Keiji Muramatsu

Background: The safety of initiating early physical rehabilitation therapy and its optimal load in patients with acute decompensated heart failure (ADHF) remain unclear. This study evaluated the safe timing and load of early rehabilitation therapy for patients with ADHF. Methods: In this cohort study using nationwide medical claims data from Japan, we included patients aged ≥18 years who were admitted for ADHF and received in‐hospital rehabilitation therapy for at least 2 days within the first 4 days of admission between 2016 and 2020. Nine hypothetical treatment regimens within the first 7 days of admission, varying in timing, duration, and load were used as exposures. The outcome was the cumulative incidence of adverse events (eg, death) within 30 days after admission. A per‐protocol analysis was conducted using a target trial emulation framework with a sequential doubly robust estimator. Results: Altogether, 10 179 patients with ADHF were enrolled, with 752 developing adverse events (incidence 7.39%). The lowest incidence rate (4.13%) was observed in the regimen where therapy was initiated on the first day of admission with 20 minutes of therapy, continuing for up to 7 days (95% CI, 3.30–4.95). Conversely, the highest incidence rate was observed in the regimen where therapy was initiated on the third day of admission with 40 minutes of therapy, continuing for up to 7 days (8.67% [95% CI, 8.22–9.13]). Conclusions: Very early, low‐load rehabilitation therapy for patients with ADHF may reduce the risk of adverse events. These findings suggest important implications in the implementation of early rehabilitation.

This study aimed to clarify the relationship between presenteeism and the level of satisfaction with the work environment in the anime industry. Data from the Animation Producers Survey 2023 were analyzed. A total of 366 laborers were included in this study. Presenteeism was assessed using the Work Functioning Impairment Scale (WFun). The satisfaction levels with eight items were evaluated, including current income level, income stability, working hours, workload, professional content, work relationships, job stability, and prospects for future work and work style. No significant differences were observed in the current income level and working hours, which were not according to the Effort–Reward Imbalance model, whereas those of other items were consistent with the model or the Job Demand–Control–Support model. Providing occupational health services tailored to the industry’s characteristics is necessary for preventing occupational dysfunction among animators.

Background and Objective: The benefits of physical rehabilitation for very-low-birth-weight infants (VLBWI) have been reported in previous studies; however, the implementation rate of physical rehabilitation in this population remains to be clarified. This study aimed to examine the implementation rate of physical rehabilitation among VLBWI admitted to the neonatal intensive care unit (NICU) using real-world data. Material and Methods: This observational study obtained data from a nationwide administrative database associated with the diagnostic procedure combination (DPC) system in Japan (2014–2019). The participants were 30,464 infants admitted to the NICU between 2014 and 2019. The overall NICU physical rehabilitation rates and background factors of the participants were examined. Results: The overall physical rehabilitation rate in NICUs was 18%. Infants born at Conclusions: One-fifth of all patients admitted to the NICU received physical rehabilitation interventions. Extremely preterm infants and ELBWI were more likely to receive physical rehabilitation interventions. We need to consider ways to increase physical rehabilitation intervention rates in the NICU.

