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Although universal health coverage (UHC) is pursued by many countries, not all countries with UHC include dental care in their benefits. Japan, with its long-held tradition of UHC, covers dental care as an essential benefit, and the majority of dental care services are provided to all patients with minimal copayment. Being under UHC, the scope of services as well as prices are regulated by the uniform fee schedule, and dentists submit claims according to the uniform format and fee schedule. The author analyzed the publicly available dental health insurance claims data as well as a sampling survey on dental hygiene to illustrate how Japan's dental care is responding to the challenges from population aging. A marked improvement was found in dental health status in the elderly population as measured by improved tooth-specific survival. The improvement may be attributable to the universal coverage of dental care, as evidenced by the steady increase in home visits by dentists/dental hygienists as well as home oral rehabilitation services.

Background: The reductions achieved in infant mortality in Japan are globally regarded as remarkable. However, no studies in Japan have classified infant mortality trends into neonatal and postneonatal or considered regional issues. This study aimed to explore trends in neonatal and postneonatal deaths, both overall for Japan and in a region affected by a natural disaster., Methods: Drawing on national infant death data, we used a multi-attribute compositional study design to examine all infant deaths occurring in a region affected by a disaster (Tohoku, which consists of Iwate, Miyagi, and Fukushima) between 2002 and 2012. We used conjoint analysis to clarify the associations between infant and maternal characteristics and age of infant death., Results: We obtained data of a total of 31,012 infant deaths between 2002 and 2012, which included 1450 from Tohoku. Infant mortality rates in Japan overall declined over the period but increased in 2011. There were more postneonatal (29-364 days post-birth) than neonatal (0-28 days post-birth) deaths. Infant deaths in Tohoku declined slightly overall, with a fluctuation in 2011. In Tohoku, the trends in postneonatal death rates were similar; the overall rates for males increased, but those for females decreased in 2011. We found that the cause and place of infant death differed by gender for neonatal and postneonatal deaths in both Japan in general and Tohoku. The conjoint analysis showed that most variables affected the age of postneonatal death. The factor with the largest influence on the variation in infant death age was gestational week (55.5%). A maternal gestational week ≤36 was linked to an average age at death of 43.4 days, and > 37 was linked to an average of 83.7 days., Conclusions: In Japan, infant death rates have declined steadily over the past 10 years. The recent trends indicated that postneonatal death rates were higher than neonatal rates, especially in Tohoku. However, not much attention has been focused on postneonatal deaths in Japan. Our findings may help health planners to prioritise work on the factors that are linked to infant deaths in the neonatal and postneonatal periods., Trial Registration: Not applicable.

Objectives: To examine associations between access to medical care, geological data, and infant and child mortality in the area of North-Eastern Japan that was impacted by the Great East Japan Earthquake and Tsunami (GEJET) in 2011., Design: A population-based ecological study using publicly available data., Setting: Twenty secondary medical areas (SMAs) in the disaster-affected zones in the north-eastern prefectures of Japan (Iwate, Fukushima and Miyagi)., Participants: Children younger than 10 years who died in the 20 SMAs between 2008 and 2014 (n=1 748). Primary and secondary outcome measures: Multiple regression analysis for infant and child mortality rate. The mean values were applied for infant and child mortality rates and other factors before GEJET (2008-2010) and after GEJET (2012-2014)., Results: Between 2008 and 2014, the most common cause of death among children younger than 10 years was accidents. The mortality rate per 100 000 persons was 39.1±41.2 before 2011, 226.7±43.4 in 2011 and 31.4±39.1 after 2011. Regression analysis revealed that the mortality rate was positively associated with low age in each period, while the coastal zone was negatively associated with fewer disaster base hospitals in 2011. By contrast, the number of obstetrics and gynaecology centres (β=-189.9, p=0.02) and public health nurses (β=-1.7, p=0.01) was negatively associated with mortality rate per person in 2011., Conclusions: In 2011, the mortality rate among children younger than 10 years was 6.4 times higher than that before and after 2011. Residence in a coastal zone was significantly associated with higher child mortality rates., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Japan's National Database (NDB) includes data on health checks and health insurance claims, is linkable using hash functions, and is available for research use. However, the linkage rate between health check and health insurance claims data has not been investigated., Methods: Linkage rate was evaluated by comparing observed medical and pharmaceutical charges among health check recipients in fiscal year (FY) 2009 (N = 21 588 883) with expected charges from the same population when record linkage was complete. Using the NDB, observed charges were estimated from the first published result of linking health check recipients in FY2009 and their health insurance claims in FY2010. Expected charges were estimated by combining 3 publicly available datasets, including data from the Medical Care Benefit Survey and an ad-hoc report by the Japan Health Insurance Association., Results: Only 14.9% of expected charges were linked by the NDB. The linkage rate was higher for women than for men (18.2% vs 12.4%) and for elderly adults as compared with younger adults (>25% vs <10%)., Conclusions: The linkage rate in the NDB was so low that any research linking health check and health insurance claims will not be reliable. Causes for the low linkage rate include differences between health check and health insurance claims data in name format (eg, insertion of a space between family and given names) and date of birth (Japanese vs Gregorian calendar). Investigation of the causes for the low linkage rate and measures for improvement are urgently needed.

