Associations of HIV testing and late diagnosis at a Japanese university hospital

OBJECTIVES: This study was conducted to clarify the rate of late diagnosis of HIV infection and to identify relationships between the reasons for HIV testing and a late diagnosis. METHODS: This retrospective cohort study was conducted among HIV-positive patients at the Jikei University Hospital between 2001 and 2014. Patient characteristics from medical records, including age, sex, sexuality, the reason for HIV testing and the number of CD4-positive lymphocytes at HIV diagnosis, were assessed. RESULTS: A total of 459 patients (men, n=437; 95.2%) were included in this study and the median age at HIV diagnosis was 36 years (range, 18-71 years). Late (CD4 cell coun

Organized and Sustainable Education Program for Drug Abuse Prevention by Yogo-teachers

　学校における喫煙・飲酒・薬物乱用防止教育の充実には，問題行動が顕在化する中学校期だけでなく小学校期 における指導の推進が重要であり，系統的な指導計画を立て，指導者や時間の確保，教材作成などに組織的に取 組み，継続可能なプログラム開発を行う必要がある。そこで，地区内12 校の養護教諭が協働して，発達段階に応 じた系統的・組織的かつ継続可能な地区共通の指導計画を開発し，各校の教育課程・年間計画に位置付けた実践 研究を行った。その結果，指導計画の実施状況は，小学校11 校中，学級活動10 校，ミニ保健指導10 校，長期 休業前指導6 校，広報活動9 校となり，特別支援学校1 校では広報活動のみを行うことができた。小学校におけ る喫煙・飲酒・薬物乱用防止教育の推進には，学校保健活動の中核的役割を担う養護教諭が専門性を活かし協働 して，系統的な指導計画を各校の教育課程に位置付け組織的で継続可能なプログラムとする取組が有効であった

Association between the proportion of laparoscopic approaches for digestive surgeries and the incidence of consequent surgical site infections, 2009-2019: A retrospective observational study based on national surveillance data in Japan.

BackgroundSurgical site infections (SSIs) are among the most common healthcare-associated infections. Laparoscopy is increasingly being used in various surgical procedures. However, no study has examined the association between the proportion of laparoscopic procedures and the incidence of SSIs in digestive surgery using nationwide surveillance data.MethodsWe retrospectively investigated national SSI surveillance data from the Japan Nosocomial Infections Surveillance between 2009 and 2019. The annual trend of the SSI rate and the proportion of laparoscopic procedures were assessed, focusing on five major digestive surgeries. This was based on data from 109,544 (appendix surgery), 206,459 (gallbladder surgery), 60,225 (small bowel surgery), 363,677 (colon surgery), and 134,695 (rectal surgery) procedures. The effect of a 10% increase in the proportion of laparoscopic procedures on the reduction of the SSI rate was estimated using mixed-effect logistic regression.FindingsThe average SSI rate of the five digestive surgeries decreased from 11.8% in 2009 to 8.1% in 2019. The proportion of laparoscopic procedures in each of the five digestive surgeries increased continuously (pConclusionAn increase in the proportion of laparoscopic procedures was associated with a reduction in the SSI rate in digestive surgeries

Comparison of disease and economic burden between MRSA infection and MRSA colonization in a university hospital: a retrospective data integration study

Abstract Background Although there is a growing concern and policy regarding infections or colonization caused by resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), the prognosis of MRSA infections compared to that of methicillin-susceptible Staphylococcus aureus (MSSA) infections remains controversial. Moreover, there have not been any studies comparing both the burden of disease and its impact on the healthcare economy between MRSA infection and colonization while adjusting for confounding factors. These comparisons are crucial for developing effective infection control measures and healthcare policies. We aimed to compare the disease and economic burden between MRSA and MSSA infections and between MRSA infection and colonization. Methods We retrospectively investigated data of 496 in-patients with MRSA or MSSA infections and of 1178 in-patients with MRSA infections or MRSA colonization from a university hospital in Japan from 2016 to 2021. We compared in-hospital mortality, length of stay, and hospital charges between in-patients with MRSA and MSSA infections and those with MRSA infections and MRSA colonization using multiple regressions. We combined surveillance data, including all microbiological test results, data on patients with infections, treatment histories, and clinical outcomes, to create the datasets. Results There was no statistically significant difference in in-hospital mortality rates between matched MRSA vs. MSSA infections and MRSA infection vs. colonization. On the contrary, the adjusted effects of the MRSA infection compared to those of MSSA infection on length of stay and hospital charges were 1.21-fold (95% confidence interval [CI] 1.03–1.42, P = 0.019) and 1.70-fold (95% CI 1.39–2.07, P < 0.00001), respectively. The adjusted effects of the MRSA infection compared to those of MRSA colonization on length of stay and hospital charges were 1.41-fold (95% CI 1.25–1.58, P < 0.00001) and 1.53-fold (95% CI 1.33–1.75, P < 0.00001), respectively. Regarding confounding factors, hemodialysis or hemofiltration was consistently identified and adjusted for in the multiple regression analyses comparing MRSA and MSSA infections, as well as MRSA infection and MRSA colonization. Conclusions MRSA infection was associated with longer length of stay and higher hospital charges than both MSSA infection and MRSA colonization. Furthermore, hemodialysis or hemofiltration was identified as a common underlying factor contributing to increased length of stay and hospital charges

