Objective: This study was conducted to examine the conditions and characteristics of older adults who use short-stay services as well as those of their primary caregivers by categorizing them into long-term use and short-term use groups.

Patients and Methods: We conducted logistic regression analyses on the data of 679 short-term residential care (short-stay) users using the χ² test, with the type of use as the dependent variable.

Results: The results of the comparison show that users in long-term care were likely to be men, ≥95 years old, live alone, and require care for severe dementia (level three or more). Primary caregivers lived farther away from the user’s neighborhood, felt burdened by and lacked knowledge about providing care, and preferred that the patient continue to receive care in a facility or be hospitalized.

Conclusion: It was suggested that care support specialists in charge of elderly persons requiring severe nursing care who live alone may be adjusting to the long-term use of short stays, which is not usually expected, because they are influenced by the nursing care burden of the primary caregiver who lives far away, the level of knowledge and skills of nursing care, and the primary caregiver’s willingness to continue caring, and because they cannot immediately enter a facility when they are no longer able to live alone.

Objectives: Older adults in skip-generation households (SGHs) play a valuable role in maintaining the cohesion of extended families in the absence of the middle generation. Little is known about the health and well-being of older adults in SGHs or how it varies depending on their age. This study aimed to examine 1) the association between living in SGHs and subjective health and well-being and 2) the association between subjective health and well-being of older adults in SGHs across age groups.

Methods: Drawing data from the 2017 national survey of older people, older adults aged ≥60 years without disability in activities of daily living (n=38,088) were included for multiple regression analyses. Living arrangements were classified into SGHs and non-SGHs. Subjective health was evaluated based on self-rated health, whereas subjective well-being was evaluated using a happiness score. Ordinal logistic regression and linear regression models, stratified by age groups (young-old, 60–69; middle-old, 70–79; and old-old, ≥80), compared subjective health and well-being of older adults in SGHs and non-SHGs, while controlling for potential covariates.

Results: Among older Thai adults, 10.1% lived in SGHs, and 11.1%, 9.5%, and 6.3% were among the young-old, middle-old, and old-old, respectively. Across age groups, older adults living in SGHs reported better health status but worse well-being than those living in non-SGHs. Older adults from the old-old group living in SGHs seemed to report the best health status, whereas those in the young-old and old-old groups tended to report the worst well-being. The direction of the association between living arrangements and subjective health and well-being did not differ by age group.

Conclusion: Better health status but worse well-being were observed in SGHs. Social sectors should pay attention to the well-being of these older adults.

Objective: The present study aimed to identify pesticide poisoning symptoms and related protective habits to effectively prevent pesticide poisoning among farmworkers in Kratie, Cambodia, where pesticide poisoning is an urgent public health problem.

Materials and Methods: This cross-sectional study based on a questionnaire survey analyzing social demographics, number of symptoms, and protective behavior regarding pesticide application was conducted in Kratie Province from January 25 to 31, 2021. In total, 210 farmworkers completed the survey. The effects of social demographics and pesticide-protective behavioral scores on the number of symptoms were investigated using multivariable regression analysis.

Results: The observed number of symptoms was 1.16 times higher among women (P=0.004), increased with the duration of work, and decreased with age. In addition, we identified five significant pesticide-protective behaviors: 1) preparing using gloves, 2) using protective equipment, 3) avoiding wiping sweat, 4) avoiding leaking, and 5) resting when feeling ill. Pesticide-protective behaviors tended to decrease with the duration of working years in the low-education group (B=−0.04, SE=0.01), whereas no association was observed in the high-education group (B=0.01, SE=0.01).

Conclusion: Pesticide-protective behaviors significantly correlated with fewer symptoms. The female and aging groups required continuous special education or instructions for implementing pesticide-protective actions, especially the aforementioned five protective actions.

Objective: This study assessed the regional disparities and the associated factors in the implementation of cardiac rehabilitation in Japan.

