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PubMed1993

Lack of regional variation in IDDM risk in Japan. Japan IDDM Epidemiology Study Group.

OBJECTIVE: To examine the intracountry variation of IDDM incidence in Japan and compare it with data from the British Isles and the U.S. RESEARCH DESIGN AND METHODS: IDDM incidence was determined with a standardized registry approach in five geographically different areas in Japan (Hokkaido, Tokyo, Yokohama, Osaka, and Kagoshima) with a total at-risk population < 15 yr of age of 4.4 million. Data collection was completed under the guidelines of the World Health Organization DiaMond project. RESULTS: The incidence and patterns of disease were remarkably similar across the five environmentally different areas. Incidence rates per 100,000 were very low and almost identical from northern to southern Japan (Hokkaido, 2.07; Tokyo, 1.65; Yokohama, 1.66; Osaka, 1.78; and Kagoshima, 1.93). This remarkably low intra-country variation of 0.4/100,000 stands in sharp contrast with the 13.0/100,000 regional variation in the British Isles and the 10.6/100,000 variation in the U.S. CONCLUSIONS: The results suggest that the remarkable genetic homogeneity in Japan may produce uniformity of incidence.

Adolescent↗
PubMed2001

New strategy for better geriatric oral health in Japan: 80/20 movement and Healthy Japan 21.

A review of strategies for better geriatric oral health in Japan is presented. The rapid growth of the aged population in Japan has been associated with the decreasing ability of family caregivers to provide home care due primarily to immature social support systems. As rural ageing has a stronger likelihood of this trend, there is a difference in the oral health of older adults in urban and rural areas. A national survey demonstrated that only 29.8% of the adult population in rural areas had at least one dental visit in the preceding year versus 34.0% in urban areas. Another national survey showed that the proportions of the elderly with untreated teeth that have decay and those without any treated teeth in metropolitan areas, urban areas, and rural areas were 6%, 7% and 12%, respectively. Maintaining good oral health is crucial for maintaining quality of life in later years. A survey in a rural area in Japan demonstrated that, among elderly with nine or fewer natural teeth who wore no dentures, 45% were bed-bound or house-bound. However, among those with 10 or more natural teeth, 80% were active and able to go out alone. Another survey suggested very few house-bound elderly requested dental care, although most of them had oral health problems and mastication dysfunction. A new strategy, 'Healthy Japan 21' suggests positive actions to keep 20 or more teeth by the age of 80, and encourages collaboration between local health authorities and dental associations to encourage positive oral care for the frail elderly including domiciliary dental services within communities.

Activities of Daily Living↗
PubMed1994

[C.P. Thunberg and his voyage to Japan (4). Mercury water therapy for syphilis introduced into Japan by Thunberg].

During his 16-month stay in Japan from August 1775 to December 1776, Thunberg taught mercury water therapy to Japanese medical doctors and interpreters in order to help them treat syphilis, which was prevalent in Japan at that time. Kohgyu Yoshio, a Japanese-Dutch interpreter who was taught this therapy by Thunberg, recorded Thunberg's teaching in his "Kohmoh Hijiki." According to this book, the mercury water therapy that Thunberg introduced to Japan had been tested successfully by van Swieten, a Dutch doctor, about 20 years previously in Europe and used corrosive sublimate (mercuric chloride), the active ingredient, dissolved in distilled water with honey. The formula is described, in measurement units used in Europe at that time, in a letter addressed by van Swieten to a doctor in Rotterdam in 1755. The formula recorded in "Kohmoh Hijiki" in measurement units used in Japan at that time gives a content of the active ingredient equivalent to that mentioned in van Swieten's letter. This fact indicates that van Swieten's formula introduced by Thunberg was correctly accepted by Japanese doctors and interpreters, who had acquired basic medical knowledge since the publication of "Kaitai Shinsho" in 1774.

Expeditions↗
PubMed2001

[Quality control survey implemented by Japan Medical Association and standardization of external quality assessment in Japan].

