Cholecystitis after Placement of Covered Self-Expandable Metallic Stents in Patients with Distal Malignant Biliary Obstructions

Background/Aims@#Cholecystitis can occur after the placement of covered self-expandable metallic stents for distal malignant biliary obstructions. We aimed to identify risk factors for cholecystitis following covered self-expandable metallic stent placement. @*Methods@#We investigated risk factors related to cholecystitis following covered self-expandable metallic stent placement in 118 patients with distal malignant biliary obstructions between January 1, 2015 and April 30, 2019. Endoscopic assessments and tumor invasion to the arteries feeding the gallbladder were determined by a pancreaticobiliary endoscopist and a radiologist, respectively. @*Results@#The median patient age was 72 years (men, 61.0%). The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct were observed in 35 (29.7%) and 35 (29.7%) patients, respectively. During the observation period (median, 179 days), cholecystitis occurred in 18 (15.3%) patients. Multivariate analysis revealed the flow of the contrast agent into the gallbladder (p=0.023) and tumor involvement in the orifice of the cystic duct (p=0.005) as significant independent risk factors associated with cholecystitis. @*Conclusions@#The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct are potential independent risk factors for cholecystitis following the placement of covered self-expandable metallic stents. A follow-up prospective study is warranted to validate their influence.

Cholecystitis after Placement of Covered Self-Expandable Metallic Stents in Patients with Distal Malignant Biliary Obstructions

Background/Aims@#Cholecystitis can occur after the placement of covered self-expandable metallic stents for distal malignant biliary obstructions. We aimed to identify risk factors for cholecystitis following covered self-expandable metallic stent placement. @*Methods@#We investigated risk factors related to cholecystitis following covered self-expandable metallic stent placement in 118 patients with distal malignant biliary obstructions between January 1, 2015 and April 30, 2019. Endoscopic assessments and tumor invasion to the arteries feeding the gallbladder were determined by a pancreaticobiliary endoscopist and a radiologist, respectively. @*Results@#The median patient age was 72 years (men, 61.0%). The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct were observed in 35 (29.7%) and 35 (29.7%) patients, respectively. During the observation period (median, 179 days), cholecystitis occurred in 18 (15.3%) patients. Multivariate analysis revealed the flow of the contrast agent into the gallbladder (p=0.023) and tumor involvement in the orifice of the cystic duct (p=0.005) as significant independent risk factors associated with cholecystitis. @*Conclusions@#The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct are potential independent risk factors for cholecystitis following the placement of covered self-expandable metallic stents. A follow-up prospective study is warranted to validate their influence.

Out-of-pocket Costs of Disabilities and Their Association with Household Socioeconomic Status Among School-aged Children in Vietnam / Journal of Rural Medicine

<b>Objective:</b> The aim of this study was to assess the economic burden of disability of school-aged children and to evaluate the association between disabilities and household socioeconomic status, as well as the economic burden of disability and household socioeconomic status in Vietnam.<br><b>Materials and Methods:</b> Nationally representative data for 9,882 children aged 6 to 17 years from the Vietnam Household Living Standard Survey 2006 were used. Disabilities were measured in six basic functional domains, including vision, hearing, remembering or concentrating, mobility, self-care, and communication. We evaluated the association between area, household income, educational attainment, or occupation of household head, and each difficulty. The ratio of health-care expenditure to per capita household income was compared by presence of a disability as well as household socioeconomic status.<br><b>Results:</b> The prevalence of difficulty was 1.9% for vision and 2.3% for at least one of the other five domains. Difficulty in vision was more prevalent in the richer households (p=0.001), whereas difficulty in the other five domains was more prevalent in the poorer households (p=0.002). The ratio of health-care expenditure to per capita household income was greater than 0.05 in 4.6% of children. The adjusted odds ratio of children with difficulty in vision having a health-care expenditure share greater than 0.05 compared with children without difficulty was 4.78 (95% CI: 2.95, 7.73; p<0.001), and that for difficulty in the other five domains was 3.13 (95% CI: 2.04, 4.80; p<0.001). Among children with difficulty in at least one of the five domains other than vision, the proportion of children with a health-care expenditure share greater than 0.05 was higher among children from the poorer households (p=0.033).<br><b>Conclusions:</b> Children with a disability spent more on health care relative to their income than those without. Visual disability was more prevalent among children from the richer households, whereas other disabilities were more prevalent among children from the poorer households.

