Publications by authors named "Masahiro Kami"

249 Publications

Japan's Drug Regulation During the COVID-19 Pandemic: Lessons From a Case Study of Favipiravir.

Clin Pharmacol Ther 2021 Apr 21. Epub 2021 Apr 21.

Medical Governance Research Institute, Tokyo, Japan.

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http://dx.doi.org/10.1002/cpt.2251DOI Listing
April 2021

Are less aggressive national lockdowns in COVID-19 associated with enhanced economic activity?

QJM 2021 Jan 30. Epub 2021 Jan 30.

Medical Governance Research Institute, Tokyo, Japan, Address: 2-12-13-201 Takanawa, Minato-ku, Tokyo, 108-0074.

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http://dx.doi.org/10.1093/qjmed/hcab021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7928696PMC
January 2021

Prevalence of iron deficiency among university kendo practitioners in Japan: an observational cohort study.

J Int Soc Sports Nutr 2020 Dec 7;17(1):62. Epub 2020 Dec 7.

Medical Governance Research Institute, Minato-ku, Tokyo, Japan.

Background: Iron deficiency is widely recognized as being the cause of anemia in athletes, although iron status in athletes of Kendo, a traditional Japanese martial art based on swordsmanship and practiced as an educational sport, has not been widely investigated.

Methods: We performed a health assessment on anemia and serum ferritin levels, along with nutrient intake evaluation, for Kendo practitioners in a university in Japan.

Results: A total of 56 Kendo practitioners (39 male and 17 female) aged between 18 and 23 years participated in the study. No individuals exhibited WHO-defined anemia (less than 13 or 12 g/dL of hemoglobin levels in male or female), while hypoferritinemia (less than 30 ng/mL) was found in seven (41%) females but not in males. Significantly higher body mass index was found in the female athletes with hypoferritinemia compared to females with normo-ferritinemia in sub-analysis (median [interquartile range]; 25.6 [24.2, 26.9] versus 22.6 [21.7, 24.1], respectively. p < 0.05). No significant differences in the intake of iron were registered between males and females (with and without hypoferritinemia) using data from a food-frequency questionnaire survey.

Conclusion: No apparent anemia was found in adolescent Kendo practitioners, although this study confirmed the presence of hypoferritinemia in several female athletes. Careful follow-up, involving both clinical and nutritional assessment, will be necessary for them to prevent progression into anemia. A future study with larger cohorts in multiple sites is warranted to assess the prevalence of iron deficiency for validation and, if necessary, to devise a strategy for improving the iron status in Kendo athletes.
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http://dx.doi.org/10.1186/s12970-020-00393-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720520PMC
December 2020

Atypical Femur Fracture Risk versus Fragility Fracture Prevention with Bisphosphonates.

N Engl J Med 2020 11;383(22):2188

Medical Governance Research Institute, Tokyo, Japan.

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http://dx.doi.org/10.1056/NEJMc2029828DOI Listing
November 2020

The Proportion of Female Physician Links With Advanced Educational Opportunity for Female and by Female.

Int J Health Policy Manag 2020 09 1;9(9):411-412. Epub 2020 Sep 1.

Medical Governance Research Institute, Tokyo, Japan.

Background: The overall proportion of female physician is increasing worldwide. However, its ratio exhibits a substantial diversity among each member country of Organisation for Economic Co-operation and Development (OECD). This study aimed to reveal the social factors of countries associated with the percentage of female physicians.

Methods: We retrieved the percentage of female physicians and social characteristic which may affect the ratio of female physicians of 36 OECD countries in 2016 or nearest year from the World Bank Open Data. Multivariate regression analysis was performed after univariate evaluations with Spearman's coefficient to explore correlation of social variables with the proportion of female physicians.

Results: The percentages of female adolescents who dropped out of school before lower secondary school, female population that attained or completed Master's or equivalent degree, female labour force, and female academic staff in tertiary education showed statistically significant correlation with proportion of female physicians (Spearman coefficient = -0.527, 0.585, 0.501, and 0.499; =.01, .001, .002, and .008). Female's educational attainment at least Master's or equivalent and that of female academic staff at tertiary education were selected after multivariate analysis.

Conclusion: Our study revealed the relationships between advanced education opportunity and female participation in academic positions with the percentage of female physicians. Our research is limited in the difficulty to evaluate physicians' working hours in spite of its possible effect. Further studies with qualitative assessment are warranted to explore the detail reasons to cause gender gap in physician.
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http://dx.doi.org/10.15171/ijhpm.2019.147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557424PMC
September 2020

Statins for Familial Hypercholesterolemia from Childhood.

N Engl J Med 2020 01;382(5):488

Medical Governance Research Institute, Tokyo, Japan.

