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[Background] A serious shortage of cefazolin (CEZ) occurred in Japan in 2019. We compared the impact of the CEZ shortage on the selection of parenteral antibiotics at affected and non-affected hospitals. [Methods] The data were extracted from a nationwide Japanese administrative database and included all hospitalized cases between April 2016 and December 2020. We defined ‘hospitals with shortage’ as those hospitals with a statistically significant decrease in the use of CEZ during the supply disruption period compared to the same months of the previous year; other hospitals as ‘hospitals without shortage’. We determined the proportion of each selected parenteral antibiotic use to the sum of all selected antibiotic use in the two groups of hospitals during the supply disruption period and during the same months of the previous year. A controlled interrupted time series (CITS) analysis was conducted to estimate the impact of the CEZ shortage on each antibiotic use and the cost of all parenteral antibiotics per patient day in hospitals with shortage as compared to those without shortage. [Results] In the hospitals with shortage, the proportion of CEZ use to the sum of all selected antibiotics decreased (23.5–11.1%). The decrease in CEZ use was mainly offset by the use of ceftriaxone, ceftriaxone, and ampicillin/sulbactam. The CITS analysis showed a statistically significant increase in the use of broader-spectrum beta-lactams and clindamycin during the supply disruption period (flomoxef up 58.1%, cefotiam up 63.1%, cefmetazole up 14.5%, ceftriaxone up 13.9%, and clindamycin up 20.1%). The analysis showed no statistically significant change in the cost of all parenteral antibiotics per patient day. [Conclusions] During the CEZ supply disruption, there was a statistically significant increase in the use of broader-spectrum beta-lactams and clindamycin in hospitals with shortage compared with those without shortage.

[Background] Discharge planning enhances the safe and timely transfer of inpatients between facilities. Predicting the discharge destination of inpatients with aspiration pneumonia is important for discharge planning. We aimed to develop and validate prediction models for the discharge destination of elderly patients with aspiration pneumonia. [Methods] Using a nationwide inpatient database, we identified aspiration pneumonia cases for patients aged ≥65 years who had been admitted to hospital from their home or from a nursing home between April 2020 and March 2021. We divided the cases into derivation and validation cohorts according to the location of the admitting hospital. We developed two prediction models by dividing the cases based on the patient’s place of residence prior to admission, one model to predict the home discharge of cases admitted from home and the other to predict the home or to a nursing home discharge of cases admitted from a nursing home. The models were internally validated with bootstrapping and internal-externally validated using a validation cohort. Nomograms that could be used easily in clinical practice were also created. [Results] The derivation cohort included 19, 746 cases admitted from home and 14, 359 cases admitted from a nursing home. Of the former, 10, 760 (54.5%) cases were discharged home; from the latter, 7, 071 (49.2%) were discharged to either home or a nursing home. The validation cohort included 6, 262 cases admitted from home and 6, 352 cases admitted from a nursing home. In the internal-external validation, the C-statistics of the final model for the cases admitted from home and the cases admitted from a nursing home were 0.71 and 0.67, respectively. [Conclusions] We developed and validated new prediction models for the discharge of elderly patients with aspiration pneumonia either to home or to a nursing home. Our models and nomograms could facilitate the early implementation of discharge planning.

The suppression of the first wave of COVID-19 in Japan is assumedly attributed to people’s increased risk perception after acquiring information from the government and media reports. In this study, going out in public amidst the spread of COVID-19 infections was investigated by examining new polymerase chain reaction (PCR) positive cases of COVID-19 and its relationship to four indicators of people going out in public (the people flow, the index of web searches for going outside, the number of times people browse restaurants, and the number of hotel guests, from the Regional Economic and Social Analysis System (V-RESAS). Two waves of COVID-19 infections were examined using cross-correlation analysis. In the first wave, all four indicators of going out changed to be opposite the change in new PCR positive cases, showing a lag period of –1 to +6 weeks. In the second wave, the same relationship was only observed for the index of web searches for going outside, and two indicators showed the positive lag period of +6 to +12 weeks after the change in new PCR positive cases. Moreover, each indicator in the second wave changed differently compared to the first wave. The complexity of people’s behaviors around going out increased in the second wave, when policies and campaigns were implemented and people’s attitudes were thought to have changed. In conclusion, the results suggest that policies may have influenced people’s mobility, rather than the number of new PCR positive cases.

[Background] In Japan’s super-aging society, the number of long-term care service providers is increasing, and the quality of care is a matter of concern. One aspect of the quality of care is the user’s quality of life. The questionnaires EQ-5D and WHO-5 are representative indicators of quality of life. Herein, we aimed to measure the quality of life in long-term care service users in Japan and to clarify the relationship between quality of life and the level of care required. [Methods] A questionnaire study was conducted in 106 facilities of 22 corporations. In addition to the EQ-5D and WHO-5, sex, age, and the level of care required were assessed by descriptive statistics. Bonferroni’s multiple comparison test was used to analyze each quality of life score, and the differences by sex and age were analyzed multiple regression analyses, with each quality of life score as the objective variable. [Results] Of 4647 cases collected, 2830 were analyzed, with no missing data. Both indicators tended to be lower than the general older population. Those scores tended to be higher in females than males (EQ-5D: males, 0.58 ± 0.26; females, 0.60 ± 0.24; P = 0.06 and WHO-5: males, 13.8 ± 5.92; females 14.9 ± 5.70; P < 0.001). In terms of age, those under 65 years old with specific diseases had lower EQ-5D scores than those in other age groups (P < 0.001); however, WHO-5 scores did not differ by age. Multiple regression analysis showed a significant association between the EQ-5D score and level of care required, except for support-required level 1, which tended to worsen as the level of care required increased. Conversely, the WHO-5 score was significantly lower for care need levels 2, 4, and 5. [Conclusions] The quality of life of long-term care service users was worse than that of the general older population, it tended to be low among males and those under 65 years old with specific diseases. Furthermore, it gradually decreased as the level of care required increased. It is im

