek (n = 294) groups exhibited similar age, sex, and underlying diseases. There were no significant differences in pneumonia-related factors, such as CURB-65 score, A-DROP score, extent of shadow on chest radiograph, incidence of bacteremia, and ventilator use. The weekend group exhibited a significantly shorter time to oral intake and hospital duration, as well as a significantly lower incidence of discontinuation of oral intake than the midweek group. Multivariate analysis revealed that starting oral intake on the weekend was independently associated with a lower incidence of discontinuation of oral intake due to aspiration. Conclusion: The weekend group exhibited a shorter total hospital duration and a lower incidence of discontinuation of oral intake due to aspiration.


Asunto(s)
Ingestión de Alimentos , Neumonía por Aspiración/terapia , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Masculino , Análisis Multivariante , Neumonía por Aspiración/diagnóstico , Neumonía por Aspiración/mortalidad , Estudios Retrospectivos , Factores de Tiempo
3.
BMJ Open ; 7(7): e016322, 2017 Jul 17.
Artículo en Inglés | MEDLINE | ID: mdl-28716792

RESUMEN

OBJECTIVES: It is unclear whether family medical history influences the willingness to undergo genetic testing. This study aimed to determine how family history affected the willingness to undergo genetic testing for salt-sensitive hypertension in patients with and without hypertension. DESIGN: Cross-sectional study using a self-administered questionnaire. SETTING: Six primary care clinics and hospitals in Japan. PARTICIPANTS: Consecutive 1705 outpatients aged >20 years, 578 of whom had hypertension. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome variable was the willingness to undergo genetic testing to determine the risk of salt-sensitive hypertension, and the secondary variables were age, sex, education level, family history and concerns about hypertension. Factors associated with a willingness to undergo genetic testing were evaluated in patients with and without hypertension using a logistic regression model. RESULTS: In the hypertension and non-hypertension groups, 323 (55.9%) and 509 patients (45.2%), respectively, were willing to undergo genetic testing. This willingness was related with a high level of education (adjusted OR (ad-OR): 1.81, 95% CI 1.12 to 2.93), family history of stroke (1.55, 1.04 to 2.31) and concerns about hypertension (2.04, 1.27 to 3.28) in the hypertension group, whereas in the non-hypertension group, it was influenced by education level (ad-OR: 1.45, 95% CI 1.13 to 1.86), family history of hypertension (1.52, 1.17 to 1.98) and concerns about hypertension (2.03, 1.53 to 2.68). CONCLUSIONS: The influence of family history on the willingness to undergo genetic testing for risk of salt-sensitivity hypertension differed between participants with and without hypertension. In particular, participants without hypertension wished to know their likelihood of developing hypertension, whereas those with hypertension were interested to know the risk of stroke (a complication of hypertension). Family history could help better counsel patients about genetic testing on the basis of their medical history.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Hipertensión/genética , Anamnesis , Aceptación de la Atención de Salud , Cloruro de Sodio Dietético/administración & dosificación , Adulto , Anciano , Estudios Transversales , Femenino , Pruebas Genéticas/estadística & datos numéricos , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Japón , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pacientes Ambulatorios/psicología , Pacientes Ambulatorios/estadística & datos numéricos , Autoinforme , Cloruro de Sodio Dietético/efectos adversos , Accidente Cerebrovascular/epidemiología
4.
Clin Interv Aging ; 12: 283-291, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28223786

RESUMEN

PURPOSE: To assess the factors involved in oral intake discontinuation in elderly patients with recurrent aspiration pneumonia. PATIENTS AND METHODS: This study included patients with pneumonia who were treated at Jichi Medical University Hospital between 2007 and 2013, at Toyooka Public Hospital between 2011 and 2013 and at Yuzawa Community Medical Center between 2010 and 2012. We consecutively enrolled patients with aspiration pneumonia. The primary study point was oral intake discontinuation after the initiation of oral intake during hospitalization in cases of recurrent aspiration. Various parameters were recorded at admission, at the initiation of intake, and during hospitalization; these parameters were statistically evaluated. RESULTS: A total of 390 patients were assigned to either a "no reaspiration of intake" group (n=310) or a "reaspiration of intake" group (n=80), depending on whether intake was discontinued owing to aspiration during hospitalization. At admission, the following items significantly differed between the groups: level of consciousness, respiratory rate, oxygen saturation, CURB-65 score, extent of infiltration/opacity on chest radiography, albumin levels, blood urea nitrogen levels, and application of swallowing function assessment. At the initiation of intake, level of consciousness, pulse rate, and albumin levels significantly differed between the groups. The following items did not significantly differ between groups: systolic blood pressure, pulse rate, C-reactive protein, bacteremia, use of ventilator at admission, oxygen administration, respiratory rate, and systolic blood pressure at initiation of intake. Multivariate analysis revealed that application of swallowing function assessment, level of consciousness at the initiation of intake, and extent of infiltration/opacity on chest radiography were significant predictive variables for discontinuation of intake. CONCLUSION: A low level of consciousness at the initiation of intake and a greater extent of infiltration/opacity on chest radiography and the application of a swallowing function are important factors. These factors may be helpful to determine a suitable timing for resumption of oral intake.


