Healthcare Facilities In Japan Research Articles

Establishing the cutoff value of near visual acuity for assessment of early presbyopia.

There is limited evidence to evaluate the numerical cutoff point for detecting early presbyopia. Thus, we aimed to establish a clinically relevant optimal cutoff value of near visual acuity for detecting early presbyopia. Prospective diagnostic accuracy study. We included consecutive individuals aged ≥ 20 years with a binocular-corrected distance visual acuity of ≥ 20/25 who did not undergo ophthalmic surgery between December 17, 2020 and December 19, 2021, at two healthcare facilities in Japan. Binocular distance-corrected near visual acuity at 40cm, accommodative amplitude, awareness of presbyopia, and Near Activity Visual Questionnaire scores were examined. The optimal cutoff values of distance-corrected near visual acuity for diagnosing early presbyopia were evaluated using receiver operating characteristic plots. Among 115 participants, 74 (64.3%) had presbyopia. The proportion of participants with no difficulty performing near-vision tasks decreased markedly when near visual acuity decreased to 20/20 (> 0.00 logMAR). A cutoff value of 0.00 logMAR for distance-corrected near visual acuity was optimal, showing high sensitivity of 56.76% and specificity of 92.68%, as opposed to the commonly used cutoff value of 0.40 logMAR (20/50; sensitivity, 9.46% and specificity, 100%) for diagnosing early presbyopia. Near visual acuity of 0.00 logMAR (20/20) could be the optimal cutoff value for diagnosing early presbyopia.

Molecular Epidemiology of Carbapenem-Resistant Klebsiella aerogenes in Japan.

Information regarding Klebsiella aerogenes haboring carbapenemase in Japan is limited. A comprehensive nationwide survey was conducted from September 2014 to December 2022, and 67 non-duplicate strains of carbapenem-resistant K. aerogenes were isolated from 57 healthcare facilities in Japan. Through genetic testing and whole-genome sequencing, six strains were found to possess carbapenemases, including imipenemase (IMP)-1, IMP-6, New Delhi metallo-β-lactamase (NDM)-1, and NDM-5. The strain harboring blaNDM-5 was the novel strain ST709, which belongs to the clonal complex of the predominant ST4 in China. The novel integron containing blaIMP-1 featured the oxacillinase-101 gene, which is a previously unreported structure, with an IncN4 plasmid type. However, integrons found in the strains possessing blaIMP-6, which were the most commonly identified, matched those reported domestically in Klebsiella pneumoniae, suggesting the prevalence of identical integrons. Transposons containing blaNDM are similar or identical to the transposon structure of K. aerogenes harboring blaNDM-5 previously reported in Japan, suggesting that the same type of transposon could have been transmitted to K. aerogenes in Japan. This investigation analyzed mobile genetic elements, such as integrons and transposons, to understand the spread of carbapenemases, highlighting the growing challenge of carbapenem-resistant Enterobacterales in Japan and underscoring the critical need for ongoing surveillance to control these pathogens.

Nationwide status of progestogen treatment to prevent spontaneous preterm birth: A questionnaire survey for childbirth healthcare facilities in Japan.

This study aimed to investigate the current status of progestogen treatment for pregnant women at a high risk for preterm birth (PTB) in childbirth healthcare facilities in Japan. A web-based nationwide questionnaire survey regarding progestogen use for prevention of PTB was conducted among childbirth healthcare facilities from 2019 to 2021. Valid responses were obtained from 528 facilities (25.2% of those surveyed), including 155 tertiary perinatal facilities (making up 92.3% of all tertiary perinatal care facilities). In the survey period, progestogen treatment was implemented in 207 facilities (39.2%) for PTB prevention. Regarding types of progestogens, 17α-hydroxyprogesterone caproate was used in 170 facilities (82.1%), with a low dose (125 mg/week) administered in 62.9% of the facilities to comply with the regulations of the national health insurance system, although 250 mg/week is considered the best dose. Vaginal progesterone was used in 36 facilities (17.4%), although the cost of vaginal progesterone was not covered by health insurance. Of the facilities not administering progestogen treatment, approximately 40% expressed that vaginal progesterone would be their first choice for PTB prevention in daily practice if it would be covered by health insurance in the future. Due to the current regulations of the Japanese health insurance system, 17α-hydroxyprogesterone caproate, rather than vaginal progesterone, was mainly used for PTB prevention. Despite global evidence supporting vaginal progesterone as the approach with the highest efficacy, only a limited number of facilities have utilized it due to the current drug use regulations in Japan.

