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Objective: To measure the prevalence of cardiac sequelae 1 y after the onset of Kawasaki disease and determine the risk factors associated with these cardiac sequelae.Material and Methods: 1594 patients who initially visited one of the 87 target hospitals in 1996 for Kawasaki disease participated. Selection of the target hospitals was based on a nationwide survey. The patients were followed-up and information concerning cardiac sequelae occurring within 1 y of onset was obtained by mail survey.Results: The prevalence of cardiac sequelae 1 mo after onset was 10.2% and decreased to 4.2% in 1 y. The prevalence was higher among males than females and higher in patients less than 1 y and 5 ys or older than in 1-4 year-olds. Of the patients with cardiac sequelae at 1 mo, the sequelae disappeared in 60.7% after 1 y. Analysis revealed low serum albumin as a risk factor related to the occurrence of cardiac sequelae 1 y after onset. Of the 1594 patients, 10 had giant anuerysms and 3 had a fatal outcome.Conclusions: Approximately 60% of cardiac sequelae due to Kawasaki disease that developed within 1 mo after onset disappeared in 1 y. The odds ratio was significantly higher among patients with a low serum albumin level 1 y after onset. [ABSTRACT FROM AUTHOR]

Abstract Background The relative shortage of physicians in Japan's rural areas is an important issue in health policy. In the 1970s, the Japanese government began a policy to increase the number of medical students and to achieve a better distribution of physicians. Beginning in 1985, however, admissions to medical school were reduced to prevent a future oversupply of physicians. In 2007, medical school entrants equaled just 92% of their 1982 peers. The urban annual population growth rate is positive and the rural is negative, a trend that may affect denominator populations and physician distribution. Methods Our data cover six time points and span a decade: 1998, 2000, 2002, 2004, 2006, and 2008. The spatial units for analysis are the secondary tier of medical care (STM) as defined by the Medical Service Law and related legislation. We examined trends in the geographic disparities in population and physician distribution among 348 STMs in Japan. We compared populations and the number of physicians per 100,000 populations in each STM. To measure maldistribution quantitatively, we calculated Gini coefficients for physician distribution. Results Between 1998 and 2008, the total population and the number of practicing physicians for every 100,000 people increased by 0.95% and 13.6%, respectively. However, the inequality of physician distribution remained constant, although small and mostly rural areas experienced an increase in physician to population ratios. In contrast, as the maldistribution of population escalated during the same period, the Gini coefficient of population rose. Although the absolute number of practicing physicians in small STMs decreased, the fall in the denominator population of the STMs resulted in an increase in the number of practicing physicians per population in those located in rural areas. Conclusions A policy that increased the number of physicians and the physician to population ratios between 1998 and 2008 in all geographic areas of Japan, irrespective of size, did not lead to a more equal geographical distribution of physicians. The ratios of physicians to population in small rural STMs increased because of concurrent trends in urbanization and not because of a rise in the number of practicing physicians.

Background: Patients with familial adenomatous polyposis (FAP) experience psychological and social challenges concerning future events such as marriage and childbirth alongside the medical risks of colorectal cancer (CRC) and FAP-related disease. We retrospectively investigated the rate of marriage and childbirth postoperatively in Japanese patients with FAP., Methods: We included 161 patients who had colorectal surgery and reported marital status from a national survey of 35 Japanese institutions. Participants were classified according to marital status: married before colectomy (80 patients), married after colectomy (13 patients), and unmarried (68 patients)., Results: The marriage rate for all 161 patients (57.8%, standardized ratio 0.95, 95% confidence interval [CI] 0.76-1.14) was comparable to that in the general Japanese population (57.1%). The marriage rate among the 81 patients who were unmarried before colectomy was low (16.0%); however, the standardized marital ratio (0.75, 95% CI 0.34-1.15) was not significantly lower than that of the general population. In multivariable logistic regression, younger age (born after 1980, odds ratio [OR] 0.12, p < 0.001) and genetic testing (OR 4.06, p = 0.001) were associated with postoperative marriage. Seventy-one percent of patients with FAP who married after colectomy became pregnant and achieved delivery., Conclusions: The marriage rate of patients with FAP was comparable to that of the general population whereas the rate after colectomy was low among patients with FAP. However, in patients with FAP, colorectal surgery itself may not lead to negative consequences in terms of fecundity., (© 2024. The Author(s) under exclusive licence to Japan Society of Clinical Oncology.)

Aim: Japan faces a public health challenge of dementia, further complicated by the increasing complications from diabetes within its rapidly aging population. This study assesses the impact of diabetes on mortality and hospitalization among individuals aged ≥75 years with new dementia diagnoses., Methods: We analyzed administrative claims data in Japan from 73 324 individuals aged ≥75 years with dementia, of whom 17% had comorbid diabetes. Dementia and diabetes were identified from the International Classification of Diseases, Tenth Revision codes. We used Kaplan-Meier survival analysis, Cox proportional hazards analysis, and population attributable fractions (PAFs) to evaluate the impact on mortality and hospitalization after dementia diagnosis., Results: One-year mortality and 1-year hospitalization probabilities in individuals with dementia and diabetes (10.3% and 31.7%, respectively) were higher than those without diabetes (8.3% and 25.4%, respectively). The adjusted hazard ratios for individuals with diabetes, as compared to those without, were 1.126 (95% confidence interval [CI], 1.040-1.220) for mortality and 1.191 (95% CI, 1.140-1.245) for hospitalization. The PAFs from the comorbidity of dementia and diabetes were 2.2% for mortality and 3.1% for hospitalization. Subgroup analysis showed that the PAFs were highest in men aged 75-79 years and women aged 80-84 years for mortality and in individuals aged 75-79 for hospitalization., Conclusion: During the early postdiagnosis period, comorbid diabetes increases mortality and hospitalization risks in older adults with dementia. The variation in disease burden across age groups underscores the need for age-specific health care strategies to manage comorbid diabetes in individuals with dementia. Geriatr Gerontol Int 2024; 24: 773-781., (© 2024 Japan Geriatrics Society.)

