Tomoaki Imamura

A survey of patients with self-reported severe food allergies in Japan

Food allergies have increased in recent years in Japan. Details of causative foods, places where anaphylaxis developed, and other allergic factors remain unknown, and we investigated them. A‘questionnaire survey for the prevention of food allergies’ was conducted using a nationwide group of patients with food allergies. A total of 1383 patients from 878 families (including 319 patients who experienced anaphylaxis) provided valid answers to the questionnaire. The average age of the first anaphylactic attack was 3.20u2003±u20036.327u2003yr. The most common allergens causing anaphylaxis were in order milk, eggs, wheat, peanuts, and soybeans, followed by sesame and buckwheat. The most common place where anaphylaxis developed was the patient’s own home, followed by fast food restaurants, places visited, restaurants, and schools. In patients’ own homes, fast food restaurants (buffet), places visited and schools, the most common allergens were milk, eggs, and wheat. In restaurants and accommodation facilities, eggs were the most common allergen followed by milk. As possible food allergies can cause anaphylaxis, it is necessary to provide precise information for consumers regarding packaged and processed foods.

Impact of telephone dispatcher assistance on the outcomes of pediatric out-of-hospital cardiac arrest.

Objective: Most previous studies of pediatric out-of-hospital cardiac arrest have typically examined relatively small datasets from small study regions. Although several studies have reported the impact on adult out-of-hospital cardiac arrest, little information is available on the impact of telephone dispatcher assistance on the outcomes of pediatric out-of-hospital cardiac arrest. We set out to examine the impact of cardiopulmonary resuscitation instruction by telephone dispatcher on the outcomes of pediatric out-of-hospital cardiac arrest. Design: Population-based, observational study. Setting: Japan-wide population-based setting. Patients: We identified 1,780 pediatric out-of-hospital cardiac arrest patients (67.8% male) with witnessed collapse from a nationwide, population-based, out-of-hospital cardiac arrest database. Intervention: None. Measurement and Main Results: We assessed the impact of telephone dispatcher assistance on the outcomes of 1-month survival rates and favorable neurologic status among the groups. The overall rate of bystander-performed chest compression and mouth-to-mouth ventilation among the witnessed pediatric out-of-hospital cardiac arrests were 39.5% and 25.6%, respectively. Telephone dispatcher assistance was offered in 28.4% of the witnessed pediatric out-of-hospital cardiac arrest cases and resulted in a significant increase in both chest compression (adjusted odds ratio 6.04; 95% confidence interval 4.72–7.72) and mouth-to-mouth ventilation (adjusted odds ratio 3.10; 95% confidence interval 2.44–3.95), and a significant improvement in 1-month survival rate (adjusted odds ratio 1.46; 95% confidence interval 1.05–2.03), but no significant effect on favorable neurologic outcomes at 1 month (adjusted odds ratio 1.15; 95% confidence interval 0.70–1.88). Potential confounding factors included age categories, sex, bystander type, cause of cardiac arrest, bystander cardiopulmonary resuscitation, and attempted defibrillation. Conclusions: Telephone dispatcher assistance could significantly increase bystander cardiopulmonary resuscitation among witnessed pediatric out-of-hospital cardiac arrests. Although there was only a small, nonsignificant effect on the improvement in favorable neurologic outcome at 1 month, the improved survival associated with telephone dispatcher assistance in pediatric out-of-hospital cardiac arrest is clinically important, and is of major public health importance. In cases where cardiac arrest was uncertain from the bystander’s replies during the call to emergency medical services, telephone dispatcher assistance was not offered, which could affect the adjusted odds ratio of the present study.

Updated Japanese Urological Association Guidelines on prostate-specific antigen-based screening for prostate cancer in 2010

The exposure rate of screening for prostate cancer using prostate‐specific antigen (PSA) in Japan is still very low compared with that in the USA or western Europe. The mortality rate of prostate cancer will increase in the future and in 2020 it will be 2.8‐fold higher than in 2000. Therefore, there is an urgent need to determine the best available countermeasures to decrease the rate of prostate cancer death. PSA screening, which can reduce the risk of death as a result of prostate cancer, should be offered to all men at risk of developing prostate cancer with fact sheets showing updated benefits and drawbacks of screening for prostate cancer.

Characteristics and outcomes of pediatric out-of-hospital cardiac arrest by scholastic age category.

Objectives: There is a paucity of data examining nationwide population-based incidences and outcomes of pediatric out-of-hospital cardiac arrest. The objective of this study is to describe the detailed characteristics of pediatric out-of-hospital cardiac arrest by scholastic age category and to evaluate the impact of bystander cardiopulmonary resuscitation and public access–automated external defibrillators on the 1-month survival and favorable neurological status of pediatric out-of-hospital cardiac arrest patients. Design: A nationwide, population-based, observational study. Setting: Nationwide emergency medical system in Japan. Patients: Out-of-hospital cardiac arrest patients aged ⩽ 18 yr. Measurements and Main Results: We identified 7,624 pediatric out-of-hospital cardiac arrest patients (⩽ 18 yr old) from a nationwide population-based out-of-hospital cardiac arrest database in Japan from 2005 to 2008 and stratified them into five categories by scholastic age. The overall rates of 1-month survival and favorable neurological outcomes were 11.0% and 5.1%, respectively. Bystander cardiopulmonary resuscitation resulted in a significant improvement in both 1-month survival (odds ratio 2.81; 95% confidence interval 2.30–3.44) and favorable neurological outcomes (odds ratio 4.55; 95% confidence interval 3.35–6.18). Performing public access–automated external defibrillators had a significant effect on the 1-month survival rate (odds ratio 3.51; 95% confidence interval 1.81–6.81) and favorable neurological outcomes (odds ratio 5.13; 95% confidence interval 2.64–9.96). Conclusions: This study demonstrated that bystander cardiopulmonary resuscitation and public access–automated external defibrillators had a significant impact on the outcomes of pediatric out-of-hospital cardiac arrest. The improved survival associated with bystander cardiopulmonary resuscitation and public access–automated external defibrillators are clinically important and are of major public health importance for school-aged out-of-hospital card-iac arrest patients.

