Background Reducing health inequalities is an important public health challenge. Many studies have examined the widening health gap by occupational class among men, but few among women. We therefore estimated variation in absolute and relative mortality by occupational category across four leading causes of mortality—cancer, ischaemic heart disease, cerebrovascular disease, and suicide—to explore how occupational class is associated with health among working women aged 25–64 in Japan. Methods We conducted a repeated cross-sectional study using Poisson regression analysis on each five-yearly mortality data from 1980 to 2015, obtained from the National Vital Statistics and the Japanese Population Census. Results There was a decreasing trend in mortality from all cancers, ischaemic heart disease, cerebrovascular disease, and suicide among women in all occupational groups from 1980 to 2015. Agriculture workers had higher risk of mortality than professional workers for all four causes of death. The absolute difference in mortality rates for all cancers and cerebrovascular disease was higher in 2000–2015 than 1980–1995. The mortality trend among clerks and sales workers decreased after 2000, except for suicide. Conclusions Mortality rates from all four causes are higher among agriculture workers compared to professional workers, and attention is needed to reduce this mortality gap. Continuous monitoring of ongoing mortality trends is essential to ensure better health and wellbeing in Japan.
SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, coronavirus disease 2019, mortality, infectivityThe present retrospective study aimed to examine the real-world data regarding time-dependent changes in the age distribution of patients with coronavirus disease 2019 (COVID-19) as well as the severity and infectivity in a regional core hospital in Japan. Patients with COVID-19 who visited the fever outpatient branch in Takagi Hospital during phase I (May 1 to December 31, 2021), and during phase II (January 1 to April 30, 2022) were evaluated. The age distribution of outpatients and the characteristics of inpatients aged > 75 years were compared between phases I and II. The age distribution of outpatients shifted from the older generation in phase I to the younger generation in phase II (p < 0.01). Disease severity might be reduced in a time-dependent manner with a decrease in the hospitalization rate (phase I: 145/368 (39.4%); phase II: 104/1496 (7.0%); p < 0.01) and mortality rate (phase I: 10/368 (2.7%); phase II: 7/1496 (0.5%); p < 0.01). The number of patients increased in phase II (374.0/month) compared to that in phase I (36.8/month). Regarding the older inpatients, the disease severity of COVID-19 and hospitalization days were reduced in phase II compared to those in phase I (p < 0.01, each). In conclusion, the present study suggests a change in the age distribution of patients with COVID-19, a decrease in toxicity, and an increase in infectivity of severe acute respiratory syndrome coronavirus 2 in a time-dependent manner.
BACKGROUND: Dementia is a general term for loss of memory, language, problem solving, and other thinking skills that can interfere with daily life. Dementia is generally experienced by the older people. Nearly 10 million new cases of dementia reported each year, and more than 50% of dementia patients live in low and middle-income countries. With these potentially increasing number of dementia cases, accurate knowledge about dementia is essential for the community as it could be beneficial for the quality of care and reducing its progression. AIM: This study aimed to assess knowledge about dementia in the middle-aged age group and to determine the sociodemographic factors associated with knowledge about dementia in Indonesia. METHODS: A cross-sectional survey targeted the middle-aged population (40–59 years old), using an online questionnaire examining sociodemographic characteristics (age, gender, occupation), living arrangements, and the Dementia Knowledge Assessment Scale. RESULTS: A total of 1147 respondents were examined, revealing that more than 67% of the participants had poor knowledge about dementia. We revealed that female gender, younger age, and higher occupational level were significantly associated with good knowledge about dementia in various subscales. Interestingly, the living arrangements showed no significant association with knowledge about dementia in any subscale. CONCLUSION: The results emphasize the importance of intensive public health awareness to improve public knowledge about dementia in Indonesia, specifically targeting men and older individuals, as well as those with lower occupational levels.
Background Metastatic neuroendocrine carcinoma has an extremely poor prognosis, and no effective second-line treatment is available. Herein, we describe a case of multiple metastases after primary resection of esophageal neuroendocrine carcinoma successfully treated with nivolumab plus radiotherapy in a short time. Case presentation A man in his 70s presented to our hospital after an abnormality was detected on an upper gastrointestinal series. Upper gastrointestinal endoscopy revealed a type 2 tumor spanning the endothelial cell junction to the abdominal esophagus. Histopathological examination of the biopsy confirmed a diagnosis of esophageal neuroendocrine carcinoma. The patient had no distant metastases. Thoracoscopic esophagectomy with three-field lymph node dissection was performed. Histopathological examination confirmed a diagnosis of esophageal neuroendocrine carcinoma with features of adenoid cystic-like carcinoma and squamoid pattern (pT2 [MP], INF a, ly1, v1 [EVG], pIM0, pDM0, pRM0, pN1 [1/28], M0; Stage II), which was positive for synaptophysin. The postoperative course was good, with no complications. The patient was treated with 100 mg of irinotecan and 100 mg of cisplatin, administered every 4 weeks, as postoperative adjuvant chemotherapy. Grade 3 loss of appetite was observed, and adjuvant chemotherapy was discontinued after four cycles of first-line treatment. A positron emission tomography–computed tomography scan 3 years after surgery showed abnormal uptake in the subaortic, left hilar, and left axillary lymph nodes, and in a mass in the right lung apex. The patient was diagnosed with metastatic esophageal neuroendocrine carcinoma postoperatively. First-line treatment could not be repeated due to toxicity from the initial treatment. Nivolumab (240 mg every 2 weeks) was administered as second-line treatment, and radiotherapy was started (56 Gy delivered in 28 fractions to the local [subaortic and hilar] lymph nodes). After 10 cycles of nivolumab in combination with radiotherapy (56 Gy), a positron emission tomography–computed tomography scan showed disappearance of all lesions. A complete response was achieved. Maintenance therapy (240 mg of nivolumab) was continued. No recurrence has been observed for 42 months. Conclusions We experienced a case in which nivolumab in combination with radiotherapy was effective for metastatic esophageal neuroendocrine carcinoma after primary resection.
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