Yonago acta medica最新文献

Background: Obstructive sleep apnea syndrome is a common disorder characterized by repeated upper airway obstruction during sleep. Oral appliance therapy is a noninvasive treatment option commonly recommended for patients who are intolerant to continuous positive airway pressure. This study aimed to evaluate the treatment outcomes of oral appliance therapy in patients with obstructive sleep apnea syndrome and to examine the relationship between therapeutic effectiveness and patient characteristics, including age, disease severity, and body mass index.

Methods: A total of 42 patients diagnosed with obstructive sleep apnea syndrome and treated with oral appliance therapy were retrospectively analyzed. The treatment effect was assessed using the apnea-hypopnea index measured before and after therapy (by polysomnography or portable monitoring). Effective treatment was defined as a post-treatment apnea-hypopnea index of <15 events per hour and a ≥ 50% reduction from baseline.

Results: The mean apnea-hypopnea index decreased significantly from 27.6 ± 15.7 to 10.3 ± 8.7 events per hour following oral appliance therapy, with a mean improvement in AHI of 59.6%. Effectiveness was achieved in 66.7% of patients. A significant overall improvement was observed. Reductions in the apnea-hypopnea index were seen across age, severity, and body mass index (BMI) strata. However, only three patients had BMI ≥30 kg/m²; hence, BMI-stratified findings for this subgroup are descriptive and no inferential testing was conducted.

Conclusion: Oral appliance therapy was effective in reducing the apnea-hypopnea index in a broad range of patients, including those traditionally considered less responsive because of advanced age, obesity, or severe disease. These findings suggest a potential role for oral appliance therapy as an alternative to continuous positive airway pressure treatment within the examined strata (age, severity, and BMI), particularly when continuous positive airway pressure therapy is not feasible. Larger prospective studies are warranted.

Background: In Indonesia, stunting remains a health issue among children aged < 5 years, with a prevalence of 36.8% in 2021, the highest prevalence of malnutrition in the said age group, and the quality of drinking water consumed being one of the main causes. This study aimed to identify the quality of drinking water and determine the risk factors for stunting.

Methods: This study was conducted at four Primary Health Care work areas in an urban city between July and October 2022 using a cross-sectional study design with 172 under-fives, 106 of whom had drinking water-related stunting. The sampling methods employed were two-stage, including cluster and purposive sampling. Data collection included anthropometric measurements, interviews, and collecting drinking water samples. This study used the logistic regression test for multivariate analysis.

Results: The results showed that 93.6% of the drinking water was positive for microbiological agents, whereas analysis of heavy metals in drinking water revealed concentrations within acceptable limits as defined by standard drinking water quality regulations. Multivariate analysis showed that exposure to microbiologically contaminated drinking water was significantly associated with a higher risk of stunting. Children exposed to contaminated drinking water had a 3.3 times higher risk of stunting (OR 3.328; 95% CI 1.681-6.587). Additional confounding factors such as children over 23 months of age, history of infectious disease, low birth weight, and poor hygiene practices also contributed to increased stunting risk.

Conclusion: This study highlights the significant role of drinking water quality in the incidence of stunting among children under five. The high prevalence of microbiological contamination in household drinking water was strongly associated with increased stunting risk. Children exposed to contaminated water were over three times more likely to experience stunting. While concentrations of heavy metals remained within safe limits, additional confounding factors including child age, history of infectious disease, low birth weight, and poor hygiene practices further exacerbated the risk. These findings underscore the urgent need for integrated public health interventions focusing on water safety, hygiene education, and early childhood care to effectively reduce stunting prevalence in urban communities.

Background: A shared sense of professionalism among healthcare professionals enhances team-based care through interprofessional collaboration. This study aimed to develop a reliable and valid scale for assessing healthcare professionals' professionalism.

Methods: This study targeted 1,162 healthcare professionals aged ≥ 20 years, including physicians, dentists, nurses, pharmacists, clinical laboratory technologists, radiologic technologists, physical therapists, occupational therapists, and speech-language-hearing therapists. A preliminary 90-item scale was developed, and an anonymous self-administered questionnaire survey was conducted. Construct validity was examined through item, exploratory, and confirmatory factor analyses. Reliability and criterion-related validity were assessed using Cronbach's alpha coefficient and Pearson's correlation analyses, respectively.

