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BackgroundOpportunities for face-to-face communication with patients is increasing in modern hospital pharmacist practice. This may impose new burdens on hospital pharmacists. We performed a cross-sectional study to examine the prevalence of psychological distress, burnout, and compassion fatigue among hospital pharmacists. We also investigated possible relevant factors, such as sex, years of experience, hospital size, interpersonal work hours, and personality traits related to communication.MethodsWe mailed self-administered questionnaires to all pharmacists (n = 823) belonging to the prefectural society of hospital pharmacists in Japan. The questionnaires were the General Health Questionnaire (GHQ-12), Burnout (BO) and Compassion Fatigue and Secondary Traumatic Stress (CF/STS) subscales of the Professional Quality of Life Scale, the Autism Spectrum Quotient (AQ), and the Adult ADHD (attention deficit hyperactivity disorder) Self-Report Scale (ASRS). We examined associations between personality traits (AQ, ASRS) and psychological burden (GHQ-12, BO, CF/STS) using rank ANCOVA or multivariate logistic regression analyses.ResultsComplete responses were obtained from 380 pharmacists (46.2 % response rate). A substantial number of participants obtained scores that were higher than the cutoff points of the GHQ-12 (54.7 %), BO (49.2 %), and CF/STS (29.2 %). The GHQ-12 scores were negatively affected by years of experience (p < 0.001), and positively affected by AQ (p < 0.001) and ASRS (p < 0.001) scores. The BO scores was positively affected by AQ (p < 0.001) and ASRS (p = 0.001) scores, while the CF/STS (p = 0.023) score was negatively affected by years of experience, and positively affected by AQ (p < 0.001) and ASRS (p < 0.001) scores.ConclusionsThere is a high prevalence of psychological distress and work-related burnout/CF among hospital pharmacists. Additionally, two common personality traits, such as autistic-like traits and ADHD-like symptoms, which might be related to communication style, could increase the risk of psychological distress and burnout/CF. Early risk assessment and preventive interventions that are specialized for these characteristics could protect individuals with these specific traits from burnout.

Objectives To describe and examine trends in polypharmacy according to age in Japan from 2010 to 2016. Design Retrospective observational study. Setting Outpatient settings. Participants Japanese individuals aged 20 and older. Measurements We analyzed pharmacy claims data that the Japanese Ministry of Health, Labor, and Welfare provided in the Survey of Medical Care Activities in Public Health Insurance from 2010 to 2016. The use of 5 or more oral prescription medications per month was defined as polypharmacy and of 10 or more as excessive polypharmacy. Regression analysis was used to estimate trends in polypharmacy with annual percentage changes. Using number of medications (polypharmacy vs excessive polypharmacy), trends in polypharmacy and crude and age‐adjusted rates of polypharmacy per 1,000 persons were calculated according to year and age group (20–34, 35–49, 50–64, 65–79, ≥ 80). Results We analyzed 240 million pharmacy claims data. The age‐adjusted monthly prevalence rate of polypharmacy increased from 85.2 to 93.8 per 1,000 persons per month and of excessive polypharmacy from 13.6 to 14.0 per 1,000 persons per month from 2010 to 2016 in the entire study population. The highest rate of polypharmacy (per 1,000 persons) was observed in 2016 in those aged 80 and older (326.8), followed by those aged 65 to 79 (167.3). The polypharmacy rate increased by 6.3% (95% confidence interval (CI)=4.0–8.7) per year from 2010 to 2012, then decreased by 0.7% (95% CI=–1.3–0.0) per year from 2012 to 2016. The rate of excessive polypharmacy increased by 4.5% (95% CI=1.1–8.0) per year from 2010 to 2013 and then decreased by 3.7% (95% CI=–6.7 to –0.6) per year from 2013 to 2016. Conclusion The overall trend of polypharmacy in Japan increased during the study period, although the increase ceased in 2013 and then declined from 2013 to 2016. Policy changes in Japan might be responsible for some of the changes. J Am Geriatr Soc 66:2267–2273, 2018.

Royal jelly (RJ) produced by honey bees is known to contain three major nutrients including amino acids, vitamins and minerals.1) Additionally, RJ has various biological activities such as a hypotensive effect, insulin-like action and antitumor activity.2-4) Therefore, it is possible that RJ may have some effects on insulin resistance, which is considered to be a cause of various lifestyle-related diseases. Many clinical studies have shown a possible relationship between hypertension and insulin resistance, since patients with type 2 (noninsulin dependent) diabetes mellitus frequently have insulin resistance associated with hypertension. 5-7)Chronic administration of fructose to rats has been reported to cause insulin resistance, which is characterized by increased serum insulin and euglycemia.8) Especially, a hyperinsulinemic state associated with hypertension was more prominently induced by fructose drinking than by fructose feeding.9) Previously, we reported that rats with chronic hyperinsulinemia, which was induced by giving a 15% fructose solution in drinking water for 10 weeks (fructose-drinking rats, FDR), showed deficient neuronal regulation of vascular tone, and this leads to hypertension. 10,11) Recently, we demonstrated that chronic administration of RJ prevented development of insulin resistance in Ohtsuka Long-Evanse Fatty (OLETF) rats, which is a spontaneous type 2 diabetic model. 12)Thus, in the present study, we investigated the effects of RJ on the insulin resistance in FDR. We also examined whether RJ prevents hypertension and altered vascular responsiveness induced by insulin resistance using isolated mesenteric vascular beds of rats. MATERIALS AND METHODS AnimalsSix week-old male Wistar rats were used in this study. They were given 15% fructose solution as drinking water ad libitum for 8 weeks. The control group was given tap water instead of 15% fructose solution. Three rats were housed in each cage (W 220ϫL 320ϫH 135 mm; Natsume Seisakusho, Tokyo, Japan), and given normal rat chow (Oriental Yeast, Tokyo, Japan). They were housed in the Animal Research Center of Okayama University at a controlled ambient temperature of 22Ϯ2°C with 50Ϯ10% relative humidity and with a 12-h light/12-h dark cycle (lights on at 8:00 a.m.). This study was carried out in accordance with the Guidelines for Animal Experiments at Okayama University Advanced Science Research Center, Japanese Government Animal Protection and Management Law (No. 105) and the Japanese Government Notification on Feeding and Safekeeping of Animals (No. 6). Every effort was made to minimize the number of animals used and their suffering.Long-Term Administration of RJ RJ, which was enzymatically treated and supplied by Yamada Apiculture Center, Inc. (Okayama, Japan) (Lot No. 020605), was used in this study. RJ was diluted by adding distilled water and orally administered at doses of 100 mg/kg/d and 300 mg/kg/d for 8 weeks from 6 to 14 weeks of age. Each animal was lightly anesthetized with ether and orally administrated RJ solution at a volum...

