Nationwide Questionnaire Survey Research Articles

Unmet need for palliative rehabilitation in inpatient hospices/palliative care units: a nationwide post-bereavement survey.

In end-of-life care, rehabilitation for terminally ill cancer patients is inconsistently provided and rarely discussed. We sought to clarify the prevalence of unmet rehabilitation need for patients admitted to inpatient hospice/palliative care units as perceived by bereaved family members. We conducted a nationwide questionnaire survey of 1001 family members of cancer patients who died at inpatient hospices/palliative care units. For cancer patients who did not receive rehabilitation, we asked if family members perceived that the patient would have wanted rehabilitation intervention. Data were obtained from 416 respondents. Of these, 281 (67.5%) cases received no rehabilitation. The need for physical modalities was the most frequently reported (27.8%; 95% CI: 22.6-33.4), followed by relief of dyspnea (25.6%; 95% CI: 20.6-31.1) and treatment of edema (23.8%; 95% CI: 19.0-29.3). A non-negligible proportion of bereaved families reported unmet need for rehabilitation related to symptom management in inpatient hospices/palliative care units.

Career - Employee or Beneficiary? Implications of Careers’ Status on Public Finance - Case of the European Union

Purpose: This paper aims to indicate the critical role as an important actor of public policy and the undervalued entity with an essential impact on public finance. Design/Methodology/Approach: The article employs document analysis, desk research, statistical analysis of the caregiver's households' budgets from a nationwide questionnaire survey in 2015 and 2020. Findings: The empirical results show that in countries with underdeveloped care infrastructure, the lack of caregivers' input can induce considerable increases in public burdens within the next 50 years. As the group of caregivers is not (economically) homogeneous, public actions should aim to prevent the impact of pandemic risk and provide caregivers with adequate income for the activities performed, treated, or as an employee or as an allowance. Practical Implications: The ongoing (although very late) process of reforms on long-term care within UE should be more evidence-based to avoid further income stratification between caregivers households and a rapid increase in public finance expenditure. Originality/value: The article presents the original concept of the classification of caregivers' income, changes taking place over the last five years in the forms of careers' income in the EU, and the selected results of the author's research on the budgets of caregivers' households in Poland in 2015 and 2020.

Nationwide survey of the coronavirus disease 2019 prevention and treatment systems for kidney disease patients: a study of Japanese Society of Nephrology-certified educational facilities.

BackgroundThere are no reports of a large-scale survey on the infection prevention measures against coronavirus disease 2019 (COVID-19) in nephrology facilities. This study investigated the facility-level nephrology practices adopted during the COVID-19 pandemic and their associated challenges. Additionally, the treatment patterns and outcomes of chronic kidney disease (CKD) patients with COVID-19 were reviewed.MethodsWe conducted a nationwide questionnaire survey of 704 educational facilities that were certified by the Japanese Society of Nephrology (JSN) from October 20, 2020 to November 16, 2020. The questionnaire reviewed the facility characteristics, infection prevention measures taken during routine nephrology practice, impact of COVID-19 on nephrology practice, experiences in managing CKD patients with COVID-19, and nosocomial transmission in the nephrology unit.ResultsOf the 347 facilities that responded, 95.1% checked outpatients’ body temperatures and COVID-19 symptoms at their visits. To reduce face-to-face contact, 80% and 70% of the facilities lengthened the intervals between outpatient visits and introduced online/telephonic consultations, respectively. As a result, more than half of the hospitals experienced a decrease in the numbers of outpatients and inpatients (64% and 50%, respectively). During the study period, 347 facilities managed 479 CKD patients with COVID-19. Oxygen administration and mechanical ventilation were performed for 47.8% and 16.5% of the patients, respectively, with a 9.2% total mortality rate.ConclusionThis survey demonstrated that JSN-certified educational nephrology facilities adopted multiple measures to manage the COVID-19 pandemic; however, they faced several challenges. Sharing these experiences could standardize these approaches and prepare us better for the future.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10157-021-02082-z.

