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Aim Digestive reconstruction after pharyngolaryngectomy with total esophagectomy (PLTE) remains challenging, with the optimal method remaining unclear. The current study aimed to clarify the short‐term outcomes after PLTE and determine the optimal digestive reconstruction method. Methods Based on a nationwide survey of 151 patients who underwent PLTE, outcomes of digestive reconstruction methods are described. Results Among digestive reconstruction methods, a simple gastric tube was most frequently used (37.1%), followed by gastric tube combined with free graft transfer (FGT) (35.1%), gastric tube with microvascular anastomosis (22.5%), and other procedures (5.3%). Intraoperative evaluation of microcirculation (IOEM) was utilized in 29 patients (19.2%). Among the included patients, 66.9% developed any‐grade complications, 41.0% developed severe complications, and 23.8% developed digestive reconstruction‐related complications (DRRCs; leakage or necrosis). Reoperation within 30 days for any complications and DRRCs was required in 13.9% and 8.6% of the patients, respectively. Mortality within 90 days was observed in 4.6%. Among the three major methods, gastric tube combined with FGT promoted the least DRRCs in the gastric tube (P = .005), although the overall incidence of DRRCs was comparable. The use of IOEM was significantly associated with a reduction of severe DRRCs (P = .005). Conclusions Pharyngolaryngectomy with total esophagectomy is a high‐risk surgery significantly associated with the occurrence of postoperative morbidity and mortality. Nonetheless, the addition of FGT can help prevent gastric tip complications, while IOEM can be an effective method for improving outcomes., In this nationwide survey on digestive reconstruction following pharyngolaryngectomy with total esophagectomy, reconstruction using a gastric tube with free graft transfer was significantly associated with fewer digestive reconstruction‐related complications (DRRCs) in the gastric tube. However, it did not decrease overall and severe DRRCs. Intraoperative evaluation of microcirculation significantly reduced severe DRRCs.

As protests erupted across the United States in recent years over racialized issues (e.g., Black Lives Matter and Confederate monuments), so too did questions about when and how police should respond. Understanding public attitudes toward protest policing is important for police legitimacy and policy. One theory is that citizens are willing to trade civil liberties, such as the right to assemble, for security, and thus disruptive or dangerous protest tactics should increase support for police control by elevating public fear. Another theory is that citizens view protests through the lens of group position, and thus, they should be more supportive of repression when protest goals conflict with preexisting racial beliefs and threaten racial interests. To test these theories, we embedded an experiment in a nationwide survey fielded in 2020 after George Floyd's killing sparked the broadest protests in U.S. history. We randomized protest tactics (e.g., weapon carrying) and goals, as well as other contextual characteristics (e.g., protest size). We found that the public generally opposed repressive protest policing. Certain protest tactics, however, increased support for repression by elevating fear. Protest goals (e.g., pro-Black Lives Matter and pro-immigrants) also impacted support for repression, but the effect depended on respondents’ racial beliefs. © 2021 American Society of Criminology

Aims To describe nurse anesthetists' attitudes towards the importance of parental presence during their child's anaesthesia induction and to explore associating factors. Design A cross-sectional design. Methods Nurse anesthetists from 55 Swedish hospitals were asked to participate (n = 1,285). A total of 809 completed the questionnaire, Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) during 2018. Data were analysed by descriptive statistics and multiple linear regression analysis. Results Nurse anesthetists generally had a positive attitude towards the importance of parental presence. They reported a more positive attitude in family as a resource in nursing care (median = 40) followed by family as a conversational partner (median = 25), family not as a burden (median = 17) and family as its own resource (median = 13). Multiple linear regression analyses showed that working in a district hospital, working only with children, having routines/memorandum about parental presence, being a woman, allowing both parents to be present in their child's anaesthesia and greater experience of children's anesthesia, were associated with a more positive attitude. Conclusion This nationwide survey contributes important knowledge for understanding nurse anesthetists' attitudes and the result shows that nurse anesthetists generally have a positive attitude towards the importance of parents. Areas of improvement were, however, identified; the nurses tend to not value family as its own resource and family as a conversational partner highly. Impact Nurse anesthetists have a crucial role in children's anesthesia care since the quality of parental presence experience depends on a positive attitude from the nurses. Parental involvement is important to establish a child-centered anaesthesia care, which should be highlighted in the education of nurse anesthetists. Parental involvement should also be addressed in healthcare policies and routines should be established.

The COVID‐19 pandemic has disturbed medical training. Haematology registrars were surveyed using SurveyMonkey. Eighty‐nine out of 269 (24.9%) responded. Reported stressors included concerns about transmitting the infection, disruption of leave, inferior patient outcomes, survivors’ guilt and interruption of career progression. Only 31.2% felt ready to progress to the next training stage. Reported causes of lack of training were disruption of clinics and training days and utilisation of telephone consultations. Several stressors negatively impacted haematology registrars’ well‐being, training and progression. More emphasis on psychological support, outpatient clinic work and e‐learning is needed.