Asunto(s)
Deglución/fisiología , Neumonía por Aspiración/fisiopatología , Anciano , Anciano de 80 o más Años , Estado de Conciencia , Femenino , Hospitalización , Humanos , Masculino , Oxígeno/sangre , Pulso Arterial , Estudios Retrospectivos , Albúmina Sérica
5.
Geriatr Gerontol Int ; 17(3): 410-415, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-27004594

RESUMEN

AIM: We previously proposed the concept of caregiver daily impression (CDI) as a practical tool for emergency triage. We herein assessed how CDI varies by sex, education and career length by determining CDI scores as quantitative outcome measures. METHODS: We carried out a cross-sectional study using a self-reported questionnaire among caregivers in 20 long-term care facilities in Hyogo, Japan. A total of 10 CDI variables measured participants' previous experience of emergency transfers using a scale from 0-10. The resulting total was defined as the CDI score. We hypothetically considered that higher scores indicated greater caregiver focus. The CDI scores were compared by sex, education and career length using analysis of covariance. RESULTS: A total of 601 personal caregivers were evaluated (mean age 36.7 years; 36% men). The mean career length was 6.9 years, with the following groupings: 1-4 years (38%), 5-9 years (37%) and >10 years (24%). After adjustment for sex and education, the CDI scores for the variable, "poor eye contact," significantly differed between caregivers with ≥10 and <5 years of experience (scores of 5.0 ± 3.1 and 4.0 ± 2.7, respectively). The CDI scores for variables related to eyes tended to increase with experience, whereas other CDI scores decreased. Male caregivers focused on residents' eyes significantly more than did female caregivers. CONCLUSIONS: We found that the CDI variable, "poor eye contact," is influenced by career length. Caregivers with more experience attach more importance to their impression of residents' eyes than do those with less experience. Sex-related differences in CDI might also exist. Geriatr Gerontol Int 2016; 17: 410-415.


Asunto(s)
Cuidadores , Evaluación de la Discapacidad , Evaluación Geriátrica/métodos , Cuidados a Largo Plazo , Encuestas y Cuestionarios , Adulto , Anciano de 80 o más Años , Estudios Transversales , Escolaridad , Femenino , Anciano Frágil , Humanos , Japón , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Medición de Riesgo , Autoinforme , Factores Sexuales
6.
Geriatr Gerontol Int ; 17(5): 810-818, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-27164154

RESUMEN

AIM: To investigate the items that are considered by physicians when making decisions regarding the resumption of oral intake among patients with aspiration pneumonia who have undergone short-term fasting. METHODS: We surveyed 2490 Japanese hospitals that had internal medicine and respiratory medicine departments. We mailed questionnaires that contained 24 items related to oral intake resumption after aspiration pneumonia to the head of the department at each hospital. Cronbach statistics, principal component analysis and cluster analysis were used to analyze the results. RESULTS: We received responses from 350 hospitals; 89.7% of the respondents answered that they "Strongly agree" that "level of consciousness" is a useful criterion for resuming oral intake. Furthermore, 66%, 66%, 63.4%, 58.5% and 51% of the respondents answered that they "strongly agree" regarding the use of SpO2 , the discretion of the attending physician, body temperature, swallowing function test results, mental state and respiratory rate, respectively. In the cluster analysis, level of consciousness, body temperature, SpO2 , respiratory rate, mental state and the discretion of the attending physician belonged to the first cluster. The second cluster consisted of the patient's request, the family's request, the opinions of the medical staff and non-physician healthcare providers, and performance status. CONCLUSIONS: Physicians consider several criteria during decision-making regarding oral intake resumption, which can be assigned to two clusters. Future studies are required to develop generalizable and objective criteria. Geriatr Gerontol Int 2017; 17: 810-818.


