Prevalence of migraine in Japan: a nationwide survey

This study presents the first nationwide survey of migraine in Japan. A representative sample of 4029 subjects aged 15 years or older was selected from the Japanese population according to the quota method. A combination of telephone interview and mailed questionnaire methods was used. Diagnosis of migraine was based on the International Headache Society (IHS) Classification. The overall prevalence of migraine in the past year was 8.4%; 5.8% was migraine without aura and 2.6% was migraine with aura. Significant correlation was found between the prevalence of migraine and such variables as gender, age and district of residence. Doctor attendance rate was very low and 69.4% with migraine had never consulted a physician for headache. Yet, 74.2% complained that migraine headache impaired their daily activity significantly. Only 11.6% were aware that their headache was migraine and 56.9% were using only the over-the-counter drugs. The study revealed a comparably high prevalence of migraine in the general population of Japan compared with other countries. A genetic factor was speculated as the cause of regional difference in migraine prevalence.     

Evaluation of doctoral nursing education in Japan by students, graduates, and faculty: a comparative study based on a cross-sectional questionnaire survey

Evaluation of doctoral education in nursing is needed with the rapid increase in doctoral nursing programs in Japan. This study aimed to compare the evaluations of doctoral nursing education by students, graduates, and faculty. All 46 doctoral nursing programs in Japan were target settings. 127 students who had been in the doctoral program, 24 graduates and 87 faculty members had responded to the survey. A questionnaire with 17 items for program evaluation, 12 items for faculty evaluation, 9 items for resource evaluation, and 3 for overall evaluations was distributed in November and December 2008. Responses to 1 program evaluation item, 2 faculty evaluation items and 4 resource evaluation items indicated significant differences among evaluators. While 79.2% of graduates responded positively that the number of faculty members was sufficient to facilitate learning, only 36.1% of faculty members and 49.6% of students responded affirmatively. Graduates' ratings were the most positive and faculty members were the least positive, especially for infrastructure or equipment such as libraries, computers, and the number of technical and support staff. The significant differences among the evaluators suggested that having evaluators in various roles is important to evaluate the quality of doctoral nursing education.     

Management of a patient with post-polio syndrome

PURPOSE: To describe the current understanding of the management of patients with post-polio syndrome (PPS) and relate the research to a case study. DATA SOURCES: Standard neurology textbooks, current review and research articles, and a case study. CONCLUSIONS: More than 15 years following a diagnosis of poliomyelitis, a new onset of weakness, fatigue, joint pain, decreased endurance, muscle atrophy, gait disturbance, respiratory and swallowing problems, cold intolerance, and difficulties with activities of daily living might indicate a neurologic disorder called PPS. IMPLICATIONS FOR PRACTICE: Non-post-polio causes of weakness, fatigue or pain must be excluded before making a diagnosis of PPS. Approaches to management vary depending on the symptoms and level of disability. Reducing physical and emotional stress, energy conservation, adequate rest, modification of work and home environments, joint protection, and the use of orthoses, adaptive equipment, or mobility aids can reduce fatigue and preserve function.     

Prevalence of pain in Italian hospitals: results of a regional cross-sectional survey

The aims of this study were to quantify the prevalence of pain among hospitalized Italian patients and to describe the potential determinants of pain in this population. All patients older than 18 years and hospitalized for at least 24 hours in one of the 30 public hospitals of the Liguria region (n = 4709) were eligible for pain assessment. Using the Brief Pain Inventory, patients with pain during the last 24 hours were asked to score the intensity of pain at the time of the interview, and the worst pain and average pain during the previous 24 hours on 0-10 rating scales. Overall, 87% (4121 / 4709) of inpatients were interviewed, and 56.6% suffered pain during the last 24 hours. Among patients with pain, the median (interquartile range) score of the worst and of the average pain during the last 24 hours was 7 (5-9) and 5 (3-6), respectively. At the time of interview, 43.1% evaluated patients suffered pain, with a median (interquartile range) of 5 (3-7). Although significant heterogeneity in the distribution of pain was observed among the hospitals, pain prevalence was unacceptably high in most cases. Age, sex, education, diagnosis, and days from surgery were significantly related to pain prevalence in univariate analyses. In a multivariable ordinal regression logistic analysis, only sex, diagnosis, days from surgery, and hospitals remain significantly associated with increased pain prevalence.     