Inappropriate antimicrobial use is a global problem, especially because the use of antimicrobials in excess of appropriate doses is associated with increased antimicrobial resistance. Duplicate prescriptions are an issue contributing to inappropriate antimicrobial use. This study aimed to analyse antibiotic prescriptions during a specific month to examine the frequency of outpatients receiving duplicate antibiotic prescriptions and the associated determinants. Utilizing the Japan Medical Data Centre health insurance claim database, we retrospectively identified 527,110 insured individuals with at least one medicine prescription in October 2014. Data regarding age, gender, antibiotic drug usage, and health insurance status were extracted. Duplicate prescriptions entailed a patient receiving two or more prescriptions of systemic antibiotics from multiple facilities within one month. The risk factors for duplicate antibiotic prescriptions were evaluated using logistic regression analysis. Of the total sample, 131,709 individuals (25.0%) received antibiotics, and 24,529 of these individuals (18.6%) had duplicate prescriptions. Third-generation cephalosporins accounted for the largest proportion of prescriptions (37.4%). Duplicate prescriptions were significantly associated with sex, age, medical facilities, and health insurance status. These findings could help to identify patients at risk of duplicate antibiotic prescriptions, highlighting the need to promote proper antimicrobial use in both patients and medical professionals.

Background and Objective: Excellent generalizability is the precondition for the widespread practical implementation of machine learning models. In our previous study, we developed the schizophrenia classification model (SZ classifier) to identify potential schizophrenia patients in the Japanese population. The SZ classifier has exhibited impressive performance during internal validation. However, ensuring the robustness and generalizability of the SZ classifier requires external validation across independent sample sets. In this study, we aimed to present an external validation of the SZ classifier using outpatient data. Methods: The SZ classifier was trained by using online survey data, which incorporate demographic, health-related, and social comorbidity features. External validation was conducted using an outpatient sample set which is independent from the sample set during the model development phase. The model performance was assessed based on the sensitivity and misclassification rates for schizophrenia, bipolar disorder, and major depression patients. Results: The SZ classifier demonstrated a sensitivity of 0.75 when applied to schizophrenia patients. The misclassification rates were 59% and 55% for bipolar disorder and major depression patients, respectively. Conclusions: The SZ classifier currently encounters challenges in accurately determining the presence or absence of schizophrenia at the individual level. Prior to widespread practical implementation, enhancements are necessary to bolster the accuracy and diminish the misclassification rates. Despite the current limitations of the model, such as poor specificity for certain psychiatric disorders, there is potential for improvement if including multiple types of psychiatric disorders during model development.

Background: In Japan, challenges were reported in accurately estimating the prevalence of schizophrenia among the general population. Retrieving previous studies, we investigated that patients with schizophrenia were more likely to experience poor subjective well-being and various physical, psychiatric, and social comorbidities. These factors might have great potential for precisely classifying schizophrenia cases in order to estimate the prevalence. Machine learning has shown a positive impact on many fields, including epidemiology, due to its high-precision modeling capability. It has been applied in research on mental disorders. However, few studies have applied machine learning technology to the precise classification of schizophrenia cases by variables of demographic and health-related backgrounds, especially using large-scale web-based surveys., Objective: The aim of the study is to construct an artificial neural network (ANN) model that can accurately classify schizophrenia cases from large-scale Japanese web-based survey data and to verify the generalizability of the model., Methods: Data were obtained from a large Japanese internet research pooled panel (Rakuten Insight, Inc) in 2021. A total of 223 individuals, aged 20-75 years, having schizophrenia, and 1776 healthy controls were included. Answers to the questions in a web-based survey were formatted as 1 response variable (self-report diagnosed with schizophrenia) and multiple feature variables (demographic, health-related backgrounds, physical comorbidities, psychiatric comorbidities, and social comorbidities). An ANN was applied to construct a model for classifying schizophrenia cases. Logistic regression (LR) was used as a reference. The performances of the models and algorithms were then compared., Results: The model trained by the ANN performed better than LR in terms of area under the receiver operating characteristic curve (0.86 vs 0.78), accuracy (0.93 vs 0.91), and specificity (0.96 vs 0.94), while the model trained by LR showed better sensitivity (0.63 vs 0.56). Comparing the performances of the ANN and LR, the ANN was better in terms of area under the receiver operating characteristic curve (bootstrapping: 0.847 vs 0.773 and cross-validation: 0.81 vs 0.72), while LR performed better in terms of accuracy (0.894 vs 0.856). Sleep medication use, age, household income, and employment type were the top 4 variables in terms of importance., Conclusions: This study constructed an ANN model to classify schizophrenia cases using web-based survey data. Our model showed a high internal validity. The findings are expected to provide evidence for estimating the prevalence of schizophrenia in the Japanese population and informing future epidemiological studies., (©Yupeng He, Masaaki Matsunaga, Yuanying Li, Taro Kishi, Shinichi Tanihara, Nakao Iwata, Takahiro Tabuchi, Atsuhiko Ota. Originally published in JMIR Formative Research (https://formative.jmir.org), 15.11.2023.)

