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1.
PLoS One ; 14(1): e0210912, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30653563

RESUMEN

Interprofessional education (IPE) for medical students is becoming increasingly important, as reflected in the increasing number of medical schools adopting IPE. However, the current status of and barriers to pre-registration IPE implementation in Japanese medical schools remain unknown. The purpose of this study was to clarify the status and barriers of IPE implementation in medical schools in Japan. We conducted a curriculum survey from September to December 2016 of all 81 medical schools in Japan. We mailed the questionnaire and asked the schools' undergraduate education staff to respond. The survey items were the IPE implementation status and barriers to program implementation. Sixty-four of the 81 schools responded (response rate 79.0%), of which 46 (71.9%) had implemented IPE, 42 (89.1%) as compulsory programs. Half of IPE programs were implemented in the first 2 years, while less than 10% were implemented in the latter years of medical programs. As part of the IPE programs, medical students collaborated with a wide range of professional student groups. The most common learning strategy was lectures. However, one-third of IPE programs used didactic lectures without interaction between multi-professional students. The most common perceived major barrier to implementing IPE was adjustment of the academic calendar and schedule (82.8%), followed by insufficient staff numbers (73.4%). Our findings indicate that IPE is being promoted in undergraduate education at medical schools in Japan. IPE programs differed according to the circumstances of each school. Barriers to IPE may be resolved by improving learning methods, introducing group discussions between multi-professional students in lectures or introducing IPE programs using team-based learning. In summary, we demonstrated the current status and barriers of IPE implementation in Japanese medical schools. Our findings will likely lead to the promotion of IPE programs in Japan.


Asunto(s)
Educación de Pregrado en Medicina/métodos , Relaciones Interprofesionales , Facultades de Medicina , Curriculum , Humanos , Japón , Encuestas y Cuestionarios
2.
Tohoku J Exp Med ; 246(3): 183-189, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30487351

RESUMEN

Binge drinking by college students is a problematic behavior. However, data on binge drinking and the reasons for drinking by college students in Japan are scarce. We explored the reasons for drinking among college students. The study used a cross-sectional design and a self-administered questionnaire. From December 2016 to March 2017, we sampled undergraduate and graduate students aged 20 or older at 35 colleges in the Kanto region of Japan. The questionnaire addressed 1) frequency of drinking alcohol, 2) amount of drinking per day, 3) frequency of binge drinking in the past year, and 4) reasons for drinking (with 12 possible responses). The t-test was used to compare the means between binge drinkers and non-binge drinkers. Logistic regression analysis was conducted on binge drinking and the reasons for drinking. The participants included 303 men and 260 women. Significant differences between men and women included the presence of binge drinking (men: 74.9%; women: 59.6%). Among male students, the statistically significant reasons given for binge drinking were "to feel happy or be in a good mood" and "to relieve stress," whereas among female students, the reasons were "to feel happy or be in a good mood," "to facilitate interpersonal relationships," "to forget something bad," and "to relieve stress." The reasons for drinking associated with binge drinking were identified. It is important to incorporate these results into preventive education about binge drinking aimed at college students in Japan.

3.
Drug Alcohol Depend ; 193: 55-62, 2018 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-30415191

RESUMEN

BACKGROUND: Hazardous drinking (HD) and heavy episodic drinking (HED) constitute different types of alcohol-related harm. The socioeconomic status (SES) background of various alcohol consumption behaviors is not clear. The purpose of this study was to clarify existing SES differences between HD and HED. METHODS: The 2013 national survey regarding alcohol use among Japanese adults was utilized. The results from 1193 men and 1503 women aged 20-64 years were included in the analysis. Education attainment, household income, marital status, working status, and occupation were adopted as SES determinants. Binomial logistic regression analysis was conducted to estimate the odds ratios (ORs) of HD and HED for each SES group. RESULTS: ORs (95% confidence intervals) of HD were higher among persons with less education among both men [1.61 (1.18-2.20)] and women [1.78 (1.19-2.67)]. The OR of HED in men was significantly higher among those who belonged to high household income, were married, and managers or professionals. The OR of HED among women was higher in persons who were employed, as compared with those who engaged in housework. There were no correlations between HED and educational background. CONCLUSIONS: This study showed that in Japan, a lower educational background for both men and women was associated with a higher risk for HD, while higher current SES for men and working women were associated with a higher risk for HED. It is necessary to recognize the SES differences between HD and HED to achieve a policy to reduce alcohol-related harm.

