BACKGROUND: The long-term impact of symptom classification on quality of life (QOL) and economic outcomes among individuals with long coronavirus disease (COVID) remains poorly understood. This study aimed to clarify the situation of long COVID in Japan by analyzing patients using cluster classification. METHODS: This multicenter, retrospective cohort study enrolled 515 patients with COVID-19 and followed up for 36 months via standardized questionnaires. Patients were classified based on: 1) symptom trajectory over time and 2) symptom cluster profiles at 3 months. RESULTS: While the number of symptoms decreased, fatigue and dyspnea frequently persisted, whereas anosmia and dysgeusia declined. Cough and sputum decreased gradually. The proportion of patients with 5-9 symptoms increased. The mean (interquartile range) presenteeism scores were lower in the continuous (60 [50-80]) and relapse groups (65 [48-80]) than in the recovered group (70 [50-80]). The multiple symptoms cluster had the worst SF-36, presenteeism, and absenteeism scores (47.2 [44.7-49.8], 48.8 [27.5-72.5], and 10.9 [0.0-11.0], respectively). CONCLUSIONS Patients with continuous and multiple symptoms experienced persistently lower QOL and greater economic burden up to 36 months after COVID-19 diagnosis. The long-term effects of long COVID are not only physical but also mental and economical. Thus, further research is needed to clarify the economical and physiological impact of long COVID.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; COVID-19/complications* ; Japan/epidemiology* ; Post-Acute COVID-19 Syndrome/psychology* ; Quality of Life ; Retrospective Studies ; Surveys and Questionnaires ; East Asian People

  Objectives  In Sub-Saharan Africa, acquired immunodeficiency syndrome (AIDS) orphans account for a large proportion; however, their mental health problems have been overlooked. We presented an investigation of literature to provide a comprehensive overview of associated factors of mental health among AIDS orphans in Sub-Saharan Africa. Methods  Databases (PubMed and Japan Medical Abstracts Society) were searched by using relevant keywords including AIDS orphans, Sub-Saharan Africa, mental health, psychological support, education, and poverty. A total of nine papers met the inclusion criteria and were included in this literature review.Results  AIDS orphans were at high risk of various mental disorders relevant to low self-esteem, anxiety, and depression. Associated factors of the mental health of AIDS orphans were classified into the following three categories: psycho-social-cultural factors such as social discrimination, abuse, and bullying etc.; physical environmental and economic factors such as education, lack of foster care, and poverty etc; and family and community relevant factors such as lack of connection and social support from family and school etc. Regarding psycho-social-cultural factors, AIDS orphans experienced more abuse, social discrimination, and social stigma, especially those who were living in poverty. AIDS orphans living in the urban experienced severe bullying. Regarding family and community factors, due to the loss of parents and changes in living environment, AIDS orphans who were living in households headed by children tend to experience depression, anxiety, fear, and stigma. The loss of a parent resulted in lower academic performance and limited access resources including inadequate mental health services, which consequently led to poor development and adverse health outcomes in AIDS orphans including poor psychosocial well-being. Regarding environmental and economic factors. Lack of care from caregivers and parental mental health were also shown to be related to child development and mental health in AIDS orphans. Regarding physical environmental and economic factors, limited available social support in the physical environment where AIDS orphans lived was associated with impaired development and mental health. Poverty led to AIDS orphans being affected by food shortage and malnutrition (e.g., stunting), child labor, as well as risky sexual behaviors towards female AIDS orphans. Better social support from caregivers and teachers had a positive impact on the mental health of AIDS orphans. With regard to education, AIDS orphans have a high school dropout rate, resulting in fewer school connections. School connections have been shown to be an important protective factor for AIDS orphans’ mental health. Conclusions  This review identified risk and protective factors of mental health among AIDS orphans in sub-Saharan Africa. Our results, especially the positive influence of social support, encourage the development of effective mental health care programs for AIDS orphans in sub-Saharan Africa. The results suggest looking at various problems that AIDS orphans are facing from multiple perspectives.