The physical, psychiatric, and social comorbidities interfere with the everyday activities of community-dwelling individuals with schizophrenia and increase the risk of their readmission. However, these comorbidities have not been investigated comprehensively in Japan. We conducted a self-reported internet survey in February 2022 to identify individuals aged 20-75 years with and without schizophrenia using a prevalence case-control study. The survey compared physical comorbidities such as being overweight, hypertension, and diabetes; psychiatric comorbidities such as depressive symptoms and sleep disturbances; social comorbidities such as employment status, household income, and social support between participants with and without schizophrenia. A total of 223 participants with schizophrenia and 1776 participants without schizophrenia were identified. Participants with schizophrenia were more likely to be overweight and had a higher prevalence of hypertension, diabetes, and dyslipidemia than participants without schizophrenia. Additionally, depressive symptoms, unemployment, and non-regular employment were more prevalent in participants with schizophrenia than those without schizophrenia. These results highlight the necessity of comprehensive support and interventions addressing physical, psychiatric, and social comorbidities in individuals with schizophrenia in the community. In conclusion, effective interventions for managing comorbidities in individuals with schizophrenia are necessary to enable them to continue to live in the community.

Aim: Care for people with schizophrenia is shifting the locus from long-stay mental hospitals to nonspecialized community-based settings. Knowledge on the care is not a sole property of psychiatric specialists. Community healthcare workers who do not specialize in psychiatry are recommended to learn more about schizophrenia. This review aimed to summarize recent findings on subjective well-being and physical, psychiatric, and social comorbidities in individuals with schizophrenia., Methods: A literature review was conducted. We retrieved findings from existing systematic reviews and meta-analyses as our preferred method. When data were not available, we referred to other types of studies., Results: As per our review, individuals with schizophrenia demonstrated poor subjective well-being, happiness, and life satisfaction despite individual differences. Pharmacotherapy caused weight gain and constipation, whereas race and hospitalization might affect weight reduction. Individuals with schizophrenia demonstrated poor oral health, a high prevalence of noncommunicable diseases, and unique eating behaviors. Depression, sleep disorders, smoking, and alcohol and drug consumption were frequently found in the individuals. Research findings regarding problematic internet and smartphone use and stress perception were limited. Low health literacy and neglect of preventable behaviors were frequently seen in individuals with schizophrenia. They tended to be less educated, poor, unemployed, unmarried/unattached, and had poor social cognition, resulting in little social support and a small social network., Conclusion: Retrieving recent data, we confirmed that individuals with schizophrenia had poor subjective well-being and suffer from various physical, psychiatric, and social comorbidities., (© 2022 The Authors. Neuropsychopharmacology Reports published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Neuropsychopharmacology.)

Pseudoallergies caused by drugs make disease treatment difficult. Mas-relate G protein-coupled receptor X2 (MRGPRX2), which is specifically expressed in mast cells (MCs), has been implicated in pseudoallergies. High concentrations of therapeutic agents are typically required to stimulate MRGPRX2. Although regulatory mechanisms may enhance this response, the factors involved in this regulation are not well-understood. In this study, the effects of extracellular ATP on MC activation induced by MrgprB2, the mouse ortholog of human MRGPRX2, were examined in mouse peritoneal MCs (PMCs). ATP alone induced minimal PMC degranulation but markedly enhanced degranulation induced by the MrgprB2 agonist compound 48/80 (CP48/80), substance P, PAMP-12, and vancomycin. ATP promoted CP48/80-induced increase in intracellular Ca 2+ in PMCs. This enhancement effect of ATP was absent in PMCs prepared from P2X4 receptor (P2X4R)-deficient mice and inhibited by the PI3K inhibitor wortmannin. In addition, P2X4R deficiency reduced the skin-specific and systemic anaphylactic responses to CP48/80 in vivo. In MC-deficient Kit W-sh/W-sh mice, reconstitution with MCs obtained from wild-type mice led to a more severe anaphylactic response to CP48/80 compared to that from P2X4R-deficient mice. P2X4R-mediated effect may be involved in MrgprB2-mediated MC activation in vivo and is a potential target for alleviating pseudoallergic reactions., (© 2022. The Author(s).)

Introduction: This study aimed to clarify the coding and prescription rates for osteoporosis in distal radius fracture patients and to investigate the associated factors to help prevent subsequent osteoporotic fracture., Materials and Methods: Between 2014-2015, among 294,374 eligible individuals (42% female) aged 50-75 years in a health insurance claims database, we identified 192 individuals (mean age: 59.8 years, 74% female), counted the coding of distal radius fracture (International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) code: S525, S526), and determined if the patient had been assigned the code for osteoporosis and been prescribed osteoporosis medications. Logistic regression was performed to identify factors related to each rate., Results: The osteoporosis coding rate and osteoporosis medication prescription rate were 17.2% (n = 33) and 10.9% (n = 21), respectively. Most codes were assigned ≤ 3 months after injury (88%) at the distal radius fracture treatment facilities (84.8%). Patients who were assigned the code for osteoporosis or treated with osteoporosis medications were older (p = 0.08, p = 0.02, respectively), female (p = 0.05, p = 0.06, respectively) and having comorbidity (p = 0.02, p = 0.07, respectively). After adjustment, being female and having comorbidity remained the independent factors for the assignment of the code for osteoporosis (OR: 3.30, 95%, CI: 1.08-10.07, OR: 2.77, 95% CI: 1.24-6.12, respectively). No factor remained significant for the osteoporosis prescription. Active vitamin D analogues were most frequently prescribed medication (67%) followed by bisphosphonates (48%)., Conclusion: The overall coding and prescription rates for osteoporosis after distal radius fracture were low, which suggested that physician adherence to the osteoporosis guideline was low.