4.
Tohoku J Exp Med ; 245(4): 263-267, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-30158367

RESUMEN

Excessive drinking by college students is a major public health problem in Japan. However, data on heavy episodic drinking (HED) and nomihodai, a several-hour all-you-can-drink system, are scarce. We surveyed the drinking behavior of undergraduate and graduate students at 35 colleges, and examined the association between HED and use of nomihodai. The study used a cross-sectional design conducted by a self-administered questionnaire. From December 2016 to March 2017, we sampled undergraduate and graduate students aged 20 or older at 35 colleges in the Kanto area, including Tokyo. The following items were measured: 1) frequency of drinking; 2) frequency of binge drinking in the past year; 3) nomihodai use; 4) the number of drinks consumed when using or not using nomihodai; and 5) sex and age for demographic data. Paired t-test was used to compare means between use and non-use state of nomihodai. The Fisher's exact test was used to evaluate the significance of the distribution difference between the two types of states. A total of 511 subjects completed the questionnaire, including 274 men and 237 women. The amount of drinking was increased 1.8-fold (85.9 ± 49.7 g vs. 48.2 ± 29.5 g) among men and 1.7-fold (63.7 ± 39.3 g vs. 36.5 ± 26.7 g) among women during nomihodai use, comapred with non-use states. Among them, 109 (39.8%) men and 71 (30.3%) women reported HED only at nomihodai states. These data suggest that the use of nomihodai system may lead to excessive drinking among college students.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Estudiantes , Universidades , Estudios Transversales , Femenino , Humanos , Japón/epidemiología , Masculino , Adulto Joven
5.
J Gen Fam Med ; 19(3): 97-101, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29744263

RESUMEN

Objective: To assess the extent to which long-term care facilities in Japan adhere to blood pressure (BP) measurement guidelines. Design: Cross-sectional, observational survey. Setting: Japan (nationwide). Participants: Geriatric health service facilities that responded to a questionnaire among 701 facilities that provide short-time daycare rehabilitation services in Japan. Methods: A written questionnaire that asked about types of measurement devices, number of measurements used to obtain an average BP, resting time prior to measurement, and measurement methods when patients' arms were covered with thin (eg, a light shirt) or thick sleeves (eg, a sweater) was administered. Main outcome measure: Proportion of geriatric health service facilities adherent to BP measurement guidelines. Results: The response rate was 63.2% (443/701). Appropriate upper-arm BP measurement devices were used at 302 facilities (68.2%). The number of measurements was appropriate at 7 facilities (1.6%). Pre-measurement resting time was appropriate (≥5 minutes) at 205 facilities (46.3%). Of the 302 facilities that used appropriate BP measurement devices, 4 (1.3%) measured BP on a bare arm if it was covered with a thin sleeve, while 266 (88.1%) measured BP over a thin sleeve. When arms were covered with thick sleeves, BP was measured on a bare arm at 127 facilities (42.1%) and over a sleeve at 78 facilities (25.8%). Conclusions: BP measurement guidelines were not necessarily followed by long-term care service facilities in Japan. Modification of guidelines regarding removing thick sweaters and assessing BP on a visit-to-visit basis might be needed.