Objective: This study aimed to investigate the feasibility of a patient registry system for assessing PCT (palliative care team) by PRO (Patient-reported outcome) in Japan. Methods: We operated a patient registry system with electronic data collection at eight hospitals in 2021 in Japan. We consecutively included newly referred patients for a month and followed up with them for a month. IPOS or ESAS obtained as PRO at the start of the intervention, three days later, and every week after. The primary endpoint was the response rate to the symptom rating scale by patients and providers. Results: 318 patients were enrolled. The patient response rate was 59.1% at intervention and 37.0% after intervention, and the medical provider response rate was 98.4% at intervention and 70.3% after intervention. Interviews with PCT members indicated that participants required support to input PRO responses required support and paper questionnaire was better and that managing the survey date and overall management was burdensome. Discussion: Although only about half of the patients were able to respond to the PRO, this was the same level as in previous studies. The system and its operation method have many problems. We found that improvements such as reducing items and making the patient interviews paper-based are necessary to expand the system nationwide.

Objective: To investigate the factors that make observed survival of patients with terminal cancer shorter than oncologists’ estimation. Methods: We retrospectively surveyed the medical records of terminal cancer patients who were referred to our palliative care unit with a predicted survival of 1–3 months and discharged dead from hospital within 3 months. Results: A total of 249 patients were eligible for analysis. One hundred and two patients (41%) had observed survival of less than one month (OS1), and 147 (59%) lived for 1–3 months (OS1–3) as expected. Depressed level of consciousness above Japan Coma Scale II and severely reduced oral intake (a few mouthfuls or less) were associated with unexpected shorter survival. The number of patients who died within two days after sudden deterioration of general condition was significantly higher in OS1 than OS1–3. Conclusion: Although survival of patients with the above factors may be shorter than oncologists’ estimation, it is necessary to examine the physician-side factors that contribute to the inaccuracy of prognosis.

To help medical doctors practicing Kampo medicine suggest appropriate acupuncture treatments for individ­ual patients, a study group made up of 7 acupuncturists and 5 medical doctors developed an acupuncture cur­riculum. The group provided a learning program based on the curriculum for 16 medical doctors in charge of outpatient Kampo services in a research institute. The learning program consisted of a lecture and practical training, and a total of 4 sessions were held. At the end of each session, a test was conducted to examine the participants' level of understanding. After the completion of the learning program, a questionnaire survey was conducted to confirm the usefulness of the acupuncture curriculum for the practice of Kampo medicine. The mean number of participants per session was 10.8 ± 1.3. The mean test score was 9.3 ± 0.5 (full score : 10). In the questionnaire, 14 out of the 16 (88%) answered that the acupuncture curriculum was useful or relatively useful for the practice of Kampo medicine. On comparing the numbers of new acupuncture patients with a his­tory of outpatient Kampo service use before and after the acupuncture curriculum, there was a 1.8-fold increase after it. The results support the usefulness of the acupuncture curriculum to understand acupuncture and practice Kampo medicine. Further evaluation is necessary.

In Kampo medicine, general fatigue is categorized as a symptom caused by qi deficiency according to the qi-blood-­water criteria. However, in some patients with general fatigue, formulae for qi deficiency are not ef­fective, and this might be because their chronic symptoms are associated with blood stagnation. Recently, we encountered ten patients (M/F 1/9, mean age 46 years, range 23-55 years) with general fatigue that was im­proved by agents for treating blood stagnation, such as keishibukuryogan and/or tokakujokito. These patients, who were mostly of medium build, complained of neck or shoulder stiffness (9/10), consti­pation (5/10), and blushing or hot flushes (5/10). They had no problem with appetite, except that 5 patients tended to overeat. Remarkable sublingual collateral vessels (8/10), paraumbilical tenderness (9/10) and periorbital dark circles (5/10) were observed on physical examination. The tongue and abdominal signs improved or had disappeared after treatment for 3 to 8 months. Our results suggest that patients with general fatigue, but who present with symptoms associated with blood stagnation, could be treated with drugs for blood stagnation such as keishibukuryogan and/or tokakujokito.

