著者

Senda Joe Ito Keiichi Kotake Tomomitsu Kanamori Masahiko Kishimoto Hideo Kadono Izumi Nakagawa-Senda Hiroko Wakai Kenji Katsuno Masahisa Nishida Yoshihiro Ishiguro Naoki

出版者

Nagoya University Graduate School of Medicine, School of Medicine

雑誌

Nagoya Journal of Medical Science (ISSN:00277622)

巻号頁・発行日

vol.81, no.3, pp.359-373, 2019-08

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Cilostazol is a phosphodiesterase III-inhibiting antiplatelet agent that is often used to prevent stroke and peripheral artery disease, and its administration has shown significant improvements for cognitive impairment. We investigate the potential of cilostazol for reducing or restoring cognitive decline during con-valescent rehabilitation in patients with non-cardioembolic ischemic stroke. The study sample included 371 consecutive patients with lacunar (n = 44) and atherothrombosis (n = 327) subtypes of non-cardioembolic ischemic stroke (224 men and 147 women; mean age, 72.9 ± 8.1 years) who were required for inpatient convalescent rehabilitation. Their medical records were retrospectively surveyed to identify those who had received cilostazol (n = 101). Patients were grouped based on cilostazol condition, and Functional Independence Measure (FIM) scores (total and motor or cognitive subtest scores) were assessed both at admission and discharge. The gain and efficiency in FIM cognitive scores from admission to discharge were significantly higher in patients who received cilostazol than those who did not (p = 0.047 and p = 0.035, respectively); we found no significant differences in other clinical factors or scores. Multiple linear regression analysis confirmed that cilostazol was a significant factor in FIM cognitive scores at discharge (β = 0.041, B = 0.682, p = 0.045); the two tested dosages were not significantly different (100 mg/day, n = 43; 200 mg/day, n = 58). Cilostazol can potentially improve cognitive function during convalescent rehabilitation of patients with non-cardioembolic ischemic stroke, although another research must be needed to confirm this potential.

著者

Bolorchimeg Taazan Yamamoto Eiko Bayart Baatar Avirmed Amgalanbaatar Kariya Tetsuyoshi Saw Yu Mon Hamajima Nobuyuki

出版者

Nagoya University Graduate School of Medicine, School of Medicine

雑誌

Nagoya Journal of Medical Science (ISSN:00277622)

巻号頁・発行日

vol.82, no.1, pp.47-57, 2020-02

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Health services for pregnancy and delivery at public health facilities are fully subsidized by the government in Mongolia. However, it has been reported that health financing, budget planning, and implementation processes are weak. Therefore, this study aims to estimate the costs per inpatient of vaginal delivery and cesarean section (C-section) by using data gathered from a tertiary hospital in Ulaanbaatar. Inpatient and financial data were collected from the Statistics and Finance, Economics Department of National Center for Maternal and Child Health. A top-down method was used for the calculation of unit costs. The total number of deliveries in 2016 were 11,033, including 7,777 vaginal deliveries and 3,256 C-sections. The cost per inpatient stay for vaginal delivery and C-section were USD 255 and USD 592, respectively. The average cost per bed-day of the six departments of the obstetrics and gynecology hospital was USD 80. The percentage that represents employees’ salary in the cost per inpatient was as low as 12.4% for vaginal delivery and 18.5% for C-section, although the cost for salaries accounted for 51.2% of the total expenditure of the hospital. Results show that the cost per inpatient of C-section was two times higher than that of vaginal delivery. The cost of childbirths may account for approximately 9% of total health expenditure of the country. These results may be advantageous to the government in instituting a policy and controlling the health care budget to improve cost-effectiveness and equal access to all in health care services in Mongolia.