6.
J Interprof Care ; 32(4): 436-443, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29381091

RESUMEN

Rapid aging of the population necessitates improved collaboration among healthcare professionals. Unfortunately, interprofessional collaboration has yet to be implemented effectively in Japan. Therefore, we aimed to develop an interprofessional competency framework for Japanese healthcare professionals. The project was conducted as a four-step process, starting with initial categorization of potential competency domains,, followed by guiding principle and prototype development, feedback on the prototype, and final consensus. First, authors (JH and MO) collected opinions about competency in interprofessional collaboration at two academic meetings of the Japan Association for Interprofessional Education (JAIPE) and then analyzed the data thematically. Second, a project team consisting of JAIPE and University representatives extracted the domains and statements as prototype 1. Third, seven representatives from professional organizations joined the project team and developed prototype 2. We then called for feedback on the revised prototype 2 at both an open symposium and via public comments. Following revision of prototype 2, a new project team including 20 university, professional organization and health practitioner representatives finally discussed prototype 3, developed the final draft and reached a consensus. In analysis after collecting the data, we extracted 11 themes. We developed four key principles which applied to six domains as prototype 1-3. Finally, our competency framework included two core domains of "Patient-/client-/family-/community-centered" and "Interprofessional communication", and four peripheral domains of "Role contribution", "Facilitation of relationships", "Reflection" and "Understanding of others". We developed an interprofessional competency framework in Japan which consists of two core and four peripheral domains. The interprofessional competency framework is likely to affect the understanding of "high-context" and "relationalism" in Japanese healthcare. We hope that our interprofessional competency framework will encourage the systematic implementation of interprofessional education and collaboration in Japan.

7.
Blood Press Monit ; 23(1): 9-11, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28926363

RESUMEN

OBJECTIVE: Blood pressure (BP) measurement is recommended on bare arms, but undressing the arms for BP measurements is often difficult for frail elderly individuals. We aimed to assess the accuracy of BP measurements over arms with thin and thick clothing among the frail elderly. PARTICIPANTS AND METHODS: This is a cross-sectional study. Individuals aged 65 years or older were recruited from three long-term care facilities in Japan between April and May 2016. The main outcome measures were BP measurements (a) on a bare arm, (b) over a thin shirt, (c) over a thin shirt and a cardigan, and (d) over the sleeve of a thin shirt and a cardigan rolled up to the elbow. BP was compared across measurements using the paired t-test and multiple analysis of variance adjusting for sex and treatments for hypertension. RESULTS: Of 147 participants, 23.8% were men. The mean age of the participants was 87.2 years (SD: 7.8). The mean (SD) BP on a bare arm, over a shirt, over a shirt and a cardigan, and over a rolled-up sleeve were 128.8 (20.0)/69.3 (13.2), 131.0 (22.2)/73.9 (15.2), 136.9 (22.2)/78.9 (15.8), and 136.4 (26.0)/80.7 (15.9) mmHg, respectively. BP measurements over clothed arms were significantly higher than bare arm measurements. BP differences were significant when measured over a cardigan after adjusting for sex and treatments for hypertension. CONCLUSION: In the elderly, clothing has a significant effect on BP measurements. The arms should be undressed as much as possible for BP measurements in the elderly.


Asunto(s)
Brazo , Determinación de la Presión Sanguínea/métodos , Presión Sanguínea , Anciano Frágil , Anciano , Anciano de 80 o más Años , Brazo/fisiología , Vestuario , Estudios Transversales , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertensión/fisiopatología , Japón/epidemiología , Masculino
8.
Tohoku J Exp Med ; 242(2): 157-163, 2017 06.
Artículo en Inglés | MEDLINE | ID: mdl-28637993

RESUMEN

Alcohol-related injuries in college students are a major public health problem worldwide. We clarified the association between excessive drinking and alcohol-related injuries in Japanese college students. This was a cross-sectional study with a self-administered questionnaire. From January to March 2013, we sampled all college students and graduate students aged 20 years or older during annual health examinations at three colleges in Mie Prefecture in Japan. The questionnaire assessed the frequency of alcohol drinking, amount of alcohol consumed per day, binge drinking during the past year, alcohol-related injuries during the past year, and demographic data. Logistic regression analysis was conducted on the association between excessive alcohol use and alcohol-related injuries. A total of 2,842 students underwent health examinations, of whom 2,177 (76.6%) completed the questionnaire. Subjects included 1,219 men (56.0%) and 958 women (44.0%). Eighty-eight men (7.2%) and 93 women (9.7%) were classified as excessive weekly drinkers, while 693 men (56.8%) and 458 women (47.8%) were determined to be binge drinkers. Eighty-one men (6.6%) and 26 women (2.7%) had experienced alcohol-related injuries during the past year. In the logistic regression analysis, binge drinkers (odds ratio 25.6 [8.05-81.4]) and excessive weekly drinkers (odds ratio 3.83 [2.41-6.09]) had a history of significantly more alcohol-related injuries, even after adjusting for age and sex. In conclusion, alcohol-related injuries in college students in Japan were strongly associated with excessive drinking. As a strategy for preventing such injuries in this population, an interventional study is required to identify effective methods for reducing excessive alcohol use.


