From Fiscal Year Research Articles

Analysis of factors associated with premiums for reimbursed medical devices in Japan.

The aim of this study is to examine factors that relate to receipt of a reimbursement premium in Japan, which is defined as an increase in the initially calculated reimbursement price based on certain criteria, or an increase in the operating profit ratio. Reimbursement submissions and decisions for newly reimbursed medical devices in Japan from fiscal year (FY) 2015 to FY 2023 were reviewed to consider their characteristics. Moreover, the relationship between reimbursement submission characteristics, as well as other characteristics such as regulatory submission category, risk class, location of the manufacturer headquarters, etc. and the receipt of a Novelty, Usefulness, or Improvement premium (hereafter "utility premium"), or an increase in the operating profit ratio, was examined using univariate and multivariate regression. Among 131 unique medical devices newly reimbursed in Japan from FY 2015 to FY 2023, 57 devices (44%) received a reimbursement premium. Among those, 30 devices (53%) were devices to treat cardiovascular conditions. Based on univariate regression, therapy area, reimbursement category and method used, duration since the comparator device was listed, and estimated peak annual patients for the new device, are factors that affect the receipt of a utility premium or an increase in the operating profit ratio. However, based on multivariate regression, only the therapy area, risk-related regulatory submission class, regulatory submission type (novelty), and orphan device designation are associated with the receipt of a utility premium or an increase in the operating profit ratio. Receipt of a utility premium can be challenging. Moreover, medical devices to treat cardiovascular conditions have benefited more from premiums. This may be due to those devices having more data on efficacy at the time of approval and listing. More opportunities for devices to obtain premiums following initial listing may be needed to adequately capture their value.

Prevalence, incidence, and recovery of metabolic syndrome after the fukushima nuclear power plant disaster: A 10-year longitudinal study

After the 2011 Fukushima nuclear power plant accident, the prevalence of metabolic syndrome sharply increased in municipalities near the nuclear power plant, where a massive evacuation of community residents occurred (the evacuation area). However, after the initial increase, the rate of increase in metabolic syndrome in the evacuation area was slower than that in the surrounding area (non-evacuation area). In this study, we compared the incidence of and recovery from metabolic syndrome as well as its prevalence between evacuation and non-evacuation areas during the 10 years after the accident to explore whether the slower increase in metabolic syndrome after the initial increase in the evacuation area stemmed from suppressed incidence or from fast recovery. We analyzed specific health check-up data of community residents aged 40–74 in Fukushima Prefecture from fiscal year (FY) 2012 to FY 2021 (N = 710,201). To explore the prevalence of metabolic syndrome, we examined the associations of time, residential area, and their interaction with metabolic syndrome using mixed-model repeated measures. We used data from those without metabolic syndrome in FY 2012 to investigate the incidence. We similarly examined the associations of time, residential area, and their interaction with metabolic syndrome using FY 2013 to FY 2021 data. To explore recovery, we used the data of those with metabolic syndrome in FY 2012 and repeated the same procedure. The rate of increase in the prevalence and incidence of metabolic syndrome was slower in the evacuation area than in the non-evacuation area. On the other hand, as for the recovery, the time trend of metabolic syndrome did not differ between the two areas. The slower increase in metabolic syndrome in the evacuation area was partly explained by the slower incidence in the evacuation area but not by recovery.