Objectives　The Patient Survey provides basic information on disease and injury statistics of patients in Japan, and an estimation of the number of patients by disease and injury can be made using this survey. In this survey, the number of outpatients with repeat visits affects the survey results. The average interval since last visit (AILV) and a correction factor are used to estimate the number of repeat outpatients. Patients with AILV > 30 days are not included in the survey. However, in the last years, AILV exceeded 30 days in many cases, suggesting that the current 30-day threshold is no longer suitable. Thus, this study investigated the AILV in the current patient population and the effect of the increase in AILV on the number of repeat outpatients.Methods　Patients Survey data of 1996-2011 were used to estimate the effect of changing the AILV threshold on the number of repeat outpatients.Results　AILV increased for patients with most diseases and injuries. Using the current 30-day threshold, the overall outpatient coverage rate decreased from 91% in 1996 to 78% in 2011. A higher AILV threshold was necessary to maintain the overall outpatient coverage rate. For example, a threshold of 90 days increased the coverage rate in 2011 to 96%. However, raising the threshold markedly increased the number of repeat outpatients. For example, the overall number of repeat outpatients in 2011 increased from 43.01 million with the current 30-day threshold to 71.03 million using the 90-day threshold. The peak of the AILV of outpatients was observed on the next day after the first visit and the peak of the AILV of outpatients was observed every other week.Conclusion　AILV increased over time and changing the AILV threshold markedly increased the number of repeat outpatients and total patients, indicating that there is a need to raise the AILV threshold.

Study Design: Population-based retrospective descriptive study., Objective: To describe the number and therapeutic profile of patients with spinal stenosis at a large-scale community level using health insurance claims data., Summary of Background Data: A few reports have documented the prevalence of spinal stenosis, and no report has described the therapeutic profile for spinal stenosis in a population base., Methods: We studied the claims data of National Health Insurance and Late-stage Elderly Health Insurance in a prefecture in Japan from April 2010 to March 2011. We considered patients to have spinal stenosis if their claims included at least one diagnosis coded as spinal stenosis for at least 1 month during the study period. Disease criteria were based on the International Classification of Diseases, 10th version. We then described the number and the therapeutic profile of the patients with spinal stenosis by age and sex., Results: Of 699,723 beneficiaries, 52,889 patients with spinal stenosis were identified. The number of patients with spinal stenosis per 1000 beneficiaries was 76, and those for the subgroups of age ≥ 65 years, ≥ 75 years, and ≥ 85 years were 128, 155, and 152, respectively. The number of patients per 1000 beneficiaries showed unimodal distribution, and the peak for males was 191 between the ages 95 to 99 years and that for females was 160 between the ages 80 to 84 years. Analgesics, prostaglandin E1, or both were prescribed to 40%, 2%, or 20% of patients with spinal stenosis, respectively. Physical therapy, nerve blocks, and surgery were done for 19%, 8%, and 0.4% of the patients, respectively. Approximately, 33% of patients did not receive any treatment., Conclusion: There were a large number of patients with spinal stenosis in elderly people. Most of them received nonsurgical treatments. Health insurance claims data could be a useful source of surveillance for such common diseases as spinal stenosis., Level of Evidence: 4.

Background: Uncoded diagnoses in health insurance claims (HICs) may introduce bias into Japanese health statistics dependent on computerized HICs. This study's aim was to identify the causes and characteristics of uncoded diagnoses., Methods: Uncoded diagnoses from computerized HICs (outpatient, inpatient, and the diagnosis procedure-combination per-diem payment system [DPC/PDPS]) submitted to the National Health Insurance Organization of Kumamoto Prefecture in May 2010 were analyzed. The text documentation accompanying the uncoded diagnoses was used to classify diagnoses in accordance with the International Classification of Diseases-10 (ICD-10). The text documentation was also classified into four categories using the standard descriptions of diagnoses defined in the master files of the computerized HIC system: 1) standard descriptions of diagnoses, 2) standard descriptions with a modifier, 3) non-standard descriptions of diagnoses, and 4) unclassifiable text documentation. Using these classifications, the proportions of uncoded diagnoses by ICD-10 disease category were calculated., Results: Of the uncoded diagnoses analyzed (n = 363 753), non-standard descriptions of diagnoses for outpatient, inpatient, and DPC/PDPS HICs comprised 12.1%, 14.6%, and 1.0% of uncoded diagnoses, respectively. The proportion of uncoded diagnoses with standard descriptions with a modifier for Diseases of the eye and adnexa was significantly higher than the overall proportion of uncoded diagnoses among every HIC type., Conclusions: The pattern of uncoded diagnoses differed by HIC type and disease category. Evaluating the proportion of uncoded diagnoses in all medical facilities and developing effective coding methods for diagnoses with modifiers, prefixes, and suffixes should reduce number of uncoded diagnoses in computerized HICs and improve the quality of HIC databases.

Aim: To examine the relationship between family structure and the risk of institutionalisation of disabled older people., Methods: The participants were 286 disabled older people aged 65 or older who were eligible to receive formal care services under the long-term care insurance system in a town in western Japan. Family structure was categorised as living alone, living only with a spouse, living with a son, living with a daughter and living other relatives. The risks of institutionalisation were estimated by logistic regression analyses., Results: Participants living with a daughter had a significantly low odds ratio (OR) for institutionalisation (OR: 0.35, 95% confidence interval (CI): 0.13-0.93) and those living alone had a significantly high OR (OR: 2.31, 95% CI: 1.02-5.20), when compared to participants living with a son (regarded as the reference). The ORs of participants living only with a spouse and living with other relatives were 1.50 (95% CI: 0.59-3.79) and 0.66 (95% CI: 0.15-2.82), respectively., Conclusion: Living with a daughter could reduce the risk of institutionalisation for disabled older people., (© 2013 ACOTA.)