Disability in a 4-year follow-up study of people with post-polio syndrome.

OBJECTIVE: To evaluate changes over time in a clinically based cohort of individuals with post-polio syndrome. DESIGN: A prospective longitudinal study. SUBJECTS: A total of 106 individuals with poliomyelitis sequelae were included in the study. They were self-referred or had been referred to the post-polio clinic. After 4 years subjects were called for a follow-up and underwent the same measurements as at the initial assessment. METHODS: The following measurements were conducted at both the initial assessment, and the follow-up: questionnaires including Nottingham Health Profile, muscle strength and walking speed. RESULTS: Minor changes in disability during a 4-year period were shown. A significant reduction in muscle strength was only seen for 60 degrees flexion in the left leg and for right and left dorsal flexion. No change could be seen in the total Nottingham Health Profile score. CONCLUSION: The minor changes in disability found in this study are an indication that we still do not know which subjects are at risk for deterioration. It is difficult to say whether the small changes over time shown in this study are associated with support from the polio clinic or are an expression of the natural history of the syndrome. However, it is hoped that support from the polio clinic may result in self-selected lifestyle changes, which may positively influence the development of symptoms and functional capacity.     

A shigellosis outbreak associated with a sports festival at a kindergarten in Kitakyushu City,Japan

IntroductionShigellosis cases have decreased gradually in Japan in recent years, but indigenous shigellosis outbreaks sometimes occur in childcare facilities. From national surveillance data, we identified a shigellosis outbreak involving a kindergarten.MethodsAfter detecting Shigella sonnei in Kitakyushu City, we conducted active case finding and epidemiological investigation in Kindergarten Z, including stool specimen collection and interviews. The stool specimens were cultured, and isolated strains were subjected to pulsed-field gel electrophoresis (PFGE) and multiple-locus variable-number tandem-repeat analysis (MLVA).ResultsBetween September 1 and December 31, 2014, we identified 19 cases: 14 confirmed, 2 suspected, and 3 asymptomatic. Of the 19 cases, 16 were epidemiologically associated with Kindergarten Z (10 pupils, 5 family members, and 1 teacher). On October 19, a pupil with gastrointestinal illness participated in the kindergarten's sports festival, in which the pupils were split into “red” and “white” teams; the pupil in question belonged to the red team. Attack rates of the red and white teams were 8% (7/82) and 0% (0/108), respectively (relative risk, 10.5; 95% confidence interval, 1.3–82.1). PFGE patterns were identical or similar for the isolates in all 17 cases; 7 isolates were identical, and the others had one locus difference on MLVA.ConclusionsWe concluded that contact during the sports festival could have been responsible for spread of the shigellosis outbreak at the kindergarten, although the infection source was not determined. It is vital to inform guardians immediately after detection of shigellosis cases that symptomatic pupils should not participate in activities such as sports festivals.     

Characteristics and disease severity of healthcare-associated pneumonia among patients in a hospital in Kitakyushu, Japan

Healthcare-associated pneumonia (HCAP) is a newly identified condition, and epidemiologic studies in Japan are still limited. We retrospectively observed patients with HCAP and community-acquired pneumonia (CAP) who were hospitalized between December 2004 and March 2005, and compared their disease characteristics. A total of 34 patients (14 with HCAP and 20 with CAP) were evaluated. Of the patients with HCAP, seven (50%) were hospitalized for at least 2 days in the preceding 90 days and five (35.7%) resided in a nursing home or extended care facility. Compared with patients with CAP, patients with HCAP were older, had more complications, including central nerve diseases, had greater disease severity, but lower serum albumin level. More methicillin-resistant Staphylococcus aureus, Pseudomonas spp., and anaerobes were isolated from patients with HCAP than from those with CAP. Conversely, more Streptococcus pneumoniae was detected and more penicillin was used in patients with CAP. This study provides additional evidence that HCAP should be distinguished from CAP and suggests the pathogenesis and therapeutic strategy for HCAP may be similar to those for hospital-acquired pneumonia.     