Materials and Methods: Regional disparities were investigated by comparing the number of cardiac rehabilitation units in each of 47 prefectures in Japan based on the National Database of Health Insurance Claims Open Data published by the Ministry of Health, Labour, and Welfare. The relationships between the numbers of inpatient and outpatient cardiac rehabilitation units and the numbers of registered instructors of cardiac rehabilitation, board-certified physiatrists, and board-certified cardiologists were examined.

Results: The region with the highest and lowest numbers of inpatient units showed 11,620.5 and 1,650.2 population-adjusted cardiac rehabilitation units adjusted per 100,000 population, respectively, corresponding to a 7.0-fold difference. Meanwhile, 4,865.3 and 238.6 units were present in the regions with the highest and lowest numbers of outpatient units, respectively, corresponding to a 20.4-fold regional disparity. Our analysis showed that the population-adjusted number of inpatient cardiac rehabilitation units was significantly associated with the population-adjusted numbers of registered instructors of cardiac rehabilitation (r=0.647, P<0.001) and board-certified cardiologists (r=0.445, P=0.002) but only marginally associated with the population-adjusted number of board-certified physiatrists (r=0.329, P=0.024). Moreover, the population-adjusted number of outpatient cardiac rehabilitation units was significantly associated with the population-adjusted numbers of registered instructors of cardiac rehabilitation (r=0.406, P=0.005) and board-certified cardiologists (r=0.450, P=0.002) but not with the population-adjusted number of board-certified physiatrists (r=0.078, P=0.603).

Conclusion: Large regional disparities were observed during the implementation of cardiac rehabilitation. Increased numbers of cardiac rehabilitation instructors and cardiac rehabilitation practices are expected to eliminate these regional differences in cardiac rehabilitation practices.

Objectives: The most commonly used vaccine in India, Covishield, is a recombinant adenovirus vector vaccine for which safety data in pregnant women are not available. The present study was conducted to assess the uptake of COVID-19 vaccines and monitor adverse events following COVID-19 immunization among pregnant women in northern India.

Patients and Methods: A prospective cohort study was conducted among pregnant women registered with the antenatal clinics in Chandigarh Union Territory (U.T.) in northern India. The study included 247 pregnant women and a comparative group of age-matched, non-pregnant women (247) who received the first dose of the COVID-19 vaccine and were followed up by telephone interviews for adverse events following immunization at three time points until 28 days after vaccination. Multivariate regression (logistic and linear) was used for the adjusted analysis, with adverse events following immunization and the duration of adverse events following immunization as the outcomes.

Results: The COVID-19 vaccination uptake rate was 66.8% among the pregnant women. The 28-day incidence rate of adverse events following immunization among the pregnant women was 76.5%. The overall 28-day incidence of adverse events following immunization in pregnant women did not differ significantly from that of non-pregnant women (P=0.153).

Conclusion: The Covishield vaccine is safe for pregnant women in India. Further follow-up of the cohort for feto-maternal outcomes needs to be conducted with an adequate sample size to confirm the overall safety profile of the vaccine.

Objective: In this study, we investigated Progressive Era public health interventions and connected two subsequent efforts to improve outcomes in the American South: the Rockefeller Sanitary Commission’s hookworm eradication efforts in the early 1910s and investments in local health infrastructure between the 1910s and the 1930s. We tested whether hookworm eradication had the largest effects in areas that invested in public health and whether county health organizations—cooperative public-private institutional arrangements—impacted the Rockefeller Sanitary Commission program’s success.

Materials and Methods: The methods used to measure the effects involved estimation of difference-in-difference and triple-difference models across the geographic samples of the Rockefeller Sanitary Commission’s surveyed area, the American South, and the United States. Material on hookworm infection rates and activities by the Rockefeller Sanitary Commission is obtained from the Rockefeller Foundation Annual Reports. Material on the activities, spending, and duration of the different county health organizations is obtained from the Public Health Service Bulletin 222 titled, “A history of county health organizations in the United States: 1908–1933”.

Results: By comparing similar cooperative and independent county health organizations in the American South with the rest of the United States, we find that cooperative efforts are generally important and strengthen the Rockefeller Sanitary Commission’s impact on human capital outcomes in the American South. Simultaneously, independent county health organizations produced negative or non-significant effects.