We report five female patients (range 33-54 years) with irritable bowel syndrome (IBS) that were successfully treated with ireito-­based prescriptions. Showing yin deficiency and weak constitution, they maintained a good state of bowel movement with warming and invigorating prescriptions. However, when it became hot around March to June and these patients encountered stressful conditions, they became thirsty and tended to take a lot of cold food and drink. Then, they developed diarrhea, epigastric and/or abdominal fullness, anxiety and depressive feeling, which are regarded as due to qi stagnation. Stuck sensations in pit of stomach by abdominal examination were reported in all cases. Their symptoms were derived from water retention and qi stagnation, and therefore, we prescribed ireito for one patient, ireito with keishikashakuyakuto or kenchutobased prescriptions (ogikenchuto or shokenchuto) for 3 patients, and ireito with keishibukuryogan for one patient. Ireito is composed of heiisan and goreisan. The Chinese herbs Magnolia Bark and Citrus Unshiu Peel in heiisan not only help the digestive system, but also improve qi stagnation. These results suggest that ireito,containing Peony Root, is effective for patients with IBS, who show stuck sensations in the pit of stomach and suffer from diarrhea with abdominal pain after taking cold food and drink under stressful conditions.

In female patients with migraine, the triggering or exacerbating factors for migraine including stress, menstruation and fatigue, should be treated intensively in addition to treatment for headache. Patients with coldness and weak constitution become a state of qi and blood deficiency in terms of Kampo medicine under the circumstances of severe fatigue, lack of sleep and menopausal symptoms. They tend to suffer from migraine at around the 4th or 5th day of menstrual period after rather heavy menstrual bleeding on the 2nd or 3rd day. We experienced 4 patients with headache during the late period of menstruation whose symptoms were successfully treated by juzentaihoto known to improve qi and blood. In Case 1, daily prescription was changed from unkeito to juzentaihoto. In Case 2, during the 7 days of menstrual period, juzentaihoto was added to tokishigyakukagoshuyushokyoto, while juzentaihoto was substituted for tokishakuyakusan in Case 3 and Case 4. In 9 cases of headache, including these 4 cases, juzentaihoto was efficacious against migraine headache during the late period of menstruation with coldness (9/9 cases), fatigability (9/9 cases) and dryness symptoms (7/ 9 cases). These results indicate that juzentaihoto is effective for migraine during the late period of menstruation, especially in patients with fatigue after menstrual bleeding. The administration period of juzentaihoto should be individualized for each patient depending on the severity of qi and blood deficiency.

PURPOSE: Few studies have compared fractional exhaled nitric oxide (FeNO) measurement by NIOX VERO® (NOV) and other devices in children. Moreover, there is no agreement between differences in FeNO values obtained using different devices in adults. Here, we compared FeNO values obtained using NOV and NObreath® (NOB) systems to derive a correction equation for children. METHODS: Eighty-eight participants (age 7–15 years) who were diagnosed with atopic bronchial asthma and visited Sagamihara National Hospital as outpatients between January and April of 2017 were included. We measured FeNO values obtained using NOB and NOV, and analyzed them using Wilcoxon tests and Altman-Bland plots. RESULTS: The median age of the participants was 11.5 years, and the scored Asthma Control Test (ACT) or Childhood ACT (C-ACT) was 25 (interquartile range, 24–25) or 26 (24–27). NOB and NOV values were significantly different (31 [14–52] versus 36 [20–59] ppb; P = 0.020) and strongly correlated (r = 0.92). An equation to convert NOB values into NOV values was derived using linear regression as follows: log NOV = 0.7329 × log NOB + 0.4704; NOB for 20, 40, 58, 80 and 100 ppb corresponded to NOV for 27, 44, 59, 73 and 86 ppb. Thus, NOB < 58 ppb suggested NOB < NOV, whereas NOB > 58 ppb suggested NOB > NOV. CONCLUSIONS: NOB and NOV values were strongly correlated. Participants whose FeNO values were relatively low represented NOB < NOV, whereas those whose FeNO values were relatively high represented NOB > NOV.
Adult ; Asthma ; Child* ; Exhalation ; Humans ; Linear Models ; Nitric Oxide* ; Outpatients