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Nicotine stimulates presynaptic nicotinic acetylcholine receptors in perivascular adrenergic nerves and releases unknown transmitter(s) that activate transient receptor potential vanilloid-1 (TRPV1) located on calcitonin gene-related peptide (CGRP)-containing (CGRPergic) nerves, resulting in vasodilation. The present study investigated a potential transmitter transmitting between perivascular adrenergic nerves and CGRPergic nerves. Rat mesenteric vascular beds without endothelium were contracted by perfusion with Krebs' solution containing methoxamine, and the perfusion pressure and pH levels of the perfusate were measured. Nicotine perfusion for 1 min induced concentration-dependent vasodilation and lowered pH levels, which were abolished by cold-storage denervation of preparations, guanethidine (adrenergic neuron blocker), and mecamylamine (nicotinic ␣ 3 ␤ 4 -acetylcholine receptor antagonist). Capsazepine (TRPV1 antagonist) blunted nicotine-induced vasodilation, but had no effect on the reduction of pH. Injection of hydrochloric acid (HCl) and perfusion of Krebs' solution at low pH (6.0 -7.2) induced vasodilation. HClinduced vasodilation was inhibited by cold-storage denervation, capsazepine, capsaicin (CGRP depletor), and CGRP(8 -37) (CGRP receptor antagonist). Perfusion of adrenergic transmitter metabolites (normetanephrine and 3-methoxydopamine), but not of other metabolites, induced vasodilation, which was not inhibited by capsaicin treatment. Immunohistochemical staining of mesenteric arteries showed dense innervation of CGRP-and TRPV1-immunopositive nerves, with both immunostainings appearing in the same neuron. Mesenteric arteries were densely innervated by neuropeptide Y-immunopositive nerves, which coalesced with CGRP-immunopositive nerves. Scanning and immunoscanning electron microscopic images showed coalescence sites of different perivascular fibers before they intruded into smooth muscles. These results indicate that nicotine initially stimulates adrenergic nerves via nicotinic ␣ 3 ␤ 4 -receptors to release protons and thereby induces CGRPergic nerve-mediated vasodilation via TRPV1.It is widely accepted that vascular tone is maintained mainly by sympathetic adrenergic nerves via the release of the neurotransmitter norepinephrine. However, accumulating evidence reveals that nonadrenergic, noncholinergic (NANC) vasodilator nerves also play a role in regulation of vascular tone. We have demonstrated that the rat mesenteric artery has dense innervation of calcitonin gene-related peptide (CGRP)-containing (CGRPergic) nerves that release a transmitter, CGRP, causing vasodilation (Kawasaki et al., 1988). Recently, we reported that nitric oxide (NO)-containing nerves innervating rat mesenteric arteries are involved in modulation of adrenergic neurotransmission (Hatanaka et al., 2006). The rat mesenteric artery is also densely innervated by adrenergic nerves, which contain the main neuro-

There are few reports on hydrocortisone administration after cardiac arrest, and those that have been published included few subjects. This study aimed to evaluate the effect of hydrocortisone administration on the outcomes of patients who experienced cardiac arrest. We investigated the survival discharge rates and the length of hospital stay from cardiac arrest to discharge, stratified by use of hydrocortisone, using a Japanese health-insurance claims dataset that covers approximately 2% of the Japanese population. The study included the data of 2233 subjects who experienced either in-hospital or out-of-hospital cardiac arrest between January 2005 and May 2014. These patients were divided into two groups, based on the administration of hydrocortisone. We adjusted the baseline characteristics, medical treatment, and drug administration data of the two groups using propensity scores obtained via the inverse probability of treatment weighted method. The hydrocortisone group had a significantly higher survival discharge rate (13/61 [21.1%] vs. 240/2172 [11.0%], adjusted odds ratio: 4.2, 95% CI: 1.60–10.98, p = 0.004). In addition, the administration of hydrocortisone was independent predictor of survival to discharge (hazard ratio: 4.6, p < 0.001). The results demonstrate a correlation between hydrocortisone administration and the high rates of survival to discharge.