Nationwide Survey In Japan Research Articles

Does the Integration of Migrants in the Host Society Raise COVID-19 Vaccine Acceptance? Evidence From a Nationwide Survey in Japan

Research indicates that integration contributes to maintaining health among migrants, yet little is known about the association between integration and vaccination acceptance. This study aimed to explore COVID-19 vaccine intention and acceptance, and the association between integration and vaccine hesitancy among migrants in Japan. We conducted an internet survey among migrants in Japan from October 5 to October 14, 2021. Among 1,455 participants, 11.6% reported hesitancy toward COVID-19 vaccination. We found that the overall integration and social integration were associated with the vaccination intention. Some commonly identified barriers (e.g., financial difficulties, language) were not related to COVID-19 vaccination acceptance among migrants in Japan. Highly integrated migrants were less likely to report vaccine hesitancy against COVID-19. To promote COVID-19 acceptance among migrants, customized intervention policies should focus on the migrants with a lower level of integration, especially those with little social connection with the locals.

A Longitudinal Study on Loneliness during the COVID-19 Pandemic in Japan.

The prolonged COVID-19 pandemic has exacerbated existing socioeconomic and health risk factors and added additional dimensions to the loneliness problem. Considering the temporal extension of COVID-19, which exposes people to various loneliness conditions, we examined the development of loneliness and changing risk factors based on age and gender. We used longitudinal data from Hiroshima University’s nationwide survey in Japan, conducted before and during the pandemic, to categorize loneliness into three types: long-term (feeling of loneliness experienced both before and during the pandemic), post-pandemic (feeling of loneliness experienced throughout the whole pandemic period), and fresh (feeling of loneliness experienced only in the last year of the pandemic). Loneliness categorization is important because the prolonged existence of the COVID-19 pandemic has added additional dimensions to the loneliness problem, which existing studies rarely identify. As a result, the distinction between long-term and fresh loneliness remains unexplained. The weighted logit regression results revealed that many Japanese people have remained or became lonely during the pandemic and identified variations based on gender, age, and changes in socioeconomic and health characteristics. More precisely, almost 52% of the participants experienced long-term loneliness, while 8% of the participants experienced post-pandemic loneliness, and nearly 5% experienced fresh loneliness. Age and having children were associated with long-term loneliness; gender, age, leaving full-time employment, financial literacy, change in health status, and change in depression were associated with post-pandemic loneliness; and gender, having children, living in rural areas, change in household assets, financial literacy, changes in health status, and changes in depression were associated with fresh loneliness. These results indicated that long-term, post-pandemic, and fresh loneliness have distinct characteristics. The Japanese government should devise distinctive solutions for people suffering from varying loneliness before and during the pandemic rather than adopting a generalized approach.

Impact of sustained viral response for hepatitis C virus on the outcomes of liver transplantation in hemophilic patients with human immunodeficiency virus/hepatitis C virus co-infection: A nationwide survey in Japan.

Human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co-infection from blood products for hemophilia has been a social problem in Japan, and liver transplantation (LT) for these patients has been a challenging procedure. However, with the advent of the direct-acting antiviral agent for HCV and change in the policy for prioritization of deceased donor LT, the results of LT for patients co-infected with HCV/HIV may have improved. This study was conducted to provide updated results of our nationwide survey of LT for patients co-infected with HCV/HIV, from January 1997 to December 2019. We collected data on 17 patients with HIV/HCV co-infection who underwent either deceased donor LT (n=5) or living donor LT (n=12). All the patients were men with hemophilia, and the median age was 41 (range, 23-61) years. The median CD4 count before LT was 258 (range, 63-751). Most patients had poor liver function before surgery with Child-Pugh grade C and a Model for End-stage Liver Disease score of 20 (range, 11-48). The right lobe was used for most grafts for living donor liver transplantation (n=10). Overall survival was significantly better with a sustained viral response (SVR) than without an SVR, and a univariate analysis indicated that SVR after direct-acting antiviral or interferon/ribavirin showed the highest hazard ratio for patient survival after LT. A multivariate analysis was not possible because of the limited number of cases. SVR for HCV showed the highest impact on the outcome of LT for patients with hemophilia co-infected with HIV/HCV. SVR for HCV should be achieved before or after LT for patients with hemophilia co-infected with HIV/HCV for a better outcome.

