BACKGROUND: Previous studies have reported that exposure to paraben (Pb) and triclosan (TCS) is associated with allergies. However, Pb and TCS exposure in the Japanese population is not fully understood. OBJECTIVES: The present study was aimed to examine such exposure among Japanese individuals with allergic diseases. METHODS: This cross-sectional study included the International Study of Asthma and Allergies in Childhood questionnaire survey to evaluate allergic outcomes and the collection of urine samples to examine Pb and TCS exposure. RESULTS: Pb containing daily commodities was used in 84.8% children. Pb use was positively associated with current atopic dermatitis (adjusted odds ratio, 4.61; 95% confidence interval, 1.23–17.3). Urinary Pb concentrations were increased significantly in those with current atopic dermatitis (AD) (median, 4.58 vs. 0; p < 0.0001), and showed an increased tendency in those with current wheeze (median, 3.45 vs. 1.81; p = 0.0535) in participants ≤15 years old. Urinary TCS concentration was under the limit of detection in all children. CONCLUSION: Urinary levels of Pb were associated with current AD in children. We should pay more attention about Pb and TCS.
Asian Continental Ancestry Group ; Asthma ; Child ; Cross-Sectional Studies ; Dermatitis, Atopic ; Humans ; Hypersensitivity ; Limit of Detection ; Odds Ratio ; Respiratory Sounds ; Triclosan

Purpose: To investigate the association between skin advanced glycation end-products (AGEs) levels, blood antioxidative vitamin and carotenoid concentrations, and severe erectile dysfunction (ED) in community-dwelling men. Materials and Methods: This cross-sectional study used the 5-Item International Index of Erectile Function to identify 335 community-dwelling men with ED. The accumulation of skin AGEs was assessed noninvasively by measuring skin autofluorescence. Background-adjusted multivariable logistic regression analyses using the inverse probability of treatment weighting method were performed to evaluate the effects of AGEs, vitamins, and carotenoids on severe ED. Moreover, multiple linear regression analyses were performed to assess the association between skin AGEs levels and serum carotenoid concentrations. Results: The median age of study participants was 57 years. Of the 335 men, 289 (86.3%) and 46 (13.7%) were classified into the mild/moderate and severe ED groups, respectively. Multivariable analyses revealed that skin AGEs levels, blood vitamins C and E, lutein, zeaxanthin, β-cryptoxanthin, α-carotene, β-carotene, total lycopene, and cis-lycopenes concentrations were significantly associated with severe ED, whereas all-trans lycopene concentrations were not. In the multiple linear regression analyses, serum zeaxanthin concentrations were negatively and significantly correlated with skin AGEs levels. Conclusions Higher skin AGEs levels and lower blood antioxidative vitamin and carotenoid concentrations were significantly associated with severe ED. Serum zeaxanthin levels were negatively and significantly correlated with skin AGEs levels, suggesting the possible effects of zeaxanthin on ED by decreasing tissue AGEs levels.

Objective: Hospital treatment volume affects survival in patients with endometrial cancer;notably, initial treatment at high-volume centers improves survival outcomes. Our study assessed the effect of hospital treatment volume on cost-effectiveness and survival outcomes in patients with endometrial cancer in Japan. Methods: A decision-analytic model was evaluated using the following variables and their impact on cost-effectiveness: 1) hospital treatment volume (low-, intermediate-, and highvolume centers) and 2) postoperative recurrent risk factors based on pathological findings (high- and intermediate-risk or low-risk). Data were obtained from the Japan Society of Obstetrics and Gynecology database, systematic literature searches, and the Japanese Diagnosis Procedure Combination database. Quality-adjusted life years (QALY) was used as a measure of effectiveness. The model was built from a public healthcare perspective and the impact of uncertainty was assessed using sensitivity analyses. Results: A base-case analysis showed that the incremental cost-effectiveness ratio at high-volume centers was below a willingness-to-pay (WTP) threshold of ¥5,000,000with a maximum of ¥3,777,830/4.28 QALY for the high- and intermediate-risk group, and ¥2,316,695/4.57 QALY for the low-risk group. Treatment at the high-volume centers showed better efficiency and cost-effectiveness in both strategies compared to intermediate- or lowvolume centers. Sensitivity analyses showed that the model outcome was robust to changes in input values. With the WTP threshold, treatment at high-volume centers remained cost-effective in at least 73.6% and 78.2% of iterations for high- and intermediate-risk, and lowrisk groups, respectively. Conclusion Treatment at high-volume centers is the most cost-effective strategy for guiding treatment centralization in patients with endometrial cancer.

