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PubMed2003

[Socioeconomic factors for tuberculosis in Tokyo, Japan--unemployment, overcrowding, poverty, and migrants].

We investigated selected socioeconomic variables for incidence of tuberculosis and its rate of changes that might be relevant for the design of appropriate prevention and control programs. Retrospective ecological analysis was done to examine the association between eight socioeconomic measures from the 1992 census and both the average rate and the rate of change of standardized annual notification rates for tuberculosis from 1988 to 1997 for each of the 23 wards in Tokyo. Multivariate analysis identified the proportion of households with livelihood aid (p < 0.001), number of public bath per 100,000 person (p < 0.001), population density (p = 0.012), and proportion of households below standard house space (p = 0.024) as variables positively associated with average tuberculosis notification rates. The rate of change was negatively correlated with three variables: proportion of owner occupied households (p = 0.001), number of tatami (living space) per capita (p = 0.021), proportion of households with livelihood aid (p = 0.038). The results showed there were certain clear socioeconomic risk factors in tuberculosis transmission, and that it might be possible to investigate the relation between the rate of change and each socioeconomic risk factor effectively with this method.

Humans↗
PubMed2002

Living-donor liver transplantation at Tokyo University.

One hundred fourteen living-donor liver transplants were performed at Tokyo University hospital from 1996-2000, including 66 children and 48 adults. Most (86%) of the children were transplanted for biliary atresia, whereas adults were more often transplanted for primary biliary cirrhosis (40%) or liver cirrhosis (23%) due to hepatitis or other unknown causes. Among children, 52% received the left lobe lateral segment, 23% an extended lateral segment and 21% the left lobe. The graft volume to standard liver ratio averaged 84%. Among adults, 79% received a left lobe; however, we have used the right lobe for most recent cases (21%) to provide sufficient volume. Parents donated to the pediatric recipients about 95% of the time, but a variety of family members donated for the adult transplants. The actual overall 3- and 5-year patient survival rates were 88.6% and 87.7%, respectively, and were slightly higher in children than adults. The results are comparable to those achieved with cadaver livers.

Adolescent↗
PubMed1992

[Incidence rates of cerebral palsy, severe mental and motor retardation, and Down syndrome in the city of Higashiyamato in suburban Tokyo].

We investigated the incidence rates of three neurological diseases in childhood in the City of Higashiyamato in suburban Tokyo with a total population of about 70,000. The number of liveborn babies during 1985-1989 was 3,958. The number of patients with cerebral palsy (CP) was 9 and the incidence rate was 2.2/1,000, which was equal to the reports from several countries. Four out of 9 patients with CP had mild motor handicaps and were expected to "outgrow" their handicaps. The number of patients with "severe mental and motor retardation" (SMMR) was 4 and the incidence rate was 1.0/1,000. Prenatal brain damage played a major role in the pathogenesis of CP and SMMR. The number of patients with Down syndrome (DS) was 7 and the incidence rate was 1.8/1,000. Incidence rates of CP, SMMR, and DS still remain high and further strategy to prevent pediatric neurological diseases is necessary.

Birth Rate↗
PubMed2003

[Implementation of integrated mental health care in an urban district of Tokyo].

Japan had a long history of long-term hospital care and is now trying to change it into community-based psychiatry. Implementing comprehensive approach that has already been proven effective through evidence based data in one particular community, one has to overcome several local barriers, if the same approach is to be implemented in different situations, such as differences in socio-cultural background and health care system. This is a report of the activities of Minato Net 21 pointing out the "local barriers" on implementing comprehensive approach in an urban district of Tokyo.

Community Mental Health Services↗
PubMed2004

A nosocomial outbreak of febrile bloodstream infection caused by heparinized-saline contaminated with Serratia marcescens, Tokyo, 2002.