Asunto(s)
Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/epidemiología , Estudiantes/estadística & datos numéricos , Universidades/estadística & datos numéricos , Heridas y Traumatismos/epidemiología , Heridas y Traumatismos/etiología , Borrachera/epidemiología , Estudios Transversales , Femenino , Humanos , Japón/epidemiología , Modelos Logísticos , Masculino , Análisis Multivariante , Adulto Joven
9.
J Interprof Care ; 31(1): 85-90, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27996353

RESUMEN

Interprofessional education (IPE) for healthcare professionals is important in Japan because of its rapidly aging population and increasingly complex healthcare needs. However, no tools have been validated in the Japanese context to evaluate healthcare professionals' attitudes towards, or readiness for, IPE. The professional version of the Readiness for Interprofessional Learning Scale (RIPLS) with 23 items was selected for cross-cultural adaptation because it has been widely used internationally and a Japanese edition of the student version has already been developed. We followed a guideline for cross-cultural adaptation and subsequently conducted factor analysis with 368 responses from over 16 professions. Face and content validity was confirmed through the translation process. We obtained four factors with good internal consistency (Cronbach's alpha > 0.7). These results were similar to those of the original UK study, apart from one factor being divided into two different factors in this study. Studies are required to further confirm the rigor and generalisability of the results; however, the Japanese RIPLS can be used to evaluate healthcare professionals' attitudes towards IPE, which can eventually lead to a better IPE development for healthcare professionals in Japan.


Asunto(s)
Actitud del Personal de Salud , Competencia Cultural , Relaciones Interprofesionales , Estudiantes del Área de la Salud/psicología , Encuestas y Cuestionarios/normas , Humanos , Japón , Psicometría , Reproducibilidad de los Resultados
10.
Artículo en Japonés | MEDLINE | ID: mdl-27295821

RESUMEN

One of the alcohol-related goals in Japan's health promotion campaign called Health Japan 21 (secondary term) is to reduce the number of high-risk drinkers (20 years old or above) who consume 40g or more pure alcohol/day in men and 20g or more in women by year 2022. To achieve this goal, a further expansion of screening and brief intervention (SBI) in the medical setting is essential. In this research, realistic and cost-effective SBI scenarios in Japan were investigated based on international systematic review and clinicians' opinions from a semi-structured interview. Several SBI scenarios were built with 2 levels of intervention based on the AUDIT scores of 8-15 (brief advice) and 16-19 (brief advice and counseling, continuous intervention), and a simulation was conducted by applying different probabilities and success rates into the scenarios. Information associated with preparation and implementation of SBI at the 2 levels was also estimated and annual costs of SBI per drinker were calculated. It was found that approximately 2,390,000 and 530,000 high-risk drinkers require brief and extensive interventions, respectively. Furthermore, incremental costs per quality-adjusted life year (QALY) gained were calculated at 723,415 yen for brief intervention and 944,762 yen for extensive intervention, suggesting cost-effectiveness of SBI in Japan. Given the limited national healthcare budget and operational challenges such as time to provide SBI especially in the primary care setting in Japan, roles of healthcare providers and wider use of information technology were discussed with some suggestions. Furthermore, lighter and more frequent interventions at various levels and not only at the medical setting but also at multiple social settings (such as workplace and among family and friends) were discussed to increase the cost-effectiveness of SBI and to keep the number of high-risk drinkers who have successfully reduced their alcohol consumption.


