Takafumi Katayama

OBJECTIVES: Bowel preparation for colonoscopy can lead to serious adverse events (AEs), raising significant safety concerns in colorectal cancer (CRC) screening. A systematic review of these serious AEs in Japan was performed to explore potential management strategies. METHODS: The Ovid-MEDLINE and Ichushi databases were searched from inception to March 2024. Domestic studies that reported serious AEs in adults aged 18 years and older who were administered bowel cleansing agents or laxatives for a scheduled colonoscopy, regardless of its purpose, were extracted. Serious AEs were defined as those requiring hospitalization or extended hospital stays. Selected studies were assessed for quality verification using the established checklist. RESULTS: A total of 5049 articles were identified through database searches, and 54 articles were extracted based on selection criteria. Reports of the frequency of serious AEs were based on one case series study, which found 13.9 cases of bowel obstruction and 2.3 cases of bowel perforation per 100,000 colonoscopies. Multiple serious AEs caused by different agents were identified in 78 cases across 54 articles. These AEs were predominantly observed in elderly individuals and those with comorbidities. Though most cases were associated with diagnostic tests for symptomatic patients, some were also observed in primary screening or fecal test-positive individuals. The most common AE was induced by bowel obstruction, primarily in abdominally symptomatic patients, including one fatality. CONCLUSION: The frequency and characteristics of serious AEs associated with bowel preparation for colonoscopy in Japan were presented. These findings may contribute to managing these AEs, specifically in CRC screening.

BACKGROUND: Demonstrating mortality reduction in new colorectal cancer (CRC) screening programs through randomized clinical trials (RCTs) is challenging. We systematically reviewed single-round program performance outcomes using a stepwise approach proposed by the World Endoscopy Organization CRC Screening Committee framework. METHODS: The MEDLINE, EMBASE, Central, and Ichushi Web databases were searched until October 28, 2024, to find RCTs comparing guaiac-based and immunochemical fecal occult blood testing (gFOBT and FIT), flexible sigmoidoscopy (FS), computed tomographic colonography (CTC), and total colonoscopy (TCS). Paired reviewers screened studies, extracted data, and assessed bias risk. A Bayesian random-effects network meta-analysis was conducted, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. The primary outcome was advanced neoplasia (AN) detection, and the secondary outcomes were participation and colorectal cancer (CRC) detection, all during the first screening round. RESULTS: Eighteen RCTs (437,072 invitees) were included. The risk of bias was low or raised some concerns for screening participation, but it was high for detection outcomes. In the network meta-analysis of 15 RCTs not allowing crossover, the FIT-based program had a higher AN detection rate than the gFOBT-based program (relative risk [RR] 2.48; 95% credible interval [CrI] 1.52-4.21; moderate certainty). AN detection rates were not different in the CTC- (RR 1.01; CrI 0.43-2.23; very low certainty) and TCS-based (RR 1.03; CrI 0.54-1.78; low certainty) programs compared with the FS-based program. All the visualization modality programs had higher AN detection rates than the FIT-based program (FS: RR 2.13 [CrI 1.38-3.77]; CTC 2.16 [1.11-4.51]; and TCS 2.19 [1.43-3.48]; all with low certainty). Low event rates precluded definitive conclusions regarding CRC detection (very low to low certainty). The TCS-based program had the worst participation rate (very low to low certainty). Comparative data allowing crossover were limited. CONCLUSIONS: This is the first network meta-analysis that evaluates program-level initial performance indicators. FIT-based programs likely detect more AN cases than gFOBT-based programs, while FS-, CTC-, and TCS-based programs may outperform FIT. Due to limitations in first-round results, long-term outcomes should be assessed after 10-15 years.