In January 2002, 12 patients with Serratia marcescens bloodstream infection (BSI) were identified in a hospital in Tokyo, Japan. We conducted an epidemiological investigation of this outbreak. We undertook a medical-records review and employee interviews, and performed a case-control study to determine risk factors for S. marcescens BSI. An observational study of the hospital's procedures and an environmental microbiologic sampling were performed. We identified 12 suspected and 12 confirmed patients with S. marcescens BSI, including 7 who died. A case-control study showed that vascular access devices (odds ratio [OR] = 30.46; 95% confidence interval [CI] = 3.5-685.6) and the use of heparin-locks, between December 26 and January 15 (OR = 25.7; 95% CI = 2.3-680.4) were significant risk factors for S. marcescens BSI. The observational study revealed multiple lapses in infection control, including use of multi-dose vials of heparin. The outbreak strain was isolated from a hand-towel in the nurse station. The use of multi-dose vials of heparinized-saline during a particularly busy period was associated with BSI risk. The results underscore the risks inherent in infection-control lapses and the use of multi-dose vials.

Adult↗
PubMed2004

[Retinopathy of prematurity in extremely low birth weight infants: a Tokyo multicenter study].

OBJECTIVE: To investigate how the increase in survival rate in extremely low birth weight (a birth weight of 1,000 g or less) infants had affected the incidence of retinopathy of prematurity (ROP) and the frequency of laser treatment. METHODS: We retrospectively reviewed the medical records of 122 surviving premature infants with birthweights less than 1,000 g to determine the severity of ROP observed at 16 neonatal intensive care units in Tokyo between April and October 2002. RESULTS: The survival rate was 85.6%. The mean gestational age was 26.74 weeks and the mean birth weight was 782.25 g. One-hundred-and-five infants (86.1%) developed ROP, fifty (41.0%) received laser treatment, and six (4.9%) had retinal detachment. The median postmenstrual age (gestational age at birth plus chronological age in weeks, PMA) at the onset of ROP was 32.5 weeks, and the first laser treatment was performed at the median PMA of 35.7 weeks. CONCLUSIONS: In these extremely low birth weight infants, there was an increase in the survival rate and in the incidence of severe ROP that progressed to the stage that required treatment.

Birth Weight↗
PubMed2004

[Towards the establishment of a postgraduate training program of neurology--in the case of Tokyo Medical and Dental University].

The training as neurologist in Department of Neurology and Neurological Science, Tokyo Medical and Dental University has mainly been performed through 3rd to 5th year after the graduation. It includes training for neurophysiology, neuroradiology and neuropathology as well as clinical neurology. Neurophysiology training has the separate 3 months course where trainee residents study exclusively neurophysiology but neuroradiology and neuropathology were learned during training for clinical neurology in general. The major problem of our training program is that the quota is so small to prepare enough trainee's positions. This appears also true in many institutes in Japan according to a questionnaire survey by this workshop. The number of neurology staff should be increased to accomplish better training for Neurology in each institute. The Japanese Society of Neurology should support this effort in each institute.

Education, Medical, Graduate↗
PubMed2005

Development of the real-time control (RTC) system for Tokyo sewage system.

Tokyo Metropolitan government has decided to make the maximum possible use of the existing facilities while ensuring safety against inundation and to promote measures also from a software approach by introducing a system capable of minimizing combined sewer overflow, the real-time control system (RTC). A pilot RTC system was installed in August 2002 for the Shinozaki Pumping Station. The RTC system monitors the precipitation volume and the water level in the pipe. Simulations were carried out on the basis of these data. From the results, it was found that with the use of the RTC it is possible to reduce CSO by roughly 50% for small rainfalls with a total precipitation level of 20 mm or less by strong rainwater in the pipe routes at the beginning of the rain. It has also been shown that CSO can be reduced by about 80% through the use of rainfall forecasting.

Computer Simulation↗
PubMed2005

[Possible influence of psychotropic drugs detected in blood when determining the cause of death in medicolegal autopsy cases in the Tokyo Medical Examiner's Office].