Conclusion: The Rockefeller Sanitary Commission is important in guiding local health efforts. Our results are robust in both the short and long runs. This study sheds light on the effectiveness of public-private partnerships in rural public health during the Progressive Era.

Objective: Old age is a risk factor for Clostridioides difficile infection (CDI). As the world’s aging population increases, identifying risk factors for CDI in elderly patients is a matter of urgency. This study examined the relationship between CDI relapse and nutritional status using the geriatric nutritional risk index (GNRI).

Patients and Methods: Between January 2016 and December 2021, 108 patients were diagnosed with CDI. Of the 108 patients, 19 were excluded because of younger age (<65 years), early death within 14 days of the initial CDI diagnosis, and insufficient data. The patients were divided into low- (<75) and high-GNRI groups (≥75) based on the receiver operating characteristic curve analysis. Variables associated with CDI relapse were also analyzed.

Results: The median GNRI scores in all patients and in the low- and high-GNRI groups were 74.9, 68.9, and 83.9, respectively. Of the 89 patients, 28 (31.8%) experienced a CDI relapse. The log-rank test showed a significantly better relapse-free survival (RFS) in the high GNRI group (P=0.002). Univariate analysis revealed that low GNRI (P=0.004), chronic kidney disease (CKD) (P=0.004), and beta-lactamase inhibitor administration before the initial diagnosis of CDI (P=0.025) were significantly correlated with RFS. Multivariate analysis revealed that low GNRI (P=0.008) and CKD (P=0.010) were independent prognostic factors for RFS.

Conclusion: Among elderly patients, a low GNRI was strongly associated with CDI relapse. Our study may help clinicians to consider therapeutic strategies for elderly patients with CDI.

Objective: Lymph node recurrence is extremely rare in cases of stage IA1 squamous cell carcinoma (SCC) of the uterine cervix without lymphovascular space invasion (LVSI). We present two cases of extraregional lymph node recurrence after initial surgery for stage IA1 SCC of the uterine cervix without LVSI.

Patients: Both patients initially underwent hysterectomy and developed recurrent extraregional lymph nodes within a few years postoperatively.

Case 1: The patient showed no symptoms of recurrence, and follow-up computed tomography (CT) for evaluation of gallstones revealed a para-aortic lymph node (9 mm). The patient subsequently underwent serum SCC antigen testing and CT and was diagnosed with recurrence.

Case 2: The patient noticed a right inguinal node swelling, which was evaluated using CT.

Both patients survived without relapse for 8 and 4 years, respectively.

Conclusion: Although stage IA1 SCC of the uterine cervix without LVSI is associated with a low risk of lymph node recurrence, oncologists should consider the possibility of recurrence in such cases. Evaluation for recurrence is difficult in asymptomatic patients. Serum SCC antigen testing may be a useful biochemical marker before imaging for early detection of recurrence, even in asymptomatic patients.

Objective: We report a case of unusual anomalous duplication of the portal vein.

Patient: A 40-year-old man with portal vein duplication. One portal vein is derived from the superior mesenteric vein and splenic vein and enters the caudate lobe of the liver. Another portal vein, known as the prepancreatic postduodenal portal vein, is derived from the superior mesenteric vein and courses anterior to the pancreas and posterior to the duodenum.

Conclusion: Duplication of the portal vein is an extremely rare developmental anomaly, and in previous reports, the superior mesenteric and splenic veins entered the liver separately. We present a previously unreported case of anomalous duplication of the portal vein, one of which was the prepancreatic postduodenal portal vein.

Objective: We report a case of successful endoscopic retrieval of a proximal (upstream) migrated pancreatic stent through a pancreaticojejunal anastomosis.

Patient: A 71-year-old man with a history of pancreatoduodenectomy with modified Child’s reconstruction and concomitant internal pancreatic ductal stenting for cholangiocarcinoma 41 months before presentation, was referred to our department for the treatment of acute pancreatitis. Endoscopic stent retrieval was performed using a short-type single-balloon enteroscope with a transparent hood. A pancreaticojejunal anastomosis was identified as a pinhole-like opening buried within the intestinal folds and dilated using a balloon catheter. Finally, the migrated pancreatic stent was successfully retrieved using a wire-guided basket catheter, without complications.