Migrant Deaths in New Mexico: What is Known; What is Unknown

Executive Summary The United States is no stranger to migration across its borders. In 2020, its Southwestern border saw a drastic increase in apprehensions by the Border Patrol. While imperfect and an undercount of the true number of migration events, apprehension data is often used as a proxy to understand migration patterns. The rise in migration was coupled with an increased but unknown number of deaths along migration routes. This article focuses on the New Mexico portion of the El Paso Border Patrol Sector and the increased migrant caseload at New Mexico’s Office of the Medical Investigator (OMI) over the last few years. To the best of our knowledge, this article is the first academic study to examine migrant deaths in detail in southern New Mexico. We begin by contextualizing the changing pattern of migrant deaths in New Mexico within the broader framework of border policing strategies that have intentionally pushed migration routes to remote areas. We describe the work of the OMI, highlighting its very recent initiatives to track migrant deaths in its database. We then discuss the changes seen by the OMI in its migrant caseload from fiscal year (FY) 2009 to 2023, with the most drastic increase in cases occurring from 2022 to 2023. For instance, the data indicate that most of the identified migrants that have died in New Mexico were recovered in June and July (45 percent), crossed through Doña Ana County (66 percent), were male (60 percent), and among those identified, were from Mexico (65 percent) and between 20 and 39 years of age (69 percent). Of the 248 cases of migrant deaths, 87 percent have been identified. The most common causes of death were undetermined (46 percent) and environmental exposure (41 percent). We then explore the effects of changing governmental policies and state initiatives to curb/reduce migration in the US on OMI’s increased caseload. We discuss the impact that the rapid shift in migration deaths is having on the OMI and how OMI is working to respond and adjust to the dynamic situation. This work highlights the collateral damage of border security measures, underscored by the increasing number of deaths and challenges faced by the OMI. We consider the need for new and amended policies aimed at mitigating the humanitarian crisis that continues to unfold, emphasizing the need for the humane treatment of migrants. Finally, we suggest allocating resources to death investigating agencies. These resources would provide essential support to find, identify, and repatriate migrants, improve agencies’ abilities to collaborate with governmental agencies and programs such as Border Patrol’s Missing Migrant Program, and improve our understanding of the circumstances along the Southwestern border.

Trends in Psychiatric Day Care Practices in Japan: An Analysis Using the National Database of Health Insurance Claims Open Data.

Psychiatric day care is a key framework for outpatient rehabilitation in Japanese psychiatric treatment. It targets a wide range of diseases and performs various roles. The current status and utilization of psychiatric day care in Japan have changed owing to an increase in the availability of other social resources and the coronavirus disease 2019 (COVID-19) pandemic. However, no reports have quantitatively analyzed the trends or current situation of psychiatric day care in Japan. Therefore, this study aimed to analyze the status of the operation of psychiatric day care in Japan and its trends by sex, region, and age group. Based on the publicly available data from the Japanese National Database of Health Insurance Claims and Specific Health Checkups (NDB Open Data), we investigated changes in the numbers related to psychiatric day care nationwide from fiscal year (FY) 2017-2021. Furthermore, we calculated the numbers of psychiatric day care facilities use per 1,000 people by prefecture, sex, and age group in 2021. A Mann-Whitney U test was conducted to compare the total number of psychiatric day care facilities used in months during periods of emergency declarations and priority preventative measures with those used in months when there were no such periods. Pearson's correlation coefficient test was conducted to examine the correlation between the numbers of psychiatric beds per 100,000 people and the annual numbers of psychiatric day care facilities use per 1,000 people in each prefecture. A Mann-Whitney U test was conducted to compare the number per 1,000 people per year of prefectures with or without capital- and government-designated cities and compare the annual total number (FY 2017-2021) by sex. Overall, the number of psychiatric day care facilities use tended to decrease. The monthly data showed a significant decrease in the total number of psychiatric day care facilities' usage during periods of emergency declarations and priority preventative measures (p=0.02). The numbers of "psychiatric short care" use increased in 2021 and those of psychiatric day-night care (>3 years / >3 days per week) use showed an increasing trend from 2020. The overall number of psychiatric day care facilities' usage per 1,000 people by prefecture was significantly lower in prefectures having cities with populations of 700,000 or more (p<0.01). A significant positive correlation was found between the number of psychiatric day care facilities use per 1,000 people by prefecture and the number of psychiatric beds per 100,000 people by prefecture (r=0.61, p<0.01). The usage of psychiatric day care facilities was significantly lower for women (p<0.01). In terms of age group, the use of psychiatric day care facilities was significantly lower for younger age groups (under 65 years of age) (p<0.01). Trends in the numbers reflected differences in user attributes and regional differences. It is necessary to establish a management system tailored to individual attributes and in regions where support is difficult to reach.