We reviewed the records of 118 medicolegal autopsy cases, in which psychotropic drugs were detected in blood, in the Tokyo Medical Examiner's Office in 1997, to explore how the drug levels were considered in determining the cause of death. Names and doses of the drugs were clear in 70 of 118 cases, and in most cases of the 70 cases, multiple drugs (up to 13 drugs) were prescribed to a person. It was also evident that 75 of the 118 cases had demonstrated psychosis for several months to 38 years prior to death. No information concerning prescriptions or history of psychosis could be obtained in the other cases. The causes of death in these 118 cases were as follows: deaths from specific diseases, 30 cases (25.4%); deaths from extrinsic factors excluding drug intoxication, 22 cases (18.6%); suicide related to drug intoxication, 31 cases (26.3%); deaths from extrinsic factors related to drug intoxication suggestive of suicide, but not confirmed, 19 cases (16.1%); non-suicide, including probable drug intoxication, 13 cases (11.0%); and deaths from malignant syndrome, 3 cases (2.5%). There were cases diagnosed as death from specific diseases based on morphological findings, though drug concentrations in blood were at a toxic or even lethal level. In some cases, drug intoxication was suspected, but drug levels in their blood were at a therapeutic level and there were no identifiable morphological changes directly associated with deaths, resulting in a cause of death other than drug intoxication being indicated. Thus, drug levels detected in the cadaver's blood are not always useful for determining the cause of death. This might be due to poor information on interactions between drugs (including alcohol), pathological changes or genetic variability of drug metabolism and excretion, and so on. Thus, further studies of these aspects are needed in order to make information on drugs detected in the cadaver more useful for determination of cause of death.

Autopsy↗
PubMed2006

[Development of effective detection method for Coxiella burnetii in mayonnaise by real-time PCR and investigation of C. burnetii contamination in commercial mayonnaise in Tokyo].

A PCR method for the effective detection of Coxiella burnetii in commercially available mayonnaise was developed. Sample preparations were isolated from 50 g portions of each mayonnaise product by four successive extraction steps in phosphate buffer with 2.0 M NaCl. These extracts were then centrifuged at 20,000 x g for 60 min. DNA was isolated from the solution containing the precipitate with a commercial kit, and amplified quantitatively using real-time PCR that targeted the com1 region of C. burnetii. The recoveries of C. burnetii from 2 kinds of commercial mayonnaise specimens, with a baseline control of 1 x 10(7) particles of the Nine Mile phase II strain, were 85.0 +/- 6.0% and 72.0 +/- 0.4%, respectively. The determination limit of this method was 500 C. burnetii particles per 50 g of mayonnaise. The DNA specimens isolated from 50 different commercial mayonnaise samples sold in Tokyo using this method were amplified using both nested PCR and real-time PCR. No contamination by C. burnetii was detected in any of the mayonnaise samples.

Coxiella burnetii↗
PubMed1990

[Epidemiological studies of air pollution and health effects in areas near roadways with heavy traffic in Tokyo].

Recent concern regarding health effects of air pollution in Japan has concentrated mainly on traffic-induced air pollution and its health effects in large cities. In Japan, where many people in large cities have been living near major roadways, the increase of automobile exhaust due to heavy traffic congestion will predictably cause a greater impact on people living near major roadways. We surveyed the characterization of residential suspended particulate matter (SPM) and nitrogen dioxide (NO2) concentrations along the major roadways in Tokyo, along with a health survey on the respiratory conditions of residents living in the same area, to examine the relationships between indoor pollutant levels, prevalence of respiratory symptoms and distance from roadways. The environmental monitoring was conducted in five phases. Using a newly developed SPM sampler and NO2 filter badge, continuous 4 day (96 hours) measurements were conducted in two hundred residential homes for four weeks. NO2 was measured in the living room, kitchen and outside of each home, while SPM was monitored in the living room. Health information was collected in October 1987 using ATS-DLD self-administered questionnaires. Of the 1,093 homes investigated, responses from 805 homes were received. The following results were obtained. SPM and NO2 concentrations showed large variations. Indoor pollution levels mostly depended on indoor sources, i.e. cigarette smoking and unventilated space heaters, and the effects of those indoor sources were influenced by the building structure with respect to air tightness. An association between increase in pollutant levels and the distance from the roadway was observed. However its effect is small compared to indoor source effects. The prevalence rate of respiratory symptoms was higher in those areas nearest roadways with heavy traffic both in children and adults. These results suggest the presence of a relationship between automobile exhaust and health effects.