Background Sarcopenia is an independent risk factor not only for advanced‐stage non‐alcoholic fatty liver disease (NAFLD) but also for mortality. We investigated the association of sarcopenia and/or NAFLD with mortality among the Korean general population. Methods Individuals aged 35–75 years without any history of cancer, ischaemic heart disease, ischaemic stroke, or secondary causes of chronic liver disease were selected from the Korean National Health and Nutrition Examination Surveys from 2008 to 2015. Their mortality data until December 2018 were retrieved from the National Death Registry. NAFLD and sarcopenia were defined by hepatic steatosis index and appendicular skeletal muscle mass divided by body mass index (BMI), respectively. Results A total of 28 060 subjects were analysed [mean age, 50.6 (standard error, 0.1) years, 48.2 (0.3) % men]; the median follow‐up duration was of 6.8 (interquartile range, 4.8, 8.4) years. NAFLD predicted mortality after adjustment for age, sex, BMI, hypertension, dyslipidaemia, and smoking (HR 1.32, 95% CI 1.03–1.70), but this prediction lost its statistical significance after additional adjustment for diabetes mellitus. In contrast, NAFLD with advanced fibrosis independently increased the risk of mortality after adjustment for all covariates (HR 1.68, 95% CI 1.02–2.79). Stratified analysis revealed that NAFLD and sarcopenia additively increased the risk of mortality as an ordinal scale (HR 1.46, 95% CI 1.18–1.81, P for trend = 0.001). The coexistence of NAFLD and sarcopenia increased the risk of mortality by almost twice as much, even after adjustment for advanced fibrosis (HR 2.18, 95% CI 1.38–3.44). Conclusions Concurrent NAFLD and sarcopenia conferred a two‐fold higher risk of mortality. The observation that NAFLD and sarcopenia additively increase mortality suggests that risk stratification would be helpful in predicting mortality among those with metabolic derangement.

Purpose This study was conducted to investigate how the COVID‐19 pandemic has impacted reproductive medical providers’ behaviors and considerations, including their concerns regarding the necessity of fertility treatments. Methods A web‐based questionnaire was distributed to Japan Society of Fertilization and Implantation (JSFI) members from May 18 through May 31, 2020 to survey their professional behaviors and concerns during the COVID‐19 pandemic. Results Most survey participants reported a decrease in the number of patients and a decrease in their workload. Most also believe that the use of fertility treatments will return to the pre‐pandemic levels after the COVID‐19 pandemic ends. Additionally, more than half of the participants reported that they consider fertility treatment neither necessary nor unnecessary during the COVID‐19 pandemic. Conclusions At the institute where reproductive medical providers worked in Japan, the number of outpatients and the working time tended to decrease during the COVID‐19 pandemic. However, amid fears of infection during the COVID‐19 pandemic, the reproductive medical providers working at fertility institutes in Japan have remained engaged in their work with a sense of mission and hope.

Aim We examined accuracy of nurses’ clinical judgement of graft‐versus‐host‐disease (GVHD) symptoms and related factors using Common Terminology Criteria for Adverse Events (CTCAE) for patients who developed chronic cutaneous GVHD after haematopoietic stem cell transplants. Design Cross‐sectional design using nationwide survey. Methods A questionnaire survey based on Tanner's clinical judgement model to assess patients with chronic cutaneous GVHD using CTCAE was used. Free‐text descriptions and statistical analyses of relationship between correct responses and demographic data were performed. Results The rate of correct responses for main symptoms of skin GVHD was

Although pharmacogenetic testing is becoming increasingly common across medical subspecialties, a broad range of utilization and implementation exists across pediatric centers. Large pediatric institutions that routinely use pharmacogenetics in their patient care have published their practices and experiences; however, minimal data exist regarding the full spectrum of pharmacogenetic implementation among children’s hospitals. The primary objective of this nationwide survey was to characterize the availability, concerns, and barriers to pharmacogenetic testing in children’s hospitals in the Children’s Hospital Association. Initial responses identifying a contact person were received from 18 institutions. Of those 18 institutions, 14 responses (11 complete and 3 partial) to a more detailed survey regarding pharmacogenetic practices were received. The majority of respondents were from urban institutions (72%) and held a Doctor of Pharmacy degree (67%). Among all respondents, the three primary barriers to implementing pharmacogenetic testing identified were test reimbursement, test cost, and money. Conversely, the three least concerning barriers were potential for genetic discrimination, sharing results with family members, and availability of tests in certified laboratories. Low‐use sites rated several barriers significantly higher than the high‐use sites, including knowledge of pharmacogenetics (P = 0.03), pharmacogenetic interpretations (P = 0.04), and pharmacogenetic‐based changes to therapy (P = 0.03). In spite of decreasing costs of pharmacogenetic testing, financial barriers are one of the main barriers perceived by pediatric institutions attempting clinical implementation. Low‐use sites may also benefit from education/outreach in order to reduce perceived barriers to implementation.

