Ten-year questionnaire study on human papillomavirus vaccination targeting new female medical school students: Follow-up to the 2015 report.

AIM: We aimed to conduct a fixed-point observation questionnaire survey of changes in young women's human papillomavirus (HPV) vaccination status over the course of 10 years. We also investigated the influence of suspension of governmental recommendation for HPV vaccination since June 2013. METHODS: During 2011-2020, we conducted a self-completed questionnaire survey among newly enrolled female medical school students in Yokohama, Japan. The questionnaire featured items regarding HPV vaccination status, age, previous sex education, and knowledge about cervical cancer and HPV vaccination. RESULTS: HPV vaccine uptake rates in 2011 (5.4%) and 2012 (13.5%), when vaccination was self-funded, increased after 2013 (48.7%), when vaccination fees were subsidized. The rate dropped drastically in 2019 (14.3%) and 2020 (5.1%), after suspension of recommendation by the government. Comparisons between new students in 2015/2016, who had high vaccination rates (65.2%), and new students in 2019/2020, who had low vaccination rates (9.8%), showed decreased levels of HPV vaccination awareness, with fewer students having covered cervical cancer prevention in sex education and with respondents having less knowledge about the details of HPV vaccination. CONCLUSIONS: After the suspension of proactive HPV vaccine recommendation, markedly fewer students have been vaccinated against HPV, even those at the vaccination target age. This situation has substantially influenced the lower awareness about cervical cancer prevention, even among medical school students. To protect young women from cervical cancer in Japan, it is crucial for the government to resume proactive recommendation of HPV vaccines as soon as possible.

Three-year questionnaire survey on human papillomavirus vaccination targeting new female college students.

AIM: A questionnaire survey was conducted at fixed points to describe changes over a 3-year period in the human papillomavirus (HPV) vaccination uptake rate among young women. Several factors obtained from the questionnaire were investigated in relation to HPV vaccination. METHODS: The study was conducted at two universities in Yokohama City, Japan. Newly enrolled female students of the universities were recruited to participate in this study in 2011, 2012 and 2013. The study participants were asked about their HPV vaccination status. They were also questioned about factors that potentially influenced HPV vaccination, such as current age, place of residence during high school, and knowledge related to cervical cancer and HPV vaccination. RESULTS: The proportion of vaccinated participants dramatically increased in 2013 (48.7%) in comparison to 2011 (5.4%) and 2012 (13.5%). Three factors were positively related to HPV vaccination: being 18 years old in 2013, which means that they were eligible for a financial support program (P < 0.001); living in the study city, in which HPV vaccination was well conducted (P < 0.001); and proper knowledge of cervical cancer and HPV vaccination (P < 0.001). CONCLUSION: The HPV vaccination uptake rate in 2013 dramatically increased from that in 2011. Official financial support and publicity work were likely to have had an effect on the HPV vaccination uptake rate.

Inflammation in background cirrhosis evokes malignant progression in HCC development from HCV-associated liver cirrhosis.

OBJECTIVE: It is accepted that inflammation promotes malignant progression in the development of cancers. Whether, this is true for hepatocellular carcinoma (HCC) remains as an open question. We examined the relationship between the inflammatory histology activity index (HAI) in the background liver cirrhosis (LC) and the histological grading of the HCC in the hepatectomized HCC patients with HCV-associated LC. MATERIAL AND METHODS: Out of 264 HCC patients who underwent curative hepatic resection, 197 had HCV-associated LC. Among them, 52 patients with a small solitary HCC nodule (< 5 cm in diameter) were studied. Inflammation in the background LC was evaluated by modified Knodell's HAI. To evaluate the inflammation, piece meal necrosis, intra lobular cellular degeneration and focal necrosis, portal cellular inflammation (0-4, each) were estimated. The average HAI was calculated. The grade of malignancy of HCC was determined by WHO classification. RESULTS: The average HAI in the 15 patients with moderately differentiated HCC (4.3 ± 0.8, mean ± SD) was significantly larger than that in 11 patients with well differentiated HCC (3.5 ± 0.6, p = 0.036). The HAI in the 24 patients whose HCC nodules contained poorly differentiated HCC (5.2 ± 1.1) was significantly larger than that in patients with moderately differentiated HCC (p = 0.025). Thus, the HAI order was well differentiated group < moderately differentiated group < poorly differentiated group. CONCLUSIONS: Inflammation in the background non-cancerous cirrhotic portion would evoke malignant progression in HCC development from HCV-associated LC.