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http://dx.doi.org/10.1056/NEJMc1915311DOI Listing
January 2020

Unambiguous evidence is required to accurately understand the health impacts of nuclear accidents.

J Radiat Res 2020 01;61(1):90-91

Department of Public Health, Fukushima Medical University School of Medicine, Fukushima City, Fukushima 960-1295, Japan.

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http://dx.doi.org/10.1093/jrr/rrz069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6976740PMC
January 2020

Physician Decision-Making Patterns and Family Presence: Cross-Sectional Online Survey Study in Japan.

Interact J Med Res 2019 Sep 6;8(3):e12781. Epub 2019 Sep 6.

Navitas Clinic, Tachikawa, Japan.

Background: Due to a low birth rate and an aging population, Japan faces an increase in the number of elderly people without children living in single households. These elderly without a spouse and/or children encounter a lack of caregivers because most sources of care for the elderly in Japan are not provided by private agencies but by family members. However, family caregivers not only help with daily living but are also key participants in treatment decision making. The effect of family absence on treatment decision making has not been elucidated, although more elderly people will not have family members to make surrogate decisions on their behalf.

Objective: The aim is to understand the influence of family absence on treatment decision making by physicians through a cross-sectional online survey with three hypothetical vignettes of patients.

Methods: We conducted a cross-sectional online survey among Japanese physicians using three hypothetical vignettes. The first vignette was about a 65-year-old man with alcoholic liver cirrhosis and the second was about a 78-year-old woman with dementia, both of whom developed pneumonia with consciousness disturbance. The third vignette was about a 70-year-old woman with necrosis of her lower limb. Participants were randomly assigned to either of the two versions of the questionnaires-with family or without family-but methods were identical otherwise. Participants chose yes or no responses to questions about whether they would perform the presented medical procedures.

Results: Among 1112 physicians, 454 (40.8%) completed the survey; there were no significant differences in the baseline characteristics between groups. Significantly fewer physicians had a willingness to perform dialysis (odds ratio [OR] 0.55, 95% CI 0.34-0.80; P=.002) and artificial ventilation (OR 0.51, 95% CI 0.35-0.75; P<.001) for a patient from vignette 1 without family. In vignette 2, fewer physicians were willing to perform artificial ventilation (OR 0.59, 95% CI 0.39-0.90; P=.02). In vignette 3, significantly fewer physicians showed willingness to perform wound treatment (OR 0.51, 95% CI 0.31-0.84; P=.007), surgery (OR 0.35, 95% CI 0.22-0.57; P<.001), blood transfusion (OR 0.45, 95% CI 0.31-0.66; P<.001), vasopressor (OR 0.49, 95% CI 0.34-0.72; P<.001), dialysis (OR 0.38, 95% CI 0.24-0.59; P<.001), artificial ventilation (OR 0.25, 95% CI 0.15-0.40; P<.001), and chest compression (OR 0.29, 95% CI 0.18-0.47; P<.001) for a patient without family.

Conclusions: Elderly patients may have treatments withheld because of the absence of family, highlighting the potential importance of advance care planning in the era of an aging society with a declining birth rate.
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http://dx.doi.org/10.2196/12781DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764328PMC
September 2019

Factors affecting the provision of analgesia during childbirth, Japan.

Bull World Health Organ 2019 Sep 17;97(9):631-636. Epub 2019 Jul 17.

Kitasato University, Tokyo, Japan.

Japan's universal health-care system means that it is a very safe country in which to give birth. Perinatal outcomes in Japan are excellent, with low infant mortality and neonatal mortality. However, childbirth remains a challenge for many Japanese women, who are faced with a scarcity of places to give birth, limited availability of analgesia and social norms that favour natural birth. The number of birth facilities in Japan continues to decrease as fewer children are born. The numbers of qualified medical staff remain inadequate, with a continuing lack of female physicians, perpetuated by a pervasive negative gender bias. Recruitment efforts are underway, but few doctors want to specialize in obstetrics or gynaecology. Furthermore, around half of female obstetricians and gynaecologists in Japan's male-dominated medical system stop practising when they have their own children. The difficulty of obtaining analgesia during labour is another problem. Although low uptake of labour pain relief in Japan is said to be due to cultural influences, the root of the problem is a lack of qualified anaesthesiologists and the inflexibility of a system that will not allow other staff to be trained to administer labour analgesia. Problems with labour anaesthesia have been linked to 14 maternal deaths since 2010. Japanese policy-makers need to act to renovate the nation's obstetric facilities, reorganize regional perinatal care systems, train more obstetricians and anaesthesiologists, promote task-shifting and better integrate biomedical and traditional, non-medical care for pregnant women.
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http://dx.doi.org/10.2471/BLT.19.230128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6705500PMC
September 2019

Demographic and geographical characteristics of pediatric patients presenting to a convenient clinic at a large railway station in a metropolitan area of Tokyo.