运动疗法对小儿麻痹后遗症患者功能改善的作用

目的：就小儿麻痹后遗症症状、病因、运动干预对其治疗作用等分析，为小儿麻痹后遗症功能改善提供可行性理论依据。资料来源：通过计算机检索NCBI，Entrez，Pubmed，http：／／www．ninds．nih．gov／heahhand_medical／pubs／post-polio．html，Nov．10．2004，http：／／www.post-polio．org／ipn／pnn11-4d．html．和中国期刊网1998—01／2005—02期间关于小儿麻痹后遗症的相关研究文献，检索词“运动（sport）”，“小儿麻痹后遗症（Post—Polio Syndrome）”。资料选择：有关小儿麻痹后遗症症状、病因及健康问题，如何治疗等文献国外报道较多，通过文献及网站查阅，最后选择相关文献20篇。资料提炼：在20篇文献中，内容呈不同程度重复的有5篇，给予删除；对15篇文献进行分类整理，用于综述，其中8篇选用为参考文献。资料综合刊、儿麻痹后遗症产生的病因有前柱细胞感染理论、新肌肉细胞的老化和体内激素分泌影响等。临床症状表现除了有早期的肌肉疲劳和虚弱之外，患者还会产生呼吸困难、失眠、吞咽困难等其他症状。目前小儿麻痹症的发病及后遗症患者逐年减少，但国内仍有近百万的小儿麻痹后遗症患者有待矫治和康复，运动干预对小儿麻痹后遗症患者功能改善有积极的治疗作用。结论：小儿麻痹后遗症可由多种病因产生，并伴有多种临床症状。运动干预在小儿麻痹后遗症患者功能改善中起到重要作用。     

运动疗法对小儿麻痹后遗症患者功能改善的作用

目的:就小儿麻痹后遗症症状、病因、运动干预对其治疗作用等分析,为小儿麻痹后遗症功能改善提供可行性理论依据。资料来源:通过计算机检索NCBI,Entrez,Pubmed,http://www.ninds.nih.gov/health_and_medical/pubs/post-polio.html,Nov.10,2004,http://www.post-polio.org/ipn/pnn11-4d.html.和中国期刊网1998-01/2005-02期间关于小儿麻痹后遗症的相关研究文献,检索词“运动(sport)”,“小儿麻痹后遗症(Post-PolioSyndrome)”。资料选择:有关小儿麻痹后遗症症状、病因及健康问题,如何治疗等文献国外报道较多,通过文献及网站查阅,最后选择相关文献20篇。资料提炼:在20篇文献中,内容呈不同程度重复的有5篇,给予删除;对15篇文献进行分类整理,用于综述,其中8篇选用为参考文献。资料综合:小儿麻痹后遗症产生的病因有前柱细胞感染理论、新肌肉细胞的老化和体内激素分泌影响等。临床症状表现除了有早期的肌肉疲劳和虚弱之外,患者还会产生呼吸困难、失眠、吞咽困难等其他症状。目前小儿麻痹症的发病及后遗症患者逐年减少,但国内仍有近百万的小儿麻痹后遗症患者有待矫治和康复,运动干预对小儿麻痹后遗症患者功能改善有积极的治疗作用。结论:小儿麻痹后遗症可由多种病因产生,并伴有多种临床症状。运动干预在小儿麻痹后遗症患者功能改善中起到重要作用。     

Belated diagnosis of medullar compression in a case of post-polio syndrome]

The physiatrist observes about his practice individuals with sequela of old poliomyelitics. A part of them have unusual fatigue and muscular pains and weakness. The hypothesis of an evolution of neuro-biological mechanism suggested by few authors isn't, actually, demonstrated. More probably, the modifications of lesional and, functional changes with disability observed are the consequence of elderly effects and decreasing of physical activites. We report a case of spinal cord compression by intramedullar tumor, associated with a post-polio syndrome.     

