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Akaishi T, Tarasawa K, Fushimi K, Ota C, Sekiguchi S, Aoyagi T, Yaegashi N, Aoki M, Fujimori K. A Reduction in the Number of Hospitalized Cases of Acute Meningitis during the COVID-19 Pandemic in Japan. Intern Med 2024; 63:1353-1359. [PMID: 38432966 PMCID: PMC11157317 DOI: 10.2169/internalmedicine.3022-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/11/2024] [Indexed: 03/05/2024] Open
Abstract
Objective The changes in the prevalence of acute meningitis during the coronavirus disease 2019 (COVID-19) pandemic remain unclear. This study aimed to compare the prevalence of acute meningitis before and during the COVID-19 pandemic in Japan. Methods We retrospectively reviewed the Japanese nationwide administrative medical payment system database, Diagnosis Procedure Combination (DPC), from 2016 to 2022. A total of 547 hospitals consistently and seamlessly offered DPC data during this period. The study period was divided into the following three periods: April 2016 to March 2018 (fiscal years 2016-2017), April 2018-March 2020 (2018-2019), and April 2020-March 2022 (2020-2021). Results Among the 28,161,806 patients hospitalized during the study period, 28,399 were hospitalized for acute meningitis: 16,678 for viral/aseptic type, 6,189 for bacterial type, 655 for fungal type, 429 for tuberculous, 2,310 for carcinomatous type, and 2,138 for other or unknown types of meningitis. A significant decrease during the pandemic was confirmed in viral (n=7,032, n=5,775, and n=3,871 in each period; p<0.0001) and bacterial meningitis (n=2,291, n=2,239, and n=1,659; p<0.0001) cases. Meanwhile, no decrease was observed in fungal meningitis (n=212, n=246, and n=197; p=0.056) or carcinomatous meningitis (n=781, n=795, and n=734; p=0.27). The decrease in the number of tuberculous meningitis cases was equivocal (n=166, n=146, and n=117; p=0.014). The decrease during the pandemic was more remarkable in younger populations aged <50 years than in older populations, both for viral and bacterial meningitis. Conclusion The number of hospitalized cases of acute meningitis clearly decreased during the COVID-19 pandemic, especially for viral and bacterial meningitis in younger populations aged <50 years.
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Affiliation(s)
- Tetsuya Akaishi
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Japan
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Japan
| | - Chiharu Ota
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Japan
- Development and Environmental Medicine, Tohoku University Graduate School of Medicine, Japan
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Japan
| | | | - Tetsuji Aoyagi
- Department of Infectious Diseases, Tohoku University Graduate School of Medicine, Japan
| | - Nobuo Yaegashi
- Development and Environmental Medicine, Tohoku University Graduate School of Medicine, Japan
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Japan
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Japan
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Suzuki S. Postpartum care services and multi-disciplinary collaboration in Japan. J Int Med Res 2024; 52:3000605241254326. [PMID: 38785226 PMCID: PMC11119408 DOI: 10.1177/03000605241254326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
The Postpartum Care Services (PCS) programme in Japan is intended to promote physical recovery and psychological rest for mothers and their children after discharge from the delivery facility, as well as nurture the mothers' own self-care skills and support healthy childrearing for mothers, children and their families. The subsidies for PCS are based on cooperation between psychiatry and obstetrics and between multiple professions, including the local government. The services should also be implemented based on the instruction to medical institutions and the local governments that they should actively screen and approach pregnant women in need of support. This narrative review describes the challenges of expanding the PCS programme nationwide in Japan.
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Affiliation(s)
- Shunji Suzuki
- Department of Obstetrics and Gynaecology, Nippon Medical School, Tokyo, Japan
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Akaishi M, Tarasawa K, Hamada H, Iwama N, Tomita H, Akaishi T, Fushimi K, Fujimori K, Yaegashi N, Saito M. Risk Assessment of Critical Obstetric Bleeding With Low-Molecular-Weight Heparin. Cureus 2024; 16:e59933. [PMID: 38726359 PMCID: PMC11079502 DOI: 10.7759/cureus.59933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Use of unfractionated heparin (UFH) during the peripartum period is considered to be a higher risk of critical obstetric bleeding compared to low-molecular-weight heparin (LMWH). However, the evidence for the safety of using LMWH during the peripartum period is currently lacking. METHODS This study retrospectively investigated a nationwide medical database to clarify the safety of using LMWH during childbirth. The Japanese Nationwide Diagnosis Procedure Combination database was retrospectively reviewed, and data from women with childbirth between 2018 and 2022 were collected. RESULTS Among the overall 354,299 women with childbirth, 3,099 were with obstetric disseminated intravascular coagulation (DIC), 484 were with critical obstetric bleeding requiring massive red blood cell (RBC) transfusion ≥4,000 cc, and 38 were with maternal death. Among the overall women, each of the anticoagulants other than LMWH was associated with critical obstetrical bleeding with an adjusted odds ratio (aOR) greater than 1.0, while LMWH was not associated with critical obstetrical bleeding (aOR, 0.54 (95% confidence interval, 0.11-2.71)). This finding did not change in subgroup analyses among those with Cesarean section. Furthermore, UFH was associated with critical bleeding among the 3,099 women with obstetrical DIC (aOR, 3.91 (2.83-5.46)), while LMWH was not (aOR, 0.26 (0.03-1.37)). CONCLUSION The use of UFH was significantly associated with an increased critical obstetric hemorrhage requiring massive RBC transfusion or total hysterectomy. Meanwhile, the use of LMWH was not associated with increased critical obstetric bleeding. LMWH would be safer than UFH to be used for women during childbirth.