[Background] Maintaining critical care for non-Coronavirus-disease-2019 (non-COVID-19) patients is a key pillar of tackling the impact of the COVID-19 pandemic. This study aimed to reveal the medium-term impacts of the COVID-19 epidemic on case volumes and quality of intensive care for critically ill non-COVID-19 patients. [Methods] Administrative data were used to investigate the trends in case volumes of admissions to intensive care units (ICUs) compared with the previous years. Standardized mortality ratios (SMRs) of non-COVID-19 ICU patients were calculated in each wave of the COVID-19 epidemic in Japan. [Results] The ratios of new ICU admissions of non-COVID-19 patients to those in the corresponding months before the epidemic: 21% in May 2020, 8% in August 2020, 9% in February 2021, and 14% in May 2021, approximately concurrent with the peaks in COVID-19 infections. The decrease was greatest for new ICU admissions of non-COVID patients receiving invasive mechanical ventilation (IMV) on the first day of ICU admission: 26%, 15%, 19%, and 19% in the first, second, third, and fourth waves, respectively. No statistically significant change in SMR was observed in any wave of the epidemic; SMRs were 0.990 (95% uncertainty interval (UI), 0.962–1.019), 0.979 (95% UI, 0.953–1.006), 0.996 (95% UI, 0.980–1.013), and 0.989 (95% UI, 0.964–1.014), in the first, second, third, and fourth waves of the epidemic, respectively. [Conclusions] Compared to the previous years, the number of non-COVID-19 ICU patients continuously decreased over the medium term during the COVID-19 epidemic. The decrease in case volumes was larger in non-COVID-19 ICU patients initially receiving IMV than those undergoing other initial treatments. The standardized in-hospital mortality of non-COVID-19 ICU patients did not change in any waves of the epidemic.

The aging world population requires a sustainable and high-quality healthcare system. To examine the efficiency of medical cooperation, medical provider and physician networks were constructed using patient claims data. Previous studies have shown that these networks contain information on medical cooperation. However, the usage patterns of multiple medical providers in a series of medical services have not been considered. In addition, these studies used only general network features to represent medical cooperation, but their expressive ability was low. To overcome these limitations, we analyzed the medical provider network to examine its overall contribution to the quality of healthcare provided by cooperation between medical providers in a series of medical services. This study focused on: i) the method of feature extraction from the network, ii) incorporation of the usage pattern of medical providers, and iii) expressive ability of the statistical model. Femoral neck fractures were selected as the target disease. To build the medical provider networks, we analyzed the patient claims data from a single prefecture in Japan between January 1, 2014 and December 31, 2019. We considered four types of models. Models 1 and 2 use node strength and linear regression, with Model 2 also incorporating patient age as an input. Models 3 and 4 use feature representation by node2vec with linear regression and regression tree ensemble, a machine learning method. The results showed that medical providers with higher levels of cooperation reduce the duration of hospital stay. The overall contribution of the medical cooperation to the duration of hospital stay extracted from the medical provider network using node2vec is approximately 20%, which is approximately 20 times higher than the model using strength.

Aims: The Coronavirus Disease 2019 (COVID-19) pandemic has had unprecedented effects on health care utilization for acute cardiovascular diseases. Although hospitalizations for acute coronary syndrome decreased during the COVID-19 pandemic, there is a paucity of data on the trends and management of heart failure (HF) cases. Furthermore, concerns have been raised that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may increase susceptibility to COVID-19. This study aimed to elucidate changes in HF hospitalizations from the COVID-19 state of emergency in Japan and investigated changes in the prescription of ACEIs and ARBs, and in-hospital mortality. Methods and results: We performed an interrupted time series analysis of HF hospitalizations in Japan to verify the impacts of the COVID-19 state of emergency. Changes in the weekly volume of HF hospitalizations were taken as the primary outcome measure. Between 1 April 2018 and 4 July 2020, 109 429 HF cases required admission. After the state of emergency, an immediate decrease was observed in HF cases per week [−3.6%; 95% confidence interval (CI): −0.3% to −6.7%, P = 0.03]. There was no significant change in the prescription of ACEIs or ARBs after the state of emergency (4.2%; 95% CI: −0.3% to 8.9%, P = 0.07). The COVID-19 pandemic had no effect on in-hospital mortality among HF patients (5.3%; 95% CI: −4.9% to 16.6%, P = 0.32). Conclusions: We demonstrated a decline in HF hospitalizations during the COVID-19 pandemic in Japan, with no clear evidence of a negative effect on the prescription of ACEIs and ARBs or in-hospital mortality.

Background: The number of new noncommercial clinical studies conducted in Japan declined within the first year of the implementation of the Clinical Trials Act (CTA) on April 1, 2018. This study aimed to examine the impact of the CTA’s enforcement on the number of new noncommercial clinical studies registered in the Japanese Clinical Trial Registry. Methods: An interrupted time-series design was used in the analysis, which was conducted from April 2015 to March 2019. We collected data for studies registered in the Clinical Trial Registry, managed by the University Hospital Medical Information Network. Results: In total, 35, 811 studies were registered; of these, 16, 455 fulfilled the eligibility criteria. The difference in the trend of monthly number of new studies after CTA enforcement decreased significantly by 15.0 (95% confidence interval [CI], −18.7 to −11.3), and the level decreased by 40.8 (95% CI, −68.2 to −13.3) studies from the pre-enforcement to the post-enforcement period. Multigroup analyses indicated that the act exerted a significant effect on the trend of new clinical studies, particularly those with smaller sample sizes, interventional study designs, and nonprofit funding sponsors. Conclusions: The number of Japanese noncommercial clinical studies declined significantly following implementation of the CTA. It is necessary to establish a system to promote clinical studies in Japan while ensuring transparency and safety.

Background: The transtheoretical model (TTM) is composed of the multiple stages according to patient’s consciousness and is believed to lead people to realize the importance of healthier behaviors. We examined the association of TTM stages with the decline of estimated glomerular filtration rate (eGFR). Methods: We used the annual health checkup data and health insurance claims data of the Japan Health Insurance Association in Kyoto Prefecture between April 2012 and March 2016. TTM stages of change obtained from questionnaires at the first health checkup and categorized into six groups. The primary outcome was defined as a more than 30% decline in eGFR from the first health checkup. We fitted multivariable Cox proportional-hazards model for time-to-event analyses adjusting for age, sex, eGFR, body mass index, blood pressure, blood sugar, dyslipidemia, uric acid, urinary protein, and existence of kidney diseases at first health checkup. Results: We analyzed 239, 755 employees and the mean follow-up was 2.9 (standard deviation, 1.2) years. As compared with the stage 1 group, the risk of eGFR decline was significantly low in the stage 3 group (hazard ratio [HR] 0.77; 95% confidence interval [CI], 0.65–0.91); stage 4 group (HR 0.80; 95% CI, 0.65–0.98); and stage 5 group (HR 0.79; 95% CI, 0.66–0.95). Conclusion: Compared with the precontemplation stage (stage 1), the preparation, action and maintenance stages (stages 3, 4, and 5), were associated with a lower risk of eGFR decline.

