Perceptions of older adults and generativity among older citizens in Japan: a descriptive cross-sectional study

Objectives@#As the population ages worldwide, including in Japan, there is a growing expectation for older adults to remain active participants in society. The act of sharing one’s experiences and knowledge with younger generations through social engagement not onlyenriches the lives of older individuals, but also holds significant value for our society. In thisstudy, we examined both positive and negative perceptions of older adults and investigated the correlation between these perceptions and generativity among older citizens. Additionally, we evaluated the impact of life satisfaction on these factors. @*Methods@#We conducted a survey of 100 older adults in Japan (mean age, 71.68 years) and utilized multiple regression analyses, using positive and negative perceptions of older adults, life satisfaction, and demographic factors as independent variables. The sub-categories of generativity—namely, generative action, concern, and accomplishment—were used as dependent variables. @*Results@#Participants who held a more positive perception of older adults demonstrated a higher level of generative actions and concerns. Additionally, participants who reported higher levels of life satisfaction also exhibited more generative actions, concerns, and accomplishments. Conversely, those who held a more negative perception of older adults were found to have higher levels of generative actions. @*Conclusion@#Enhancing positive perceptions of older adults among them can boost the subcategories of generativity. This study, which was conducted from an exploratory perspective, has several limitations, including a potential sampling bias. A more comprehensive examination of the relationship between perceptions of older adults and generativity is anticipated in future research.

Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Japanese perspective

Striking advances in systemic therapy for unresectable advanced hepatocellular carcinoma (HCC) have improved the average prognosis of patients with HCC. As a result, the guidelines for the treatment of HCC have changed significantly. However, various issues have emerged in clinical practice. First, there is no established biomarker that can predict response to systemic therapy. Second, there is no established treatment regimen after primary systemic therapy, including combined immunotherapy. Third, there is no established treatment regimen for intermediate-stage HCC. These points make the current guidelines ambiguous. In this review, we present the Japanese guidelines for the diagnosis and treatment of HCC based on the latest evidence; introduce various efforts mainly in Japanese real-life practice to update these guidelines; and present our perspectives on future guidelines.

Application of Blockchain to Maintaining Patient Records in Electronic Health Record for Enhanced Privacy, Scalability, and Availability / 대한의료정보학회지

Patient Consent Management by a Purpose-Based Consent Model for Electronic Health Record Based on Blockchain Technology / 대한의료정보학회지

Objectives@#Currently, patients’ consent is essential to use their medical records for various purposes; however, most people give their consent using paper forms and have no control over it. Healthcare organizations also have difficulties in dealing with patient consent. The objective of this research is to develop a system for patients to manage their consent flexibly and for healthcare organizations to obtain patient consent efficiently for a variety of purposes. @*Methods@#We introduce a new e-consent model, which uses a purpose-based access control scheme; it is implemented by a blockchain system using Hyperledger Fabric. All metadata of patient records, consents, and data access are written immutably on the blockchain and shared among participant organizations. We also created a blockchain chaincode that performs business logic managing patient consent. @*Results@#We developed a prototype and checked business logics with the chaincode by validating doctors’ data access with purpose-based consent of patients stored in the blockchain. The results demonstrate that our system provides a fine-grained way of handling medical staff ’s access requests with diverse intended purposes for accessing data. In addition, patients can create, update, and withdraw their consents in the blockchain. @*Conclusions@#Our consent model is a solution for consent management both for patients and healthcare organizations. Our system, as a blockchain-based solution that provides high reliability and availability with transparency and traceability, is expected to be used not only for patient data sharing in hospitals, but also for data donation for biobank research purposes.

Privacy Enhanced Healthcare Information Sharing System for Home-Based Care Environments / 대한의료정보학회지

OBJECTIVES: Home-based nursing care services have increased over the past decade. However, accountability and privacy issues as well as security concerns become more challenging during care provider visits. Because of the heterogeneous combination of mobile and stationary assistive medical care devices, conventional systems lack architectural consistency, which leads to inherent time delays and inaccuracies in sharing information. The goal of our study is to develop an architecture that meets the competing goals of accountability and privacy and enhances security in distributed home-based care systems. METHODS: We realized this by using a context-aware approach to manage access to remote data. Our architecture uses a public certification service for individuals, the Japanese Public Key Infrastructure and Health Informatics-PKI to identify and validate the attributes of medical personnel. Both PKI mechanisms are provided by using separate smart cards issued by the government. RESULTS: Context-awareness enables users to have appropriate data access in home-based nursing environments. Our architecture ensures that healthcare providers perform the needed home care services by accessing patient data online and recording transactions. CONCLUSIONS: The proposed method aims to enhance healthcare data access and secure information delivery to preserve user's privacy. We implemented a prototype system and confirmed its feasibility by experimental evaluation. Our research can contribute to reducing patient neglect and wrongful treatment, and thus reduce health insurance costs by ensuring correct insurance claims. Our study can provide a baseline towards building distinctive intelligent treatment options to clinicians and serve as a model for home-based nursing care.