International Final Draft on quality management of medical laboratory by International Organization for Standardization (ISO) will be published soon. According to this draft, the accreditation of the laboratories should be given by the third party on the basis of objective matter, and the external quality control survey results is thought to be the most important indices for the accreditation. Although variety of external quality control surveys are now implementing in Japan, most of those surveys are done only once a year. Therefore, we could not evaluate the laboratories performance by any of those survey results. If those quality control surveys are done with the standardized system, summative results from different survey could give us fair evaluation on each participating laboratories. Japan Medical Association (JMA) is now making final draft on standardized method for quality assessment system with the consensus between the JMA, Japanese Society of Laboratory Medicine (JSLM, former Japan Society of Clinical Pathology), Japanese Association of Laboratory Medical Technologists (JALMT) and Japan Registered Clinical Laboratories Association (JRCLA). When this quality assessment system actually starts, Japanese people may receive great benefit from the laboratory tests.

Clinical Laboratory Techniques↗
PubMed1996

[Current status of the use of Welfare Centers Japan by foreign children and pregnant women living in Japan].

This survey was conducted to determine how Welfare Centers throughout Japan were addressing the health care and welfare issues of foreign children and pregnant women living in Japan, and to analyze statistics (1988-1992) on the number of consultations by foreigners living in Japan. Questionnaires were mailed to 1220 Welfare Centers throughout Japan in mid August 1993, and responses from 562 centers were received. The survey conducted among these centers revealed the following information: 1) About half of the Welfare Centers responding had had consultations with foreign children and pregnant women, and about 60% of them had encountered difficulties, including language problems. 2) Comparison of rural and urban areas revealed that a higher percentage of Welfare Centers in the urban areas had had foreigners as clients. Welfare Centers were more likely to be accessed by foreigners when there was a large foreign population in the area under their domain. About 90% of the Welfare Centers in large cities had been consulted by foreigners. 3) Only about 30% of the Welfare Centers responding had employees who were competent in foreign languages, and guidebooks in foreign languages were available at less than 10% of the Welfare Centers. In most of the Welfare Centers that had staff competent in a foreign language, the language of competency was English. About 30% of the Welfare Centers responded that they could obtain the service of interpreters when they were consulted by foreigners who spoke languages which they could not understand. 4) The responding Welfare Centers were found to have had consultations by foreign children and pregnant women from all over the world. Consultations by South American and Asian nationals were found to be increasing rapidly. With respect to visa status, an increase was noted in the number of people who had married Japanese spouses. As to the age of children, the majority of those seen at Welfare Centers were infants. 5) There was an increased number of cases related to application of the Child Welfare Law, and the Maternal and Child Health Law.

Adolescent↗
PubMed1998

Clinical and epidemiologic studies of familial hemophagocytic lymphohistiocytosis in Japan. Japan LCH Study Group.

BACKGROUND AND PROCEDURE: The etiology of familial hemophagocytic lymphohistiocytosis (FHL), which is characterized by fever, hepatosplenomegaly, pancytopenia, and coagulopathy, remains unknown. We analyzed 43 FHL patients, all with affected siblings, in 18 families who were identified during the period 1986-1995 in Japan. RESULTS: The presence of consanguinity was evident in two families (11%). The majority of families lived in western Japan, where the frequency of consanguineous marriage is high. The incidence of FHL was significantly higher in the western island, Kyushu, than in other areas. The segregation ratio calculated for these families was 0.35 by the Weinberg proband method, showing the autosomal-recessive inheritance of the disease. Since the diagnosis of an FHL patient without affected siblings (sporadic case) is quite difficult, we calculated the possible number of sporadic cases; approximately 122 patients could be identified as sporadic FHL cases during the same period in Japan. Most of the clinical and laboratory findings were not distinguishable from those of other types of lymphohistiocytosis. However, atypical lymphoid cells with azurophilic granules in peripheral blood were observed in half of the patients at diagnosis, suggesting the clinical importance of this parameter for early diagnosis. Despite intensive therapy, the prognosis of FHL was extremely poor; but 4 of the 8 patients who have survived had received bone marrow transplantation (BMT), indicating the effectiveness of BMT for this disorder. CONCLUSIONS: The distribution of FHL in areas of highly frequent consanguineous marriage and the segregation analysis indicated a genetic factor in FHL. The identification of the genes for FHL is expected to contribute to a cure for this disorder, and might also enable FHL carrier detection and donor selection for BMT.

