Pub Date : 2024-04-05Epub Date: 2023-08-31DOI: 10.2188/jea.JE20220360
Aki Kuwauchi, Satomi Yoshida, Chikashi Takeda, Yugo Yamashita, Takeshi Kimura, Masato Takeuchi, Koji Kawakami
Background: Acute pulmonary embolism (PE) is a life-threatening in-hospital complication. Recently, several studies have reported the clinical characteristics of PE among Japanese patients using the diagnostic procedure combination (DPC)/per diem payment system database. However, the validity of PE identification algorithms for Japanese administrative data is not yet clear. The purpose of this study was to evaluate the validity of using DPC data to identify acute PE inpatients.
Methods: The reference standard was symptomatic/asymptomatic PE patients included in the COntemporary ManageMent AND outcomes in patients with Venous ThromboEmbolism (COMMAND VTE) registry, which is a cohort study of acute symptomatic venous thromboembolism (VTE) patients in Japan. The validation cohort included all patients discharged from the six hospitals included in both the registry and DPC database. The identification algorithms comprised diagnosis, anticoagulation therapy, thrombolysis therapy, and inferior vena cava filter placement. Each algorithm's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were estimated.
Results: A total of 43.4% of the validation cohort was female, with a mean age of 67.3 years. The diagnosis-based algorithm showed a sensitivity of 90.2% (222/246; 95% confidence interval [CI], 85.8-93.6%), a specificity of 99.8% (228,485/229,027; 95% CI, 99.7-99.8%), a PPV of 29.1% (222/764; 95% CI, 25.9-32.4%) and an NPV of 99.9% (228,485/229,509; 95% CI, 99.9-99.9%) for identifying symptomatic/asymptomatic PE. Additionally, 94.6% (159/168; 95% CI, 90.1-97.5%) of symptomatic PE patients were identified using the diagnosis-based algorithm.
Conclusion: The diagnosis-based algorithm may be a relatively sensitive method for identifying acute PE inpatients in the Japanese DPC database.
背景急性肺栓塞(PE)是一种危及生命的院内并发症。最近,几项研究利用诊断程序组合(DPC)/按日付费系统数据库报告了日本患者肺栓塞的临床特征。然而,日本行政数据中 PE 识别算法的有效性尚不明确。本研究的目的是评估使用 DPC 数据识别急性 PE 住院患者的有效性。方法参考标准是静脉血栓栓塞症患者的当代管理和结果(COMMAND VTE)登记中的无症状/无症状 PE 患者,这是一项针对日本急性症状静脉血栓栓塞症(VTE)患者的队列研究。验证队列包括登记处和 DPC 数据库中 6 家医院的所有出院患者。识别算法包括诊断、抗凝治疗、溶栓治疗和下腔静脉滤器置入。对每种算法的灵敏度、特异性、阳性预测值(PPV)和阴性预测值(NPV)进行了估算。结果 验证队列中共有 43.4% 为女性,平均年龄为 67.3 岁。基于诊断的算法在识别有症状/无症状 PE 方面的灵敏度为 90.2%(222/246,95% CI;85.8-93.6),特异度为 99.8%(228,485/229,027,95% CI;99.7-99.8),PPV 为 29.1%(222/764,95% CI;25.9-32.4),NPV 为 99.9%(228,485/229,509,95% CI;99.9-99.9)。此外,94.6%(159/168,95% CI;90.1-97.5)的无症状 PE 患者是通过基于诊断的算法识别出来的。
{"title":"Validity of Using Japanese Administrative Data to Identify Inpatients With Acute Pulmonary Embolism: Referencing the COMMAND VTE Registry.","authors":"Aki Kuwauchi, Satomi Yoshida, Chikashi Takeda, Yugo Yamashita, Takeshi Kimura, Masato Takeuchi, Koji Kawakami","doi":"10.2188/jea.JE20220360","DOIUrl":"10.2188/jea.JE20220360","url":null,"abstract":"<p><strong>Background: </strong>Acute pulmonary embolism (PE) is a life-threatening in-hospital complication. Recently, several studies have reported the clinical characteristics of PE among Japanese patients using the diagnostic procedure combination (DPC)/per diem payment system database. However, the validity of PE identification algorithms for Japanese administrative data is not yet clear. The purpose of this study was to evaluate the validity of using DPC data to identify acute PE inpatients.