Identification of LEF1 as a Susceptibility Locus for Kawasaki Disease in Patients Younger than 6 Months of Age

Kawasaki disease (KD) is an acute febrile vasculitis predominately affecting infants and children. The dominant incidence age of KD is from 6 months to 5 years of age, and the incidence is unusual in those younger than 6 months and older than 5 years of age. We tried to identify genetic variants specifically associated with KD in patients younger than 6 months or older than 5 years of age. We performed an age-stratified genome-wide association study using the Illumina HumanOmni1-Quad BeadChip data (296 cases vs. 1,000 controls) and a replication study (1,360 cases vs. 3,553 controls) in the Korean population. Among 26 candidate single nucleotide polymorphisms (SNPs) tested in replication study, only a rare nonsynonymous SNP (rs4365796: c.1106C>T, p.Thr369Met) in the lymphoid enhancer binding factor 1 (LEF1) gene was very significantly associated with KD in patients younger than 6 months of age (odds ratio [OR], 3.07; p(combined) = 1.10 × 10⁻⁵), whereas no association of the same SNP was observed in any other age group of KD patients. The same SNP (rs4365796) in the LEF1 gene showed the same direction of risk effect in Japanese KD patients younger than 6 months of age, although the effect was not statistically significant (OR, 1.42; p = 0.397). This result indicates that the LEF1 gene may play an important role as a susceptibility gene specifically affecting KD patients younger than 6 months of age.

Spontaneous Left Main Coronary Artery Dissection Treated by Emergency Coronary Artery Bypass Grafting / 日本心臓血管外科学会雑誌

Spontaneous coronary artery dissection is a rare but often fatal cause of acute myocardial ischemia that occurs in young or middle-aged and otherwise healthy patients. We report a case of spontaneous left main coronary artery dissection in a young woman who was treated with emergency coronary artery bypass grafting. She improved after surgery but required a long recuperative period because of her cardiac failure and multiple organ failure, developed expiring on the 78th postoperative day. Spontaneous coronary artery dissection is unpredictable, and sudden death is the usual mode of clinical presentation. Prompt diagnosis and coronary artery revascularization are essential in order to achieve a favorable outcome in such cases.

An Operative Case of Idiopathic Nonspecific Inflammatory Aneurysms of the Abdominal Aorta / 日本心臓血管外科学会雑誌

We report a case of surgical treatment for idiopathic nonspecific inflammatory aneurysms of the abdominal aorta (AAA) with high-dose steroid therapy. The patient was a 35-year-old man who underwent steroid therapy (30 mg/day prednisolone) for idiopathic nonspecific inflammatory AAA and right common iliac artery aneurysm (CIAA) for 5 months. However, the sizes of the aneurysms were slowly increasing, and they were sacculated types, so surgical replacement was performed. Before the operation we continued to give 30 mg/day prednisolone, because decreasing the medicine made the c-reactive protein (CRP) value rise. Perioperatively the therapy continued, and the postoperative course was uneventful. With appropriate steroid therapy, replacement of idiopathic nonspecific inflammatory aneurysms of the abdominal aorta can be performed. It is also important to follow up the patient from long-term, to monitor for pseudoaneurysms from anastomosis or new aneurysms.

A Case of Pseudoaneurysm of the Left Ventricle after Patch-and-Glue Repair of Postinfarction Left Ventricle Free Wall Rupture / 日本心臓血管外科学会雑誌

We report a case of surgical treatment for pseudoaneurysm 4 years after Patch-and-Glue Repair of left ventricle free wall rupture (LVFWR) due to acute myocardial infarction (AMI) in 2004 in a 74-year-old woman, she had been followed in our hospital. And 2 years later, echocardiography and MRI showed a pseudoaneurysm at the repair spot which was growing very slowly. Since we found a thrombus in the pseudoaneurysm, a redo operation was performed in 2008. The pseudoaneurysm was successfully extirpated, under cardiopulmonary bypass. The infracted area had degenerated to scar tissue and we could suture tightly without worrying about a fissure in the wall. We can use Patch-and-Glue Repair to rescue the LVFWR patients due to AMI in the acute stage because it is possible to remove the pseudoaneurysm in the future, on pseudoaneurysm excision in a firmly infarcted area is possible in the chronic stage.