Estimates of unintended pregnancy among US active-duty service women and the impact on Women Peace and Security objectives as measured by potential readiness days lost

IntroductionThe prevalence of unintended pregnancy (UIP) in the United States is high among active-duty service women (ADSW).ObjectiveTo estimate the number of UIPs and the impact these pregnancies have on the...

Incidence, prevalence, and treatment of Moyamoya disease in Japan: A population-based descriptive study

BackgroundMoyamoya disease (MMD) is characterized by progressive stenosis or occlusion of the terminal portions of the bilateral internal carotid arteries. A Japanese survey in 2003 reported an incidence and prevalence of MMD of 0.54 and 6.03 per 100,000 people, respectively, showing an upward trend over previous surveys. An update to these estimates is therefore warranted. Additionally, evidence is lacking on trends in revascularization and antiplatelet therapy in MMD patients. MethodsWe conducted a population-based descriptive study using a Japanese claims database. From fiscal year (FY) 2015 to 2019, we standardized the incidence and prevalence estimates of MMD to the 2015 Japanese census population by age and sex. We also estimated the 1-year cumulative incidence of revascularization among incident MMD patients and the proportion of prevalent MMD patients receiving antiplatelet therapy in each FY. ResultsThe age-standardized male-to-female ratio of both incident and prevalent MMD patients was approximately 1:2. Standardized incidence and prevalence of MMD per 100,000 population increased slightly from 1.8 to 2.4 and 14.7 to 17.6, respectively. The 1-year cumulative incidence of revascularization among incident MMD patients varied between 21.9 % and 28.9 %. Among prevalent MMD patients, 36.6 % to 39.0 % received antiplatelet therapy. ConclusionsThe incidence and prevalence of MMD in Japan from FY 2015 to 2019 were higher than those estimated in 2003. The trends in revascularization and antiplatelet therapy identified in this study will be useful in further improving the quality of MMD clinical practice.

Nonalcoholic Fatty Liver Disease in Japan Continue to Increase Even after the Launch of Specific Health Checkups.

Objective To examine the trends and relationships between nonalcoholic fatty liver disease (NAFLD) and hypertension, type 2 diabetes mellitus (T2DM), and dyslipidemia from fiscal year (FY) 2008, when specific health checkups (SHCs) were initiated in Japan, to FY 2019 and the relationship between NAFLD trends and dietary nutrition. Methods A total of 48,332 participants (25,121 men and 23,211 women) diagnosed with NAFLD who underwent health checkups, including ultrasonography, from FY 2008 to FY 2019 were included. A fatty liver was diagnosed using ultrasonography. The dietary nutrient intake status was based on data from the National Health and Nutrition Survey, Japan. Results Over 12 years, NAFLD prevalence increased from 26.9% to 43.1% in men (p<0.0001) and from 9.9% to 17.9% in women (p<0.0001) in all body mass index (BMI) groups except for obese II (according to the World Health Organization Asia-Pacific criteria) in men and underweight in women and almost all age groups. T2DM prevalence increased in men (from 9.0% to 10.7%, p=0.0234), and obesity and higher waist circumference rates increased in women (from 16.0% to 18.0%, p=0.0059 and from 8.1% to 10%, respectively, p=0.0006). The dietary nutrient intake increased with regard to the total fat, fat/energy ratio, saturated fatty acids, monounsaturated fatty acids, and n6/n3 fatty acid ratio in both men and women, and these nutrient trends were correlated with NAFLD prevalence (all p≤0.0005). Conclusion In Japan, NAFLD increased in both men and women regardless of the BMI and age, even after starting SHCs. An unbalanced fat intake may be one of the major reasons for this increase.