Electrocautery ablation of high-grade anal intraepithelial lesions: A protocol for a clinical trial

Background: Anal cancer is predominantly caused by the human papillomavirus. The use of high-resolution anoscopy (HRA) for screening, followed by appropriate therapeutic interventions, is progressively being acknowledged as a standardized procedure to manage anal cancer. Commonly, lesions identified as potentially high-grade squamous intraepithelial lesions undergo biopsy and receive treatment if classified as anal intraepithelial neoplasia (AIN) grade 2 or 3. Numerous studies have underscored the substantial efficacy of electrocautery ablation in treating grade 2 or 3 AIN. However, relapse within and outside the targeted areas after intervention is a clinical problem. Postintervention recurrence within and beyond the initial targeted areas presents a significant clinical challenge. Most healthcare facilities in Japan do not offer electrocautery ablation. An initial pilot study demonstrated the safety and efficacy of electrocautery ablation. Consequently, we aimed to scrutinize the effectiveness and safety profile of electrocautery ablation procedures using a larger sample size. Methods: This single-arm, open-label intervention trial aims to examine the efficacy and safety associated with electrocautery ablative treatments by utilizing high-frequency medical instruments. The cohort will comprise patients diagnosed with grade 2 or 3 AIN who will then undergo ablative treatments. Subsequent follow-ups will be scheduled at intervals of 6, 12, 24, and 36 months posttreatment, incorporating HRA-guided sextant biopsies to monitor disease progression. To minimize the chances of overlooking the lesions before and after the treatment phase, systematic HRA-guided sextant biopsies will be performed. Within the scope of this study, a sextant biopsy necessitates a minimum of 6 biopsy procedures in various directions, irrespective of any abnormalities detected during HRA inspections. The principal objective of this study is to ascertain the 12-month recurrence rate, with secondary objectives focusing on monitoring adverse events and recurrence rates at the 6-, 24-, and 36-month time points. Conclusion: This study aims to provide substantial data concerning the effectiveness and safety parameters of electrocautery ablation as a viable alternative treatment for patients with grade 2 or 3 AIN.

The emerging threat of methicillin-resistant Staphylococcus aureus (MRSA) clone ST22-PT, carrying both Panton-Valentine leucocidin and toxic shock syndrome toxin 1 genes.

Some MRSA strains produce Panton-Valentine leucocidin (PVL) and/or toxic shock syndrome toxin 1 (TSST-1), which are associated with severe infectious diseases. Although PVL- or TSST-1-positive strains have been isolated worldwide, strains carrying both PVL and TSST-1 genes are rare and sporadic. The objective of this study was to characterize these strains from Japan. A total of 6433 MRSA strains isolated in Japan between 2015 and 2021 were analysed. Molecular epidemiological and comparative genomic analyses were conducted on PVL- and TSST-1-positive MRSA strains. A total of 26 strains from 12 healthcare facilities were PVL positive and TSST-1 positive, and all were classified as clonal complex (CC) 22. These strains exhibited similar genetic features to each other and were named as ST22-PT according to a previous report. Twelve and one of the ST22-PT strains were identified in patients with deep-seated skin infections and toxic shock syndrome-like symptoms, which are typical clinical features of PVL-positive and TSST-1-positive Staphylococcus aureus, respectively. Whole-genome comparative analysis revealed that the ST22-PT strains were highly similar to PVL- and TSST-1-positive CC22 strains isolated in several countries. Evaluation of the genome structure showed that ST22-PT possessed ΦSa2 harbouring PVL genes and a unique S. aureus pathogenicity island harbouring the TSST-1 gene. ST22-PT strains have recently emerged from several healthcare facilities in Japan, and ST22-PT-like strains have been identified in several countries. Our report highlights that the risk of international spread of PVL- and TSST-1-positive MRSA clone ST22-PT needs to be further investigated.