Medicine (Baltimore) 2019 Aug;98(33):e16818

Department of Internal Medicine.

There is an increasing demand for medical provision systems that are friendly for working mothers with sick children in Japan. The aim of this cross-sectional, observational study was to analyze the demographic characteristics of pediatric patients presenting to a convenient care clinic, which was located in a large railway station and offered primary care with after-hours accessibility in a metropolitan area of Tokyo.We analyzed anonymous data for patients who had visited the pediatric department at a clinic between August 2013 and June 2016. Data regarding patients' sex, age, time of visit, waiting time, presence or absence of an appointment, diagnosis, and addresses were collected from electronic health and billing records.Overall, 8091 patients visited the department 45,388 times. The numbers of visits by patients who resided within 2, 5, and 10 miles of the clinic were 37,160 (84.6%), 42,336 (96.4%), and 43,399 (98.8%), respectively. No seasonal variation in the number of visits was observed. Male patients visited the clinic 23,742 times (52.3%) and the patients' median age was 3 years (interquartile range, 1-6). Most visits occurred on Mondays, and 5643 (15.2%) and 4790 (12.9%) patients visited the clinic when consultations began at 10 AM and 3 PM, respectively. Approximately 20% of weekday visits occurred after 6 PM, when other pediatricians' offices were typically closed. Children older than 7 years of age visited the clinic more frequently after 6 PM. The overall median waiting time was 650 seconds (interquartile range, 429-1020). The 3 most common diagnoses were upper respiratory tract infection (27,173), asthmatic bronchitis (23,744), and allergic rhinitis (10,556). The number of individuals who were referred to other medical institutions was 284 (0.6%).The majority of patients were children aged 1 to 4 years living near the clinic and 80% of visits were during the daytime. However, children older than 7 years of age visited the clinic more frequently after 6 PM. The convenience of the clinic contributed to the fulfillment of the medical needs of children with mild illnesses whose mothers were in full-time employment.
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http://dx.doi.org/10.1097/MD.0000000000016818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6831409PMC
August 2019

Negative Aspects of the Regional Quota System in Japan.

JMA J 2019 Mar 22;2(1):85-86. Epub 2019 Feb 22.

Medical Governance Research Institute, Tokyo, Japan.

is a measure to improve the maldistribution and shortage of physicians in rural areas in Japan. Although quota seats have been on the rise, a considerable number of young physicians and medical students return their loans and do not fulfill their duty periods for several important reasons, including an obligation term lasting for 9 years. The number of medical students who do not apply for admission to the quota has increased, and vacancies have developed in some medical schools. Urgent modification of this program is therefore required to make it suitable for actual situations of both rural medical care and the education of young physicians.
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http://dx.doi.org/10.31662/jmaj.2018-0055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930711PMC
March 2019

Bibliometric Study of Obstetrics Articles Published in the Journal of the American Medical Association, 1997-2016.

Cureus 2018 Oct 13;10(10):e3448. Epub 2018 Oct 13.

Internal Medicine, Medical Governance Research Institute, Tokyo, JPN.

Introduction A recent increase in cases of advanced maternal age in the US has been partly associated with a higher incidence of pregnancy-related complications and infertility. However, little is known on how such social changes may have influenced obstetrics articles published in high-impact medical journals subscribed by diverse physicians. The objective of this study is to elucidate the presence and trend of obstetrics investigations in high-profile medical journals. Material and methods This bibliometric study retrospectively analyzed original articles published in the Journal of the American Medical Association (JAMA) from 1997 to 2016. Two reviewers extracted obstetrics articles from PubMed, assessed whether to include specific articles, and categorized them by subtopic. Main outcomes measure was the annual number of original investigations in obstetrics divided by that of original investigations from all fields during the study period, expressed as a trend. Results A total of 3486 original investigations were published during the study period. Regarding obstetrics, 1989 articles were originally extracted from PubMed; after a two-step review process, 199 (10.0%) obstetrics-related original investigations remained. Among them, 134 (67.4%) were classified as pregnancy-related abnormalities or complications (non-infection). The proportion of obstetrics articles decreased during the first 10 years but increased in the last 10 years. The highest figures in the first 10 and last 10 years were 8.5% in 1999 and 9.4% in 2014, respectively, whereas the lowest was 1.4% in 2008. The proportion articles on pregnancy-associated complications or abnormalities (non-infection) steadily increased during the study period, that of articles on infertility increased, and that of articles on human immunodeficiency virus (HIV) infection steadily decreased. Conclusions The observed trend may suggest a changing interest in obstetrics investigations among general physicians in the last 20 years. What is particularly notable is a heightened presence of research on pregnancy-related complications and infertility, which may reflect an increasing frequency in advanced maternal age in the US.
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http://dx.doi.org/10.7759/cureus.3448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294270PMC
October 2018

Distribution of dentists in the Greater Tokyo Area, Japan.

