ボットタワーとトーラス作用

首都大学東

Tracheostomy decannulation rates in Japan: a retrospective cohort study using a claims database

Despite the exponential increase in the use of tracheostomy worldwide, rates of tracheostomy decannulation are unknown. We conducted a retrospective cohort study to investigate tracheostomy decannulation rates among adult patients over a two-year period and explored factors associated with prolonged tracheostomy. A health insurance claims database including 3, 758, 210 people in Japan was used. The primary outcome was time to decannulation. Assessed patient and hospital factors included age, sex, emergency endotracheal intubation, disease, and hospital size. A total of 917 patients underwent tracheostomy, and 752 met the eligibility criteria. Decannulation rates were 40.8% (95% confidence interval 36.8-44.9) at 3 months, 63.9% (58.4-69.0) at 12 months, and 65.0% (59.2-70.3) at 24 months. Hazard ratios of patient and hospital factors for tracheostomy decannulation were 0.44 for age (65-74 years) (95% confidence interval 0.28-0.68), 0.81 (0.63-1.05) for female sex, and 0.59 (0.45-0.76) for emergency endotracheal intubation. Cerebrovascular disease, head injuries, and cardiac arrest had lower hazard ratios compared to other diseases. Decannulation rates among adult patients in Japan increased rapidly up to 3 months after tracheostomy, reaching a plateau after 12 months. Older age, female sex, emergency endotracheal intubation, cerebrovascular disease, head injuries, and cardiac arrest were associated with prolonged tracheostomy

Social cost of mining-related lead (Pb) pollution in Kabwe, Zambia, and potential remediation measures

Lead (Pb) pollution has been one of the major environmental problems of worldwide significance. It is a latent factor for several fatal illnesses, whereas the exposure to lead in early childhood causes a lifetime IQ loss. The social cost is the concept to aggregate various adverse effects in a single monetary unit, which is useful in describing the pollution problem and provides foundation for the design of interventions. However, the assessment of the social cost is scarce for developing countries. In this study, we focus on the lead pollution problem of a former mining town, Kabwe, Zambia, where mining wastes abandoned near residential areas has caused a critical pollution problem. We first investigated the social cost of lead pollution that future generations born in 2025–2049 would incur in their lifetime. As the channels of the social cost, we considered the lost income from the IQ loss and the lost lives from lead-related mortality. The results showed that the social cost would amount to 224–593 million USD (discounted to the present value). Our results can be considered conservative, lower bound estimates because we focused only on well-identified effects of lead, but the social cost was still substantial. Then we examined several engineering remediation measures. The results showed that the social cost can be reduced (the benefits of remediations) more than the costs of implementing remediation measures. This study is the first to investigate the social cost of mining-related lead pollution problem in developing countries. Our interdisciplinary approach utilises the micro-level economic, health and pollution data and integrates the techniques in economics, toxicology and engineering.publishedVersio

Identifying important aspects of quality of life among Muslims with hypertension in rural West Java, Indonesia

Hypertension almost invariably impacts people’s quality of life (QOL). The WHO Quality of Life-BREF instrument (WHOQOL-BREF) is used widely in high-income countries and is comprised of physical, psychological, social and environmental domains. Few studies have measured QOL of people with hypertension in rural areas in low- and middleincome countries, including Indonesia. Our study aims were: 1) to assess whether WHOQOL-BREF is suitable for studying QOL among rural Muslim Indonesians with hypertension, and 2) to describe the characteristics of rural Muslim Indonesians’ QOL. In 2014, we conducted a cross-sectional survey of QOL among 447 residents of an economically stressed rural district in West Java. To assess WHOQOL-BREF’s goodness of fit, we performed structural equation modeling. We calculated Cronbach’s alpha to assess internal consistency reliability. Independent t-tests and one-way ANOVAs were used to compare differences between socio-demographic groups. Participants were mostly women (77%). Mean age was 54 and 24% were widows/widowers. Most (62%) had less than primary level education. Regarding measures of goodness of fit, only root mean square error of approximation reached a marginally acceptable level. Cronbach’s alpha for the overall scale was fairly high (0.893). Psychological QOL received the highest mean domain score (13.8). Environmental QOL received the lowest (12.6). The highest mean item score was for mobility. Financial status, access to information, and leisure received the lowest mean item scores. Domain scores differed by socioeconomic status. Low QOL on one or more domains was associated with lower education, being a widow/widower, and living in a remote area. Since the model showed that WHOQOL-BREF did not achieve desired levels on two of three goodness-of-fit indexes, other aspects of the participants’ QOL may have gone unmeasured. When providing healthcare services to Muslim patients with hypertension in rural Indonesia, planners and providers should attend to aspects of QOL identified in this study

Study of assessment of knowledge and understanding for coping with sick days among patients with diabetes in community pharmacy: a cluster randomized controlled trial (SAKURA trial)