Background: the COVID-19 pandemic has had wide-reaching primary and secondary health implications. The UK government implemented a national lockdown to slow the rate of infection at the end of March 2020, lasting until early summer 2020. The results from a UK nationwide survey suggest the majority of inflammatory bowel disease patients were followed up using technology-enabled care services (TECS) during this time. We therefore aimed to explore the impact of the pandemic on nutritional status of children with inflammatory bowel disease, focusing on the effect of national lockdown from March to early summer 2020. Methods: a retrospective study was conducted. All patients with a diagnosis of inflammatory bowel disease, aged Results: in total, 116 patients had paired measures. Using the World Health Organization criteria of nutritional status, 19% (n = 22/116) were mildly malnourished with a body mass index Z score (BMIZ) −1 to 1) (n = 0/43) children (p ≤ 0.0001) had a TECS nutrition review. Conclusions: dietetic reviews were severely restricted during the first national lockdown. Patients with low BMIZ prior to lockdown became more malnourished. During the ongoing pandemic, it is important to identify those children with nutrition risk, focusing support on this group of children.

Background Pancreatic trauma is reportedly associated with high morbidity and mortality. Main pancreatic duct (MPD) injury is critical for treatment. Methods As a study project of the Japanese Society for Abdominal Emergency Medicine (JSAEM), we collected the data of 163 patients with pancreatic trauma who were diagnosed and treated at JSAEM board‐certified hospitals from 2006 to 2016. Clinical backgrounds, diagnostic approaches, management strategies, and outcomes were evaluated. Results Sixty‐four patients (39%) were diagnosed as having pancreatic trauma with MPD injury that resulted in 3% mortality. Blunt trauma and isolated pancreatic injury were independent factors predicting MPD injury. Nine of 11 patients with MPD injury who were initially treated nonoperatively had serious clinical sequelae and five (45%) required surgery as a secondary treatment. Among all cases, the detectability of MPD injury of endoscopic retrograde pancreatography (ERP) was superior to that of other imaging modalities (CT or MRI), with higher sensitivity and specificity (sensitivity = 0.96; specificity = 1.0). Conclusions Acceptable outcomes were observed in pancreatic trauma patients with MPD injury. Nonoperative management should be carefully selected for MPD injury. ERP is recommended to be performed in patients with suspected MPD injury and stable hemodynamics., Highlight Ando and colleagues analyzed data from 163 patients with pancreatic trauma in a nationwide multicenter study. They found that serum amylase and C‐reactive protein levels were significantly higher in patients with main pancreatic duct injuries, indicating that endoscopic retrograde pancreatography was the most accurate imaging modality for assessing pancreatic duct injury.

Objectives Due to the time and cost effectiveness, online teaching has played a significant role in the provision of education and has been a well‐accepted strategy for higher education in the world. The aim of this study was to survey the current online undergraduate education status in dental medicine in mainland China during the critical stage of the COVID‐19 outbreak, as well to provide a better understanding of practicing this learning strategy for the improvement and development of dental education. Methods For the cross‐sectional survey, recruitment emails regarding to the implementation of online education were sent to 42 dental colleges and universities in mainland China between March and April 2020. Results Ninety‐seven percent of the respondents have opened online courses during COVID‐19 pandemic in China, 74% of which chose live broadcast as the major teaching way. As compared with theoretical courses, fewer specialized practical curriculums were set up online with a lower satisfaction from students in most dental schools. For the general evaluation of online learning from students of different dental schools, the “online learning content” received the highest support, while the “interaction between teachers and students” showed the lowest satisfaction. Most schools reported that the difficulty in assurance of students’ learning motivation was the main problem in online education. Conclusions Our findings indicate the necessity and efficacy of the overall online teaching for dental education during the epidemic that can be further improved with the education model and pedagogical means to boost the informationization of dental education for future reference.

Objectives Comprehensive training in ultrasound (US) imaging during radiology residency is crucial if radiologists are expected to maintain a substantial role in this widely used imaging modality. This study aimed to evaluate the current curriculum of US training among radiology residency programs across the country via a nationwide survey. Methods A 28-question survey was distributed among all academic radiology departments in the United States and their radiology residents. The survey consisted of 4 sections: general demographic information, training information, clinical competency, and adequacy of training (perspective). The Student t test and 1-way analyses of variance were performed to assess statistical significance. Results Overall, 256 residents from 32 states completed the questionnaire. Only 114 (45%) residents reported having a dedicated rotation for performing US studies. Although 228 (89%) of trainees believed they received adequate experience for interpreting US studies, only 66 (26%) of them had the same belief about performing them. Only 116 (45%) of the residents were comfortable operating the US machines in their departments. Higher years of residency training, having a dedicated rotation for performing US studies, and having more than 10 hours per year of didactic lectures and/or more than 5 hours per year of case conferences dedicated to US had a positive impact on the residents' clinical competency and perspective (all P Conclusions Most radiology residents do not feel confident in performing US examinations by themselves. However, higher clinical competency was reported in the residents who had dedicated rotations for performing US studies and received more hours of US lectures and case conferences throughout their residency.

