JMA journal最新文献

Introduction: In Japan, suicide is the most common cause of death among women who die in the first year after childbirth. This study aimed to analyze the loneliness of mothers raising infants in central Tokyo and to provide evidence for improving maternal mental health.

Methods: Fieldwork was conducted from June to September 2024, and questionnaire surveys were administered to 104 mothers who visited childcare support groups in Setagaya ward, Tokyo. Survey items were socioeconomic indicators and the Japanese version of the University of California, Los Angeles (UCLA) loneliness Scale Version 3 (UCLA-LS3-J), containing 20 items. Structured equation modeling (SEM) was conducted to analyze differences in loneliness by mother and infant characteristics.

Results: The average age of the mothers was 34.4 years, and that of their youngest child was 9.8 months. Among them, 24.0% of the mothers had a UCLA-LS3-J score >40 (which is considered moderate to high in terms of loneliness). SEM identified three factors independently associated with loneliness: health status, daily use of a nursery school or kindergarten, and the number of people the mothers could consult (p <0.05). Specifically, loneliness of the mothers was significantly higher when they were feeling less healthy, not using a nursery school or kindergarten, and having fewer people that they could consult.

Conclusions: Some mothers felt particularly isolated, and an intervention to strengthen consultation could be effective in improving loneliness of the mothers living in central Tokyo. Moreover, promotion of the use of nursery schools or kindergartens is also expected to improve the mothers' mental health.

Introduction: Polypharmacy is common among hospitalized post-stroke patients and is associated with adverse outcomes, such as decreased physical function and increased risk of drug-related complications. However, the association with functional outcomes, such as activities of daily living (ADLs) and muscle health remains unclear in this population. This study aimed to investigates whether reducing the number of medications during hospitalization is associated with improved ADL and muscle health in post-stroke patients.

Methods: We conducted a retrospective observational study of post-stroke patients with polypharmacy (≥5 medications) undergoing inpatient rehabilitation. Patients were categorized based on whether the number of medications decreased during hospitalization. Outcomes at discharge included the motor domain of the functional independence measure (FIM), handgrip strength, and skeletal muscle mass index (SMI), assessed by bioelectrical impedance analysis. Propensity score (PS) matching and multivariate linear regression was performed to examine associations between medication reduction and each outcome, adjusting for clinically relevant confounders.

Results: A total of 419 patients (mean age 75.9 years; 55.8% male) were included. Medication reduction occurred in 32.5% of patients, with a median decrease of two drugs. After PS matching, the cohort included 212 patients. In the multivariate analysis of this cohort, medication reduction was independently associated with higher FIM-motor scores (β = 0.105, p = 0.006) and greater handgrip strength (β = 0.073, p = 0.043), but were negatively associated with SMI (β = -0.158, p = 0.017).

Conclusions: Medication reduction during hospitalization was associated with improved ADL and muscle strength, but were negatively associated with muscle mass, in post-stroke patients with polypharmacy. Medication optimization may support functional recovery in this population.

Introduction: The importance of promoting the autonomy of people with dementia has been globally emphasized. Several studies have investigated factors that impede and facilitate their decision-making. However, few studies have explored these factors in light of their decision-making process. Therefore, this study aimed to determine factors in patient-clinician interactions that influence patient autonomy and participation in decision-making among Japanese patients with dementia.

Methods: The authors adopted qualitative methods to understand the perceptions of health care professionals such as physicians, nurses, physical therapists, care managers, and social workers. Between January and March 2022, individual in-depth interviews were conducted online with 24 health care professionals with ample experience in primary palliative care for dementia. The topics were the support provided in patients' decision-making, the support provided to proxy decision-makers, and the efforts undertaken for building a relationship between patients and families or among multidisciplinary teams. All interviews were audio-recorded electronically and transcribed verbatim. These data were synthesized and analyzed using content analysis.

Results: Four main themes were derived that captured the factors that influence the decision-making process of Japanese patients with dementia in patient-clinician interactions: rapport, decision-making capability, provision of explanation, and presentation of options. The findings highlighted the importance of building rapport with patients through communication in the early stages of dementia, improving patients' decision-making capability and protecting vulnerable patients who cannot make decisions independently, explaining each option's risks and benefits in a comprehensible manner, and presenting a wide range of options to patients in everyday decision-making.

Conclusions: Overall, the themes were in accordance with the process of informed consent. The findings also showed that clinicians must understand the barriers to obtaining informed consent that arise from patients' cognitive impairment, decline, and fluctuations, in addition to cultural factors.