[Background] Awareness regarding coping with sick days among patients with diabetes is limited. Thus, we evaluated the effectiveness of sick-day education by community pharmacists among patients with type 2 diabetes (T2D) using sick-day educational materials (sick-day cards). [Methods] A cluster randomized controlled trial was conducted. Pharmacists in the intervention group educated patients with T2D on coping with sick days (adjusting medication dosage and seeking medical advice) using sick-day cards compared with the usual counseling. Differences in questionnaire scores (“Anxiety”, “Intention”, “Attitude”, and “Knowledge” about sick days) before and after the intervention were compared between the groups. [Results] Overall, 318 patients with T2D (intervention, 119; control, 199) participated in this study, and 270 (intervention, 92; control, 178) patients were examined. There were no significant differences in “Anxiety”, “Intention”, or “Attitude” scores between the two groups, but “Knowledge” scores improved in the intervention group. For all intervention groups (92/92), a physician reviewed and approved medication and adjustment doses for sick days on the cards. [Conclusions] According to patients’ responses, sick-day education using teaching materials improved patient knowledge. This may help patients and their caregivers cope with sick days appropriately through medication dose adjustment and fluid intake. Research registration number: UMIN000043161 (February 1, 2021), https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr.cgifunction=brows&action=brows&recptno=R000048124&type=summary&language=

Sensitization to secretoglobin and lipocalins in a group of young children with risk of developing respiratory allergy

Background: Multiple sensitizations in early age have been reported to be a risk for development of asthma. This study evaluates the emergence and evolution of IgE to aeroallergens among a cohort of children with physician-diagnosed atopic dermatitis and/or showing food allergy symptoms and to examine the relation to asthma development. Methods: Three-hundred and four children (median age 13.4 months at entry) with food allergy symptoms and/or atopic dermatitis without asthma at inclusion were analysed for IgE antibodies against food-, indoor- and outdoor-allergens and pet allergen components and correlated to the individuals’ outcome on asthma inception. Results: At 2 years of follow-up, physician-diagnosed asthma was 19.7% (n = 49) and asthma diagnosed any time was 24% (n = 67). History of persistent cough and asthma of father, combination of milk- and wheat-allergy symptoms and dual sensitization to house dust mite and Japanese cedar were independent risk factors for asthma. Sensitization to dog was the most prevalent inhalant allergen at entry. Asthma children had a higher proportion of sensitization to dog, cat and horse allergens at entry compared with non-asthma children. Being sensitized to both food, house dust mite and pet allergens was strongly associated with asthma (p = 0.0006). Component resolved diagnosis for dog and cat allergens showed that IgE antibodies to Can f 1 and Fel d 1 was common even at very young age. Conclusions: Early sensitization to inhalant allergens increases the risk of developing asthma as well as having milk and wheat allergy symptoms. Sensitization to dog, was common at an early age despite dog ownership. Sensitization to secretoglobin and lipocalins and less to serum albumins explained the pet sensitization

Urinary neonicotinoids profiles in adults from Aveiro district, NW Portugal

Neonicotinoid insecticides (Neonics - NNs) are systemic insecticides widely used in agriculture to control insects. Due to their broad-spectrum insecticide activity, they are also used in the domestic environment and on animals, including household pets. Owing to their toxicity towards non-target organisms, particu-larly honeybees, the agricultural outdoor use of some neonics was already banned. Nevertheless, they can still be used in indoor activities. Neonics’ residues have been detected in food, water and indoor dust and, consequently, humans are exposed to these insecticides. However, human biomonitoring data is limited to a few studies worldwide, with no data for Portugal. In this study, levels of neonicotinoids namely ace-tamiprid (and its metabolite dm-acetamiprid), clothianidin, dinotefuran, imidacloprid, nitenpyran, thi-acloprid and thiamethoxan, were quantified in spot urine samples provided by 46 volunteers from Aveiro district. The volunteers were recruited from RESPIRA project, an ongoing study that aims to evaluate the role of environmental contaminants in the progression of respiratory diseases. Overall, the obtained re-sults disclose that 81.4% of the individuals were exposed to at least one neonicotinoid. Dinotefuran and dm-acetamiprid showed the highest detection frequencies (46.5%), followed by imidacloprid (41.9%), whereas nitenpyran and thiacloprid were never detected (bellow detection limit). The neonics with the highest concentrations were dm-acetamiprid (max: 1443 ug/g creatinine, average: 39.1 ug/g creatinine) and thiamethoxan (max: 152 ug/g creatinine, average: 6.9 ug/g creatinine). These results are in general accordance with previous reports that disclosed dm-acetamiprid as one of the most frequently detected NN in human urine samples.publishe

Salivary Effects of Facial Vibrotactile Stimulation in Patients with Sjogren’s Syndrome and Poor Salivation

We examined the effect of vibrotactile apparatus in patients with Sjögren’s syndrome and others with reduced salivation in comparison to normal subjects. The most effective salivation in normal subjects was produced by 89 Hz vibrotactile stimulation with 9.8 μm amplitude on the parotid or submandibular glands vibrotactile stimuli. First, we examined by measuring the weight of dental cotton rolls positioned at the opening of the secretory duct for total salivation 3 min during resting, and then after 5-min intervals, the weights were measured every 3 min of vibrotactile stimulation on salivary glands. Furthermore, we measured facial temperature around vibrators after 2 min of vibration. We investigated 10 poor salivation patients with Sjögren’s syndrome (8 patients) defined by examinations (contrast study or scintigraphic test) and others (2 patients). About 50% of patients with poor salivation gained recognition for good results, although they had periods of short-term (3 months) and long-term effects (6–7 years) during recuperation. Furthermore, facial skin temperatures on both sides of parotid glands were decreased in Sjogren’s syndrome after vibration, although their temperatures were increased following recovery. Although the mechanism is not clear, we think that vibrotactile stimulation gives activation to salivary glands under the rising facial temperature