Asunto(s)
Actitud del Personal de Salud , Estado de Conciencia/fisiología , Toma de Decisiones , Deglución , Hospitales/estadística & datos numéricos , Médicos/normas , Neumonía por Aspiración/fisiopatología , Anciano , Análisis por Conglomerados , Estudios Transversales , Femenino , Humanos , Japón/epidemiología , Masculino , Neumonía por Aspiración/epidemiología , Encuestas y Cuestionarios
7.
Int J Gen Med ; 9: 257-66, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27555795

RESUMEN

OBJECTIVE: Disclosing genetic testing results may contribute to the prevention and management of many common diseases. However, whether the presence of a disease influences these effects is unclear. This study aimed to clarify the difference in the effects of disclosing genetic testing results of the risk for developing salt-sensitive hypertension on the behavioral modifications with respect to salt intake in hypertensive and nonhypertensive patients. METHODS: A cross-sectional study using a self-administered questionnaire was conducted for outpatients aged >20 years (N=2,237) at six primary care clinics and hospitals in Japan. The main factors assessed were medical histories of hypertension, salt preferences, reduced salt intakes, and behavior modifications for reducing salt intake. Behavioral modifications of participants were assessed using their behavior stages before and after disclosure of the hypothetical genetic testing results. RESULTS: Of the 2,237 participants, 1,644 (73.5%) responded to the survey. Of these respondents, 558 (33.9%) patients were hypertensive and 1,086 (66.1%) were nonhypertensive. After being notified of the result "If with genetic risk", the nonhypertensive participants were more likely to make positive behavioral modifications compared to the hypertensive patients among all participants and in those aged <65 years (adjusted relative ratio [ad-RR], 1.76; 95% confidence interval, 1.12-2.76 and ad-RR, 1.99; 1.11-3.57, respectively). In contrast, no difference in negative behavioral modifications between hypertensive and nonhypertensive patients was detected after being notified of the result "If without genetic risk" (ad-RR, 1.05; 95% confidence interval, 0.70-1.57). CONCLUSION: The behavior of modifying salt intake after disclosure of the genetic testing results differed between hypertensive and nonhypertensive patients. Disclosing a genetic risk for salt-sensitive hypertension was likely to cause nonhypertensive patients, especially those aged <65 years, to improve their behavior regarding salt intake. We conclude that disclosing genetic testing results could help prevent hypertension, and that the doctor should communicate the genetic testing results to those patients with a medical history of hypertension, or those who are at risk of developing hypertension.

8.
Springerplus ; 5: 361, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27064451

RESUMEN

INTRODUCTION: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that was first reported in China in 2011. However, it is now endemic in Japan, and the SFTS viruses in Japan and China have evolved independently. Its fatality rate is 26.5 % in Japan, and the viral load is related to morbidity. CASE DESCRIPTION: We encountered two patients with SFTS. Case 1 is a 72-year-old woman who visited our hospital owing to severe fatigue, diarrhea, and nausea. Her consciousness level score on the Glasgow Coma Scale was 14 points, and her serum lactate dehydrogenase level was 646 IU/L. Case 2 is an 82-year-old woman who visited our hospital owing to diarrhea and general fatigue. Her consciousness level score on the Glasgow Coma Scale was 11 points, and her serum lactate dehydrogenase level was 935 IU/L. DISCUSSION AND EVALUATION: Both patients had hemophagocytic syndrome and presented with similar symptoms. Although both were treated with similar drug regimens, their clinical courses were different: after treatment, the 72-year-old woman survived whereas the 82-year-old woman died. In addition to age, the two patients differed in terms of time between symptom onset and treatment initiation, consciousness level, viral load, and extent of elevation of liver enzyme levels. CONCLUSIONS: The viral load, which is a predictor of morbidity, was associated with the level of consciousness and the serum lactate dehydrogenase level, both of which might be useful for predicting death in patients with SFTS.