Int Dent J 2019 Apr 23;69(2):150-157. Epub 2018 Oct 23.

Medical Governance Research Institute, Tokyo, Japan.

Introduction: Japan is considered to have an overabundance of dentists; however, there are scarce data on regional inequalities in the ratio of dentists to patients. We examined these inequalities in Japan's Greater Tokyo Area - otherwise known as the Kanto region, and the world's most populous metropolitan area - by subdividing it into small- and medium-sized medical care zones.

Methods: We calculated the number of dentists per 100,000 population using the 2012 Survey of Physicians, Dentists, and Pharmacists for the three medical district tiers [primary medical care zones: municipalities (cities, towns, villages and special wards); secondary medical care zones: multiple adjacent municipalities; and tertiary care zones: prefectures]. We also estimated the influence of having a dental school in the district or an adjacent district on the number of dentists.

Results: The number of dentists per 100,000 population was 79.2 across the whole Kanto region; the range for each type of medical care zone was as follows: 65.3-126.4 at the tertiary level; 38.0-929.6 at the secondary level; and 0-3,087.6 at the primary level. The median Gini coefficient among tertiary medical care zones was 0.16 (range 0.11-0.36). The median number of dentists per 100,000 population was 273.8 in primary medical care zones that had a dental school, 79.9 in adjacent zones, and 59.6 in other zones.

Conclusions: We identified significant inequalities in the number of dentists among the medical care zones, and the presence of a dental school had a major influence on this number.
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http://dx.doi.org/10.1111/idj.12446DOI Listing
April 2019

Involvement of doctors in Aum Shinrikyo.

Lancet 2018 09;392(10153):1116

Medical Governance Research Institute, Tokyo, Japan.

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http://dx.doi.org/10.1016/S0140-6736(18)31869-5DOI Listing
September 2018

A model-based estimation of inter-prefectural migration of physicians within Japan and associated factors: A 20-year retrospective study.

Medicine (Baltimore) 2018 Jun;97(22):e10878

Keio University Navitas Clinic, Tokyo Jyoban Hospital of Tokiwa Foundation Soma Central Hospital, Fukushima Medical Governance Research Institute, Tokyo National Cancer Center Hospital East, Chiba National Center for Child Health and Development, Tokyo Kyoto University, Kyoto Ohmachi Hospital, Fukushima Graduate School of Public Health, Teikyo University, Tokyo Kanagawa Cancer Center, Kanagawa Institute of Medical Sciences, University of Tokyo, Tokyo, Japan.

Despite an increase in the number of physicians in Japan, misdistribution of physicians within the 47 prefectures remains a major issue. Migration of physicians among prefectures might partly explain the misdistribution. However, geographical differences and the magnitude of physicians' migration are unclear. The aim of this study was to estimate the extent of migration of physicians among prefectures and explore possible factors associated with physicians' migration patterns.Using a publicly available government database from 1995 to 2014, a quantitative estimation of physicians' migration after graduation from a medical school was performed. The inflow and outflow of physicians were ostensibly calculated in each prefecture based on the differences between the number of newly licensed physicians and the actual number of practicing physicians after an adjustment for the number of deceased or retired physicians. Simple and multiple linear regression analyses were conducted to examine socio-demographic background factors.During the 20-year study period, the mean annual numbers of newly licensed physicians, deceased or retired physicians, and increase in practicing physicians in the whole country were 7416, 3382, and 4034, respectively. Among the 47 prefectures, the median annual number of newly licensed physicians to 100,000 population ratio (PPR) was 6.4 (range 1.5-16.5), the median annual adjusted number of newly licensed physicians was 61 (range, -18 to 845; the negative and positive values denote outflow and inflow, respectively), whereas the median annual number of migrating physicians was 13 (range, -171 to 241). The minimum and maximum migration ratios observed were -68% and 245%, respectively. In the final regression model of the 8 variables examined, only "newly licensed PPR" remained significantly associated with physician's migration ratios.A significant inequality in the proportion of the migration of physicians among prefectures in Japan was observed. The multivariate analyses suggest that the newly licensed PPRs, and not from-rural-to-urban migration, might be one of the keys to explaining the migration ratios of physicians. The differences and magnitude of physicians' migration should be factored into mitigate misdistribution of physicians.
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http://dx.doi.org/10.1097/MD.0000000000010878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6392712PMC
June 2018

Demographic transition and factors associated with remaining in place after the 2011 Fukushima nuclear disaster and related evacuation orders.