Objective: Hospital treatment volume affects survival in patients with endometrial cancer;notably, initial treatment at high-volume centers improves survival outcomes. Our study assessed the effect of hospital treatment volume on cost-effectiveness and survival outcomes in patients with endometrial cancer in Japan. Methods: A decision-analytic model was evaluated using the following variables and their impact on cost-effectiveness: 1) hospital treatment volume (low-, intermediate-, and highvolume centers) and 2) postoperative recurrent risk factors based on pathological findings (high- and intermediate-risk or low-risk). Data were obtained from the Japan Society of Obstetrics and Gynecology database, systematic literature searches, and the Japanese Diagnosis Procedure Combination database. Quality-adjusted life years (QALY) was used as a measure of effectiveness. The model was built from a public healthcare perspective and the impact of uncertainty was assessed using sensitivity analyses. Results: A base-case analysis showed that the incremental cost-effectiveness ratio at high-volume centers was below a willingness-to-pay (WTP) threshold of ¥5,000,000with a maximum of ¥3,777,830/4.28 QALY for the high- and intermediate-risk group, and ¥2,316,695/4.57 QALY for the low-risk group. Treatment at the high-volume centers showed better efficiency and cost-effectiveness in both strategies compared to intermediate- or lowvolume centers. Sensitivity analyses showed that the model outcome was robust to changes in input values. With the WTP threshold, treatment at high-volume centers remained cost-effective in at least 73.6% and 78.2% of iterations for high- and intermediate-risk, and lowrisk groups, respectively. Conclusion Treatment at high-volume centers is the most cost-effective strategy for guiding treatment centralization in patients with endometrial cancer.

Objective: Hospital treatment volume affects survival in patients with endometrial cancer;notably, initial treatment at high-volume centers improves survival outcomes. Our study assessed the effect of hospital treatment volume on cost-effectiveness and survival outcomes in patients with endometrial cancer in Japan. Methods: A decision-analytic model was evaluated using the following variables and their impact on cost-effectiveness: 1) hospital treatment volume (low-, intermediate-, and highvolume centers) and 2) postoperative recurrent risk factors based on pathological findings (high- and intermediate-risk or low-risk). Data were obtained from the Japan Society of Obstetrics and Gynecology database, systematic literature searches, and the Japanese Diagnosis Procedure Combination database. Quality-adjusted life years (QALY) was used as a measure of effectiveness. The model was built from a public healthcare perspective and the impact of uncertainty was assessed using sensitivity analyses. Results: A base-case analysis showed that the incremental cost-effectiveness ratio at high-volume centers was below a willingness-to-pay (WTP) threshold of ¥5,000,000with a maximum of ¥3,777,830/4.28 QALY for the high- and intermediate-risk group, and ¥2,316,695/4.57 QALY for the low-risk group. Treatment at the high-volume centers showed better efficiency and cost-effectiveness in both strategies compared to intermediate- or lowvolume centers. Sensitivity analyses showed that the model outcome was robust to changes in input values. With the WTP threshold, treatment at high-volume centers remained cost-effective in at least 73.6% and 78.2% of iterations for high- and intermediate-risk, and lowrisk groups, respectively. Conclusion Treatment at high-volume centers is the most cost-effective strategy for guiding treatment centralization in patients with endometrial cancer.

OBJECTIVE: We aimed to propose a set of quality indicators (QIs) based on the clinical guidelines for cervical cancer treatment published by The Japan Society of Gynecologic Oncology, and to assess adherence to standard-of-care as an index of the quality of care for cervical cancer in Japan. METHODS: A panel of clinical experts devised the QIs using a modified Delphi method. Adherence to each QI was evaluated using data from a hospital-based cancer registry of patients diagnosed in 2013, and linked with insurance claims data, between October 1, 2012, and December 31, 2014. All patients who received first-line treatment at the participating facility were included. The QI scores were communicated to participating hospitals, and additional data about the reasons for non-adherence were collected. RESULTS: In total, 297 hospitals participated, and the care provided to 15,163 cervical cancer patients was examined using 10 measurable QIs. The adherence rate ranged from 50.0% for ‘cystoscope or proctoscope for stage IVA’ to 98.8% for ‘chemotherapy using platinum for stage IVB’. Despite the variation in care, hospitals reported clinically valid reasons for more than half of the non-adherent cases. Clinically valid reasons accounted for 75%, 90.9%, 73.4%, 44.5%, and 88.1% of presented non-adherent cases respectively. CONCLUSION: Our study revealed variations in pattern of care as well as an adherence to standards-of-care across Japan. Further assessment of the causes of variation and non-adherence can help identify areas where improvements are needed in patient care.
Guideline Adherence ; Humans ; Insurance ; Japan* ; Methods ; Patient Care ; Platinum ; Proctoscopes ; Qi ; Standard of Care ; Uterine Cervical Neoplasms*