著者

Takeuchi Jiro Sakagami Yu

出版者

Nagoya University Graduate School of Medicine, School of Medicine

雑誌

Nagoya Journal of Medical Science (ISSN:00277622)

巻号頁・発行日

vol.80, no.3, pp.367-378, 2018-08

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Increasing numbers of international students require Japanese universities to provide mental health support as one of their primary responsibilities. The problem with the provision of such support is that the stigma of mental disorder causes many individuals to avoid seeking help. We aim to clarify the association between stigma and mental illness to develop anti-stigma education. We performed a crosssectional observational study. The target population comprised international students enrolled in a Japanese university. Online questionnaires were used to assess self-stigma, perceived stigma, recognized knowledge of schizophrenia and depression, gender, country and region, general mental health status, parents' income, non-clinical and clinical help-seeking attitudes, and Japanese and English language ability. Logistic regression model was used to estimate odds ratios (ORs) for self-stigma and perceived stigma after adjusting for the above factors. A total of 119 students were invited to participate, 61 (51.3%) of whom were enrolled. Students with good knowledge of depression/schizophrenia did not indicate more severe self-stigma compared with those without such knowledge. Students with good knowledge of schizophrenia indicated more severe perceived stigma compared with those without such knowledge (OR 3.78 [95% confidence intervals; CI, 1.21-11.78]). Students with good knowledge of depression indicated less severe perceived stigma compared with those without such knowledge (OR 0.31 [95% CI, 0.10–0.94]). In this study, among international students, higher perceived stigma was associated with knowledge of schizophrenia and lower knowledge of depression.This work was supported by JSPS KAKENHI [Grant-in-Aid for Scientific Research on Innovative Areas] Grant Number JP17H05925 and JSPS KAKENHI [Grant-in-Aid for Scientific Research (C)] Grant Number JP15K01650.

著者

Takeuchi Jiro Sakagami Yu

出版者

Nagoya University Graduate School of Medicine, School of Medicine

雑誌

Nagoya Journal of Medical Science (ISSN:00277622)

巻号頁・発行日

vol.80, no.3, pp.367-378, 2018-08

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Increasing numbers of international students require Japanese universities to provide mental health support as one of their primary responsibilities. The problem with the provision of such support is that the stigma of mental disorder causes many individuals to avoid seeking help. We aim to clarify the association between stigma and mental illness to develop anti-stigma education. We performed a crosssectional observational study. The target population comprised international students enrolled in a Japanese university. Online questionnaires were used to assess self-stigma, perceived stigma, recognized knowledge of schizophrenia and depression, gender, country and region, general mental health status, parents’ income, non-clinical and clinical help-seeking attitudes, and Japanese and English language ability. Logistic regression model was used to estimate odds ratios (ORs) for self-stigma and perceived stigma after adjusting for the above factors. A total of 119 students were invited to participate, 61 (51.3%) of whom were enrolled. Students with good knowledge of depression/schizophrenia did not indicate more severe self-stigma compared with those without such knowledge. Students with good knowledge of schizophrenia indicated more severe perceived stigma compared with those without such knowledge (OR 3.78 [95% confidence intervals; CI, 1.21-11.78]). Students with good knowledge of depression indicated less severe perceived stigma compared with those without such knowledge (OR 0.31 [95% CI, 0.10–0.94]). In this study, among international students, higher perceived stigma was associated with knowledge of schizophrenia and lower knowledge of depression.

著者

Senda Joe Watanabe Hirohisa Endo Kuniyuki Yasui Keizo Hawsegawa Yasuhiro Yoneyama Noritaka Tsuboi Takashi Hara Kazuhiro Ito Mizuki Atsuta Naoki Epifanio Bagarinao Jr. Katsuno Masahisa Naganawa Shinji Sobue Gen

出版者

Nagoya University Graduate School of Medicine, School of Medicine

雑誌

Nagoya Journal of Medical Science (ISSN:00277622)

巻号頁・発行日

vol.78, no.4, pp.455-463, 2016-11

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Voxel-based analysis (VBA) of diffusion tensor images (DTI) and voxel-based morphometry (VBM) in patients with multiple sclerosis (MS) can sensitively detect occult tissue damage that underlies pathological changes in the brain. In the present study, both at the start of fingolimod and post-four months clinical remission, we assessed four patients with MS who were evaluated with VBA of DTI, VBM, and fluid-attenuated inversion recovery (FLAIR). DTI images for all four patients showed widespread areas of increased mean diffusivity (MD) and decreased fractional anisotropy (FA) that were beyond the highintensity signal areas across images. After four months of continuous fingolimod therapy, DTI abnormalities progressed; in particular, MD was significantly increased, while brain volume and high-intensity signals were unchanged. These findings suggest that VBA of DTI (e.g., MD) may help assess MS demyelination as neuroinflammatory conditions, even though clinical manifestations of MS appear to be in complete remission during fingolimod.