The clinical characteristics of congenital toxoplasmosis cases with poor outcomes in Japan were analyzed. Ten cases were selected, identified from a nationwide survey by the Japan Society for Neonatal Health and Development and a literature review. Based on outcomes, two fatal cases showed generalized symptoms at birth; four cases with neurological sequelae showed the three main congenital toxoplasmosis manifestations (chorioretinitis, intracranial calcification, hydrocephalus); four cases with ophthalmological sequelae showed only one or two of the three main manifestations. Eight cases with poor outcomes were not prenatally diagnosed with congenital toxoplasma infection or suspected maternal toxoplasma infection. The outcome of congenital toxoplasmosis might differ depending on the symptomology.

Aim The dementia supporter training program is conducted by community general support centers (CGSCs) to raise dementia awareness. Convenience stores are widespread throughout Japan, and they play an important role in the daily lives of older adults. We examined whether participation of convenience stores in the program promotes cooperation between the stores and CGSCs. Methods Using data from a nationwide survey, we conducted a longitudinal observational study. Participation of stores in the program and cooperation with CGSC were measured. The proportion of cooperation with CGSCs in 2017 and 2018 were compared between stores that had already participated in the program in 2016 (participation group) and those that did not (non-participation group). Results Of the 14 884 stores, 542 stores participated in the program in 2016. In 2017 and 2018, 8.1% and 7.2% of the participation group cooperated with CGSCs, while 3.2% and 4.0% of the non-participation group did. Conclusions Dementia supporter training programs could be an opportunity to promote cooperation between convenience stores and CGSCs to support older adults. Geriatr Gerontol Int 2020; 20: 956-960.

Introduction Laparoscopic bariatric procedures have been performed in Japan since 2000. Laparoscopic sleeve gastrectomy (LSG) has been fully covered by National Health Insurance since 2014, and it has been increasingly performed recently. The Japan Consortium of Obesity and Metabolic Surgery conducts a nationwide survey on laparoscopic bariatric/metabolic surgery every 2 years. Methods The survey was sent by post or email to 97 Japanese institutions in January 2020. Results From 2000 to 2019, a total of 3669 laparoscopic bariatric/metabolic procedures were performed in 64 institutions. The most popular procedure was LSG (n = 2866), followed by LSG with duodenojejunal bypass (LSG‐DJB, n = 337) and laparoscopic Roux‐en‐Y gastric bypass (LRYGB, n = 280). Morbidity and reoperation rates were, respectively, 29.8% and 11.8% for LRYGB, 16.8% and 2.8% for LSG, and 13.6% and 6.6% for LSG‐DJB. At 5 years after the procedures, the percentage of excess weight loss was 78% for LRYGB, 66% for LSG, and 80% for LSG‐DJB. Conclusion This nationwide survey clearly showed that laparoscopic bariatric/metabolic surgery has been safely and effectively performed for 20 years in Japan.

BACKGROUND AND AIMS: Crohn’s disease (CD) frequently affects young women and may require surgery during pregnancy. Data regarding operation for CD in expectant mothers are scare. MATERIALS AND METHODS: This was a retrospective nationwide survey from the GETAID Chirurgie. Any woman with CD undergoing surgery during pregnancy was eligible. RESULTS: A total of 15 cases were collected between 1992 and 2015. Most operations were performed due to penetrating or stricturing complications. Mean gestational age at delivery was 34 weeks, with a mean birth weight of 2507 g. Maternal post-operative complications occurred in two-thirds of cases. Maternal mortality rate was 6.7% and neonatal mortality rate 9.1%. CONCLUSIONS: This is the largest case series of surgery for CD during pregnancy. This operation may have significant morbidity and mortality for mother, fetus, and newborn. Indication needs to be tailored to maternal status, disease severity, and gestational age. Surgery should be managed by experienced gynecologists, physicians, and surgeons. Active CD may be associated with a greater risk to the fetus than the surgical procedure itself.

Philadelphia-negative (Ph-negative) myeloproliferative neoplasms (MPNs), including polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), are exceptionally rare during childhood. Thus, clinical features of pediatric Ph-negative MPNs remain largely unknown. This study was therefore performed to address this.We performed a retrospective study to collect clinical information of children diagnosed with Ph-negative MPNs from 2000 to 2016 using questionnaires in qualified institutions in Japan. The results obtained from the questionnaire survey were then combined with those from the national registry data.Among 50 children identified, five had PV, 44 had ET, and one had PMF. Median age at diagnosis was 14.0, 9.0, and 0 years, respectively. Male to female ratio was 4:1, 21:23, and 1:0, respectively. Detection rates of theThis is the first nationally representative survey of pediatric Ph-negative MPNs. Given its rarity, an international collaboration with comprehensive genetic analyses might be needed to fully elucidate the clinical and genetic features.