9.
Int J Gen Med ; 9: 73-8, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27110136

RESUMEN

PURPOSE: To identify the differences in genotype frequencies of salt-sensitive genes between residents of fishing communities (FCs) and nonfishing communities (NFCs). METHODS: The subjects included 18,156 individuals (8,043 males [44%] and 10,113 females [56%]; average age: 57.2±16.1 years) from the general population who were registered with large-scale genome banks and resided in 30 prefectures and 78 different regions in Japan. The measurement items were age, sex, blood pressure, presence or absence of hypertension, body mass index, alcohol consumption, and smoking habit. Furthermore, to analyze the genotype frequencies of salt-sensitive genes, α-adducin 1 (ADD1), angiotensinogen (AGT), angiotensin II receptor type 1 (AT1), and guanine nucleotide-binding protein ß peptide 3 (GNB3) were measured. According to the 2004 government classification of municipalities (cities, towns, and villages), communities existing in areas bordering an ocean and with an ocean port were defined as FCs (28 areas). The others were defined as NFCs (50 areas). A logistic regression model was used for comparison of genotype frequencies between subjects residing in FCs and NFCs. RESULTS: Of the included subjects, 4,916 (27.0%) and 13,240 (73.0%) resided in FCs and NFCs, respectively. In FCs, the mean age was 59.4±16.7 years and men accounted for 41.0% of the cohort (n=2,015). In NFCs, the mean age was 56.4±15.8 years and men accounted for 45.5% of the cohort (n=6,028). The adjusted odds ratios of the AA and AG genotypes compared with the GG genotype for AGT were 0.80 (95% confidence interval [CI]: 0.68-0.95) and 0.76 (95% CI: 0.64-0.91), respectively. The adjusted odds ratio of the CC genotype compared with AA for AT1 was 0.63 (95% CI: 0.40-0.93). CONCLUSION: The incidence of the salt-sensitive genotypes AGT and AT1 in residents of FCs were significantly lower than in NFCs.

10.
Geriatr Gerontol Int ; 16(5): 612-7, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-26044283

RESUMEN

AIMS: To propose a caregiver daily impression (CDI) rating instrument for personal caregivers of residents living in long-term care facilities (LTCF) to comprehensively evaluate residents' daily health condition, and to investigate whether the CDI reflects illness latency and severity in residents transferred emergently. METHODS: We carried out a retrospective review of facility care records from 20 LTCF in Hyogo, Japan. The participants were 169 LTCF residents with episodes of transfer to emergency hospitalization facilities during a 3-month period. We determined specific CDI variables by interviewing experienced LTCF caregivers, and then carried out a principal component analysis to determine the major parameter set. The generated components were incorporated into a regression model to investigate the association with hospitalization. RESULTS: The mean age was 87.9 ± 6.5 years, 68% were women and 28% of transfers resulted in hospitalization. The interview procedure identified 12 specific CDI variables, and the principal component analysis generated five distinct components: "change in feeding," "change in emotion," "disengaged or listless gaze," "decrease in eye reactivity" and "change in movement." By multivariate logistic regression, hospitalization was associated with "decrease in eye reactivity" (adjusted OR 1.78, 95% CI 1.07-2.97) and poor vital signs (adjusted OR 2.84, 95% CI 1.15-6.98), but not with body temperature (adjusted OR 1.29, 95% CI 0.52-3.21). CONCLUSIONS: The CDI might reflect underlying illness severity beyond quantitative physical findings. Once the CDI can be appropriately validated, quantified and linked to physical findings, it could be used by caregivers for daily resident assessments and as a practical triage tool in emergency situations. Geriatr Gerontol Int 2016; 16: 612-617.


Asunto(s)
Actitud del Personal de Salud , Cuidadores , Evaluación Geriátrica , Hospitalización , Cuidados a Largo Plazo , Instituciones de Cuidados Especializados de Enfermería , Anciano , Anciano de 80 o más Años , Femenino , Anciano Frágil , Estado de Salud , Humanos , Japón , Modelos Logísticos , Masculino , Proyectos Piloto , Estudios Retrospectivos
11.
PLoS One ; 10(8): e0136220, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26292215