Conclusion: Endoscopic retrieval of a proximally migrated pancreatic stent after pancreatoduodenectomy should be attempted, even in cases of stenotic pancreaticojejunal anastomosis, to avoid highly invasive procedures, including surgery.

Objective: Medication-resistant essential tremor requires surgical treatment. Deep brain stimulation to the thalamic ventral intermediate nucleus is an established procedure to diminish tremors. Tremor on both sides needs dual deep brain stimulation implantation. Nowadays, magnetic resonance-guided focus ultrasound is broaden to treat essential tremor. However, the safety of magnetic resonance-guided focus ultrasound against dual ventral intermediate is still under discussion, since bilateral thalamotomy causes speech disturbance or ataxia.

Patient and Methods: A 66-year-old right-handed man had medication-resistant essential tremor at bilateral upper extremities superior to the left arm. A treatment of magnetic resonance-guided focus ultrasound was performed by using the ExAblate transcranial system against the left ventral intermediate. One year after magnetic resonance-guided focus ultrasound treatment, the stereotactic implantation of a deep brain stimulation electrode into the right ventral intermediate was done.

Results: Clinical rating scale for tremor in the right arm was reduced from 12 to 0 points by magnetic resonance-guided focus ultrasound against the left ventral intermediate. The clinical rating scale for tremor in the left arm was reduced from 23 to 1 point by deep brain stimulation to the right ventral intermediate.

Conclusion: Hybrid surgery of magnetic resonance-guided focus ultrasound and deep brain stimulation refined bilateral essential tremor, without any neurological deficiencies. This combined surgery would be useful to manage medication-resistant bilateral essential tremor patients who are carrying some difficulties to introduce deep brain stimulation on the bilateral side.

Objective: This report presents a case of supracondylar femur fracture with finite element analysis and discusses its causes and prevention.

Patient and Methods: A 53-year-old man presented with right talar osteonecrosis after osteosynthesis for a talus fracture. A medial femoral condyle-free vascularized bone graft (size, 20 × 12 × 17 mm) from the contralateral femur was performed, including the posteromedial cortical corner. The patient suffered a donor-site supracondylar femoral fracture while standing up from a cross-legged sitting position on the bed on postoperative day 6. The fracture was treated with intramedullary nailing. We analyzed the effects of the location of the bone graft harvest in an intact model using the three-dimensional finite element method (FEM).

Results: The talar necrosis and the femur fracture healed. The FEM result revealed that the longitudinal axial pressure had minimal effect on the femur; however, the stress around the bone defect increased with rotation, especially in the posteromedial bone defect model.

Conclusion: Harvesting the bone graft should not include the posteromedial corner of the supracondylar femur. The patient should strictly limit the motion of torsional stress, such as standing from a cross-legged sitting position or pivoting turn.

Objective: This pilot study aimed to examine the content of Japanese newspaper editorials concerning the coronavirus disease 2019 (COVID-19) pandemic and its change over time using text mining analysis.

Materials and Methods: The authors analyzed qualitative data from the editorials of five national and 12 regional newspapers on April 7 and 8, 2020 (first state of emergency) and January 8, 2021 (second state of emergency). All analyses were conducted using KH Coder version 3.

Results: The co-occurrence network showed a low level of content diversity and a high degree of politicization in the COVID-19 news coverage. The top five high frequency words from the newspapers were “infection”, “declaration”, “healthcare”, “government”, and “emergency” at the first state of emergency, and were “declaration”, “measures”, “government”, and “restaurant” at the second one.

Conclusion: The results suggest a lack of detailed information and recommendations concerning the public health challenges of the COVID-19 pandemic in Japanese newspaper editorials, even one year after the first wave of the pandemic. This study provides a data-driven foundation for the effectiveness of newspapers in COVID-19 public health communications. The extent to which the quantity and quality of information from newly emerging communication channels, such as social media, influences public understanding of public health measures remains to be established.