Objectives: The aim of this study was to evaluate the effectiveness and sustainability of educational interventions to encourage incident reporting., Methods: This was a quasi-experimental design. The study involved nurses working in two gastroenterology surgical wards at Fukuoka University Hospital, Japan. The number of participants on each ward was 26 nurses at baseline. For the intervention group, we provided 15 minutes of education about patient safety and the importance of incident reporting once per month for six months. After the completion of the intervention, we compared incident reporting in the subsequent 12 months for both groups. Questionnaires about reasons/motives for reporting were administered three times, before the intervention, after the intervention, and six months after the intervention for both the intervention group and the control group., Results: For the intervention group, incident reporting during the 6 months after the intervention period increased significantly compared with the baseline. During the same period, the reasons and motives for reporting changed significantly in the intervention group. The increase in reported incidents during the 6- to 12-month period following the intervention was not significant. In the control group, there was no significant difference during follow-up compared with the baseline., Conclusions: A brief intervention about patient safety changed the motives for reporting incidents and the frequency of incidents reported by nurses working in surgical wards in a university hospital in Japan. However, the effect of the education decreased after six months following the education. Regular and long-term effort is required to maintain the effect of education.

The aim of this study was to investigate the trends and antimicrobial susceptibilities of methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates from outpatients and inpatients from April 2008 to March 2013 at Fukuoka University Chikushi Hospital. The proportion of MRSA among the S. aureus isolates from outpatients was stable over the study period, however, that from inpatients gradually decreased (p=0.026). There was no difference in the susceptibility to anti-MRSA agents between MRSA isolates from outpatients and inpatients, however, the susceptibilities to fosfomycin (FOM), minocycline (MINO), levofloxacin, erythromycin and clindamycin were higher in MRSA isolates from outpatients than from inpatients (48.6% vs. 35.6%, 56.1% vs. 40.1%, 38.2% vs. 4.9%, 16.2% vs. 3.9% and 18.5% vs. 4.5%, respectively, p<0.01). The susceptibility to FOM improved in MRSA from both outpatients and inpatients over time (p<0.05). In MRSA isolates from inpatients, the susceptibility to FOM and gentamicin increased significantly over the study period (p=0.023 and p=0.010, respectively), while, the susceptibility to MINO tended to decrease (p=0.094). The rate of MRSA isolates which were susceptible to more than two non-β-lactam antibiotics was significantly higher in outpatients than in inpatients (24.5% vs. 47.4%, p<0.01), however, this rate increased significantly during the study period only in inpatients, with a rate of 12.2% in 2008 and 53.1% in 2012 (p<0.01). In conclusion, our findings indicate a changing antimicrobial susceptibility of MRSA isolates, especially to non-β-lactam antibiotics. The determination of the prevalence and antimicrobial susceptibilities of MRSA clinical isolates will help physicians to select the initial empirical treatment.

The aim of this study was to evaluate whether linezolid minimum inhibitory concentration (MIC) creep occurred in Staphylococcus aureus clinical isolates, including methicillin-resistant S. aureus (MRSA), over a recent 5-year period at a single Japanese center. A total of 453 MRSA and 195 methicillin-susceptible S. aureus (MSSA) isolates recovered from inpatients from April 1, 2008 to March 31, 2013 were analyzed. The MIC of linezolid was determined by automated Vitek-2 system. The modal MIC, MIC range, MIC50 and MIC90 (MICs required to inhibit the growth of 50% and 90% of organisms, respectively), geometric mean MIC and percentages of susceptible and resistant isolates were evaluated for each fiscal year. None of the S. aureus isolates were resistant to linezolid. Isolates with an MIC of >1 µg/mL were more common in the MSSA samples than in the MRSA samples (91.3% versus 38.2%, p<0.001). The linezolid geometric mean MIC increased by 0.403 µg/mL (from 1.178 in 2008 to 1.582 in 2012) in the MRSA isolates (p=0.006, r(2)=0.945 according to a linear regression analysis) over the 5-year period; however, no increase was observed in the MSSA isolates. The frequency of MRSA isolates with an MIC of 1 µg/mL decreased (from 76.3% in 2008 to 35.4% in 2012) and the isolates with MICs of >1 µg/mL increased over time (from 23.7% in 2008 to 64.6% in 2012). This report demonstrates the occurrence of linezolid MIC creep, as determined using the geometric mean MIC, in MRSA clinical isolates at a single Japanese center.

Setting public health priorities requires precise estimation of the burden of disease, including disease-specific medical expenditure. Information on multiple and ruled-out diagnoses on health insurance claims (HICs) has been ignored in traditional analyses of disease-specific medical expenditures in Japan. This study reviewed 448 inpatients with at least one diagnosis of sepsis on their HICs, who were insured by corporate health insurance organizations making claims on services provided from April 2006 to March 2007 in Japan. Subjects in whom sepsis-related diagnoses were specified as "ruled-out" were compared with subjects in whom sepsis-related diagnoses were classified as "not-ruled-out" (i.e., subjects in whom sepsis was considered possibly or likely present). Direct medical expenditure, length of stay (LOS), cost per day, cost of antibiotics, and proportion of administered cephalosporin and carbapenems were significantly higher in subjects classified as not-rule-out. When using health insurance claims in Japan, the statistics of medical expenditures and LOS are influenced by procedures performed to rule out a diagnosis, as well as those performed to treat a confirmed diagnosis of sepsis.

