JMA journal最新文献

{"title":"Assessing the Association of Physician and Specialist Maldistribution with Out-of-hospital Cardiac Arrest Outcomes: Implications for Regulatory Policy.","authors":"Atsushi Takayama, Hemant Poudyal","doi":"10.31662/jmaj.2024-0241","DOIUrl":"10.31662/jmaj.2024-0241","url":null,"abstract":"<p><strong>Introduction: </strong>Because regional physician maldistribution is considered a potential contributor to disparities in healthcare outcomes, several countries regulate the number of physicians and specialists per region to ameliorate health disparities. However, the association between regional physician maldistribution and specific outcomes, such as out-of-hospital cardiac arrest (OHCA) at the regional level, remains unclear. This study aims to evaluate the association between regional physician and specialist maldistribution and OHCA outcomes.</p><p><strong>Methods: </strong>This ecological study used 12 years of longitudinal public open datasets in Japan. We examined the disparity trends of indices of physician and specialist (emergency physicians, cardiologists, and cardiac surgeons) distribution using the Gini index. We also examined the physician uneven distribution index, a newly introduced policy index incorporating local demand and supply of medical services. Next, we analyzed the association between these distributions and OHCA-related outcomes (30-day survival rate and 30-day favorable neurological outcome).</p><p><strong>Results: </strong>The overall number of physicians and each specialist steadily increased throughout all regions and the observation period, but the trends in the regional distribution of specialists for each region were not always synchronized with the distribution of overall physicians. Although the disparity within each index has gradually decreased, the disparity of specialists remained high compared with overall physicians. Moreover, regional physician distributions, which showed the lowest level of disparity across regions, were consistently associated with OHCA-related outcomes, whereas the regional disparity of specialists, which consistently exhibited a higher level of disparity, was not associated with the outcomes.</p><p><strong>Conclusions: </strong>Paradoxically, the unevenly distributed specialist distribution indices did not reflect their relevant outcomes, despite their direct involvement in the specific outcomes. Therefore, our findings call into question the validity of policies aimed at correcting the total number of physicians without considering the impact of specialists on healthcare outcomes.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"506-516"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Transplantation of Multiple Organs from Donor after Helium Asphyxiation: First Case Report in Japan.","authors":"Shunta Jinno, Takashi Hongo, Takafumi Obara, Tsuyoshi Nojima, Kohei Tsukahara, Tetsuya Yumoto, Hiromichi Naito, Atsunori Nakao","doi":"10.31662/jmaj.2024-0395","DOIUrl":"10.31662/jmaj.2024-0395","url":null,"abstract":"<p><p>Helium inhalation has increased, but most cases are either minor injuries or deaths; there have not yet been any reported cases of brain death leading to organ donation. We report a patient who attempted helium inhalation and was declared brain dead and became an organ donor without complications. To the best of our knowledge, this is the first reported case of deceased organ donation following helium asphyxiation in Japan. The patient in cardiac arrest was found with a helium-filled vinyl bag sealed around the neck. During emergency medical transport to the hospital, a spontaneous return of circulation was obtained after 31 minutes of cardiopulmonary resuscitation. Upon hospital arrival, the physical examination revealed dilated pupils with no response to light. Electrocardiography showed widespread ST-segment depression and ST-segment elevation in augmented Vector Right, as well as elevated cardiac enzymes and decreased myocardial contractility. Head computed tomography revealed diffuse cerebral edema and loss of the gray-white matter boundary without signs of air embolism in the cerebral and coronary arteries. Despite comprehensive post-cardiac arrest care with recovery of organ function, brain death was confirmed on day 4 after hospitalization. The family consented to organ donation on the 11th day of hospitalization. The heart, lungs, liver, and two kidneys were successfully transplanted and all organs functioned. All organ grafts were functioning well at the 3-month follow-up. Our case demonstrates that brain death caused by helium inhalation is not a contraindication to organ donation.