Regional differences in the incidence of severe brain damage in survivors with cardiac disease and witnessed out-of-hospital cardiac arrest

Background: Brain damage can occur after out-of-hospital cardiac arrest (OHCA) leading to permanent disability.Aims: This study investigated the incidence of severe brain damage and associated risk factors in survivors with cardiac disease after OHCA.Methods: The Utstein database for Japan was used to identify 23,640 survivors with cardiac disease and witnessed OHCA between 2005 and 2012. Survivors were assessed at 1 month. Odds ratios (ORs) for the incidence of severe brain damage according to regional variables were determined with logistic regression analysis.Results: The incidence of severe brain damage was 37.3%. Automated external defibrillator use and cardiopulmonary resuscitation were associated with significant improvement in cerebral function; adrenaline administration and longer duration from request for transport until hospital arrival were associated with deterioration of cerebral function. Twenty of 47 prefectures showed significant ORs for the incidence of severe brain damage.Conclusion: Regional differences in the incidence of severe brain damage were found among survivors with cardiac disease and witnessed OHCA

大規模レセプトデータを用いた脊柱管狭窄症の年間患者数と治療状況

学位の種別:課程博士University of Tokyo(東京大学

Anemia among freshmen of a faculty of physical education : Risk factors among female students

Purpose: The purpose of this study was to examine the frequency of anemia and to explore risk factors related to anemia among female students at admission. Methods: Participants were 2,361 freshmen in a faculty of physical education from 2008 to 2011. Risk factors for anemia were examined in 577 female students out of 2,361 students in total. Rates of anemia and iron storage depletion were examined in both male and female students, and risk factors for anemia were examined in a multiple logistic regression model. Results: The rate of anemia （less than 12 g/dl of hemoglobin） was 0.1% among males, 6.1% among females, and 1.7% among both sexes. The rate of anemia （less than 13 g/dl of hemoglobin） was 0.6% among males, 31.0% among females, and 8.0% among both sexes. The rate of ion storage depletion was 2.9% among males, 31.0% among females, and 25.3% among both sexes. A multiple logistic regression model indicated that sFe levels, TIBC, and CK levels were significant factors related to anemia among female students. Conclusion: The rate of anemia was 0.6% among male students（ defined as hemoglobin <13 g/dl） and 6.1% among female students（ defined as hemoglobin <12 g/dl） at admission. Results indicated that risk factors related to anemia in female students were an iron deficiency and elevated CK due to excessive exercise

Medical expenses for cilostazol to treat Alzheimer\u27s disease in Japan

Background: Cilostazol (CL) is an antithrombotic agent that was approved for prescribing under Japan’s national health insurance system in 2000. Clinical and experimental studies of CL to treat Alzheimer’s disease (AD) have been reported since 2009.Aims: To use the propensity score method to ascertain whether CL reduced medical expenses among patients with AD in a prefecture of Japan.Methods: Records of 21,181 patients with AD (6,484 males and 14,697 females) from April 2010 to March 2011 were selected from a claims database of the National Health Insurance and the Long-term Care Insurance systems in a prefecture in Japan. Covariates were patient characteristics, comorbidities, and drugs prescribed for AD, i.e. psychoactive agents, narcotics, anticonvulsants, or cholinesterase inhibitors. The outcome variable was medical expenses for the whole year.Results: The propensity score indicated that patients receiving CL had medical expenses ¥10.9 higher than those of patients not receiving CL.Conclusion: According to the propensity score method, CL did not efficiently reduce medical expenses for patients with AD based on claims data

Selection of regional factors associated with low birthweight in Japan

Background　Babies with low birthweight have potential physical and mental disadvantages.Purpose　The purpose of this study was to determine the social and demographic variables (SDVs) related to the low birthweight rate (LBWR) in Japan using a combination of the correlation coefficient (CC) and coefficient of determination (R2)．Methods　We obtained 704 variables from 13 statistical tables in the SDVs of the 2017 e-Stat database of Japan. We calculated the CCs between the LBWR and the 704 variables in each Japanese prefecture. Of the original 704 variables, 21 were selected, as the CCs between the LBWR and variables were ≥0.4. We conducted multiple regression analysis between the LBWR and these 21 variables to obtain a list of 21 explanatory variables in ascending order by p-value. We also repeated the multiple regression analysis 21 times to obtain the R2 and adjusted R2.Results　The median LBWR was 9.5%, the maximum was 11.5%, the minimum was 8.2%, and the mean was 9.5% among 47 prefectures. Only the variable amount of saving per household” exhibited statistical significance (p＝0.048)， and its R2 and R2adj were 0.164 and 0.149, respectively. The R2 was 0.669 (88.3% of the maximum)， and the R2adj was 0.610 (95.3% of the maximum) and the maximum in seven explanatory variables that reached the plateau.Conclusion　The combination of CCs and R2 indicated that the LBWR was significantly related to the regional factor “amount of savings per household,” as determined from the social and demographic database in Japan