Incidence/mortality of liver cancer follow logistic curves because there is a limit reflecting the prevalence of hepatitis virus carriers in the cohort. The author fitted logistic curves to incidence/mortality data covering the nine five-year cohorts born in 1911-1955 of both sexes. Goodness-of-fit of logistic curves was sufficiently precise to be used for future predictions. Younger cohorts born in 1936 or later were predicted to show constant decline in incidence/mortality in the future. The male cohort born in 1931-35 showed an elevated incidence/mortality of liver cancer early in their lives supporting the previous claim that this particular cohort had suffered massive HCV infection due to nation-wide drug abuse in the 1950s. Declining case-fatality observed in younger cohorts suggested improved treatment of liver cancer. This study demonstrated that incidence/mortality of liver cancer follow logistic curves and fitted logistic formulae can be used for future prediction. Given the predicted decline of incidence/mortality in younger cohorts, liver cancer is likely to be lost to history in the not-so-distant future.

Objectives: The aim of this study was to assess the risk of developing bile duct cancer among workers in the other printing industry in comparison with workers in all industries in general., Methods: Prevalence of bile duct cancer was compared between workers in the printing industry and age-standardized controls in all other industries using the claims database of the Japan Health Insurance Association, which insures workers of small-medium sized employers of all industries., Results: Young (aged 30-49) male workers in the printing industry showed an elevated but insignificant standardized prevalence rate ratio (SPRR) for bile duct cancer in comparison with workers in all other industries (SPRR: 1.78; 95%CI: 0.63-5.00). The risk was higher for intrahepatic bile duct cancer but remained insignificant (SPRR: 3.03; 95%CI: 0.52-17.56)., Conclusions: The sharply elevated risk of bile duct cancer observed among proof-printing workers of a printing factory in Osaka may not be generalizable to workers in the printing industry nationwide.

Background: It remains unknown whether the Rome III criteria can exclude organic colonic lesions prior to the diagnosis of irritable bowel syndrome (IBS). We evaluated the colonoscopy results of patients meeting the Rome III criteria for the diagnosis of IBS to determine the presence of organic colonic lesions., Methods: This study was prospectively conducted at 17 centers in Japan. We enrolled 4528 patients who underwent diagnostic colonoscopy examinations. The diagnosis of IBS was evaluated by questionnaire results according to the Rome III criteria., Results: We evaluated 4178 patients (350 were excluded because of incomplete data or previous colonic surgery), of whom 203 met the Rome III criteria (mean age 57.9 years; range 14-87 years) prior to the diagnostic colonoscopy examination. We identified organic colonic diseases in 21 of these 203 patients (10.3 %) , and these disease were also identified in 338 (8.5 %) of 3975 patients who did not fulfill the Rome III criteria. There were no differences in regard to the prevalence of organic colonic diseases between patients who did and did not fulfill the Rome III criteria., Conclusions: The prevalence of organic colonic diseases in patients who met the Rome III criteria was at an acceptably low level, indicating that the Rome III criteria are adequately specific for the diagnosis of IBS without performing a colonoscopy examination.