PLoS One 2018 14;13(3):e0194134. Epub 2018 Mar 14.

Department of Research, Minamisoma Municipal General Hospital, Minamisoma City, Fukushima, Japan.

Introduction: Demographic changes as a result of evacuation in the acute phase of the 2011 Fukushima nuclear disaster are not well evaluated. We estimated post-disaster demographic transitions in Minamisoma City-located 14-38 km north of the nuclear plant-in the first month of the disaster; and identified demographic factors associated with the population remaining in the affected areas.

Materials And Methods: We extracted data from the evacuation behavior survey administered to participants in the city between July 11, 2011 and April 30, 2013. Using mathematical models, we estimated the total population in the city after the disaster according to sex, age group, and administrative divisions of the city. To investigate factors associated with the population remaining in place after the disaster, a probit regression model was employed, taking into account sex, age, pre-disaster dwelling area, and household composition.

Results: The overall population decline in Minamisoma City peaked 11 days after the disaster, when the population reached 7,107 people-11% of the pre-disaster level. The remaining population levels differed by area: 1.1% for mandatory evacuation zone, 12.5% for indoor sheltering zone, and 12.6% for other areas of the city. Based on multiple regression analyses, higher odds for remaining in place were observed among men (odds ratio 1.72 [95% confidence intervals 1.64-1.85]) than women; among people aged 40-64 years (1.40 [1.24-1.58]) than those aged 75 years or older; and among those living with the elderly, aged 70 years or older (1.18 [1.09-1.27]) or those living alone (1.71 [1.50-1.94]) than among those who were not.

Discussion: Despite the evacuation order, some residents of mandatory evacuation zones remained in place, signaling the need for preparation to respond to their post-disaster needs. Indoor sheltering instructions may have accelerated voluntary evacuation, and this demonstrates the need for preventing potentially disorganized evacuation in future nuclear events.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0194134PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851610PMC
July 2018

Patients' demographics of a convenient clinic located in a large railway station in metropolitan Tokyo area.

Medicine (Baltimore) 2018 Jan;97(2):e9646

Department of Hematology and Rheumatology, Teikyo University Chiba Medical Center, Chiba Department of Internal Medicine, Navitas Clinic, Tokyo Graduate School of Education, Seisa University, Kanagawa Department of Pediatrics, Navitas Clinic Medical Governance Research Institute, Tokyo, Japan.

Hidden barriers to visit a medical facility especially for young busy workers have been neglected in the aging society. The aim of this cross-sectional study is to analyze demographics of patients who had visited the first known convenient clinic located inside a railway station, which is adjusted to the lifestyle of working generations.We analyzed de-identified data of patients who had visited the department of internal medicine of a clinic, which is located inside a railway station building and offers primary care with after-hours accessibility in Tokyo, between August 2013 and June 2016. Data were collected on patients' sex, age, time of visit, waiting time, presence or absence of an appointment, diagnosis, and patients' addresses using the electronic health and billing records.Overall, 28,001 patients visited 87,126 times. Number of visits increased in winter season compared with the other seasons. Sixty-one percent were women and the median age of all patients was 38 years (range, 0-102). The number of visits on Mondays was the highest in a week and the most frequent visiting time was between 6 and 7 p.m. The number of visits of working generations (from 15 to 65 years old) and men increased after 6 p.m. and on weekends. The 3 most common diagnoses were upper respiratory tract infection (22,457), allergic rhinitis (20,916), and hypertension (4869). The number of individuals who were referred to other medical institutions was 1022 (1.2%). The median waiting time was 748 seconds (range, 2-5344). The number of visits from within 2-, 5-, and 10-mile radius from our clinic was 41,696 (50.6%), 63,190 (76.7%), and 75,015 (91.1%), respectively, and patients' addresses were mainly located along the railway network.The locational and temporal convenience of our clinic has attracted the unmet medical demands especially for young workers who have difficulty in visiting conventional medical institutions.
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http://dx.doi.org/10.1097/MD.0000000000009646DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5943878PMC
January 2018

Long-Term Outcomes of 107 Cases of Primary Thyroid Mucosa-Associated Lymphoid Tissue Lymphoma at a Single Medical Institution in Japan.

J Clin Endocrinol Metab 2018 02;103(2):732-739

Ito Hospital, Tokyo, Japan.

Context: Thyroid mucosa-associated lymphoid tissue (MALT) lymphoma is a type of extranodal lymphoma with a favorable prognosis.

Objective: To provide information on long-term outcomes that would facilitate establishment of the optimal management strategy for thyroid lymphoma.