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"650-653"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retracted: Chronic Epipharyngitis Treated with Epipharyngeal Abrasion Therapy: Symptoms, Diagnosis, Pathogenesis, and Treatment Outcomes.","authors":"Yasuaki Harabuchi, Takumi Kumai, Kensuke Nishi, Ayaki Tanaka, Osamu Hotta, Hitoshi Hagino, Toshiyuki Kusuyama, Manabu Mogitate, Yoshihiro Ohno, Akira Sakakibara, Satsuki Araki, Yoshinao Nishida, Tomoko Shintani, Hiroyuki Takezawa, Hirofumi Ito, Daigo Komazawa, Noriko Nishiwaki, Ryuzo Toritani, Koichi Hirahata, Satoshi Marumo","doi":"10.31662/jmaj.2024-0437","DOIUrl":"10.31662/jmaj.2024-0437","url":null,"abstract":"<p><p>Chronic epipharyngitis is associated with a wide variety of symptoms, including local symptoms such as postnasal drip, sore throat, lump sensation of the pharynx, headache, chronic cough, nasal obstruction, tinnitus/ear fullness, chronic phlegm and dysphonia due to inflammation of the epipharynx, functional somatic symptoms such as chronic fatigue, dizziness, insomnia, brain fog, abdominal discomfort, and depression caused by dysfunction of the hypothalamus-limbic system via disturbances of vagal response and cerebrospinal fluid outflow, and distant organ symptoms such as immunoglobulin A nephropathy and palmoplantar pustulosis caused by the epipharyngeal lymphoid tissue as an etiologic organ. In the past, chronic inflammation in the epipharynx was difficult to prove by gross findings, now, direct observation of the epipharyngeal inflammation by endoscopy has become easier for the diagnosis. For the treatment of chronic epipharyngitis, epipharyngeal abrasive therapy (EAT), epipharyngeal application of a 1% zinc chloride solution intranasally or orally was popular since the 1960s, recently, endoscopic EAT (E-EAT), in which epipharynx is safely and accurately observed and abraded under clear vision using an endoscope, has been developed. The mechanisms of EAT effects can be classified into anti-inflammatory/antiviral effect, bloodletting effect, and vagus nerve stimulation effect. Recently, the effectiveness of EAT for post-acute sequelae of coronavirus disease 2019 (COVID-19), known as long COVID, has come into the limelight, and the number of patients for whom EAT is expected to increase. In 2019, the Japan Society of Stomato-pharyngology established the EAT Review Committee to accumulate evidence on the efficacy of EAT and to establish indications and techniques for its use. In this article, the EAT Review Committee outlines its symptoms, pathogenesis, and diagnosis of chronic epipharyngitis, technique of E-EAT, mechanisms of EAT effects, past reports for the efficacy of EAT, and a multicenter prospective study.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"371-384"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retraction: Chronic Epipharyngitis Treated with Epipharyngeal Abrasion Therapy: Symptoms, Diagnosis, Pathogenesis, and Treatment Outcomes.","authors":"Yasuaki Harabuchi, Takumi Kumai, Kensuke Nishi, Ayaki Tanaka, Osamu Hotta, Hitoshi Hagino, Toshiyuki Kusuyama, Manabu Mogitate, Yoshihiro Ohno, Akira Sakakibara, Satsuki Araki, Yoshinao Nishida, Tomoko Shintani, Hiroyuki Takezawa, Hirofumi Ito, Daigo Komazawa, Noriko Nishiwaki, Ryuzo Toritani, Koichi Hirahata, Satoshi Marumo","doi":"10.31662/jmaj.R-0001","DOIUrl":"https://doi.org/10.31662/jmaj.R-0001","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.31662/jmaj.2024-0437.].</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"671"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Saturated Fat Restriction for Cardiovascular Disease Prevention: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Satoru Yamada, Tomomi Shirai, Sakiko Inaba, Gaku Inoue, Minami Torigoe, Naoto Fukuyama","doi":"10.31662/jmaj.2024-0324","DOIUrl":"10.31662/jmaj.2024-0324","url":null,"abstract":"<p><strong>Background: </strong>The recommendation to limit dietary saturated fat intake is primarily drawn from observational studies rather than randomized controlled trials of cardiovascular disease prevention. Thus, we aimed to investigate the efficacy of saturated fat reduction in preventing mortality and cardiovascular diseases.