Objective The impact of the 2018 Japan Floods on prescriptions of Yokukansan was evaluated. Methods This was a retrospective cohort study based on the National Database of Health Insurance Claims which covers all the prescriptions issued in Japan. Participants were patients aged 65 or older who received any medical care at medical institutions located in the three most-severely affected prefectures between 1 year before and after the disaster. We analyzed the number of new prescriptions of Yokukansan and other Kampo drugs among those who had not been prescribed any Kampo for 1 year before the disaster. Kaplan-Meier analysis and a Cox proportional hazards model were used to evaluate the risk of the disaster for a new prescription. Results Subjects comprised 1,372,417 people (including 12,787 victims, 0.93%). The hazard ratio (HR) of the disaster for Yokukansan prescriptions was 1.49 [95% confidence intervals (CI): 1.25–1.78], and 1.54 (95% CI: 1.29–1.84) in the crude and age-sex adjusted model, respectively. The HR of the disaster for prescription of other Kampo drugs in the crude and adjusted model was 1.33 (95% CI: 1.27–1.39), and 1.32 (95% CI: 1.27–1.38), respectively. The magnitude of increase of victims prescribed Yokukansan (31.4%) was statistically higher than for those prescribed other Kampo drugs (19.3%) ( p < 0.001). Conclusion The disaster increased prescriptions of both Yokukansan and other Kampo drugs among elderly victims. The increase was more remarkable in Yokukansan than other Kampo drugs. Clinicians and policymakers should be aware of the increased need for Yokukansan in times of natural disaster.
It has been well known that exposure of asbestos results in pulmonary diseases.Pulmonary concentration of asbestos bodies (Ab) is a good indicator of asbestos exposure.the aim of the present study is to determine the pulmonary concentration of Ab in the Japanese urban population.We observed age dependent increase of incidence of Ab. this may indicate that the very low level exposure of asbestos would be continued in a daily life.
In this study, we compared T cell receptor (TCR) repertoire diversity between patients with lymphedema, post-lymphatic venous anastomosis and healthy controls (HCs). TCR diversity was decreased in lymphedema compared with HCs; such TCR skewing was drastically improved in post-LVA.
Objectives The objective of this study was to examine the structural validity and internal consistency of the original English version of the Patient Centred Assessment Method (PCAM) in a primary care setting in a Japanese island area. Design Cross-sectional study. Setting A clinic on a remote island in Okinawa, Japan, that provides general outpatient and 24-hour emergency services. Participants This study included 355 patients who visited Tarama Clinic from 1 April 2018 to 30 June 2018, were aged ≥20 years, lived in Tarama Village and had decision-making capacity. Main outcome measures Patient complexity scored by the PCAM. Results The mean (SD) PCAM score was 21.4 (5.7). The distribution was skewed to the right and there were no ceiling and floor effects. Confirmatory factor analysis found that the previously reported two-factor and three-factor structures did not show a good fit (root mean square error of approximation 0.18 and 0.16, comparative fit index 0.83 and 0.89 and standardised root mean square residual 0.14 and 0.11, respectively). Exploratory factor analysis revealed a new two-factor structure: ‘Biomedical complexity’ and ‘Psychosocial complexity’. The Cronbach’s alpha values for the total PCAM score, the ‘Biomedical complexity’ factor, and the ‘Psychosocial complexity’ factor were 0.81, 0.82 and 0.74, respectively. Conclusions In this study, confirmatory factor analysis found that the data did not fit sufficiently using the previously reported two-factor and three-factor structures. Instead, exploratory factor analysis revealed a new two-factor structure, for which the Cronbach’s alpha values exceeded the threshold level. Therefore, the structural validity and internal consistency of the English version of the PCAM were verified in a primary care setting in a Japanese island area.