Background: Uncoded diagnoses in computerized health insurance claims are excluded from statistical summaries of health-related risks and other factors. The effects of these uncoded diagnoses, coded according to ICD-10 disease categories, have not been investigated to date in Japan., Methods: I obtained all computerized health insurance claims (outpatient medical care, inpatient medical care, and diagnosis procedure-combination per-diem payment system [DPC/PDPS] claims) submitted to the National Health Insurance Organization of Kumamoto Prefecture in May 2010. These were classified according to the disease categories of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). I used accompanying text documentation related to the uncoded diagnoses to classify these diagnoses. Using these classifications, I calculated the proportion of uncoded diagnoses by ICD-10 category., Results: The number of analyzed diagnoses was 3,804,246, with uncoded diagnoses accounting for 9.6% of the total. The proportion of uncoded diagnoses in claims for outpatient medical care, inpatient medical care, and DPC/PDPS were 9.3%, 10.9%, and 14.2%, respectively. Among the diagnoses, Congenital malformations, deformations, and chromosomal abnormalities had the highest proportion of uncoded diagnoses (19.3%), and Diseases of the respiratory system had the lowest proportion of uncoded diagnoses (4.7%)., Conclusions: The proportion of uncoded diagnoses differed by the type of health insurance claim and disease category. These findings indicate that Japanese health statistics computed using computerized health insurance claims might be biased by the exclusion of uncoded diagnoses.

Objective: Loss of patient information can hinder medical care for evacuees and the reconstruction of medical facilities damaged by major incidents. In Japan, health insurance coverage is universal, and information about diagnoses and health care services provided is shared by the medical facilities, Health Insurance Claims Review and Reimbursement Services or the National Health Insurance Organization (NHIO), and the insurers. After the Great East Japan Earthquake on March 11, 2011, we interviewed officers in charge of NHIO in the 3 prefectures that were damaged by the earthquake and elicited how they assisted with medical care for evacuees and reconstruction of the damaged medical facilities., Methods: Comprehensive interviews were conducted with officers in charge of the NHIO in the 3 prefectures to obtain information about the use and provision of health insurance claims data 3 to 4 months after the event. We then analyzed the official data concerning use of the information from the claims in chronological order., Results: The NHIO headquarters in the 3 prefectures were not physically affected by the disaster, and their information on the health insurance claims was intact. Patient information acquired before the disaster was obtained from the health insurance claims and applied to the medical care of the evacuees. The information also was used to reconstruct patient records lost in the disaster., Conclusion: The information that was obtained from health insurance claims was used to improve medical care after the large-scale disaster.

Background and Aim: Steatosis is an increasingly common problem worldwide, accompanying increasing obesity. Recently, it has been suggested that oxidative stress plays an important role in development of fatty liver disease. We carried out an epidemiological study to clarify the role of oxidative stress and antioxidative activity in steatosis., Methods: This study was conducted with 184 male workers who had received their annual health checkup. Steatosis was confirmed using ultrasonography. Oxidative stress and antioxidative activity were assessed using the dROM test and the BAP test, respectively., Results: Steatosis was confirmed in 59 subjects (29.7%) by ultrasonography. There was no significant difference between cases and controls in BAP levels (2229.0 μmol/L vs. 2194.3μmol/L, p = 0.83). The steatosis group showed significantly lower dROM levels than the control group (332.7 U. CARR vs. 316.8 U. CARR, p < 0.05). In addition, we carried out logistic regression analysis to assess the combination between dROM levels and BAP levels. Subjects with high dROM levels and high BAP levels had 74% lower risk for steatosis than subjects with low dROM levels and high BAP levels., Conclusions: Our results suggested that moderate oxidative stress and high antioxidative activity was associated with decreased steatosis risk in Japanese males., (© 2012 Wiley Periodicals, Inc.)

Background: There are technical limitations to handling all the information mentioned in health insurance claims (HICs) in Japan. Therefore, conventional methods for estimating disease-specific medical expenditures assume that all medical care expenditures in a given HIC are spent on only one principal diagnosis even when the HIC contains multiple diagnoses., Objectives: To estimate the disease-specific medical expenditures that consider all diagnosis on a given HIC., Methods: Data were obtained from 169 622 outpatient HICs in May 2006 from health insurance provided by the employer. We compared the estimated disease-specific medical expenditures of the conventional method with a proportional distribution method (PDM), which considers all diagnoses on the HICs., Results: For diabetes mellitus and other diseases of the digestive system, the proportion of principal diagnoses among total diagnoses was 52.4% (4849/9251) and 19.6% (2614/13331), respectively. In addition, the ratio of the estimated disease-specific medical expenditures between the conventional method and the PDM method was 1.49 for diabetes mellitus and 0.64 for other diseases of the digestive system. The estimation of disease-specific medical expenditures using the conventional method may therefore have overestimated the expenditures on the disease category typically selected as the principal diagnosis and underestimated the expenditures on the disease category less likely to be selected as the principal diagnosis., Conclusions: The conventional method for estimation of disease-specific medical expenditures should be improved by utilizing all the diagnoses information on HICs., (© 2011 Blackwell Publishing Ltd.)