Asunto(s)
Consumo de Bebidas Alcohólicas/prevención & control , Intoxicación Alcohólica/epidemiología , Alcoholismo/epidemiología , Análisis Costo-Beneficio , Atención Primaria de Salud/economía , Adulto , Consumo de Bebidas Alcohólicas/terapia , Alcoholismo/diagnóstico , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Años de Vida Ajustados por Calidad de Vida , Riesgo
11.
J Interprof Care ; 30(5): 675-7, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27351518

RESUMEN

This article presents a project that aimed to identify a set of competencies (domains and statements) to prepare Japanese students and healthcare practitioners for collaborative practice. The Japan Association for Interprofessional Education (JAIPE) has started a government-funded project to formulate its interprofessional competency framework, in cooperation with professional organisations (e.g. Japan Society for Medical Education) in healthcare and social sciences. This three-year project is underway as part of the Initiative to Build up the Core Healthcare Personnel programme of Mie University. This project consists of five stages: literature review, data collection, prototype development, consensus formation, and finalisation. Our efforts will culminate in Japan's first interprofessional competency framework, with consensus from relevant academic societies and other stakeholders. We hope that the involvement of stakeholder participation will improve the usability of the final interprofessional competency framework.


Asunto(s)
Conducta Cooperativa , Comunicación Interdisciplinaria , Competencia Profesional , Desarrollo de Programa , Prestación de Atención de Salud , Humanos , Japón , Ciencias Sociales
12.
Alcohol Alcohol ; 51(4): 465-73, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-26873982

RESUMEN

AIMS: Nationwide surveys to clarify the characteristics and trends of the drinking behavior of Japanese adults were carried out in 2003, 2008, and 2013. METHODS: These were periodical cross-sectional surveys. Subjects were chosen through a stratified two-stage random sampling method. The surveys included drinking frequency and amount, ICD-10 alcoholism diagnostic standards, questionnaire for the determination of harmful alcohol use ( AUDIT: Alcohol Use Disorders Identification Test). In 2003, the surveys obtained responses from 2547 people (73% response rate); in 2008, 4123 people (55% response rate); and in 2013, 4153 people (59% response rate). RESULTS: The proportion of lifetime experience of alcohol dependence diagnosed by ICD-10 was 1.9% for male and 0.2% for female, and the estimated number of patients was 1.07 million. The declining trends were observed in the percentage of daily drinkers and the amount of alcohol consumed per week for male. The lowering of the age for consuming their first alcoholic drink and their first drunken experience was observed among female. The gender difference of prevalence of problem drinking is getting smaller. The binge drinking and heavy episodic drinking were observed especially younger generation. The only small proportion of patients with alcohol dependence had received specialized medical care, whereas the many of these visited medical institutions and health screening. CONCLUSIONS: The survey observed many hidden alcoholic patients, and showed the possibility that the healthcare facilities and health screening became the place of screening and intervention for alcohol dependence.


Asunto(s)
Trastornos Relacionados con Alcohol/epidemiología , Alcoholismo/epidemiología , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Estudios Transversales , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Encuestas y Cuestionarios , Adulto Joven
13.
Seishin Shinkeigaku Zasshi ; 117(8): 646-54, 2015.
Artículo en Japonés | MEDLINE | ID: mdl-26642732

RESUMEN

Japan has just enacted a national law for alcohol, that named "Basic Act on Measures Against Alcohol-related Health Harm". This article includes 5 topics; i) General psychiatrists have the roles and responsibilities in this law, ii) All psychiatrists need to know about alcohol-related health harm and alcohol-related problem, iii) Alcohol dependence is attributed to change of neurotransmitter in the brain, iv) Mood disorder is more likely to be complicated by alcohol dependence and/or hazardous drinking. Some of the patients with the above-mentioned complicated disease have alcohol-induced mood disorder, v) If the patient has alcohol-induced mood disorder, it will place priority on alcoholism treatment and will be important to quickly resolve with abstinence. Finally, the proposals are made as follows; i) Making a guideline, ii) Physicians skilled at SBIRT (Screening, Brief Intervention, and Referral to Treatment) should be qualified as a certifying physician, and having the qualification should allow reimbursing medical institutions for the alcohol related service provided.