Results: A lot of 393 responses were received (response rate: 33.8%). Responses from 347 participants without missing data were analyzed (valid response rate: 88.3%). Item and exploratory factor analyses produced a preliminary model of 36 items across five factors: Factor 1, "Practice Based on Advanced Skills and Knowledge;" Factor 2, "Understanding Patients and Their Surrounding Environment;" Factor 3, "Contribution to Health, Medical, and Welfare Policy;" Factor 4, "Implementation of Team-Based Medical Care;" and Factor 5, "Adherence to Ethics." Confirmatory factor analysis and model modifications were conducted based on the modification indices in collaboration with three researchers. Finally, a five-factor model consisting of 32 items was constructed. The model fit indices were as follows: comparative fit index = 0.885, goodness of fit index = 0.764, adjusted goodness of fit index = 0.731, and root mean square error of approximation = 0.085. Cronbach's alpha coefficient for the entire scale was 0.972, ranging from 0.884 to 0.950 across the five factors. The correlation coefficient between the model and the Vocational Identity Scale for Company Employees was 0.355.

Conclusion: The findings provide evidence for the reliability and validity of the scale for healthcare professionals.

Background: COVID-19 pandemic-related changes have increased mental health problems of essential workers. However, little is known about its impact on direct support professionals (DSPs) working at facilities for people with disabilities. This study examined the resilience and related factors, including psychological distress, burnout, depression, among DSPs working during the COVID-19 pandemic, including those in facility with cluster occurrences in Japan.

Methods: We conducted an online survey from May 18 to June 9, 2021, targeting staff at Social Welfare Corporation Shirane Gakuen, a cluster facility. An additional survey was conducted on May 24, 2021, through Yahoo! Crowd Sourcing, targeting individuals who worked at disability support facilities categorized as non-cluster facilities. We obtained 108 and 95 responses, respectively, including 76 and 16 DSPs. The following instruments were used: Maslach Burnout Inventory-General Survey, Bidimensional Resilience Scale, Kessler 6-item Psychological Distress Scale, and Patient Health Questionnaire-9. Multiple regression analysis was conducted to examine associations between resilience and related factors.

Results: The prevalence of severe psychological distress, burnout, and depression among DSPs within the COVID-19 cluster facility was 11.8%, 69.7%, and 29.0%, respectively. In the non-cluster facilities, the prevalence was 37.5%, 68.8%, and 62.5%, respectively. A positive association between acquired resilience factors and burnout was observed (coefficient = 2.35, 95% CI 0.38 to 4.31). However, no significant association was observed between acquired resilience factors and the interaction term of COVID-19 cluster occurrences at the workplace and burnout (coefficient = -2.03, 95% CI -6.97 to 2.90).

Conclusion: This study demonstrated that the acquired resilience factors of Japanese DSPs was linked with increased burnout during the COVID-19 pandemic, regardless of the COVID-19 cluster occurrences. As burnout intensifies, DSPs may cultivate acquired resilience, and programs enhancing these factors may help alleviate their burnout and promote well-being.

Background: The Coronavirus disease 2019 ¹ global pandemic is transmitted through respiratory droplets from infected people. We aim to determine the risk factors for COVID-19 reinfection, and the degree of its severity in patients reinfected with it.

Methods: We conducted a cross-sectional study on COVID-19 reinfection in Semarang, Indonesia using the two-stage sampling technique. There were a total of 312 participants. We used logistic regression tests for multivariate analysis of reinfection risk associated with various factors. The study spanned from June 2022 to October 2022.

Results: We found that symptoms such as cough and sore throat, seen during first infection, often recurred during reinfection. The fixed multivariate result showed that males (OR 3.863; 95% CI 1.459-10.234; P = 0.007), persons having comorbidities (OR 2.382; 95% CI 1.025-5.536; P = 0.044), health workers (OR 32.881; 95% CI 3.120-346.566; P = 0.004) or non-health workers (OR 21.661; 95% CI 2.192-214.034; P = 0.008), persons with mild symptoms (OR 6.503; 95% CI 2.771-15.264; P < 0.001) or moderate symptoms (OR 43.408; 95% CI 5.963-315.980; P < 0.001) at first COVID-19 infection, persons displaying poor rule-following behavior (OR 4.162; 95% CI 1.569-11.037; P = 0.004) and having only a middle school education (OR 0.303; 95% CI 0.098-0.93; P = 0.037) were highly related parameters associated with COVID-19 reinfection.

