ABSTRACT
Introduction: The purpose of this study was to clarify the relationship between the available service information on small-scale multifunctional in-home nursing care (KANTAKI) and its operational status via text mining.Methods: We obtained nationwide textual information on KANTAKI from the Nursing Care Service Information Disclosure System and the Ministry of Health, Labour, and Welfare, and analyzed the characteristics of the word usage using KH Coder. The number of users and employees and the implementation of services were compared among the facilities that used terms relating to medical dependency and end-of-life care, which are KANTAKI characteristics, and with other facilities.Results: The facilities that used terms relating to medical dependency and end-of-life care showed significantly more users requiring nursing care level 5 and more full-time nursing staff than those not using such terms. Moreover, regarding service provision, the rate of procedures was significantly higher in 11 of 12 items, except for stoma.Conclusion: The facilities that use terms relating to medical dependency and end-of-life care in their information have more users and provide a greater variety of services. In the future, educational support is required to enable facility managers to understand the services and translate them into their work.
ABSTRACT
To elucidate the host genetic loci affecting severity of SARS-CoV-2 infection, or Coronavirus disease 2019 (COVID-19), is an emerging issue in the face of the current devastating pandemic. Here, we report a genome-wide association study (GWAS) of COVID-19 in a Japanese population led by the Japan COVID-19 Task Force, as one of the initial discovery GWAS studies performed on a non-European population. Enrolling a total of 2,393 cases and 3,289 controls, we not only replicated previously reported COVID-19 risk variants (e.g., LZTFL1, FOXP4, ABO, and IFNAR2), but also found a variant on 5q35 (rs60200309-A at DOCK2) that was associated with severe COVID-19 in younger (<65 years of age) patients with a genome-wide significant p-value of 1.2 x 10-8 (odds ratio = 2.01, 95% confidence interval = 1.58-2.55). This risk allele was prevalent in East Asians, including Japanese (minor allele frequency [MAF] = 0.097), but rarely found in Europeans. Cross-population Mendelian randomization analysis made a causal inference of a number of complex human traits on COVID-19. In particular, obesity had a significant impact on severe COVID-19. The presence of the population-specific risk allele underscores the need of non-European studies of COVID-19 host genetics.
ABSTRACT
BACKGROUND: Mortality rates may be high in adult Fontan patients; however, the clinical determinants remain unclear. PURPOSE: We conducted a prospective multicenter study of adult Fontan survivors to determine the 5-year mortality rate and clarify the determinants. METHOD AND RESULTS: We followed 600 adult Fontan survivors from 40 Japanese institutions (307 men, 28⯱â¯7â¯years old, follow-up: 18⯱â¯6â¯years). The New York Heart Association (NYHA) functional class I and II was 51% and 42%, respectively. During the follow-up period of 4.1⯱â¯1.6â¯years, 33 patients died, and the 5-year survival rate was 93.5%. The mode of death was heart failure in 11 patients (34%), arrhythmia or sudden death in 8 (24%), cancer in 5 (15%), perioperative problems and hemostatic problems in 4 each (12% for each), and infection in 1 (3%). Left isomerism, prior hospitalization, protein losing enteropathy (PLE), pulmonary arteriovenous fistulae, NYHA functional class, impaired hemodynamics, hyponatremia, hepatorenal dysfunction, and use of diuretics were associated with a high mortality rate (pâ¯<â¯0.05-0.0001). Further, PLE (hazard ratio [HR]: 14.4), left isomerism (HR: 3.5), and NYHA (HR: 2.4) independently predicted a high 5-year high mortality (pâ¯<â¯0.05 for all). The incidence of cancer-related mortality increased markedly with age >40â¯years. CONCLUSIONS: Majority of the Japanese adult Fontan survivors had good functional status, with an acceptable 5-year survival rate. However, the significant prevalence of non-cardiac mortality highlights Fontan pathophysiology as a multi-organ disease that requires a multidisciplinary management strategy to improve the long-term outcome.
Subject(s)
Cause of Death/trends , Fontan Procedure/mortality , Fontan Procedure/trends , Heart Diseases/mortality , Neoplasms/mortality , Adolescent , Adult , Female , Follow-Up Studies , Heart Diseases/diagnosis , Humans , Japan/epidemiology , Male , Middle Aged , Neoplasms/diagnosis , Predictive Value of Tests , Prospective Studies , Survival Rate/trends , Young AdultABSTRACT
The purpose of the present study was to obtain the insights about the roles of specialized home care clinics and the “Doctor net” in community palliative care by investigating changes in the home death rates of cancer patients in a city where both specialized home care clinics and the Doctor net are available. A region palliative care intervention study was conducted, and data on the rate of cancer patients who died at home between 2007 and 2010 in the region were collected. The rate of cancer patients who died at home increased from 7.0% in 2007 to 13.0% in 2010. In 2007, 49% of the total number of people who died at home were patients of specialized home care clinics, and the rate increased to 13.0% in 2010. However, the number of cancer patients of other clinics who died at home did not decrease, from 63 in 2007 to 98 in 2009 and 77 in 2010. The functions of specialized home care clinics and the Doctor net adopted in general clinics were not exclusive to each other, and specialized home care clinics may improve palliative care implemented for cancer patients at home by participating in the Doctor net to provide general clinics with support.