COVID-19 pandemic and the international classification of functioning in multiple system atrophy: a cross-sectional, nationwide survey in Japan

The present study aimed to determine the magnitude of and risk factors for the effects of the COVID-19 pandemic on the international classification of functioning, disability and health (ICF) in patients with multiple system atrophy (PwMSA). The study was part of a cross-sectional, nationwide, multipurpose mail survey for Japanese PwMSA from October to December, 2020. The primary outcome was the impact of the early COVID-19 pandemic on ICF functioning, consisting of body function, activity, and participation. Age, sex, disease type, disease duration, and dwelling place were asked as participants’ characteristics, and the multiple system impairment questionnaire (MSIQ), patient health questionnaire-2, modified rankin scale, barthel index, life-space assessment (LSA), and EuroQoL were examined. Multivariate logistic regression analyses were performed to identify independent risk factors for a worse function score due to the COVID-19 pandemic for each ICF functioning domain. A total of 155 patients (mean age 65.6 [SD 8.1] years; 43.9% women; mean disease duration 8.0 [SD 6.2] years; 65% MSA with cerebellar ataxia, 13% MSA with parkinsonism, 9% MSA with predominant autonomic features) were analyzed. Of the ICF functioning domains, the respondents reported that the early COVID-19 pandemic affected body function in 17.4%, activity in 17.6%, and participation in 46.0%. The adjusted multivariate model identified MSIQ and LSA as the two variables that independently contributed to all domains. The COVID-19 pandemic affected ICF functioning of PwMSA in Japan, and the severity of disease-related impairments and a large daily living space were common risk factors. These results help support the focus on patient characteristics for medical and social welfare support.

Effect of COVID-19 on hepatitis B and C virus countermeasures: Hepatologist responses from nationwide survey in Japan.

AimAchieving hepatitis B virus (HBV) and hepatitis C virus (HCV) elimination requires continuous and sustained high volumes of diagnosis and treatment which have been affected by the ongoing COVID‐19 pandemic. This study assessed COVID‐19 effect on hepatitis‐related services in Japan and compare Japan’s situation with global survey.MethodsWe conducted an online cross‐sectional questionnaire survey of hepatologist of the Japan Society of Hepatology from August to October 2021 by using the same questionnaire from which a survey was conducted globally to address the COVID‐19 effect on hepatitis‐related services. Hepatologists responded based on own impression of their affiliated institutions.ResultsA total of 196 hepatologists participated from 35 prefectures including 49.5% were in managerial positions. Around 40% survey participants reported a 1‐25% decline in HBV and HCV screening and confirmatory testing. In addition, 53.6% and 45.4% reported no decline in HBV and HCV treatment initiation, respectively. Comparing any level of decrease, less decline was observed in Japan for screening (HBV: 51% vs 56.3%, HCV: 51% vs 70.9%) and treatment initiation (HBV: 32.7% vs 52.4%, HCV: 41.8% vs 66%) from global survey. However, Patient anxiety/fear (67.4%), and loss of staff due to COVID‐19 response (49.0%) were reported as challenges to resume services to pre‐COVID‐19 levels.ConclusionAlthough in Japan all‐inclusive decline in HBV and HCV related services were lower than in other countries, a greater decline was observed in HBV and HCV screening and diagnosis than in treatment initiation. Prolonged anxiety/fear among patients, loss of staffs and facilities on COVID‐19 responses must be addressed to achieve the hepatitis elimination by 2030.This article is protected by copyright. All rights reserved.

Is Caring for Grandchildren Good for Grandparents' Health? Evidence From a Fourteen-wave Nationwide Survey in Japan.

BackgroundEnhanced female labor force participation is raising the importance of grandparents’ caring for their grandchildren. However, previous studies have reported mixed results of the association between grandchild care and grandparents’ health.MethodsLongitudinal data of 33,204 individuals born between 1946 and 1955 were collected from a 14-wave nationwide panel survey conducted from 2005 to 2018. We examined how caring for at least one co-residing grandchild aged <6 years was associated with grandparents’ psychological distress (defined by five or higher Kessler 6 score) and poor self-rated health in pooled cross-sectional, fixed-effects, and 3-year follow-up logistic models.ResultsWhile pooled cross-sectional models showed a positive association between grandchild care and grandparents’ health, the fixed-effects or follow-up logistic models did not find any significant association between them. In the case of grandmothers, the odds ratio of reporting psychological distress in response to caring for grandchildren was 0.98 (95% confidence interval [CI], 0.89–1.08) and 1.04 (95% CI, 0.85–1.27) observed from fixed-effects and 3-year follow-up models, respectively, compared to 0.86 (95% CI, 0.81–0.91) in the pooled cross-sectional model. Similar patterns were observed for self-rated health for grandmothers, while grandfathers’ health outcomes were not sensitive to grandchild care. These results contrasted with those of caring for parents, which had almost consistently a negative association with grandparents’ health.ConclusionThe results suggest that caring for grandchildren does not have a beneficial or detrimental effect on grandparents’ health.