Asunto(s)
Alcoholismo/diagnóstico , Alcoholismo/prevención & control , Rol Profesional , Adulto , Alcoholismo/complicaciones , Depresión , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psiquiatría , Factores Sexuales , Suicidio , Adulto Joven
14.
Nihon Rinsho ; 73(9): 1528-35, 2015 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-26394516

RESUMEN

The prevalence of alcohol dependence in Japan was 0.9% in 2013, but up to 16% adults drink alcohol at levels of unhealthy use. Primary care physicians play an important role in recognizing alcohol use disorder, helping patients change their behavior, and preventing its medical complications. The Screening, Brief Intervention, Referral to Treatment (SBIRT) model is an evidence-based, cost-effective intervention implemented worldwide to reduce alcohol use disorder.


Asunto(s)
Trastornos Relacionados con Alcohol/diagnóstico , Alcoholismo/diagnóstico , Alcoholes/efectos adversos , Análisis Costo-Beneficio , Tamizaje Masivo , Derivación y Consulta , Trastornos Relacionados con Alcohol/terapia , Alcoholismo/terapia , Humanos , Japón , Tamizaje Masivo/métodos
15.
Nihon Rinsho ; 73(9): 1585-91, 2015 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-26394525

RESUMEN

Japan passed the national law "Basic Act on Measures against Alcohol-related Health Harm" on December 2013. This law is expected to prevent inappropriate drinking that leads to alcohol-related problems such as physical and mental disorder, drunk driving, suicide, domestic violence, child abuse, and poor work performance. The physician's responsibilities under this law are described as follows: i) to provide high quality and appropriate medical care concerning alcohol-related health harm; ii) to reduce or eliminate the consumption of alcohol, thus preventing the progression of alcohol-related health harm; and iii) to coordinate these efforts amongst medical institutions. Based on this law, we believe that Japanese physicians will have essential roles in achieving the goals of this law and that we can fulfill our responsibilities by observing the following aspects: a) changing our message to the patients from "drink sensibly and moderately" to "low-risk drinking; but any drinking has a risk of harm and low-risk drinking is not risk-free"; b) encouraging the spread and use of Screening, Brief Intervention, and Referral to Treatment (SBIRT); and c) establishing community healthcare systems for alcohol-related problems, including dementia in the elderly and during alcohol emergencies.


Asunto(s)
Consumo de Bebidas Alcohólicas/terapia , Alcoholismo/terapia , Alcoholes/efectos adversos , Rol del Médico , Derivación y Consulta , Conducta Social , Consumo de Bebidas Alcohólicas/prevención & control , Alcoholismo/diagnóstico , Alcoholismo/prevención & control , Humanos , Japón
16.
Eur Spine J ; 23(10): 2166-74, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25047653

RESUMEN

PURPOSE: To conduct a retrospective multicenter study to investigate the accuracy of pedicle screw (PS) placement in the cervical spine by freehand technique and the related complications in various pathological conditions including trauma, rheumatoid arthritis, degenerative conditions and others. METHODS: 283 patients with 1,065 PSs in the cervical spine who were treated at eight spine centers and finished postoperative CT scan were enrolled. The numbers of placed PSs were 608 for trauma, 180 for rheumatoid arthritis (RA), 199 for spondylosis, and 78 for others. Malposition grades on CT image in the axial plane were defined as grade 0 (G-0) correct placement, grade 1 (G-1): malposition by less than half screw diameter, grade 2 (G-2): malposition by more than half screw diameter. The direction of malposition was classified into four categories: medial, lateral, superior and inferior. RESULTS: Overall malposition rate was 14.8 % (9.6 % in G-1 and 5.3 % in G-2). The highest malposition rate was 26.7 % for RA, followed by 16.6 % for spondylosis, and 11.2 % for trauma. The malposition rate for RA was significantly higher than those for other pathologies. 79.7 % of the malpositioned screws were placed laterally. Though intraoperative vertebral artery injury was observed in two patients with RA, there were no serious complications during a minimal 2-year follow-up. CONCLUSIONS: Malposition rate of PS placement in the cervical spine by freehand technique was high in rheumatoid patients even when being performed by experienced spine surgeons. Any guidance tools including navigation systems are recommended for placement of cervical PSs in patients with RA.


