Aim
The risk of developing infectious diarrhea among elderly residents at Japanese geriatric intermediate care facilities is unclear. We investigated the incidence rate and risk factors of ...norovirus‐related diarrhea at such facilities.
Methods
This prospective cohort study followed 1727 residents from November 2018 to April 2020 at 10 geriatric intermediate care facilities in Osaka, Japan regarding the occurrence of diarrhea. Resident data were collected from their medical records using structured forms at two to three of the following three time points: at recruitment, if they developed diarrhea, and when they left the facility. Residents who developed diarrhea were tested using rapid diagnostic tests for norovirus. Cox proportional hazard model was employed to hazard ratios (HRs) with 95% confidence intervals (CIs) to estimate the risk factors for norovirus‐related diarrhea.
Results
During the study period, 74 residents developed diarrhea, 13 of whom were norovirus positive. The incidence rate of norovirus‐related diarrhea was 10.11 per 1000 person‐years (95% CI: 4.61–15.61). In terms of risk factors, people with care‐needs level 3 were at a higher risk for developing norovirus‐related diarrhea (adjusted HR aHR = 7.35, 95% CI: 1.45–37.30). Residents with hypertension (aHR = 3.41, 95% CI: 1.05–11.04) or stroke (aHR = 8.84, 95% CI: 2.46–31.83), and those who walked with canes (aHR = 16.68, 95% CI: 1.35–206.52) also had a significantly higher risk for norovirus‐related diarrhea.
Conclusions
Throughout the study period, the incidence of development of diarrhea was low. Care‐needs level 3, stroke, hypertension and use of a cane were identified as risk factors for norovirus‐related diarrhea in Japanese geriatric intermediate care facilities. Geriatr Gerontol Int 2023; 23: 179–187.
The study aimed to investigate the incidence rate and risk factors of norovirus‐related diarrhea at Japanese geriatric intermediate care facilities. The incidence rate of norovirus‐related diarrhea was 10.11 per 1000 person‐years, and people with care‐needs level 3, stroke, hypertension and use of a cane were identified as risk factors for norovirus‐related diarrhea.
The enantioselective alkylation of the Schiff base 2 was carried out in the presence of a novel phase‐transfer catalyst, the guanidine‐containing pentacyclic compound 1. The product 3 was obtained ...with enantiomeric excesses of 76–90 % (see scheme).
•Immunogenicity of BNT162b2 vaccine were evaluated using two immunoassays.•Elderly Japanese residents showed lower antibody responses than staff.•Aging, steroid and NSAID usage are independent risk ...factors for lower responses.
To evaluate antibody responses against the primary series of vaccination of severe acute respiratory syndrome coronavirus-2 SARS-CoV-2 vaccines in the staff and residents of Japanese geriatric intermediate care facilities.
All subjects (159 staff and 96 residents) received two doses of the BNT162b2 mRNA vaccine 3 weeks apart. Baseline data of subject were collected using a structured form. Serum samples were collected three times: before vaccination, 3 weeks after the first dose, and 4 weeks after the second dose, and anti-receptor binding domain of the spike protein of SARS-CoV-2 anti-RBD IgG was measured using two immunoassays.
After the second dose, geometric mean titers GMT of anti-RBD with both the Abbott and Roche assay were significantly lower in residents than staff (2282 AU/mL vs. 8505 AU/mL, and 258 U/mL vs. 948 U/mL, respectively). Multivariate analysis of characteristics affecting antibody responses (≥1280 AU/mL for Abbott and > 210 U/mL for Roche) showed lower odds ratios ORs for older age (adjusted OR per 10 year increase aOR = 0.62, 95 % confidence interval 95 %CI; 0.38–1.02), steroid usage (aOR = 0.09, 95 %CI; 0.01–0.60) and regular nonsteroidal anti-inflammatory drugs NSAIDs usage (aOR = 0.16, 95 %CI; 0.03–0.88).
Elderly people and steroid and NSAID users had lower antibody responses following the second vaccine dose.
When infielders field a ground ball, decreasing the interval from catching to releasing the ball (release time) increases the probability of outing a batter or runner. The present study examines the ...relationship between lower extremity kinematics and release time. Right-handed fourteen infielders caught a ground ball that was rolled towards them from a distance of 5 m and then they threw the ball as quickly as possible towards a net located 20 m in front. The interval between the catch to the left-foot lift-off (foot off phase), and the stride-foot contacting the ground after the step motion (stride phase) significantly correlated with release time. We assessed relationships between these phases and lower extremity movement. The angular variation of the joints of the right lower extremity from the catch to the right foot lift off significantly correlated with the foot off phase. Forward mid-hip and left foot variation significantly correlated with the stride phase. Velocity data did not significantly correlate with these phases, indicating that the size, rather than the speed of the fielding motion has a greater effect on release time.