Validity and Reliability of Seattle Angina Questionnaire Japanese Version in Patients With Coronary Artery Disease

PURPOSE: The aim of this study was to evaluate the validity and reliability of the Seattle Angina Questionnaire, Japanese version (SAQ-J) as a disease-specific health outcome scale in patients with coronary artery disease. METHODS: Patients with coronary artery disease were recruited from a university hospital in Tokyo. The patients completed self-administered questionnaires, and medical information was obtained from the subjects' medical records. Face validity, concurrent validity evaluated using Short Form 36 (SF-36), known group differences, internal consistency, and test-retest reliability were statistically analyzed. RESULTS: A total of 354 patients gave informed consent, and 331 of them responded (93.5%). The concurrent validity was mostly supported by the pattern of association between SAQ-J and SF-36. The patients without chest symptoms showed significantly higher SAQ-J scores than did the patients with chest symptoms in 4 domains. Cronbach's alpha ranged from .51 to .96, meaning that internal consistency was confirmed to a certain extent. The intraclass correlation coefficient of most domains was higher than the recommended value of 0.70. The weighted kappa ranged from .24 to .57, and it was greater than .4 for 14 of the 19 items. CONCLUSIONS: The SAQ-J could be a valid and reliable disease-specific scale in some part for measuring health outcomes in patients with coronary artery disease, and requires cautious use.

Bacterial quality of drinking water stored in containers by boat households in Hue City, Vietnam

<p><b>OBJECTIVES</b>To examine the bacterial quality of drinking water stored in containers by boat households in the river basin of Hue City, and associated factors.</p><p><b>METHODS</b>Ready-to-drink water stored in containers on boats was collected from 766 households. Escherichia coli (E. coli), total coliforms, and Enterobacteriaceae in the water were examined by the rehydratable dry-film plating method. Socioeconomic characteristics, water source, handling practices, and proficiency of disease prevention of individual households were assessed.</p><p><b>RESULTS</b>E. coli, over ten counts of total coliforms, and over ten counts of Enterobacteriaceae were detected in 25.7, 44.5, and 51.5% of 1-ml samples of ready-to-drink water stored in containers on the boats. Bacterial contamination of the water stored in containers by boat households was significantly associated with use of river water as a source of drinking water, non-boiling before storing containers for drinking, and limited proficiency in disease prevention regardless of the influence of socioeconomic characteristics of the households (P < 0.01, P < 0.05, P < 0.01, respectively).</p><p><b>CONCLUSIONS</b>Bacterial contamination of ready-to-drink water stored by boat households was indicated. The households' proficiency in disease prevention buffered contamination. A comprehensive health promotion program with a wide range of contents is required for the communities of boat households.</p>

Water quality and concentration of alkylphenols in rivers used as source of drinking water and flowing through urban areas

<p><b>OBJECTIVES</b>To examine nonylphenol (NP) and 4-t-octylphenol (OP) concentrations and general water quality indicators along a river in the greater Tokyo area and to specify the distribution and origin of alkylphenols.</p><p><b>METHODS</b>Water was sampled from the Edogawa River, a main river in the greater Tokyo area, which is a source of public drinking water; and the Sakagawa River system, a tributary of the Edogawa River. To determine alkylphenol in river water. NP and OP concentrations were quantified using gas chromatography-mass spectrometry (GC-MS).</p><p><b>RESULTS</b>The detection rates of NP above the detection limit were 100% in both rivers, and those of OP were 75.0% in the Edogawa River and 92.9% in the Sakagawa River system. The median NP and OP concentrations in the Edogawa River were 0.24 μg/1 and 0.066 μg/l, and those in the Sakagawa River system were 0.87 μg/l and 0.19 μg/l respectively. Alkylphenol concentrations are significantly higher in the Sakagawa River system than in the Edogawa River. In the Sakagawa River system, the NP and OP concentrations were highest in the water along the nonindustrial area with an underdeveloped sewerage system.</p><p><b>CONCLUSIONS</b>NP and OP were detected widely in the Edogawa River and Sakagawa River system. Endocrine-disrupting chemical (EDC) pollution in a river by the inflow of urban wastewater was demonstrated. A systematic monitoring of alkylphenols in tributary rivers and streams as well as in main rivers will help control EDC pollution and protect the source of drinking water in urban areas.</p>

Improved perinatal health through qualified antenatal care in urban Phnom Penh, Cambodia