Several instruments for evaluating patient complexity have been developed from a biopsychosocial perspective. Although relationships between the results obtained by these instruments and the length of stay in hospital have been examined, many instruments are complicated and not easy to use. The Patient Centred Assessment Method (PCAM) is a candidate for practical use. This study aimed to test the validity and reliability of the PCAM and examine the correlations between length of hospital stay and PCAM scores in a regional secondary care hospital in Japan.Prospective cohort study.Two hundred and one patients admitted to Ouji Coop Hospital between July 2014 and September 2014.PCAM total score in initial phase of hospital admission.Length of stay in hospital.Among 201 patients (Female/Male=98/103) with mean (SD) age of 77.4±11.9 years, the mean PCAM score was 25±7.3 and mean (SD) length of stay in hospital (LOS) 34.1±40.9 days. Using exploratory factor analysis to examine construct validity, PCAM evidently has a two-factor structure, comprising medicine-oriented and patient-oriented complexity. The Spearman rank correlation coefficient for evaluating criterion-based validity between PCAM and INTERMED was 0.90. For reliability, Cronbach's alpha was 0.85. According to negative binomial regression analyses, PCAM scores are a statistically significant predictor (p<0.001) of LOS after adjusting for age, gender, Mini Nutritional Assessment Short-Form, Charlson Comorbidity Index, serum sodium concentration, total number of medications and whether public assistance was required. In another model, each factor in PCAM was independently correlated with length of stay in hospital after adjustment (medicine-oriented complexity: p=0.001, patient-oriented complexity: p=0.014).PCAM is a reliable and valid measurement of patient complexity and PCAM scores have a significant correlation with hospital length of stay.
Abstract Background Japan has one of the lowest COVID-19 death rates, while the annual suicide rate in 2020 has risen for the first time since 2007. This study aimed to identify high-risk populations and assess the impact of medical visits on suicide trends post-COVID-19 pandemic in Japan. Method This quasi-experimental study analyzed a population-based database from Hyogo Prefecture (2012–2022). Interrupted time-series analyses identified level and trend changes in monthly suicide rates per 1 million population during the exposure period (2020–2022) versus the control period (2012–2019). Regular visits to primary care and psychiatry stratified analysis. Results 2181 cases were analyzed, with two-thirds male and a median age of 54. Primary care physicians and psychiatric history were present in 69% and 40% of patients. The study found significant level changes in suicide rates overall (4.14, 95% CI: 1.70, 6.58) among individuals without regular primary care physician visits (2.83, 95% CI: 1.35, 4.32) and without psychiatric visits (2.85, 95% CI: 0.56, 5.14). In contrast, no significant changes were observed in individuals with regular primary care (0.99, 95% CI: -0.78, 2.76) or regular psychiatric visits (0.59, 95% CI: -0.98, 2.16). The trend changes were not significant in any of the groups. Conclusion This study suggests that a history of attending a medical institution may have prevented the rapid increase in suicides during the early stages of the COVID-19 pandemic.
Level of care-need (LOC) is an indicator of elderly person's disability level and is officially used to determine the care services provided in Japan's long-term care insurance (LTCI) system. The 2018 Japan Floods, which struck western Japan in July 2018, were the country's second largest water disaster. This study determined the extent to which the disaster affected the LOC of victims and compared it with that of non-victims.This is a retrospective cohort study, based on the Japanese long-term care insurance claims from two months before (May 2018) to five months after the disaster (December 2018) in Hiroshima, Okayama, and Ehime prefectures, which were the most severely damaged areas in the country. A code indicating victim status, certified by a residential municipality, was used to distinguish between victims and non-victims. Those aged 64 years or younger, those who had the most severe LOC before the disaster, and those whose LOC increased even before the disaster were excluded. The primary endpoint was the augmentation of pre-disaster LOC after the disaster, which was evaluated using the survival time analysis. Age, gender, and type of care service were used as covariates.Of the total 193,723 participants, 1,407 (0.7%) were certified disaster victims. Five months after the disaster, 135 (9.6%) of victims and 14,817 (7.7%) of non-victims experienced the rise of LOC. The victim group was significantly more likely to experience an augmentation of LOC than the non-victim group (adjusted hazard ratio 1.24; 95% confidence interval 1.06-1.45).Older people who were affected by the disaster needed more care than before and the degree of care-need increase was substantially more than non-victims. The result suggests that natural disasters generate more demand for care services among the older people, and incur more resources and cost for society than before.