The incidence of cerebral infarction due to Takayasu's arteritis is relatively low, and there are few reports on rehabilitation for this condition. We report the case of a patient with Takayasu's arteritis, repeated expansion of cerebral infarction, and subclavian steal syndrome who required careful observation at the start of ambulation. A 17-year-old male was diagnosed with Takayasu's arteritis complicated by subclavian steal syndrome eleven months ago. He was admitted for the treatment of cerebral infarction in the right side of the middle cerebral artery. One day after admission, the area of the infarction expanded. Next day, after he started ambulation (16 days after admission), the area of the infarction further expanded despite ongoing medical treatments, including corticosteroid and immunosuppressant administration. Cerebral blood flow scintigraphy showed stenosis of right middle cerebral, right internal carotid, right common carotid, brachiocephalic, left subclavian, and left vertebral arteries.These arterial stenosis progressed in the two weeks following admission. Thereafter, he complained of dimmed vision more frequently when he raised his body to an upright position. The rehabilitation schedule had to be carefully adjusted according to his symptoms. Two and a half months later, angiographic examination showed development of adequate collateral circulation from the bilateral intercostal arteries to both vertebral arteries. After we confirmed the collateral circulation, we allowed him to use a wheelchair. The confirmation of collateral circulation by image analysis is important in order to decide the time to start ambulation in patients with Takayasu's arteritis (early phase) along with repeated cerebral ischemia.

The incidence of cerebral infarction due to Takayasu's arteritis is relatively low, and there are few reports on rehabilitation for this condition. We report the case of a patient with Takayasu's arteritis, repeated expansion of cerebral infarction, and subclavian steal syndrome who required careful observation at the start of ambulation. A 17-year-old male was diagnosed with Takayasu's arteritis complicated by subclavian steal syndrome eleven months ago. He was admitted for the treatment of cerebral infarction in the right side of the middle cerebral artery. One day after admission, the area of the infarction expanded. Next day, after he started ambulation (16 days after admission), the area of the infarction further expanded despite ongoing medical treatments, including corticosteroid and immunosuppressant administration. Cerebral blood flow scintigraphy showed stenosis of right middle cerebral, right internal carotid, right common carotid, brachiocephalic, left subclavian, and left vertebral arteries.These arterial stenosis progressed in the two weeks following admission. Thereafter, he complained of dimmed vision more frequently when he raised his body to an upright position. The rehabilitation schedule had to be carefully adjusted according to his symptoms. Two and a half months later, angiographic examination showed development of adequate collateral circulation from the bilateral intercostal arteries to both vertebral arteries. After we confirmed the collateral circulation, we allowed him to use a wheelchair. The confirmation of collateral circulation by image analysis is important in order to decide the time to start ambulation in patients with Takayasu's arteritis (early phase) along with repeated cerebral ischemia.

People with high health knowledge tend to use information and communication technology (ICT) to obtain, maintain, and promote information necessary for health management. Therefore, experts hypothesize that improving health knowledge will increase the use of online medication guidance via ICT. In this study, we investigated the relationship between health knowledge and willingness to use online medication guidance among Iwaki Health Promotion Project health checkup subjects. The 736 examinees participating in this project in 2022 were surveyed on age, gender, number of people living with them, whether they exercise, drink alcohol, or smoke, whether they use smartphones, whether they use medication registers, their health knowledge score, and whether they take any medications. The presence/absence of desire for online medication guidance (1/0) was used as the objective variable to identify influencing factors. Univariate and multivariate analyses showed that independence was found for four factors: age (OR: 0.975, P<0.001), gender (male) (OR: 1.914, P<0.001), smartphone use (OR: 2.156, P＝0.004) and health knowledge score (OR: 1.405, P<0.001). This study found that health knowledge plays a role in the intention to use online medication guidance. In order to improve health knowledge, it will be necessary to enhance skills to obtain and use high-quality health information and to improve the environment for using ICT-based communication devices.