Clinical features of Vibrio vulnificus infections in the coastal areas of the Ariake Sea, Japan.

Vibrio vulnificus infection can result in necrotizing fasciitis and sepsis and is associated with high mortality. Most patients infected with this microbe have liver dysfunction as an underlying disease. However, because of the sporadic nature of outbreaks and unidentified cases, extensive evaluation of clinical features and identification of factors affecting prognosis have not been performed. We retrospectively analyzed 37 cases in Japan from 1984 to 2008 to review clinical features and to identify risk factors associated with prognosis. Statistical differences between clinical features (patient's characteristics, initial clinical laboratory data, symptoms upon admission, and other risk indicators) and prognosis were analyzed by use of the chi(2) test or the Mann-Whitney U test. Multivariate logistic regression analysis was also performed to assess factors which potentially affect hospital mortality. The mortality rate was 64.9%. An underlying liver disease was observed in 91.6% of the patients. The presence of liver cirrhosis tended to be related to hospital mortality; however, statistical significance was not achieved. Advanced age, lower platelet counts, and the presence of extensive skin lesions at onset affected outcomes with statistical significance. The prognosis of this disease is poor, because septic shock and necrotizing fasciitis often develop within a few days. Early diagnosis and treatment are needed to improve the prognosis of V. vulnificus infection.

High serum alanine aminotransferase levels for the first three successive years can predict very high incidence of hepatocellular carcinoma in patients with Child Stage A HCV-associated liver cirrhosis.

Abstract Objective. To assess retrospectively whether continuously high serum alanine aminotransferase (ALAT) levels (<80 IU) in the first three successive years after the diagnosis of liver cirrhosis (LC) are predictive of a subsequent high incidence of hepatocellular carcinoma (HCC) in patients with Child Stage A hepatitis C virus (HCV)-LC. Material and methods. The study comprised 132 HCV-LC (Child Stage A) patients who had not received interferon therapy but had been treated with anti-inflammatory agents. At the end of a 3-year follow-up after the diagnosis of LC, the patients were subdivided into three groups according to their serum ALAT levels and the subsequent incidence of HCC was assessed. Results. The cumulative incidence of HCC starting from 3 years after the diagnosis of LC in the continuously high ALAT group (annual average over 3 years always > or =80 IU; n=41; Group A) was markedly higher than that in the continuously low ALAT group (always <80 IU; n=48; Group B) (p<0.005) during an observation period of 7.9+/-3.7 years. The incidence of HCC in Group A was 11.8%/year. The odds ratios of developing HCC in Group A and Group C (mixed high and low ALAT levels; n=43) were 5.1-fold and 1.5-fold that of Group B, respectively. A multivariate analysis revealed that the ALAT group was independently associated with HCC development. Conclusions. Continuously high ALAT levels for three successive years following the diagnosis of LC can be predictive of a very high incidence of HCC in Child A HCV-LC patients. Prospective trials using therapeutic approaches aimed at decreasing ALAT levels are necessary in order to confirm a positive impact of ALAT reduction on the incidence of HCC in patients with HCV-LC.

Evaluation of an algorithm for estimating a patient's life threat risk from an ambulance call.

