Factors Associated with Delayed Diagnosis among Patients with COVID-19 in Okinawa, Japan.

The delayed presentation and diagnosis of COVID-19 can contribute to spread of the disease to others but can also cause severe conditions. This study examined factors associated with delayed diagnosis among patients with COVID-19 in Okinawa, Japan. We used the data from 7125 reported cases of people living in Okinawa prefecture with symptom onset between September 2020 and March 2021. The outcome variable was the number of days from symptom onset to diagnosis. The predictor variables included age, sex, occupation, residential area, presumed infection route, and the day of the week. Cox regression analysis was used to compare the outcome between categories for each predictor variable. The median number of days from onset to diagnosis was 3 days, with an interquartile range of 1 to 5 days. Significantly more time from onset to diagnosis was observed in patients in their 60s vs. those in their 20s (hazard ratio: 0.88; 95% confidence interval: 0.81-0.96); hospitality workers were compared to office workers (0.90; 0.83-0.97), patients with unknown infection routes to those with known infection routes (0.77; 0.70-0.84), and those with symptom onset on Sundays/national holidays to those with symptom onset on weekdays (0.90; 0.85-0.96).

The moderating effect of place attachment on the relationship between economic status and well-being among the older adults in Japan.

IKIGAI is culturally defined as a subjective evaluation of well-being in Japan and is believed to be an important factor in achieving a better life. This study determined the association between economic status and well-being using IKIGAI and the moderating effect of place attachment on their association among 499 older adults people over 65 years of age in Japan. The result of hierarchical multiple regression analysis revealed that lower economic status significantly decreased well-being. We also observed a significant interactive effect of place attachment on the association between economic status and well-being (ß = 0.085, p = 0.041). In other words, improving place attachment was beneficial in alleviating the impact of lower economic status on well-being for the older adults. As the aged population increases across the globe, the way in which societies can counteract the adverse impact of economic status through place attachment could be highly beneficial.

Visiting Nurses' Perspectives on Practices to Achieve End-of-Life Cancer Patients' Wishes for Death at Home: A Qualitative Study.

OBJECTIVE: This study aimed to clarify visiting nurses' perspectives on critical practices to ensure they could advocate for patients who prefer to die at home. METHODS: Sixteen nurses, working at home-visit nursing agencies in Japan, participated in this study. Data were generated by interviews with the nurses and participant observations from nursing home-visits for six end-of-life cancer patients and were analyzed using content analysis. RESULTS: Five themes emerged: (1) nursing assessment, (2) support for comfortable daily life of the patient and their family, (3) advocating for the patient's views about continuing homecare until death, (4) supporting the patient's preparedness for death, and (5) coordination with other health professionals and related facilities for a comfortable environment for the patient. In addition, the nurses sometimes used humorous responses to death-related work to change the patient's melancholy thoughts. CONCLUSION: The present study found that the participants advocated for the patient's views about continuing homecare until death while coordinating views between the patient and their family; they further supported the patient's daily life while helping them prepare for death to achieve their wish for death at home. In addition, our study uncovered the visiting nurses' unconscious practical wisdom of using humorous responses to death-related work to alleviate the patients' feelings of hopelessness. To develop practical wisdom for using humor effectively in end-of-life care, nurses need to verbalize unconscious practices, and accumulate empirical knowledge about nursing interventions using humor, including cultural attitudes, through case study analysis.

Association between Daily Life Difficulties and Acceptance of Disability in Cancer Survivors after Total Laryngectomy: a Cross-Sectional Survey.

OBJECTIVE: This study aimed to clarify the relationships between the acceptance of disability and daily life difficulties in patients after total laryngectomy. METHODS: An anonymous questionnaire was mailed to 135 patients who were participating in a self-help group after laryngectomy. The questionnaire included items on personal attributes, daily life difficulties, and acceptance of disability according to the Nottingham Adjustment Scale - Japanese Laryngectomy version (NAS-J-L). Multiple regression analysis was conducted using the NAS-J-L acceptance of disability subscale score as the dependent variable and daily life difficulties as the independent variables. RESULTS: Among the 57 respondents, 43 who provided valid answers were included in the analysis (41 men and 2 women; mean age = 67.5 ± 10.6 years). Acceptance of disability was significantly associated with difficulties in defecation (ß = -0.409, P < 0.01) and breathing (ß = -0.356, P < 0.05). CONCLUSIONS: Our findings suggested that difficulties in defecation and breathing due to airway alterations influence acceptance of disability after laryngectomy. Therefore, nurses should carefully assess daily life difficulties and patient's ability to perform self-care activities such as defecating and breathing to promote acceptance of disability and facilitate adaptation to daily life after total laryngectomy.

Current status of extended spectrum ß-lactamase-producing Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis in Okinawa prefecture, Japan.

Enterobacteriaceae producing extended spectrum ß-lactamase (ESBL) are distributed worldwide. In this study, 114 ESBL-producing Enterobacteriaceae were isolated by analyzing 1672 clinical isolates of Enterobacteriaceae collected from an Okinawa prefectural hospital in Japan between June 2013 and July 2014. The overall prevalence of ESBL-producing Enterobacteriaceae was 6.8%; the prevalence of different bacterial species among the ESBL-producing isolates was as follows: 11.5% Escherichia coli (90 of 783 isolates), 6.2% Klebsiella pneumoniae (19 of 307 isolates), and 11.1% Proteus mirabilis (5 of 45 isolates). The ESBL types blaCTX-M-1, -3, -15, -2, -14, -27, and mutants of blaSHV-1 were detected. Among them, blaCTX-M-15 (33.3%), blaCTX-M-14 (27.8%) and blaCTX-M-27 (33.3%) were dominant in the E. coli isolates, whereas a blaSHV mutant which possessed four mutations (Tyr7Phe, Leu35Gln, Gly238Ser and Glu240Lys) in the amino acid sequence of SHV-1 dominated in the K. pneumoniae isolates (11 of 19, 57.9%). The pandemic E. coli ST131 clone was found to constitute 3.3% of the overall examined isolates and 62.2% of the ESBL-producing E. coli isolates. Our results suggest that the genetic combination of blaCTX-M, and blaSHV and antibiotics-resistant profile were different from that in other regions such as other areas of Japan, Asia, Europe, and North America, especially in the ESBL-producing K. pneumoniae isolates and in the E. coli B2-O25b-ST131 isolates possessing blaCTX-M-15 (40.7% of the E. coli B2-O25b-ST131 isolates). Taken together, our results indicate that the ESBL-producing Enterobacteriaceae in Okinawa, Japan, might be of a unique nature.

Carriage of Escherichia coli Producing CTX-M-Type Extended-Spectrum ß-Lactamase in Healthy Vietnamese Individuals.

Healthy carriage of CTX-M-type extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli was examined by thrice collecting fecal samples from the same 199 healthy Vietnamese subjects every 6 months. Using pulsed-field gel electrophoresis (PFGE), identical PFGE patterns throughout the three samplings were not observed, although prevalence of E. coli in the subjects was around 50% in the three samplings. Our results suggested a short carriage period of the CTX-M-type ESBL-producing E. coli in healthy Vietnamese subjects.