Conclusion: Thus, we found that males having comorbidities, employed in public jobs (health and non-health workers), with mild or moderate severity during first infection, and displaying poor rule-following behavior hold the highest risk factors for COVID-19 reinfection. Interestingly, having at least a middle school education seems to be a protective factor against COVID-19 reinfection.

Background: Survival rates improve significantly if basic life support (BLS) is administered for an out-of-hospital cardiac arrest (OHCA); however, it has a low rate of implementation. Even though bystanders' low willingness to administer BLS may be a contributing factor, the factors influencing their willingness have not been sufficiently elucidated. Therefore, this study investigated the relationship between personality traits and the willingness to administer BLS in a large cohort.

Methods: In a previous study, we found an association between the willingness to perform BLS and facilitative and obstructive factors. In this study, we used the same cohort and performed a secondary analysis of the willingness to perform BLS and the big five personality traits. This observational study assessed Japanese respondents' willingness to perform three BLS techniques (with varying levels of intervention) and the big five personality traits, using a questionnaire. The collected data were analyzed using logistic regression.

Results: Responses were obtained from 937 Japanese residents aged 20-65 years who had no experience performing BLS. The willingness to perform low-intervention actions-such as checking the victim's condition and seeking assistance-was significantly and positively correlated with extraversion and agreeableness. Conversely, the willingness to perform higher-intervention actions-such as performing chest compressions and related actions-was positively correlated with openness and negatively correlated with neuroticism.

Conclusion: Certain personality traits are related to the willingness to perform BLS. Hence, training methods based on personality traits may increase BLS implementation rates. For instance, creating awareness of affected individuals' pain or joy of survival through anecdotes may be effective for individuals with low levels of agreeableness, whereas providing correct knowledge for dispelling anxiety and instilling prepared mindsets may be effective for individuals with high levels of neuroticism. Overall, the findings indicate the potential effectiveness of training methods tailored to individual personality traits.

Background: Accurate assessment of pressure injuries is critical in clinical settings, especially when evaluating necrotic tissue using the DESIGN-R® scale widely adopted in Japan. This study aimed to integrate artificial intelligence (AI) into the evaluation process to enhance diagnostic consistency and accuracy. By leveraging deep learning and convolutional neural networks, we explored the potential of AI models in classifying necrotic tissue from wound images.

Methods: A retrospective observational study was conducted using electronic medical records and wound photographs from patients treated at Tottori University Hospital between 2014 and 2022. Two supervised learning models were developed: a Categorical Classification Model (CCM) for multi-class prediction, and a Binary Classification Model (BCM) implementing a two-step binary classification. Necrotic tissue was categorized based on the DESIGN-R® scale into three classes: n0 (no necrosis), N3 (soft necrosis), and N6 (hard, adherent necrosis). The models' performance was evaluated using standard classification metrics.

Results: The CCM showed recall rates of 0.7824 for n0, 0.6620 for N3, and 1.0000 for N6. In contrast, the BCM achieved higher recall rates: 0.9074 for n0, 0.9884 for N3, and 1.0000 for N6. Overall metrics for CCM were: accuracy 0.8148, precision 0.8166, and F-1 score 0.8089. The BCM surpassed these with an accuracy of 0.8711, precision 0.8418, and F-1 score 0.8508. Across all performance indicators, the BCM demonstrated superior classification capability.

Conclusion: The study demonstrated that AI, particularly the binary classification approach, can enhance necrotic tissue assessment in pressure injury evaluation. The BCM consistently outperformed the CCM, supporting its potential as a reliable tool to assist clinicians in objective and standardized pressure injury evaluation using the DESIGN-R® framework.

Background: Children with autism spectrum disorder frequently experience persistent sleep difficulties that persist into adulthood. These issues are linked to adverse outcomes like behavioral issues, poor academic performance, and increased parental stress, highlighting the importance of early interventions. We assessed an internet-based sleep education program for parents of children with autism spectrum disorder and conducted a preliminary examination of its potential to improve sleep quality and behavioral outcomes.