The Personal Health Information Reference System based on e-P.O.Box Conception / 대한의료정보학회지

IT Strategic Headquarters of the Japanese government compiled the Priority Policy Program 2007, in which "Establishment of the structure for every citizen to be able to manage and utilize his health information by himself" and "Foundation of the e- Post-Office box for the realization of the social security service in aspects of people" are declared. For this purpose, a health information system is considered that delivers healthcare data to the server, where the data is to be individually self.administered by the owner. A patient can register his data, and download or reference it from any medical institution or home when necessary. We made a prototype system to realize such a personal health data referring system based on the e. post.office box concept. The system is to be used in field trial experiment with the staffs and students of Tokyo Institute of Technology using their ID Card. This prototype system is expected to be available for the policy suggestion in the realization of the e-P.O.Box stated in the Priority Policy Program of the government.

Successful Treatment of Annulo-aortic Ectasia Associated with DeBakey's Type IIIb Dissecting Aortic Aneurysm / 日本心臓血管外科学会雑誌

A 52-year-old man with annulo-aortic ectasia and DeBakey's type IIIb dissecting aortic aneurysm was successfully treated. Aortography showed moderate to severe aortic regurgitation and enlargement of the ascending aorta, and CT showed a huge type IIIb dissecting aortic aneurysm. We scheduled a two-staged operation because dissection occurred 6 months previously and ECG showed severe LVH and ST-T change. The aortic root replacement using Bentall's procedure was performed, which was followed by arch replacement with an elephant trunk prosthesis on distal aorta. The entry in the distal aortic arch was covered by an elephant trunk prosthesis and postoperative diagnostic images showed thrombo-occlusion of the false lumen in the descending aorta. This operation was safe and might be a useful method for annulo-aortic ectasia with type IIIb dissecting aortic aneurysm.

Successful Surgical Closure of a Coronary Sinus Atrial Septal Defect Using a Heart-Shaped Patch / 日本心臓血管外科学会雑誌

A 21-year-old man with coronary sinus atrial septal defect (ASD) was treated successfully. This case had been diagnosed as an ASD without a lower margin preoperatively but we confirmed this to be a coronary sinus ASD intraoperatively, and this case was classified as partially unroofed coronary sinus without PLSVC. The diagnosis of coronary sinus ASD before operation is sometimes difficult. Therefore we should pay attention to the location of the defect and the dilated coronary sinus in echocardiography, and the course of the cardiac catheter entering into the left atrium, for a correct diagnosis. In this case, the defect was located in the vicinity of the ostium of a large coronary sinus, therefore we could close the defect between the CS and the LA using a heart-shaped patch without any damage to the AV node.

Two-staged Operation for an Infected Common Illiac Arterial Aneurysm / 日本心臓血管外科学会雑誌

A 56-year-old man with uncontrolled diabetis mellitus was admitted with general fatigue and high fever. Abdominal CT and aortography showed a saccular aneurysm in the left common illiac artery. Salmonella choleraesuis infection was diagnosed on the basis of blood culture. We performed a two-staged operation because of the tight inflammatory adhesions and the abcess formation around the aneurysm. First we performed surgical treatment of the aneurysm and extra-anatomical bypass grafting (F-F crossover bypass). Then the <i>in situ</i> graft replacement was performed, 4 weeks later. After the second surgery, antibiotics were administered for 6 more weeks. The patient remains asymptomatic for 6 months after the record operation.

The Effects of Toki-Inshi and a Bath Preparation Containing Licorice Extract on Patients with Senile Pruritus / 日本東洋医学雑誌

The main cause of senile pruritus is said to be dryness of the skin. Therefore, we treated patients with xerosis senilis, a common dry skin condition, using an oral preparation of Toki-inshi and a bath preparation containing licorice extract. The effectiveness of these treatments was determined by measuring changes in the water content of the epidermal horny layer over time using an electrical measuring device. The ability of the skin to retain moisture was expressed as the degree of dryness of the skin, and the results compared with the untreated group.<br>When the bath preparation was used, the skin dryness improved quickly, but the effects soon disappeared when the treatment was stopped. When Toki-inshi was administered orally, the improvement was slower than with the bath preparation, but the effects did not disappear immediately when the drug was withdrawn as in the case of the bath preparation. However, since there was not necessarily agreement between improvement in skin dryness and alleviation of pruritus, factors other than skin dryness might be involved.