Associations between health literacy and information-evaluation and decision-making skills in Japanese adults

BackgroundHealth literacy among Japanese is often low, making it difficult for them to evaluate health information and make informed decisions. However, the health literacy scales applied measure the perceived difficulty of health-related tasks; they do not directly assess the specific skills needed to perform the tasks: the skills to judge the reliability of diverse information using evaluation criteria and implement rational decision-making. Therefore, the study objectives were to investigate the following issues using a nationwide survey in Japan. (1) When obtaining information, to what extent do people apply criteria for evaluating information to confirm its reliability; when making decisions, to what extent do they seek out available options and compare pros and cons based on their own values? (2) How strongly are such skills associated with health literacy and demographic characteristics? (3) What opportunities are available to learn these skills?MethodsWe conducted an online questionnaire survey using a Japanese Internet research company; 3,914 valid responses were received. The measures comprised health literacy (European Health Literacy Survey Questionnaire), five items on information evaluation, four items on decision-making, and items on the availability and location of learning opportunities. We calculated Pearson correlations to explore the association of health literacy with information-evaluation and decision-making skills. Multivariate analyses were also conducted using these factors as dependent variables.ResultsFewer than half (30%–50%) of respondents reported always or often evaluating information and engaging in decision-making. Health literacy was significantly and positively correlated with the specific skills of information evaluation and decision-making (r = .26 and .30, respectively) as were multivariate analyses (beta = .15 and .22, respectively).Over 40% of respondents had never learned those skills. The most common resources for learning the skills were the Internet and television; less-used resources were schools and workplaces.ConclusionsBoth information-evaluation and decision-making skills were associated with health literacy. However, these skills are not sufficiently widespread in Japan because there are few opportunities to acquire them. More research is needed to raise awareness of the importance of such skills for improving health literacy and providing learning opportunities.

THU274 - Assessment of COVID-19 impact and response on hepatitis B virus and hepatitis C virus prevention and treatment from nationwide survey in Japan

THU274 - Assessment of COVID-19 impact and response on hepatitis B virus and hepatitis C virus prevention and treatment from nationwide survey in Japan

Needle tract seeding after endoscopic ultrasound-guided tissue acquisition of pancreatic tumors: A nationwide survey in Japan.

Endoscopic ultrasound-guided tissue acquisition (EUS-TA) plays a crucial role in the diagnosis of pancreatic tumors. The present study aimed to investigate the current status of needle tract seeding (NTS) after EUS-TA of pancreatic tumors based on a nationwide survey in Japan. Patients who underwent surgical resection of primary pancreatic tumors after EUS-TA performed between April 2010 and March 2018 were surveyed. The incidence rates of NTS were determined, and compared in patients with pancreatic ductal adenocarcinomas (PDACs) and other tumors, and in patients who underwent transgastric and transduodenal EUS-TA of PDACs. The detailed features and prognosis of patients with NTS were also assessed. A total of 12,109 patients underwent surgical resection of primary pancreatic tumors after EUS-TA. The overall incidence rate of NTS was 0.330%, and the NTS rate was significantly higher in patients with PDAC than in those with other tumors (0.409% vs. 0.071%, P=0.004). NTS was observed in 0.857% of patients who underwent transgastric EUS-TA, but in none of those who underwent transduodenal EUS-TA. Of the patients with NTS of PDACs, the median time from EUS-TA to occurrence of NTS and median patient survival were 19.3 and 44.7 months, respectively, with 97.4% of NTS located in the gastric wall and 65.8% of NTS resected. The patient survival was significantly longer in patients who underwent NTS resection than in those without NTS resection (P=0.037). NTS appeared only after transgastric not after transduodenal EUS-TA. Careful follow-up provides an opportunity to remove localized NTS lesions by gastrectomy.