Red-crowned cranes (Grus japonensis) are native to eastern Hokkaido (island population), in contrast to the mainland, which migrates between the Amur River basin and eastern China-Korea peninsula. During the 1990s we found that Red-crowned cranes in Hokkaido were highly contaminated with mercury: however, the source was unknown. We investigated the time trend of mercury contamination in Red-crowned cranes. Total mercury levels in the livers and kidneys from cranes dead in the 2000s were lower than those dead in the 1990s. Feather is a major pathway of mercury excretion for many bird species and is used as an indicator of blood mercury level during feather growth. As internal organs from the specimens collected before 1988 were not available, we analyzed the flight feather shavings from stuffed Red-crowned cranes dead in 1959-1987 and found that the mercury level of feathers from cranes dead in the 1960s and 1970s was not more than those from the cranes dead in the 2000s. These results suggest that mercury contamination in Red-crowned cranes in Hokkaido decreased temporally during the 1990s-2000s. This indicates the possible occurrence of some mercury pollution in Red-crowned cranes' habitat in this region in the 1990s or before.

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: 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.)

A cross-sectional study was conducted to determine antimicrobial use and to analyze the correlation to resistant bacteria. Records on antimicrobial prescriptions in Suwa area, Nagano prefecture, were collected from December 2009 to May 2010 from a national health insurance database system. Records on antimicrobial-resistant bacteria during the same period were collected from area hospitals. Data was then compared to data published in Europe. The target population was 31,505, or 27.1% of the total area population. More antimicrobials were prescribed in an outpatient setting rather for inpatients. Total outpatient antimicrobial use was 9.34 defined daily dose (DDD) per 1,000 subject days. Macrolides, lincosamides, and streptogramins (MLS) was the most prescribed drug group, followed by beta-lactams other than penicillin and quinolone. The quinolone-resistance rate among Escherichia coli in this area was within a predictable range based on European data, although that of macrolide-resistance among Streptococcus pneumoniae exceeded the predictable range. The health insurance system electronic database proved useful in collecting data on antimicrobial use for curbing action against antimicrobial resistance, including antimicrobial stewardship.

Reports that oseltamivir causes abnormal behaviors in influenza patients and, thereby, increases the risk of injuries or death alerted the world. Such reports came almost exclusively from Japan, which consumes more than 75% of the world supply, even before the novel influenza pandemic started. The Japanese government will not revoke its warning issued in March 2007 against the use of oseltamivir in teenagers despite the accumulating evidence that such abnormal behaviors are part of generic symptoms of influenza-like delirium and not attributable to certain drugs. The author analyzes the background of the 'ado' by compiling the various sources of information, some of which have not been readily available to the international audience and explains why Japan is incapable of producing firm evidence to draw a definite conclusion. The author also alarms the potential risk of sudden death related to oseltamivir and foresees how the problem may be solved in the future.

Background: An ideal classification should have maximum intercategory variance and minimal intracategory variance. Health insurance claims typically include multiple diagnoses and are classified into different disease categories by choosing principal diagnoses. The accuracy of classification based on principal diagnoses was evaluated by comparing intercategory and intracategory variance of per-claim costs and the trend in accuracy was reviewed., Methods: Means and standard deviations of log-transformed per-claim costs were estimated from outpatient claims data from the National Health Insurance Medical Benefit Surveys of 1995 to 2007, a period during which only the ICD10 classification was applied. Intercategory and intracategory variances were calculated for each of 38 mutually exclusive disease categories and the percentage of intercategory variance to overall variance was calculated to assess the trend in accuracy of classification., Results: A declining trend in the percentage of intercategory variance was observed: from 19.5% in 1995 to 10% in 2007. This suggests that there was a decline in the accuracy of disease classification in discriminating per-claim costs for different disease categories. The declining trend temporarily reversed in 2002, when hospitals and clinics were directed to assign the principal diagnosis. However, this reversal was only temporary and the declining trend appears to be consistent., Conclusions: Classification of health insurance claims based on principal diagnoses is becoming progressively less accurate in discriminating per-claim costs. Researchers who estimate disease-specific health care costs using health insurance claims must therefore proceed with caution.