Features and Issues of Disaster Management Education Practices in Schools and Communities in Japan: Based on an Analysis of Activities of Organizations Participating in the “Disaster Management Education Challenge Plan” of the Cabinet Office

In this study, we analyzed the disaster management education programs implemented by organizations included in the Disaster Management Education Challenge Plan, a program established to support disaster management education efforts in Japan. We examined the changes in these programs and identified the current state and issues in the promotion of disaster education in Japan by classifying the contents. The study methodology involved creating data sets of the program reports submitted from fiscal year (FY) 2004 to FY2021 by organizations admitted to the Disaster Management Education Challenge Plan, and evaluating them on scales of “fundamental skills of disaster management” and “factors regarding implementing the programs.” Analysis of the former found that there were few programs aimed at acquiring a scientific understanding of disasters as natural phenomena or learning about measures to prevent damage at normal times. Cluster analysis yielded eight clusters, based on which we discussed and proposed ways to implement the programs in order to improve the “fundamental skills of disaster management.” Similarly, analysis of the latter identified issues with regard to program logistics, such as securing financial resources and cultivating future successors. Cluster analysis yielded five clusters, based on which we discussed and proposed ways to effectively implement the programs.

Minimization of preventable drug waste through use of a vial combination calculator tool.

This project aimed to determine whether a supportive calculator that automates the vial selection process might offer a practical and efficient method of reducing pharmaceutical expenditures through minimizing preventable drug waste in outpatient pharmacy settings. Drug waste is a substantial target of cost-saving efforts in the areas of oncology and autoimmune therapy, which involve use of a vast number of high-cost medications packaged in single-dose vials of varying strength. To facilitate selection of the optimal combination of medication vials and thereby minimize preventable drug waste, a Microsoft Excel-based calculator was developed for use by staff of a large oncology pharmacy network. Twenty-three high-cost chemotherapy and monoclonal antibody medications were identified as initial targets for the drug waste prevention initiative. After dissemination and implementation of the calculator and provision of monthly pharmacy staff education, the dollar value of preventable drug waste and the number of suboptimal vial combination selections were reduced by 51% ($412,300) and 54% (315 selections), respectively, in fiscal year 2022 and further reduced by 46% ($183,400) and 27% (71 selections), respectively, in fiscal year 2023. After implementation of an automated vial selection tool, preventable drug waste and the quantity of suboptimal vial combination selections were markedly reduced across 11 outpatient compounding pharmacies.

THE COST OF INFLAMMATORY BOWEL DISEASE: A POPULATION-BASED ANALYSIS OF ADMINISTRATIVE DATA

Abstract BACKGROUND As the global prevalence of inflammatory bowel disease (IBD) rises, it is important that the direst costs associated with medical care be analyzed to determine the impact on healthcare systems. Components making up the direct healthcare cost to the IBD population (e.g., hospitalizations, colonoscopies, and medications) are constantly changing and with this so may be the cost related to taking care of the IBD population. AIM Analyze component-specific costs, total costs, and the proportion of total costs attributed to each component, and changes over time. METHODS Using a validated algorithm and population-based administrative data from Alberta, Canada (Population: 4.3m), prevalent IBD patients were identified from fiscal year (FY) 2009/10 to 2018/19 (April 1–March 31). Costs from the Discharge Abstract Database, Physician Claims, National Ambulatory Care, and Pharmacy Information Network were converted to 2020 (CAD$) costs using Statistics Canada’s Consumer Price Index. Only IBD-related outpatient dispensed medications were included in the costs (inpatient not captured in data). Annual average costs per patient (with 95% confidence interval [CI]) were calculated. Medication costs per person were stratified on whether or not an individual was on a biologic (e.g. anti-TNF therapy) versus a non-biologic IBD-related medication (e.g., 5-ASA). The cost of an individual’s IBD-related hospitalization, IBD-related surgery, emergency department visit, colonoscopy, or IBD-related medication were calculated. Proportion of the total costs contributed by each category were calculated. Temporal trends of mean annual costs were analyzed using Poisson, or negative binomial, regression and average annual percentage change (AAPC) with 95%CI were reported. RESULTS In FY2018/19, the average cost of an IBD patient was $15,786 (95%CI:15,478, 16,094). This cost significantly increased from the 2009 value ($8,477; 95%CI: 8,407, 8,908) with an AAPC of 6.28% (95%CI: 5.51, 7.05). The annual costs of medications when a patient is on one or more biologics significantly increased (AAPC: 3.48%; 95%CI:2.32, 4.65). In contrast, the average annual cost per patient of IBD-related non-biologic medications significantly decreased (AAPC: -2.32; 95%CI: -3.48, -1.14). The largest contributor to IBD costs is medications (57.6% of the total costs) followed by IBD-related hospitalizations (20.6%). The costs of IBD-related hospitalizations and surgeries have remained stable, whereas the costs for emergency department visits and colonoscopies increased. DISCUSSION The costs associated with treating people IBD is rising and predominantly attributable to the cost of biologics. As the prevalence of IBD continues to increase, healthcare systems, payers and governments need to work to address these costs while ensuring these individuals receive the care they need. *Proportions will not add up to 100% as individuals can be captured in multiple cost categories each year (e.g., an IBD-related surgery cost is also captured as a hospitalization) and not all costs are reported in table. Overall and Biologics are Per Person; Hospitalization and Sugery are Per Event