Impact of COVID-19 on the Volume of Acute Stroke Admissions: A Nationwide Survey in Japan

This study aimed to measure the impact of the COVID-19 pandemic on the volumes of annual stroke admissions compared with those before the pandemic in Japan. We conducted an observational, retrospective nationwide survey across 542 primary stroke centers in Japan. The annual admission volumes for acute stroke within 7 days from onset between 2019 as the pre-pandemic period and 2020 as the pandemic period were compared as a whole and separately by months during which the epidemic was serious and prefectures of high numbers of infected persons. The number of stroke patients declined from 182,660 in 2019 to 178,083 in 2020, with a reduction rate of 2.51% (95% confidence interval [CI], 2.58%-2.44%). The reduction rates were 1.92% (95% CI, 1.85%-2.00%; 127,979-125,522) for ischemic stroke, 3.88% (95% CI, 3.70%-4.07%, 41,906-40,278) for intracerebral hemorrhage, and 4.58% (95% CI, 4.23%-4.95%; 13,020-12,424) for subarachnoid hemorrhage. The admission volume declined by 5.60% (95% CI, 5.46%-5.74%) during the 7 months of 2020 when the epidemic was serious, whereas it increased in the remaining 5 months (2.01%; 95% CI, 1.91%-2.11%). The annual decline in the admission volume was predominant in the five prefectures with the largest numbers of infected people per million population (4.72%; 95% CI, 4.53%-4.92%). In conclusion, the acute stroke admission volume declined by 2.51% in 2020 relative to 2019 in Japan, especially during the months of high infection, and in highly infected prefectures. Overwhelmed healthcare systems and infection control practices may have been associated with the decline in the stroke admission volume during the COVID-19 pandemic.

Practices, Recommendations, Knowledge, and Sources of Information for Primary Care Physicians regarding Vaccinations: A Nationwide Survey in Japan, 2019

目的：プライマリ・ケア医の予防接種実施と接種推奨度およびワクチンに関する知識と情報源を明らかにする．

Clinical outcomes of organ-preserving pancreatectomy for benign or low-grade malignant pancreatic tumors: A multicenter nationwide survey in Japan.

Whether organ-preserving pancreatic surgery has an advantage in postoperative short- and long-term outcomes or not is still unknown because only small case series studies have been available to date. In this multicenter retrospective study, we aimed to elucidate the clinical advantage and disadvantage of organ-preserving pancreatectomy among patients with low-grade malignant pancreatic tumors and benign pancreatic diseases. We included patients diagnosed with benign or low-malignant pancreatic tumor who underwent pancreaticoduodenectomy (PD) in 621 cases, duodenum-preserving pancreatic head resection (DPPHR) in 31 cases, middle pancreatectomy (MP) in 148 cases, distal pancreatectomy (DP) in 814 cases, and spleen-preserving distal pancreatectomy (SPDP) in 259 cases between January 1, 2013, and December 31, 2017. Preoperative backgrounds, surgical outcomes and pre- and postoperative (3, 6, 12, 24, and 36months) nutritional status were compared between these procedures. In terms of short-term outcomes, the incidence of pancreatic fistula in patients who underwent MP was significantly higher than in patients with standard pancreatectomy. As for the long-term pancreatic functions in the cases of head or body lesion, both exocrine and endocrine functions after MP were significantly favorable compared with the PD group from 3 to 36months after surgery. In pancreatic body or tail lesion, significant advantage of endocrine function, but not exocrine function, was found in the MP group compared to standard DP at all time points. MP may contribute to the improvement of postoperative quality of life for patients with pancreatic body low-malignant tumors, rather than PD or DP; however, reducing the incidence of short-term complications such as pancreatic fistula is a future challenge.

Characteristics of hospitals that report adverse drug reactions: Results of a nationwide survey in Japan

Adverse drug reactions (ADRs) are one of the primary reasons for hospitalization. The spontaneous reporting of ADRs by healthcare professionals is important for issuing post-marketing drug safety measures. The Japanese Society of Hospital Pharmacists (JSHP) conducts a nationwide survey annually. Using data from this large-scale survey, we identified the characteristics of hospitals that reported ADRs to regulatory authorities and pharmaceutical companies. Data were obtained from annual surveys conducted by JSHP from 2015 to 2020. All variables were expressed as categorical variables and tabulated. The Chi-square test was used to compare the categorical variables. The Cochran-Armitage trend test was used to identify significant trends in the proportion of hospitals reporting ADRs. From 2015 to 2020, 22,362 responses were recorded. There was a significant increase in the proportion of hospitals that reported ADRs with an increase in number of beds and pharmacists (p<0.0001). The proportion of hospitals reporting ADRs to regulatory authorities was also significantly higher in those charging an additional fee for pharmacist-performed ward operations and in those with an ADR data management section than in hospitals without these attributes (p<0.0001). Hospitals that submitted ADR reports to the regulatory authorities and pharmaceutical companies charged an additional fee for pharmacist-performed ward operations, had a central ADR data management section, and had fewer beds per pharmacist. This trend was similar, regardless of the size of the hospital.