An 80-year-old woman with type 2 diabetes was admitted due to right-handed muscle weakness. The patient presented with Brown-Sequard syndrome, with complete paralysis of the right lower limb along ...with a loss of pain and temperature sensations in the left lower limb. Magnetic resonance imaging revealed a cervical epidural abscess, and accompanying edema or inflammation of the right side of the spinal cord at the C5 level. She underwent drainage and evacuation of the spinal abscess, followed by intravenous antibiotic administration. These interventions ameliorated the neurological deficits. The present case suggests the importance of epidural abscess as a rare pathogenetic cause of Brown-Sequard syndrome in type 2 diabetes.
Abstract
Background
Norovirus infection and Clostridioides difficile infection (CDI) are major causes of acute infectious diarrhea at medical facilities. “Geriatric intermediate care facilities” are ...a type of medical facility that tend to the daily life needs of elderly Japanese people. However, there is no research about norovirus- or CDI-related diarrhea at Japanese geriatric intermediate care facilities.
Methods
This prospective cohort study included 1445 residents at 10 geriatric intermediate care facilities in Osaka between November 2018 and October 2019. The study subjects were followed regarding the occurrence of acute infectious diarrhea and the results of rapid diagnostic tests for norovirus and CDI. We calculated incidence rates and hazard ratios (HR) with 95% confidential intervals (CI) to identify the risk factors of infectious diarrhea.
Results
Thirty-seven residents developed diarrhea during the observation period, although none of them was positive for norovirus or CDI. The total incidence rate was 1.21/10,000 person-days (95%CI: 0.82-1.60). Compared with residents aged 87-91 years, those aged ≤ 80 years had a significantly higher risk of diarrhea (HR = 3.85, 95%CI: 1.27-11.66). Moreover, residents with thyroid diseases had a significantly higher risk of diarrhea than those without thyroid disease (HR = 5.33, 95%CI: 2.32-12.25).
Conclusions
The incidence of acute infectious diarrhea is relatively low. However, residents who are < 80 years old and those with thyroid diseases are more likely to develop diarrhea.
Key messages
We describe the situation of acute infectious diarrhea at Japanese geriatric intermediate care facilities
The purpose of this study was to investigate the changes of salty taste sensitivity (STS) during the physicaleducation (P.E.) swim class in outdoor, summer. Eight healthy young males (age: 16 years) ...were volunteered to thisinvestigation and swam (approximate 400 m for 70 minutes) in July (temperature: 31.2 ± 0.6 ℃ ). Participant’s STS,urinary electrolyte, ration of dehydration and the degree of salty appetite (DSA) were measured before and after P.E.(respectively, Pre and Post). DSA at Post was significantly higher than that of Pre. STS, urinary Na / Cr and urinaryCl / Cr at Post were significantly lower than that of Pre. STS at Post significantly increased even if that ration of dehydration(0.45 ± 0.20 %) was not enough to the level of concern in summer.
The patient was a 38-year old woman. She experienced epigastralgia on July 15, 2011. She was admitted to a hospital with a diagnosis of acute pancreatitis on July 20. Her plasma glucose level was 92 ...mg/dl at the time of admission. Although the acute pancreatitis was quickly resolved, nausea and general fatigue appeared on July 26. She was found to be in the fifth week of pregnancy, but she had a miscarriage the next day. She was discharged from the hospital on July 29, although the symptoms persisted. However, she was transported to this hospital on July 31, due to frequent vomiting that began the day after her discharge. Her plasma glucose level was 498 mg/dl at the time of admission and she had ketoacidosis. She was admitted with a diagnosis of diabetic ketoacidosis. She was diagnosed to have fulminant type 1 diabetes based on her HbA1c level (6.0 %) and low serum and urinary levels of CPR. Fulminant type 1 diabetes is associated with acute pancreatitis and pregnancy. This is an instructive case of fulminant type 1 diabetes that developed during early pregnancy (fifth week) along with the preexisitng acute pancreatitis more than 10 days before the onset of hyperglycemia.
PDF