Study Design: A retrospective cohort study using the Kaplan-Meier method with propensity-score matching.Purpose: To evaluate whether the presence of prevalent morphometric vertebral fractures (VFs) poses a risk for subsequent clinical VFs after short-fusion surgery in women aged ≥60 years with degenerative spondylolisthesis.Overview of Literature: VFs are common osteoporotic fractures and are associated with a low quality of life. Subsequent VFs are a complication of instrumented fusion in patients with degenerative lumbar disorders. Thus, risk factors for subsequent VFs after fusion surgery must be analyzed. Population-based studies have suggested that prevalent morphometric VFs led to a higher incidence of subsequent VFs in postmenopausal women; however, no studies have investigated whether prevalent morphometric VFs are a risk factor for subsequent VFs after fusion surgery in patients with degenerative spondylolisthesis.Methods: The study enrolled a total of 237 older female patients: 50 and 187 patients had prevalent morphometric VFs (VF [+] group) and nonprevalent morphometric VFs (VF [−] group), respectively. The time to subsequent clinical VFs after fusion surgery was compared between the two groups using the Kaplan-Meier method. Moreover, 40 and 80 patients in the VF (+) and VF (−) groups, respectively, were analyzed and matched by propensity scores for age, follow-up duration, surgical procedure, number of fused segments, body mass index, and number of patients treated for osteoporosis.Results: Kaplan-Meier analysis indicated that the VF (+) group had a higher incidence of subsequent clinical VFs than the VF (−) group, and Cox regression analysis showed that the presence of prevalent morphometric VFs was an independent risk factor for subsequent clinical VFs before matching. Kaplan-Meier analysis demonstrated comparable results after matching.Conclusions: The presence of prevalent morphometric VFs may be a risk factor for subsequent clinical VFs in older women with degenerative spondylolisthesis who underwent short-fusion surgery.

Objective: To clarify the relationship between the prognosis of patients with placental abruption (PA) and the healthcare delivery system using data from a large national inpatient database in Japan. Methods: Using the Diagnosis Procedure Combination database, we conducted a retrospective cohort study with the data of patients in almost 1000 hospitals with the primary diagnosis of PA who were hospitalized from April 2014 to March 2021. We divided the hospitals into four groups based on the number of deliveries per month. We performed multilevel logistic regression analysis to analyze the relationship between hospital case volume and maternal end‐organ injury (MEOI). Results: Altogether, 8222 patients were included for analysis; among whom, 3575 (44%) were transferred by ambulance. MEOI was noted in 977 patients (12%) with no obvious difference by hospital case volume. Ambulance transfer, age, gestational weeks at admission, delivery on the first day of hospitalization, and history of eclampsia were significantly associated with a higher incidence of MEOI, but the hospital case volume was not. Conclusion: Using a Japanese administrative database, our study shows that hospital case volume was not significantly associated with the severity of maternal illness among patients with PA.

Objective: Discriminatory treatment against those with emerging infection is a long-standing problem. The present study investigates whether workers infected or in close contact with COVID-19 were susceptible to workplace mistreatment during the pandemic in Japan. Methods: This Internet-based cross-sectional study analyzed a total of 18,170 workers aged 20 to 60 years in Japan in December 2020. Odds ratios (ORs) for workplace mistreatment were estimated. Results: For workers with close contact or infection, ORs for workplace mistreatment in a model adjusted for socioeconomic factors were 7.64 (95% CI: 5.52–10.6, P < 0.001) and 10.7 (95% CI: 8.44–13.6, P < 0.001), respectively. Conclusions: Workers with infection or close contact were significantly more likely to experience workplace mistreatment. Actions against workplace mistreatment for workers with emerging infection are still required.

Objectives: Presenteeism adversely affects workers’ quality of life, leading to further deterioration of their health and affecting their ability to continue working. Unemployment is one of the most serious consequences for workers experiencing presenteeism. A worker’s ability to work depends on the degree of mismatch between their health status and job demands and work factors. The COVID-19 pandemic has affected workers’ experiences of presenteeism as well as their employment status. We examined the association between presenteeism and risk of job resignations and unemployment among Japanese workers during the COVID-19 pandemic. Methods: A prospective study of 27 036 internet monitors was conducted, starting in December 2020, with 18 560 (68.7%) participating in the follow-up by December 2021. The Work Functioning Impairment Scale (WFun) was used to measure the degree of work function impairment. Results: The group with the highest WFun scores had higher odds ratios (ORs) for both retirement and unemployment for health reasons than the group with the lowest WFun scores. ORs were 2.99 (95% CI, 2.48-3.62; P < .001) and 1.82 (95% CI, 1.65-2.00; P < .001), respectively. Conclusions: Workers with work functioning impairment are at increased risk of resignation or unemployment. Management strategies for workers with work functioning impairment are needed to reduce their disadvantages in employment.