Infection prevention measures for patients undergoing hemodialysis during the COVID-19 pandemic in Japan: a nationwide questionnaire survey

BackgroundCoronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic affecting a variety of medical treatments, including hemodialysis. This study aims to investigate the implementation of infection control measures, to examine the shortage of personal protective equipment (PPE) and disinfectants, and to quantify the number of nosocomial COVID-19 transmissions in hemodialysis facilities in Japan during the pandemic.MethodsWe conducted a nationwide questionnaire survey between 20 October and 16 November 2020 (i.e., between the “second wave” and “third wave” in Japan) in the 4198 dialysis facilities of the Japanese Association of Dialysis Physicians and the Japanese Society for Dialysis Therapy. A total of 2227 facilities (53.0%) responded. The questionnaire consisted of (i) characteristics of facilities, (ii) infection prevention measures in routine dialysis practices, (iii) shortage of PPE, (iv) feasibility of various isolation measures, and (v) nosocomial transmission.ResultsHalf of the responding facilities were hospitals with multiple departments, and the other half were clinics specialized in dialysis. Several infection prevention measures such as health checks of staff and patients, donning of masks before and after hemodialysis, and disinfection of frequently contacted areas were implemented during the COVID-19 pandemic. There was a significant improvement in the implementation rate of these measures during the pandemic, compared to before it, which reached over 90%. More than half of the facilities reported a shortage of disposable masks (67.2%) and hand sanitizer alcohol (56.7%). Isolation of COVID-19 patients in private rooms was possible only in 52.7% of the facilities. The majority of facilities (73.3%) could not accept COVID-19 dialysis patients due to lack of space and manpower. Nosocomial transmission of COVID-19 occurred in 4.0% of the facilities. Of those infected, 51.9% were staff.ConclusionsThis survey revealed that most hemodialysis facilities in Japan had improved implementation of infection control measures and had shortage of PPEs and disinfectants, though some facilities did not implement infection prevention measures adequately, mainly due to the limited space of the facility. It may be recommended that each facility immediately establishes isolation measures to prepare for the pandemic of COVID-19.

Current status of community-acquired infection of COVID-19 in delivery facilities in Japan.

A nationwide questionnaire survey about community-acquired infection of coronavirus disease 2019 (COVID-19) was conducted in July 2020 to identify the characteristics of and measures taken by Japanese medical facilities providing maternity services. A case-control study was conducted by including medical facilities with (Cases) and without (Control) community-acquired infection of COVID-19. Responses from 711 hospitals and 707 private clinics were assessed (72% of all hospital and 59% all private clinics provided maternity service in Japan). Seventy-five COVID-19-positive pregnant women were treated in 52 facilities. Community-acquired infection was reported in 4.1% of the facilities. Of these, 95% occurred in the hospital. Nine patients developed a community-acquired infection in the maternity ward or obstetric department. Variables that associated with community-acquired infection of COVID-19 (adjusted odds ratio [95% confidence interval]) were found to be state of emergency prefecture (4.93 [2.17–11.16]), PCR test for SARS-CoV-2 on admission (2.88 [1.59–5.24]), and facility that cannot treat COVID-19 positive patients (0.34 [0.14–0.82]). In conclusion, community-acquired infection is likely to occur in large hospitals that treat a higher number of patients than private clinics do, regardless of the preventive measures used.

Risk factors for the onset of sick building syndrome: A cross-sectional survey of housing and health in Japan

People's living environments and lifestyles have drastically changed with the times. It is necessary to reassess risk factors associated with changes in social conditions to prevent sick building syndrome (SBS). This study aimed to determine the association between the onset of SBS and participant characteristics, social and residential environments, and lifestyle. An online nationwide questionnaire survey involving 4996 participants was conducted. The risk factors for SBS were examined using logistic regression analyses. The main risk factors for SBS were female sex (odds ratio [OR] = 1.20, confidence interval [CI] = 1.01–1.42) and young age (OR = 2.42, CI = 1.55–3.78). Other risk factors included having a medical history of allergies and mental illness (OR = 1.75, CI = 1.34–2.29), special housing specifications for the indoor environment (OR = 0.77, CI = 0.63–0.95), smoking indoors (OR = 1.25, CI = 1.00–1.55), and others. Women, young individuals, and those with a history of diseases, such as allergies and mental illness, had an increased risk of SBS, indicating that such individuals need to pay attention to chemical exposure. The study results indicate the possibility of preventing SBS by the careful selection of indoor environments and lifestyle.

