ABSTRACT
Objective：The number of heart failure （HF） patients is increasing in Japan as its population continues to age, but little is known about current medication strategies. We investigated the relationship between medication changes during hospitalization and the readmission rate among older Japanese patients with new-onset HF.Design：Retrospective cohort study.Methods：We analyzed medical record data from Toho University Medical Center Omori Hospital between March 2004 and April 2018. Initial admissions for new-onset HF in patients aged≥75 years were examined (n＝329). The class Ⅰ recommended medications stipulated in the JCS 2017/JHFS 2017 guidelines were used as the target medications for this study. Patients with dose titrations or additions of the target medications during hospitalization (dose titrations or additions group) were compared with patients without these changes (the other group). The primary outcome was readmission due to HF within one year of discharge. A hazard ratio, adjusted for potential confounders, was estimated using a Cox proportional hazards model.Results：There were 231 patients in dose titrations or additions group and 98 patients in the other group.The one-year readmission rate was 26.5％ in dose titrations or additions group and 31.8％ in the other group. The adjusted hazard ratio of medication changes for readmission was 0.82 (95％ confidence interval, 0.51-1.33, P＝0.415), but was not statistically significant.Conclusion：The older HF patients in dose titrations or additions group showed a reduced risk of readmission, but lacked significance due to low statistical power.
ABSTRACT
Objectives: This study aimed to clarify the present system of palliative care at general hospitals, and to examine the factors contributing to the opioid consumption. Methods: We surveyed the palliative care system using a self-administered questionnaire, which was mailed to 37 general hospitals in Southern and Southwestern wards, Tokyo. Multiple regression analyses were used to identify the associations between explanatory variables and the opioid consumption. Results: Valid responses were obtained from 18 hospitals (response rate: 48.6%). 35% of the general hospitals didn’t have a palliative care team and most hospitals had no specialists. In multivariate analyses, factors associated with the opioid consumption were pharmacists with speciality of pharmaceutical palliative care, physicians joined the palliative care education program based on the Cancer Control Act of Japan, and the number of physicians’ correct answers of questions regarding palliative care. Conclusion: The survey showed that the higher consumption of opioids is significantly associated with the number of health care workers who have knowledge of palliative care. Our study suggested that the arrangement of palliative care experts might decrease the differences in the opioid consumption between general hospitals.
ABSTRACT
Objective：The number of heart failure（HF）patients is increasing in Japan as its population continues to age, but little is known about current medication strategies. We investigated the relationship between medication changes during hospitalization and the readmission rate among older Japanese patients with new-onset HF.Design：Retrospective cohort study.Methods：We analyzed medical record data from Toho University Medical Center Omori Hospital between March 2004 and April 2018. Initial admissions for new-onset HF in patients aged≥75 years were examined (n＝329). The class Ⅰ recommended medications stipulated in the JCS 2017/JHFS 2017 guidelines were used as the target medications for this study. Patients with dose titrations or additions of the target medications during hospitalization (dose titrations or additions group) were compared with patients without these changes (the other group). The primary outcome was readmission due to HF within one year of discharge. A hazard ratio, adjusted for potential confounders, was estimated using a Cox proportional hazards model.Results：There were 231 patients in dose titrations or additions group and 98 patients in the other group.The one-year readmission rate was 26.5％ in dose titrations or additions group and 31.8％ in the other group. The adjusted hazard ratio of medication changes for readmission was 0.82 (95％ confidence interval, 0.51-1.33, P＝0.415), but was not statistically significant.Conclusion：The older HF patients in dose titrations or additions group showed a reduced risk of readmission, but lacked significance due to low statistical power.
ABSTRACT
BACKGROUND@#Oral health is thought to be associated with diet quality, and socioeconomic status (SES) affects both oral health and diet. The aim of this study was to investigate the association between the number of teeth and dietary intake as well as nutritional biomarker, considering the subjects' SES.@*METHODS@#We conducted a cross-sectional analysis of data from 2049 individuals aged ≥ 50 years from the National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged 2010. The number of remaining teeth was categorized into age-specific quartiles (Q1 to Q4). We assessed the adjusted means and 95% confidence intervals for dietary variables by the number of teeth using analysis of covariance. Stratified analyses by SES were also conducted.@*RESULTS@#The intake of grain products was 31 g higher, and those of vegetables and meat were 30 g and 8 g lower, respectively, in Q1 (fewer teeth) than in Q4 (more teeth). Carbohydrate intake was higher whereas protein, minerals (potassium, magnesium, and zinc), vitamins (vitamins A, E, B, B, β-carotene, and folic acid), and dietary fiber intakes were lower among individuals with fewer teeth. Adjusted mean serum albumin levels were low in Q1. The associations between the number of teeth and dietary intake were more evident in individuals with a low SES.@*CONCLUSIONS@#Having few remaining teeth was associated with a low nutrient intake and low serum albumin levels in middle-aged and older Japanese adults, and these associations were more evident in individuals with low SES.