Background: According to the regulations concerning reimbursement rules for the uniform coverage scheme in Japan's health insurance system, rule-out diagnoses must be included in a health insurance claim (HIC) to ensure reimbursement for clinical procedures whose results show that a suspected disease is not present. However, estimations of disease-specific medical expenditure by conventional methods have not considered the information on rule-out diagnoses., Objectives: To estimate disease-specific medical expenditure for rule-out diagnoses., Methods: Data were obtained from 169,622 outpatient HICs in May 2006 from corporate health insurance societies. We used the proportional distribution method to estimate medical expenditure for each of the major disease categories defined by the Classification of Diseases for the use of Social Insurance, which is based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision., Results: There were 442,010 diagnoses on the HICs, of which 20,330 (4.60%) were rule-out diagnoses. Rule-out diagnoses accounted for 8.5% of total medical expenditure. The proportion of medical expenditure spent on rule-out diagnoses varied across the major diseases categories, and it was estimated that more than one-third (36.9%) of the medical expenditure on neoplasm is spent on rule-out diagnoses., Conclusions: The existence of rule-out diagnoses affects the estimation of disease-specific medical expenditure. Therefore, the estimation of disease-specific medical expenditure and evaluation of prevention and treatment programmes should be improved by utilizing information on rule-out diagnoses., (© 2011 Blackwell Publishing Ltd.)

Background: In many studies, high-molecular-weight (HMW) adiponectin has been considered the active form of adiponectin. However, whether HMW adiponectin is a good surrogate marker for coronary artery disease still needs to be elucidated., Methods: We conducted a hospital-based cross-sectional study to examine the relationship between total, HMW or non-HMW adiponectin concentrations and coronary stenosis in 83 male patients and 138 male controls., Results: Patients with coronary stenosis had significantly lower total adiponectin concentrations compared with controls. Non-HMW adiponectin concentrations in cases were significantly lower than the controls. However, there were no significant differences between cases and controls in HMW adiponectin concentrations. From the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) for total and non-HMW adiponectin was significantly larger than that for HMW adiponectin concentrations. Of the three models, that for non-HMW adiponectin showed the largest AUC (total adiponectin 0.74, HMW adiponectin 0.54, and non-HMW adiponectin 0.79)., Conclusions: Despite associations between total adiponectin levels and coronary stenosis, our data go against any apparent association between HMW adiponectin concentrations and coronary stenosis.

Background: As each clinical procedure must be justified by a corresponding diagnosis in Japanese health insurance claim (HIC), unconfirmed diagnoses marked as rule-out diagnoses will be written on an HIC. However, little is known about the statistical profiles of such rule-out diagnoses., Objectives: To illustrate the basic statistical profiles of rule-out diagnoses., Methods: We analysed all the diagnoses on 169 622 outpatient HICs in May 2006 from corporate health insurance societies. The proportions of additional diagnoses and rule-out diagnoses in each of the major disease categories defined by the Classification of Diseases for the use of Social Insurance, which is based on the International Statistical Classification of Diseases and Related Health Problems 10th Revision were calculated., Results: There were 442 010 diagnoses on the HICs, of which 96 253 (21.8%) were principal diagnoses and 345 757 (78.2%) were additional diagnoses. Of the principal diagnoses, 1022 (1.1%) were rule-out diagnoses. Of the additional diagnoses, 19 308 (5.6%) were rule-out diagnoses. The percentage of rule-out diagnoses in the additional diagnosis category was significantly higher than that in the principal diagnosis category. Among the major disease categories, neoplasms showed the highest percentage of rule-out diagnoses for both principal diagnosis and additional diagnosis., Conclusions: The existence of rule-out diagnoses affects the results of statistics based on HIC data. Japanese statistics based on HIC data should be improved by utilizing the information on rule-out diagnoses., (© 2010 Blackwell Publishing Ltd.)

The infant mortality rate (IMR) in Japan declined dramatically in the immediate post-War period (1947-60) in Japan. We compared the time trends in Growth Domestic Product (GDP) in Japan against declines in IMR. We then conducted a prefecture-level ecological analysis of the rate of decline in IMR and post-neonatal mortality from 1947 to 1960, focusing on variations in medical resources and public health strategies. IMR in Japan started to decline after World War II, even before the era of rapid economic growth and the introduction of a universal health insurance system in the 1960s. The mortality rates per 1000 infants in 2009 were 2.38 for IMR, 1.17 for neonatal mortality and 1.21 for post-neonatal mortality. The rate of decline in IMR and preventable IMR (PIMR) during the post-War period was strongly correlated with prefectural variations in medical resources (per capita physicians, nurses, and proportion of in-hospital births). The correlation coefficients comparing the number of physicians in 1955 with the declines in IMR and PIMR from 1947 to 1960 were 0.46 [95% confidence interval (CI) 0.19, 0.66] and 0.39 [95% CI 0.11, 0.61], respectively. By contrast, indicators of public health strategies were not associated with IMR decline. The IMR in Japan has been decreasing and seems to be entering a new era characterised by lower neonatal compared with post-neonatal mortality. Furthermore, the post-War history of Japan illustrates that improvement in infant mortality is attributable to the influence of medical care, even in the absence of rapid economic development., (© 2011 Blackwell Publishing Ltd.)

