[A Clinical Pathway Based on Medical and Nursing Teamwork in Drug Management Facilitates Integrated Community Care for Elderly Patients with Chronic Heart Failure].

　Chronic heart failure (CHF) is a critical disease in the aging population. Conventional therapy in hospitals cannot cure elderly patients with CHF at the end of life. Patients and their families experience anxiety and need comfortable care at home or in a nursing facility. To improve chronic cardiovascular disease management, we developed a simplified but integrated clinical pathway to facilitate medical and nursing care teamwork in the local community. Our institution is a central hospital in the North Shinshu district, which has an approximate population of 100000. We developed a pathway for both clinical program and information provision between our hospital and neighboring clinics. A hospital team evaluates and shares patient information with a homecare medical team every 6 months using the medical staff pathway. To maintain the efficacy and security of pharmacotherapy, a hospital clinical pharmacist reviews the prescriptions and prepares a drug profile book to share drug information between patients and all medical staff. These efforts have resulted in preventing adverse effects of drugs and reduced the cost of medications. Physical activity evaluation and nutrient guidance are also useful for patients to maintain their personal lifestyles. We initiated use of the pathway from 2009 and have followed up over 500 patients since then. We have also established a community partnership council to promote face-to-face communication among multiple categories of institutions and government agencies. Members of the council collaborate to help patients with cardiovascular disease to manage their own lives at home.

Colonization of segmented filamentous bacteria and its interaction with the luminal IgA level in conventional mice.

Segmented filamentous bacteria (SFB) colonize in the ileum. They promote the development of intraepithelial lymphocytes and immunoglobulin A (IgA)-producing cells in the small intestine. In SFB-monoassociated mice, changes in SFB colonization of the small intestine were related to the level of IgA derived from maternal milk during the suckling period and self-produced in the small intestine after weaning. In this study, we investigated whether or not maternal and neonatal IgA influence the colonization of SFB in conventional mice from 18 to 105 days old. The pups were forcedly weaned at 20 days old. SFB could be detected in the distal small intestine after day 22, and their number rapidly reached a maximum on day 28. Thereafter, they gradually declined to one-fourth of the maximum level. The lowest concentrations of IgA in the small intestinal and cecal contents were detected on day 22. Thereafter, they increased as the age of the mice increased. The expression of the polymeric immunoglobulin receptor gene in the distal small intestine increased after weaning. These results suggested that the colonization of SFB in the pre-weaning and post-weaning periods might be prevented with IgA derived from maternal milk and self-produced IgA, respectively.

Inequality in the health status of workers in small-scale enterprises.

BACKGROUND: Small-scale enterprises (SSEs) usually share poorer resources for promoting occupational health. AIM: To investigate inequality of health status among SSEs in Japan. METHOD: A cross-sectional, multiple-centred study was carried out using the periodical health check-up data for the fiscal year 2000 to compare the age-adjusted proportions of workers with hypertension (HT), hyperlipidaemia, impaired glucose tolerance (IGT) and obesity and of current smokers by size of enterprise, i.e. or=1000 employees in Japan. RESULTS: From five leading occupational health organizations, data were collected for 9833 enterprises with a total of 436 729 subjects, 302 383 males and 134 346 females. The proportions of workers in SSEs with or=50 male employees. The prevalence of smokers in SSEs with or=50 male employees. These proportions showed a significantly increasing tendency with decreasing size of male workforce. CONCLUSION: Despite the cross-sectional design and only adjusting age as a potential confounder, higher proportions of HT, IGT, obesity and smoking in male workers were found in SSEs compared to larger organizations.

Recent trends in ILO conventions related to occupational safety and health.

The present study was conducted to analyze the ratification status of International Labour Organization (ILO) conventions related to occupational safety and health (OSH) by ILO member states in terms of national indicators (length of ILO membership and national income status) and regional affiliation. 17 conventions designated as OSH-related by the 2003 International Labour Conference were examined. In general, countries with longer ILO membership ratified higher numbers of conventions related to OSH. With some variation, long-membership countries had the largest number of ratifications, followed by middle- and short-membership countries in all regions. There were also incremental increases in the number of ratifications for OSH-related conventions according to the national income status. Common regional characteristics that could not be explained by the factors studied also existed. Future efforts to increase ratification at an international level will need to consider the factors influencing ratification practice among the member states.

A retrospective cohort study among iron-steel workers in Anshan, China: exposure assessment.

Although adequate assessment of exposure is needed in epidemiological studies among foundry workers, previous studies are often lacking in this aspect. We conducted a retrospective cohort study of a Chinese iron and steel company with a 14-yr follow up during 1980-1993. Exposure assessment was performed for a single job, i.e., the current job for the active worker and the longest job for the retired or deceased worker as of the end of the follow-up, which was allocated as the surrogate of lifetime job and was applied to a job-exposure matrix. Of the 147,062 cohort members, 52,394 males (43%) and 5,291 females (21%) were exposed to any of 15 hazardous factors such as dust, silica, PAHs (polycyclic aromatic hydrocarbons), CO (carbon monoxide) and heat. In 2,104 randomly selected samples, the exposure assessment of exposed workers based on a single job was found to be 12-14% lower than the real situation. This study suggests that the exposure assessment is valuable in evaluating the health effects among the foundry workers, despite some limitations such as underestimation of exposure assessment and the lack of data regarding smoking and drinking habits.

