Impact of a learning health system on acute care and medical complications after intracerebral hemorrhage

Introduction: Patients with stroke often experience pneumonia during the acute stage after stroke onset. Oral care may be effective in reducing the risk of stroke‐associated pneumonia (SAP). We aimed to determine the changes in oral care, as well as the incidence of SAP, in patients with intracerebral hemorrhage, following implementation of a learning health system in our hospital. Methods: We retrospectively analyzed the data of 1716 patients with intracerebral hemorrhage who were hospitalized at a single stroke center in Japan between January 2012 and December 2018. Data were stratified on the basis of three periods of evolving oral care: period A, during which conventional, empirically driven oral care was provided (n = 725); period B, during which standardized oral care was introduced, with SAP prophylaxis based on known risk factors (n = 469); and period C, during which oral care was risk‐appropriate based on learning health system data (n = 522). Logistic regression analysis was performed to evaluate associations between each of the three treatment approaches and the risk of SAP. Results: Among the included patients, the mean age was 71.3 ± 13.6 years; 52.6% of patients were men. During the course of each period, the frequency of oral care within 24 hours of admission increased (P < .001), as did the adherence rate to oral care ≥3 times per day (P < .001). After adjustment for confounding factors, a change in the risk of SAP was not observed in period B; however, the risk significantly decreased in period C (odds ratio 0.61; 95% confidence interval 0.43‐0.87) compared with period A. These associations were maintained for SAP diagnosed using strict clinical criteria or after exclusion of 174 patients who underwent neurosurgical treatment. Conclusions: Risk‐appropriate care informed by the use of learning health system data could improve care and potentially reduce the risk of SAP in patients with intracerebral hemorrhage in the acute stage

Current state of hypnotic use disorders: Results of a survey using the Japanese version of Benzodiazepine Dependence Self-Report Questionnaire

Aims Benzodiazepine receptor agonists (BZ-RAs) are frequently prescribed to treat insomnia; however, their long-term use is not recommended. To introduce an appropriate pharmaco-therapy, the current state and background factors of BZ-RAs\u27 dependence must be elucidated. In this study, we developed a Japanese version of the Benzodiazepine Dependence Self-Report Questionnaire (Bendep-SRQ-J) and conducted a study of BZ-RAs\u27 use disorder. Methods The Bendep-SRQ-J was created with permission from the original developer. Subjects were inpatients and outpatients receiving BZ-RAs between 2012 and 2013. Clinical data collected were Bendep-SRQ-J scores, sleep disorders for which BZ-RAs were prescribed, physical comorbidities, psychotropic drugs, and lifestyle factors. Logistic analysis was performed to extract factors associated with severe symptoms. Results Of the 707 patients prescribed BZ-RAs, 324 had voluntarily tapered or discontinued their drugs. Logistic analysis showed that the total number of drugs administered in the last 6 months correlated with both worsening of symptoms or conditions. This was more notable among younger patients, and the proportion of patients with severe symptoms or conditions increased with the increasing number of drugs. Conclusion Using the Bendep-SRQ-J, we elucidated the current state of BZ-RA dependence. Nearly half of the patients were non-compliant. The proportion of patients with severe symptoms or disease conditions increased with the increase in the number of drugs administered. These findings highlight the need for clinicians to be aware of the likelihood of benzodiazepine dependence, especially in young patients and patients prescribed multiple hypnotics

The Effect of Negative and Positive Emotionality on Associative Memory: An fMRI Study

In general, emotion is known to enhance memory processes. However, the effect of emotion on associative memory and the underling neural mechanisms remains largely unexplored. In this study, we explored brain activation during an associative memory task that involved the encoding and retrieval of word and face pairs. The word and face pairs consisted of either negative or positive words with neutral faces. Significant hippocampal activation was observed during both encoding and retrieval, regardless of whether the word was negative or positive. Negative and positive emotionality differentially affected the hemodynamic responses to encoding and retrieval in the amygdala, with increased responses during encoding negative word and face pairs. Furthermore, activation of the amygdala during encoding of negative word and neutral face pairs was inversely correlated with subsequent memory retrieval. These findings suggest that activation of the amygdala induced by negative emotion during encoding may disrupt associative memory performance

Variants of C-C Motif Chemokine 22 (CCL22) Are Associated with Susceptibility to Atopic Dermatitis: Case-Control Studies

Atopic dermatitis (AD) is a common inflammatory skin disease caused by multiple genetic and environmental factors. AD is characterized by the local infiltration of T helper type 2 (Th2) cells. Recent clinical studies have shown important roles of the Th2 chemokines, CCL22 and CCL17 in the pathogenesis of AD. To investigate whether polymorphisms of the CCL22 gene affect the susceptibility to AD, we conducted association studies and functional studies of the related variants. We first resequenced the CCL22 gene and found a total of 39 SNPs. We selected seven tag SNPs in the CCL22 gene, and conducted association studies using two independent Japanese populations (1st population, 916 cases and 1,032 controls; 2nd population 1,034 cases and 1,004 controls). After the association results were combined by inverse variance method, we observed a significant association at rs4359426 (meta-analysis, combined P = 9.6×10−6; OR, 0.74; 95% CI, 0.65–0.85). Functional analysis revealed that the risk allele of rs4359426 contributed to higher expression levels of CCL22 mRNA. We further examined the allelic differences in the binding of nuclear proteins by electrophoretic mobility shift assay. The signal intensity of the DNA-protein complex derived from the G allele of rs223821, which was in absolute LD with rs4359426, was higher than that from the A allele. Although further functional analyses are needed, it is likely that related variants play a role in susceptibility to AD in a gain-of-function manner. Our findings provide a new insight into the etiology and pathogenesis of AD