Lifestyle factors associated with a rapid decline in the estimated glomerular filtration rate over two years in older adults with type 2 diabetes–Evidence from a large national database in Japan

Background The present study investigated lifestyle risk factors from metabolic syndrome-related lifestyles for a rapid decline in the estimated glomerular filtration rate (eGFR) among adults aged 40–74 years with treated and untreated type 2 diabetes. Methods and results This study analyzed data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan, encompassing the period from fiscal year (FY) 2017 to FY2020. We established FY2018 as our baseline year. The subjects of this study were adults aged 40–74 in FY2018(baseline) who had type 2 diabetes and underwent specific health checkups in FY2020. We excluded adults with a medical record of kidney dialysis between FY2017 and FY2018, records of suspected type 1 diabetes between FY2017 and FY2020, or a baseline eGFR &gt;85 mL/min/1.73 m2 or missing eGFR data as of FY2020. Eventually we analyzed 573,860 individuals. The outcome variable was a rapid decline in eGFR (≥30%) during the follow-up. Exposure lifestyle factors included skipping breakfast, late-night dinners, regular smoking, a high alcohol intake, non-refreshing sleep, and a lack of habitual exercise. Logistic regression models were stratified by age (40–59 and 60–74 years) and baseline eGFR levels (60–85, 30–59, and &lt;30 mL/min/1.73 m2). Covariates included sex, a history of heart disease, a history of stroke, a history of renal failure, anemia, low-density lipoprotein, systolic blood pressure, hemoglobin A1C, body mass index, antidiabetic medications, antihypertension drugs, lipid-lowering drugs, the oral adsorbent Kremezin, non-steroidal anti-inflammatory drugs, and drugs for the treatment of renal anemia. A rapid decline in eGFR was detected in approximately 1.3% of participants (7,683 cases). In the baseline eGFR &gt;30 subgroups (60–85 or 30–59 mL/min/1.73 m2), skipping breakfast and regular smoking were associated with a rapid decline in eGFR in both age groups, while a lack of habitual exercise and late-night dinners in the 60–74 age group and non-refreshing sleep in the 40–59 age group were identified as risk factors. Additionally, skipping breakfast was a risk factor for a rapid decline in eGFR in the 60–74 age group regardless of baseline eGFR levels. In the baseline eGFR &lt;30 mL/min/1.73 m2 subgroup, skipping breakfast and non-refreshed sleep were risk factors for a rapid decline in eGFR. Conclusions We found specific lifestyle risk factors were associated with a rapid eGFR decline among people with type 2 diabetes from a nationwide database in Japan. The associations varied by baseline eGFR level, age, and sex. Lifestyle modifications may effectively prevent the aggravation of diabetic kidney disease.

Increasing Local Productivity Through a Regional Antimicrobial Stewardship Collaborative.