PS-C19-8: A COMPARISON OF THE MEDICATION COST AND INCIDENCE RATE OF CARDIOVASCULAR EVENTS BETWEEN INTENSIVE AND STANDARD ANTIHYPERTENSIVE PHARMACOTHERAPIES IN JAPAN

Objective: Hypertension is a major health challenge, imposing an enormous economic burden as well as health burden worldwide. In Japan, the economic burden of hypertension and related diseases is estimated to be JPY1.7 trillion (USD 13 billion) per year, around 4% of total healthcare expenditures. This study aimed to compare treatment outcomes and costs between intensive and standard pharmacotherapies, focusing on the types of antihypertensive drugs and prescribing patterns. Design and method: We performed a retrospective cohort study using electronic medical record data obtained from 34 healthcare facilities in Japan. The incidence of cardiovascular events captured via claims data was set to be the outcome measure. Multivariable mixed effects Cox-proportional hazards model was applied to compare the costs and the outcomes from intensive pharmacotherapy arm (i.e., short prescribing interval/expensive drugs) and standard one (i.e., long prescribing interval/low-cost drugs). Results: During 6,013 person-years of follow-up, 74 events were observed. While age at the beginning of treatment had significant impact on the incidence of cardiovascular events [Hazard Ratio, 1.05 (95%CI 1.02 - 1.07); p < 0.001], no associations with cardiovascular events were found for mechanism of drug action (CCB) [1.37, (95%CI 0.839 - 2.24); p = 0.21] and for short prescribing interval (less than 30 days) [1.17 (95%CI 0.695 - 1.98); p = 0.55]. The mean medication costs per day per patient of CCB and ARB were JPY 28.9 and JPY 51.8, respectively. Conclusions: No significant impacts on treatment outcomes were observed for drug type and prescribing interval, although the medication costs of intensive pharmacotherapy arm were more expensive than standard arm.

First nationwide survey of infection prevention and control among healthcare facilities in Japan: impact of the national regulatory system

BackgroundInfection prevention and control (IPC) measures in Japan are facilitated by a financial incentive process at the national level, where facilities are categorized into three groups (Tier 1, Tier 2, or no financial incentive). However, its impact on IPC at the facility level using a validated tool has not been measured.MethodsA nationwide cross-sectional study was conducted from August 2019 to January 2020 to evaluate the situation of IPC programs in Japan, using the global IPC Assessment Framework (IPCAF) developed by the World Health Organization. Combined with the information on the national financial incentive system, the demographics of facilities and each IPCAF item were descriptively analyzed. IPCAF scores were analyzed according to the facility level of care and the national financial incentive system for IPC facility status, using Dunn-Bonferroni and Mann–Whitney U tests.ResultsFifty-nine facilities in Japan responded to the IPCAF survey: 34 private facilities (57.6%) and 25 public facilities (42.4%). Of these, 11 (18.6%), 29 (49.2%), and 19 (32.3%) were primary, secondary, and tertiary care facilities, respectively. According to the national financial incentive system for IPC, 45 (76.3%), 11 (18.6%), and three (5.1%) facilities were categorized as Tier 1, Tier 2, and no financial incentive system, respectively. Based on the IPCAF total score, more than half of the facilities were categorized as “Advanced” (n = 31, 55.3%), followed by “Intermediate” (n = 21, 37.5%). The IPCAF total score increased as the facility level of care increased, while no statistically significant difference was identified between the secondary and tertiary care facilities (p = 0.79). There was a significant difference between Tier 1 and Tier 2 for all core components and total scores. Core components 5 (multimodal strategies for implementation of IPC interventions) and 6 (monitoring/audit of IPC and feedback) were characteristically low in Japan with a median score of 65.0 (interquartile range 40.0–85.0) and 67.5 (interquartile range 52.5–87.5), respectively.ConclusionsThe national financial incentive system was associated with IPC programs at facility level in Japan. The current financial incentive system does not emphasize the multimodal strategy or cover monitoring/audit, and an additional systematic approach may be required to further promote IPC for more practical healthcare-associated infection prevention.