Asunto(s)
Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Fluoroscopía/normas , Fracturas de la Columna Vertebral/cirugía , Fusión Vertebral/normas , Tomografía Computarizada Espiral/normas , Adulto , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/cirugía , Femenino , Fluoroscopía/métodos , Humanos , Masculino , Persona de Mediana Edad , Traumatismos del Cuello/diagnóstico por imagen , Traumatismos del Cuello/cirugía , Tornillos Pediculares , Periodo Posoperatorio , Estudios Retrospectivos , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fusión Vertebral/métodos , Espondilosis , Tomografía Computarizada Espiral/métodos
17.
Nihon Arukoru Yakubutsu Igakkai Zasshi ; 49(6): 369-80, 2014 Dec.
Artículo en Japonés | MEDLINE | ID: mdl-25831951

RESUMEN

This report describes the effect of a screening and brief intervention via the Internet (6-month Total health Management Program: TMP, a kind of life evolution program), for improvement of alcohol related problem in the workplace. At a certain company, 2,096 employees were screened.using AUDIT-C and CAGE via the Internet (electronic screening). From those screened, 17 risky drinkers were picked up. The classification of "risky drinker" was determined based on employees scoring over six points on AUDIT-C and over two points on_ AGE. These employees were then called to one-day practical seminar program (including the program of food education, music therapy, aro-atherapy, body conditioning etc.). After which, during 6 months, they were followed up via e-mail every month. After the 6-month follow up, their results of AUDIT-C were significantly decreased. Additionally, aside from the frequency of drinking at bedtime, maximum alcohol consumption per day was also significantly decreased. The Visual Analogue Scale for anxiety captured the initial screen and then again after follow-up was reduced significantly. Moreover, quality-of-life index for sleep and dinner were both significantly improved as well..These results suggest that the SBI (screening and brief intervention: TMP) is effective for reducing drinking behavior, can be used to effectively elevate quality of life.


Asunto(s)
Consumo de Bebidas Alcohólicas/prevención & control , Consumo de Bebidas Alcohólicas/psicología , Alcoholismo/prevención & control , Promoción de la Salud/métodos , Internet , Servicios de Salud Mental , Servicios de Salud del Trabajador/métodos , Salud Laboral , Psicoterapia Breve/métodos , Gestión de Riesgos/métodos , Lugar de Trabajo , Consumo de Bebidas Alcohólicas/efectos adversos , Alcoholismo/diagnóstico , Ansiedad , Estudios de Seguimiento , Humanos , Calidad de Vida , Derivación y Consulta , Riesgo , Factores de Tiempo , Escala Visual Analógica
18.
Nihon Arukoru Yakubutsu Igakkai Zasshi ; 48(5): 314-23, 2013 Oct.
Artículo en Japonés | MEDLINE | ID: mdl-24427903

RESUMEN

OBJECTIVE: Though heavy drinkers and patients with alcohol dependence make use of the ambulance more frequently as compared with the general population, there are few data on the alcohol-related use of the emergency department (ED) in Japan. METHOD: A cross sectional study was conducted. 170 patients with alcohol dependence in one clinic and 306 primary care patients across two clinics provided demographic data and answered some questions about the use of emergency ambulance services over the age of 20. The questions asked included whether use of the ambulance caused injuries, as well as AUDIT-C (primary care patients only). In this study, multiple logistic regression analysis was used. RESULT: The use of emergency ambulance services by patients with alcohol dependence was 4.68 times more than primary care patients, and the occurrence of ambulance-caused injuries was 6.03 times higher, as determined by multiple logistic regression. Among primary care patients, AUDIT-C positive patients (male; 5 points or more, female; 3 points or more) were 37 (12.2%), and the occurrence of ambulance-caused injuries was 3.32 times higher. CONCLUSION: Like with other countries, in Japan, heavy drinkers and patients with alcohol dependence lead to a significant increase in the use of emergency ambulance services as well as ambulance-caused injuries.