<p><b>OBJECTIVES</b>The aim of this study is to examine the utilities of antenatal care with comprehensive health education qualified in Phnom Penh for the health of mothers and infants during perinatal and postpartum periods. Attention was given to the existing socioeconomic disparties among women in this urban area, and the utilities were discussed irrespective of socioeconomic status.</p><p><b>METHODS</b>A total of 436 pregnant women in an urban area in Phnom Penh were selected using a complete survey in randomly sampled villages and were followed up. Participating in antenatal care with comprehensive health education at least three time was regarded as the use of "qualified antenatal care" during pregnancy. In this study, we investigated the independent associations of the use of qualified antenatal care with the following outcome variables after the adjustment for the influence of socieconomic variables: postpartum maternal health knowledge, postpartum maternal anemia, low birth weight, and infant immunization.</p><p><b>RESULTS</b>Of the 314 subjects who completed the follow-up examination, 66.8% used qualified antenatal care during pregnancy. The use of qualified antenatal care was positively associated with postpartum maternal health knowledge (OR=2.38, 95% CI: 1.12-5.05). and reductions in the incidences of postpartum anemia (OR=0.22,95% CI: 0.05-0.95) and low birth weight (OR=0.05,95% CI: 0.01-0.39) after the adjustment of the influence of socioeconomic status. The infants born to mothers who used qualified antenatal care had significantly higher coverage of BCG, DPT(1), and DTP(3) immunizations (P<0.001,P<0.001, andP<0.01, respectively), independent of their socioeconomic conditions.</p><p><b>CONCLUSION</b>This study shows the solid utilities of qualified antenatal care in Phnom Penh for perinatal health.</p>

Improved Perinatal Health through Qualified Antenatal Care in Urban Phnom Penh, Cambodia

Objectives: The aim of this study is to examine the utilities of antenatal care with comprehensive health education qualified in Phnom Penh for the health of mothers and infants during perinatal and postpartum periods. Attention was given to the existing socioeconomic disparities among women in this urban area, and the utilities were discussed irrespective of socioeconomic status. Methods: A total of 436 pregnant women in an urban area in Phnom Penh were selected using a complete survey in randomly sampled villages and were followed up. Participating in antenatal care with comprehensive health education at least three times was regarded as the use of “qualified antenatal care” during pregnancy. In this study, we investigated the independent associations of the use of qualified antenatal care with the following outcome variables after the adjustment for the influence of socioeconomic variables: postpartum maternal health knowledge, postpartum maternal anemia, low birth weight, and infant immunization. Results: Of the 314 subjects who completed the follow-up examination, 66.8% used qualified antenatal care during pregnancy. The use of qualified antenatal care was positively associated with postpartum maternal health knowledge (OR=2.38, 95%CI: 1.12–5.05), and reductions in the incidences of postpartum anemia (OR=0.22, 95%CI: 0.05–0.95) and low birth weight (OR=0.06, 95%CI: 0.01–0.39) after the adjustment of the influence of socioeconomic status. The infants born to mothers who used qualified antenatal care had significantly higher coverage of BCG , DPT1, and DPT3 immunizations (P<0.001, P<0.001, and P<0.01, respectively), independent of their socioeconomic conditions. Conclusion: This study shows the solid utilities of qualified antenatal care in Phnom Penh for perinatal health.

Water Quality and Concentration of Alkylphenols in Rivers Used as Source of Drinking Water and Flowing through Urban Areas

Objectives: To examine nonylphenol (NP) and 4-t-octylphenol (OP) concentrations and general water quality indicators along a river in the greater Tokyo area and to specify the distribution and origin of alkylphenols. Methods: Water was sampled from the Edogawa River, a main river in the greater Tokyo area, which is a source of public drinking water; and the Sakagawa River system, a tributary of the Edogawa River. To determine alkylphenol in river water, NP and OP concentrations were quantified using gas chromatography-mass spectrometry (GC-MS). Results: The detection rates of NP above the detection limit were 100% in both rivers, and those of OP were 75.0% in the Edogawa River and 92.9% in the Sakagawa River system. The median NP and OP concentrations in the Edogawa River were 0.24 μg/l and 0.066 μg/l, and those in the Sakagawa River system were 0.87 μg/l and 0.19 μg/l respectively. Alkylphenol concentrations are significantly higher in the Sakagawa River system than in the Edogawa River. In the Sakagawa River system, the NP and OP concentrations were highest in the water along the nonindustrial area with an underdeveloped sewerage system. Conclusions: NP and OP were detected widely in the Edogawa River and Sakagawa River system. Endocrine-disrupting chemical (EDC) pollution in a river by the inflow of urban wastewater was demonstrated. A systematic monitoring of alkylphenols in tributary rivers and streams as well as in main rivers will help control EDC pollution and protect the source of drinking water in urban areas.