BACKGROUND: Utilizing a computer algorithm, information from calls to an ambulance service was used to calculate the risk of patients being in a life-threatening condition (life threat risk), at the time of the call. If the estimated life threat risk was higher than 10%, the probability that a patient faced a risk of dying was recognized as very high and categorized as category A+. The present study aimed to review the accuracy of the algorithm. METHODS: Data collected for six months from the Yokohama new emergency system was used. In the system, emergency call workers interviewed ambulance callers to obtain information necessary to assess triage, which included consciousness level, breathing status, walking ability, position, and complexion. An emergency patient's life threat risk was then estimated by a computer algorithm applying logistic models. This study compared the estimated life threat risk occurring at the time of the emergency call to the patients' state or severity of condition, i.e. death confirmed at the scene by ambulance crews, resulted in death at emergency departments, life-threatening condition with occurrence of cardiac and/or pulmonary arrest (CPA), life-threatening condition without CPA, serious but not life-threatening condition, moderate condition, and mild condition. The sensitivity, specificity, predictive values, and likelihood ratios of the algorithm for categorizing A+ were calculated. RESULTS: The number of emergency dispatches over the six months was 73,992. Triage assessment was conducted for 68,692 of these calls. The study targets account for 88.8% of patients who were involved in triage calls. There were 2,349 cases where the patient had died or had suffered CPA. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of the algorithm at predicting cases that would result in a death or CPA were 80.2% (95% confidence interval: 78.6% - 81.8%), 96.0% (95.8% - 96.1%), 42.6% (41.1% - 44.0%), 99.2% (99.2% - 99.3%), 19.9 (18.8 - 21.1), and 0.21 (0.19 - 0.22), respectively. CONCLUSION: A patient's life threat risk was quantitatively assessed at the moment of the emergency call with a moderate level of accuracy.

Seasonal influence on blood pressure in elderly normotensive subjects.

The aim of this study was to examine whether or not fluctuations in blood pressure (BP) differ by season. Subjects were 45 elderly individuals (20 men and 25 women; mean age, 66.5+/-4.9 [SD] years). Each subject's BP was recorded with an ambulatory BP monitoring device for 24 h during each of the four seasons. Subjects also wore a portable weather meter to obtain ambient temperature, relative humidity, and barometric pressure simultaneously with BP. The relationships between meteorologic values and BP were investigated at various parts of the day. Seasonal differences in BP fluctuation around wake-up-time were analyzed by means of the Tukey's test. The difference between the pre-wake-up-time systolic BP and the wake-up-time systolic BP was significantly greater in winter than in summer (8.7 mmHg greater, p<0.001). The difference between pre-wake-up-time and wake-up-time systolic BP was significantly greater in autumn than in spring (9.4 mmHg greater, p<0.001) or summer (13.1 mmHg greater, p<0.001). The difference between pre-wake-up-time heart rate and wake-up-time heart rate did not differ statistically between seasons. In conclusion, the present study showed that the difference between pre-wake-up-time systolic BP and wake-up-time systolic BP was greatest in the colder seasons, i.e., autumn and winter. There appears to be a large fluctuation in wake-up-time in the colder seasons. Low ambient temperature likely induces this large fluctuation.

Circadian variation in cardiovascular emergencies among the elderly.

Clarification of the cyclic pattern of emergency events is useful for identifying risk factors for emergency events. We attempted to characterize the circadian variation in emergency calls for the elderly (aged 65 years or older) because the use of emergency transportation by elderly patients is increasing rapidly. The study targeted mainly patients with cardiovascular disease. Additionally, the study analyzed circadian variability in the occurrence of cardiopulmonary arrest (CPA) and heat stroke. Data for this study were obtained from computerized records of ambulance transport from 1997 to 2003 (a total of 874,495 transported patients) managed by the Emergency Medical Division of the Yokohama Fire Bureau. A partial Fourier model was used to analyze circadian patterns of emergency calls for each disease category and determine the peak time of occurrence of disease events. A prominent peak of cardiovascular disease and CPA in the morning was observed among elderly patients, whereas amplitudes of the morning and evening peaks were almost the same among younger patients. Heat stroke among elderly patients occurred frequently from 10:00 AM to 3:00 PM, and the occurrence peaked around noon. The increase in cardiovascular disease events and CPA during the morning among elderly patients may be due to a natural fluctuation in blood pressure. A morning increase in hemoconcentration induced by dehydration during the night is thought to be another cause of the frequent occurrence of cardiovascular disease, CPA, and heat stroke events in the morning hours. In conclusion, there was a prominent peak in the morning in the occurrence of emergency events such as cardiovascular disease, CPA, and heat stroke events among the elderly.

Influence of mental stress on the plasma homocysteine level and blood pressure change in young men.