Design, Setting, And Participants: Medical records of 107 patients (median age 67 years, 20 males, 87 females) who were diagnosed with localized thyroid MALT lymphoma stage IE or IIE at Ito Hospital were retrospectively reviewed.

Main Outcome Measure: Overall and event-free survival (EFS).

Results: Initial treatments included radiation therapy (RT) alone (n = 58), combined modality therapy (CMT) (n = 48), or chemotherapy alone (n = 1). All 107 patients responded to the treatment, six of whom experienced relapse. Only one patient died of lymphoma. The 5-year overall survival (OS) and EFS rates were 94% [95% confidence interval (CI), 87% to 97%] and 92% (95% CI, 85% to 95%), respectively, and the 10-year OS and EFS rates were 91% (95% CI, 83% to 95%) and 84% (95% CI, 74% to 90%), respectively. Of the 106 patients with information available on adverse events, 71 patients (67%) developed hypothyroidism after primary thyroid lymphoma treatment. The CMT group showed additional chemotherapy-induced adverse reactions in the form of neutropenia, neuropathy, constipation, and pneumonia. The 5-year OS rates of patients treated with CMT and RT were 93% (95% CI, 81% to 98%) and 94% (95% CI, 84% to 98%), respectively.

Conclusions: Long-term outcomes of localized thyroid MALT lymphoma are favorable with all initial treatment modalities.
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http://dx.doi.org/10.1210/jc.2017-01478DOI Listing
February 2018

Tranexamic acid for post-partum haemorrhage in the WOMAN trial.

Lancet 2017 09 28;390(10102):1583-1584. Epub 2017 Sep 28.

Kobe City Medical Center General Hospital, Hyogo 650-0047, Japan.

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http://dx.doi.org/10.1016/S0140-6736(17)31949-9DOI Listing
September 2017

Organophosphate Poisoning and Terrorism.

Malays J Med Sci 2017 Aug 18;24(4):111-112. Epub 2017 Aug 18.

Medical Governance Research Institute, Tokyo, Japan.

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http://dx.doi.org/10.21315/mjms2017.24.4.14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5609697PMC
August 2017

Excess mortality due to indirect health effects of the 2011 triple disaster in Fukushima, Japan: a retrospective observational study.

J Epidemiol Community Health 2017 10 22;71(10):974-980. Epub 2017 Aug 22.

Division of Social Communication System for Advanced Clinical Research, Institute of Medical Science, The University of Tokyo, Tokyo, Japan.

Background: Evidence on the indirect health impacts of disasters is limited. We assessed the excess mortality risk associated with the indirect health impacts of the 2011 triple disaster (earthquake, tsunami and nuclear disaster) in Fukushima, Japan.

Methods: The mortality rates in Soma and Minamisoma cities in Fukushima from 2006 to 2015 were calculated using vital statistics and resident registrations. We investigated the excess mortality risk, defined as the increased mortality risk between postdisaster and predisaster after excluding direct deaths attributed to the physical force of the disaster. Multivariate Poisson regression models were used to estimate the relative risk (RR) of mortality after adjusting for city, age and year.

Results: There were 6163 and 6125 predisaster and postdisaster deaths, respectively. The postdisaster mortality risk was significantly higher in the first month following the disaster (March 2011) than in the same month during the predisaster period (March 2006-2010). RRs among men and women were 2.64 (95% CI 2.16 to 3.24) and 2.46 (95% CI 1.99 to 3.03), respectively, demonstrating excess mortality risk due to the indirect health effects of the disaster. Age-specific subgroup analyses revealed a significantly higher mortality risk in women aged ≥85 years in the third month of the disaster compared with predisaster baseline, with an RR (95% CI) of 1.73 (1.23 to 2.44).

Conclusions: Indirect health impacts are most severe in the first month of the disaster. Early public health support, especially for the elderly, can be an important factor for reducing the indirect health effects of a disaster.
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http://dx.doi.org/10.1136/jech-2016-208652DOI Listing
October 2017

Intensive speech and language therapy after stroke.

Lancet 2017 07;390(10091):228

Medical Governance Research Institute, 1080074 Tokyo, Japan; Navitas Clinic, Tokyo, Japan.

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http://dx.doi.org/10.1016/S0140-6736(17)31800-7DOI Listing
July 2017

Breast cancer patient delay in Fukushima, Japan following the 2011 triple disaster: a long-term retrospective study.

BMC Cancer 2017 Jun 19;17(1):423. Epub 2017 Jun 19.

Department of Surgery, Minamisoma Municipal General Hospital, 2-54-6 Takamicho, Haramachi, Minamisoma, Fukushima, 975-0033, Japan.