</p><p><strong>Methods: </strong>The reference standard was symptomatic/asymptomatic PE patients included in the COntemporary ManageMent AND outcomes in patients with Venous ThromboEmbolism (COMMAND VTE) registry, which is a cohort study of acute symptomatic venous thromboembolism (VTE) patients in Japan. The validation cohort included all patients discharged from the six hospitals included in both the registry and DPC database. The identification algorithms comprised diagnosis, anticoagulation therapy, thrombolysis therapy, and inferior vena cava filter placement. Each algorithm's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were estimated.</p><p><strong>Results: </strong>A total of 43.4% of the validation cohort was female, with a mean age of 67.3 years. The diagnosis-based algorithm showed a sensitivity of 90.2% (222/246; 95% confidence interval [CI], 85.8-93.6%), a specificity of 99.8% (228,485/229,027; 95% CI, 99.7-99.8%), a PPV of 29.1% (222/764; 95% CI, 25.9-32.4%) and an NPV of 99.9% (228,485/229,509; 95% CI, 99.9-99.9%) for identifying symptomatic/asymptomatic PE. Additionally, 94.6% (159/168; 95% CI, 90.1-97.5%) of symptomatic PE patients were identified using the diagnosis-based algorithm.</p><p><strong>Conclusion: </strong>The diagnosis-based algorithm may be a relatively sensitive method for identifying acute PE inpatients in the Japanese DPC database.</p>","PeriodicalId":15799,"journal":{"name":"Journal of Epidemiology","volume":" ","pages":"155-163"},"PeriodicalIF":4.7,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10918337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9416152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: In Japan, sentinel surveillance is used to monitor the trend of infectious gastroenteritis. Another method of pathogen surveillance, wastewater-based epidemiology, has been used recently because it can help to monitor infectious disease without relying on patient data. Here, we aimed to determine the viral trends reflected in the number of reported patients and number of gastroenteritis virus-positive samples. We focused on gastroenteritis viruses present in wastewater and investigated the usefulness of wastewater surveillance for the surveillance of infectious gastroenteritis.
Methods: Real-time polymerase chain reaction was used for viral gene detection in wastewater. The number of reported patients per pediatric sentinel site and number of viral genome copies were compared for correlation potential. The number of gastroenteritis virus-positive samples reported by National Epidemiological Surveillance of Infectious Disease (NESID) and the status of gastroenteritis viruses detected in wastewater were also evaluated.
Results: Genes of norovirus genotype I, norovirus genotype II, sapovirus, astrovirus, rotavirus group A, and rotavirus group C were detected in wastewater samples. Viruses were detected in wastewater during periods when no gastroenteritis virus-positive samples were reported to NESID.
Conclusion: Norovirus genotype II and other gastroenteritis viruses were detected in wastewater even during periods when no gastroenteritis virus-positive samples were found. Therefore, surveillance using wastewater can complement sentinel surveillance and is an effective tool for the surveillance of infectious gastroenteritis.
