Factors associated with community residents' preference for living at home at the end of life: The Yamagata Cohort Survey.

Japan's rapidly aging and high-mortality society necessitates a wider awareness and implementation of advance care planning. This Yamagata Cohort study investigated local residents' preferences for where they would like to spend their final days, and the underlying factors associated with those preferences with a self-administered questionnaire survey of local residents aged 40 years and over . Logistic regression analyses were used to assess those factors and, specifically, the choice of "Home" as the preferred place for end-of-life residence. Among the 10,119 responders, 61% chose their home as the most desirable place to spend their final days. The multiple logistic regression analysis showed that the independent factors associated with the choice of "Home" were: male, older age, not living with someone who needs care, not discussing the end of life, currently happy, struggling to live on current income, not feeling anxious or depressed, and current place of residence the same as their grandparents' birthplace. This suggested that reducing the burden of home care and addressing frequent emotional issues such as happiness and anxiety could increase the number of people choosing "Home". Open-ended comments indicated the importance of getting information and options, and discussing the choice of place for terminal care in light of individual backgrounds including having reservations about family. Support and systems are needed to understand what community residents consider important when deciding where to spend their final days, and to bridge the gap between their desired location and their actual end of life.

[Tuberculosis detected after emergency cesarean section].

A 29-year-old woman at 37 weeks of gestation was brought to our hospital as an emergency patient complaining of severe cough, hemoptysis and dyspnea. On arrival, we suspected that she was suffering from bronchial asthma or pulmonary embolism, but were unable to improve her respiratory condition. The decision was made to terminate gestation immediately and an emergency cesarean section was performed under spinal anesthesia. Postoperatively diagnosis of tuberculosis was made. Fortunately, there was no intramural tuberculous infection. She was a nurse. Nurses are twice as likely as the general public to contract tuberculosis. Medical workers must keep in mind that they may be infected with tuberculosis and they could also become the source of infection of tuberculosis. It is important to rule out tuberculosis when a patient, particularly a medical worker, complains of severe cough, hemoptysis and dyspnea.