Objective : The economic aspect of pharmaceuticals is becoming a major issue of health care financing in Japan due to the high total volume of drug consumption. To consider the feasibility and usefulness of pharmacoeconomic (PE) studies in health policy making, we aimed to conduct a review of PE studies published in Japan.
Methods : We collected original published PE studies conducted in Japan from 1985 to 1995, by retrieving through computer databases such as MEDLINE and JMEDICINE, as well as other methods. We then reviewed the papers according to a checklist developed by Drummond et al.
Results : Fourteen articles were found to satisfy the inclusion criteria. The overall checklist compliance rate were 45.8%. All of the PE studies were based on randomized clinical trial. Most of the studies lacked some important elements of PE analysis, such as the identification of all important and relevant costs and consequences (14.3%) and the presentation of all issues of concern (7.1%). Furthermore, most models and assumptions used in the studies were considered by us to be unreliable and inappropriate.
Discussion : The quality of PE studies conducted in Japan was not considered by us to be satisfactory and our analysis identified areas for improvement. Further improvement in this field is urgently needed and may be achieved through PE guideline development and the training of specialists.

Introduction

  In Sri Lanka, there was ethnic violence in the form of armed conflict that lasted 26 years from 1983 through 2009. The conflict between two ethnic groups were bogged down by terrorism or by foreign military intervention. It destroyed the life of inhabitants and it is thought to have inhibited the health and growth of children.

  A case study was conducted in Sri Lanka to establish the effects of the armed conflict on children’s health, soon after the conflict ended. The case study was aimed at using the result for planning health administration.

Methods

  400 participants aged 12 and above were selected from 10 schools of two out of 11 Divisional Secretariat Divisions in Trincomalee District in Sri Lanka. 10 schools were classified into two DS Divisions, severely devastated and less devastated. Each participant was assessed, using anthropometric techniques and questionnaires including GHQ-12.　Reliability of the questions was confirmed through back translation and the use of an English-Tamil questionnaire. The mean values of the anthropometric measurements, the mean values of score by factor analysis of GHQ-12 response, and various items of social environment were compared between the two regions. These different significances were tested using F-test, t-test and Chi-square test.

Results

  　In comparisons between two regions, body weight, height and BMI among participants in severely affected region were significantly lower. Additionally, susceptibility to infectious and endemic diseases in severely affected were significantly increased.

  Four characteristics of mental health were identified, but there was no significant difference about the state of depression between the two regions.

Conclusion

  Children in conflict zones are susceptible not only to malnutrition, but also infectious diseases caused by unhygienic living conditions. The application of simple anthropometric techniques and relevant knowledge and food distribution are important in evaluating and responding to these children’s health problems.

The patient was a 74-year-old man who was brought to the emergency room with severe chest pain and shock. Transthoracic echocardiography showed moderate pericardial effusion, and contrast-enhanced computed tomography (CT) showed a dilated ascending aorta with hematoma. However, no evidence of an intimal flap in the aorta was found. Bloody pericardial effusion was suggested by the CT attenuation value ; therefore, type A aortic dissection was highly suspected. At surgery, an extramural hematoma was observed on the ascending aorta. An 8-mm dehiscence that had penetrated the adventitia was identified just above the commissure between the right and left coronary cusps of the aortic valve, without dissection in the ascending aorta, and thus spontaneous aortic root rupture was diagnosed. The dehiscence was closed directly with a mattress suture from outside of the sinus, and the dilated ascending aorta was replaced. The patient's postoperative course was unremarkable, and he was discharged 14 days after surgery.

1) All students but 1 correctly typed the ABO blood groups, but only 33.2% of students and 63.9% of physicians properly performed cross-matching.
2) Most failures in cross-matching were due to the inability to detect allogeneic antibodies, but 5.2% of students and 2.9% of physicians failed to detect ABO mismatching.
3) Although laboratory practice is suggested to help students to solidify knowledge and comprehend principles, achieving an official goal of residency - gaining competence in performing and interpreting cross-matching independently - appeared difficult.

No abstract available.
Melanoma

In response to the outbreak of coronavirus disease 2019 (COVID-19) in Japan, a national COVID-19 cluster taskforce (comprising governmental and nongovernmental experts) was established to support the country’s Ministry of Health, Labour and Welfare in conducting daily risk assessment. The assessment was carried out using established infectious disease surveillance systems; however, in the initial stages of the pandemic these were not sufficient for real-time risk assessment owing to limited accessibility, delay in data entry and inadequate case information. Also, local governments were publishing anonymized data on confirmed COVID-19 cases on their official websites as daily press releases. We developed a unique database for nationwide real-time risk assessment that included these case lists from local government websites and integrated all case data into a standardized format. The database was updated daily and checked systematically to ensure comprehensiveness and quality. Between 15 January 2020 and 15 June 2021, 776 459 cases were logged in the database, allowing for analysis of real-time risk from the pandemic. This semi-automated database was used in daily risk assessments, and to evaluate and update control measures to prevent community transmission of COVID-19 in Japan. The data were reported almost every week to the Japanese Government Advisory Panel on COVID-19 for public health responses.

BACKGROUND: The Hokkaido Study on Environment and Children's Health is an ongoing study consisting of two birth cohorts of different population sizes: the Sapporo cohort and the Hokkaido cohort. Our primary objectives are to (1) examine the effects that low-level environmental chemical exposures have on birth outcomes, including birth defects and growth retardation; (2) follow the development of allergies, infectious diseases, and neurobehavioral developmental disorders, as well as perform a longitudinal observation of child development; (3) identify high-risk groups based on genetic susceptibility to environmental chemicals; and (4) identify the additive effects of various chemicals, including tobacco. METHODS: The purpose of this report is to provide an update on the progress of the Hokkaido Study, summarize recent results, and suggest future directions. In particular, this report provides the latest details from questionnaire surveys, face-to-face examinations, and a collection of biological specimens from children and measurements of their chemical exposures. RESULTS: The latest findings indicate different risk factors of parental characteristics on birth outcomes and the mediating effect between socioeconomic status and children that are small for the gestational age. Maternal serum folate was not associated with birth defects. Prenatal chemical exposure and smoking were associated with birth size and growth, as well as cord blood biomarkers, such as adiponectin, leptin, thyroid, and reproductive hormones. We also found significant associations between the chemical levels and neuro development, asthma, and allergies. CONCLUSIONS Chemical exposure to children can occur both before and after birth. Longer follow-up for children is crucial in birth cohort studies to reinforce the Developmental Origins of Health and Disease hypothesis. In contrast, considering shifts in the exposure levels due to regulation is also essential, which may also change the association to health outcomes. This study found that individual susceptibility to adverse health effects depends on the genotype. Epigenome modification of DNA methylation was also discovered, indicating the necessity of examining molecular biology perspectives. International collaborations can add a new dimension to the current knowledge and provide novel discoveries in the future.
Biomarkers/blood* ; Child ; Child Health ; Child, Preschool ; Cohort Studies ; Environmental Exposure/adverse effects* ; Environmental Health ; Environmental Pollutants/adverse effects* ; Female ; Fetal Blood/chemistry* ; Follow-Up Studies ; Growth/drug effects* ; Humans ; Hypersensitivity/etiology* ; Infant ; Japan/epidemiology* ; Male ; Neurodevelopmental Disorders/etiology* ; Pregnancy ; Prenatal Exposure Delayed Effects/etiology* ; Prevalence ; Smoking/adverse effects*