RESUMEN

OBJECTIVES: The present study investigated the incidence of hyperammonemia in urinary tract infections and explored the utility of urinary obstruction relief and antimicrobial administration to improve hyperammonemia. METHODS: This was an observational study. Subjects were patients who were diagnosed with urinary tract infection and hospitalized between June 2008 and June 2009. We measured plasma ammonia levels on admission in patients who were clinically diagnosed with urinary tract infection and hospitalized. We assessed each patient's level of consciousness on admission using the Glasgow Coma Scale (GCS) and performed urine and blood cultures. We also assessed hearing prior to hospitalization using the Eastern Cooperative Oncology Group performance status (ECOG-PS). In cases with high ammonia levels on admission, plasma ammonia and GCS were measured 24 hours and 5-7 days later. RESULTS: Sixty-seven candidates were enrolled; of these, 60 cases (89.6%) with bacterial cell counts ≥10(4) CFU/mL were studied. Five cases (8.3%) presented with high plasma ammonia levels. Cases with hyperammonemia were significantly more likely to present with low GCS scores and urinary retention rate. All five cases received antimicrobial therapy with an indwelling bladder catheter to relieve urinary retention. The case 5 patient died shortly after admission due to complicated aspiration pneumonia; in the remaining cases, plasma ammonia levels were rapidly normalized and the level of consciousness improved. CONCLUSIONS: The occurrence of hyperammonemia in urinary tract infections is not rare. The cause of hyperammonemia is urinary retention obstruction. Therefore, along with antimicrobial administration, relief of obstruction is important for the treatment of hyperammonemia caused by this mechanism.


Asunto(s)
Antiinfecciosos/uso terapéutico , Hiperamonemia/complicaciones , Hiperamonemia/terapia , Infecciones Urinarias/complicaciones , Infecciones Urinarias/terapia , Anciano , Anciano de 80 o más Años , Amoníaco/sangre , Femenino , Humanos , Hiperamonemia/sangre , Masculino , Persona de Mediana Edad , Infecciones Urinarias/sangre
12.
Wilderness Environ Med ; 25(3): 258-62, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24882656

RESUMEN

OBJECTIVE: Symptoms consistent with neurological decompression sickness (DCS) in commercial breath-hold (Ama) divers has been reported from a few districts of Japan. The aim of this study was to detect circulating intravascular bubbles after repetitive breath-hold diving in a local area where DCS has been reported in Ama divers. METHODS: The participants were 12 partially assisted (descent using weights) male Ama divers. The equipment (AQUALAB system) consisted of continuous-wave Doppler with a 5-MHz frequency, and the Doppler probe was placed in the precordial site with the ultrasonic wave directed into the pulmonary infundibulum. We carried out continuous monitoring for 10 minutes at the end of the series of repetitive dives, and the recordings were made on numerical tracks and graded in a blind manner by 2 experienced investigators, according to the Spencer Doppler code. RESULTS: Depths and number of dives were 8 to 20 m and 75 to 131 times. Mean diving duration and surface interval were 64 ± 12 seconds and 48 ± 8 seconds, respectively (mean ± SD). We detected the lowest grade of intravascular bubbles (Spencer's grade I) in an Ama diver whose mean surface interval was only 35.2 ± 6.2 seconds. His mean descending, bottom, and ascending times were 10.4 ± 1.6 seconds, 39.2 ± 8 seconds, and 18.2 ± 3.0 seconds, respectively, over the course of 99 dives. CONCLUSIONS: Intravascular bubbles may be formed after repetitive breath-hold dives with short surface intervals or after a long breath-holding session in Ama divers. Symptoms consistent with neurological accidents in repetitive breath-hold diving may be caused in part by the intravascular presence of bubbles, indicating the need for safety procedures.


Asunto(s)
Enfermedad de Descompresión/fisiopatología , Buceo/fisiología , Nitrógeno/metabolismo , Anciano , Enfermedad de Descompresión/diagnóstico por imagen , Enfermedad de Descompresión/etiología , Enfermedad de Descompresión/metabolismo , Buceo/efectos adversos , Humanos , Japón , Masculino , Persona de Mediana Edad , Factores de Tiempo , Ultrasonografía Doppler
13.
Int J Gen Med ; 7: 259-69, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24940078