A technique for identifying three diagnostic findings using association analysis

In diagnosing diseases in clinical practice, a combination of three clinical findings is often used to represent each disease. This is largely because it is often difficult or impractical to assess for all possible combinations of symptoms and abnormal exam findings that occur in any particular disease. For most diseases, diagnostic triads are based on empirical observations. In this study, we determined diagnostic triads for chronic diseases using data mining procedures. We also verified the combinations’ validity as well as our procedure for determining them. We used symptoms and examination findings from 477 patients with chronic diseases, collected as part of a 35-year longitudinal study begun in 1968. For each patient there were 295 items from examinations in internal medicine, dermatology, ophthalmology, dentistry and blood tests. We judged each item to be either normal or abnormal, and restricted the analysis to the abnormal findings. To analyze such an exhaustive assortment, we used the data mining technique of association analysis. The analysis generated three clinical findings for each disease. Diseases were defined based on blood tests. Searching through all 295 items to find the three most useful clinical findings would be impractical on a commodity PC. However, by excluding normal items, we were able to sufficiently reduce the total number of combinations so as to make combinatorial analysis on a PC feasible. In addition to more accurate diagnoses, we believe our technique can identify those diagnostic data that are more cost effective in terms of time and other resources required for their collection.

Willingness to pay for health care services in common cold, retinal detachment, and myocardiac infarction: an internet survey in Japan

BackgroundThe application of Willingness To Pay (WTP) measurement with Contingent Valuation Method (CVM) to medical services is gradually increasing. Knowing what influences WTP is an important matter because validity of CVM in medical services remains controversial. The objective of this survey is to measure WTP for the treatment of typical acute illnesses and to analyze the factors affecting WTP.MethodsA questionnaire survey was conducted over the Internet, in which 795 men and women between 40 and 59 years old responded to questions about WTP for medical expenses in three hypothetical scenarios: common cold (CC), retinal detachment (RD) and myocardiac infarction (MI).ResultsMean WTP was

Development of a Web-Based Survey for Monitoring Daily Health and its Application in an Epidemiological Survey

29.9 for CC,

Influence of Japan's New Diagnosis Procedure Combination-Based Payment System on the Surgical Sector: Does it Really Shorten the Hospital Stay?

2,233 for RD, and

Prevalence of insomnia among residents of Tokyo and osaka after the great East Japan earthquake: a prospective study.

8,976 for MI. WTP for RD and MI was lower in the low-income group. While WTP for CC did not vary with income, WTP was higher in groups whose current subjective fitness levels were low.ConclusionAlthough WTP measurements are criticized frequently for their validity and reliability, they are still useful for determining the economic value of medical services. Based on the results of this study, it is deemed necessary to enhance safety nets for low-income earners in regards to serious illnesses that incur high medical expenses. Further, it is recommended that the rate of co-payments be set relatively high with respect to mild illnesses for which alternative services are available.

Immediate Defibrillation or Defibrillation After Cardiopulmonary Resuscitation

Background Early detection of symptoms arising from exposure to pathogens, harmful substances, or environmental changes is required for timely intervention. The administration of Web-based questionnaires is a potential method for collecting information from a sample population. Objective The objective of our study was to develop a Web-based daily questionnaire for health (WDQH) for symptomatic surveillance. Methods We adopted two different survey methods to develop the WDQH: an Internet panel survey, which included participants already registered with an Internet survey company, and the Tokyo Consumers’ Co-operative Union (TCCU) Internet survey, in cooperation with the Japanese Consumers’ Co-operative Union, which recruited participants by website advertising. The Internet panel survey participants were given a fee every day for providing answers, and the survey was repeated twice with modified surveys and collection methods: Internet Panel Survey I was conducted every day, and Internet Panel Survey II was conducted every 3 days to reduce costs. We examined whether the survey remained valid by reporting health conditions on day 1 over a 3-day period, and whether the response rate would vary among groups with different incentives. In the TCCU survey, participants were given a fee only for initially registering, and health information was provided in return for survey completion. The WDQH included the demographic details of participants and prompted them to answer questions about the presence of various symptoms by email. Health information collected by the WDQH was then used for the syndromic surveillance of infection. Results Response rates averaged 47.3% for Internet Panel Survey I, 42.7% for Internet Panel Survey II, and 40.1% for the TCCU survey. During a seasonal influenza epidemic, the WDQH detected a rapid increase in the number of participants with fever through the early aberration reporting system. Conclusions We developed a health observation method based on self-reporting by participants via the Internet. We validated the usefulness of the WDQH by its practical use in syndromic surveillance.