Objective. This study aimed to determine whether mental stress influences the plasma total homocysteine level or blood pressure in young men. Method. Twenty-seven male university students were assigned to a normal blood pressure group (24-h systolic blood pressure <125 mmHg and diastolic blood pressure <75 mmHg; 13 subjects) or a high blood pressure group (24-h systolic blood pressure > or =125 mmHg, or 24-h diastolic blood pressure > or =75 mmHg; 14 subjects). Wearing an ambulatory blood pressure monitoring device, subjects rested for 30 minutes, underwent an arithmetic test for 15 minutes, and rested again for 15 minutes. Blood samples were taken before and after the test. Plasma total homocysteine levels were measured. Heart rate, blood pressure, and sympathovagal balance were determined during the test. Results. The mean total homocysteine level at rest in the high blood pressure group was slightly, but not significantly, higher than that in the normal blood pressure group. The resting total homocysteine level was significantly higher in subjects with parental history of hypertension than in those without (p < 0.01). Blood pressure, heart rate, and the plasma total homocysteine level were increased significantly by mental stress (p < 0.05). The change in total homocysteine correlated significantly with the changes in systolic blood pressure and sympathovagal balance (p < 0.05). Conclusion. Resting total homocysteine level was significantly higher in male students with a parental history of hypertension than in those without. It was shown that mental stress elevates heart rate, blood pressure, sympathovagal activity, and the plasma total homocysteine level in young men.

Influence of mental stress on cardiovascular function as evaluated by changes in energy expenditure.

We assessed the influence of mental stress on cardiovascular parameters, including systolic blood pressure (SBP), heart rate (HR) and sympathetic activity (LF/HF), with the use of a quantitative indicator of energy expenditure (EE). Forty-four male university students underwent a mental arithmetic test. Their EE was 1.3-fold that at rest in response to the test. Change in EE (DeltaEE) in response to the test was compared between subjects with high blood pressure (BP) and those without and between subjects with high salt intake and those without. Changes in SBP (DeltaSBP), changes in HR (DeltaHR) and changes in LF/HF (DeltaLF/HF) in relation to DeltaEE were represented by linear regression. Regression analysis showed that the coefficients of DeltaEE were positively related to the dependent variables DeltaSBP, DeltaHR and DeltaLF/HF. The slopes of the regression curves for the high-BP group (24-h SBP >or=127 mmHg) and the high-salt-intake group (>or=11 g/day) were steeper than those for the normal BP group and the low-salt-intake group (p=0.11 and p=0.01, respectively). Thus, we were able to determine the influence of mental stress on cardiovascular function. The influence of mental stress on cardiovascular function likely differs according to a subject's environmental conditions. Our study implied that high salt intake increases the sensitivity of cardiovascular functions to mental stress.

Influence of socioeconomic factors on medically unnecessary ambulance calls.

BACKGROUND: Unnecessary ambulance use has become a socioeconomic problem in Japan. We investigated the possible relations between socioeconomic factors and medically unnecessary ambulance calls, and we estimated the incremental demand for unnecessary ambulance use produced by socioeconomic factors. METHODS: We conducted a self-administered questionnaire-based survey targeting residents of Yokohama, Japan. The questionnaire included questions pertaining to socioeconomic characteristics, dichotomous choice method questions pertaining to ambulance calls in hypothetical nonemergency situations, and questions on the city's emergency medical system. The probit model was used to analyze the data. RESULTS: A total of 2,029 out of 3,363 targeted recipients completed the questionnaire (response rate, 60.3%). Probit regression analyses showed that several demographic and socioeconomic factors influence the decision to call an ambulance. Male respondents were more apt than female respondents to state that they would call an ambulance in nonemergency situations (p < 0.05). Age was an important factor influencing the hypothetical decision to call an ambulance (p < 0.05); elderly persons were more apt than younger persons to state that they would call an ambulance. Possession of a car and hesitation to use an ambulance negatively influenced the hypothetical decision to call an ambulance (p < 0.05). Persons who do not have a car were more likely than those with a car to state that they would call an ambulance in unnecessary situations. CONCLUSION: Results of the study suggest that several socioeconomic factors, i.e., age, gender, household income, and possession of a car, influence a person's decision to call an ambulance in nonemergency situations. Hesitation to use an ambulance and knowledge of the city's primary emergency medical center are likely to be important factors limiting ambulance overuse. It was estimated that unnecessary ambulance use is increased approximately 10% to 20% by socioeconomic factors.