Methods: Eighteen parent-child pairs participated in an internet-based sleep education program. Outcomes related to the program were assessed at three time points: baseline, 4 weeks post-intervention, and 10 weeks post-intervention. Key measures analyzed included sleep parameters, sleep habits, children's behavioral problems, parental mental health, and parenting attitudes, using validated assessment tools.

Results: At 4 weeks post-intervention, the program demonstrated a reduction in the time required for children to fall asleep, an enhancement in sleep efficiency, and an improvement in parental mental health. At 10 weeks post-intervention, improvements were also observed in children's externalizing behavior problems. Parents reported increased confidence in managing their children's sleep issues and noted a positive impact on family dynamics.

Conclusion: The findings suggest that the internet-based sleep education program may be an effective and acceptable intervention for addressing sleep difficulties in children with autism spectrum disorder. This study contributes substantially to the existing literature, highlighting the potential for internet-based interventions to enhance sleep management strategies. This study was retrospectively registered with the jRCT on September 30, 2024 (jRCT1062240058).

Background: Brain injury accompanied by hemorrhage, such as cerebral contusion or intracerebral hemorrhage, leads to the accumulation of activated microglia around the lesion. In addition, microglia at the site of injury can act either damagingly or protectively, depending on the time; for instance, it is damaging in the acute phase and protective in the chronic phase. Moreover, during brain injury, glutamate-induced excitotoxicity leads to secondary damage to neurons. However, the source of glutamate released from cells remains largely unknown. Our previous studies have revealed that cystine/glutamate antiporter system x_c ^- (xc-) in microglia is an important source of glutamate release and that the induction of expression of xCT, a component molecule of xc-, is vital.

Methods: We investigated the effect of microglial xCT on traumatic brain injury using xCT-deficient mice.

Results: In cultured microglia supplemented with crude brain extract and the affected side of the brain injury model accompanied by hemorrhage, the expression level of xCT was increased on the affected side, and induction was observed mainly in microglia. In addition, EAAT2 levels on the affected side decreased. On the affected side, the number of CD80-positive microglia was significantly increased, and the xCT expression rate was elevated in CD80-positive cells. Assuming that xCT in microglia is important, we investigated xCT-deficient mice and microglia-specific xCT knockdown mice and found that the extent of brain damage was milder than in wildtype mice. The proportion of CD80-positive microglia was lower than that in wild-type mice. Assuming that microglial xCT could be a therapeutic target, we performed an experiment using the xCT inhibitor SSZ administered intraperitoneally. The extent of damage was narrowed, and the ratio of CD80-positive microglia was reduced, demonstrating a therapeutic effect.

Conclusion: Thus, microglial xCT is important in the pathology of brain injury accompanied by bleeding and is considered a promising therapeutic target.

Background: The objective of this study is to devise a simplified approach for estimating respiratory particle trajectory to avoid infection in gathering places of emergency departments.

Methods: To the authors' knowledge, no sufficient/obvious data exist on lateral routes of disease transmission through respiratory droplets along the x-axis. The present study establishes a preliminary baseline approach based on the upper pharynx-mouth geometry for lateral social distancing to protect susceptible persons from the droplets of an infected person. An enhanced version of ART (Aydin's Research Team) model has been employed as a supplementary tool of Stokes's law for quantification of motion dynamics of the virus/bacterium-laden droplets in public indoor places.

Results: A range of droplet diameters varying from 1 μm to 2000 μm were considered in this study. The droplets with a diameter of ≤ 22.5 μm can completely evaporate during settling and droplet nuclei can remain in the air for extended periods. An individual Influenza virus can stay airborne for 34.4 days, while a single Streptococcus bacterium remains suspended for 18.6 hours. The proper social distancing between infected and healthy persons should be about 2.9 and 0.9 m longitudinally, and 0.45 and 0.15 m laterally based on the novel aspects of the present study for sneezing/coughing and breathing/talking, respectively. The trajectory of respiratory particles in the streamwise and radial directions resembles the shape of a truncated cone due to the upper pharynx-mouth relationship.

Conclusion: The outcomes of this study can help further understanding of respiratory particle trajectory, thereby improving measures to mitigate disease transmission.