背景:在日本,哨点监测用于监测传染性肠胃炎的趋势。另一种病原体监测方法,即基于废水的流行病学,最近也得到了应用,因为它可以帮助监测传染病,而无需依赖患者数据。在此,我们旨在确定从报告的患者人数和肠胃炎病毒阳性样本数量中反映出的病毒趋势。我们重点研究了废水中的肠胃炎病毒,并调查了废水监测对传染性肠胃炎监测的有用性:方法:采用实时聚合酶链反应检测废水中的病毒基因。方法:采用实时聚合酶链反应法检测废水中的病毒基因。比较了每个儿科哨点报告的患者人数和病毒基因组拷贝数的相关性。此外,还对 NESID 报告的肠胃炎病毒阳性样本数量和废水中检测到的肠胃炎病毒状况进行了评估:结果:在废水样本中检测到了诺如病毒 GI、诺如病毒 GII、沙波病毒、星状病毒、轮状病毒 A 组和轮状病毒 C 组的基因。在没有向 NESID 报告肠胃炎病毒阳性样本的时期,废水中也检测到了病毒:结论:即使在没有发现肠胃炎病毒阳性样本的时期,也能在废水中检测到诺罗病毒 GII 和其他肠胃炎病毒。因此,利用废水进行监测可以补充哨点监测,是监测传染性肠胃炎的有效工具。
{"title":"Surveillance of Wastewater to Monitor the Prevalence of Gastroenteritis Viruses in Chiba Prefecture (2014-2019).","authors":"Chiemi Hotta, Yuki Fujinuma, Takashi Ogawa, Mamiko Akita, Tomoko Ogawa","doi":"10.2188/jea.JE20220305","DOIUrl":"10.2188/jea.JE20220305","url":null,"abstract":"<p><strong>Background: </strong>In Japan, sentinel surveillance is used to monitor the trend of infectious gastroenteritis. Another method of pathogen surveillance, wastewater-based epidemiology, has been used recently because it can help to monitor infectious disease without relying on patient data. Here, we aimed to determine the viral trends reflected in the number of reported patients and number of gastroenteritis virus-positive samples. We focused on gastroenteritis viruses present in wastewater and investigated the usefulness of wastewater surveillance for the surveillance of infectious gastroenteritis.</p><p><strong>Methods: </strong>Real-time polymerase chain reaction was used for viral gene detection in wastewater. The number of reported patients per pediatric sentinel site and number of viral genome copies were compared for correlation potential. The number of gastroenteritis virus-positive samples reported by National Epidemiological Surveillance of Infectious Disease (NESID) and the status of gastroenteritis viruses detected in wastewater were also evaluated.</p><p><strong>Results: </strong>Genes of norovirus genotype I, norovirus genotype II, sapovirus, astrovirus, rotavirus group A, and rotavirus group C were detected in wastewater samples. Viruses were detected in wastewater during periods when no gastroenteritis virus-positive samples were reported to NESID.</p><p><strong>Conclusion: </strong>Norovirus genotype II and other gastroenteritis viruses were detected in wastewater even during periods when no gastroenteritis virus-positive samples were found. Therefore, surveillance using wastewater can complement sentinel surveillance and is an effective tool for the surveillance of infectious gastroenteritis.</p>","PeriodicalId":15799,"journal":{"name":"Journal of Epidemiology","volume":" ","pages":"195-202"},"PeriodicalIF":4.7,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10918334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9497548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Little is known about the trends of imported infectious diseases among travelers to non-endemic countries during the novel coronavirus disease 2019 (COVID-19) pandemic. This article aimed to describe those among travelers to Japan.
Methods: This is a descriptive study based on national surveillance data. Imported infectious disease cases were defined as those with a reported overseas source of infection among 15 diseases pre-selected based on the probability and impact of importation. The number of notified cases from April 2016 to March 2021 were described by disease and time of diagnosis. The relative ratio and absolute difference in case counts-both by number and per arrival-were calculated by disease comparing those from the pandemic period (April 2020-March 2021) to the pre-pandemic period (April 2016-March 2020).
Results: A total of 3,524 imported infectious disease cases were diagnosed during the study period, including 3,439 cases before and 85 cases during the pandemic. The proportionate distribution of diseases changed but notification counts of all 15 diseases decreased during the pandemic. Accounting for arrivals, however, seven diseases showed a two-fold or greater increase, with a notable absolute increase per million arrivals for amebiasis (60.1; 95% confidence interval [CI], 41.5-78.7), malaria (21.7; 95% CI, 10.5-33.0), and typhoid fever (9.3; 95% CI, 1.9-16.8).