Use of psychotropic drugs and drugs with anticholinergic properties among residents with dementia in intermediate care facilities for older adults in Japan: a cohort study

ObjectivesTo evaluate the prescription and discontinuation of psychotropic drugs (PD) and drugs with anticholinergic properties (DAP) in residents with dementia admitted to Roken, a major type of long-term care facility...

Awareness of Complications of Dental Treatment in Patients Treated with Drugs Affecting the Immune System : A Nationwide Questionnaire Survey of Dental Practitioners in Japan.

The aim of this study was to investigate the awareness and experience, among dental practitioners, of adverse events resulting from dental treatment of patients undergoing therapy with drugs that affect the immune system [angiogenesis inhibitors, biological agents, immunosuppressants, and disease-modifying anti-rheumatic drugs (DMARDs)]. For this purpose, a nationwide questionnaire survey was conducted. Questionnaires were sent to 2,050 dentists, of which 206 (10.1%) were completed and returned. The results showed that most dentists were aware of complications associated with dental treatment of patients treated with drugs that affect the immune system, and about half had actually experienced such complications. Delayed wound healing, osteonecrosis of the jaw (ONJ), and postoperative infections were reported. Whereas approximately 50% of dentists did not discontinue the drugs during dental treatment, about 18% did. During temporary drug discontinuation, some patients experienced aggravation of the primary disease, such as worsening of rheumatism, growth of tumors, and rejection reactions of transplanted organs. As for medical cooperation, only less than half of the dentists were asked for oral hygiene management by a physician prior to starting the drug treatment. Prospective studies are needed because evidence for dental treatments in patients treated with these drugs remains limited.

COVID-19 Vaccination Willingness among Chinese Adults under the Free Vaccination Policy.

(1) Background: China will provide free coronavirus disease 2019 (COVID-19) vaccinations for the entire population. This study analyzed the COVID-19 vaccination willingness rate (VWR) and its determinants under China’s free vaccination policy compared to a paid vaccine. (2) Methods: Data on 2377 respondents were collected through a nationwide questionnaire survey. Multivariate ordered logistic regression models were specified to explore the correlation between the VWR and its determinants. (3) Results: China’s free vaccination policy for COVID-19 increased the VWR from 73.62% to 82.25% of the respondents. Concerns about the safety and side-effects were the primary reason for participants’ unwillingness to be vaccinated against COVID-19. Age, medical insurance and vaccine safety were significant determinants of the COVID-19 VWR for both the paid and free vaccine. Income, occupation and vaccine effectiveness were significant determinants of the COVID-19 VWR for the free vaccine. (4) Conclusions: Free vaccinations increased the COVID-19 VWR significantly. People over the age of 58 and without medical insurance should be treated as the target intervention population for improving the COVID-19 VWR. Contrary to previous research, high-income groups and professional workers should be intervention targets to improve the COVID-19 VWR. Strengthening nationwide publicity and education on COVID-19 vaccine safety and effectiveness are recommended policies for decision-makers.

The home environment in a nationwide sample of multi-family buildings in Sweden: associations with ocular, nasal, throat and dermal symptoms, headache, and fatigue among adults.

Risk factors at home for ocular, nasal, throat and dermal symptoms, headache, and fatigue were studied in a nationwide questionnaire survey in Sweden, the BETSI study in 2006. Totally, 5775 adults from a stratified random sample of multi-family buildings participated. Associations between home environment factors and weekly symptoms were analyzed by multi-level logistic regression. In total, 8.3% had ocular symptoms; 11.9% nasal symptoms; 7.1% throat symptoms; 11.9% dermal symptoms; 8.5% headache and 23.1% fatigue. Subjects in colder climate zones had more mucosal and throat symptoms but less fatigue and ocular symptoms. Rented apartments had poorer indoor environment than self-owned apartments. Those living in buildings constructed from 1961 to 1985 had most symptoms. Building dampness, mold and mold odor were risk factors, especially headache and ocular symptoms. Lack of mechanical ventilation system was another risk factor, especially for headache. Environmental tobacco smoke (ETS), electric radiators, and crowdedness were other risk factors. Oiled wooden floors, recent indoor painting, and new floor materials were negatively associated with symptoms. In conclusion, building dampness, mold, poor ventilation conditions, crowdedness, ETS, and emissions from electric radiators in apartments in Sweden can increase the risk of ocular, nasal, throat and dermal symptoms, headache, and fatigue.