Antimicrobial stewardship programs (ASPs) are vital to improving patient safety and ensuring quality of care but are often underresourced, limiting their effectiveness and reach. While barriers to ASP success have been well documented, approaches to address these barriers with limited resources are needed. Stewardship networks and collaboratives have emerged as possible solutions. In January 2020, 5 US Department of Veterans Affairs facilities created a regional ASP collaborative. In this article, we describe the impact of this collaborative on the productivity of the facilities' ASPs. ASP annual reports for each of the 5 facilities provided retrospective data. Reports from fiscal year (FY) 2019 and reports from FY 2020-2022 were reviewed. Staffing, inpatient and outpatient stewardship reporting, individual and collaborative initiatives, and publications data were collected to measure productivity. Yearly results were trended for each facility and for the region. Additionally, the COVID-19 antibiotic use dashboard and upper respiratory infection dashboard were used to review the impact of initiatives on antibiotic prescribing during the collaborative. Regular reporting of outpatient metrics increased; 27% of measures showed improvement in 2019 and increased to 60% in 2022. For all 5 facilities, ASP initiatives increased from 33 in 2019 to 41 in 2022 (24% increase) with a corresponding increase in collaborative initiatives from 0 to 6. Likewise, publications increased from 2 in 2019 to 17 in 2022 (750% increase). Rates of reporting and improvement in inpatient metrics did not change significantly. The ASP collaborative aided in efficiency and productivity within the region by sharing improvement practices, distributing workload for initiatives, and increasing publications.

Association between the number of teeth and incident pre-diabetes among middle-aged adults with periodontal disease: a retrospective cohort analysis of Japanese claims data

ObjectivesTo investigate the association between the number of teeth and the new onset of pre-diabetes.DesignRetrospective cohort study.SettingThe National Database of Health Insurance Claims and Specific Health Checkups of Japan, which...

Severity of posttraumatic stress disorder, type 2 diabetes outcomes and all-cause mortality: A retrospective cohort study

BackgroundSome evidence suggests patients with comorbid PTSD and type 2 diabetes (T2D) have worse T2D outcomes than those with T2D alone. However, there is no evidence regarding PTSD severity and risk for starting insulin, hyperglycemia, microvascular complications, and all-cause mortality. MethodsIn this retrospective cohort study, Veterans Health Affairs (VHA) medical record data from fiscal year (FY) 2012 to FY2022 were used to identify eligible patients (n = 23,161) who had a PTSD diagnosis, ≥1 PTSD Checklist score, controlled T2D (HbA1c ≤ 7.5) without microvascular complications at baseline. PTSD Checklist for DSM-5 (PCL-5) scores defined mild, moderate, and severe PTSD. Competing risk and survival models estimated the association between PTSD severity and T2D outcomes before and after controlling for confounding. ResultsMost (70%) patients were ≥ 50 years of age, 88% were male, 64.2% were of white race and 17.1% had mild, 67.4% moderate and 15.5% severe PTSD. After control for confounding, as compared to mild PTSD, moderate (HR = 1.05; 95% CI:1.01–1.11) and severe PTSD (HR = 1.15; 95%CI:1.07–1.23) were significantly associated with increased risk for microvascular complication. Hyperarousal was associated with a 42% lower risk of starting insulin. Negative mood was associated with a 16% increased risk for any microvascular complication. Severe PTSD was associated with a lower risk for all-cause mortality (HR = 0.76; 95%CI:0.63–0.91). ConclusionsPatients with comorbid PTSD and T2D have an increased risk for microvascular complications. However, they have lower mortality risk perhaps due to more health care use and earlier chronic disease detection. PTSD screening among patients with T2D may be warranted.

Rule-Based Identification of Individuals with Mild Cognitive Impairment or Alzheimer's Disease Using Clinical Notes from the United States Veterans Affairs Healthcare System.

