Heart failure (HF) has a significant impact on quality of life and employment. For patients with HF of work age, return to work (RTW) is an important goal because of its social and economic significance. This scoping review aimed to investigate the definition of RTW, RTW rates, support programs, and factors associated with RTW in patients with HF, and to propose future research and clinical support strategies. We included 47 studies with 64,048 individuals: 21 cohort studies (five prospective studies, 16 retrospective studies), three cross sectional studies, three case series studies (two retrospective studies, one prospective study), 18 case reports, two qualitative studies. Participants were aged 18–65 years old and were employed prior to a diagnosis of HF. Only one study defined RTW in patients with HF, and it was described as “whether or not patients were working for income.” The overall RTW rate across the studies had a median of was 56.0
BACKGROUND:"Sacred moments" refer to times when people experience deep mutual connection, accompanied by spiritual emotions. Previous North American studies reveal that such moments can predict overall well-being for patients and clinicians. However, sacred moments have not been studied in Japanese healthcare, where the cultural background differs substantially from previous studies. OBJECTIVE:To examine sacred moments among patients and clinicians in Japan. DESIGN:An exploratory qualitative study featuring two facilities: a Tokyo community hospital and a national university hospital in Western Honshu. PARTICIPANTS:Hospital-based clinicians and patients. APPROACH:Semi-structured interviews with 30 participants from January to March 2024. Interviews were audio recorded and transcribed verbatim, and thematic analysis was performed. KEY RESULTS:Most participants-22 of 26 clinicians (84.6%) and 3 of 4 patients (75.0%)-reported having experienced sacred moments during healthcare visits once the concept had been explained, as most initially expressed unfamiliarity with the term "sacred moments" in either Japanese or English. Twenty of 26 clinicians (76.9%) and 2 of 4 patients (50.0%) highlighted the importance of taking time to build rapport and trust for sacred moments to occur. Twenty-three of 26 clinicians (88.5%) and all 4 patients (100.0%) believed that fostering the mind and spirit was beneficial, while 4 of 26 clinicians (15.4%) and 1 of 4 patients (25.0%) expressed negative views toward religion and spirituality. Qualitative findings were divided into three domains: (1) common elements that characterize sacred moments; (2) discomfort or resistance to religion; (3) elements necessary to foster sacred moments. CONCLUSIONS:Our exploratory study highlights the important concept of sacred moments in Japan. The high prevalence of reported sacred moments after the concept had been explained underscores the need for a conceptual translation into the Japanese cultural space. Alternative terms may resonate more naturally within non-Western cultural contexts, such as emphases on deep connection and fate.
Alterations in gut microbiota are prevalent in patients with chronic kidney disease (CKD) and are associated with pathogenic phenotypes, including the progression of kidney damage and defecation conditions. We developed a fermented low-protein brown rice (LPBR), a whole grain unpolished rice, and examined its effects on renal function, defecation condition, and gut microbiota composition in CKD patients. In this 3-month, single-arm study, 30 outpatients with stage 3 − 4 CKD were recruited and received a dietary intervention with LPBR. Changes in the defecation condition were evaluated using the Constipation Scoring System (CSS) and the Bristol Stool Form Scale. Alterations in urinary protein excretion and estimated glomerular filtration rate (eGFR) as well as stool condition were assessed as primary outcomes. Among the 29 participants with CKD, intervention with LPBR led to a significant improvement in CSS scores (P = 0.023), a reduction in urinary protein excretion (P = 0.050), and a decrease in eGFR levels (P = 0.044). Fecal acetic acid increased (P = 0.024) and the abundance of Bifidobacterium longum in the gut microbiota increased (P = 0.094). Changes in Bifidobacterium longum were positively associated with alterations in fecal acetic acid levels and CCS scores. Additionally, changes in fecal acetic acid were positively associated with changes in eGFR and Bristol stool scores. The trend toward increased Bifidobacterium longum abundance and elevated acetic acid production with LPBR intake may contribute to the attenuation of CKD complications. Our findings suggest that LPBR intervention may offer beneficial effects for CKD patients.
Abdominal pseudohernia is a condition characterized by abdominal wall bulging without structural defects. We report a case of pseudohernia following herpes zoster infection diagnosed and followed up using ultrasonography. A 60-year-old woman developed right flank pain with vesicular eruptions, treated with valacyclovir. While her pain improved, she noticed new right lateral abdominal bulging. Standing-position ultrasonography revealed relaxation of the right rectus abdominis muscle without fascial defects, confirming an abdominal pseudohernia. Subsequent ultrasounds showed improvement in muscle relaxation, and abdominal bulging visibly reduced. This case illustrated that point-of-care ultrasonography proved particularly valuable for dynamic evaluation in upright positions and for follow-up of recovery progression, since abdominal pseudohernia manifests as positional muscle relaxation. The modality offers rapid, radiation-free assessment for this rare complication of herpes zoster.
Background Population aging and depopulation pose substantial challenges to the sustainability of healthcare and long-term care systems in rural and remote communities. This study aimed to describe temporal trends in out-of-municipality long-term care insurance (LTCI) benefits and contemporaneous public hospital management indicators in two remote island areas in Japan. Methods We conducted an exploratory descriptive ecological study using aggregated municipality-level LTCI and population data and hospital-level management data from fiscal year (FY) 2015 to FY2023 in the Oki Islands, Shimane Prefecture, Japan. We described trends in the Dozen region and Okinoshima Town, including population structure, the proportion of out-of-municipality LTCI benefits, inpatient and outpatient revenue, bed occupancy rates, and financial indicators. Percentage changes, annualized percentage changes, and outpatient-to-inpatient revenue ratios were calculated descriptively. No inferential hypothesis testing was performed. Results The population decreased in both areas. In the Dozen region, the proportion of out-of-municipality LTCI benefits increased overall from 9.5% in FY2015 to 21.9% in FY2023, whereas it remained relatively stable in Okinoshima Town, ranging from 2.6% to 3.2%. In Dozen Hospital, inpatient revenue decreased from JPY 330.8 million to JPY 260.6 million (-21.2%), while outpatient revenue increased from JPY 226.0 million to JPY 267.9 million (+18.6%). In Oki Hospital, inpatient revenue decreased from JPY 1,294.3 million to JPY 1,082.5 million (-16.4%), while outpatient revenue increased from JPY 1,035.5 million to JPY 1,116.2 million (+7.8%). The outpatient-to-inpatient revenue ratio increased from 0.68 to 1.03 in Dozen Hospital and from 0.80 to 1.03 in Oki Hospital. Conclusions The increase in out-of-municipality LTCI benefits in the Dozen region coincided with a comparatively large shift in the composition of Dozen Hospital revenue from inpatient toward outpatient services. These hypothesis-generating ecological findings do not demonstrate individual relocation or establish a causal relationship. Out-of-municipality LTCI benefits may warrant further evaluation as an administrative indicator alongside individual-level care utilization, residential histories, service capacity, and patient-flow data before being used to inform health policy or resource allocation.