Toxicokinetic Study of Acute Paraquat Poisoning / 日本農村医学会雑誌

The rate of mortality from paraquat poisoning is high and the principal manifestation of toxicosis is pulmonary impairment.<BR>In this study, we measured the concentration of paraquat in the urine, blood, and some organs in 10 patients with acute paraquat poisoning in order to study the relationships of the kinetics in the body to the concentration in the lungs and to the pulmonary impairment.<BR>The concentration of paraquat dichloride in the blood stream rapidly decreased in the first 24 hours. The half life was about 0.5 hour, within 2 hours (case 3) after intoxication, about 1 hour after 5 hours (case 5), about 2 hours after 10 hours (case 6) and after 24 hours (case 6) was prolonged to over 26 hours.<BR>Therefore, it was suggested that half life was subsequently prolonged with the passage of time.<BR>There were indications that renal disturbance appeared in about 5 hours after oral intake.<BR>Accumulations of paraquat were seen in the organs examined. The largest amount within 24 hours after exposure was recognized in the lungs, and the largest amount after 271 hours was seen in the skeletal muscle. The concentration of paraquat in the lungs was higher than the concentration levels in the blood at death in all the cases.<BR>Although excretion of paraquat from the lungs was very slow. it became faster with DHP and HD. However, excretion from the skeletal muscle was slow, Excretion from the other organs excepting the kidney was considered to be constant, being proportional to the blood concentration levels.<BR>The pathologic examination of the lungs found congestive edema in 6 cases, which became severer with the lapse of time. Partial pulmonary fibrosis was recognized only in long-term survival cases.<BR>The cause of irreversible pulmonary impairment was considered to be the effect of the small amount of paraquat remaining in the lungs which exceeds the concentration in the blood.

Mutagenicity of Pesticides and Their Catabolites / 日本農村医学会雑誌

By use of 18 varieties of pesticide and six of their breakdown products, experiments were conducted to cause mutation and reversion in S. typhimurium TA98 and TA100 within a range of 0.01ug-100 ug/plate.<BR>The results showed that Captan had mutagenic effects on TA98 and TA100. However, when S-9 mix was added, the number of revertant colonies ceased increasing.<BR>Ethylenthio urea caused mutations in TA98. When S-9 mix was added, revertant colonies increased about twice the number in the control. In the absense of S-9 mix, the result was the same.

Effects of Agricultural Chemicals on Rural Inhabitants in Miye Prefecture-A Report on the Findings of Health Examinations / 日本農村医学会雑誌

Farmers are constantly exposed to the hazards of agrochemicals. Especially those who regularly spray their fields with pesticides are at high risk of being contracted with pesticideinduced maladies.<BR>During the three-year period from 1980 to 1982, health examinations were conducted, covering a total of 1, 164 pesticide sprayers in eight rural communities, Miye Prefecture. Of the number, 869 were women. Mercury residues in hair were also measured.<BR>The findings are as follows:<BR>1. Abnormal lipid metabolism topped the list of disorders, followed by hypertension, ECG abnormalities, anemia, albuminuria and liver dysfunction in that order.<BR>2. The rates of detection of these abnormalities were not particularly high as compared with those in ordinary health checkups.<BR>3. When compared with previous findings, the cases of abnormal lipid metabolism and anemia decreased in number both in men and women, whereas the cases of abnormal cholinesterase activities and albuminuria increased in both sexes.<BR>4. The majority of pesticides used by the farmers were organophosphorous.<BR>5. The average level of mercury residues in hair was 5.35 ppm for men and 2.97 for women. 6. More than 6.0 ppm of mercury were detected in 23.1 % of the men and 1.9% of the women. None were found to carry more than 20 ppm of mercury in their hair.

Studies on the Paraquat Toxicity (1) / 日本農村医学会雑誌

Paraquat (1, 1'-dimethy1-4, 4'-dipyridylium dichloride) was administered to Wister rats orally at100mg/kg, 50mg/kg and 25mg/kg.<BR>Death generally occured in1-5days, many animals of the group administered at 100mg/kg died within 24 hours.<BR>Loss of body weight began on the second day after paraquat ingestion.<BR>The lung became the organ of highest concentration of paraquat, that reached maximum level with in 2 hours and was eliminated approximately 62-82% 24 hours later.<BR>Biochemical studies gave high levels of serum LDH and GOT, but no abnormalities were detected hematologically.<BR>Histopathological examinations has shown that the lung was the target organ of the paraquat poisoning. At the early stage, there were atelectasis, pulmonary edema and disintegration of the alveolar epithelium. These were followed by an infiltration of fibroblasts and glandular proliferation of the terminal bronchiolar epithelium. Parenchymal damages of the heart, liver and kidney were most dominant in 24 hours after paraquat ingestion, from which animals recovered subsequently.