Nader Ghotbi

Assessment of the knowledge and attitude of female students towards cervical cancer prevention at an international university in Japan.

Cervical cancer resulting from prior infection with human papillomavirus (HPV) is a significant public health threat against young Japanese women. A national immunization plan to vaccinate 13~16 year old female students against HPV infection has been started in Japan since 2010, and may reach almost full coverage by the end of 2012. Older age females who may already be sexually active are not targeted by this plan but should follow safer sex practices as well as periodic screening of the cervix cytology to reduce their risk of developing cervical cancer. HPV vaccination alone does not offer full protection either, because only some HPV types are covered by the vaccines and the long-term efficacy of the vaccines has not been determined yet. Therefore, we did a survey at an international university in Japan to study the knowledge and attitude of female college students towards prevention of cervical cancer, to examine the age when they start sexual activity and other related attributes that may influence the risk of cervical cancer. We discuss the results of our survey and what they imply for the possible impact of an HPV immunization plan on the risk of cervical cancer in Japan, and conclude by an emphasis on the need to increase awareness among Japanese female adolescents and to enhance the cervical screening rates among older females who are already sexually active.

Pediatric CT scan usage in Japan: results of a hospital survey

PurposeThe aim of this study was to examine the usage parameters of diagnostic computed tomography (CT) in children because of concerns of possible overuse in Japanese hospitals, including the “technical” CT exposure settings and the “clinical” grounds for CT requests.Materials and methodsWe examined the methodology at the radiology department to reduce radiation exposure to children and performed a retrospective study on pediatric CT requests during a 1-year period at Nagasaki University Hospital. The parameters of diagnostic CT usage for minor head trauma and acute appendicitis were studied in detail.ResultsCT radiation dose settings are adjusted for children based on guidelines issued by the Japan Radiological Society, with few limitations. CT requests were made for 62% of minor head trauma cases and 76% of cases clinically suspected to be acute appendicitis. These figures are considerably higher than those reported by studies in the United Kingdom, Canada, or the United States. No specific guidelines are advocated regarding CT usage for minor head trauma. The diagnosis of acute appendicitis in children is almost routinely referred for “confirmation” by CT.ConclusionCT radiation risks to children at Japanese hospitals need to be considered more seriously. Physicians should be encouraged to follow diagnostic algorithms that help avoid unnecessary CT usage in children.

Text Mining in Radiological Data Records: An Unsupervised Neural Network Approach

The rapid growth in digitalized medical records presents new opportunities for coalescing terra bytes of data into information that could provide us with new knowledge. The knowledge discovered as such could assist medical practitioners in a myriad of ways, for example in selecting the optimal diagnostic tool from among many possible choices. We analyzed the radiology department records of children who had undergone a CT scanning procedure at Nagasaki University Hospital in the year 2004. We employed self organizing maps (SOM), an unsupervised neural network based text-mining technique for the analysis. This approach led to the identification of keywords within the narratives accompanying the medical records that could contribute to reduction of unnecessary CT requests by clinicians. This is important because overuse of medical radiation poses significant health risks to children in spite of the invaluable diagnostic capacity of such procedures

Text Mining of Medical Records for Radiodiagnostic Decision-Making

The rapid growth of digitalized medical records presents new opportunities for mining terra bytes of data that may provide new information & knowledge. The knowledge discovered as such could assist medical practitioners in a myriad of ways, for example in selecting the optimal diagnostic tool from among numerous possible choices. We analyzed the radiology department records of children who had undergone a CT scan procedure at Nagasaki University Hospital in the year 2004. We employed Self Organizing Maps (SOM), an unsupervised neural network based text-mining technique for the analysis. This approach led to the identification of keywords with a significance value within the narratives of the medical records that could predict & thereby lower the number of unnecessary CT requests by clinicians. This is important because, in spite of the valuable diagnostic capacity of such procedures, the overuse of medical radiation does pose significant health risks and staggering cost especially with regard to children.

Japan's national tuberculosis control strategies with economic considerations.

We made a bibliographic search for Japanese and non-Japanese literature on tuberculosis control programs to study the current public health policies for tuberculosis control in Japan especially in regard to cost-effectiveness. Then, we compared the Japanese, strategies for tuberculosis control with those in other countries including the United States, and those recommended by World Health Organization (WHO). The current trend of tuberculosis incidence in the Japanese community demonstrates major differences from the situation that had prompted installation of tuberculosis control measures several decades ago. The tuberculosis control measures should be targeted to the elderly people (over 65 years old) because of the following three aspects. (1) A continuing decline of tuberculosis in the young Japanese population, particularly children who might attain benefits from BCG immunization; (2) The enhancement of the prevalence among the elderly people who are not covered by a uniform national surveillance strategy; (3) Cost-ineffectiveness of Mass Miniature Radiography (MMR) being used as a means to screen for tuberculosis. The cost-effectiveness issue must be considered more seriously, and the WHO recommendations especially in regard with the DOTS (directly-observed treatment, short course) strategy need to be incorporated more effectively into the national program since the incidence of drug resistant tuberculosis in Japan has been recently increasing. Finally, we propose to limit BCG immunization further and to discontinue annual MMR in the young population, and instead to develop effective strategies of both active and passive case finding in the elderly through public and community health services.

Data-Mining for the Analysis of Alternative Medicine: The Case of Osteopathy Diagnostic Methodology in Japan

Osteopathy is a relatively common form of alternative medicine modalities used to treat musculoskeletal complaints in Japan. However, the diagnostic and therapeutic manipulations used are very different and sometimes unique, compared to that of western medicine. One problem is the difficulties in verification of alternative medical practices through modern clinical scientific methods. We examined whether and how data-mining methodologies can be applied to overcome some of the problems. We were fortunate to obtain diagnostic records from a very popular osteopathy clinic in Osaka, Japan thatincluded over 30,000 patient visits over 6 years of practice. The data consists of some careful measurements of tissue electro-conductivity differences at 5 anatomical positions which as a whole are looked upon as an indication of the most appropriate approach/ location of the patients problem. These include the left and right side of the neck, the armpits, the wrists, the knees, and the ankles. Our research group received these records and applied data mining and knowledge discovery algorithms to look for any scientifically meaningful associations within the patient data elements recorded. This study might assist the osteopath in discovering potentially useful and valuable knowledge in the form of patterns/correlations within the data elements and more importantly to help us scientifically verify the diagnostic methodology adopted by the osteopath.