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Affiliation(s)
- Miho Akaishi
- Department of Obstetrics and Gynecology, Tohoku University, Sendai, JPN
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University, Sendai, JPN
| | - Hirotaka Hamada
- Department of Obstetrics and Gynecology, Tohoku University, Sendai, JPN
| | - Noriyuki Iwama
- Department of Obstetrics and Gynecology, Tohoku University, Sendai, JPN
| | - Hasumi Tomita
- Department of Obstetrics and Gynecology, Tohoku University, Sendai, JPN
| | - Tetsuya Akaishi
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, JPN
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, JPN
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University, Sendai, JPN
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University, Sendai, JPN
| | - Masatoshi Saito
- Department of Obstetrics and Gynecology, Tohoku University, Sendai, JPN
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Palagini L, Cipriani E, Miniati M, Bramante A, Gemignani A, Geoffroy PA, Riemann D. Insomnia, poor sleep quality and perinatal suicidal risk: A systematic review and meta-analysis. J Sleep Res 2024; 33:e14000. [PMID: 37448156 DOI: 10.1111/jsr.14000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
Suicidal risk in mothers is a public health priority. Risk factors include biological, psychological and psychosocial factors. Among the biological factors, the role of sleep disturbances as potential contributors to increased suicidal risk during the peripartum period is becoming apparent. To explore this further, we conducted a systematic review following the PRISMA criteria. Currently, 10 studies have examined the role of insomnia and poor sleep quality in suicidal risk during the peripartum period and have involved 807,760 women. The data showed that disturbed sleep and poor sleep quality increase the risk of suicidal ideation in both pregnant women with and without perinatal depression. The results of the meta-analysis indicated that insomnia and poor sleep quality increase the odds of suicidal risk in pregnant women by more than threefold (OR = 3.47; 95% CI: 2.63-4.57). Specifically, the odds ratio (OR) for poor sleep quality was 3.72 (95% CI: 2.58-5.34; p < 0.001), and for insomnia symptoms, after taking into account perinatal depression, was 4.76 (95% CI: 1.83-12.34; p < 0.001). These findings emphasise the importance of assessing and addressing sleep disturbances during the peripartum period to mitigate their adverse effects on peripartum psychopathology and suicidal risk.
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Affiliation(s)
- Laura Palagini
- Department of Experimental and Clinical Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Enrico Cipriani
- President of the Italian Section of the Marcè Society for Perinatal Psychopathology, Milan, Italy
| | - Mario Miniati
- Department of Experimental and Clinical Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Alessandra Bramante
- President of the Italian Section of the Marcè Society for Perinatal Psychopathology, Milan, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Pierre A Geoffroy
- Department of Psychiatry and Addiction, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, Paris, France
- Université Paris Cité, NeuroDiderot, Inserm, Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center- University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Akaishi T, Tarasawa K, Fushimi K, Yaegashi N, Aoki M, Fujimori K. Improved Activities of Daily Living With Adjunctive Intravenous Steroids in Bacterial Meningitis: A Nationwide, Population-Based Medical Database Study. Cureus 2024; 16:e54292. [PMID: 38496109 PMCID: PMC10944626 DOI: 10.7759/cureus.54292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
The benefit of using adjunctive intravenous steroids (IVS) to reduce the neurological sequelae in bacterial meningitis remains inconclusive. This study evaluated the effect of IVS on improving the subsequent Activities of Daily Living (ADL) in bacterial meningitis by analyzing data from a large nationwide administrative medical database in Japan. Data from 1,132 hospitals, covered by the administrative Diagnosis Procedure Combination (DPC) payment system from 2016 to 2022, were evaluated. The ADL levels at admission and discharge were measured using the Barthel Index (BI). Out of the cumulative 47,366,222 patients hospitalized, 8,736 were diagnosed with acute bacterial meningitis and had BI data available. The BI at discharge, adjusted for sex, age, and BI at admission, was significantly better among those treated with IVS (p<0.0001). Exploratory subgroup analyses suggested that this benefit is expected across a broad spectrum of bacterial species. In summary, the use of IVS for improving the subsequent ADL level in bacterial meningitis was suggested.