Background: The relative shortage of physicians in Japan's rural areas is an important issue in health policy. In the 1970s, the Japanese government began a policy to increase the number of medical students and to achieve a better distribution of physicians. Beginning in 1985, however, admissions to medical school were reduced to prevent a future oversupply of physicians. In 2007, medical school entrants equaled just 92% of their 1982 peers. The urban annual population growth rate is positive and the rural is negative, a trend that may affect denominator populations and physician distribution., Methods: Our data cover six time points and span a decade: 1998, 2000, 2002, 2004, 2006, and 2008. The spatial units for analysis are the secondary tier of medical care (STM) as defined by the Medical Service Law and related legislation. We examined trends in the geographic disparities in population and physician distribution among 348 STMs in Japan. We compared populations and the number of physicians per 100,000 populations in each STM. To measure maldistribution quantitatively, we calculated Gini coefficients for physician distribution., Results: Between 1998 and 2008, the total population and the number of practicing physicians for every 100,000 people increased by 0.95% and 13.6%, respectively. However, the inequality of physician distribution remained constant, although small and mostly rural areas experienced an increase in physician to population ratios. In contrast, as the maldistribution of population escalated during the same period, the Gini coefficient of population rose. Although the absolute number of practicing physicians in small STMs decreased, the fall in the denominator population of the STMs resulted in an increase in the number of practicing physicians per population in those located in rural areas., Conclusions: A policy that increased the number of physicians and the physician to population ratios between 1998 and 2008 in all geographic areas of Japan, irrespective of size, did not lead to a more equal geographical distribution of physicians. The ratios of physicians to population in small rural STMs increased because of concurrent trends in urbanization and not because of a rise in the number of practicing physicians.

Most of the studies that have examined the relationship between the speed of eating and obesity have been cross-sectional. We investigated 529 male workers who received health check-ups provided by the employer in 2000 and 2008. We obtained information on the subjects' alcohol consumption, smoking status, self-reported speed of eating, and exercise in 2008, and height and weight in both 2000 and 2008. We compared weight change from 2000 to 2008 between 2 groups classified according to the speed of eating: a group of fast eaters, and a combined group of medium and slow eaters. The fast-eating group had a higher average weight gain (1.9 kg) than the medium and slow eating group (0.7 kg). Although statistically significant only for the 20-29-year age group, weight gain was greater in the fast-eating group for all age groups and was statistically significant when the age groups were combined. The relationship between eating fast and weight change was statistically significant even after adjusting for age and body mass index in 2000, drinking, smoking, and exercise. Our results suggested that the speed of eating is related to the rate of weight gain., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Assessment of the quality of care is a key element in current diabetes care. However, the quality of care for diabetes patients in Japan has rarely been reported., Objectives: To assess the quality of diabetes care in two communities in Japan by using National Health Insurance claims data., Methods: We analysed claim data of 13,650 beneficiaries of National Health Insurance in two communities in Japan from May 2006 to April 2007. Diabetes cases were identified by using a case detection algorism. Our main outcome measures were three process quality indicators: (1) haemoglobin A1c (HbA1c) testing; (2) annual eye examination; and (3) annual nephropathy screening, recommended in the existing clinical guidelines. We calculated the performance rate of each quality indicator and examined the effects of demographic characteristics and co-morbid conditions., Results: We identified 636 diabetes cases. Of these, 97.0% had at least one HbA1c test, and 69.8% had ≥ 4 tests during the study period. The odds ratios (ORs) for ≥ 4 HbA1c tests were lower in subgroups aged 75-79 (OR 0.58, 95% confidence interval 0.35-0.96), and aged ≥ 80 (OR 0.54, 95% confidence interval 0.32-0.88) compared with the subgroup aged <70 after adjusting for other patient characteristics. The annual rate for eye examinations and nephropathy screenings were 20.8% and 5.8% respectively., Conclusions: We found high performance rates for HbA1c testing, while the annual rates for eye examinations and nephropathy screenings were suboptimal. Using administrative data would facilitate more comprehensive assessment of the quality of care in Japan., (© 2010 Blackwell Publishing Ltd.)

Despite a close association between adiponectin and both hypertension and type 2 diabetes, the relationship between adiponectin and metabolic syndrome has not yet been well-investigated. To examine and evaluate the association between serum adiponectin levels and metabolic syndrome based on Japanese diagnostic criteria, we analyzed adiponectin and anthropometric parameters in 869 male employees aged 40-59 who belonged to a health insurance society in Fukuoka Prefecture and who underwent annual health check-ups from August 2006 to July 2007. Two hundred and thirty-two of the 869 subjects (26.7%) were diagnosed with metabolic syndrome. The serum adiponectin levels were significantly higher in the non-metabolic syndrome group. In a multiple logistic regression analysis, the subjects in the top quartile of serum adiponectin (adjusted odds ratio:0.36;95% confidence interval:0.21-0.63) and the second (adjusted odds ratio:0.51;95% confidence interval:0.31-0.84) quartile had a significantly decreased risk for metabolic syndrome in comparison to the bottom quartile. The dose-response relationship between serum adiponectin levels and metabolic syndrome was significant (p for trend 0.0001) after adjusting for age, body mass index, smoking status, and drinking status. The current findings suggest that hypoadiponectinemia is inversely correlated with the risk of metabolic syndrome in middle-aged Japanese male workers.

Leptin is a hormone which is predominantly secreted by adipose tissue. Recent studies have shown that leptin increases arterial blood pressure. Although data from available animal studies clearly indicate an association between leptin and hypertension, results of human studies have been less definitive. We conducted a case-control study to examine the association between serum leptin levels and hypertension in 111 hypertensive subjects and 222 male controls, using conditional logistic regression analyses. Mean serum leptin levels were found to be marginally higher in the case subjects than in the control subjects (3.3 ng/ml versus 3.0 ng/ml), however, conditional logistic regression analysis revealed that subjects in the highest quartile had a significantly increased risk of hypertension compared with those in the lowest quartile, even after adjusting for drinking status and diabetes mellitus (adjusted OR, 2.11;95% CI, 1.01-4.39). Our findings suggest that leptin plays an important role in the development of hypertension.