Objectives: To illustrate how administrative sanctions (AS) and criminal prosecution (CP) differ with regard to application with doctors' misconducts., Methods: A total 465 doctors who were punished twice by AS and CP were analyzed using the proportional distribution method (PDM) to break down into the charge-specific months of suspension or imprisonment., Results: Overall, the Minister of Health, Labor & Welfare (MHLW) sanctioned doctors by suspending their licenses for twice the number of months that the court ordered for imprisonment. Charge-specific analysis of months (suspension or prison terms) revealed a different pattern of judgment. The MHLW judged obscenity more unethical, allocating a larger share of the total months of suspension to punish this misconduct, but judged bribery less unethical allocating a smaller share of the total months of suspension to punish this than the court. For traditional crimes like swindling, murder and psychostimulant abuse, both judgments followed similar patterns allocating the same share of months for punishment of such acts., Discussion: CP and AS were shown to have different patterns in their judgments of doctors' crimes or misconducts reflecting the different purposes they pursue: justice by CP and ethics by AS. (186 words).

Background: Helicobacter pylori stool antigen (HpSA) test is a new tool for evaluating the H. pylori infection. The present study was carried out to investigate the clinical usefulness of the HpSA test in the evaluation of eradication therapy by comparing it with the (13)C-urea breath test (UBT)., Methods: One hundred and five patients received eradication therapy for H. pylori. After more than 8 weeks, the success of the therapy was evaluated by the HpSA test and the UBT. Concordant results were regarded as a final diagnosis, but when the results were discordant, histological examination was carried out., Results: Of the 105 patients receiving eradication therapy for H. pylori, 25 patients were regarded as H. pylori positive by the UBT and and 20 patients were regarded as H. pylori positive by the the HpSA test. Nine patients (8.6%) showed discordant results (seven cases with UBT(+) and HpSA(-), and two with UBT(-) and HpSA(+)). Five cases out of nine were ultimately judged as having a false-positive result of the UBT, and in these cases the UBT values were relatively low (below 10 per thousand). The final diagnostic accuracies of the UBT and the HpSA test were 94.3% (88.0-97.9%; 95% CI) and 97.1% (91.9-99.4%), respectively. When we used the HpSA test in cases with weakly positive UBT values, we were able to diagnose the correct status of H. pylori infection after eradication in 99% of all patients (94.8-100.0%)., Conclusion: The HpSA test is a useful tool for the evaluation of eradication therapy and a combination of the HpSA test and UBT is clinically recommended.

Purposes: To estimate disease-specific costs in a dataset of health insurance claims with multiple diagnoses with known aggregate cost per claim and unknown disease-specific cost of each diagnosis using PDM (Proportional Disease Magnitude) method, validate its accuracy using simulation data with Monte Carlo method and improve its accuracy by developing an adjustment formula., Methods: Developed simulation data with pre-assigned disease-specific costs, applied PDM method using arithmetic means of per-diem-per-disease cost as magnitude, validated its accuracy by observing the correlation between estimates by PDM method and known disease-specific costs and formulated an adjustment formula to improve accuracy. The reproducibility of the findings was assessed using Monte Carlo method by repeating the same procedures., Results: The observed arithmetic means of per-diem-per-disease cost did not match well with actual values resulting in unsatisfactory accuracy. However, when the observed means were adjusted with a formula in which the observed mean is multiplied by (observed mean/overall mean) in the power of 2, PDM method yielded an accurate estimate of disease-specific cost. The accuracy was reproduced by Monte Carlo method with 0.9 or above R square value and slope of regression line in 76, 56 out of 100 iterations respectively., Conclusions: PDM method proved to be an objective, reproducible and accurate method for estimation of disease-specific costs of health insurance claims.