Objective The aim of this study was to elucidate the status of health-care, medical, and welfare planning (hereafter, "planning")-in which public health nurses (PHNs) had participated-and the factors associated with community collaboration in the implementation phase. Additionally, suggestions regarding health activities that would contribute to improving the entire community's health level were obtained.Methods The Plan-Do-Check-Act (PDCA) cycle was the conceptual framework for this study, and the focus was the implementation phase of the plan (i.e., corresponding to the "Do" phase). Survey items were part of the "Plan" phase and identified the extent to which PHNs collaborated with community-dwellers in implementation, their demographics, their participation in the planning process, organizational factors, and the strategies used in the planning phase. The participants were full-time PHNs working in local governments who had participated in the planning process since 2013 (when the guidelines for PHNs' practices were published). A nationwide, cross-sectional survey was conducted in Japan with 2,185 PHNs from 220 regions (36 prefectures, 41 cities with public health centers, and 153 municipalities) who expressed the willingness to participate in this study. A binomial logistic regression analysis was conducted to examine the association between community collaboration and the independent variables.Results A total of 1,281 answers (a 58.6% response rate) were received. Ultimately, 1,028 (a 47.0% valid response rate) were analyzed; exclusions were 203 for no experience in health care planning since 2013 and 50 with missing values. There were 125 (12.2%) PHNs who answered that they "did not collaborate with the community-dwellers at all," 293 (28.5%) who answered that they "did not collaborate with them much," 482 (46.9%) who replied that they "collaborated with them a little," and 128 (12.4%) who responded that they "collaborated with them a lot." The binomial logistic regression analysis showed that the following were associated with PHNs' collaboration with the community: being in a managerial position, having experience developing a health promotion plan, conducting a questionnaire survey or group work, as well as participating in municipal health planning committees with community-dwellers, utilizing research evidence, identifying target groups, and managing the plan's progress.Conclusion From the planning phase, PHNs must collaborate with community residents and reflect their voices so that the formulated plan will help resolve medium to long-term issues in the community related to health and life.

BACKGROUND/AIMS: Transcriptomics technology in human nutrition intervention studies would allow for genome-wide screening of the effects of nutrients. We observed the time course of gene expression changes in peripheral white blood cells (WBC) to elucidate the metabolic changes in the postprandial state that are a reflection and a marker of whole body metabolic changes. METHODS: In a randomized crossover study, 7 healthy subjects consumed test meals of glucose (GL), white rice (WR) and rolled barley (BAR), each containing 75 g of available carbohydrate, and water (WAT). Blood glucose, insulin and nonesterified fatty acid concentrations, as well as the subjective levels of fullness and hunger were measured. Microarray analysis of the WBC and the real-time PCR were examined during 360 min after the intake of the test meals. RESULTS: The number of genes that changed more than 1.5-fold and the expression patterns in the time course were different between the GL, the WR and the BAR groups. Several genes involved in glycolysis and fatty acid β-oxidation were markedly changed after the intake of the GL, the WR and the BAR; however, these genes did not change at any time point in the WAT. CONCLUSIONS: Gene expression profiling in the WBC can reflect food-related metabolic changes, even in the postprandial state.

離島や僻地を含む近畿地方2府4県の医療機関に勤務する医療者(医師153名、看護師459名)を対象に、看護師の業務拡大に関する意識調査を実施した。その結果、医療行為を行える看護師の養成については、看護師よりも医師の方がより必要を感じており、看護師が医療行為を行うことに対して医師のほうがより肯定的であった。その理由として、「医師の負担の軽減」「医師不足の解消」を挙げていた。それに比較して、看護師自身が医療行為を行うことに対して消極的な姿勢であり、その理由として、「より責任が重くなる」「看護本来の業務を見失う」ことが挙げられていた。医療行為の一部を看護師が肩代わりするミニドクターを目指すのではなく、看護の視点に基づいた医療行為のアプローチを確立することが必要である。

We tried to develop an education program which aimed at not only disaster prevention but also the development of well.rounded character and social skill among junior high school students. In the beginning, degree of students’ preparedness fordisaster was evaluated by computer. CG animation was used to explore several issues such as the importanceofcommunications with neighbors in ordinary time. Role play scenar-ios illustrating victims’ selfish behavior in the evacuation shelter were used to promote experience.based learning. Finally, dangerous areas vs. safe areas in the neighborhood were mapped out from the standpoints of the elderly and handicapped persons to expand the learning place from e.learning to the real world. We concluded that this disaster preventioneducation program developed well.rounded character and social skill among students.

思春期講座の充実にむけての示唆を得るために、高校生の性知識、性意識、性行動に関する実態調査を行った。高校1年生から3年生の男女1000例から回答が得られ、有効回答は993例であった。性知識について、10項目の問題の正解率は全体の58.8%で、性知識は主に友人・漫画・雑誌・テレビから得ていた。性に対するイメージは、男子・女子ともに恥ずかしいと捉えていた。同年代が性交・出産を容認する傾向は学年が進むにつれ高くなった。性交の実践率はいずれも男子より女子のほうが高く、全体では14.4%であった。避妊は、コンドームを使用した者が一番多かった。性感染症防止、避妊に対する具体的な指導の必要性が示唆された。