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Affiliation(s)
- Tetsuya Akaishi
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, JPN
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Hospital, Sendai, JPN
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, JPN
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, JPN
| | - Masashi Aoki
- Department of Neurology, Tohoku University Hospital, Sendai, JPN
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Hospital, Sendai, JPN
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Akaishi T, Tarasawa K, Fushimi K, Yaegashi N, Aoki M, Fujimori K. Demographic profiles and risk factors for mortality in acute meningitis: A nationwide population-based observational study. Acute Med Surg 2024; 11:e920. [PMID: 38162167 PMCID: PMC10756990 DOI: 10.1002/ams2.920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024] Open
Abstract
Aim Acute meningitis encompasses bacterial, viral (aseptic), fungal, tuberculous, and carcinomatous meningitis. The rate and risks of mortality in each type remain uncertain. This study aimed to elucidate these aspects in each type of meningitis. Methods This study utilized Japan's nationwide administrative Diagnosis Procedure Combination (DPC) database. Patients with acute meningitis, treated at 1132 DPC-covered hospitals from 2016 to 2022, were enrolled. Results Among 47,366,222 cumulative hospitalized patients, 48,758 (0.10%) were hospitalized with acute meningitis. The types of meningitis were as follows: 10,338 with bacterial, 29,486 with viral/aseptic, 965 with fungal, 678 with tuberculous, and 3790 with carcinomatous meningitis. Bacterial and viral meningitis exhibited bimodal age distributions, with the first peak occurring at 0-9 years. The median onset age was below 50 years only in viral meningitis. The mortality rate was the highest in carcinomatous meningitis (39%), followed by fungal meningitis (21%), and the lowest in viral meningitis (0.61%). Mortality rates increased with age across all meningitis types, but this trend was less prominent in carcinomatous meningitis. The duration from admission to mortality was longer in fungal and tuberculous meningitis compared with other types. Staphylococcus aureus in bacterial meningitis (adjusted odds ratio 1.71; p = 0.0016) and herpes simplex virus in viral meningitis (adjusted odds ratio 1.53; p = 0.0467) exhibited elevated mortality rates. Conclusion Distinct demographic profiles and mortality rates were observed among different meningitis types. The high mortality rates in less common types of meningitis emphasize the necessity to further optimize the required diagnostic and treatment strategies.
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Affiliation(s)
- Tetsuya Akaishi
- Department of NeurologyTohoku University Graduate School of MedicineSendaiJapan
- Department of Education and Support for Regional MedicineTohoku University HospitalSendaiJapan
| | - Kunio Tarasawa
- Department of Health Administration and PolicyTohoku University Graduate School of MedicineSendaiJapan
| | - Kiyohide Fushimi
- Department of Health Policy and InformaticsTokyo Medical and Dental University Graduate School of Medical and Dental SciencesTokyoJapan
| | - Nobuo Yaegashi
- Department of Obstetrics and GynecologyTohoku University Graduate School of MedicineSendaiJapan
- Tohoku Medical Megabank OrganizationTohoku UniversitySendaiJapan
| | - Masashi Aoki
- Department of NeurologyTohoku University Graduate School of MedicineSendaiJapan
| | - Kenji Fujimori
- Department of Health Administration and PolicyTohoku University Graduate School of MedicineSendaiJapan
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Palagini L, Cipriani E, Caruso V, Sharma V, Gemignani A, Bramante A, Miniati M, Riemann D. Insomnia During the Perinatal Period and its Association with Maternal and Infant Psychopathology: A Systematic Review and Meta-Analysis. Curr Psychiatry Rep 2023; 25:617-641. [PMID: 37819491 DOI: 10.1007/s11920-023-01463-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW While sleep serves important regulatory functions for mental health, sleep disturbances, in particular insomnia, may contribute to mental disorders. Since insomnia symptoms are frequent during the perinatal period, the aim of this work is to systematically review the potential association between perinatal insomnia and maternal and infant psychopathology. RECENT FINDINGS A systematic search was conducted according with PRISMA guidelines, and meta-analytic calculations were conducted. Totally, 34 studies were included and involved 835,021 perinatal women. Four meta-analysis yielded four statistically significant random-effect models. All models show that women with perinatal symptoms of insomnia possess increased odds of developing clinically relevant symptoms of depression OR = 3.69, p = 0.001 and anxiety OR = 2.81; p < 0.001, as well as increased suicidal risk OR = 3.28; p < 0.001, and distress in the newborn OR = 2.80 (P = 0.007). These findings emphasize the role of assessing and addressing insomnia during the perinatal period to mitigate its negative effect on maternal and infant mental health via sleep regulation.
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Affiliation(s)
- Laura Palagini
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy.
| | - Enrico Cipriani
- Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Via Savi, 10-56126 Pisa, Italy
| | - Valerio Caruso
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Verinder Sharma
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Obstetrics & Gynaecology, Western University, London, ON, Canada
- Parkwood Institute Mental Health, St. Joseph's Health Care, London, ON, Canada
| | - Angelo Gemignani
- Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Via Savi, 10-56126 Pisa, Italy
| | - Alessandra Bramante
- President of the Italian Section Marcè Society for Perinatal Psychopathology, Milan, Italy
| | - Mario Miniati
- Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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