To collect large-scale data for further research to improve treatment outcomes in patients with colorectal liver metastasis (CRLM), the Joint Committee for Nationwide Survey on CRLM was established by the Japanese Society for Cancer of the Colon and Rectum and the Japanese society of Hepato-Biliary-Pancreatic Surgery. The joint committee was initiated to collect data since 2014 and has already reported data including the prognostic data of 3820 patients newly diagnosed with CRLM between 2005 and 2007.The data of patients newly diagnosed with CRLM after 2013 are continuously being registered prospectively, and herein, we report the data of the patients newly diagnosed with CRLM in 2013 and 2014.The data of 3839 patients newly diagnosed with CRLM in 2013 and 2014 were registered from 156 departments (75%) of 152 institutions among 209 departments (from 201 institutions) that agreed to participate in this database system at its initiation. Finally, 3525 patients were enrolled in this study after a quality management process conducted by the joint committee. We report the comprehensive data obtained from 3525 patients, including clinicopathological findings, treatment strategies, and implementation status of chemotherapy.The joint committee will provide these raw data while updating prognostic data to researchers who will conduct meaningful studies that meet the aim of the joint committee.

Due to heightened levels of consumer skepticism, it has become crucial for many companies to discern what corporate social responsibility (CSR) activities to undertake and how to deliver CSR‐related information to consumers. We aim to examine the role of consumer evaluations of a company's CSR, from both content and delivery perspectives, in shaping consumer skepticism about overall corporate responsibility and advancing retail patronage intentions. We conducted an online nationwide survey with 402 U.S. consumers and used structural equation modeling for the data analysis. The results indicate that the fit between a company's core values and the CSR activities it communicates plays a significant role in alleviating skepticism, while the fit between a consumer's personal values and CSR activity does not have significant effects on skepticism. Both inauthentic information and self‐promotional tone significantly increase skepticism, and skepticism is found to be a significant mediator in the paths from CSR content and delivery factors to retail patronage intentions. Our supplementary analyses suggest that delivery of CSR information can be more important than the content itself in affecting skepticism. The results should inspire practitioners, when planning for CSR communication, to carefully consider fit, tone, and authenticity in order to minimize skepticism and avoid negatively impacting consumers' retail patronage intentions.

In mainland China, histology and embryology (HE) are taught in one course as an essential component of medical curricula. The effectiveness of HE courses directly affects the quality of medical students. To determine the present situation and changes in HE teaching in Chinese medical schools, a nationwide survey was conducted among the HE departmental leaders. In total, 66 responses were included in the study, representing prominent Chinese mainland medical schools. The results revealed that most HE teachers have medical educational backgrounds; an increasing number of teaching staff with PhDs have joined the teaching staffs. A range of 71 to 90 HE curriculum contact hours is predominant. The ratio of theory to practice for HE contact hours is 1:1 at half of the surveyed medical schools. The numbers of students in each laboratory are less than 30 and from 31 to 60 at 23 and 36 medical schools, respectively. Virtual microscopy is employed in 40% of the surveyed medical schools. Didactic teaching is the most common strategy, although new teaching approaches are being employed gradually. During the past 20 years, both the total number of HE teachers and the number of HE teachers with medical educational backgrounds have been reduced in at least half of the surveyed schools. A total of 83.33% of the surveyed schools have reduced their HE contact hours. Almost half of the Chinese medical schools remained unchanged in both their ratio of theory to practice and the number of students in each laboratory. The data derived from this study help to understand the development of the HE discipline at Chinese medical schools.

Using China Family Panel Studies (CFPS), this study investigates factors associated with the choice of farmland leasing strategies and the impact of leasing options on farm performance. Particular attention is given to off‐farm employment and farm subsidies. Additionally, the study applies a selectivity‐based approach to assess the relationship between farmland leasing choices and farm businesses’ performance. Off‐farm employment, older and educated operators, large farms and old‐age pension plans increase the likelihood of leasing out farmland. Part‐time off‐farm employment, grain subsidies and mechanised farms increase the likelihood of leasing in farmland. Finally, the selectivity correction terms in the value of crop production are significantly negative in the choices of farmland leasing, indicating the presence of sample selection effects. Accounting for selectivity is essential to ensure unbiased and consistent estimates.

Objective This study aimed to investigate the association between general physical activity level and TMD pain in Koreans in a large-scale national database established through a nationwide survey. Methods Data from the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV), which was conducted from 2007 to 2009, were analysed. In total, 16 941 participants were included in this cross-sectional study. Data on sociodemographic characteristics, TMD-related variables, and general physical activity level were collected. Participants were divided into moderate- and low-intensity exercise groups according to their physical activity levels. Multivariate logistic regression analyses were performed, adjusting for sociodemographic and other covariates. Results The adjusted odds ratio (OR) (95% confidence interval; CI) for TMD pain was 1.373 (1.017-1.854) for people doing moderate-intensity exercises and 0.797 (0.629-1.008) among people doing low-intensity exercises. Those who did moderate-intensity exercises had significantly more TMD pain. This was higher in the 30- to 39-year age group (OR: 1.991, 95% CI: 1.137-3.488), with significantly higher risk for TMD pain in those who did moderate-intensity exercise, whereas low-intensity exercise significantly decreased the risk for TMD pain in the same age group (OR: 0.625, 95% CI: 0.409-0.958). Conclusions Moderate-intensity physical activity is associated with more TMD pain. Patients with TMD should avoid high-intensity level exercises and continue low-intensity exercises to prevent pain aggravation.