Aims: Declines in cardiovascular diseases during the first surge of coronavirus disease 2019 (COVID-19) have been reported. With the repeating surges of COVID-19, we aim to investigate the medium-term impact of the COVID-19 pandemic on the practice of percutaneous coronary interventions (PCIs). Methods: We performed a descriptive analysis of rates of PCIs, utilizing administrative data in Japan. Changes in the proportion of severe cases and in-hospital mortality since the start of the COVID-19 pandemic were investigated using interrupted time series (ITS) analyses. Results: From April 2018 to February 2021, 38, 696 and 28, 585 cases of elective and emergency PCIs, respectively, were identified. The rates of PCIs decreased during the first and third COVID-19 surges. The ratios of monthly rates of elective PCIs to that in the corresponding months during the previous 2 years were 50.3% in May 2020 and 76.1% in January 2021. The decrease in rates of emergency PCIs was smaller than that of elective PCIs. The ITS analyses did not identify any significant changes in the proportion of severe cases and in-hospital mortality. Conclusions: We found that the impacts of COVID-19 on PCIs were larger in the first surge than in the subsequent and larger in the elective than in the emergency; this continued over the medium-term. During the COVID-19 pandemic, in-hospital mortality of cases undertaking emergency PCIs did not change.

Aim: The coronavirus disease 2019 (COVID-19) pandemic has left negative spillover effects on the entire health care system. Previous studies have suggested significant declines in cases of acute coronary syndrome (ACS) and primary percutaneous coronary intervention (PCI) during the COVID-19 pandemic. Methods: We performed a quasi-experimental, retrospective cohort study of ACS hospitalisations by using a multi-institutional administrative claims database in Japan. We used interrupted time series analyses to ascertain impacts on cases, treatment approaches, and in-hospital mortality before and after Japan’s state of emergency to respond to COVID-19. The primary outcome was the change in ACS cases per week. Results: A total of 30, 198 ACS cases (including 21, 612 acute myocardial infarction and 8, 586 unstable angina) were confirmed between 1st July 2018 and 30th June 2020. After the state of emergency, an immediate decrease was observed in ACS cases per week (-18.3%; 95% confidence interval, -13.1 to -23.5%). No significant differences were found in the severity of Killip classification (P=0.51) or cases of fibrinolytic therapy (P=0.74). The impact of the COVID-19 pandemic on in-hospital mortality in ACS patients was no longer observed after adjustment for clinical characteristics (adjusted odds ratio, 0.93; 95% confidence interval, 0.78 to 1.12; P=0.49). Conclusions: We demonstrated the characteristics and trends of ACS cases in a Japanese population by applying interrupted time series analyses. Our findings provide significant insights into the association between COVID-19 and decreases in ACS hospitalisations during the pandemic.

During the coronavirus disease 2019 (COVID-19) pandemic, there have been health concerns related to alcohol use and misuse. We aimed to examine the population-level change in cases of alcohol-related liver disease and pancreatitis that required admission during the COVID-19 epidemic by interrupted time series (ITS) analysis using claims data. We defined the period from April 2020, when the Japanese government declared a state of emergency, as the beginning of the COVID-19 epidemic. This ITS analysis included 3, 026, 389 overall admissions and 10, 242 admissions for alcohol-related liver disease or pancreatitis from 257 hospitals between July 2018 and June 2020. The rate of admissions per 1000 admissions during the COVID-19 epidemic period (April 2020–June 2020) was 1.2 times (rate ratio: 1.22, 95% confidence interval: 1.12–1.33) compared to the pre-epidemic period. Analyses stratified by sex revealed that the increases in admission rates of alcohol-related liver disease or pancreatitis for females were higher than for males during the COVID-19 epidemic period. The COVID-19 epidemic in Japan might associates an increase in hospital admissions for alcohol-related liver disease and pancreatitis. Our study could support the concern of alcohol consumption and health problems during the COVID-19 pandemic.

[Objective] The coronavirus disease 2019 (COVID-19) pandemic has affected all healthcare systems. This study aimed to assess the impact of the COVID-19 pandemic on the number and severity of cases of community-acquired pneumonia (CAP) in Japan. [Methods] Using claims data from the Quality Indicator/Improvement Project (QIP) database, urgent cases of inpatients for CAP from 01 August 2018 to 30 July 2020 were included. The monthly ratios of inpatient cases were compared from August 2018 to July 2019 and August 2019 to July 2020 as a year-over-year comparison. These ratios were also compared according to the “A-DROP” severity score, and an interrupted time series (ITS) analysis was performed to evaluate the impact of the COVID-19 pandemic on the monthly number of inpatient cases. [Results] This study included a total of 67, 900 inpatient cases for CAP in 262 hospitals. During the COVID-19 pandemic (defined as the period between March and July 2020) the number of inpatient cases for CAP drastically decreased compared with the same period in the previous year (–48.1%), despite a temporary reduction in the number of other urgent admissions. The number of inpatient cases decreased according to the severity of pneumonia. Milder cases showed a greater decrease in the year-over-year ratio than severe ones: mild –55.2%, moderate –45.8%, severe –39.4%, and extremely severe –33.2%. The ITS analysis showed that the COVID-19 pandemic significantly reduced the monthly number of inpatient cases for CAP (estimated decrease: –1233 cases; 95% CI –521 to –1955). [Conclusions] This study showed a significant reduction in the number of inpatient cases for CAP during the COVID-19 pandemic in Japan. The milder cases showed a greater decrease in the year-over-year ratio of the number of inpatient cases.

