Purpose: Although a late-evening snack (LES) has been recommended to patients with chronic liver disease, the effects of long-term carbohydrate-enriched LES still remain debatable. The purpose of this study was to clarify the usefulness of the LES in outpatients with liver cirrhosis.　　Materials and Methods: A nutritional education using LES was given once every month during six months by registered dietitians and pharmacists to 23 outpatients with liver cirrhosis. Seventeen patients were graded A in light of Child classification, and six were graded B. The LES consisted of health foods such as rice balls and bread with 100-200 kcal carbohydrate. Serum AST, ALT, total bilirubin, total protein and albumin levels were evaluated before the nutritional education and 12 months after the start of the education.　　Results: The nutritional education was finished by 19 patients (82.9%). No significant differences were observed in AST, ALT, total bilirubin and total protein values between before and after the education. In 14 patients who were graded Child A and B after the education, with the exception of two patients graded Child C after the education, serum albumin concentrations after the education were significantly higher than those before the education.　　Conclusions: The long-term nutritional therapy with carbohydrate-enriched LES can be performed in the most efficient way on a large percentage of outpatients with liver cirrhosis. This nutritional therapy may be useful for liver cirrhosis patients so long as the liver functions fairly well.

OBJECTIVEThe aim of this study was to establish reference concentrations of urinary strontium by inductively coupled plasma atomic emission spectrometry (ICP-AES).

METHODSFor the determination of strontium, urine samples were collected from healthy Japanese (n=146; 115 males, 31 females; mean age, 33±9 years; age range, 18 to 58 years). The urine samples stored at or below -20°C were thawed with incubation at 40°C for 30 min and sediments were dissolved by vigorous shakings. Then, the samples were centrifuged at 3000 g for 5 min, and the supernatant was directly aspired into a P-5200-3600/1200 ICP-AES system from Hitachi Ltd., Tokyo, Japan.

RESULTSA steeper increase in the S/N ratio and a good effective linearity of the calibration line was obtained at 407.771 nm in the range of 0-300 μg/L strontium standard solution. Urine samples having the same background signal as that of 18 MΩ cm ultrapure blank water, a good correspondence of the single peak pattern of the spectra, accuracy and precision of spike recovery were also confirmed. Urinary strontium concentrations showed a log-normal distribution and a geometric mean concentration of 143.9 μg/L, with 5-95% confidential interval of 40.9-505.8 μg/L.

CONCLUSIONThe results of this study will be useful as guidelines for the biological monitoring of strontium in normal subjects and in individuals therapeutically or environmentally exposed to strontium.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic may have increased the rate of presenteeism among front-line physicians. Presenteeism is the term used to describe attendance at work despite ill health that would normally prompt rest or absence from work. This study aimed to examine the associations between COVID-19 clinical practice and presenteeism among physicians. METHODS: A cross-sectional study was conducted from December 2021 to January 2022. The questionnaires were distributed to 21,737 employed physicians who were members of the Japan Medical Association. Presenteeism was measured by the Work Functioning Impairment Scale. Multiple logistic regression analysis was used to evaluate the association between COVID-19 clinical practice and presenteeism. RESULTS: Overall, 3,968 participants were included in the analysis, and presenteeism was observed in 13.9% of them. The rate of presenteeism significantly increased with both the number of COVID-19 patients treated and the percentage of work time spent treating these patients (both P values for trend < 0.001). In comparison to those not currently engaged in the treatment of COVID-19 patients, presenteeism was significantly higher among front-line (adjusted odds ratio [aOR] = 1.71, 95% confidence interval [CI]: 1.16-2.53) and second-line physicians supporting those in the front-line (aOR = 1.45, 95% CI: 1.17-1.78). There was no association between involvement in COVID-19 vaccination services and presenteeism. CONCLUSIONS The burden on front-line and second-line physicians in COVID-19 clinical practice must be minimized. Employed physicians also need to recognize the importance of communicating with their workplaces about presenteeism.
Humans ; COVID-19/epidemiology* ; Presenteeism ; Japan/epidemiology* ; Cross-Sectional Studies ; COVID-19 Vaccines ; Physicians ; Surveys and Questionnaires