Nationwide multicenter questionnaire surveys on countermeasures against antimicrobial resistance and infections in hospitals

BackgroundThe goals of the National Action Plan on Antimicrobial Resistance (AMR) of Japan include “implementing appropriate infection prevention and control” and “appropriate use of antimicrobials,” which are relevant to healthcare facilities. Specifically, linking efforts between existing infection control teams and antimicrobial stewardship programs was suggested to be important. Previous studies reported that human resources, such as full-time equivalents of infection control practitioners, were related to improvements in antimicrobial stewardship.MethodsWe posted questionnaires to all teaching hospitals (n = 1017) regarding hospital countermeasures against AMR and infections. To evaluate changes over time, surveys were conducted twice (1st survey: Nov 2016, 2nd survey: Feb 2018). A latent transition analysis (LTA) was performed to identify latent statuses, which refer to underlying subgroups of hospitals, and effects of the number of members in infection control teams per bed on being in the better statuses.ResultsThe number of valid responses was 678 (response rate, 66.7%) for the 1st survey and 559 (55.0%) for the 2nd survey. More than 99% of participating hospitals had infection control teams, with differences in activity among hospitals. Roughly 70% had their own intervention criteria for antibiotics therapies, whereas only about 60 and 50% had criteria established for the use of anti-methicillin-resistant Staphylococcus aureus antibiotics and broad-spectrum antibiotics, respectively. Only 50 and 40% of hospitals conducted surveillance of catheter-associated urinary tract infections and ventilator-associated pneumonia, respectively. Less than 50% of hospitals used maximal barrier precautions for central line catheter insertion.The LTA identified five latent statuses. The membership probability of the most favorable status in the 2nd study period was slightly increased from the 1st study period (23.6 to 25.3%). However, the increase in the least favorable status was higher (26.3 to 31.8%). Results of the LTA did not support a relationship between increasing the number of infection control practitioners per bed, which is reportedly related to improvements in antimicrobial stewardship, and being in more favorable latent statuses.ConclusionsOur results suggest the need for more comprehensive antimicrobial stewardship programs and increased surveillance activities for healthcare-associated infections to improve antimicrobial stewardship and infection control in hospitals.

Esophageal cancer patients' survival after complete response to definitive chemoradiotherapy: a retrospective analysis.

Chemoradiotherapy is an alternative to surgery for esophageal cancer, with a putatively equivalent outcome. However, disease recurrence after a complete response is common and if follow-up surveillance detects recurrence, salvage treatments for potentially curable disease must follow. We conducted a nation-wide questionnaire survey of institutions in Japan certified by the Japanese Esophageal Society to investigate outcomes of primary thoracic esophageal cancer patients initially treated by chemoradiotherapy with complete response diagnoses. The primary endpoint was overall survival, the secondary endpoint disease recurrence. Outcomes of patients who had undergone salvage treatments were also investigated. Cases were excluded from analysis if endoscopic study, endoscopic biopsy, or computed tomography data were lacking. At 41 institutes 544 case records were collected; valid data on 392 patients were obtained; 5-year survival was 74.8%, 5-year disease-free survival, 66.8%. Clinical staging before treatment significantly affected both overall and disease-free survival rates, but differences between adjoining stages were unexpectedly small. The primary relapse site was classified as primary site (n = 58), regional lymph nodes (n = 36), or distant disease (n = 34). Salvage treatments with curative intent (surgery, endoscopic treatments, and additional radiation) were performed on 38, 23, and 4 cases; 5-year survival after esophagectomy (n = 22), endoscopic treatment (n = 23), and lymphadenectomy (n = 9) was 47.4%, 70.9%, and 33.3%, respectively. A quarter of patients developed recurrent disease, mostly locoregional, after complete response. Complete response patients with originally advanced stage disease had fair clinical outcomes; salvage treatments after locoregional recurrence achieved modest long-term survival.