Intra-operative autologous blood donation is a blood conservation technique with limited evidence. We evaluated the association between intra-operative autologous blood donation and decrease in peri-operative transfusion in cardiovascular surgery based on evidence from a Japanese administrative database. We extracted the data of patients who had undergone cardiovascular surgery from the Diagnosis Procedure Combination database in Japan (2016–2019). Based on the surgery type, we examined the association of intra-operative autologous blood donation with the transfusion rate and amount of blood used in cardiac and aortic surgeries using multilevel propensity score matching. We enrolled 32, 433 and 4, 267 patients who underwent cardiac and aortic surgeries and received 5.0% and 6.7% intra-operative autologous blood donation with mean volumes of 557.68 mL and 616.96 mL, respectively. The red blood cell transfusion rates of the control and intra-operative autologous blood donation groups were 60.6% and 38.4%, respectively, in the cardiac surgery cohort (p < .001) and 91.4%, and 83.8%, respectively, in the aortic surgery cohort (p = .037). The transfusion amounts for the control and intra-operative autologous blood donation groups were 5.9 and 3.5 units of red blood cells, respectively, for cardiac surgery patients (p < .001) and 11.9 and 7.9 units, respectively, for aortic surgery patients (p < .001). Intra-operative autologous blood donation could reduce the transfusion rate or amount of red blood cells and fresh frozen plasma for patients undergoing index cardiovascular surgery and could be an effective blood transfusion strategy in cardiovascular surgery for Japanese patients.

Cardiovascular disease is the leading cause of death in the Kingdom of Bhutan. Thus, the early detection and prevention of hypertension is critical for reducing cardiovascular disease. However, the influence of sociocultural factors on vulnerability to hypertension needs further investigation. This study performed secondary data analysis on 1, 909 individuals in a cross-sectional study (the National survey for noncommunicable disease risk factors and mental health using World Health Organization (WHO) STEPS approach in Bhutan– 2014). Multivariate logistic regression demonstrated a significant association between gender with marital status and hypertension. Women had a higher odds ratio than men (Ref) when married (AOR: 1.27, 95% confidence intervals (CI): 1.23–1.31), and when separated, divorced, or widowed (AOR: 1.18, 95% CI: 1.12–1.26). People who speak the Tshanglakha language scored the highest odds (AOR: 1.24, 95% CI: 1.20–1.27), followed by Lhotshamkha (AOR: 1.09, 95% CI: 1.06–1.12) and Dzongkha (Ref) after adjusting for various social and biomedical factors. Additionally, tobacco use displayed decreased odds for hypertension. To promote the early detection and prevention of hypertension, these cultural factors should be considered even within small geographic areas, such as Bhutan. It is necessary to strengthen hypertension preventive strategies for people who speak Tshanglakha and Lhotshamkha. Furthermore, careful consideration should be given to preventing hypertension among adults aged 40 years or more, women who are married, separated, divorced, or widowed, and men who never married in Bhutan.

[Background] The pandemic of the coronavirus disease 2019 (COVID-19) has affected health care systems globally. The aim of our study is to assess the impact of the COVID-19 pandemic on the number of hospital admissions for ischemic stroke by severity in Japan. [Methods] We analysed administrative (Diagnosis Procedure Combination—DPC) data for cases of inpatients aged 18 years and older who were diagnosed with ischemic stroke and admitted during the period April 1 2018 to June 27 2020. Levels of change of the weekly number of inpatient cases with ischemic stroke diagnosis after the declaration of state of emergency were assessed using interrupted time-series (ITS) analysis. The numbers of patients with various characteristics and treatment approaches were compared. We also performed an ITS analysis for each group (“independent” or “dependent”) divided based on components of activities of daily living (ADL) and level of consciousness at hospital admission. [Results] A total of 170, 294 cases in 567 hospitals were included. The ITS analysis showed a significant decrease in the weekly number of ischemic stroke cases hospitalized (estimated decrease: −156 cases; 95% confidence interval (CI): −209 to −104), which corresponds to −10.4% (95% CI: −13.6 to −7.1). The proportion of decline in the independent group (−21.3%; 95% CI: −26.0 to −16.2) was larger than that in the dependent group (−8.6%; 95% CI: −11.7 to −5.4). [Conclusions] Our results show a marked reduction in hospital admissions due to ischemic stroke after the declaration of the state of emergency for the COVID-19 pandemic. The independent cases were affected more in proportion than dependent cases.

[Aims] To investigate the effects of regular periodontal management for people with type 2 diabetes on total healthcare expenditure, hospitalization and the introduction of insulin. [Materials and methods] We collected data of individuals who were prescribed diabetes medications during the fiscal year 2015 from the claims database of a prefecture in Japan. We fitted generalized linear models that had sex, age, comorbidities and the status of periodontal management during the previous two years as predictors. [Results] A total of 16, 583 individuals were enrolled. The annual healthcare expenditure in the third year was 4% less (adjusted multiplier 0.96, 95% confidence interval [CI] 0.92–1.00) in the group receiving periodontal management every year. The adjusted odds ratio (aOR) for all-cause hospitalization was 0.90 (95% CI: 0.82–0.98). The aOR of introducing insulin in the third year for those who had not been prescribed insulin during the previous two years (n = 13, 222) was 0.77 (95% CI: 0.64–0.92) in the group receiving periodontal management every year. [Conclusion] Regular periodontal management for diabetic people was associated with reduced healthcare expenditure, all-cause hospitalization and the introduction of insulin therapy.

Since the coronavirus disease 2019 (COVID-19) pandemic has begun, Asian countries/regions, such as Japan, South Korea, and Taiwan, had generally controlled the pandemic better than other countries. In this article, we showed the big impact of the pandemic on acute care hospitals in Japan, where the number of COVID-19 patients has been smaller than in other countries. We also compared the mitigation measures against the COVID-19 pandemic among Japan, South Korea, and Taiwan to study the factors affecting the differences among these relatively well-controlled countries/regions. We analyzed Diagnosis Procedure Combination data from the Quality Indicator/Improvement Project database, in which Japanese hospitals participated voluntarily. During the first declaration of emergency, which was from April 4 to May 25, the numbers of inpatients decreased roughly 20% for adults and 40% for those aged under 18 years compared to those of the same period in the previous year. In the analyses by disease, hospitalizations with acute coronary syndrome, ischemic stroke, cancer, childhood non-COVID-19 acute infections, infant and pediatric asthma decreased in number, whereas those with alcohol-related liver diseases and pancreatitis increased. Comparing selected mitigation measures against COVID-19, such as border control, enforced measures, information governance, and contact tracing, among Japan, South Korea, and Taiwan, the implementation and dissemination of measures were less strict, slower, and less comprehensive in Japan. This might explain why Japan has experienced a comparatively high incidence of COVID-19 and indicate a substantial risk of infection explosion. A change in behavioral compliance could trigger an infection explosion under poor performance in the response set. Further monitoring is warranted to promote the evolution of effective sets of countermeasures to overcome the pandemic.