Asunto(s)
Alcohólicos/estadística & datos numéricos , Alcoholismo/epidemiología , Ambulancias , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad
19.
Eur Spine J ; 18(9): 1326-34, 2009 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-19653013

RESUMEN

Cervical pedicle screw is thought to be the most stable instrumentation for reconstructive surgery of the cervical spine. However, because of the unresolved and inherent risk of neurovascular injuries due to screw perforation, it remains not widespread nowadays despite the excellent biomechanical property. Fifty-two consecutive cases having undergone spinal reconstruction using cervical pedicle screw were investigated. There were 24 females and 28 males. The mean follow-up period was 53 months. Those patients were stratified into three groups according to the period of screw insertion. A total of 280 screws were inserted. Ninety-two screws in 19 cases, 100 screws in 18 cases and 88 screws in 15 cases were inserted in the earlier, the middle and the later periods, respectively. Clinical results including complications were recorded in all cases. Screw perforations were evaluated in both plain X-ray and CT. Screw perforations occurred in 11 (12.0%), 7 (7.0%) and 1 (1.1%) screws in each period. There were no complications, such as infection, neurological deterioration and neurovascular injury directly related to screw insertion. The learning curve showed a significant improvement especially in the later period. However, the perforation rates in both the earlier and middle periods must not be underestimated. Surgeons with less experience must insert cervical pedicle screws with the assistance of a senior surgeon to avoid lethal complications.


Asunto(s)
Tornillos Óseos/normas , Vértebras Cervicales/diagnóstico por imagen , Fluoroscopía/métodos , Neuronavegación/métodos , Implantación de Prótesis/educación , Fusión Vertebral/educación , Adulto , Anciano , Anciano de 80 o más Años , Vértebras Cervicales/patología , Vértebras Cervicales/cirugía , Femenino , Humanos , Imagen Tridimensional , Fijadores Internos , Periodo Intraoperatorio , Aprendizaje , Masculino , Persona de Mediana Edad , Evaluación de Resultado (Atención de Salud)/métodos , Complicaciones Posoperatorias/prevención & control , Valor Predictivo de las Pruebas , Implantación de Prótesis/instrumentación , Implantación de Prótesis/métodos , Sensibilidad y Especificidad , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Enseñanza/métodos , Adulto Joven
20.
J Neurosurg Spine ; 6(1): 47-51, 2007 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-17233290

RESUMEN

The authors report the case of an 83-year-old woman with refractory sciatica attributable to isthmic spondylolisthesis at L-5. Her symptoms were successfully improved after posterior lumbar interbody fusion (PLIF) at L5-S1; however, notable swelling in her left leg suddenly developed 2 days postoperatively. Anterior migration of a fragment of bone graft was demonstrated on computed tomography scanning, and there was obvious occlusion of the left common iliac vein (CIV) on magnetic resonance venography. Ultrasonography revealed a thrombus in the left CIV at the site of compression. To prevent a pulmonary embolism during manipulation of the affected vein, an inferior vena cava filter was placed just before excision of the migrated bone fragment. The swelling in the patient's leg subsided quickly after the surgery, and she was treated with heparin and warfarin to prevent recurrent deep vein thrombosis (DVT). Six months after the second surgery, complete restoration of blood flow to the left CIV and no recurrence of DVT were demonstrated on magnetic resonance venography. Especially in elderly patients with degenerative disc disease, excessive curettage and impaction of disc materials during the PLIF procedure may cause migration of bone graft fragments. Surgeons should be aware of the possible vascular complications of PLIF.


Asunto(s)
Trasplante Óseo/efectos adversos , Desplazamiento del Disco Intervertebral/cirugía , Región Lumbosacra/cirugía , Complicaciones Posoperatorias , Fusión Vertebral/métodos , Trombosis de la Vena/etiología , Anciano de 80 o más Años , Femenino , Humanos , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Región Lumbosacra/diagnóstico por imagen , Imagen por Resonancia Magnética , Flebografía , Ciática/etiología , Espondilolistesis/complicaciones , Ultrasonografía , Filtros de Vena Cava , Trombosis de la Vena/diagnóstico por imagen
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