Public health education in Japan has been carried out, on the one hand, as part of professional education for physicians and other medical professionals based on the Constitution of Japan Article 25 and medical professional’s laws introduced in post–world war II, and on the other hand, as part of general education subjects, in which main health problems in each stage of the life is taught in universities throughout Japan. In addition, postgraduate programs （doctoral program） are carried on in order to train public health researchers, while their training is rather specific topic–oriented, but not systematic nor extensive in terms of public health discipline. Recently, because the Japanese society faces new health and medical problems and various environmental risks, the specialist education for new public health discipline has been required. Therefore, a few professional schools （master program）, which is equivalent to schools of public health overseas, have been established in Japan.

The objective of this study is to assess the differences in access to antiretroviral treatment among health insurance recipients, using a patient-based analysis.
METHODS: The subjects were 324 outpatients with the human immunodeficiency virus who were treated at a regional hospital for infectious diseases in Khon Kaen Province. We collected data every visit of the patients during the study period between April1 and September 30 in 2002. We defined access to antiretroviral treatment as having a prescription for antiretroviral drugs on at least one visit during the study period. We examined the relationship between access to antiretroviral treatment and age, sex, stage of acquired immune deficiency syndrome (AIDS), and health insurance. We also compared the results of the patient-based analysis and the record-based analysis that was used in our previous study.
RESULTS: Multiple logistic regression analysis shows that patients insured by the Civil Servant Medical Benefit Scheme have better access to antiretroviral treatment than the others (vs. Universal Coverage; odds ratio=11.38, 95% confidence interval=4.09, 31.65). We have also shown that patients with AIDS-related complex have better access to antiretroviral treatment compared to asymptomatic AIDS patients (odds ratio=3.38, 95% confidence interval=1.31-8.76). Values of these odds ratios were lower in the record-based analysis than in the patient-based analysis.
CONCLUSIONS: Patients insured by the Civil Servant Medical Benefit Scheme had better access to antiretroviral drugs. We reconfirm the differences in access to antiretroviral treatment among health insurance recipients, using the patient-based analysis.

Objective
 To investigate the relationship between uses of highly active antiretroviral therapy (HAART) and sexual behavior among people living with HIV (PLHIV) in northeast Thailand.
Methods
 Data were collected both by interviews using a structured questionnaire and by a self-administered questionnairewith HIV positive patients who made an outpatient visit to a public hospital in northeast Thailand between March2004 and January 2005. Fisher's exact test and multiple logistic regression analysis were conducted to identify thefactors associated with regular condom use when these patients had sex with their spouse/partner.
Results
 Among 289 patients (146 with HAART and 143 without HAART) who participated in the study, 122 had sex with their spouse/partner in the three months before the survey. Among them, 70 used a condom every time, 17 used a condom sometimes, 32 never, and 3 unknown. Excluding the 6 patients who did not answer all of the questions, 116 patients remained in the analysis. In the multiple logistic regression analysis, sex, education, employment, years since HIV infection, illness episode in the past one month, and use of HAART were entered as the explanatory factors. Use of HAART (odds ratio=9.8, 95% CI: 2.9 - 32.9) and current employment (odds ratio= 5.2, 95%CI: 1.3 - 20.9) were significantly associated with regular condom use.
Conclusion
 Use of HAART was positively associated with use of condoms when PLHIV had sex with their spouse or partner.

Background: We investigated how individual home care services by nurses, care workers, and therapists at patients' homes are related with the continuation of home medical care service provided by medical doctors.Methods: This research retrospectively analyzed primary insured patients registered with the Japanese long-term care insurance system who had newly started using home medical care service, and whose care level was between 1 and 5 according to national long-term care insurance system claims data. We performed multivariable logistic regression analysis to evaluate patients who used home medical care continuously for >3 months and the utilization of each home care service adjusted for patient age, gender, and care level.Results: A total of 26,590 patients were analyzed. Multivariable analysis revealed that the following home care services were associated with longer continuation of home medical care service compared with home medical care alone: day service (OR, 2.10; 95% CI, 1.98-2.23), home help service (1.91; 1.81-2.01), day care including rehabilitation (1.88; 1.69-2.10), home-visit rehabilitation (1.49; 1.31-1.69), and home-visit nursing (1.23; 1.16-1.31).Conclusions: Our results demonstrated a correlation between utilization of home care services and longer continuation of home medical care from the start. These findings may help medical doctors who provide home medical care service collaborate with other home care services by nurses, care workers, and in-home care therapists.

Background/Aims: Serum leucine-rich alpha-2 glycoprotein (LRG) is a potential biomarker of Crohn’s disease (CD). This study aimed to evaluate the usefulness of LRG in predicting clinical relapse in patients in remission with CD. Methods: This retrospective observational study assessed the relationships among patient-reported outcome (PRO2), LRG, and other blood markers. The influence of LRG on clinical relapse was assessed in patients in remission with CD. Results: Data of 94 patients tested for LRG between January 2021 and May 2023 were collected. LRG level did not correlate with PRO2 score (ρ = 0.06); however, it strongly correlated with C-reactive protein (CRP) level (r=0.79) and serum albumin level (r=–0.70). Among 69 patients in clinical remission, relapse occurred in 22 patients (31.9%). In the context of predicting relapse, LRG showed the highest area under the curve, followed by CRP level, platelet count, and albumin level. Multivariate analysis revealed that only LRG (P= 0.02) was an independent factor for predicting clinical remission. The cumulative non-relapse rate was significantly higher in patients with LRG < 13.8 μg/mL than in patients in remission with LRG ≥ 13.8 μg/mL and normal CRP level (P= 0.002) or normal albumin level (P= 0.001). Cumulative non-relapse rate was also higher in patients with LRG < 13.8 μg/mL compared to those with LRG ≥ 13.8 μg/mL in patients with L3 or B2+B3 of Montreal calcification. Conclusions LRG is useful in predicting clinical relapse in patients with CD during biological remission. LRG is a useful biomarker for predicting prognosis, even in patients with intestinal stenosis, or previous/present fistulas.