[Background] The goals of the National Action Plan on Antimicrobial Resistance (AMR) of Japan include “implementing appropriate infection prevention and control” and “appropriate use of antimicrobials, ” which are relevant to healthcare facilities. Specifically, linking efforts between existing infection control teams and antimicrobial stewardship programs was suggested to be important. Previous studies reported that human resources, such as full-time equivalents of infection control practitioners, were related to improvements in antimicrobial stewardship. [Methods] We posted questionnaires to all teaching hospitals (n = 1017) regarding hospital countermeasures against AMR and infections. To evaluate changes over time, surveys were conducted twice (1st survey: Nov 2016, 2nd survey: Feb 2018). A latent transition analysis (LTA) was performed to identify latent statuses, which refer to underlying subgroups of hospitals, and effects of the number of members in infection control teams per bed on being in the better statuses. [Results] The number of valid responses was 678 (response rate, 66.7%) for the 1st survey and 559 (55.0%) for the 2nd survey. More than 99% of participating hospitals had infection control teams, with differences in activity among hospitals. Roughly 70% had their own intervention criteria for antibiotics therapies, whereas only about 60 and 50% had criteria established for the use of anti-methicillin-resistant Staphylococcus aureus antibiotics and broad-spectrum antibiotics, respectively. Only 50 and 40% of hospitals conducted surveillance of catheter-associated urinary tract infections and ventilator-associated pneumonia, respectively. Less than 50% of hospitals used maximal barrier precautions for central line catheter insertion. The LTA identified five latent statuses. The membership probability of the most favorable status in the 2nd study period was slightly increased from the 1st study period (23.6 to 25.3%). However, the increase in the least

We analyzed trajectories of medical and long-term care expenditures during the 60 months before the date of death. We identified six distinct spending trajectories for the total care expenditures. Factors associated with the high-persistent trajectory were chronic illnesses, various organ failures, neurodegenerative diseases, fractures, and tube feeding. This finding has implications for improving the quality of end-of-life care and its financial foundation.

[Introduction] The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for the medical staff worldwide, especially for those in hospitals where COVID-19-positive patients are hospitalized. The announcement of COVID-19 hospital restrictions by the Japanese government has led to several limitations in hospital care, including an increased use of physical restraints, which could affect the care of elderly dementia patients. However, few studies have empirically validated the impact of physical restraint use during the COVID-19 pandemic. We aimed to evaluate the impact of regulatory changes, consequent to the pandemic, on physical restraint use among elderly dementia patients in acute care hospitals. [Methods] In this retrospective study, we extracted the data of elderly patients (aged > 64 years) who received dementia care in acute care hospitals between January 6, 2019, and July 4, 2020. We divided patients into two groups depending on whether they were admitted to hospitals that received COVID-19-positive patients. We calculated descriptive statistics to compare the trend in 2-week intervals and conducted an interrupted time-series analysis to validate the changes in the use of physical restraint. [Results] In hospitals that received COVID-19-positive patients, the number of patients who were physically restrained per 1, 000 hospital admissions increased after the government’s announcement, with a maximum incidence of 501.4 per 1, 000 hospital admissions between the 73rd and 74th week after the announcement. Additionally, a significant increase in the use of physical restraints for elderly dementia patients was noted (p = 0.004) in hospitals that received COVID-19-positive patients. Elderly dementia patients who required personal care experienced a significant increase in the use of physical restraints during the COVID-19 pandemic. [Conclusion] Understanding the causes and mechanisms underlying an increased use of physical restraints for demen

In this contribution we review the possibility of establishing the depositional age and tectonic settings of metamorphosed carbonate rocks from continental collision zones in the East African-Antarctic Orogen. The geochemical characteristics of regionally distributed meta-carbonate rocks from the Highland Complex (HC) in Sri Lanka are considered in detail and compared with similar occurrences in East Antarctica, India, Madagascar and Africa. The variations seen in the Highland Complex of Sri Lanka imply that carbonate deposition was younging from west to east, spanning apparent ages from Mesoproterozoic to Neoproterozoic. In the case of East Antarctica, such variations are within the Neoproterozoic, whereas in southern India, Madagascar and Mozambique they have a broader age range possibly from the Paleoproterozoic to Mesoproterozoic. There is also clear evidence that some carbonates were deposited in an open ocean surrounding volcanic islands in the Mesoproterozoic. Shale-normalized REE patterns have typical signatures of open ocean deposition in a passive continental margin with variable continental input in platforms nearby to island arcs. In comparison to Phanerozoic equivalents, the absence of a Ce anomaly is most significant, whereas other parameters such as (Pr/Yb)SN, (Pr/Tb)SN, and (Tb/Yb)SN were used to evaluate relative enrichments of the LREE, MREE and HREE fractions that are characteristic of ambient seawater. Pronounced La, and Y anomalies with minor Eu and Gd anomalies and correlations of REE parameters and anomalies with carbon and oxygen isotopes, 87Sr/86Sr initial ratios and εNd values are evaluated for meta-carbonate rocks in the Proterozoic collision zone. The εNd values and Sr initial ratios suggest that basins in the western Mozambique Ocean that separated the East Gondwana from West Gondwana received contributions from Archean continental crust and ambient seawater, whereas the eastern Mozambique Ocean had REE contributions from specific craton

Titania-based materials are attractive for hard tissue repair due to their bone-bonding ability induced by apatite formation in the body environment. Various surface treatments have therefore been developed to produce a hydrated titania layer on Ti and its alloys. Titania takes various valences, such as TiO (Ti2+) and Ti2O3 (Ti3+), as well as typical TiO2 (Ti4+); however, there is no comprehensive study of structural effects on the apatite-forming ability of these titanias. In this study, we investigated apatite formation on titania powders with various valences in simulated body fluid. Anatase- and rutile-type TiO2 formed apatite in simulated body fluid within 7 days, but TiO and Ti2O3 did not. In contrast, when the titania powders were treated with NaOH solution, the surface converted to tetravalent titania and all samples formed apatite. It is proposed that the surface electrical states of TiO and Ti2O3 are strongly affected by their bulk conductivity and that these behaved like pure Ti metal, which has poor apatite-forming ability. Apatite formation was favorable when the titania had a high absolute value and exhibited high fluctuations of zeta potential during initial stages in simulated body fluid, owing to adsorption of large amounts of Ca2+ and HPO42−.