Early identification of individuals with mild cognitive impairment (MCI) and Alzheimer's disease (AD) is a clinical and research imperative. Use of diagnostic codes for MCI and AD identification has limitations. We used clinical notes to supplement diagnostic codes in the Veterans Affairs Healthcare System (VAHS) electronic health records (EHR) to identify and establish cohorts of Veterans recorded with MCI or AD. Targeted keyword searches for MCI ("Mild cognitive impairment;" "MCI") and AD ("Alz*") were used to extract clinical notes from the VAHS EHR from fiscal year (FY) 2010 through FY 2019. Iterative steps of inclusion and exclusion were applied until searches achieved a positive predictive value ≥ 80%. MCI and AD cohorts were identified via clinical notes and/or diagnostic codes (i.e., including Veterans recorded by "Notes Only," "Notes + Code," or "Codes Only"). A total of 2,134,661 clinical notes from 339,007 Veterans met the iterative search criteria for MCI due to any cause and 4,231,933 notes from 572,063 Veterans met the iterative search criteria for AD. Over the 10-year study period, the number of clinical notes recording AD was generally stable, whereas the number for MCI more than doubled. More Veterans were identified for the MCI or AD cohorts via clinical notes than by diagnostic codes, particularly in the AD cohort. Among Veterans identified by having "Notes + Code" for MCI, the number first recorded by a code was lower than the number first recorded by a note until FY 2015 and then gradually became comparable after FY 2015. Among Veterans identified by having "Notes + Code" for AD, the number first recorded by a note was more than double the number first recorded by a code AD in each of the FYs. Clinical note-based identification captured more Veterans recorded with MCI and AD than diagnostic code-based identification.

Malunions following lower extremity fractures in veterans with a spinal cord injury/disorder

Background Nearly 50% of all persons with a spinal cord injury/disorder (SCI/D) will sustain an osteoporotic fracture sometime in their life, with lower extremity fractures being the most common. There are a number of complications that can occur post fracture, including fracture malunion. To date, there have been no dedicated investigations of malunions among persons with SCI/D. Objectives The primary objective of this study was to identify risk factors associated with fracture malunion among fracture-related (type of fracture, fracture location, initial fracture treatment) and SCI/D-related factors. Secondary objectives were to describe treatment of fracture malunions and complications following these malunions. Methods Veterans with SCI/D with an incident lower extremity fracture and subsequent malunion from Fiscal Year (FY) 2005–2015 were selected from the Veteran Health Administration (VHA) databases using International Classification of Diseases, 9th edition (ICD-9) codes for lower extremity fractures and malunion. These fracture malunion cases underwent electronic health record (EHR) review to abstract information on potential risk factors, treatments and complications for malunion. Twenty-nine cases were identified with a fracture malunion with 28 of them successfully matched with Veterans with a lower extremity fracture during FY2005-FY2014 without a malunion (matched 1:4) based on having an outpatient utilization date of care within 30 days of the fracture case. There was trend towards more nonsurgical treatment in the malunion group (n = 27, 96.43%) compared to the control group (n = 101, 90.18%) (P = 0.05), though fracture treatment proved not to be not associated with developing a malunion in univariate logistic regression analyses (OR = 0.30; 95% CI: 0.08–1.09). In multivariate analyses, Veterans with tetraplegia were significantly less likely (approximately 3-fold) to have a fracture malunion (OR = 0.38; 95% CI: 0.14–0.93) compared to those with paraplegia. Fracture malunion was significantly less likely to occur for fractures of the ankle (OR = 0.02; 95% CI: 0–0.13) or the hip (OR = 0.15; 95% CI: 0.03–0.56) compared to femur fractures. Fracture malunions were rarely treated. The most common complications following malunions were pressure injuries (56.3%) followed by osteomyelitis (25.0%). Conclusions Persons with tetraplegia as well as fractures of the ankle and hip (compared to the femur) were less likely to develop a fracture malunion. Attention to prevention of avoidable pressure injuries following a fracture malunion is important.

Long-Term Analysis of Internal Exposure Dose-Reduction Effects by Food Regulation and Food Item Contribution to Dose after the Fukushima Daiichi Nuclear Power Plant Accident.

Over 10 years have passed since the Fukushima Daiichi Nuclear Power Plant accident. This study verifies the efficacy of longitudinal regulation on internal exposure doses and analyzes food group contributions to radiation doses using accumulated monitoring test results. The committed effective doses in 10,000 virtual persons from fiscal year (FY) 2012 to 2021, with and without regulation, were estimated as products of radioactivity concentrations randomly sampled from the test results, food intake, and dose coefficient. The distributed values of food intake rather than a mean value in dose estimation were assumed to reflect food intake variations and avoid underestimation of internal exposure doses for high-intake consumers. Furthermore, the ingestion of radioactive cesium from the calculation was analyzed per food group. The 95th percentile of the internal exposure dose (the dose of a "representative person") was less than 1 mSv/year in both FYs. The regulation effect was substantial in FY 2012, and no noticeable difference in radiation doses was found between the regulation and no regulation conditions after FY 2016. Internal exposure doses decreased until approximately FY 2016 and then remained constant. It was also shown that not only radioactivity concentration but also food intake is a major factor affecting cesium intake. In summary, it was confirmed that Japan had ensured food safety regarding radioactive materials.