The increasing use of pediatric emergency facilities in the evening.

OBJECTIVES: In Japan, the demand for pediatric emergency medicine has been increasing, especially in the evening. The purpose of this study was to identify the reasons for overcrowding of pediatric emergency facilities in the evening. METHODS: A population-based survey was conducted in Yokohama City, Japan, that targeted parents of children 1 or 3 years of age. These children participate in regular health checkups. Questionnaires about their child's illnesses and the pediatric emergency system were mailed to 30,000 parents of a child expected to undergo a health checkup between May 2004 and January 2005. RESULTS: Data obtained from the completed questionnaires indicated that many parents noticed their child's illness or injury most frequently during the evening, when most medical facilities are closed. The peak period when parents noticed their child's illness was the evening (4:00 pm-12 midnight, 54.4%), followed by the daytime (8:00 am-4:00 pm, 30.3%) and then the nighttime (12 midnight-8:00 am, 15.3%). During all 3 periods, parents felt it difficult to judge their child's condition and thus many used emergency facilities unnecessarily. CONCLUSIONS: The overcrowding of pediatric emergency facilities in the evening is likely due mainly to a mismatch between the peak time of children's illnesses and the office hours of pediatric clinics. Parents' difficulties in assessing their child's condition and anxiety over their child's illness and injuries seem to be other factors that contribute to this imbalance.

Evaluation of out-of-hospital cardiopulmonary resuscitation with resuscitative drugs: a prospective comparative study in Japan.

OBJECTIVE: This study aimed at evaluating two emergency medical service systems, one in which emergency life-saving technicians (ELSTs) are allowed to administer epinephrine (adrenaline) to patients with out-of-hospital cardiac arrest and one in which ELSTs are allowed to administer epinephrine, lidocaine, and atropine. METHODS: A modified, prospective community health trial was conducted from April 1 to October 31, 2003. Areas served by physician-manned ambulances, where out-of-hospital cardiopulmonary resuscitation (CPR) was performed with resuscitative drugs (experimental areas), were compared to areas served by ELST-manned ambulances, where resuscitative drugs were not administered outside the hospital (reference areas). The sequence of emergency procedures performed in the experimental areas was divided into three phases. Phase I included administration of epinephrine, which simulated administration of epinephrine by ELSTs. Phase II started with the use of lidocaine or atropine. Phases I and II simulated administration of epinephrine, lidocaine, and atropine by ELSTs. Phase III began with administration of another drug. Outcomes, resuscitation rates and 1-month survival rates were determined, and differences between the two types of areas were analyzed. RESULTS: For non-traumatic cardiac arrest, outcomes through phase II in the experimental areas were significantly better than those in the reference areas. Phase I-only outcomes in the experimental areas were better, but not significantly better, than those in the reference areas. CONCLUSION: Use of resuscitative drugs for non-traumatic prehospital CPR appears to be effective in terms of resuscitation rates and 1-month survival rates.

Recent trends in colonic diverticulosis in Yokohama City: a possibility of changing to a more Western profile.

OBJECTIVE: Right-sided type colonic diverticulosis has been predominant in Japan, in contrast to European counties where the left-sided type is predominant. Considering the recent change in the dietary habits of Japanese people to a more Western diet in urban areas of Japan, the features of colonic diverticulosis may also change to reflect a more Western type. Therefore, we attempted to clarify the current situation. METHODS: A total of 435 consecutive outpatients who agreed to a barium enema and complete examination were enrolled in this study. RESULTS: 113 patients (26.0%) revealed colon diverticulosis; 50.4% of the patients had more than ten diverticula. The percentage of man with ten or more diverticula (67.4%) was significantly higher than that of women patients (40.0%, p<0.01). Among the 88 patients who had four or more diverticula, 39 patients (44.3%) were right-side dominant, 27 (30.7%) left-side dominant and 22 (25.0%) were both-sides. Thirteen (68.4%) of the 19 patients who had more than 30 diverticula were left-side dominant. CONCLUSION: The clinical features of colon diverticulosis in the patients living in Yokohama may be changing to reflect a more Western type, in particular decreased right-side dominance, increases in the left-side and both-sides dominant patients, and the emergence of patients with crowded diverticula in the left-side colon was observed.