AIM Hepatitis B vaccination in infancy was carried out in Japan only when the mother was persistently infected from 1986 to 2016. The aim of the present study was to elucidate the results of vaccination for the prevention of hepatocellular carcinoma in young adults. METHODS We studied the number of patients who had liver cancer and died from 1976 to 2017 using a national database. Furthermore, we carried out a nationwide survey focusing on patients with hepatitis B virus-related hepatocellular carcinoma who were diagnosed when aged

Background The use of sunscreen can reduce the risk of UV-induced skin lesions. Health authorities have provided recommendations for the correct use of sunscreen use: Sufficient amount of sunscreen should be applied at least 30 min before the sun exposure and should be reapplied every 2 h. Objective We aimed to research the practice of sunscreen use in a population-based and representative sample in Germany. Methods For this cross-sectional survey, 3000 German residents aged 14-45 years were surveyed in standardized telephone interviews in 2018. Survey participants provided data on the frequency of sunscreen use in summer, timing of (re-)application and their skin characteristics. The data were weighted by age, sex, educational level and federal state to ensure the national representativeness of the sample. Results Overall, 79.4% of respondents used sunscreen always, often or sometimes when being exposed to the sun. However, 87.2% of sunscreen users did not follow the recommendations on timing of application, 59.5% did not comply with the timing of reapplication. We also saw, that people potentially used too little sunscreen. These data did not differ noticeably by skin types of participants. Conclusion Our study revealed deficits in use of sunscreen in Germany, indicating that people here pay little attention to the recommendations of health authorities, regardless of their skin type. There is therefore an urgent need for targeted public information on this issue. Improving public knowledge on correct sunscreen use through educational campaigns or individual counselling by health professionals could be a first step.

Aim Pain can have a critical negative impact on the quality of life of institutionalized older people. This study aimed to examine the characteristics of pain and associated factors among older people at nursing homes in Korea. Methods A nationwide survey was carried out on the functional status of 1444 older residents at 91 nursing homes using the interRAI Long-Term Care Facilities instrument. The frequency, intensity, severity and consistency of pain were assessed, and data on potential attributes at the resident and facility levels were collected. Multivariate and multilevel regression analysis models were developed. Results More than one-third (36.7%) of older residents had pain. Pain prevalence differed by several sociodemographic and clinical factors, including sex, depressive symptoms, cognition, or whether or not the resident was a Medical Aid beneficiary. Pain prevalence also varied according to nursing home size and location. In the multivariate, multilevel regression analyses, both having severe pain and having consistent pain were positively associated with depressive symptoms, and the pain experience was significantly lower among older residents in nursing homes that met the nursing staffing standard. Conclusions This is the most comprehensive study on pain assessment in long-term care facilities in Korea using a representative sample so far. Pain is prevalent among nursing home residents in Korea. Besides individual factors, facility characteristics - in particular, meeting the staffing standard - were important to pain control, which implies there is room for improving pain assessment and management through advancing quality of care policies. Geriatr Gerontol Int 2020; 20: 118-124.

Aims/Introduction Insulin resistance syndrome (IRS) of type A or B is triggered by gene abnormalities of or autoantibodies to the insulin receptor, respectively. Rabson–Mendenhall/Donohue syndrome is also caused by defects of the insulin receptor gene (INSR), but is more serious than type A IRS. Here, we carried out a nationwide survey of these syndromes in Japan. Materials and Methods We sent questionnaires to a total of 1,957 academic councilors or responsible individuals at certified facilities of the Japan Diabetes Society, as well as at the department pediatrics or neonatology in medical centers with >300 beds. Results We received 904 responses with information on 23, 30 and 10 cases of type A or B IRS and Rabson–Mendenhall/Donohue syndrome, respectively. Eight cases with type A IRS‐like clinical features, but without an abnormality of INSR, were tentatively designated type X IRS, with five of these cases testing positive for PIK3R1 mutations. Fasting serum insulin levels at diagnosis (mean ± standard deviation) were 132.0 ± 112.4, 1122.1 ± 3292.5, 2895.5 ± 3181.5 and 145.0 ± 141.4 μU/mL for type A IRS, type B IRS, Rabson–Mendenhall/Donohue syndrome and type X IRS, respectively. Type A and type X IRS, as well as Rabson–Mendenhall/Donohue syndrome were associated with low birthweight. Type B IRS was diagnosed most frequently in older individuals, and was often associated with concurrent autoimmune conditions and hypoglycemia. Conclusions Information yielded by this first nationwide survey should provide epidemiological insight into these rare conditions and inform better healthcare for affected patients., (a) Rabson–Mendenhall/Donohue syndrome and type B insulin resistance syndrome (IRS) showed the highest and second highest levels of hyperinsulinemia, respectively, and those with type A and type X IRS were similar. Fasting serum insulin levels for 26 of the 27 (96.3%) type A and type X IRS patients for whom such data were available were >30 μU/mL. (b) Type A and type X IRS, as well as Rabson–Mendenhall/Donohue syndrome were associated with low birthweight.