RESUMEN

PURPOSE: Although many new patients are seen at small hospitals, there are few reports of new health problems from such hospitals in Japan. Therefore, we investigated the reasons for encounter (RFE) and diagnoses of new outpatients in a small hospital to provide educational resources for teaching general practice methods. METHODS: This observational study was conducted at the Department of General Internal Medicine in a small community hospital between May 6, 2010 and March 11, 2011. We classified RFEs and diagnoses according to component 1, "Symptoms/Complaints", and component 7, "Diagnosis/Diseases", of the International Classification of Primary Care, 2nd edition (ICPC-2). We also evaluated the differences between RFEs observed and common symptoms from the guidelines Model Core Curriculum for Medical Students and Goals of Clinical Clerkship. RESULTS: We analyzed the data of 1,515 outpatients. There were 2,252 RFEs (1.49 per encounter) and 170 ICPC-2 codes. The top 30 RFE codes accounted for 80% of all RFEs and the top 55 codes accounted for 90%. There were 1,727 diagnoses and 196 ICPC-2 codes. The top 50 diagnosis codes accounted for 80% of all diagnoses, and the top 90 codes accounted for 90%. Of the 2,252 RFEs, 1,408 (62.5%) included at least one of the 36 symptoms listed in the Model Core Curriculum and 1,443 (64.1%) included at least one of the 35 symptoms in the Goals of Clinical Clerkship. On the other hand, "A91 Abnormal result investigation", "R21 Throat symptom/complaint", and "R07 Sneezing/nasal congestion", which were among the top 10 RFEs, were not included in these two guidelines. CONCLUSION: We identified the common RFEs and diagnoses at a small hospital in Japan and revealed the inconsistencies between the RFEs observed and common symptoms listed in the guidelines. Our findings can be useful in improving the general practice medical education curricula.

14.
Int Med Case Rep J ; 7: 89-92, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24855394

RESUMEN

A 23-year-old man became unconscious while jogging. He immediately received basic life support from a bystander and was transported to our hospital. On arrival, his spontaneous circulation had returned from a state of ventricular fibrillation and pulseless electrical activity. Following admission, hyperthyroidism led to a suspicion of thyroid storm, which was then diagnosed as a possible cause of the cardiac arrest. Although hyperthyroidism-induced cardiac arrest including ventricular fibrillation is rare, it should be considered when diagnosing the cause of treatable cardiac arrest.

15.
Int J Gen Med ; 7: 205-10, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24790467

RESUMEN

PURPOSE: A salt preference questionnaire may be a convenient and cost-effective method for predicting salt intake; however, the influence of salt preference on daily salt intake is unclear. This study aimed at revealing the effectiveness of the salt preference question in determining the daily salt intake in primary care outpatients. PATIENTS AND METHODS: This cross-sectional study included 1,075 outpatients (men, n=436, 40.6%) at six primary care institutions in Japan. Primary outcomes included a salty food preference assessed by using one question and a daily salt intake, assessed using early morning second urine samples. Multivariate analyses determined the relationships between the salt intake and the two salt preference levels. RESULTS: The mean age was 67.6±14.6 years, and 594 (55.3%) preferred salty foods. The daily salt intake was 12.3±4.0 g per day and 11.4±3.7 g per day in the salt preference and nonsalt preference groups, respectively (P<0.001). A salt intake <10 g per day was consumed by 169 (28.5%) and 181 (37.6%) patients (P=0.001), respectively, and <6 g salt per day was consumed by 28 (4.7%) and 26 (5.4%) patients (P=0.606), respectively. The patients who preferred salty foods consumed a significantly larger amount of salt per day than those who did not prefer salty foods (ß coefficient, 0.621; 95% confidence interval [CI], 0.146-1.095). There was no difference in the number of patients who consumed <10 g salt per day (adjusted odds ratio [ad-OR], 1.29; 95% CI, 0.99-1.69) or <6 g salt per day (ad-OR, 1.39; 0.90-1.69) between the groups. CONCLUSION: Preference for salty foods was positively associated with daily salt intake. However, daily salt intake was not always appropriate, even in the patients who did not prefer salty foods. Behavioral interventions for salt restriction after an assessment of daily salt intake are necessary for primary care patients, regardless of their preference for salty foods.

