Home caregiver anxiety and depression

In recent years, Japan has promoted home visits to support older adults, with caregivers playing an important role. However, caregivers generally experience a high frequency of anxiety and depression, and the factors associated with these conditions among home visit caregivers remain unknown. To identify the associated factors, we conducted a questionnaire-based cross-sectional study of home visit caregivers in Tokushima Prefecture, Japan. The survey included caregivers’ Hospital Anxiety and Depression Scale ; sociodemographic items of patients and caregivers ; and caregivers’ perceptions of the home care environment, patients, and themselves. The questionnaires were sent to 379 caregivers ; 203 responded (53.6% response rate), of which 173 were valid (85.2% valid response rate). The prevalence of anxiety and depression was 43.9% and 69.4%, respectively. Multiple logistic regression analysis of factors associated with anxiety and depression showed that stable family finances (OR : 0.69, 95% CI : 0.48-1.00, p = 0.049) and stable caregiver health (OR : 0.45, 95% CI : 0.30-0.68, p < 0.001) were associated with anxiety. Further, stable family finances (OR : 0.60, 95% CI : 0.38-0.93, p = 0.022), stable caregiver health (OR : 0.49, 95% CI : 0.30-0.81, p = 0.005), and stable patient condition (OR : 0.51, 95% CI : 0.29-0.92, p = 0.025) were associated with depression. These findings demonstrate that caregiver wellbeing is essential in home care settings

Evaluating on-demand video lectures

The popularity of online classes in university education has grown rapidly since the COVID-19 outbreak. This study aims to examine the association between the detailed characteristics / various contexts of students and the evaluation of online classes. An online questionnaire survey administered to third- and fourth-grade medical students of Tokushima University in September 2021—with 101 (42.8%) valid responses—showed the respondents’ general impressions, comprehension, convenience, and desire for online classes even after the pandemic ends were significantly higher for the on-demand lectures than for simultaneous online classes. Notably, students who did not do other things while watching video lectures (10.9%) rated on-demand lectures as facilitating significantly higher impression, comprehension, and convenience than those who did other things (89.1%). A multivariate analysis revealed that students who did not do anything else while watching, whose waking time changed slightly, who commuted to school for shorter periods, who were not good at morning lectures, and who watched at high speed rated the video lectures highly. Thus, video lectures are appreciated by students who are committed to learning, which is a positive result for the future of on-demand education

PMR and RS3PE Syndrome

Polymyalgia rheumatica (PMR) and remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome are common inflammatory rheumatic diseases in the elderly. In this study, we investigated the difference of the therapeutic responses between patients with PMR and RS3PE syndrome. Twenty-four patients with PMR and 12 patients with RS3PE syndrome were treated with initial dosages of 10-20 mg per day oral prednisolone, and the dosages were then tapered. Percentages of patients with negative c-reactive protein (CRP) after 8-week treatment were significantly more in RS3PE syndrome than in PMR. Percentages of patients with relapse during one-year treatment were less likely to be in RS3PE syndrome than in PMR. These differences observed between the two disorders were not associated with the level of initial CRP. There was no significant difference in percentages of patients with prednisolone-free remission after two-year treatment between PMR and RS3PE syndrome. These results indicate that the early response to the treatment is greater in RS3PE syndrome than in PMR

Comparison of treatment in patients

The terminal elimination half-life (t1/2) of empagliflozin is 13.1 hours. Accordingly, we hypothesized that the administration of empagliflozin every other day might improve glycemic control in patients with type 2 diabetes mellitus, not being inferior to the therapy every day. We investigated the clinical effects and safety of the addition of empagliflozin every day or every other day to type 2 diabetic patients with a poor control in glycemia. Thirteen Japanese patients diagnosed as type 2 diabetes mellitus recruited to this study. Subjects were divided into two groups ; one was treatment with 10 mg of empagliflozin every day (Group A), the other was 10 mg of empagliflozin every other day (Group B). The comparable study of multiple clinical indexes between the 2 groups was made before and 8, 16, and 24 weeks after the treatment. After the treatment for 24 weeks, the HbA1c level was decreased both in group A (from 7.5%±1.1% to 6.5%±0.8%) and in group B (from 7.6%±0.8% to 7.2%±0.5%). This pilot trial suggested the possibility of 10-mg every other day administration with empagliflozin for Japanese patients with type 2 diabetes mellitus

Chest computed tomography of a patient revealing severe hypoxia due to amniotic fluid embolism: a case report

<p>Abstract</p> <p>Introduction</p> <p>Amniotic fluid embolism is one of the most severe complications in the peripartum period. Because its onset is abrupt and fulminant, it is unlikely that there will be time to examine the condition using thoracic computed tomography (CT). We report a case of life-threatening amniotic fluid embolism, where chest CT in the acute phase was obtained.</p> <p>Case presentation</p> <p>A 22-year-old Asian Japanese primiparous woman was suspected of having an amniotic fluid embolism. After a Cesarean section for cephalopelvic disproportion, her respiratory condition deteriorated. Her chest CT images were examined. CT findings revealed diffuse homogeneous ground-glass shadow in her bilateral peripheral lung fields. She was therefore transferred to our hospital. On admission to our hospital's intensive care unit, she was found to have severe hypoxemia, with SpO₂of 50% with a reservoir mask of 15 L/min oxygen. She was intubated with the support of noninvasive positive pressure ventilation. She was successfully extubated on the sixth day, and discharged from the hospital on the twentieth day.</p> <p>Conclusion</p> <p>This is the first case report describing amniotic fluid embolism in which CT revealed an acute respiratory distress syndrome-like shadow.</p