Vancomycin-resistant enterococci (VRE) outbreak at a university hospital in Kitakyushu,Japan: case-control studies

At a university hospital in Japan, a total of 15 patients (14 adults and 1 newborn baby) with vancomycinresistant enterococci (VRE) infection or colonization (inf/col) were identified via routine clinical examinations and two nonroutine examinations from January to April 2007. Two case-control studies were conducted to identify the factors related to VRE inf/col. In study 1, the patients with VRE inf/col from ward A (n = 8) were compared with all of the patients without VRE isolates in the same ward, i.e., the controls (n = 26). In study 2, all adult patients with VRE inf/col throughout the hospital (n = 14) were compared with controls randomly selected from among all patients without VRE isolates (n = 45). All the subject cases were found to be infected or colonized with Enterococcus faecium, vanB. All but two of the isolated strains were completely identical according to pulsed field gel electrophoresis. Univariate analysis in study 2 showed several factors, including the isolation of methicillin-resistant Staphylococcus aureus (MRSA) (odds ratio [OR], 8.6; 95% confidence interval [CI], 1.3–53.7) and the use of antibiotics other than anti-MRSA drugs (OR, 33.0; 95% CI, 1.8–587.6) to be risk factors for VRE inf/col. Multivariate logistic regression analysis in study 2 demonstrated associations with VRE inf/col in the use of an ultrasound nebulizer (OR, 5.9; 95% CI, 1.5–22.8) and extended bed rest (OR, 3.8; 95% CI, 1.02–24.5). Although severe infection with VRE did not occur, to avoid the spread of VRE in hospital wards, further staff education should be implemented in regard to the usual standard and contact precautions, and the appropriate selection of antibiotics.     

Travel medicine facilities: The first nationwide cross-sectional questionnaire survey in Japan

IntroductionTravel medicine has gained importance in recent years; however, there is little data regarding travel medicine departments in Japanese hospitals.MethodsThis cross-sectional study contacted 488 hospitals designated by either the Japanese government or major Japanese associations. A questionnaire comprising 11 questions pertaining to the availability of pre-travel consultation, out-of-hours service for travel-related patients, number of medical doctors engaged in travel medicine and infectious disease specialists, and the number of negative pressure rooms available for inpatients and outpatients was distributed. It also asked about the facilities available to combat specific diseases like malaria, dengue, and post-exposure prophylaxis for rabies as these are most common diseases affecting returning travelers.ResultsOf the 263 hospitals (58.7%) that responded to our questionnaire, 82 hospitals (31.2%) provided pre-travel consulting, 188 hospitals (72.0%) accepted travel-related patients out-of-hours, median (interquartile range [IQR]) number of medical doctors involved in travel medicine was 1 (0–3), and median (IQR) number of patients accepted for admission was 2 (1–4). Only 106 (41%) hospitals could diagnose malaria at any time, 56 hospitals (21%) could immediately provide oral anti-malarial medicines; rapid diagnostic test for dengue was available in 99 hospitals (39%), while 67 hospitals (26%) could immediately administer post-exposure prophylaxis for rabies.ConclusionsJapan's medical care system is concerned about illnesses—especially malaria, dengue and rabies in returned travelers. We suggest construction of a medical care system centered on designated medical facilities for category I and II infectious diseases to build capacity for early diagnosis and treatment of common tropical infectious diseases.     

Prevalence of restless legs syndrome in migraine patients with and without aura: a cross-sectional,case-controlled study

Background

Although the comorbidity of migraine and restless legs syndrome (RLS) has been well-documented, the association between RLS and migraine frequency has yet to be elucidated. The present study aims to evaluate the prevalence of RLS among individuals who experience low-frequency, high-frequency, or chronic migraine presenting with and without aura.

Methods

We conducted a cross-sectional, case-controlled study involving 505 participants receiving outpatient headache treatment. Standardized questionnaires were administered to collect information on experiences of migraine, RLS, sleep quality, anxiety, depression, and demographics. Participants were categorized into low-frequency (1–8/month), high-frequency (9–14/month), and chronic (≥15/month) headache groups. RLS was diagnosed according to the criteria outlined by the International RLS Study Group (IRLSSG). The Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS) were used to assess sleep quality and identify symptoms of anxiety and depression. Associations between migraine frequency and RLS prevalence were investigated using multivariate linear and logistic regression.

Results

Univariate analysis revealed an effect of migraine frequency on RLS prevalence (p?=?0.026), though this effect did not persist following adjustment for baseline characteristics (p?=?0.256). The trend was robust in patients whose migraines presented with auras (p _univariate?=?0.002; p _multivariate?=?0.043) but not in those without auras (p _univariate and p _multivariate?>?0.05). Higher anxiety [odds ratio (OR)?=?1.18, p?=?0.019] and sleep disturbance (OR?=?1.17, p?=?0.023) scores were associated with higher RLS prevalence.