Mortality of iron-steel workers in Anshan, China: a retrospective cohort study.

Foundry workers have increased mortality and morbidity risks from numerous causes, including various cancers. A retrospective Chinese iron-steel cohort study was conducted to examine the mortality effects of exposure to foundry work. Standardized mortality ratios (SMRs) and standardized rate ratios (SRRs) were calculated to evaluate mortality risks among male workers with exposure to 15 hazardous factors, adjusting for confounders. During 14 years of follow-up, 13,363 of 121,846 male workers died. SMR analysis showed a healthy-worker effect in comparison with the general population. SRR analysis showed increased risks for all causes, all neoplasms, and others among the exposed workers compared with non-exposed blue-collar workers. Combined exposure to polycyclic aromatic hydrocarbons and two or more dusts increased the risks of lung cancer (SRR = 654; 95% CI: 113-3,780) and other malignancies. Foundry work has adverse health effects, including carcinogenic risks.

Chemistry of renieramycins. Part 5. Structure elucidation of renieramycin-type derivatives O, Q, R, and S from thai marine sponge Xestospongia species pretreated with potassium cyanide.

Four minor renieramycin-type derivatives, including renieramycins O (1o) and Q-S (1q-s), were isolated from the sponge Xestospongia sp. pretreated with potassium cyanide. Their structures were elucidated by comparison of spectral data with those of recently reported renieramycins M (1m) and N (1n). The results of transformation and cytotoxicity measurements are also described.

Chemistry of renieramycins. Part 4.synthesis of a simple natural marine product, 6-hydroxy-7-methoxyisoquinolinemethanol.

6-Hydroxy-7-methoxyisoquinolinemethanol (15) and mimosamycin (1) were recently isolated from a marine sponge, Haliclona sp. The former was prepared in ten steps from vanillin (22) in 26% overall yield using an isopropyl for phenol protection.

Chemistry of renieramycins. Part 3.(1) isolation and structure of stabilized renieramycin type derivatives possessing antitumor activity from Thai sponge Xestospongia species, pretreated with potassium cyanide.

Renieramycins M (1m) and N (1n) were isolated from the Thai sponge Xestospongia sp., pretreated with potassium cyanide in methanolic buffer solution, and their structures and relative stereochemistries were elucidated on the basis of spectroscopic data. This strategy is the first example of the gram-scale preparation of this series of compounds and presents a potential solution for increasing the gram-scale supply of novel natural products from marine sources.

[Questionnaire survey of the actual working conditions of care-managers].

In order to clarify the present status of care-managers, a questionnaire was sent to 1,714 care-managers working in Kanagawa Prefecture in June 2002. The aspects investigated included their background, amount of care-management and degree of achievement, conditions of employment, opinion poll and training system. The response rate was 45.6% (782 out of 1,714). Concerning the total number of users in care at present, 37% of care-managers had less than 30 people, 24% from 31 to 50 and, surprisingly, 39% had more than 51 people. However, 42% answered that less than 30 was an appropriate number of users, 52% said 31 to 50 and only 6% answered that more than 51 people was an appropriate number. The conferences of users service representative were held only 8%. Concerning the burden of care-management, 87% of them answered the evaluation of every month and 86% did the conferences of users service representative. The cases requiring much time for the support, had problems not only the users but also in the household, who lacked the understanding and judgment for long-term care insurance. Most care-managers needed information on the available services and newly open care-service institutions. 27% of care-managers satisfied their care-management, 25% dissatisfied and the remainder were neither off nor on. The satisfaction to the care-management correlated well with the intelligibility of the management leader, motivation regarding care management and the degree of satisfaction with their income. It is concluded that the number of users per care-manager is too large, and that unfortunately it might further increase in the future. The conferences of users service representative were extremely held too low. It is also showed that information of the other service office and informal service with the exception of long-term care insurance are required.

[Questionnaire survey of the actual working conditions of care-managers].

In order to clarify the present status of care-managers, a questionnaire was sent to 1,714 care-managers working in Kanagawa Prefecture in June 2002. The aspects Investigated included their background, amount of care-management and degree of achievement, conditions of employment, opinion poll and training system. The response rate was 45.6% (782 out of 1,714). Concerning the total number of users in care at present, 37% of care-managers had less than 30 people, 24% from 31 to 50 and, surprisingly, 39% had more than 51 people. However, 42% answered that less than 30 was an appropriate number of users, 52% said 31 to 50 and only 6% answered that more than 51 people was an appropriate number. The conferences of users service representative were held only 8%. Concerning the burden of care-management, 87% of them answered the evaluation of every month and 86% did the conferences of users service representative. The cases requiring much time for the support, had problems not only the users but also in the household, who lacked the understanding and judgment for long-term care insurance. Most care-managers needed information on the available services and newly open care-service institutions. 27% of care-managers satisfied their care-management, 25% dissatisfied and the remainder were neither off nor on. The satisfaction to the care-management correlated well with the intelligibility of the management leader, motivation regarding care-management and the degree of satisfaction with their income. It is concluded that the number of users per care-manager is too large, and that unfortunately it might further increase in the future. The conferences of users service representative were extremely held too low. It is also showed that information of the other service office and informal service with the exception of long-term care insurance are required.