Randomized controlled trial of sour milk on blood pressure in borderline hypertensive men.

BACKGROUND: A double-blind randomized controlled trial was carried out to assess the effect of sour milk, containing two tripeptides (valine-proline-proline and isoleucine-proline-proline), on blood pressure (BP). METHODS: A total of 46 borderline hypertensive men aged 23 to 59 years were recruited at their workplace for this trial. Subjects were randomly allocated into two groups; sour milk drink group (S-group, n = 23) and placebo (acidified milk) drink group (P-group, n = 23) for 4 weeks. Blood pressure was measured twice at each occasion by a physician, at the health center of the company, with a mercury at baseline, 2 and 4 weeks. Statistical analysis was performed by SPSS 10.0J. RESULTS: The S-group and P-group showed no significant difference in baseline systolic BP (mean [SD], S: 147.6 [9.6], P: 145.3 [13.0]) or diastolic BP (S: 95.3 [9.9], P: 91.5 [9.6]). In the S-group, change in systolic BP at 2 and 4 weeks were -4.3 mm Hg (95% confidence interval [CI] -8.3 to -0.4; P = .032) and -5.2 mm Hg (95% CI -10.1 to -0.3; P = .039), both statistically significant. Diastolic BP showed change from -1.7 mm Hg (95% CI -5.4 to 2.0) at 2 weeks and -2.0 (95% CI -5.4 to 1.5) at 4 weeks, respectively. In the P-group, change in systolic BP were -0.5 (95% CI -5.8 to 4.8) at 2 weeks and -3.7 (95% CI -8.3 to 0.9) and change in diastolic BP were -0.6 (95% CI -4.7 to 3.6) and -0.3 (95% CI -3.9 to 3.3), which were not statistically significant. CONCLUSIONS: This trial demonstrated the beneficial effect of sour milk on BP in borderline hypertensive men who were not taking antihypertensive medication.

Circadian pattern of ambulance use for children in a Japanese city.

OBJECTIVES: Many emergency events have a unique cyclic pattern. Understanding the patterns is important for anticipating the events and for providing appropriate medical services. This study aimed at verifying periodic fluctuation in ambulance use for children in Yokohama, Japan, and determining whether the periodic pattern differs between holidays and ordinary days. METHODS: The study comprised a retrospective analysis of Yokohama city ambulance records covering transport of children aged 14 years or less between January 1994 and December 2001. A partial Fourier model was used to compare the pattern of ambulance use on holidays with that on ordinary days. The least squares method was used to determine coefficients of the partial Fourier series. RESULTS: Twenty-four-hour periodicity was observed in the use of ambulances for children. Ambulance use per hour peaked in the evening and bottomed in the early morning. The patterns were nearly identical between holidays and ordinary days, although the frequencies of ambulance use differed significantly between holidays and ordinary days. CONCLUSIONS: Ambulances are used for children more frequently from late afternoon to evening than in the morning.

Accuracy and applicability of the Terumo ES-H55 double-cuff sphygmomanometer for hospital use.