Implementation of geriatric assessment and long-term care insurance system by medical professionals in cancer treatment: a nationwide survey in Japan.

A questionnaire survey was conducted to assess the implementation status of geriatric assessment in cancer treatment and the potential for collaboration between medical care and the long-term care insurance system. Questionnaires were sent to 795 facilities in Japan. The questions were instructed to be answered via an online survey (SurveyMonkey®), which began in September 2020 and closed on 31 October 2020. The questionnaire consisted of 8 questions on the status of geriatric assessment implementation and 15 questions on the long-term care insurance system. In total, 631 departments in 340 (42.8%) of 795 hospitals and clinics provided responses. Approximately 81.5% of the departments did not perform geriatric assessment. The common reasons were lack of knowledge about geriatric assessment (54.0%) and lack of personnel (35.5%). Even if geriatric assessment was conducted, 63.6% of departments did not utilize geriatric assessment results in clinical practice. Approximately 61.7% of respondents were familiar with the long-term care insurance system and 62.9% with the certification process. Moreover, 28% of respondents used certification examination results in treatment planning. Geriatric assessment is less recognized than the long-term care insurance system, and its results are rarely used in clinical practice. However, 28% of certification examination results are utilized in treatment decision-making. Notably, this survey first showed the incorporation of the long-term care insurance system into the medical care of vulnerable elderly patients with cancer.

The Relationship Between Long Working Hours and Stress Responses in Junior High School Teachers: A Nationwide Survey in Japan.

Background: Long working hours and mental health problems among teachers are a concern in Japan. More specifically, it has been reported that junior high school teachers tend to work overtime. In this study, examined the working hours of junior high school teachers in public schools and investigated the association between overtime work and stress responses across job titles.Methods: From June to December 2018, 54,772 teachers in public junior high schools completed a web-based nationwide survey regarding occupational stress and submitted self-evaluated working hours per day of the previous month. Psychological and physical stress responses were assessed using the Brief Job Stress Questionnaire.Results: Results showed that 59.6% of the participants worked 11 h or more per day. Additionally, the length of working hours significantly differed across job titles (χ2 (30) = 5295.8, p < 0.001, Cramér’s V = 0.14). With respect to tenured teachers, sex (female), age, taking charge of the class, number of working years in the same school, working hours of 10 to 11 h, 11 to 12 h, 12 to 13 h, and 13 h or more were significantly associated with high stress, compared to those who worked less than 9 h per day. Moreover, for fixed-term teachers, sex (female), age, working hours of 9 to 10 h, 10 to 11 h, 11 to 12 h, 12 to 13 h, and 13 h or more were related with more stress as compared to those who worked less than 9 h per day. On the other hand, there was no significant relationship between long working hours and stress response among vice-principals, even though they tended to work the longest hours.Conclusion: We verified that Japanese junior high school teachers work long hours. Long working hours were associated with stress responses in both tenured and fixed-term teachers, but not in vice-principals. However, vice-principals work the longest hours among teachers, and we suggest that these long working hours may be a hidden problem that is often overlooked.

Surgical results of non-ampullary duodenal cancer: a nationwide survey in Japan.

As non-ampullary duodenal cancer is relatively rare, the optimal treatment strategy, including the appropriate surgical procedure and efficacy of adjuvant chemotherapy, remains unclear. This nationwide survey aimed to clarify the actual lymph node spread pattern and determine the optimal treatment strategy for this disease, using a large-scale database. We used a questionnaire and a retrospective registry of 1083 patients with non-ampullary duodenal cancer who had undergone surgery during 2008-2017 in 114 high-volume Japanese Society of Hepatobiliary and Pancreatic Surgery-certified training institutions. Propensity score-matched analyses were conducted to minimise background bias. Cox regression was performed to identify covariates associated with recurrence-free survival. There were distinct disparities in the nodal dissection rate according to the predominant tumor location and tumor invasion depth. Metastases were frequently observed in the peripancreatic nodes and those along the superior mesenteric artery, irrespective of tumor location. Their dissection seemed to be beneficial for improved survival. In the overall cohort, no survival benefit was observed in patients who received adjuvant chemotherapy when compared with that in patients who underwent surgery alone. Nevertheless, in the matched cohort, adjuvant chemotherapy for > 6months was associated with a significant improvement in recurrence-free survival (median: 43.5 vs. 22.5months, p = 0.016), particularly in patients with tumor invasion of the subserosa or deeper tumor invasion, lymph node metastasis, or elevated serum carbohydrate antigen 19-9 levels. Pancreatoduodenectomy should be the standard procedure for advanced non-ampullary duodenal cancer. Adjuvant chemotherapy for > 6months, especially for advanced tumors, significantly improves survival.