Background: "Ethical Guidelines for Epidemiological Research" took effect in July 2002, with a moral duty of all researchers to comply when conducting epidemiological studies although it is not legally binding. Public health research entails various forms of studies including not only epidemiological studies but also attention to psychological, societal and economic aspects, which are outside of the jurisdiction of the guidelines. Hence, confusion may arise among members of Japanese Society of Public Health as to whether the study they conduct falls within the definition of epidemiological research. The author discusses legal interpretations of the guidelines arising in the course of translation work as part of government-funded project, "Dissemination of the 'Ethical Guidelines for Epidemiological Research' via Internet (principal investigator: Toru Doi)" and argues that a case-method approach would be best suited to enhance understanding by researchers with diverse, non-legal backgrounds., Methods: The author proposes an algorithm for classification of studies as to whether the guideline applies, and applies it to all original articles published in the Japanese Journal of Public Health (JJPH) in one year (March 2002 thru February 2003). The rationale for classification is discussed from the strict legal viewpoint in each case., Results: Sixteen out of 46 original articles published in JJPH for one year were classified as epidemiological studies to which the guidelines apply. Those classified otherwise were psychological studies (10), epidemiological studies not targeting specific diseases and are exempt form the guidelines (3), purely methodological studies (4), economics studies (3), fact-finding or opinion surveys with no hypothesis testing (2), as well as studies authorized by law (4) or using unlinkable anonymous data only (4), all of which are exempt from the guidelines. Reference to ethical considerations in the methodology section as required by the instructions for authors was generally well performed in epidemiological studies although some shortcomings were noted., Discussions: The guidelines affect approximately a third of original articles published in the JJPH. The ratio of applicable to non-applicable articles was roughly 1 to 2. This gives both authors and reviewers confusion as to whether articles are subject to the guidelines and would require ethical approval. This case-method approach using actual articles readily available to members should help unnecessary confusion and enhance appropriate application of the guidelines. (366 words).

Where is the place which should be helped in a patient with congestive heart failure? The answer may be contraction of the heart. At Tohoku University, development research of "the artificial myocardium" has been conducted, using a ball screw type electromagnetic motor. Furthermore, super-miniaturization is being attempted at present. Thus, a system with shape memory alloy is being developed. The cooling speed problem was solved by the application of the Peltier element. A drive at a speed equal to that of a heartbeat was realized by the application of this system. At present, a ventricular assist device is used for patients waiting for a heart transplant in Japan. An air driven type system disturbs a patient's QOL remarkably because it is connected to the drive device. With our concept, energy is provided by using the electromagnetic force from outside of the body by the use of transcutaneous energy transmission system. Magnetic shielding by amorphous fibers was used at Tohoku University to improve the total efficiency. A natural heart can alter the cardiac output corresponding to the demand. Artificial internal organs must participate in the system of the living body, too. Tohoku University has developed a resistance based artificial heart control algorithm, which simulated a baroreflex system to cope with every demand. Nano level sensing equipment is now under development at Tohoku University. At present, development is being conducted aiming at an "intelligent artificial myocardium".

This study was designed to clarify what differences the last 25 years have made in surgical results for patients with hepatocellular carcinoma (HCC). We examined results for 716 hepatectomized patients in four treatment eras: first era (1973-1980; n = 58), second era (1981-1985; n = 155), third era (1986-1990; n = 243), and fourth era (1991-1997; n = 260). Patient background, tumor characteristics, type of hepatectomy, treatment for intrahepatic recurrences, and surgical results in the four eras were compared by univariate analysis to clarify the factors that have contributed to or impeded progress in the surgical treatment of HCC. Although there were no significant chronological differences in liver pathology and surgical resectability, operative mortality was reduced to 2% in the fourth era, from 29% in the first era. With an increasing proportion of early-stage HCCs (TNM, stages I and II), the cumulative survival rate at 5 years improved in the course of the eras in our overall population of patients (12%, 31%, 38%, and 51%, respectively, for the first, second, third, and fourth eras) and in a subset of the population divided according to tumor stage. Also, we found a chronological improvement in the survival rate at 3 years after intrahepatic recurrence (10%, 28%, 36%, and 44%, respectively in the first second, third, and fourth eras). This improvement was associated with the establishment of an early detection program for intrahepatic recurrences. However, the recurrence rate was similar in any subset of the population through the four eras. Although this univariate study could not determine independent factors that contributed to the chronological progress in results for HCC surgery in the four eras, it is conceivable that the establishment of indication criteria for hepatectomy, an early detection program for primary and recurrent lesions, and the introduction of multimodal treatment for recurrence were contributory factors in this improvement. A strategy for alleviating the frequent recurrences originating from posthepatectomy metachronous carcinogenesis remains to be established.