看護系大学生の災害時生活体験における学習効果に関する研究

本研究の目的は、災害時生活体験学習を実施して1年4か月を経て、再度看護系大学生に災害への準備行動に関するアンケート調査を実施し、(1)科目受講者と未受講者間の災害準備状況の違いを明らかにすること、次に、(2)受講者のなかの災害準備実施者と非実施者間の体験学習終了レポートの特徴と認識の広がりの特徴を明らかにすることを目的とした。研究対象者は、看護系大学3年生の70名で、科目受講者33名、同学年同クラスの科目未受講者37名(男性17名、女性53名)である。研究方法および分析方法は、集合調査法による「災害への準備行動に関するアンケート調査」、資料の比較にはWilcoxonの符号付順位検定を用いた。体験学習終了レポートの分析は一文一意味を記録単位として類型化した。その結果、体験学習受講者と未受講者間には災害準備行動において有意差が認められた。また、災害への準備行動を実施していた学生の体験学習終了レポートは、記載量が多く、詳細で、記述された思考プロセスには認識の具象化、表象化、抽象化による「のぼりおり運動」が自在に活用されていたことから、災害への準備行動への方略の一つに、認識力を鍛えることの有効性が示唆された

通院がん患者の療養生活上の課題

【目的】東北地方にあるがん診療連携拠点病院の通院がん患者の日常生活での悩みや困難さの実態を明らかにする. 【方法】横断的研究. 東北地方にあるがん診療連携拠点病院3施設の外来に通院中のがん患者で, 調査の協力に同意の得られた患者222名を対象者とした. 自記式調査用紙を用いて, がんの診療や治療過程を「診断時」「診断から現在まで」「現在」の3時点に分け, 主な悩みとその内容(自由記載)と相談の有無と相談相手について回答を得た記述統計と内容分析により分析された. 【結果】記述統計と内容分析により分析された悩みや困難さは, 内容の変化はあるが3時点のどの時期においても様々な側面において認められた. その多くは, 「身体的苦痛」, 「心理的な悩み」, 「経済的な悩み」であった. 対象者の多くは家族に相談しており, 次に医師, 友人その他の人々に相談していた. 相談しなかった対象者は, その理由として「自分で解決できた」と回答している. 【結論】外来がん患者の悩みや困難さに対応することや患者・家族への支援を向上・充実させる質の高い看護ケアプログラムの開発が求められる.Background/Purpose: Little is known about daily life issues of ambulatory cancer patients in northern Japan. Therefore, the purpose of this study was to describe daily life issues of ambulatory cancer patients in northern Japan as a process, the time of diagnose through the present. Methods: In a cross-sectional study, subjects comprised a convenience sample of 222 ambulatory cancer patients receiving follow-up care at cancer care hospitals in northern Japan. Data were collected by using a self-report questionnaire about daily life issues of ambulatory cancer patients focusing on three time points: time of diagnose, during and after treatments, and the present time. Descriptive statistics and content analysis were performed. Results: In all three time points, the numbers of patients with strong concerns were consistently high. The top three concerns were psychological concerns, financial problems, and physical pain. Most subjects asked for help from family members, physician, friends and the others. However, other subjects decided to solve their concerns by themselves. Conclusion: Based on the results of this report, a new cancer care program for ambulatory cancer patients should be provided with improved quality. Further intervention studies on ambulatory cancer patients are required to evaluate the new program

MicroRNAs 106b and 222 Improve Hyperglycemia in a Mouse Model of Insulin-Deficient Diabetes via Pancreatic β-Cell Proliferation

Major symptoms of diabetes mellitus manifest, once pancreatic β-cell numbers have become inadequate. Although natural regeneration of β-cells after injury is very limited, bone marrow (BM) transplantation (BMT) promotes their regeneration through undetermined mechanism(s) involving inter-cellular (BM cell-to-β-cell) crosstalk. We found that two microRNAs (miRNAs) contribute to BMT-induced β-cell regeneration. Screening murine miRNAs in serum exosomes after BMT revealed 42 miRNAs to be increased. Two of these miRNAs (miR-106b-5p and miR-222-3p) were shown to be secreted by BM cells and increased in pancreatic islet cells after BMT. Treatment with the corresponding anti-miRNAs inhibited BMT-induced β-cell regeneration. Furthermore, intravenous administration of the corresponding miRNA mimics promoted post-injury β-cell proliferation through Cip/Kip family down-regulation, thereby ameliorating hyperglycemia in mice with insulin-deficient diabetes. Thus, these identified miRNAs may lead to the development of therapeutic strategies for diabetes