高齢者における認知症及び介護サービス利用状況と要介護度悪化との関連

京都大学0048新制・課程博士博士(社会健康医学)甲第19275号社医博第66号新制||社医||9(附属図書館)32277京都大学大学院医学研究科社会健康医学系専攻(主査)教授 古川 壽亮, 教授 佐藤 俊哉, 教授 髙橋 良輔学位規則第4条第1項該当Doctor of Public HealthKyoto UniversityDFA

COVID-19 Impact on the Japanese Healthcare System and Comparison of its Countermeasures With South Korea and Taiwan

Since the coronavirus disease 2019 (COVID-19) pandemic has begun, Asian countries/regions, such as Japan, South Korea, and Taiwan, had generally controlled the pandemic better than other countries. In this article, we showed the big impact of the pandemic on acute care hospitals in Japan, where the number of COVID-19 patients has been smaller than in other countries. We also compared the mitigation measures against the COVID-19 pandemic among Japan, South Korea, and Taiwan to study the factors affecting the differences among these relatively well-controlled countries/regions. We analyzed Diagnosis Procedure Combination data from the Quality Indicator/Improvement Project database, in which Japanese hospitals participated voluntarily. During the first declaration of emergency, which was from April 4 to May 25, the numbers of inpatients decreased roughly 20% for adults and 40% for those aged under 18 years compared to those of the same period in the previous year. In the analyses by disease, hospitalizations with acute coronary syndrome, ischemic stroke, cancer, childhood non-COVID-19 acute infections, infant and pediatric asthma decreased in number, whereas those with alcohol-related liver diseases and pancreatitis increased. Comparing selected mitigation measures against COVID-19, such as border control, enforced measures, information governance, and contact tracing, among Japan, South Korea, and Taiwan, the implementation and dissemination of measures were less strict, slower, and less comprehensive in Japan. This might explain why Japan has experienced a comparatively high incidence of COVID-19 and indicate a substantial risk of infection explosion. A change in behavioral compliance could trigger an infection explosion under poor performance in the response set. Further monitoring is warranted to promote the evolution of effective sets of countermeasures to overcome the pandemic

Determination of dimethoxyphenethylamine derivatives in urine by deuterium labeled internal standards

The use of gas chromatography–mass spectrometry (GC–MS) in forensic analysis is increasing. To exploit fully the capabilities of MS, labeled standards, that can be used to improve the performance of the quantitative analysis, and to increase accuracy and precision, are required. A series of deuterated internal standards, corresponding to the 2C-series of phenethylamine derivatives, including 4-bromo-2,5-dimethoxyphenethylamine-d6 (2C-B), 4-chloro-2,5-dimethoxyphenethylamine-d6 (2C-C), 4-iodo-2,5-dimethoxy-phe¬nethyl-amine-d6 (2C-I), 4-ethylthio-2,5-dimethoxy-phenethylamine-d6 (2C-T-2) and 2,5-dimethoxy-4-n-propylthiophenethylamine-d6 (2C-T-7), were synthesized. These deuterated compounds were used to analyze for the corresponding unlabeled compounds in urine. The analysis was performed using GC–MS, with the selected ion monitoring (SIM) technique, whereby good results were achieved

Dual regulation by ethanol of the inhibitory effects of ketamine on spinal NMDA-induced pressor responses in rats

<p>Abstract</p> <p>Background</p> <p>Acute exposure of ethanol (alcohol) inhibits NMDA receptor function. Our previous study showed that acute ethanol inhibited the pressor responses induced by NMDA applied intrathecally; however, prolonged ethanol exposure may increase the levels of phosphorylated NMDA receptor subunits leading to changes in ethanol inhibitory potency on NMDA-induced responses. The present study was carried out to examine whether acute ethanol exposure influences the effects of ketamine, a noncompetitive NMDA receptor antagonist, on spinal NMDA-induced pressor responses.</p> <p>Methods</p> <p>The blood pressure responses induced by intrathecal injection of NMDA were recorded in urethane-anesthetized rats weighing 250-275 g. The levels of several phosphorylated residues on NMDA receptor GluN1 subunits were determined by western blot analysis.</p> <p>Results</p> <p>Intravenous injection of ethanol or ketamine inhibited spinal NMDA-induced pressor responses in a dose-dependent and reversible manner. Ketamine inhibition of NMDA-induced responses was synergistically potentiated by ethanol when ethanol was applied just before ketamine. However, ketamine inhibition was significantly reduced when applied at 10 min after ethanol administration. Western blot analysis showed that intravenous ethanol increased the levels of phosphoserine 897 on GluN1 subunits (pGluN1-serine 897), selectively phosphorylated by protein kinase A (PKA), in the lateral horn regions of spinal cord at 10 min after administration. Intrathecal administration of cAMPS-Sp, a PKA activator, at doses elevating the levels of pGluN1-serine 897, significantly blocked ketamine inhibition of spinal NMDA-induced responses.</p> <p>Conclusions</p> <p>The results suggest that ethanol may differentially regulate ketamine inhibition of spinal NMDA receptor function depending on ethanol exposure time and the resulting changes in the levels of pGluN1-serine 897.</p