ジュウショウ カンジャ ニオケル エイヨウ カンリ

Nutritional management is one of very important therapeutic intervention for every kind of patients. In critically ill patients, metabolic state varies according to the severity of injury or disease. It is crucial to give appropriate calories to overcome their stress. Recently, it is reported that hyperalimentation should be avoided in acute phase of critically illness, which is generally agreed as permissive underfeeding. It is also necessary to supply those patients with enough amount of protein because protein deficiency decrease the lean body mass（LBM）. Loss of LBM induce organ dysfunction as well as immunodeficiency which lead to patient mortality. Enteral nutrition is superior to parenteral nutrition. Intestine plays an important role as endocrine and immune organ. Bacterial translocation, which is one of the most important causes of sepsis in critically ill patients, is prevented by enteral feeding. We should start enteral feeding as early as possible and make the most of intestinal function

Perspectives on enteral tube feeding in Japan

[Introduction] The purpose of this study was to investigate the differences in the preference of enteral tube feeding between elderly inhabitants of Mugi town, Tokushima Prefecture, Japan, and their parents in various physical conditions. [Methods] This population-based questionnaire survey studied 300 randomly selected participants aged 65–80 years. Respondents were to consider a situation where eating was difficult, and were questioned on their desire for tube feeding, using a visual analogue scale (VAS) ranging from “do not want tube feeding (0)” to “want tube feeding (100).” [Results] Valid responses of 103 (34.4%) participants were analyzed. Under conditions of being “healthy,” “bedridden,” “with dementia,” and “bedridden and with dementia,” the median (IQR) of the VAS values for the desire for tube feeding were 31.8 (3.3 to 83.8), 19.3 (2.4 to 52.3), 5.2 (0.7 to 18.9), 4.0 (0.3 to 15.2) for respondents and 55.2 (11.6 to 92.2), 48.7 (5.5 to 85.5), 9.0 (1.2 to 46.8), 5.1 (0.1 to 36.5) for parents, respectively. The VAS values for the parents were significantly higher (p=0.001, 0.002, 0.001, and 0.01, respectively for the four conditions described) for the same items. [Conclusion] Surrogate decisions made by family members often differ from what the patients would have desired

Past infections and low ACPA in RA

Background : Rheumatoid arthritis (RA), an autoimmune disease of unknown etiology, is believed to occur as the result of actions of genetic and environmental factors. In this study, we examined the relation of past histories about infectious diseases with the levels anti-citrullinated protein autoantibodies (ACPA) in RA. Methods : Results of a questionnaire about histories of infectious diseases were obtained from 85 patients with RA, and were analyzed. Results : Significantly lower level of ACPA was detected in patients with the history of tonsillitis, otitis media or urinary cystitis than in those without it. There was no difference in the level of ACPA in RA patients between with and without cold / influenza, rubella, chickenpox, herpes labialis or herpes zoster. When RA patients were divided into two groups, high-level and low-level ACPA, multiple logistic regression analysis revealed that the history of otitis media was a significantly independent factor for the low level of ACPA. There was no significant relation between the level of rheumatoid factor and histories of infectious diseases. Conclusion : This study clarified that the past history of otitis media is associated with the low level of ACPA in RA

CRP in PMR and RS3PE syndrome

Polymyalgia rheumatica (PMR) and remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome are common inflammatory rheumatic diseases in the elderly. In this study, we investigate predictive factors which correspond to subsequent disease control of PMR and RS3PE syndrome. Twenty four patients, which contained 18 PMR and 6 RS3PE syndrome, were treated with initial dosages of 10-20 mg per day oral prednisolone, and the dosage of prednisolone was then tapered. Significantly higher initial CRP was observed in patients with poor disease control than in those with good disease control afterwards. The number of patients with negative CRP after 4 weeks was significantly more in patients with good disease control after 1 year than in those with poor disease control. Patients were shown to be in good disease control status after 1 year when CRP after 4 weeks became negative even if they had initial high CRP. Our study clarify that to make CRP negative after 4 weeks is associated with subsequent suppression of the disease activity and with decreased dosages of corticosteroids

ヘキチ イリョウ キョテン ビョウイン ニオケル センモン ガイライ ノ カンジャ ジュリョウ ドウコウ ニ オヨボス エイキョウ

There were few reports about the role of medical specialists in community medicine organizations such as hospitals in rural area where the number of doctors is insufficient. The aim of this study was to investigate the effect of a medical specialist for collagen vascular diseases having started periodically ambulatory care in the medical institution of the area where the specialist was absent. We examined the trend of outpatients with a collagen vascular disease about moving the hospital comparing before and after the specialist started to work in the medical institution. The number of outpatients with a collagen vascular disease in the medical institution became 95 at 3 years and a half after the specialist started to work there. There were many transfer patients from medical institutions other than the area, and the distance from their home to the hospital was shortened by changing the hospital in most of patients. The ambulatory care performed periodically and continuously by the specialist in a community medicine organization showed significances that patients became to receive the special medical care by the specialist