</p><p><strong>Methods: </strong>In this systematic review and meta-analysis of randomized controlled trials, Cochrane CENTRAL, PubMed, and Ichu-shi databases were searched for articles up to April 2023. Randomized controlled trials on saturated fat reduction to prevent cardiovascular diseases were selected. Cardiovascular and all-cause mortality and cardiovascular outcomes were evaluated. Changes in electrocardiography or coronary angiography findings were excluded because they could be evaluated arbitrarily. Two or more reviewers independently extracted and assessed the data. A random-effects meta-analysis was performed.</p><p><strong>Results: </strong>Nine eligible trials with 13,532 participants were identified (2 were primary and 7 were secondary prevention studies). No significant differences in cardiovascular mortality (relative risk [RR] = 0.94, 95% confidence interval [CI]: 0.75-1.19), all-cause mortality (RR = 1.01, 95% CI: 0.89-1.14), myocardial infarction (RR = 0.85, 95% CI: 0.71-1.02), and coronary artery events (RR = 0.85, 95% CI: 0.65-1.11) were observed between the intervention and control groups. However, owing to limited reported cases, the impact of stroke could not be evaluated.</p><p><strong>Conclusions: </strong>The findings indicate that a reduction in saturated fats cannot be recommended at present to prevent cardiovascular diseases and mortality. Clinical trials are needed to evaluate the effects of saturated fat reduction under the best possible medical care, including statin administration.</p><p><strong>Systematic review registration number: </strong>This systematic review and meta-analysis was registered with the International Prospective Register of Systematic Reviews (CRD42023428498).</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"395-407"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Practitioners' Attitudes toward the Recommendations for Clinical Questions of the Japanese Guideline for Management of Hyperuricemia and Gout, Third Edition between 2018 and 2020 in the Questionnaire's Surveys: Involving Their Attitude toward the New Questionnaires in 2020.","authors":"Naoyoshi Otani, Toshihiro Hamada, Masanari Kuwabara, Satoshi Miyazaki, Yasuto Sato, Takeo Nakayama, Haruaki Ninomiya, Tsuneo Konta, Ichiro Hisatome","doi":"10.31662/jmaj.2024-0399","DOIUrl":"10.31662/jmaj.2024-0399","url":null,"abstract":"<p><strong>Introduction: </strong>The Japanese Society of Gout, Uric, and Nucleic Acid developed the Japanese Guideline for Management of Hyperuricemia and Gout (JGMHG) third edition, which contains seven clinical questions (CQs) and corresponding recommendations. Questionnaire surveys were conducted to clarify how recommendations regarding CQs influence decision-making in clinical practice.</p><p><strong>Methods: </strong>The surveillances were conducted twice in 2018, just after the publication of JGMHG, and in 2020, 2 years later. The participants were members of the Japanese Society of Gout, Uric, and Nucleic Acid. While the 2018 surveys contained questionnaires on the recommendations of seven CQs as well as three questionnaires on the status of their use, the 2020 surveys contained those regarding their recommendations of seven CQs and seven questionnaires on the status of their use. The answers from 74 (response rate: 16%) and 61 (response rate: 14%) participants in 2018 and 2020, respectively, were analyzed using the chi-square test or Fisher's exact test.</p><p><strong>Results: </strong>The proportion of respondents in 2020 who agreed to reduce serum uric acid levels below 6 mg/dL in gout patients with tophi significantly increased compared to 2018. The agreement in 2020 with the long-term use of colchicine to reduce the recurrence of gout flares when initiating urate-lowering agents (ULAs) significantly increased compared to 2018. There were no significant differences between 2018 and 2020 in clinicians' attitudes toward support for the third JGMHG in daily practice, support for the use of recommendations toward each CQ, or support for finding themes for research or important clinical issues.