Contains fulltext : 227400.pdf (publisher's version ) (Open Access)

Contains fulltext : 227400.pdf (publisher's version ) (Open Access)

Objective: The hospitalist system is considered successful with respect to the quality of care and cost effectiveness in the United States. Studies have consistently demonstrated an improved clinical efficiency with this system. In Japan, however, the efficacy of the hospitalist system has not yet been examined. As a "super-aged society", Japan has a high number of elderly patients with multiple comorbidities who may theoretically receive better care by the hospitalist system than by the conventional system. This study investigates the impact of the hospitalist system on the quality of care and healthcare economics in a Japanese population. Methods: We analyzed 274 patients ≥65 years of age in whom the most resource-consuming diagnosis at admission was aspiration pneumonia over a 1-year period. We categorized patients as those managed by hospitalists and those managed by various departments (control group) and compared the groups. Propensity score matching was used to minimize selection bias. Results: For matched pairs, the length of hospital stay in the hospitalist group was shorter than that in the control group. Care by the hospitalist system was associated with significantly lower hospital costs. The quality of care (rate of switching from intravenous to oral antibiotics, duration of antibiotics therapy, number of chest X-rays and blood tests during hospitalization) was also considered to be favorably impacted by the hospitalist system. There was no statistically significant difference in the mortality rate or readmission rate between the groups. Conclusion: This study showed that the hospitalist system had a favorable impact on the quality of care and cost effectiveness, suggesting the potential utility of its implementation in the Japanese medical system.

Background: Across countries, a small group of patients accounts for the majority of health care spending. These patients are more likely than other patients to experience problems with quality and safety in their care, suggesting that efforts targeting efficiency and quality among this population might have significant payoffs for health systems. Better understanding of similarities and differences in patient characteristics and health care use in different countries may ultimately inform further efforts to improve care for HNHC patients in these health systems. Methods: We conducted a cross-sectional descriptive study using one year of patient-level data on high-cost patients in seven high-income OECD member countries. Countries were selected based on availability of detailed information (large enough samples of claims, administrative, and survey data of high-cost patients). We studied concentration of spending among high-cost patients, characteristics of high-cost patients, and per capita spending on high-cost patients. Findings: Cost-concentration of the top 5% of patients varied across countries, from 41% in Japan to 60% in Canada, driven primarily by variation in the top 1% of spenders. In general, high-cost patients were more likely to be female (57.7% on average), had a significant number of multi-morbidities (up to on average 10 major diagnostic categories (ICD chapters), and had a lower socioeconomic status. Characteristics of high-cost patients varied as well: median age ranged from 62 in the Netherlands to 75 in Germany and the difference in socioeconomic status is particularly stark in the US. Lastly, utilization, particularly for inpatient care, varied with an average number of inpatient days ranging from 6.6 nights (US) to 97.7 nights in Japan. Interpretation: In this descriptive study, there is substantial variation in the cost concentration, characteristics, and per capita spending on high-cost patient populations across high-income countries. Diffe

Objectives: It remains unclear whether insufficient information technology (IT) infrastructure in hospitals hinders implementation of clinical practice guidelines (CPGs) and affects healthcare quality. The objectives of this study were to describe the present state of IT infrastructure provided in acute care hospitals across Japan and to investigate its association with healthcare quality. Methods: A questionnaire survey of hospital administrators was conducted in 2015 to gather information on hospital-level policies and elements of IT infrastructure. The number of positive responses by each respondent to the survey items was tallied. Next, a composite quality indicator (QI) score of hospital adherence to CPGs for perioperative antibiotic prophylaxis was calculated using administrative claims data. Based on this QI score, we performed a chi-squared automatic interaction detection (CHAID) analysis to identify correlates of hospital healthcare quality. The independent variables included hospital size and teaching status in addition to hospital policies and elements of IT infrastructure. Results: Wide variations were observed in the availability of various IT infrastructure elements across hospitals, especially in local area network availability and access to paid evidence databases. The CHAID analysis showed that hospitals with a high level of access to paid databases (p<0.05) and internet (p<0.05) were strongly associated with increased care quality in larger or teaching hospitals. Conclusions: Hospitals with superior IT infrastructure may provide higher-quality care. This allows clinicians to easily access the latest information on evidence-based medicine and facilitate the dissemination of CPGs. The systematic improvement of hospital IT infrastructure may promote CPG use and narrow the evidence-practice gaps.

Contains fulltext : 208468.pdf (publisher's version ) (Open Access), BACKGROUND: Across countries, a small group of patients accounts for the majority of health care spending. These patients are more likely than other patients to experience problems with quality and safety in their care, suggesting that efforts targeting efficiency and quality among this population might have significant payoffs for health systems. Better understanding of similarities and differences in patient characteristics and health care use in different countries may ultimately inform further efforts to improve care for HNHC patients in these health systems. METHODS: We conducted a cross-sectional descriptive study using one year of patient-level data on high-cost patients in seven high-income OECD member countries. Countries were selected based on availability of detailed information (large enough samples of claims, administrative, and survey data of high-cost patients). We studied concentration of spending among high-cost patients, characteristics of high-cost patients, and per capita spending on high-cost patients. FINDINGS: Cost-concentration of the top 5% of patients varied across countries, from 41% in Japan to 60% in Canada, driven primarily by variation in the top 1% of spenders. In general, high-cost patients were more likely to be female (57.7% on average), had a significant number of multi-morbidities (up to on average 10 major diagnostic categories (ICD chapters), and had a lower socioeconomic status. Characteristics of high-cost patients varied as well: median age ranged from 62 in the Netherlands to 75 in Germany and the difference in socioeconomic status is particularly stark in the US. Lastly, utilization, particularly for inpatient care, varied with an average number of inpatient days ranging from 6.6 nights (US) to 97.7 nights in Japan. INTERPRETATION: In this descriptive study, there is substantial variation in the cost concentration, characteristics, and per capita spending on high-cost patient populations across high-income countries. Diffe

Contains fulltext : 212278.pdf (publisher's version ) (Open Access)