Background: Little information is available concerning how patient delay may be affected by mass disasters. The main objectives of the present study are to identify whether there was a post-disaster increase in the risk of experiencing patient delay among breast cancer patients in an area affected by the 2011 triple disaster in Fukushima, Japan, and to elucidate factors associated with post-disaster patient delay. Sociodemographic factors (age, employment status, cohabitant status and evacuation status), health characteristics, and health access- and disaster-related factors were specifically considered.

Methods: Records of symptomatic breast cancer patients diagnosed from 2005 to 2016 were retrospectively reviewed to calculate risk ratios (RRs) for patient delay in every year post-disaster compared with the pre-disaster baseline. Total and excessive patient delays were respectively defined as three months or more and twelve months or more from symptom recognition to first medical consultation. Logistic regression analysis was conducted for pre- and post-disaster patient delay in order to reveal any factors potentially associated with patient delay, and changes after the disaster.

Results: Two hundred nineteen breast cancer patients (122 pre-disaster and 97 post-disaster) were included. After adjustments for age, significant post-disaster increases in RRs of experiencing both total (RR: 1.66, 95% Confidence Interval (CI): 1.02-2.70, p < 0.05) and excessive patient delay (RR: 4.49, 95% CI: 1.73-11.65, p < 0.01) were observed. The RRs for total patient delay peaked in the fourth year post-disaster, and significant increases in the risk of excessive patient delay were observed in the second, fourth, and fifth years post-disaster, with more than five times the risk observed pre-disaster. A family history of any cancer was the only factor significantly associated with total patient delay post-disaster (odds ratio: 0.38, 95% CI: 0.15-0.95, p < 0.05), while there were no variables associated with delay pre-disaster.

Conclusions: The triple disaster in Fukushima appears to have led to an increased risk of patient delay among breast cancer patients, and this trend has continued for five years following the disaster.
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http://dx.doi.org/10.1186/s12885-017-3412-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477136PMC
June 2017

Health economics.

Lancet 2017 05 11;389(10082):1880. Epub 2017 May 11.

Medical Governance Research Institute, Tokyo, Japan.

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http://dx.doi.org/10.1016/S0140-6736(17)31210-2DOI Listing
May 2017

Social isolation and cancer management - advanced rectal cancer with patient delay following the 2011 triple disaster in Fukushima, Japan: a case report.

J Med Case Rep 2017 May 16;11(1):138. Epub 2017 May 16.

Department of Surgery, Minamisoma Municipal General Hospital, 2-54-6 Takamicho, Haramachi, Minamisoma, Fukushima, 975-0033, Japan.

Background: Little is known about the effects of social isolation in the elderly on their process of gaining health information and seeking health care.

Case Presentation: In March 2011, Fukushima, Japan experienced an earthquake, tsunami, and nuclear disaster, also known as Japan's triple disaster. In June 2016, an 80-year-old Japanese man, who lived alone after divorce at the age of 42, presented to our hospital with bloody stools and dizziness. Although his bloody stools initially occurred in May 2015, a year earlier, he did not pursue the possibility of malignancy. He was diagnosed as having stage IIIA rectal cancer. Detailed history taking revealed that he experienced social isolation after the disaster, due to the evacuation of his friends, losing his regular opportunities for socialization. He additionally reported that the current diagnosis of rectal cancer made him feel he had lost his health in addition to his social relationships. Although radical surgery was attempted, it failed to resect the lesion completely, and thereafter his disease gradually progressed. As support from family or friends was not available, he was not able to receive palliative radiation therapy or home-based care in his end-of-life period. He died at a long-term care facility in February 2017.

Conclusions: This case suggests that intense social isolation after the Fukushima disaster was a likely contributor to the patient delay, poor treatment course, and poor outcome of an elderly patient with rectal cancer. Direct communication with family and friends may play an indispensable role in increasing health awareness and promoting health-seeking behaviors, and in the midst of social isolation, elderly patients with cancer may lose these opportunities and experience increased risk of patient delay. Although health care providers may be able to alleviate isolation-induced delay by promoting cancer knowledge and awareness widely among local residents, policy-led interventions at the community level may be essential to reducing social isolation and its health consequences.
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http://dx.doi.org/10.1186/s13256-017-1306-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5433021PMC
May 2017

Obesity management in primary care.

Lancet 2017 04;389(10079):1606

Medical Governance Research Institute, Tokyo, Japan.

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http://dx.doi.org/10.1016/S0140-6736(17)31015-2DOI Listing
April 2017

Multiple Norovirus Outbreaks Due to Shredded, Dried, Laver Seaweed in Japan.

Infect Control Hosp Epidemiol 2017 07 25;38(7):885-886. Epub 2017 Apr 25.