Conclusions

Higher migraine frequency correlates with a higher prevalence of RLS, particularly among patients with auras.

     

Current status of Japanese emergency medicine based on a cross-sectional survey of one prefecture

Objective: To ascertain the current status of emergency medicine at certified emergency hospitals in Fukuoka, a Japanese prefecture. Fukuoka prefecture has the 9th largest population volume of the 46 prefectures throughout Japan. Methods: Written questionnaire sent to 146 certified emergency hospitals. Results: A total of 132 of 146 (90.4%) emergency hospitals replied. Data were complete from 131. Nineteen of 131 hospitals (14.5%) were qualified by the Japanese Association for Acute Medicine, whereas 85 of 131 (64.9%) were certified by other medical associations. In 32 of 131 hospitals (24.4%), there was an emergency medicine specialist or acute care physician, whereas 117 hospitals (89.3%) had a specialist doctor qualified by another medical association. In 33 of 131 hospitals (25%), there were doctors who undertook training in emergency medicine of surgery‐related courses, and 66 (50%) undertook internal medicine‐related courses. Conclusion: The current status of emergency medicine practice in the Fukuoka prefecture is poor. Medical associations relevant to emergency medicine should collaborate with each other to share information, as well as provide help to solve problems associated with emergency medicine manpower. This collaboration should occur as a national effort within the Japanese Association for Acute Medicine.     

Quality of life for post-polio syndrome: a patient derived,Rasch standard scale

Objective: To design a disease-specific quality of life (QoL) questionnaire for people with post-polio syndrome (PPS).

Methods: Qualitative interviews were conducted with 45 people with PPS to identify themes and derive potential items reflecting impact upon QoL. After cognitive debriefing, these were made into a questionnaire pack along with comparative questionnaires and posted to 319 patients. The 271 (85%) returned questionnaires were subjected to exploratory factor analysis (EFA) and Rasch analysis.

Results: A 25 item scale, the post-polio quality of life scale (PP-QoL), showed good fit to the Rasch model (conditional chi-square p?=?0.156), unidimensionality (% t-tests 2.0: CI 0.7–3.8), and Cronbach’s alpha of 0.87. With the latent estimate transformed to a 0–100 scale, the mean score was 56.9 (SD 18.5) with only 3.3% of respondents at the floor or ceiling of the scale. Test–retest reliability showed an intraclass correlation coefficient (ICC) (2.1) of 0.916, and correlation of 0.85.

Conclusion: The disease-specific PP-QoL demonstrated excellent reliability, appropriate concurrent validity, and satisfied the standards of the Rasch model. It enables examination of the impact of health status upon perceived QoL, and the impact of rehabilitation interventions. The scale is freely available for academic or not-for-profit users to improve research in this neglected, disabling condition.

• Implications for Rehabilitation

• In post-polio syndrome (PPS), existing work examines aspects of health-related quality of life (HRQoL), such as activity limitations.

• A disease-specific QoL measure would enable researchers to model the impact of health status, such as fatigue or mobility restrictions, upon QoL in PPS.

• The post-polio quality of life scale (PP-QoL) is based on the patients’ lived experience, meets Rasch standards and is free for use for academic and not-for-profit researchers.

• The raw score is reliable for individual use in clinical settings, and interval scale transformation is available for parametric applications and the calculation of change scores.

     

The influence of post-polio syndrome on independence and life satisfaction

PURPOSE: The aim of the study was to find out the influence of the new symptoms on life satisfaction and independent living and the most frequent disabilities in patients with post-polio syndrome that are affecting the satisfaction and independence. METHOD: A questionnaire was sent to all the post-polio survivors (207) who visited the Rehabilitation Institute in Ljubljana at least once in the last ten years. We got 100 answers, which were analysed by SPSS (statistical package for social sciences). RESULTS: Sixty nine reported that they had new symptoms that may be classified as post-polio syndrome. CONCLUSIONS: We have found that the new symptoms in post-polio survivors, which may be classified as post-polio syndrome, increased their walking and climbing stairs disability, increased their disability to perform daily activities and also decreased their satisfaction with life.