Contains fulltext : 208468.pdf (publisher's version ) (Open Access), BACKGROUND: Across countries, a small group of patients accounts for the majority of health care spending. These patients are more likely than other patients to experience problems with quality and safety in their care, suggesting that efforts targeting efficiency and quality among this population might have significant payoffs for health systems. Better understanding of similarities and differences in patient characteristics and health care use in different countries may ultimately inform further efforts to improve care for HNHC patients in these health systems. METHODS: We conducted a cross-sectional descriptive study using one year of patient-level data on high-cost patients in seven high-income OECD member countries. Countries were selected based on availability of detailed information (large enough samples of claims, administrative, and survey data of high-cost patients). We studied concentration of spending among high-cost patients, characteristics of high-cost patients, and per capita spending on high-cost patients. FINDINGS: Cost-concentration of the top 5% of patients varied across countries, from 41% in Japan to 60% in Canada, driven primarily by variation in the top 1% of spenders. In general, high-cost patients were more likely to be female (57.7% on average), had a significant number of multi-morbidities (up to on average 10 major diagnostic categories (ICD chapters), and had a lower socioeconomic status. Characteristics of high-cost patients varied as well: median age ranged from 62 in the Netherlands to 75 in Germany and the difference in socioeconomic status is particularly stark in the US. Lastly, utilization, particularly for inpatient care, varied with an average number of inpatient days ranging from 6.6 nights (US) to 97.7 nights in Japan. INTERPRETATION: In this descriptive study, there is substantial variation in the cost concentration, characteristics, and per capita spending on high-cost patient populations across high-income countries. Diffe

Contains fulltext : 212278.pdf (publisher's version ) (Open Access)

Contains fulltext : 212278.pdf (publisher's version ) (Open Access)

Contains fulltext : 208468.pdf (publisher's version ) (Open Access), BACKGROUND: Across countries, a small group of patients accounts for the majority of health care spending. These patients are more likely than other patients to experience problems with quality and safety in their care, suggesting that efforts targeting efficiency and quality among this population might have significant payoffs for health systems. Better understanding of similarities and differences in patient characteristics and health care use in different countries may ultimately inform further efforts to improve care for HNHC patients in these health systems. METHODS: We conducted a cross-sectional descriptive study using one year of patient-level data on high-cost patients in seven high-income OECD member countries. Countries were selected based on availability of detailed information (large enough samples of claims, administrative, and survey data of high-cost patients). We studied concentration of spending among high-cost patients, characteristics of high-cost patients, and per capita spending on high-cost patients. FINDINGS: Cost-concentration of the top 5% of patients varied across countries, from 41% in Japan to 60% in Canada, driven primarily by variation in the top 1% of spenders. In general, high-cost patients were more likely to be female (57.7% on average), had a significant number of multi-morbidities (up to on average 10 major diagnostic categories (ICD chapters), and had a lower socioeconomic status. Characteristics of high-cost patients varied as well: median age ranged from 62 in the Netherlands to 75 in Germany and the difference in socioeconomic status is particularly stark in the US. Lastly, utilization, particularly for inpatient care, varied with an average number of inpatient days ranging from 6.6 nights (US) to 97.7 nights in Japan. INTERPRETATION: In this descriptive study, there is substantial variation in the cost concentration, characteristics, and per capita spending on high-cost patient populations across high-income countries. Diffe

Background: Although many previous studies have examined the determinants of happiness in older adults, few have investigated the association between pension types and happiness. When compared to other conventional socioeconomic indicators, pension types may be more indicative of long-term socioeconomic status as they can reflect a person’s job history over their life course. This study examined the association between pension types and happiness in Japanese older people. Methods: Cross-sectional survey data from the Japan Gerontological Evaluation Study were used to analyze the association between pension types and happiness. The study population comprised 120152 participants from 2013. We calculated the prevalence ratios of happiness for the different pension types using Poisson regression models that controlled for age, sex, marital status, equivalent income, wealth, education level, working status, occupation, depression, and social support. Results: After controlling for socioeconomic indicators, the prevalence ratios (95% confidence intervals) of happiness for no pension benefits, low pension benefits, and moderate pension benefits relative to high pension benefits were 0.77 (0.73–0.81), 0.95 (0.94–0.97), and 0.98 (0.97–0.99), respectively. However, the inclusion of depression as a covariate weakened the association between pension types and happiness. Conclusions: While pension types were associated with happiness after adjusting for other proxy measures of socioeconomic status, the association diminished following adjustment for depression. Pension types may provide rich information on socioeconomic status and depression throughout the course of life. In addition to conventional socioeconomic indicators, pension types should also be considered when assessing the determinants of happiness in older adults.

Background: Many perforated peptic ulcers (PPUs) require surgical repair due to diffuse peritonitis. However, few studies have examined the clinical effects of postoperative drainage after PPU repair. This study aimed to investigate the drain insertion rates in patients who underwent PPU repair in Japan, and to clarify the impact of drain insertion on the postoperative clinical course. Methods: A retrospective nationwide cohort study was performed using administrative claims data of patients who had undergone PPU repair between 2010 and 2016. These patients were divided into two groups based on whether or not they had received a postoperative abdominal drain. Using propensity score matching, we compared the incidences of postoperative interventions for abdominal complications between both groups. Results: A total of 4869 patients from 324 hospitals were analyzed. At the hospital level, drains were placed in all PPU repair patients in 229 (70.7%) hospitals. At the patient level, 4401 patients (90.4%) had drains inserted. The drain group was associated with a higher emergency admission rate, poorer preoperative shock status, longer anesthetic time, and a higher amount of intra-abdominal irrigation. In the propensity score-matched patients, the drain group had a significantly lower incidence of postoperative interventions than the no-drain group (1.9 vs. 5.6%; risk ratio = 0.35; 95% confidence interval 0.16–0.73; P = 0.003). Conclusion: Postoperative drainage was performed in the majority of patients who underwent PPU repair in Japan. Drainage following PPU repair may facilitate patient recovery by reducing the need for postoperative interventions.

Background: Patients admitted to hospital during off-hours may experience poorer quality of care and clinical outcomes. However, few studies have examined the variations in clinical processes and outcomes across admission times and days of the week in acute myocardial infarction (AMI) patients. This study aimed to comparatively analyze the effect of weekend and weekday admissions stratified by admission time on in-hospital mortality in AMI patients. Methods and results: Using a large nationwide administrative database, we analyzed 103, 908 AMI patients admitted to 639 Japanese acute care hospitals between April 2011 and March 2015. We divided patients into the following 4 groups: weekday daytime admissions, weekday night-time admissions, weekend daytime admissions, and weekend night-time admissions. A hierarchical logistic regression model was used to comparatively examine in-hospital mortality among the groups after adjusting for age, sex, ambulance use, Killip class, comorbidities, and the number of cardiologists in the admitting hospital. In addition, we also calculated and compared the adjusted odds ratios of various AMI therapies among the groups. The in-hospital mortality rate of weekend daytime admissions was higher than those admitted during other times (weekday daytime: 6.8%; weekday night-time; 6.5%, weekend daytime; 7.6%; weekend night-time: 6.6%; P < 0.001), even after adjusting for the covariates (adjusted odds ratio for weekend daytime admissions: 1.10; 95% confidence interval: 1.03–1.19). The prescription rates of guideline-based medications provided on the first day of admission were higher in night-time admissions than in daytime admissions. Conclusions: In-hospital mortality rates were higher in AMI patients admitted during weekend daytime hours when compared with patients admitted during other times. Furthermore, patients admitted during daytime hours had lower prescription rates of guideline-based medications. Our findings indicate that weekend d