16.
Open Access Emerg Med ; 6: 27-32, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-27147876

RESUMEN

BACKGROUND: Unintentional injury is a major cause of death across the globe. The accessibility to emergency medical services may affect the rate of preventable trauma deaths. The purpose of this study was to analyze the accessibility to emergency medical hospitals in municipalities in Japan and to clarify whether accessibility was associated with the mortality rate attributed to unintentional injuries. METHODS: An observational epidemiological study was conducted in all 1,742 municipalities in Japan. Measurements assessed were population size, accessibility to emergency hospitals, and mortality rates attributed to unintentional injuries. Accessibility of each municipality to their nearest emergency hospital was calculated with a computer simulation using a geographic information system. After calculating demographic statistics and the Gini coefficient of accessibility, multivariate analyses were used to examine the correlation between accessibility time and mortality. Municipalities were divided into six groups according to accessibility time, and we then performed a correlation analysis between accessibility time and mortality using analysis of covariance. RESULTS: The median time of accessibility to emergency hospitals was 34.5 minutes. The Gini coefficient of accessibility time was 0.410. A total of 385 municipalities (23.4%) had an accessibility time of over 60 minutes. Accessibility was significantly related to mortality (beta coefficient =0.006; P<0.001). The mortality rate in municipalities with an accessibility time of <15 minutes was lower than that in all other groups. The mortality rate in municipalities with an accessibility time of 15-30 minutes was lower than that in municipalities with an accessibility time of >30 minutes, and the mortality rate in municipalities with an accessibility time of 30-45 minutes was lower than that in municipalities with an accessibility time of 60-90 minutes (P<0.001). CONCLUSION: The geographical disparities for emergency care accessibility were related to the rate of death by unintentional injury. Improving accessibility to emergency hospitals could help decrease the mortality rate of preventable trauma. Meanwhile, our findings suggest the need for substantially shorter accessibility times to emergency care facilities in many municipalities in Japan.

17.
Int J Gen Med ; 6: 817-20, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24101880

RESUMEN

BACKGROUND: It is necessary to establish an effective subcutaneous injection procedure for adult and elderly individuals because many drugs such as hormones and interferon are generally delivered by subcutaneous injection. We tested whether pain during subcutaneous injection can be decreased by prior application of localized manual pressure at the injection site. METHODS: In this semirandomized, open-label study evaluating the manual pressure method for transient analgesia, physicians applied pressure with their thumbs for 10 seconds to create a nonpainful skin depression at the injection site immediately before subcutaneous injection of the influenza vaccine to patients. Control patients received the vaccine by the same route, but without prior application of focal pressure. In addition to pain, we evaluated patient age, gender, height, weight, body mass index, body temperature, and fat thickness at the brachial triceps muscle. Pain intensity was estimated using a 100 mm visual analog scale (VAS) and the face scale (FS). Categorical variables were compared using Chi-square tests and continuous variables were compared using unpaired t-tests between the intervention group and control group. Multivariate analysis was performed using the VAS or FS score as the dependent variable and weight, age, height, fat thickness at the brachial triceps muscle, and body temperature as independent variables. RESULTS: There were no significant differences in demographic variables, VAS scores (22.5 ± 23.0 versus 21.2 ± 23.6, P = 0.4), or FS scores (2.5 ± 2.1 versus 2.4 ± 2.1, P = 0.4) between the intervention and control groups. There was a significant negative correlation between age and subjective pain intensity (VAS, r = -0.32; FS, r = -0.28). CONCLUSION: The manual pressure method was not effective in decreasing pain during subcutaneous injection. Alternative methods of focal transient analgesia should be developed to improve vaccination rates and relieve anxiety associated with subcutaneous injection.

18.
BMC Fam Pract ; 14: 149, 2013 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-24103405

RESUMEN

BACKGROUND: The current research into single nucleotide polymorphisms has extended the role of genetic testing to the identification of increased risk for common medical conditions. Advances in genetic research may soon necessitate preparation for the role of genetic testing in primary care medicine. This study attempts to determine what proportion of patients would be willing to undergo genetic testing for salt-sensitive hypertension in a primary care setting, and what factors are related to this willingness. METHODS: A cross-sectional study using a self-report questionnaire was conducted among outpatients in primary care clinics and hospitals in Japan. The main characteristics measured were education level, family medical history, personal medical history, concern about hypertension, salt preference, reducing salt intake, and willingness to undergo genetic testing for salt-sensitive hypertension. RESULTS: Of 1,932 potential participants, 1,457 (75%) responded to the survey. Of the respondents, 726 (50%) indicated a willingness to undergo genetic testing. Factors related to this willingness were being over 50 years old (adjusted odds ratio [ad-OR] = 1.42, 95% Confidence interval = 1.09 - 1.85), having a high level of education (ad-OR: 1.83, 1.38 - 2.42), having a family history of hypertension (ad-OR: 1.36, 1.09 - 1.71), and worrying about hypertension (ad-OR: 2.06, 1.59 - 2.68). CONCLUSIONS: Half of the primary care outpatients surveyed in this study wanted to know their genetic risk for salt-sensitive hypertension. Those who were worried about hypertension or had a family history of hypertension were more likely to be interested in getting tested. These findings suggest that primary care physicians should provide patients with advice on genetic testing, as well as address their anxieties and concerns related to developing hypertension.