Background/Aims: Serum leucine-rich alpha-2 glycoprotein (LRG) is a potential biomarker of Crohn’s disease (CD). This study aimed to evaluate the usefulness of LRG in predicting clinical relapse in patients in remission with CD. Methods: This retrospective observational study assessed the relationships among patient-reported outcome (PRO2), LRG, and other blood markers. The influence of LRG on clinical relapse was assessed in patients in remission with CD. Results: Data of 94 patients tested for LRG between January 2021 and May 2023 were collected. LRG level did not correlate with PRO2 score (ρ = 0.06); however, it strongly correlated with C-reactive protein (CRP) level (r=0.79) and serum albumin level (r=–0.70). Among 69 patients in clinical remission, relapse occurred in 22 patients (31.9%). In the context of predicting relapse, LRG showed the highest area under the curve, followed by CRP level, platelet count, and albumin level. Multivariate analysis revealed that only LRG (P= 0.02) was an independent factor for predicting clinical remission. The cumulative non-relapse rate was significantly higher in patients with LRG < 13.8 μg/mL than in patients in remission with LRG ≥ 13.8 μg/mL and normal CRP level (P= 0.002) or normal albumin level (P= 0.001). Cumulative non-relapse rate was also higher in patients with LRG < 13.8 μg/mL compared to those with LRG ≥ 13.8 μg/mL in patients with L3 or B2+B3 of Montreal calcification. Conclusions LRG is useful in predicting clinical relapse in patients with CD during biological remission. LRG is a useful biomarker for predicting prognosis, even in patients with intestinal stenosis, or previous/present fistulas.

Background/Aims: Serum leucine-rich alpha-2 glycoprotein (LRG) is a potential biomarker of Crohn’s disease (CD). This study aimed to evaluate the usefulness of LRG in predicting clinical relapse in patients in remission with CD. Methods: This retrospective observational study assessed the relationships among patient-reported outcome (PRO2), LRG, and other blood markers. The influence of LRG on clinical relapse was assessed in patients in remission with CD. Results: Data of 94 patients tested for LRG between January 2021 and May 2023 were collected. LRG level did not correlate with PRO2 score (ρ = 0.06); however, it strongly correlated with C-reactive protein (CRP) level (r=0.79) and serum albumin level (r=–0.70). Among 69 patients in clinical remission, relapse occurred in 22 patients (31.9%). In the context of predicting relapse, LRG showed the highest area under the curve, followed by CRP level, platelet count, and albumin level. Multivariate analysis revealed that only LRG (P= 0.02) was an independent factor for predicting clinical remission. The cumulative non-relapse rate was significantly higher in patients with LRG < 13.8 μg/mL than in patients in remission with LRG ≥ 13.8 μg/mL and normal CRP level (P= 0.002) or normal albumin level (P= 0.001). Cumulative non-relapse rate was also higher in patients with LRG < 13.8 μg/mL compared to those with LRG ≥ 13.8 μg/mL in patients with L3 or B2+B3 of Montreal calcification. Conclusions LRG is useful in predicting clinical relapse in patients with CD during biological remission. LRG is a useful biomarker for predicting prognosis, even in patients with intestinal stenosis, or previous/present fistulas.

BACKGROUND: As society is aging, retirement takes on increasing importance for individuals in the later life. This study aimed to describe mortality before and after retirement in the Japanese middle-aged/elderly with special attention to socioeconomic position and social relationships. METHODS: We conducted a 10-year follow-up study (the Komo-Ise cohort study) and assessed mortality according to socioeconomic positions (relative poverty and occupation) and social relationships (e.g., marital status, living alone, and social support) in workers and the retired. Relative poverty was defined as a household equivalent income of 12,700 US dollars (1.37 million Japanese Yen) or less in 2000. Stratified analyses were conducted according to sex in two groups of employment status: the workers and the retired. Adjusted hazard ratios (HRs) were calculated using the Cox proportional hazard model. RESULTS: We included 5534 individuals. Of these, 3360 were men (working, 2499; retired, 861) and 2174 were women (working, 1306; retired, 868). We observed 610 deaths (475 in men and 135 in women) during the study period. Relative poverty was a significant risk factor for death (HR 1.52, 95% confidence interval [CI] 1.07-2.14) among retired men but not among working men (HR 1.20, 95% CI 0.79-1.83). Among workers, self-employed men showed a significantly higher hazard of death (HR 1.57, 95% CI 1.09-2.25) than white-collar employees. Retired men who lacked participation in social activities were more likely to die than those who did not (HR 1.44, 95% CI 1.06-1.94). All results, except marital status, indicated non-significant associations in women. CONCLUSIONS Relative poverty and lack of social engagement may be related to high mortality risk in retired men. Further studies are needed to assess the health status among the middle-aged/elderly population around retirement.
Aged ; Female ; Follow-Up Studies ; Health Status ; Humans ; Japan ; Male ; Middle Aged ; Mortality ; Poverty ; psychology ; statistics & numerical data ; Proportional Hazards Models ; Retirement ; psychology ; Risk Factors ; Social Environment