Adolescent↗
PubMed1998

Cooperative oncology groups in Japan: experience from the Japan Adult Leukemia Study Group.

To ensure reliable statistical analysis in clinical trials, a large number of patients is required and therefore multicenter cooperative studies are indispensable in clinical oncology. However, both in the field of oncology and other fields of medicine, well-functioning clinical study groups are rare in Japan. In this review, the reason why multicenter cooperative study groups are difficult to organize in Japan is analyzed. Subsequently, the experience of a self-supporting and successful cooperative study group, the Japan Adult Leukemia Study Group, is reviewed. Finally, in the absence of significant financial support and thus no financial benefit for participating institutions, how to organize a cooperative study group successfully is discussed.

Antineoplastic Agents↗
PubMed2006

Demography, immigration background, difficulties with living in Japan, and psychological distress among Japanese Brazilians in Japan.

This study examined the relationship of demography, immigration background, and concerns and difficulties associated with living in Japan to nonpsychotic psychological disturbance (i.e., "caseness") measured by the GHQ-12. Data are from a sample of 265 Japanese Brazilians (JB) residing outside the Tokyo Metropolitan area. Employing multiple logistic regression analyses, it was found that JB who experienced lower economic conditions, lived alone, stayed relatively longer in Japan, migrated to Japan due to their dissatisfaction with the socio-economic conditions in Brazil, and who experienced severe family life concerns had a significantly higher ratio of "caseness," that is psychologically distressed. In contrast, JB over the age of 25 years, who acquired moderate Japanese language proficiency and decided to return to Brazil as soon as possible, were observed to have a significantly lower ratio of psychological distress. Socio-cultural and situational interpretations of the findings are presented.

Acculturation↗
PubMed2004

Pathology review for paediatric non-Hodgkin's lymphoma patients in Japan; a report from the Japan association of childhood leukaemia study (JACLS).

A central pathology review system with an immunophenotyping laboratory was established in Japan to support the clinical trial, the Japan Association of Childhood Leukaemia Study (JACLS) NHL-98, for patients with paediatric non-Hodgkin's lymphoma (NHL). Pathology samples from 155 clinically-suspected NHL cases were evaluated centrally initially using the Revised European-American Lymphoma (REAL) classification in a rapid review (within 2 weeks after surgery/biopsy) and then later at the consensus review (once a year). The samples were subsequently re-classified according to the new World Health Organisation (WHO) classification. After the pathology review, 96 (62%) patients were eligible for the study, and 58 of them (60%) had extra-nodal primaries. These NHL cases included B-cell lymphomas (precursor B-cell, 11; Burkitt, 18; diffuse large B-cell, 18; not otherwise specified, 3) and T/Natural Killer (NK)-cell lymphomas (precursor T-cell, 23; anaplastic large cell, 20; others, 3). There was excellent concordance in making the diagnoses (95/96, 99%) and typing (93/96, 97%) of NHL between the rapid and consensus reviews. Five cases, initially diagnosed as diffuse large B-cell lymphoma by the review, were re-classified as Burkitt lymphoma according to the immunocytochemical criteria by the WHO classification. A total of 59 (38%) cases were excluded from the study: they were Hodgkin lymphoma (7), leukaemias (11), reactive lymphoid hyperplasia (20), necrotizing lymphadenitis (7), no consensus diagnosis (1), insufficient materials (2), and others (11). This is the first report of the central pathology review from the paediatric NHL group study in Japan. Because various diseases, either neoplastic or reactive, mimicked NHL, clinically and histopathologically, the central pathology review system was critical and essential for patient enrollment and protocol assignment in our clinical trial. Through the two-step review system, highly reliable data were generated to support this study.

Adolescent↗
PubMed1999

Intracranial haemorrhage as a cause of maternal mortality during 1991-1992 in Japan: a report of the Confidential Inquiry into Maternal Deaths Research Group in Japan.