Consumer welfare effects from policy changes are traditionally calculated using estimates of consumer preferences for the underlying goods and services affected. This conventional approach is indirect, does not consider preferences people may have for the policies themselves, and makes it difficult to easily compare relative preferability of a large set of policy options. In this paper, we use the best–worst scaling approach to determine consumers’ preferences for 13 policies. A nationwide survey of 1,056 U.S. consumers indicates the highest levels of support for investments in agricultural research and requirements of food and agricultural literacy standards in public education. Fat, calorie, and soda taxes are the least popular; fewer than one‐third of respondents are in favor of these three policies.

Objectives To investigate the knowledge and practices of Chinese doctors in the management of osteoporotic fractures after the Chinese osteoporotic fracture guidelines update and aseries of medical education in 2017. Methods This was a cross‐sectional survey of doctors in 71 cities across Mainland China. Based on the 2017 Chinese guidelines for the diagnosis and treatment of osteoporotic fractures, a questionnaire was designed and pre‐tested for reliability and validity. Doctors were surveyed with the questionnaire after scientific meetings during February 2017 to January 2018 through WeChat or conference digital platforms or in paper form. Descriptive statistics was used to analyze the responses to the questionnaire. Results Overall, 314 valid questionnaires were confirmed. Regarding diagnosis, 77% agreed that osteoporosis could be diagnosed once an osteoporotic fracture occurred; 83% believed that the bone mineral density criteria for osteoporosis diagnosis would be T ≤ −2.5 SD. For treatment, almost all (99.7%) agreed with anti‐osteoporosis treatment being one of the basic principles of osteoporotic fracture treatment; 71.6% considered bisphosphonates as the most commonly used anti‐osteoporosis drug; 97% believed that patients who have used anti‐osteoporosis drugs should reassess osteoporosis after osteoporotic fractures instead of discontinue; 95% thought that the patients who did not use anti‐osteoporosis medications before osteoporotic fracture should be treated with anti‐osteoporosis drugs after fracture treatment as early as possible; 89% agreed that the standard use of bisphosphonates after osteoporotic fracture would not affect bone healing adversely; 59% believed the course of bisphosphonates treatment for osteoporosis would be 3–5 years, and 27% considered it to be 1–3 years. The patient follow‐up rate was poor: 46% selected follow‐up rate 50%. Only 31% of the hospitals had long‐term management programs for osteoporotic fractures. Conclusions Doctors generally adhered to the updated Chinese guidelines for osteoporotic fractures; frequent participation in medical education can help doctors to increase their awareness of osteoporosis as well as their acceptance and practice of the guidelines.

Background: Airway complications account for almost one third of anaesthesia-related brain damage and death. Immediate access to equipment enabling rescue airway strategies is crucial for successful management of unanticipated difficult airway situations. Methods: We conducted a nationwide survey of Swedish anaesthesiologists to analyse availability and organization of difficult airway trolleys (DATs), and multiple factors pertaining to difficult airway management, to highlight areas of potential improvement. Results: Six hundred and thirty-nine anaesthesiologists completed the 14-item survey. Whereas DATs were almost ubiquitous (95%) in main operating departments of hospitals, prevalence was low in remote anaesthetizing locations (20.3%) and electroconvulsive therapy units (26.6%). Approximately 60% of emergency departments had a DAT. Immediate (within 60 seconds) access to videolaryngoscopes in all units where general anaesthesia is conducted was reported by 56.8%. Almost half of anaesthesiologists reported that all DATs at their workplace were standardized. Forty-six per cent reported that the DATs were organized according to a difficult airway algorithm; almost 90% believe that such an organization can impact the outcome of a difficult airway situation positively. Only 36.2% of DATs contained second-generation supraglottic airway devices exclusively. Most Swedish anaesthesiologists use the Swedish Society of Anaesthesiology and Intensive care Medicine difficult airway algorithm, but almost one fifth prefer the Difficult Airway Society algorithm. Less than half of respondents underwent formal difficult airway training annually. Conclusion: Our results motivate efforts to (a) increase availability of DATs in remote anaesthetizing locations, (b) increasingly standardize DATs and organize DATs according to airway algorithms, and (c) increase the frequency of difficult airway training. (Less)