Frequent Pet Contact as Risk Factor for Allergic Bronchopulmonary Aspergillosis in Cystic Fibrosis.

Aspergillus fumigatus (Af) frequently colonizes the respiratory tract of patients with cystic fibrosis (CF). Af is associated with loss of pulmonary function and allergic bronchopulmonary aspergillosis (ABPA), a hypersensitivity fungal lung disease. Environmental factors have impact on CF patients’ lung function variation. The aim of this nationwide questionnaire survey was to investigate the amount of CF patients with frequent pet contact including pet species and to examine the potential impact of frequent pet contact on the occurrence of Af colonization and ABPA diagnosis in these patients. The survey was carried out in 31 German CF centers in 2018. A total of 1232 who completed the surveys were included, and statistical analysis was performed by chi-squared test. Within the study cohort 49.8% of subjects (n = 614; CF patients < 18years: 49.4%, n = 234; ≥ 18years: 50.1%, n = 380) reported frequent contact to pets, of which 60.7% reported frequent contact to dogs, 42.3% to cats and other animals. Of those with frequent pet contact, 71.8% (n = 441) had contact to one pet or more pets from the same family. Af colonization was not significantly associated with frequent pet contact. ABPA diagnosis was documented in 16.7% (n = 206) of all included CF patients and was significantly associated with frequent pet contact (18.9%, n = 116, p = 0.042), confirming previous single center examinations. Particularly, patients with frequent contact to dogs showed an increased ABPA prevalence of 21.3%. Frequent pet contact might be a risk factor for ABPA. CF patients who are sensitized to Af should be informed about the increased risk to develop an ABPA by frequent pet contact. Patients with recurrent onset of ABPA should be evaluated in terms of frequent pet contact.

Changes in infection control practice for coronavirus disease 2019 (COVID-19) between 2020 and 2021: A nationwide questionnaire survey in Japan.

The coronavirus disease 2019 (COVID-19) pandemic has influenced current infection control practices in the healthcare setting. We surveyed 74 hospitals in Japan regarding changes in their infection control practices or policies between 2020 and the present. We found that the current hospital infection control practices for COVID-19 are adequate.

Accidental Swallowing of Dental Objects During Pediatric Dental Care in Thailand.

ABSTRACTAim:Accidental swallowing of dental objects can occur at any time during dental treatment, especially in child patients. Its severity and sequelae can range from minor to life-threatening. The study aimed to find out the occurrence of accidental swallowing and type of swallowed objects regarding pediatric dental treatment in Thailand.Materials and Methods:A nationwide questionnaire survey was performed among Thai dentists to anonymously report child patients’ accidental swallowing throughout their working experience for up to 10 years. Percentage and frequencies of accidental swallowing in child patients, as well as types of dental objects swallowed, were investigated. Association between factors of the respondents and their experiences was assessed by the logistic regression analysis.Results:Among 408 respondents, 99 respondents [24.26%, 95% confidence interval (CI): 20.10–28.42] had experienced accidental swallowing during pediatric dental treatment. All of them reported ingestion with only one respondent reporting aspiration. Extracted teeth, stainless steel crowns, and rubber cups were top on the list of swallowed items experienced by 11.52%, 8.33%, and 3.92% of respondents, respectively. Dental sharps such as endodontic files and orthodontic wires were reported as well. Dentists with higher educational backgrounds, mostly exposed to more complicated cases, were more likely to experience accidental swallowing (odds ratio of 2.90, 95% CI: 1.61–5.21).Conclusion:Our results indicate that accidental swallowing in child patients appeared to occur more frequently than anticipated. Awareness on patient safety of dental professionals and preventive measures against accidental swallowing when dealing with child patients should be greatly emphasized.