Adult↗
PubMed1992

[Survey of Fukuyama type congenital muscular dystrophy in Tokyo].

On the 1st of April in 1988, we identified 26 children with Fukuyama type congenital muscular dystrophy (FCMD) among 1,227,000 children in Tokyo whose ages ranged from 6 to 14 years. The prevalence rate of FCMD was 2.1 per 100,000. All affected children attended special school for crippled children. Mean absence from school on account of illness was 33.9 days in a year. Fifteen among 26 affected children had ability of verbal communication. The loss of gross motor function started at ages 6-7 years but muscle weakness might have occurred earlier. Ten affected children were treated with antiepileptic drugs. Six affected children needed to be hospitalized for the treatment of vomiting with dehydration, acute bronchitis, or pertussis infection during one year until the 1st of April in 1989. Two cases among 26 with FCMD died of respiratory complications shortly after admission.

Adolescent↗
PubMed1991

[Subjective health and related factors among middle-aged men living in Tokyo--a comparative study].

Random samples of middle-aged (35-64) male residents of two different areas in Tokyo, Bunkyo-ku, a low-mortality area (n = 767) and Koto-ku a high mortality area (n = 790) were interviewed between March and April in 1988, concerning health and life style. The two populations were compared regarding, 1) health status which was examined from the view point of fatigue, symptoms and self-rated health, 2) factors related to the three health indices. The main results were as follows: 1. No significant differences were seen between the two populations in the gross means for health indices. However when the health indices were stratified by age group, mental fatigue and minor symptoms were more prevalent in Bunkyo-ku than Koto-ku among young people, while prevalence of physical fatigue and major symptoms was higher in Koto-ku among old people. 2. The relationship between the health indices and job type, income, education and marital status was examined. In Bunkyo-ku, no relationship was seen after controlling for age, working conditions and life style. On the other hand, in Koto-ku, significant relationships were seen with age, job type and marital status, and health problems were prevalent not only among those with low socioeconomic status but also in other socioeconomic groups. These results were maintained even after controlling for age, working conditions and life style, similar to the analysis for Bunkyo-ku, indicating that health problems in this population do not appear to be solely the result of working conditions or life style.

Adult↗
PubMed1991

Seroepidemiology of anti-Entamoeba histolytica antibody by enzyme-linked immunosorbent assay in the greater Tokyo area.

An enzyme-linked immunosorbent assay (ELISA) for detecting antibody against Entamoeba histolytica was used in a survey to determine the prevalence of E. histolytica infection in the greater Tokyo area. Serum samples were collected from 1,869 randomly chosen, symptom-free volunteers (1,645 males and 224 females). Seventeen individuals (0.91%), 14 males and three females, had ELISA values that were interpreted as positive. The calculated histogram of the anti-E. histolytica IgG values, after logarithmic transformation of the original skewed values, revealed a normal (Gaussian) distribution. It was also found that the results of the ELISA were closely correlated with those obtained by an indirect immunofluorescent assay (IFA).

Adult↗
PubMed1991

[Mortality patterns of non-institutionalized severely retarded children in Tokyo].

Mortality patterns of severely retarded children who were cared at their homes in Tokyo were investigated. We identified sixty-seven physically handicapped children who died in 1988 and 1989 at 15 schools for such children. 42 children out of 67 were severely retarded (children who neither walk nor have IQs over 35). Annual case-fatality rate of severely retarded children was 2.5%. Respiratory tract infections accounted for 38% of the causes of severely retarded children and other respiratory tract diseases such as aspiration and complications of tracheotomy accounted for 29%.