Interannual Variation of Springtime Biomass Burning in Indochina: Regional Differences, Associated atmospheric dynamical changes, and downwind impacts

During March and April, widespread burning occurs across farmlands in Indochina in preparation for planting at the monsoon onset. The resultant aerosols impact the air quality downwind. In this study, we investigate the climatic aspect of the interannual variation of springtime biomass burning in Indochina and its correlation with air quality at Mt. Lulin in Taiwan using long-term (2005–2015) satellite and global reanalysis data. Based on empirical orthogonal function (EOF) analysis, we find that the biomass burning activities vary with two geographical regions: northern Indochina (the primary EOF mode) and southern Indochina (the secondary EOF mode). We determine that the variation of biomass burning over northern Indochina is significantly related with the change in aerosol concentrations at Mt. Lulin. This occurs following the change in the so-called India-Burma Trough in the lower and middle troposphere. When the India-Burma Trough is intensified, a stronger northwesterly wind (to the west of the trough) transports the dryer air from higher latitude into northern Indochina, and this promotes local biomass burning activities. The increase in upward motion to the east of the intensified India-Burma Trough lifts the aerosols, which are transported toward Taiwan by the increased low-level westerly jet. Further diagnoses revealed the connection between the India-Burma Trough and the South Asian jet\u27s wave train pattern as well as the previous winter\u27s El Niño–Southern Oscillation phase. This information highlights the role of the India-Burma Trough in modulating northern Indochina biomass burning and possibly predicting aerosol transport to East Asia on the interannual time scale

Projection of Supply and Demand of the Physical Therapy Manpower in Taiwan for the Next Twenty Years: Part I. Current Status and Productivity of Physical Therapists and Physical Therapist Assistants

Background and purposes: The purposes of this study were 1) to describe the general productivity and productivities in 4 special fields (neurological, orthopedic, pediatric, and cardiopulmonary) of physical therapists (PT) and physical therapist assistants (PTA) in Taiwan, and 2) to explore the association between characteristics of PT/PTA and productivity. Method: Questionnaire was mailed to the members of all PT and PTA associations in Taiwan. The total mailing number of questionnaire for PT and PTA were 2466 and 1117, respectively. The content of this questionnaire included basic demographic data and information in clinical work. Survey period was between September, 2002 and December, 2002. Results: Total returned questionnaires were 764 from PT and 269 from PTA. General productivity for aPT was 21.39 patients per day, assuming working 8 hours per day. For each specialization field, the productivity of neurological, orthopedic, pediatric, cardiop­ ulmonary patients of each PT per day was 19.72 (sd=9.50), 24.98 (sd=11.07), 15.55 (sd=8.75), and 21.42 (sd=10.63), respectively. For the association between PT characteristics and productivity, working place and PT\u27 s gender were significantly associated with general productivity. PT\u27s age, educational level, and working place were significantly associated with neurological and pediatric productivities. Working experience was also significantly associated with neurological productivity. PT\u27 s characteristics were not significantly associated with orthopedic and cardiopulmonary productivity. General productivity for a PTA was 29.75 patients per day. The productivity of neurological, orthopedic, pediatric, cardiopulmonary patients of each PTA per day was 22.29 (sd=9.50), 35.07 (sd=11.07), 19.48 (sd=8.75), and 19.55 (sd=10.63), respectively. Only PTA\u27s education level was signifi­cantly associated with orthopedic productivity. There were no other significant associations between any of the PTA\u27s characteristics and productivity. Conclusion: This study repported the current status of clincial practice in PT and PTA. There will be a series of articles investigating the projection of supply and demand of physical therapy manpower for the next twenty years

Phenome-wide analysis of Taiwan Biobank reveals novel glycemia-related loci and genetic risks for diabetes

To explore the complex genetic architecture of common diseases and traits, we conducted comprehensive PheWAS of ten diseases and 34 quantitative traits in the community-based Taiwan Biobank (TWB). We identified 995 significantly associated loci with 135 novel loci specific to Taiwanese population. Further analyses highlighted the genetic pleiotropy of loci related to complex disease and associated quantitative traits. Extensive analysis on glycaemic phenotypes (T2D, fasting glucose and Hb