Mourners' Dissatisfaction with Funerals May Influence Their Subsequent Medical/Welfare Expenses-A Nationwide Survey in Japan.

Japan’s super-aged mortality rate bereaves millions of people annually, threatening the mental health of the bereaved population. Previous research suggests that participation in satisfying funeral rituals can protect or improve the health of a bereaved population—but pandemic restrictions threaten traditional funeral assemblies. To determine how bereaved mourners’ mental health—and consequent dependence upon medical, pharmaceutical, or social services—are affected by funerals and the aspects of funerals most likely to cause satisfaction or dissatisfaction, we conducted an anonymous nationwide survey across Japan. In total, 1078 bereaved Japanese responded; we analyzed their responses by comparing the 106 citing funeral dissatisfaction with the 972 citing no dissatisfaction. The cohort showing greatest satisfaction with funerals tended to be older widows or parents who lost children; they showed greater grief but spent less on medical, pharmaceutical, or social services thereafter than the dissatisfied. Conversely, mourners with the greatest dissatisfaction toward their interactions with funeral directors and Buddhist priests tended to spend more on medical, pharmaceutical, or social services after bereavement. We conclude that training or education to improve priests’ and funeral directors’ interactions may reduce dissatisfaction with funerals, potentially reducing subsequent costs of medical, pharmaceutical, or social services for the rapidly growing population of bereaved Japanese.

Verbal Abuse, Physical Assault, and Harassment in Pediatric Medical Settings: A Nationwide Survey in Japan

Background: Verbal abuse, physical assault, and harassment of pediatric healthcare workers by patients and their families have become increasingly serious. These incidents lead to various problems, including the deterioration of staff members’ mental health and employee turnover. Methods: This study was conducted as the first Japanese nationwide survey to assess the abuse perpetrated by patients and families and experienced by medical staff in pediatric medical settings in 2018, countermeasures employed, and staff member evaluations of the countermeasures. Results: Responses from 526 facilities were received, clinics accounted for 79.8% of these facilities; 88.1% of the respondents were females. Further, 10.5% of the facility staff reported having experienced verbal abuse, violence, or harassment from patients or family members. Of 1103 cases of victimizations, there were 719, 136, and 248 cases of verbal abuse, violence, and harassment, respectively. Manuals and guidelines had been created and training and drill performances were conducted as countermeasures in 10.7% and 9.0% of facilities, respectively; 7.3% of staff members felt that the countermeasures were effective, corresponding to 45.6% of the affected staff. Conclusion: The findings suggest the necessity of thoroughly familiarizing staff with existing facility countermeasures as well as introducing new countermeasures such as victimization simulations.

Rothmund-Thomson syndrome investigated by two nationwide surveys in Japan.

Rothmund-Thomson syndrome (RTS) is an autosomal recessive genetic disorder characterized by poikiloderma of the face, small stature, sparse scalp hair, juvenile cataract, radial aplasia, and predisposition to cancers. Due to the rarity of RTS, the situation of patients with RTS in Japan has not been elucidated. In 2010 and 2020, following the results of a primary questionnaire survey, a secondary questionnaire survey on RTS was conducted nationwide to investigate the number of RTS cases and their associated skin lesions, bone lesions, other clinical features, and quality of life in Japan. In 2010 and 2020, 10 and eight patients with RTS were recruited, respectively. Skin lesions such as poikiloderma, erythema, pigmentation, and abnormal scalp hair were observed in almost all cases. Bone lesions were observed in four cases in the 2010 and 2020 surveys, respectively. Two cases had mutations in the RECQL4 gene in the 2020 survey. Two nationwide surveys have shown the actual situation of patients with RTS in Japan. Cutaneous and bone manifestations are important for the diagnosis of RTS. However, many patients have no RECQL4 mutations. The novel causative gene of RTS should be further elucidated.

Difficulties with Stoma Care in Home Nursing and the Usefulness of Visits with Accompanying Expert Ostomy Care Nurses:A Nationwide Survey in Japan

Difficulties with Stoma Care in Home Nursing and the Usefulness of Visits with Accompanying Expert Ostomy Care Nurses:A Nationwide Survey in Japan