Introduction: Frailty is often considered a pre-disability overall health state. However, even among older adults with disability, assessing frailty can be crucial for providing appropriate support and care services that maintain or promote their remaining independent abilities. The FRAIL-NH scale was developed to assess frailty in nursing home residents and has been shown to be useful in predicting their prognosis. We aimed to determine the prevalence and degree of frailty assessed by the FRAIL-NH scale among nursing home residents in Japan and investigate the associations between frailty status and long-term care (LTC) needs.

Methods: A cross-sectional study was conducted in four nursing homes in the Tokyo metropolitan area of Japan, 2020. Frailty status was assessed using the 7-item FRAIL-NH scale Japanese version: non-frail (0-1 points), frail (2-5 points), and most-frail (6-14 points). Levels of LTC needs at the latest LTC needs certification were obtained from electronic health records. Age- and sex-adjusted multivariable logistic regression analyses were conducted to evaluate the associations between frailty status and the level of LTC needs.

Results: Among 372 residents, 20.7% and 69.9% were frail and most-frail, respectively. Adjusted odds ratios (95% confidence intervals) for being either frail or most-frail were 3.62 (1.31-10.01) and 3.69 (1.14-11.94) for LTC needs levels 4 and 5, respectively, compared to level 3. Similarly, adjusted odds ratios (95% confidence intervals) for most-frail were 3.09 (1.77-5.38) and 6.38 (3.13-13.03) for LTC needs levels 4 and 5, respectively.

Conclusions: Most nursing home residents were assessed as being frail or most-frail. Frailty was strongly associated with LTC needs, indicating important resource implications for care services. Moreover, assessing frailty with the FRAIL-NH scale may support medical and care-related decision-making.

Introduction: This study aimed to investigate the changes in maternal body composition during pregnancy in Japanese women and the relationship between maternal body composition and newborn birth weight using pre-pregnancy body mass index (BMI) in all trimesters.

Methods: A total of 1,851 pregnant Japanese women were enrolled in this study. Body composition was measured using TANITA MC-190EM. The associations between newborn birth weight and maternal BMI, fat mass (FM), fat-free mass (FFM), total body water (TBW), muscle mass (MM), FM gain, FFM gain, and weight gain were evaluated.

Results: The participants' age and pre-pregnancy BMI were 34.1 years and 21.4 kg/m², respectively. Among the patients, 13.4%, 73.0%, 10.3%, and 3.3% were underweight, average weight, overweight, and obese, respectively. The FM showed no significant change from the second to third trimesters in the underweight, overweight, and obese groups. Moreover, the FM in the overweight and obese groups did not change during any period. The FFM, TBW, and MM significantly increased from the first to second and second to third trimesters. In BMI-stratified multivariate regression analyses, FFM in the normal and overweight groups was positively associated with birth weight, whereas FM gain was negatively associated in the underweight and normal groups. No significant associations were observed in the obese group.

Conclusions: Changes in maternal body composition during pregnancy in Japanese women varied by pre-pregnancy BMI. Associations with birth weight also differed by BMI group. Further prospective studies are needed to confirm these relationships and investigate the mechanisms.

Introduction: To clarify whether continuous-monitoring can detect bradycardia during propranolol treatment for infantile hemangioma (IH) and explore management practices for patients with bradycardia.

Methods: This retrospective study with historic controls was conducted on children with IH aged 0-1 year admitted for propranolol treatment at the National Center for Child Health and Development between October 2016 and July 2023. Patients were divided into two groups based on the monitoring method, namely, the spot-measurement group (October 2016 to August 2018) and the continuous-monitoring group (September 2018 to July 2023). Bradycardia was defined as a heart rate of <90/min lasting for 20 minutes. Patient data included clinical characteristics, propranolol dosage, and adverse effects (bradycardia, hypotension, and hypoglycemia). Statistical analyses were performed using Fisher's exact and Mann-Whitney U tests.

Results: During the study period, 106 patients were admitted for propranolol therapy; 49 were in the spot-measurement group and 57 in the continuous-monitoring group. The frequency of bradycardia was significantly higher in the continuous-monitoring group than in the spot-measurement group (21% vs. 2%, p = 0.003). In the continuous-monitoring group, 2 of 12 patients with bradycardia were symptomatic. All patients experienced prompt resolution of symptoms with the reduction of propranolol dosage and had favorable outcomes for IH.

Conclusions: Continuous-monitoring can detect bradycardia more effectively during propranolol treatment for IH than spot-measurement, and reducing the dosage of propranolol can lead to favorable outcomes for IH while minimizing the risk of bradycardia.

Introduction: As the "pharmacy of the world," India plays a critical role in global pharmaceutical supply. However, increasing reports of substandard and falsified medicines raise serious concerns. With Jammu and Kashmir witnessing repeated quality failures of ceftriaxone, this study aims to verify its quality using a refined high-performance liquid chromatography (HPLC)-based analytical method.