OBJECTIVE: To determine the causes of maternal deaths by intracranial haemorrhage in Japan. DESIGN: Retrospective analysis of records relating to maternal deaths in 1991 and 1992. SAMPLES: Two hundred and thirty maternal deaths, including 25 cases of primary intracranial haemorrhage and two cases with secondary bleeding. METHODS: Attending doctors were interviewed and completed a 600-item data collection instrument for each maternal death. An expert committee reviewed the data for each death to determine whether the maternal deaths could have been prevented. MAIN OUTCOME MEASURES: Preventability of maternal death from intracranial haemorrhage treated in obstetric and emergency services in Japan. RESULTS: Half of the primary intracranial haemorrhages occurred during pregnancy, 20% during labour, and 30% in the postnatal period. Neurosurgeons considered that there were only three women in whom surgical drainage was indicated. The committee determined that there was only one maternal death which had a > or = 70% of being prevented. After detailed discussion of each case, 60% of the women (15/25) may have been saved by earlier and more intensive medical intervention. CONCLUSIONS: These findings suggest that detailed history taking and early diagnosis of intracranial haemorrhage would be helpful. Regionalisation of obstetric emergency systems are necessary to reduce maternal deaths in Japan due to intracranial haemorrhage.

Adult↗
PubMed1995

Alpha 1-antitrypsin-deficient variant Siiyama (Ser53[TCC] to Phe53[TTC]) is prevalent in Japan. Status of alpha 1-antitrypsin deficiency in Japan.

In contrast to the fact that alpha 1-antitrypsin (alpha 1-AT) deficiency is one of the most common hereditary disorders of Caucasians, deficient variants among Orientals have been recognized to be extremely rare. Only 12 cases of alpha 1-AT deficiency have been reported in Japan, including five cases in which the genetic defects have already been elucidated: Mnichinan (delta Phe52[TTC] and Gly148[GGG]-->Arg148[AGG]), two unrelated cases of Siiyama (Ser53[TCC]-->Phe53[TTC]), a heterozygote of Mmalton (delta Phe52[TTC]), and one additional case of 14q- syndrome (sporadic deletion of the neighboring region of the alpha 1-AT gene locus). alpha 1-AT Siiyama is a deficient variant originally identified in a 38-yr-old patient with pulmonary emphysema in Japan. The amino acid substitution in this variant occurs in a highly conserved residue of the serpin (serine protease inhibitor) backbone (Seyama K, et al. 1991. J. Biol. Chem. 266:12627-12632). We attempted to determine whether alpha 1-AT deficiency in Japan was caused by independent genetic defects or whether it shared some common mutations in the alpha 1-AT gene. We examined five of seven available families for which the genetic defects causing alpha 1-AT deficiency have not yet been explored. When the allele-specific polymerase chain reaction (PCR) was performed with a pair of oligonucleotide primers having the mutated base sequence of the alpha 1-AT Siiyama allele at the 3' end, all eight cases of alpha 1-AT deficiency among five unrelated families turned out to be homozygous carriers of the alpha 1-AT Siiyama mutation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Licensing and training requirements for direct care workers in Japan: what can the United States and Japan learn from each other?

Shortages of direct care workers have been of concern both in the United States and in Japan. This article compares issues surrounding long-term care provisions in the two countries and introduces Japan's unique licensure and certificate system for direct care workers. Japan has established three levels of direct care worker certificates and a direct care licensure, which can be potentially used as a career ladder. Studies show that this system has resulted in different work conditions and benefits between different certificate and licensure levels but had a limited impact on hourly wage and task differentiation. Implications for the United States are also discussed.

Allied Health Personnel↗
PubMed1997

Quality control in the health care in Japan--why CQI does not take root in Japan?