The results of the semi-annual nationwide surveillance of antimicrobial susceptibilities, conducted by the Japanese Ministry of Health and Welfare during the period of January 1993 to July 1995, were analyzed for typical Gram-negative bacilli in the purpose of provision of an index for antimicrobial selection. During these 3 years, Escherichia coli, Citrobacter freundii, Enterobacter aerogenes and Proteus mirabilis showed slightly increasing tendency in susceptibility to fosfomycin (FOM) and Citrobacter freundii. Klebsiella pneumoniae and Enterobacter aerogenes showed slightly increasing tendency to minocycline (MINO). While Haemophilus influenzae and Haemophilus parainfluenzae showed slightly decreasing tendency to cefmetazole (CMZ). However, these annual changes were almost negligible. Generally, these microorganisms showed relatively good susceptibilities, every year, to the principal antimicrobial agents being approved for use against Gram-negative bacilli. However, Enterobacter cloacae, Enterobacter aerogenes, Serratia marcescens and Pseudomonas aeruginosa showed tendencies of decreased susceptibility to some of the antimicrobial agents. On the other hand, sulfamethoxazole-trimethoprim (ST), CMZ, latamoxef (LMOX), gentamicin (GM) and amikacin (AMK) showed good activities against some of the Gram-negative bacilli to which no indications are approved. In conclusion, bedside the identification of the causative microorganisms and the performance of antimicrobial susceptibility testing, such analyses (graphics of susceptibility tendency of clinical isolates to variety of antimicrobial agents) could be used as an index for selection of antimicrobial agents, when emergent and urgent selection of antimicrobial agents is necessary.

The results of the semi-annual nationwide surveillance of antimicrobial susceptibilities, conducted by the Japanese Ministry of Health and Welfare during the period of January 1993 to July 1995, were analyzed for typical Gram-positive cocci and Gram-negative cocci in the purpose of provision of an index for antimicrobial selection. During these 3 years, Streptococcus pyogenes (group A) and Streptococcus agalactiae (group B) showed slightly increasing tendency in susceptibility to ofloxacin (OFLX) and sulfamethoxazole/trimethoprim (ST), while Streptococcus pneumoniae and Moraxella (Branhamella) catarrhalis showed slightly decreasing tendency to cefaclor (CCL). However, these annual changes were almost negligible. Generally, these microorganisms showed relatively good susceptibilities, every year, to the principal antimicrobial agents being approved for use against Gram-positive and -negative cocci. However, Staphylococcus aureus, Staphylococcus epidermidis and Enterococcus faecalis showed tendencies of decreased susceptibility to some of the antimicrobial agents. On the other hand, cefmetazole (CMZ), vancomycin (VCM), latamoxef (LMOX), ST and minocycline (MINO) showed good activities against some of the Gram-positive and -negative cocci to which no indication are approved. In conclusion, beside the identification of the causative microorganisms and the performance of antimicrobial susceptibility testing, such analyses (graphics of susceptibility tendency of clinical isolates to variety of antimicrobial agents) could be used as an index for selection of antimicrobial agents, when emergent and urgent selection of an antimicrobial agent is necessary.

The Liver Cancer Study Group of Japan registered 11,379 patients with hepatocellular carcinoma (HCC) diagnosed from January 1, 1990 to December 31, 1991 in 536 hospitals throughout the country. This nationwide survey revealed the current status of HCC in Japan regarding the epidemiology, clinical characteristics, histopathological features, diagnosis, surgical and conservative treatments, and the outcome. The survival rates of the HCC patients who received hepatic resection, transarterial embolization (TAE), and percutaneous ethanol injection (PEI) were also calculated based on follow-up from January 1, 1987 to December 31, 1991. Three-year and 5-year survival rates of the patients who underwent hepatic resection were 57.5% and 40.8%, respectively, and those of TAE were 19.5% and 8.0%, respectively. Three-year survival rate of the patients with PEI was 53.2%. Cox's multivariate analysis showed that significant prognostic variables after partial hepatectomy were serum alpha-fetoprotein level, tumor size, number of tumors, associated liver cirrhosis, age, surgical curability, and portal involvement.