</p><p><strong>Conclusions: </strong>The third JGMHG plays an important role in popularizing recommendations for serum uric acid levels in patients with tophi and the long-term use of colchicine for prophylaxis of gout flares when initiating ULA, although it did not influence the distribution of responses regarding clinicians' attitudes toward its support.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"470-478"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detecting Breast Cancer via Innovative Magnetic Resonance Elastography with External Vibrations to the Back.","authors":"Emi Yamaga, Tomoyuki Fujioka, Leona Katsuta, Makiko Hayashi, Katsura Yamamuro, Yuichi Kumaki, Kumiko Hayashi, Goshi Oda, Kazunori Kubota, Ukihide Tateishi","doi":"10.31662/jmaj.2024-0239","DOIUrl":"10.31662/jmaj.2024-0239","url":null,"abstract":"","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"596-598"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Images of Inferior Vena Cava Injury Secondary to Lumbar Vertebral Fracture in Diffuse Idiopathic Skeletal Hyperostosis.","authors":"Yushi Sakamoto, Hidetaka Takemura, Tomonori Ozaki, Dan Sugiki, Daisuke Yamazaki","doi":"10.31662/jmaj.2024-0356","DOIUrl":"10.31662/jmaj.2024-0356","url":null,"abstract":"","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"599-601"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Hypothetical Experiment: Evaluating the Real-world Impact of Artificial Intelligence Use in Academic Writing.","authors":"Shigeki Matsubara","doi":"10.31662/jmaj.2024-0411","DOIUrl":"10.31662/jmaj.2024-0411","url":null,"abstract":"","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"662-663"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Loneliness as a Key Factor in Depressive and Anxiety Symptoms among Vietnamese Migrants in Japan during the COVID-19 Pandemic: A Cross-sectional Study.","authors":"Tadashi Yamashita, Pham Nguyen Quy, Emi Nogami, Chika Yamada, Kuniyasu Kamiya, Kenji Kato","doi":"10.31662/jmaj.2024-0134","DOIUrl":"10.31662/jmaj.2024-0134","url":null,"abstract":"<p><strong>Introduction: </strong>Loneliness is a major factor hindering the health of migrants. There is concern that social changes due to the COVID-19 pandemic, in addition to the acculturation gap with their host country, exacerbated loneliness among Vietnamese migrants in Japan. Therefore, this study aimed to clarify the prevalence of loneliness and to evaluate the relationship with depressive and anxiety symptoms among Vietnamese migrants in Japan.</p><p><strong>Methods: </strong>We used a cross-sectional study design with a self-administered questionnaire. The data were collected from May 2 to June 6, 2022. The target population for this study was Vietnamese migrants living in Japan, 213 of whom were included in the analysis. The questionnaire consisted of items regarding participants' characteristics, socioeconomic status, social support, Patient Health Questionnaire-9 scores, Generalized Anxiety Disorder-7 scores, and University of California Los Angeles 3-Item Loneliness Scale scores. Logistic regression analysis was performed with depressive and anxiety symptoms as dependent variables and loneliness and other socioeconomic factors as independent variables.</p><p><strong>Results: </strong>The mean age of the participants was 26.8 ± 4.4 years. The study included 112 men (52.6%) and 101 women (47.4%). Their mean years of residence in Japan was 4.4 ± 2.5 years. The mean score on the University of California Los Angeles 3-Item Loneliness Scale was 7.2 ± 2.4. Multivariate logistic regression analysis revealed that depressive symptoms were associated with loneliness (odds ratio [OR]: 1.797; 95% confidence interval [CI]: 1.434-2.251). Similarly, factors associated with anxiety disorders included loneliness (OR: 2.051; 95% CI: 0.204-1.750).</p><p><strong>Conclusions: </strong>Loneliness is a significant factor contributing to depressive and anxiety symptoms among Vietnamese migrants in Japan. Therefore, reducing loneliness is essential to improving the mental health and overall well-being of the rapidly growing Vietnamese migrant population.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"8 2","pages":"444-452"},"PeriodicalIF":1.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}