Experiences of patients with cancer at health care facilities in Japan: results from a nationwide survey

BackgroundTo elucidate the experience of patients with cancer from diagnosis to early survivorship in Japan using a nationwide questionnaire survey, and to inform the current progress of the cancer control programs.MethodsThe survey was sent to a representative sample of adult patients with cancer identified from the national database of hospital-based cancer registries. The patients’ responses were compared across three groups: patients with rare cancers, patients aged < 40 years, and patients with non-rare cancers aged ≥40 years.ResultsOf 20,488 patients invited to participate in the survey, 8935 (43.6%) responded. Respondents reported an average score of 7.9 out of 10 on global ratings of care. Patients with rare cancers experienced a longer time to diagnosis but the shortest time from diagnosis to first treatment (p < 0.05). Patients aged < 40 years rated worse for the majority of the survey items, especially on items that related to communication with medical staff and items referring to early survivorship.ConclusionThe care experienced by patients with cancer in Japan varies on the basis of age group and cancer type. Efforts should be directed to ensuring prompt access to diagnostic facilities for patients with rare cancers and providing sufficient support to younger patients.

Associations of Ambient Air Pollutant Concentrations With Respiratory Symptoms and Perceived Health Status in Japanese Adults With and Without Chronic Respiratory Diseases: A Panel Study.

ObjectivesIn recent years, transboundary air pollution from mainland East Asia has led to growing concerns about air pollution in Japan. Air pollution is reportedly associated with the exacerbation of respiratory diseases. In this study, we assessed the effects of air pollution on respiratory symptoms and the health status of participants with and without chronic respiratory diseases.MethodsParticipants (n=2753) with and without chronic respiratory diseases who visited healthcare facilities in Japan during February from 2010 to 2015 filled out a self-report questionnaire regarding their symptoms and perceived health status. Participants were followed up during April-May and June-July.ResultsOxidant concentrations were associated with respiratory symptoms, overall health, and quality of life (QoL). Suspended particulate matter (SPM) and particulate matter <2.5 μm levels were associated with physical fitness; SPM was also associated with QoL. Recent experience of an Asian sand dust event had a significant effect on allergic symptoms, change in health, and QoL.ConclusionsRespiratory symptoms were more strongly affected by oxidants than by other pollutants. Significant associations of air pollutants were found with a comprehensive range of items related to perceived health status, including overall health and QoL. Although the effects of air pollutants on respiratory symptoms and health status were more apparent among patients with respiratory diseases, the adverse effects of air pollutants were significant even among participants without such conditions.

Guiding patients to appropriate care: developing Japanese outpatient triage nurse competencies.

ABSTRACTJapanese patients often seek hospital services without a primary provider’s referral. A triage nurse who is the initial point of contact for a patient is challenged with the task of expertly evaluating the urgency of the condition and selecting the appropriate specialty service for every patient’s needs. A triage nurse must also recognize any conditions requiring emergency medical services instead of a specialty outpatient service. A modified Delphi method was used to establish expert consensus regarding triage nursing competencies for secondary and higher-level health care facilities in Japan.The initial Delphi round was completed using a questionnaire of 80 competencies that were evaluated by 85 Japanese nurse experts with in-depth knowledge of triage and/or the current Japanese hospital system. Four additional competency items were added based on the experts’ suggestions for a total of 84 items. The experts rated these items on a 7-point Likert scale based on importance. Minimal attrition rate yielded consistent and rich results.The results were analyzed to identify items rated as very important by the majority. Twenty-two items were included in the final list of competencies. The authors then refined the language and reorganized the items into four proposed domains. The proposed domains and the refined list of competencies provide a foundation for the development of training programs for outpatient triage nurses in the current Japanese health care system.

Occurrence and fate of endotoxin activity at drinking water purification plants and healthcare facilities in Japan

Occurrence of residual endotoxin activity (ET) in dialysis water and also tap water as its source is a matter of great concern to medical professionals conducting dialysis therapy at healthcare facilities (HCFs). The present study was performed to determine the occurrence and fate of the ET at selected Japanese drinking water purification plants and HCFs between 2014 and 2016. Chemical coagulation and sedimentation, rapid sand filtration, and membrane filtration were highly effective to decrease both ET dissolved in water (free-ET) and ET bound to cells/particles (bound-ET). Moderate decreases in bound-ET and limited decreases in free-ET were observed by chlorination and ozonation. Bacterial activated carbon filtration was a major cause of significant increases in endotoxin activity during the course of drinking water purification process. Levels of residual ET in water supplied to HCFs were strongly affected by their source waters and the configurations of water purification processes served. Microbial regrowth on the premises, from water tanks to faucets at HCFs could also contribute to ET increases in tap water.