Background Clinical studies on the effects of thalidomide‐induced damage on thalidomide victims as they age have only recently started to be conducted, but no studies have examined socioeconomic differences in terms of healthcare and social status between thalidomiders and the age‐matched general population in Japan. Therefore, we carried out a nationwide survey focusing on the life situations of thalidomiders. Method Questionnaires were sent to 274 thalidomiders in Japan. The questionnaire items basically matched those of the Comprehensive Survey of Living Conditions (CSLC) in the general population conducted by the Japanese Government. The results were compared with those of the CSLC for individuals aged 55–59 years, which was the cohort most similar in age to the average thalidomider living in Japan. Results More thalidomiders rated their health condition as relatively bad or bad compared with the general population (20.2% vs. 13.3%, respectively). A much higher percentage of thalidomiders reported having some health or physical problem caused by a disease or injury (68.8% vs. 32.6%, respectively), and thalidomiders reported visiting medical and healthcare‐related facilities more frequently. A higher proportion of thalidomiders (9.2%) were unemployed, and thalidomiders tended to feel higher levels of worry and stress, especially in terms of the future. Conclusions The results of this nationwide survey of the life situations of thalidomiders in Japan clarified their health conditions and the related associations with socioeconomic status. These findings could be expected to help improve the provision of medical and healthcare, welfare measures, and financial support for thalidomiders in the near future.

This article examines data from the first‐ever nationwide survey of cybersecurity among American local governments. The data show that these governments are under constant or near‐constant cyberattack, yet, on average, they practice cybersecurity poorly. While nearly half reported experiencing cyberattacks at least daily, one‐third said that they did not know whether they were under attack, and nearly two‐thirds said that they did not know whether their information systems had been breached. Serious barriers to their practice of cybersecurity include a lack of cybersecurity preparedness within these governments and a lack of adequate funding for it. The authors make recommendations to local governments to improve their cybersecurity practice and to scholars for additional research into local government cybersecurity, an area that, to date, has largely been neglected by researchers from the social sciences and computer science. link

What is known and objective:Pharmacogenomics (PGx) testing can be effective for supporting precision medicine. The purpose of this study was to assess the knowledge, attitude and practice behaviours of pharmacists in relation to such testing through a survey. We also aimed to identify potential obstacles to implementation of PGx testing by pharmacists and the characteristics of hospital pharmacists involved., Methods:We performed a web-based survey regarding PGx in Japan. The survey contained a questionnaire related to PGx, which consisted of 30 items and was made accessible via the official Japanese Society of Pharmaceutical Health Care and Sciences (JSPHCS) website. The characteristics of hospital pharmacists associated with involvement in PGx testing were evaluated using univariate and multivariate analyses., Results and discussion:One thousand three-hundred and thirteen pharmacists responded to the survey. The results revealed that the majority of respondents recognized the role that germline PGx testing can play in determining individual drug responses and that pharmacists have embraced the potential of PGx testing to improve patient care. However, only 26% of pharmacists were involved in PGx testing. We also found that most respondents (81.0%) believed that the lack of insurance coverage for PGx testing was a major barrier to its clinical implementation. Hospital pharmacists involved in PGx testing included certified pharmacists in JSPHCS and pharmacists who had studied PGx in university; however, only 12.4% of pharmacists had received specific PGx-related education., What is new and conclusion:The findings of this survey highlight the necessity to increase the number of PGx tests covered by insurance, and the importance of effective education to inform and facilitate clinical implementation of PGx testing.

Aim To investigate and clarify the surge capacity of staff/equipment/space, and patient outcome in the first wave of COVID‐19 in Japan. Methods We analyzed questionnaire data from the end of May 2020 from 180 hospitals (total of 102,578 beds) with acute medical centers. Results A total of 4,938 hospitalized patients with COVID‐19 were confirmed. Of 1,100 severe COVID‐19 inpatients, 112 remained hospitalized and 138 died. There were 4,852 patients presumed to be severe COVID‐19 patients who were confirmed later to be not infected. Twenty‐seven hospitals (15% of 180 hospitals) converted their ICU to a unit for COVID‐19 patients only, and 107 (59%) had to manage both severe COVID‐19 patients and others in the same ICU. Restriction of ICU admission was occurred in one of the former 27 hospitals and 21 of later 107 hospitals. Shortage of N95 masks was the most serious concern regarding personal protective equipment (PPE). As for issues which raised ICU bed occupancy, difficulty performing or progressing rehabilitation for severe patients (42%), and the improved patients (28%), long lasting severely ill patients (36%) and unclear isolation criteria (34%) were mentioned. Many acute medicine physicians assisted regional governmental agencies functioning as advisors and volunteer coordinator. Conclusion The mortality rate of COVID‐19 in this study was 4.5% of all hospitalized patients and 14% (approximately one in 7) severe patients. The hospitals with dedicated COVID‐19 ICUs accepted more patients with severe COVID‐19 and had lower ICU admission restrictions, which may be helpful as a strategy in the next pandemic.