Development of performance indicators for hepatitis countermeasures as a tool for the assessment and promotion of liver cancer prevention in Japan.

Hepatitis countermeasures are being promoted by governments in Japan. We aimed to develop performance indicators (PIs) to assess the process and outcome of such countermeasures implemented for the prevention of viral hepatitis-related liver cancer at the national and prefectural government levels. We developed 19 PIs for hepatitis countermeasures implemented by local governments, covering the morbidity and mortality of liver cancer, hepatitis testing, subsidy programs for examinations and antiviral treatment, and education on hepatitis patient care to healthcare workers. We analyzed the PIs for each prefecture from Fiscal Year (FY) 2018-2020. The morbidity and mortality of liver cancer significantly decreased in the study period. The percentage of municipalities conducting hepatitis screening was already high at 95% in FY2017. The usage rate of government-subsidized screenings did not change. The subsidy usage rate for periodic viral hepatitis examination significantly increased. Meanwhile, the subsidy usage rate for antiviral treatment of hepatitis B increased, whereas that for hepatitis C decreased. The number of certified healthcare workers providing care for hepatitis patients increased significantly, and these workers were efficiently placed at regional core centers, institutions specialized in liver diseases, health care centers, and municipal governments. Liver cancer mortality was positively correlated with hepatitis screening, subsidies for periodic examinations, and the number of hepatitis medical care coordinators but was negatively correlated with subsidies for anti-HCV therapy, suggesting that rigorous countermeasures were implemented in prefectures with high liver cancer mortality. The developed PIs could be a useful tool for monitoring government efforts and achievements, thereby providing basic data for setting practical goals in liver cancer prevention.

Setting a quality indicator for actual surgery time relative to scheduled surgery time in the context of increasing robotic-assisted thoracic surgery cases.

This study aimed to demonstrate to the involved departments the goal of increasing the number of robotic-assisted thoracic surgery (RATS) cases/surgeons and acceptable surgery times. This retrospective study included 1572 patients who underwent thoracic surgery from fiscal year (FY) 2018 to FY 2021. The factors evaluated included the number of surgery cases and actual and scheduled surgery times. The total number of RATS and total surgery cases increased after the quality indicator (QI) setting (n = 363, 360, 417, and 432 in FY 2018, 2019, 2020, and 2021, respectively). In FY 2020, 93.3% of the QI target was achieved, while in FY 2021, 88% was achieved. The number of RATS lobectomy/segmentectomy increased as the FY progressed (n = 31, 47, 58, and 116 in FY 2018, 2019, 2020, and 2021, respectively). The mean surgical time by RATS starters decreased in FY 2020 and 2021 (171.4min.; 74 cases; seven RATS starters) compared with those in FY 2018 and 2019 (198.0min.; 57 cases; six RATS starters) (P = 0.002). The goal of increasing the number of surgery cases and RATS cases/surgeons within the given framework was achieved by setting the QI.

NEED FOR SUPPORT FOR PERSONS WITH DISABILITIES IN ELDER ABUSE

Abstract Among the elder abuse cases reported to Matsudo City, Chiba Prefecture (population 487,091 as of April 1, 2017) from fiscal year (FY) 2017 to FY 2019. Of the 525 reported cases, 497 for which records could be judged to be accurate were included in the study. There were 119 cases (23.9%) in which the abusers were presumed to have a disability. Out of these 119 cases, the abusers of 86 (72.3%) cases were not involved with health and welfare policies for people with disabilities or such involvement had been suspended. If the abuser had received support in the field of health and welfare for the disabled or as a person in need at an early stage, the elder abuse might not have occurred. Support for people with disabilities and support for persons in financial need are required before they become abusers.