Methods: The ceftriaxone assay was performed using Agilent 1260 Infinity HPLC System with a C18 column and EZChromS1 software. A solvent system of acetonitrile and water (20:80, v/v) was used, with flow rate of 0.5 mL/min and ultraviolet detection at 254 nm. Standard solutions (20-70 μg/mL) were prepared from a 1,000 μg/mL stock for calibration. Nineteen injectable ceftriaxone brands were procured and coded for anonymity. Sample solutions were prepared at 50 μg/mL. The method was validated as per International Council for Harmonisation (ICH) guidelines for accuracy, precision, linearity, specificity, limit of detection (LOD), limit of quantification (LOQ), and robustness. Solution stability was assessed over 7 days at 2°C-8°C.

Results: The developed isocratic reversed-phase HPLC method showed good linearity (R² = 0.9991) over the range 20-70 μg/mL, with LOD and LOQ of 5.88 μg/mL and 17.83 μg/mL, respectively. Intra-day and inter-day precision and accuracy showed percentage relative standard deviation (%RSD) values <2% and mean recovery within acceptable limits (96.9%-102.6%). Robustness was confirmed through variations in flow rate, mobile phase composition, detection wavelength, and column temperature, all yielding %RSD <2%. Analysis of 19 marketed formulations revealed that 89.5% complied with pharmacopoeial standards (90.0%-115.0% recovery), while 10.5% (CEF A17, CEF A19) were substandard, indicating significant quality variation among brands (p < 0.05).

Conclusions: A simple, sensitive, and cost-effective HPLC method was developed and validated for estimation of ceftriaxone in pharmaceutical dosage forms. Among 19 tested formulations, 89.5% complied with Indian Pharmacopoeial standards, while two formulations were found substandard, indicating variability in product quality.

The triad of blood pressure measurement, urinalysis, and edema assessment has constituted the cornerstone of prenatal care for over eight decades and has been consistently recorded at each examination in Japan's Maternal and Child Health Handbook. Historically, these examinations were prioritized to facilitate the early diagnosis and treatment of pregnancy toxemia-now termed hypertensive disorders of pregnancy-which once represented a leading cause of maternal mortality. The triad has undeniably played a pivotal role in the early diagnosis, prediction, and treatment of hypertensive disorders of pregnancy, while potentially contributing to the detection of other obstetric complications. However, conclusive evidence linking these conventionally performed assessments to actual pregnancy and delivery outcomes remains limited, and critical unresolved issues persist within each examination category. Blood pressure assessment requires the establishment of optimal blood pressure thresholds to achieve favorable pregnancy and perinatal outcomes; to achieve this, home blood pressure monitoring should be adopted. Evidence-based target blood pressure ranges for treatment initiation in hypertensive disorders of pregnancy and therapeutic targets are urgently needed. For urinary protein assessment, the establishment of standardized criteria for postpartum proteinuria follow-up is essential. In terms of edema, critical evidence is lacking regarding the evaluation and treatment of pathological edema that adversely affects pregnancy outcomes. This review traces the historical evolution of these examinations while critically examining their contemporary role in perinatal care. A notable characteristic of this triad is its noninvasive nature and minimal cost burden. The establishment of robust evidence supporting their clinical utility could optimize maternal and fetal outcomes while maintaining cost-effective healthcare delivery.

Background: The increase in international tourists and residents in Japan has necessitated Japanese medical institutions to extend their services to patients, presenting new challenges such as unpaid medical bills. The treatment of foreign patients is further complicated by linguistic, cultural, and social barriers, which heighten the risk of unpaid bills. This highlights the critical need to examine the issue of unpaid medical bills in the context of foreign patient care in Japan. This study investigates trends in research, the regions most affected, and the impact of unpaid medical expenses on patients and healthcare institutions.

Methods: A scoping review was conducted using articles indexed in MEDLINE, Web of Science, Scopus, CINAHL Plus, Ichushi-Web (Japanese medical literature), and Google Scholar, with a focus on publications from Japan discussing unpaid medical bills with foreign patients.

Results: Seventeen publications met the criteria, highlighting the difficulties in collecting medical expenses from foreign patients. Prevention methods, such as prepayment and presenting estimated costs before care were suggested but had limited success. There are also few policies to assist medical institutions with outstanding expenses from foreign patients.

Conclusions: This study underscores the urgent need for comprehensive strategies to address unpaid medical bills among foreign patients in Japan, emphasizing further research to develop effective interventions and enhance the overall healthcare experience for these patients.