Osteoporosis-Related Fractures in HIV-Infected Patients Receiving Long-Term Tenofovir Disoproxil Fumarate: An Observational Cohort Study.

IntroductionPatients with HIV infection may have a higher prevalence of osteoporosis and osteopenia, as well as an increased risk of bone fracture compared with non-HIV-infected individuals. Antiretroviral therapy is thought to be one of factors associated to osteoporosis-related bone fractures.ObjectiveThe aim of this study was to assess the effects of long-term exposure to tenofovir disoproxil fumarate (TDF) on the cumulative risk of osteoporosis-related bone fractures in Japanese patients with HIV infection.DesignThis observational cohort study comprised a joint HIV-related drug survey of patients treated with TDF between April 2004 and March 2013.MethodsThirty-five healthcare facilities in Japan participated in the survey. The incidence of osteoporosis-related fractures was extracted from all adverse events (AEs) using standardized Medical Dictionary for Regulatory Activities queries, and used to calculate the fracture rate per 10,000 patient-years (PY). Kaplan–Meier analysis was used to estimate the cumulative probability of fracture during the study period.ResultsA total of 3251 patients who received TDF or TDF/emtricitabine between April 2004 and March 2013 were analyzed in this study; 93.5% of patients were male. The fracture rate was 13.5 per 10,000 PY in males and 42.2 per 10,000 PY in females. The mean age for male patients with osteoporosis-related fracture was 43.2 years, whereas it was 65.7 years in female patients. The cumulative probability of osteoporosis-related fracture increased after ≥ 5 years of TDF exposure. The rate of hip fracture (95% confidence interval) was 7.2 (3.1–14.2) per 10,000 PY.ConclusionsAmong HIV-infected patients in Japan, treatment with TDF for ≥ 5 years increases the risk of bone fractures in younger men, in addition to that seen in older post-menopausal women.

Relationship between health literacy, health information access, health behavior, and health status in Japanese people

ObjectiveTo examine the relationship between health literacy (HL), health information access, health behavior, and health status in Japanese people. MethodsA questionnaire survey was conducted at six healthcare facilities in Japan. Eligible respondents aged 20–64 years (n=1218) were included. Path analysis with structural equation modeling was performed to test the hypothesis model linking HL to health information access, health behavior, and health status. ResultsThe acceptable fitting model indicated that the pathways linking HL to health status consisted of two indirect paths; one intermediated by health information access and another intermediated by health behavior. Those with higher HL as measured by the 14-item Health Literacy Scale (HLS-14) were significantly more likely to get sufficient health information from multiple sources, less likely to have risky habits of smoking, regular drinking, and lack of exercise, and in turn, more likely to report good self-rated health. ConclusionHL was significantly associated with health information access and health behavior in Japanese people. HL may play a key role in health promotion, even in highly educated countries like Japan. Practice implicationsIn order to enhance the effects of health promotion interventions, health professionals should aim at raising HL levels of their target population groups.

1391Policies for prevention of influenza transmission in health care facilities in Japan

1391Policies for prevention of influenza transmission in health care facilities in Japan

일본 공공의료시설 재편에 따른 신규병원 조성과정과 시설계획에 관한 연구

This research examined the development process of new hospitals and features of facilities plan according to merger and reorganization of public healthcare facilities in Japan, and it is summarized as below. First of all, in order to establish the reorganization plan according to merger of public hospitals, apprehending what is lacking or needed in local health service sector should come first. Reorganizing only with valuable medical institutions by grasping strengths and weaknesses of each hospital or Concentration and Choice that can maintain only strong points of each institution is needed based on this. Secondly, the way of creating new hospitals in the example is in the form of Consolidation focused style, which is reorganizing multiple public hospitals into 1~2, and Connection focused style, which is satellization of small and medium size medical institutions with one public hospital as center, having mutual relation. Thirdly, the function of connection with local hospital and the action to the emergency patient of new hospital is strengthened most, compared to the existing facilities. To have a connection with local hospital, plan with consideration of facility standardization and sharing need to be added to the stronghold hospital that the local medical function is concentrated.