More than 450 nuclear atomic explosions including atmospheric, aboveground and underground nuclear tests had been conducted by the former Soviet Union (USSR) at the Semipalatinsk Nuclear Test Site (SNTS) over the past 40 years. Since 1994, we have concentrated our energies on assessing the human health and environmental impacts of nuclear testing. Especially, residual long-lived radionuclides such as 137Cs and Pu isotopes have been measured for soil samples from various areas. The studies focused on the evaluation of radioactive contamination in the settlements where the Semipalatinsk historical cohort resided. In October 2005, detailed soil sampling was carried out around Dolon settlement to estimate the width and position of center-axis of the fallout plume associated with the first USSR atomic bomb on 29 August 1949, and provided useful information on the efforts to estimate radiation dose in Dolon settlement as reliably as possible. Such studies were, next, devoted more time and attention to the Sarzhal and Karaul settlements located in the southeastern direction from the SNTS. The local fallout from the fist thermonuclear event on 12 August 1953 (30 m in height, 400 kt in scale) heavily affected those settlements. Here, laying stress on Sarzhal and Karaul settlements, the accumulated levels and spatial distribution of soil contamination by 137Cs and 239,240Pu have been excessively investigated since 2007. Besides, the radionuclides 236U and 237Np derived from bomb materials themselves were also measured together with the induced radionuclides, 152Eu and 60Co, in some soil samples. Based on those data obtained, radiation doses in air in two settlements were first reconstructed. As a result, adsorbed doses in air in case of the evacuation (non-evacuation) for inhabitants in Sarzhal and Karaul settlements were evaluated to be 20〜100 mGy (210〜530 mGy) and 10〜75 mGy (120〜380 mGy), respectively, as our tentative estimate for 1-year cumulative external doses mainly du, … 1 Ⅰ．はじめに… 2 Ⅱ．サルジャール及びカラウル集落… 3 Ⅲ．カイナル集落及びパブロダール州南部の集落…16 Ⅳ．これまでに調査したセミパラチンスク全地域の137Cs及び239,240Pu蓄積量と 239,240Pu/137Cs及び238Pu/239,240Pu放射能比の比較… 24 Ⅴ．全体のまとめ…24 参考文献…26 Appendix…29, 本研究は、長期に渡る文部省の科学研究費助成金（基盤研究（A,B）: 海外、代表者 : 星 正治、山本政儀、川野徳幸） No.22404004、19404005、23406002、20406002、26257501、24310044、23310183、15H03137の助成を受けて行われた。

[EN] Developing a technique to disperse hydrophobic ingredients homogeneously in a water-soluble solid matrix (solid dispersion) is one of the topics that have been extensively investigated in the pharmaceutical and food industries. Recently, we have devised a novel solid dispersion technique (surfactant-free solid dispersion), in which a preliminarily amorphized sugar was dissolved in an organic media containing hydrophobic component, without using any surface active substances, and then vacuum dried into the amorphous solid mixture [Food Chem., 197 (2016) 1136; Mol. Pharm., 14 (2017) 791]. In this study, the physicochemical properties, especially thermal stability of the surfactant-free amorphous solid dispersion, were investigated.

Objective: We aimed to quantify the personal economic burden of dementia care in Japan according to residence type. Methods: A cross-sectional online survey was conducted on 3841 caregivers of people with dementia. An opportunity cost approach was used to calculate informal care costs. All costs and the observed/expected (OE) ratio of costs were adjusted using patient sex, age, and care-needs levels, and compared among the residence types. Results: The mean daily informal care time was 8.2 hours, and the mean monthly informal care costs for community-dwelling people with dementia were US$1559. The OE ratio for informal care costs in community-dwelling patients was higher than in institutionalized patients. Conclusion: The inclusion of informal care costs reduced the differences in total personal costs among the residence types. The economic burden of informal care should be considered when quantifying dementia care costs.

[EN] Developing a technique to disperse hydrophobic ingredients homogeneously in a water-soluble solid matrix (solid dispersion) is one of the topics that have been extensively investigated in the pharmaceutical and food industries. Recently, we have devised a novel solid dispersion technique (surfactant-free solid dispersion), in which a preliminarily amorphized sugar was dissolved in an organic media containing hydrophobic component, without using any surface active substances, and then vacuum dried into the amorphous solid mixture [Food Chem., 197 (2016) 1136; Mol. Pharm., 14 (2017) 791]. In this study, the physicochemical properties, especially thermal stability of the surfactant-free amorphous solid dispersion, were investigated.

[EN] Developing a technique to disperse hydrophobic ingredients homogeneously in a water-soluble solid matrix (solid dispersion) is one of the topics that have been extensively investigated in the pharmaceutical and food industries. Recently, we have devised a novel solid dispersion technique (surfactant-free solid dispersion), in which a preliminarily amorphized sugar was dissolved in an organic media containing hydrophobic component, without using any surface active substances, and then vacuum dried into the amorphous solid mixture [Food Chem., 197 (2016) 1136; Mol. Pharm., 14 (2017) 791]. In this study, the physicochemical properties, especially thermal stability of the surfactant-free amorphous solid dispersion, were investigated.

[EN] Developing a technique to disperse hydrophobic ingredients homogeneously in a water-soluble solid matrix (solid dispersion) is one of the topics that have been extensively investigated in the pharmaceutical and food industries. Recently, we have devised a novel solid dispersion technique (surfactant-free solid dispersion), in which a preliminarily amorphized sugar was dissolved in an organic media containing hydrophobic component, without using any surface active substances, and then vacuum dried into the amorphous solid mixture [Food Chem., 197 (2016) 1136; Mol. Pharm., 14 (2017) 791]. In this study, the physicochemical properties, especially thermal stability of the surfactant-free amorphous solid dispersion, were investigated.