1Navitas Clinic,Tokyo,Japan.

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http://dx.doi.org/10.1017/ice.2017.70DOI Listing
July 2017

Low hospital referral rates of school scoliosis screening positives in an urban district of mainland China.

Medicine (Baltimore) 2017 Apr;96(14):e6481

Department of Health Promotion, Shanghai Jingan Center for Disease Control and Prevention Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China Department of Internal Medicine, Jyobal Hospital, Tokiwa Foundation, Iwaki, Fukushima Medical Governance Research Institute, Tokyo, Japan Department of School Health, Shanghai Center for Disease Control and Prevention, Shanghai, China Global Public Health Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK Research Institute of Innovative Medicine, Tokiwa Foundation, Iwaki, Fukushima, Japan Jing'an Preventive Medicine Association, the Jing'an Centre of Management and Service for Elderly Health, Shanghai, China.

Significant prevalence rates of adolescent scoliosis in China were suggested in previous studies. However, school screenings for adolescent scoliosis have been suspended due to low rates of positive detection under the past screening system in China. The present study was undertaken to screen for adolescent scoliosis in middle school students under a modern assessment system in a district of Shanghai. We performed a population-based, cross-sectional study of a middle school scoliosis screening program in the Jingan district. In 2015, schoolchildren were initially screened by visual inspection of clinical signs and the forward-bending test. Suspected cases were referred for radiography in hospital for scoliosis diagnosis. A total of 5327 middle school students (grades 6-8) were screened with 520 (9.76%) positives (the positive rates of girls and boys at 15.28% and 4.59%, respectively) and no statistically significant difference among grades. Only 301 positives (57.9%) followed the referral for hospital radiography. There were 102 cases (33.9%) that were diagnosed with scoliosis by radiography criteria (Cobb angle ≥10°) including mild scoliosis (Cobb 10-25) for 94 cases and moderate scoliosis (Cobb 25-40) for 8 cases, and false-positives (Cobb 0) for 39 cases. The putative prevalence rate was estimated as 1.9% from the referred students. Under an accurate and modern assessment system, school screenings can detect scoliosis at a significant rate, but awareness of scoliosis risks is needed for residents in China to take up referrals for hospital diagnosis after school screenings.
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http://dx.doi.org/10.1097/MD.0000000000006481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411196PMC
April 2017

Concerns About the Attitudes of President Trump Toward Isolationism, Vaccination, and Climate Change.

Clin Infect Dis 2017 05;64(10):1465-1466

Medical Governance Research Institute, Tokyo, Japan.

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http://dx.doi.org/10.1093/cid/cix225DOI Listing
May 2017

Decontamination Work and the Long-term Increase in Hospital Visits for Hymenoptera Stings Following the Fukushima Nuclear Disaster.

Disaster Med Public Health Prep 2017 10 8;11(5):545-551. Epub 2017 Mar 8.

1Department of Surgery,Minamisoma Municipal General Hospital,Minamisoma,Fukushima,Japan.

Objective: Animals, including arthropods, are one health threat that can be affected by disasters. This institution-based study aimed to assess trends in Hymenoptera stings following the 2011 Fukushima nuclear disaster.

Methods: We reviewed the medical records of patients with hymenopteran stings who visited Minamisoma Municipal General Hospital, located 23 km from Fukushima Daiichi Nuclear Power Plant, from March 2005 to March 2016. Patient and sting characteristics of post-disaster patients were examined, and the annual incidence of hospital visits for hymenopteran stings was compared with the pre-disaster baseline, calculating an incidence rate ratio (IRR) for each year.

Results: We identified 152 pre-disaster patients (2005-2011) and 222 post-disaster patients (2011-2016). In the post-disaster period, 160 males (72.1%) were identified, with a median age of 59 years (range: 2-89 years). A total of 45 patients (20.3%) were decontamination workers. Post-disaster increases were found in the IRR for hymenopteran stings, peaking first in 2011 (IRR: 2.8; 95% confidence interval [CI]: 1.9-4.2) and later in 2014 (IRR: 3.2; 95% CI: 2.4-4.3) and 2015 (IRR 3.3; 95% CI: 2.5-4.4).

Conclusions: Long-term increases were found in the IRR of hospital visits for hymenopteran stings in an institution affected by the Fukushima nuclear disaster. Decontamination workers appear to have been particularly affected by this phenomenon. Better disaster field worker monitoring and education about potential environmental health hazards may help to identify and prevent worker exposure to insect stings and other vectors in these settings. (Disaster Med Public Health Preparedness. 2017;11:545-551).
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http://dx.doi.org/10.1017/dmp.2016.194DOI Listing
October 2017