Conclusion: The epidemiology of imported infectious diseases changed during the pandemic. While the number of imported infectious disease cases decreased, the number of cases per arrivals increased considerably both in relative and absolute terms for several diseases of public health and clinical importance.
{"title":"Epidemiologic Trends and Distributions of Imported Infectious Diseases Among Travelers to Japan Before and During the COVID-19 Pandemic, 2016 to 2021: A Descriptive Study.","authors":"Ayu Kasamatsu, Kazuhiko Kanou, Munehisa Fukusumi, Yuzo Arima, Shun Omori, Haruna Nakamura, Tetsuro Sato, Yusuke Serizawa, Asuka Takeda, Hiroyuki Fujikura, Chiaki Ikenoue, Shingo Nishiki, Yoshihiro Fujiya, Takeshi Arashiro, Takuri Takahashi, Tomoe Shimada, Motoi Suzuki, Tomimasa Sunagawa","doi":"10.2188/jea.JE20230025","DOIUrl":"10.2188/jea.JE20230025","url":null,"abstract":"<p><strong>Background: </strong>Little is known about the trends of imported infectious diseases among travelers to non-endemic countries during the novel coronavirus disease 2019 (COVID-19) pandemic. This article aimed to describe those among travelers to Japan.</p><p><strong>Methods: </strong>This is a descriptive study based on national surveillance data. Imported infectious disease cases were defined as those with a reported overseas source of infection among 15 diseases pre-selected based on the probability and impact of importation. The number of notified cases from April 2016 to March 2021 were described by disease and time of diagnosis. The relative ratio and absolute difference in case counts-both by number and per arrival-were calculated by disease comparing those from the pandemic period (April 2020-March 2021) to the pre-pandemic period (April 2016-March 2020).</p><p><strong>Results: </strong>A total of 3,524 imported infectious disease cases were diagnosed during the study period, including 3,439 cases before and 85 cases during the pandemic. The proportionate distribution of diseases changed but notification counts of all 15 diseases decreased during the pandemic. Accounting for arrivals, however, seven diseases showed a two-fold or greater increase, with a notable absolute increase per million arrivals for amebiasis (60.1; 95% confidence interval [CI], 41.5-78.7), malaria (21.7; 95% CI, 10.5-33.0), and typhoid fever (9.3; 95% CI, 1.9-16.8).</p><p><strong>Conclusion: </strong>The epidemiology of imported infectious diseases changed during the pandemic. While the number of imported infectious disease cases decreased, the number of cases per arrivals increased considerably both in relative and absolute terms for several diseases of public health and clinical importance.</p>","PeriodicalId":15799,"journal":{"name":"Journal of Epidemiology","volume":" ","pages":"187-194"},"PeriodicalIF":4.7,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10918336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10013629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia from the early stages and can appear even in mild cognitive impairment (MCI). However, the prognostic impact of BPSD is unclear. This study examined the association between BPSD and mortality among people with cognitive impairment.
Methods: This longitudinal study involved 1,065 males and 1,681 females (mean age: males = 77.1 years; females = 78.6 years) with MCI or dementia diagnosis, from the National Center for Geriatrics and Gerontology-Life Stories of People with Dementia (NCGG-STORIES), a single-center memory clinic-based cohort study in Japan that registered first-time outpatients from 2010–2018. Information about death was collected through a mail survey returned by participants or their close relatives, with an up to 8-year follow-up. BPSD was assessed using the Dementia Behavior Disturbance Scale (DBD) at baseline.
Results: During the follow-up period, 229 (28.1%) male and 254 (15.1%) female deaths occurred. Cox proportional hazards regression analysis showed that higher DBD scores were significantly associated with increased mortality risk among males, but not females (compared with the lowest quartile score group, hazard ratios [95% confidence intervals] for the highest quartile score group = 1.59 [1.11–2.29] for males and 1.06 [0.66–1.70] for females). Among the DBD items, lack of interest in daily living, excessive daytime sleep, and refusal to receive care had a higher mortality risk.
Conclusions: The findings suggest a potential association between BPSD and poor prognosis among males with cognitive impairment.