BACKGROUND: We have developed a new blood pressure (BP)-measuring device with a double-cuff, and evaluated its accuracy and applicability for practical use. DESIGN: The double-cuff method features a small cuff placed in the centre of the compression cuff to detect the oscillation of arterial pulsation, by which algorithms for the determination of systolic BP (SBP) and diastolic BP (DBP) were rendered more objective than with the conventional oscillometric method. Algorithms for automatic BP determination were developed from the oscillation data taken with the small cuff from 217 men and 256 women, and then installed in the Terumo ES-H55 device (length: 17 cm, weight: 120 g). This ES-H55 device was tested on 87 subjects (65 hypertensives and 22 normotensives) to compare its accuracy with that of the auscultatory method according to the AAMI SP-10 protocol. RESULTS: Using Bland and Altman scatter plots, the difference in SBP between the ES-H55 device and the auscultatory method was within +/- 5 mmHg in 88% of subjects, and within +/- 10 mmHg in 97% (mean difference +/- SD: 0.2 +/- 3.9 mmHg). The difference in DBP was within +/- 5 mmHg in 80%, and within +/- 10 mmHg in 97% (difference: -0.1 +/- 4.6 mmHg). These results satisfied AAMI guidelines, and this device was easy to use. CONCLUSIONS: The ES-H55 device is compact and light, with clear algorithms for the determination of BP, and satisfies AAMI criteria, so that it is considered a useful BP-measuring device that could be used instead of a mercury sphygmomanometer by nurses and doctors in hospital wards.

Willingness to pay for a public health checkup program: assessment by the travel cost method.

OBJECTIVE: Whether the benefit of a public health program surpasses the cost of providing the program is an important question for public service providers. This study aimed to evaluate one health checkup program provided by a municipal government by measuring the public's willingness to pay (WTP) for maintaining the program. METHODS: A questionnaire-based study of a health checkup program targeting people joining the National Health Insurance system was conducted. The WTP was estimated from a demand curve for the program, which was constructed by a revealed preference method, that is, by the travel cost method. RESULTS: The WTP was calculated as 5410 yen per person, an amount substantially below the cost to the government of providing the service. The aggregate WTP was also estimated to be lower than the current expense of the municipal government. CONCLUSION: The amount users are willing to pay for a health checkup program provided by the municipal government appears to be less than the actual cost of the program. The travel cost method might reflect short-term private benefit produced by the health checkup program but cannot take into account long-term private benefit or overall social benefits which ensues.

[A review of methods for controlling medical costs from the point of view of cost-effectiveness].

Cost-effectiveness analysis is a method used to evaluate the outcomes and costs of treatments or interventions designed to improve health. It has been widely regarded as an important aid to providing health care services efficiently. This paper reviews several measures for controlling medical costs in Japan, where a fee-for-service system is employed to remunerate for medical services provision. From the point of view of cost-effectiveness, the first step in health care reform for controlling medical costs should be minimizing useless medical services because the cost-effectiveness ratio of these tends to infinity. For the purpose of minimizing unserviceable provision in the field of medicine, two approaches must be considered. One is establishing a system so that physicians can act as perfect agencies for their patients. The other is encouraging academic research on the effectiveness of medical services.

[Quantitative analysis of the demand for emergency medicine in Yokohama City, Japan].

PURPOSE: We analyzed regional characteristics that potentially might affect regional demand for emergency medicine in Yokohama city and projected the number of future ambulance users. METHODS: The number of patients transported by ambulance was regarded as an index of the demand for emergency medicine. Various factors that may affect regional demand for emergency medicine were used as dependent variables in multiple regression analysis. The future population was estimated by the cohort change rate method based on the 1995 and 2000 censuses. Data pertaining to ambulance use were obtained from the Annual Fire Fighting Bulletin, Yokohama. Data pertaining to regional factors were obtained from the Annual Health Statistics Report, Yokohama; the Annual Health Statistics Report, Kanagawa; and the Statistics Report, Yokohama. RESULTS: Statistically significant relations were observed between ambulance use per 1000 population and particular regional characteristics, i.e. the proportion of persons undergoing health examinations conducted by public health centers, the number of educational health promotion programs managed by the public sector, the proportion of persons in receipt of livelihood protection, the proportions of roads and commercial areas in each district in relation to the total area, the mean land price, the age-adjusted mortality rate, and the proportion of persons aged 65 years or over. The demand for emergency medicine in Yokohama city was predicted to increase dramatically as the population ages. The number of patients transported by ambulance, which was 121,606 in 2000, was projected to exceed 250,000 in 2030 and to approximate 300,000 in 2050. CONCLUSION: The demand for emergency medicine will increase dramatically in Yokohama city as the society ages, Regional emergency medical systems should be improved accordingly.