In the above, I have discussed the reasons why the Japanese hospitals failed to systematically improve health care quality from historical and cultural viewpoints with reference to the Japanese health care system. However, young physicians who are also the administrators of their own hospitals have become aware of the importance of the health care quality improvement and of the hospital management assessment by a third party, and they have been making positive efforts to solve the problems in their 30s who work at hospitals are also breaking the past image of conservative and stiff-necked doctor. Though there still remains much to be improved, the idea of informed consent is gradually taking root. The number of patients who insist on "the rights of patient" and "the right to make own decision" is on the increase. The system to have a third party assess the hospital administration is also under way. Under such circumstances, the leadership taken by physician, cooperation between various specialists as a team and the management capability of clerical staff are expected to play important role in the continuous quality improvement activities participated by the whole personnel of hospitals. Japanese industries are famous for their abundant experience and know-how of the management. If the health care industry will seriously tackle with quality improvement through good team work by participation of all the staff without any boundary between the jobs, the Japanese health care level is expected to improve and to satisfy the patients. In the past, boundary between the jobs also existed in Japanese corporations, but this obstacle was removed by taking the customer-oriented stance. It has now become obligatory in the factories to check the product whether it satisfies customers or not in final stage of manufacturing. There is no reason why hospitals cannot learn from these examples. It is now necessary for specialist organizations including hospital associations and Japan Medical Association to seriously address themselves to the task of continuous improvement of health care quality. Strange to say, there is no organization for secretary-generals of hospitals in Japan, but improvement of the quality and position of clerical staff is another key to raising the quality of health care. By raising the level of clerical staff, we may avoid such criticism as "Japan's medcine is first grade but health care is third grade".

Decision Making, Organizational↗
PubMed1999

Country reports from Japan: external quality assessment scheme in Japan.

Several external quality assessment schemes (EQAS) have been conducted in Japan. Results obtained from nation-scale EQAS reveal the current quality of laboratory testing in each laboratory. The largest nation-scale EQAS in Japan is that conducted by the Japan Medical Association. The numbers of participants and of items evaluated have increased in EQAS by JMA over its history of 32 years. Improvement in inter-laboratory differences has been observed for most items in EQAS in recent decades. In 1998, about 2,500 laboratories from throughout the country participated in this surveillance, and 47 items were evaluated. The coefficient of variations for the group of all participants was less than 5% for about one third of all test items. On the other hand, very high variations over 20% were observed for 6 items. Also, inter-method differences exist for many items, which may be or may not be related to matrix effects. Retrospective evaluation of all EQAS data suggests that there is still room for improvement in inter-laboratory differences.

Bacteriological Techniques↗
PubMed2000

[Problems concerning the prices of surgical operations in Japan. Union of Social Medical Insurance Committee Members of Surgical Societies in Japan].

The Union of Social Medical Insurance Committee Members of Surgical Societies in Japan was established in 1967. The union has tried to develop scientific methods to assess the price of surgical operations in Japan and proposed a tentative plan for the assessment of the price of operations. The price of an operation includes personnel expenses and other costs such as the prime costs to repay loans for land and buildings, and taxes. Personnel expenses are calculated by the grade of technical difficulties, the number of doctors and nurses and the duration of the operation. A more precise method to judge the difficulties of the operation seems to be necessary. To examine the recent increase in expenses for surgical materials, the cooperation of main hospitals authorized by surgical societies will be necessary. The prices of surgical operations presented by the Ministry of Health and Welfare of Japan correlated well with the prices proposed by the Union.

Fee-for-Service Plans↗
PubMed2001

Spondyloarthropathies in Japan: nationwide questionnaire survey performed by the Japan Ankylosing Spondylitis Society.

OBJECTIVE: The Japan Ankylosing Spondylitis Society conducted a nationwide questionnaire survey of spondyloarthropathies (SpA) in 1990 and 1997, (1) to estimate the prevalence and incidence, and (2) to validate the criteria of Amor and the European Spondylarthropathy Study Group (ESSG) in Japan. METHODS: Japan was divided into 9 districts, to each of which a survey supervisor was assigned. According to unified criteria, each supervisor selected all the clinics and hospitals with potential for SpA patients in the district. The study population consisted of all patients with SpA seen at these institutes during a 5 year period (1985-89) for the 1st survey and a 7 year period (1990-96) for the 2nd survey. RESULTS: The 1st survey recruited 426 and the 2nd survey 638 cases, 74 of which were registered in both studies. The total number of patients with SpA identified 1985-96 was 990 (760 men, 227 women). They consisted of patients with ankylosing spondylitis (68.3%), psoriatic arthritis (12.7%), reactive arthritis (4.0%), undifferentiated SpA (5.4%), inflammatory bowel disease (2.2%), pustulosis palmaris et plantaris (4.7%), and others (polyenthesitis, etc.) (0.8%). The maximum onset number per year was 49. With the assumption that at least one-tenth of the Japanese population with SpA was recruited, incidence and prevalence were estimated not to exceed 0.48/100,000 and 9.5/100,000 person-years, respectively. The sensitivity was 84.0% for Amor criteria and 84.6 for ESSG criteria. CONCLUSION: The incidence and prevalence of SpA in Japanese were estimated to be less than 1/10 and 1/200, respectively, of those among Caucasians. The adaptability of the Amor and ESSG criteria was validated for the Japanese population.