Compliance of urinary continence care for Japanese residents on short‐stay respite services

ABSTRACTA guideline for urinary incontinence care among older adults in Japan has recommended that the care should be based on types and causes of urinary incontinence. This study examined nursing ward managers' perceptions regarding compliance of urinary continence care among nursing staff, for residents on short‐stay respite services (SSRS) at health care facilities in Japan, and to examine the relationship between the compliance and residents' levels of activities of daily living upon discharge. We sent questionnaires to nursing managers at all facilities in the Kanto and Shinetsu regions in Japan (1072 facilities). The questionnaires asked about SSRS, compliance of urinary continence care for residents on the respite services and the residents' levels of activities of daily living upon discharge. A logistic regression analysis was performed with overall improvement of activities of daily living among the residents as a dependent variable and the factors that could be related to the activity levels and compliance of the care as independent variables. The final sample comprised 313 participants (response rate: 29·2%). Among the managers, 64·6% reported urinary incontinence types in the residents identified at their facilities, and 69·4% disagreed in response to a question on whether the activities of daily living levels of the residents had improved upon discharge. Logistic regression analysis showed that identifying urinary incontinence types (odds ratio 3·38, 95% confidence interval 1·71–6·69) was associated with improvement of activity levels for the residents. Identification of residents' urinary incontinence types should be carried out via systematic approaches by nursing staff.

Prevalence of and factors related to pain among elderly Japanese residents in long‐term healthcare facilities

We aimed to examine the pain prevalence among residents who stayed at healthcare facilities for the elderly requiring long-term care in Japan, and explore factors related to self-reported pain. This was a cross-sectional study. All residents in nine healthcare facilities in Japan were asked to participate in the present study, with the exclusion of short-term and temporary residents. Demographic data were collected from participating residents' medical records. The residents were evaluated using the Barthel Index, the Folstein Mini-Mental State Examination and Self-Rated Health measures. After/during patients underwent a body movement protocol, self-reported pain/Abbey Pain Scale scores were obtained. The χ(2) -test, t-test and logistic regression analyses were carried out to identify factors related to pain. Data were obtained from 246 residents. The prevalence of pain among the residents was 47.2%. Self-rated health status and history of fracture were significantly associated with self-reported pain. Logistic regression analysis showed that self-rated health status (odds ratio [OR] 0.50, 95% confidence interval (CI) 0.28-0.88), mental health diagnoses (OR 9.18, 95%CI 1.27-66.52) and respiratory diagnoses (OR 0.16; 95%CI 0.03-0.97) were associated with pain experienced by residents. Nearly half of the residents suffered from pain on movement. The pain of these elderly residents should be managed in order to improve their health status.

A Questionnaire Survey for Living Environment of Special Old Age Nursing Homes and Elderly Health Care Facilities in Japan

A Questionnaire Survey for Living Environment of Special Old Age Nursing Homes and Elderly Health Care Facilities in Japan

Low back pain deprives the Japanese adult population of their quality of life: a questionnaire survey at five healthcare facilities in Japan

To estimate the degree to which low back pain (LBP) deprives the Japanese adult population of their quality of life (QOL) in terms of quality-adjusted life-years (QALYs). A questionnaire survey was conducted among participants of health examinations at five healthcare facilities in Japan. Age- and sex-specific mean values of the EQ-5D score were calculated for (1) those who reported LBP and interference with daily activities (IDA) due to the pain (n = 251), (2) those who reported LBP but no IDA (n = 955), and (3) those who reported no musculoskeletal pain (n = 2887). To estimate the loss of QALYs due to LBP in the Japanese adult population, we multiplied the age- and sex-specific mean differences of the EQ-5D scores between the LBP with (or without) IDA group and the no pain group by the corresponding age- and sex-specific numbers of people with LBP with (or without) IDA in Japan. Among the entire Japanese adult population of 103 million people, 11,800,000 (4,910,000 men and 6,890,000 women) were estimated to suffer from LBP, and 2,403,000 (976,000 men and 1,427,000 women) people were estimated to encounter IDA due to the pain. The loss of QALYs due to LBP in the Japanese adult population was estimated at 947,000 (9.18 per 1000 population). The loss of QALYs due to IDA in the LBP people was estimated at 139,000 (1.35 per 1000 population). The estimated loss of QALYs due to LBP suggests that LBP substantially deprives the Japanese adult population of their QOL.

Survey Report of Recall Due to Sterilization Failure in Health Care Facilities in Japan

Survey Report of Recall Due to Sterilization Failure in Health Care Facilities in Japan