Cause of Death↗
PubMed1991

[Incidence rate of cerebral palsy, severe mental and motor retardation, and mental retardation in a suburban Tokyo area].

We investigated the incidence rates of several neurological diseases in childhood in a suburban Tokyo area with a total population of about 130,000. The number of liveborn babies during 1985-1989 was 6,772. The number of patients with cerebral palsy (CP) was 13 and the incidence rate was 1.9/1,000, which is equal to the results of reports from several countries. Patients with severe mental and motor retardation (SMMR) was 7 and the incidence rate was 1.0/1,000. Five out of the 7 children with SMMR always needed medical care and were always or very frequently hospitalized. Prenatal brain damage played a major role in the pathogenesis of CP and SMMR. The number of patients with Down syndrome (DS) was 9 and the incidence rate was 1.3/1,000. The number of patients with mental retardation (MR) except DS was 64 and the incidence rate was 11.6/1,000. We conclude that the incidence rates of CP, DS, SMMR, and MR still remain high and that we need further strategy to prevent pediatric neurological diseases.

Cerebral Palsy↗
PubMed1990

[A comparison of coping behavior among middle-aged males with health problems in different types of communities in Tokyo].

Coping behaviors of middle-aged men living in areas of Tokyo with differing mortality rates were analyzed to determine if regional differences exist and if so why. Coping behaviors were divided into 3 separate levels: 1) coping behavior for slight symptoms, where a small change in lifestyle would seem to be a countermeasure, 2) coping behavior for symptoms which may be signs of a serious illness, and 3) coping behaviors for illness which have been identified and diagnosed by a physician. The sample was randomly selected from men 35 to 64 years of age living in two separate communities, Koto-Ward with a high middle-aged male mortality rate and Bunkyo-Ward where it is low. The following results were obtained. 1) In both communities, the proportion of interviewees who modified their lifestyle when slight symptoms occurred was associated with educational level and occupational status. The individuals who were junior high school graduates, and blue-collar workers in small enterprises, showed a low tendency toward changing their lifestyle when confronted with slight symptoms. College graduates, and white-collar workers who were members of large or medium sized enterprises, showed a strong tendency toward changing their lifestyle when confronted with slight symptoms. 2) In both communities, there were differences in coping behaviors when confronted with potentially serious illness dependent upon self-rated health and working hours per day. Interviewees with good self-rated health status and working more than ten hours a day showed a lower tendency to see a physician. 3) Compliance with the advice of a physician was lower among those interviewees who were younger and among those who did not have a family physician. In Koto-Ward, a correlation was seen between a low rate of compliance to physician advice and the non-availability of adequate medical facilities nearby. 4) In Koto-Ward where middle-aged male mortality is high, the proportion of interviewees who changed lifestyle in response to slight symptoms was significantly lower than in Bunkyo-Ward. The proportion of those who complied with the advice of a physician was also lower. 5) Regional differences in coping behaviors associated with slight symptoms appears to be due to differences in educational level and occupational status. Differences in availability of family physicians and nearby clinics could account for regional differences in the coping behavior of individuals with diagnosed illnesses.

Adaptation, Psychological↗
PubMed1990

Staphylococcal food poisonings in Tokyo, with special reference to the coagulase types of the isolates.

Staphylococcus aureus strains isolated from the 391 confirmed cases of staphylococcal food poisonings in Tokyo, in the period 1967-1986, were studied for their coagulase types. Consequently, it was found that all the isolates could be classified into the coagulase types II, III, VI and VII. Namely, the isolates from 54 (13.8%) of 391 outbreaks were typed as type II, 72 (18.4%) as type III, 38 (9.7%) as type VI, and 227 (58.1%) as type VII, respectively. Throughout the investigation, it was found that the outbreaks of staphylococcal food poisonings due to coagulase type VII organisms were remarkably increased since 1975.

Coagulase↗