Asunto(s)
Actitud Frente a la Salud , Pruebas Genéticas/estadística & datos numéricos , Hipertensión/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Primaria de Salud , Adulto , Factores de Edad , Anciano , Estudios Transversales , Escolaridad , Femenino , Predisposición Genética a la Enfermedad/psicología , Humanos , Hipertensión/genética , Japón , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Encuestas y Cuestionarios
19.
Int J Gen Med ; 6: 361-8, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23696713

RESUMEN

BACKGROUND: A few studies have explored the effects of disclosure of genetic testing results on chronic disease predisposition. However, these effects remain unclear in cases of hypertension. Reducing salt intake is an important nonpharmacological intervention for hypertension. We investigated the effects of genetic testing for salt sensitivity on salt restriction behavior using hypothetical genetic testing results. METHODS: We conducted a cross-sectional study using a self-completed questionnaire. We enrolled consecutive outpatients who visited primary care clinics and small hospitals between September and December 2009 in Japan. We recorded the patients' baseline characteristics and data regarding their salt restriction behavior, defined as reducing salt intake before and after disclosure of hypothetical salt sensitivity genetic test results. Behavioral stage was assessed according to the five-stage transtheoretical model. After dividing subjects into salt restriction and no salt restriction groups, we compared their behavioral changes following positive and negative test results and analyzed the association between the respondents' characteristics and their behavioral changes. RESULTS: We analyzed 1562 participants with a mean age of 58 years. In the no salt restriction group, which included patients at the precontemplation, contemplation, and preparation stages, 58.7% stated that their behavioral stage progressed after a positive test result, although 29.8% reported progression after a negative result (P < 0.001). Conversely, in the salt restriction group, which included patients at the active and maintenance stages, 9.2% stated that they would quit restricting salt intake following a negative test result, and 2.2% reported they would quit following a positive result (P < 0.001). Age < 65 years (adjusted odds ratio [OR] 1.74; 95% confidence interval [CI] 1.12-2.71), female gender (adjusted OR 1.84; CI 1.29-2.62), graduation from college or university (adjusted OR 1.66; CI 1.11-2.49), and desire for genetic testing (adjusted OR 4.53; CI 3.13-6.57) were associated with progression of behavioral stage in the no salt restriction group. Conversely, salt preference (adjusted OR 2.13; CI 1.31-3.49) was associated with quitting salt restriction in the salt restriction group. CONCLUSION: Patients in the no salt restriction group show the possibility of progression from the behavioral stage to the action stage after testing positive for salt sensitivity. Conversely, patients in the salt restriction group, particularly those with a salt preference, would quit salt restriction after testing negative.

20.
Int J Gen Med ; 5: 483-8, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22701089

RESUMEN

BACKGROUND: The aim of this study was to evaluate the clinical usefulness of a semiquantitative procalcitonin kit for assessing severity of sepsis and early determination of mortality in affected patients. METHODS: This was a prospective, observational study including 206 septic patients enrolled between June 2008 and August 2009. Disseminated intravascular coagulation (DIC), Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) II scores were measured, along with semiquantitative procalcitonin concentrations. Patients were divided into three groups based on their semiquantitative procalcitonin concentrations (group A, <2 ng/mL; group B ≥ 2 ng/mL < 10 ng/mL; group C ≥ 10 ng/mL). RESULTS: A significant difference in DIC, SOFA, and APACHE II scores was found between group A and group C and between group B and group C (P < 0.01). Patients with severe sepsis and septic shock had significantly higher procalcitonin concentrations than did patients with less severe disease. The rate of patients with septic shock with high procalcitonin concentrations showed an upward trend. There was a significant (P < 0.01) difference between the three groups with regard to numbers of patients and rates of severe sepsis, septic shock, DIC, and mortality. CONCLUSION: Semiquantitative procalcitonin concentration testing can be helpful for early assessment of disease severity in patients with sepsis. Furthermore, it may also help in predicting early mortality in septic patients. Based on the level of semiquantitative procalcitonin measured in patients with suspected sepsis, a timely decision can be reliably made to transfer them to a tertiary hospital with an intensive care unit for optimal care.

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