Adult↗
PubMed1999

In vitro evaluation of cefepime and other broad-spectrum beta-lactams in 22 medical centers in Japan: a phase II trial comparing two annual organism samples. The Japan Antimicrobial Resistance Study Group.

An antimicrobial resistance surveillance study in Japan is presented representing the second year (Phase II) results from 22 medical centers. Each participant laboratory tested (Etest, AB BIODISK, Solna, Sweden) 100 organisms, 10 strains each from 10 species groups including Escherichia coli, Klebsiella spp., Enterobacter spp., Citrobacter spp., indole-positive Proteae, Serratia spp., Acinetobacter spp., Pseudomonas aeruginosa, and oxacillin-susceptible Staphylococcus aureus and coagulase-negative staphylococci. Generally only modest variations in the activity of the studied broad-spectrum beta-lactams was observed compared to the study a year before. Specifically, extended spectrum beta-lactamase (ESBL) rates in E. coli increased (2.9 to 8.1%), but the ESBL rate in Klebsiella spp. fell (8.6 to 5.0%). Overall the resistance to the beta-lactams varied from a 4.7% decrease (ceftazidime as a consequence of a modified staphylococcal breakpoint criteria) to a 1.0% increase (cefepime, not significant). The rank order of spectrums in 1998 only changed for cefoperazone-sulbactam (6.1% resistance) that was active against more strains than cefpirome (6.8% resistance). The overall spectrum rank order for the 1998 Japan sample (% resistance) was: cefepime (3.2%) > imipenem (4.1%) > cefoperazone-sulbactam (6.1%) > cefpirome (6.8%) > ceftazidime (8.4%) > piperacillin (19.9%). As with a similar study in 1997, imipenem-resistant isolates of P. aeruginosa and Serratia spp. were discovered with metalloenzymes, usually found in the same medical centers. These results demonstrate the continued in vitro activity and potential sustained clinical efficacy of several broad-spectrum beta-lactams in Japan. Rapid emergence of new or novel resistance were not wide spread using a precise quantitative MIC system. Continued surveillance in this nation would be prudent to document the activity of this clinically valuable class of safe, antimicrobial agents.

Anti-Bacterial Agents↗
PubMed2006

Features and outcome of neonatal leukemia in Japan: experience of the Japan infant leukemia study group.

BACKGROUND: Neonatal leukemia characterized by early stem cell origin and extramedullary infiltration in the first 4 weeks of life is rare. We analyzed the features and outcome of neonatal leukemia in Japan to establish an appropriate treatment strategy for this rare disorder. PROCEDURE: Patients with infant leukemia registered and treated in the Japan Infant Leukemia Study between 1996 and 2001 were analyzed. RESULTS: Among 162 infant leukemia patients, 11 exhibited neonatal leukemia; frequencies for all infant leukemias were 6.9% (8/116) for acute lymphoblastic leukemia (ALL) and 7.3% (3/41) for acute myeloid leukemia (AML). Positive MLL gene rearrangement was observed in all eight patients with ALL; a single patient with AML displayed germline configuration. Acute monoblastic leukemia was apparent in all three patients with AML (M5a in the FAB classification). Most of the patients demonstrated hepatoplenomegaly and hyperleukocytosis at diagnosis. Cutaneous and central nervous system involvement were detected in half of the patients. Four patients (one with AML, and three with ALL) have survived following stem cell transplantation (SCT); however, growth impairment related to SCT was observed in these patients. CONCLUSIONS: These results suggest an improvement attributable to treatment of neonatal leukemia. International-based collaborative studies are necessary to investigate the biology of this condition and to establish appropriate therapeutic strategies.

Acute Disease↗