Health insurance claims are legal documents for the purpose of billing health care cost and not intended for medical certification. They contain valuable public health data as well as sensitive personal information which must be kept confidential. Conflicts arise between the public interest and the privacy protection when public health researchers attempt to perform studies using health insurance claims. This article examines the legal aspects of health insurance claims and proposes legitimate procedures and forms for using claims data in public health research: researchers should act as "contractors" to perform survey under the auspices of insurers instead of requesting the "disclosure" of the personal information.

One hundred and forty-eight cases of congenital large intestinal motor dysfunction (pseudo-Hirschsprung's disease) were reported by members of the Japanese Society of Pediatric Surgeons during the past 20 years. The disorder was defined as a congenital, non-mechanical obstruction of the intestine with the presence of intramural ganglia in the terminal rectum. Intramural ganglia were abnormal in 77 cases, normal in 42, and could not be determined in 29. Of those with abnormal intramural ganglia, 54 had immature ganglia or hypoganglionosis (oligoganglionosis), 15 had neuronal intestinal dysplasia, and eight had a segmental anomaly. Of those with a normal myenteric plexus, 22 had chronic and twelve had suspected idiopathic intestinal pseudo-obstruction syndrome; eight had megacystis-microcolon-intestinal hypoperistalsis syndrome. While cases with both hypoganglionosis and normal intramural ganglia had normal acetylcholine esterase activity, a significantly greater number of patients with hypoganglionosis lacked normal rectoanal reflexes. Patients with hypoganglionosis, chronic idiopathic intestinal pseudo-obstruction syndrome, and megalocystis-microcolon-intestinal hypoperistalsis syndrome had poor prognoses with an overall mortality of 36.9%. These findings indicate that congenital large intestinal motor dysfunction remains a serious disease of childhood.

Three studies were carried out in Mino City, Osaka Prefecture, on 188 frail and elderly persons living at home (the home group), 61 elderly patients who had been hospitalized more than six months (the inpatient group), and 72 residents of welfare homes for the frail elderly (the resident group). The characteristics and social backgrounds of the three groups were compared. About 30% of each group had suffered a stroke. As for ADL score, moderate disability was dominant in the home group, severe disability in the inpatient group, and slight disability in the resident group. The proportions of those who had been living alone and those who had no spouse were significantly higher in the inpatient group and in the resident group than in the home group. Significantly fewer subjects in the resident group had been living with their offspring than in the home group or in the inpatient group. The percentage of those who did not have their own home was the highest for the resident group. Multivariate analyses using Hayashi's quantification method II were conducted for a comparison between cases belonging to the home group and the inpatient group, and between the home group and the resident group. The analysis of the home group and the inpatient group revealed a relationship of the inpatient group to severe disability in ADL, and living alone. Differences between these two groups were related to such variables as ADL, sex, living or not living alone, living or not living with offspring, and having or not having a spouse.(ABSTRACT TRUNCATED AT 250 WORDS)

The present study reports how we indicate safe and beneficial hepatectomy for hepatocellular carcinomas from the experiences of the consecutive 335 patients treated during 1973 and Dec. 1988. The first question was to appreciate the preoperative prediction of a safe limit of hepatectomy. We established a multiple regression formula consisting of several factors such as CT estimated resection rate, ICG retention rate and patient's age at the end of 1980. Since the beginning of 1981, we have been employing the formula as a major indicator guiding treatment option, leading to a significant drop of postoperative, liver failure. The influencing prognostic factors have been determined to be vascular invasion, intrahepatic metastasis, extent of resection regulated by hepatic reserve and tumor size in the decreasing order. From the viewpoint of the biological aspect, the tumors with DNA diploid pattern showed significantly better prognosis than those with non-diploid ones. The current surgical techniques of hepatectomies with en-bloc ligation of Glisson's vessels or with vascular exclusion supported by veno-venous bypass have greatly encouraged the recent surgical results achieving 56% of 4-year survival rate (1985-1988).