The Neurocognitive Effects of Aripiprazole Compared with Risperidone in the Treatment of Schizophrenia

Aripiprazole is a D2 and D3 receptor partial agonist that is unlike other second generation antipsychotics. The effectiveness of aripiprazole with regard to neurocognitive function and its adverse effects is unclear. The present study evaluates the comparative efficacy, effects on neurocognitive function, and adverse effects of aripiprazole and risperidone in the treatment of hospitalized patients with schizophrenia. This double-blind, cross-over study included 23 patients with schizophrenia who were randomly assigned to be treated first with either aripiprazole or risperidone. After eight weeks on one medication, the patients were switched to the other medication for eight weeks. The patient assessment included the Positive and Negative Syndrome Scale (PANSS), neurocognitive assessments, and adverse events including extrapyramidal symptoms, vital signs, electrocardiogram, and clinical laboratory tests. The study findings indicated that psychopathology assessed with the PANSS, extrapyramidal symptoms and other adverse effects did not differ between aripiprazole and risperidone for the subjects remaining in treatment. In the neurocognitive assessments, the score for disinhibition with aripiprazole was significantly lower than with risperidone (p<0.05). In addition, serum prolactin levels were significantly lower with aripiprazole (p<0.001). The treatment drop-out rate was higher for patients receiving aripiprazole than risperidone. In comparing aripiprazole and risperidone, risperidone is better from the viewpoint of treatment continuation. On the other hand, some adverse effects, such as hyperprolactinemia and disinhibition, are less severe with aripiprazole. Thus, for certain applications, aripiprazole may be a beneficial new treatment option for schizophrenia

Long-Term Prognosis of Patients with Major Depression and Silent Cerebral Infarction

.OBJECTIVE: Many studies have examined the effects of cerebrovascular change on treatment response in geriatric depression. However, few such studies have examined the relationship between cerebrovascular changes and long term prognosis. We examined the effects of cerebrovascular change on the course of geriatric depressive symptoms, dementia rates, and mortality over a follow-up period of approximately 10 years. METHOD: Participants were 84 patients with major depression (age of onset greater than 50 years old); patients suffering from strokes, neurological disorders, and other psychiatric disorders were excluded. MRI findings were used to classify all patients into silent cerebral infarction (SCI) positive (n = 37) or negative groups (n = 47). Patient prognoses were ascertained using a review of clinical charts and over the mail. RESULTS: Only 5% of patients with SCI were able to maintain remission, whereas 36% of those patients without SCI were able to do so. Total duration of depressive episodes was significantly longer in the SCI positive group than in the SCI negative group. In addition, SCI was associated with a higher risk of the onset of dementia. CONCLUSION: The results of this long-term follow-up study demonstrate that the presence of SCI is associated with a relatively poor prognosis for geriatric depressio

Anticipation of affective images and event-related desynchronization (ERD) of alpha activity : An MEG study

We investigated the event-related power decrease (event-related desynchronization: ERD) of the alpha bands associated with the anticipation of affective images. Participants (n = 19) were presented with emotionally positive or negative images under different anticipatory conditions, and their brain responses were recorded using magnetoencephalography (MEG). In the Affective Cue conditions, the cue stimulus indicated the emotional valence (positive or negative) of the image. In the Null Cue condition, the cue stimulus did not include any information about the valence of the image, and in the No Cue condition, the affective image was presented without a preceding cue. The cues in the affective and null conditions were followed by emotional images. During the anticipation period for the affective image, the alpha ERD preceding an anticipated negative image was larger than that preceding an anticipated positive image; this effect had an occipital dominance. Furthermore, during the anticipation period, the lower-2-alpha ERD of the right frontal area showed the same result. These results demonstrate that anticipation of negative stimuli induced alpha ERD in both the visual and the right frontal cortex, indicating that top-down modulation may be provided by the right frontal cortex to the visual cortex

Understanding the process for developing sleep disorders among Japanese workers: a qualitative study

Background: Sleep disorders have an enormous impact on occupational health and are counterproductive from an economic perspective. However, the processes of causing sleep disorders from psychosocial aspects have not yet been known. The purpose of this study was to describe how sleep disorders develop among workers with respect to different psychosocial conditions. Methods: A conventional qualitative content analysis was conducted with a semi-structured interview among twenty-seven workers (14 males and 13 females) who were diagnosed with sleep disorders or had a self-reported history of sleep difficulties. Study participants were recruited from a specialized clinic and communities using snowball sampling. This paper adhered to the Standards for Reporting Qualitative Research (SRQR) checklist. Results: The results showed that there were four steps involved in the sleep disorders development process. Firstly, participants with sleep disorders developed ‘early warning signs’ with 11 categories of triggers; secondly, ‘aggravating factors’ on top of these early warning signs; thirdly, workers tried to ‘cope with’ their sleep disorders in the ways they thought would be effective. Finally, when coping failed to improve the quality of sleep, it led to the onset of sleep disorders. Conclusion: The development of sleep disorders and triggers of psychosocial factors were revealed. An occupational health nurse can bring these findings in practice for preventing worker’s sleep disorders.This study is carried out with funding of the Grants-in-Aid for Scientific Research Program (KAKENHI), Japan (No.15H05078)