The use of information and communication technology in Japanese rural clinics.

High-speed information and communication technology (ICT) networks stretch all over Japan. However, their utility in facilitating rural healthcare remains uncharacterized. A nationwide questionnaire survey was sent by mail to 1,018 rural clinics constructed in a public manner in municipalities throughout Japan. ICT use was classified by type, including a doctor-to-doctor manner. Only 19% of the 303 clinics surveyed (with a response rate of 30%) used ICT. Specifically, 50% used it in a doctor-to-doctor manner, while 35% used it to obtain electronic medical records. Differences in proficiency levels among ICT users were cited by 21% of the respondents as a major problem associated with ICT use. In Japan, the prevalence of ICT use for rural healthcare appeared low. We suggest a policy reform to facilitate ICT use in rural healthcare.

Beliefs About Spiritual Pain among Palliative Care Physicians and Liaison Psychiatrists: A Nationwide Questionnaire Survey

Beliefs About Spiritual Pain among Palliative Care Physicians and Liaison Psychiatrists: A Nationwide Questionnaire Survey

Beliefs About Spiritual Pain among Palliative Care Physicians and Liaison Psychiatrists: A Nationwide Questionnaire Survey

Beliefs About Spiritual Pain among Palliative Care Physicians and Liaison Psychiatrists: A Nationwide Questionnaire Survey

Patterns of definitive radiotherapy practice for cervical cancer in South Korea: a survey endorsed by the Korean Radiation Oncology Group (KROG 20-06)

ObjectiveThe Korean Radiation Oncology Group conducted a nationwide questionnaire survey to evaluate the patterns of clinical practice for patients with cervical cancer receiving definitive radiation therapy (RT) in South Korea.MethodsPracticing radiation oncologists from 93 centers in South Korea were administered a questionnaire survey via e-mail. The survey focused on demographic characteristics, diagnostic evaluation, indications for definitive RT, RT techniques, RT field and dose prescription, lymph node (LN) boost RT, brachytherapy, and chemotherapy.ResultsThe response rate was 62.4% (58/93 institutions). Of the 2,134 patients treated at the radiation oncology department in 2019, 48.8% underwent definitive RT. The selection of patients for definitive concurrent chemoradiation therapy and RT field, and RT dose prescription varied greatly. The upper border of the pelvis was commonly used as the bony landmark for external beam RT (81%–88% of respondents). Most (96.6%) centers performed LN boost RT with median total doses of 59 Gy and 59.2 Gy for pelvic and retroperitoneal LN, respectively. With 50% of the centers offering brachytherapy, image-guided brachytherapy and volume-based prescription were applied in 48.3% and 37.9%, respectively. Upfront concurrent chemoradiation therapy with varying prescription doses was considered by 60.4% respondents in cases of supraclavicular LN metastasis.ConclusionMost differences were noted in the indications for treatment, RT field, and prescription dose. This finding can serve as a reference for establishing practical RT guidelines for the management of locally advanced cervical cancer.

Japanese Dialects for Expressing Symptoms in Palliative Care: A Nationwide Questionnaire Survey of Palliative Care Specialists

【目的】緩和ケア医が苦痛の評価を行う上で知っておくことが必要と考える方言を収集する．【方法】2020年2月から4月に緩和医療専門医・認定医762名を対象とした全国質問紙調査を実施した．緩和ケア医が苦痛の評価を行う上で知っておくことが必要と考える方言とその意味を自由記述で質問し，症状別に分類した．【結果】有効回答492名（64.8%）．233名（47.4％）が方言として116語を挙げ，苦痛を表現する方言は101語であった．「倦怠感・特定できない苦痛・全体的な調子の悪さ」（N=62），「疼痛」（N=13），「呼吸器・循環器症状」，「精神症状」（各N=8），「消化器症状」，「神経・筋・皮膚症状」（各N=5）であった．【結語】緩和ケア医が苦痛の評価を行う上で知っておくことが必要と考える方言とその意味が明らかになった．苦痛の適切な評価のために，苦痛を表す様々な方言があることを理解することが必要である．