Mid-career changes in the occupation or specialty among general surgeons, from youth to middle age, have accelerated the shortage of general surgeons in Japan.

PURPOSES: Concerns have been raised regarding an apparent shortage of general surgeons in Japan, but the actual situation is actually not altogether clear. To clarify the trends in the number of general surgeons in Japan, we studied the number of doctors by specialty over time. METHODS: This study investigated the covered trends in the number of doctors over time, a comparison of work formats (employment in hospitals versus clinics), and the trends in the ratio of female doctors. We used data from the Survey of Doctors, Dentists and Pharmacists from 1996, 1998, 2000, 2002, 2004, and 2006. RESULTS: Between 1994 and 2006, the number of general surgeons fell by 12.7%, from 24,718 to 21,574. More than 20% of the general surgeons, aged 25 to 54 years old, either changed jobs or changed specialties between 1996 and 2006. Among the general surgeons, aged 25 to 54 years old, the number of those working in hospitals fell by 2,567 (16.2%) between 2000 and 2006, while the number working in health clinics rose by 348 (19.8%). The ratio of female general surgeons rose from 2.4% in 1996 to 4.5% in 2006. CONCLUSIONS: The decrease in general surgeons in Japan is largely often due to mid-career job separation.

Cancer articles in weekly magazines: useful media to deliver cancer information to the public?

OBJECTIVE: Japanese weekly magazines, which have a circulation of over 2 700 000, play important roles in communicating with the public. They offer a wide range of information, entertainment, gossip, politics and economics, and often include articles on cancer. However, cancer articles in magazines have not been systematically analyzed. METHODS: We investigated cancer-related articles and advertisements in six major Japanese weekly magazines to demonstrate trends in public interest regarding cancer. RESULTS: The total number of articles assessed from July 2009 to December 2010 was 36 914, of which 696 (1.9%) were cancer articles. The total number of advertisements was 21 718, of which 340 (1.6%) were related to cancer. The number of cancer articles demonstrated an upward trend during the study period. Articles focused on lung (n = 145) and urogenital cancer (n = 122). The most common content comprised therapies and diagnosis (n = 340) and case reports on individual patients (n = 160). After a famous Japanese comedian revealed his prostate cancer diagnosis, the number of articles on prostate cancer increased from 2.0 to 6.6 per month. Immunotherapy including some dubious folk therapies was the most frequently reported cancer therapy in articles and advertisements (30.4%). A small group of oncologists were repeatedly referred to in comment sources; 35.6% of comments were presented by only five doctors. CONCLUSIONS: Cancer articles in weekly magazines are common paper media for providing cancer information to the public. However, the information provided might place emphasis on unestablished treatments or biased opinions.

Electrodialytic ion isolation for matrix removal.

We report a fully automated online sample pretreatment system for ionic analytes that extracts the ionic analytes from the sample and largely removes the nonionic sample matrix and can preconcentrate the analyte. Sample pretreatment is a key analytical process; conventional pretreatment is conducted in a difficult to automate batchwise manner. The present system relies on the transport of ions induced by an electric field to a water acceptor. Cations and anions are simultaneously and separately collected into individual acceptor streams which can be directly introduced to a chemical analyzer. Common inorganic ions (≤10 meq/L) are quantitatively transferred from samples within a few seconds. Small nonionic molecules are transferred by 0.5-10%, and proteins are not transferred at all. The method has been successfully applied to drinking water, urine, and cow's milk with 3.7 ± 2.5, 3.8 ± 2.6, and 4.6 ± 2.6%, respectively, in variance (n = 10). Present results agreed well with those from conventional pretreatment methods. Interestingly, when calcium in milk is measured by the present method, the results correspond to the total calcium by conventional methods; i.e., it can extract calcium from its protein-bound form in milk.

Increased financial burden among patients with chronic myelogenous leukaemia receiving imatinib in Japan: a retrospective survey.

BACKGROUND: The financial burden of medical expenses has been increasing for cancer patients. We investigated the relationship between household income and financial burden among patients with chronic myelogenous leukaemia (CML) who have been treated with imatinib. METHODS: A questionnaire was distributed to 1200 patients between May and August 2009. We retrospectively surveyed their household incomes, out-of-pocket medical expenses, final co-payments after refunds, and the perceived financial burden of their medical expenses in 2000, 2005 and 2008. RESULTS: A total of 577 patients completed the questionnaire. Their median age was 61 years (range, 15-94). A financial burden was felt by 41.2 % (28 of 68) of the patients treated with imatinib in 2000, 70.8 % (201 of 284) in 2005, and 75.8 % (400 of 528) in 2008. Overall, 182 patients (31.7 %) considered its discontinuation because of the financial burden and 15 (2.6 %) temporarily stopped their imatinib prescription. In 2000, 2005 and 2008, the patients' median annual household incomes were 49,615 US Dollars (USD), 38,510 USD and 36,731 USD, respectively, with an average currency exchange rate of 104 Yen/USD in 2008. Their median annual out-of-pocket expenses were 11,548, 12,067 and 11,538 USD and their median final annual co-payments were 4,375, 4,327 and 3,558 USD, respectively. Older patients (OR = 0.96, 95 % CI: 0.95-0.98, p ≪ 0.0001 for 1-year increments), and patients with higher household incomes (OR = 0.92, 95 % CI: 0.85-0.99, p = 0.03 for 10,000 USD-increments) were less likely to have considered discontinuing their imatinib treatment. Conversely, patients with higher annual final co-payments (OR = 2.21, 95 % CI: 1.28-4.28, p = 0.004 for 10,000 USD-increments) were more likely to have considered discontinuing their imatinib treatment. CONCLUSIONS: The proportion of CML patients who sensed a financial burden increased between 2000 and 2008. During this period, their annual incomes fell by 13,000 USD, although their medical expenses did not change. Financial support for patients being treated with expensive drugs remains a major problem in Japan.

Age, gender, will, and use of home-visit nursing care are critical factors in home care for malignant diseases; a retrospective study involving 346 patients in Japan.

BACKGROUND: We aimed to clarify the factors affecting outcomes of home care for patients with malignant diseases. METHODS: Of 607 patients who were treated in 10 clinics specialized in home care between January and December 2007 at Chiba, Fukuoka, Iwate, Kagoshima, Tochigi and Tokyo prefectures across Japan, 346 (57%; 145 men and 201 women) had malignant diseases. We collected information on medical and social backgrounds, details of home care, and its outcomes based on their medical records. RESULTS: Median age of the patients was 77 years (range, 11-102), and 335 patients were economically self-sufficient. Their general condition was poor; advanced cancer (n = 308), performance status of 3-4 (n = 261), and dementia (n = 121). At the beginning of home care, 143 patients and 174 family members expressed their wish to die at home. All the patients received supportive treatments including fluid replacement and oxygenation. Median duration of home care was 47 days (range, 0-2,712). 224 patients died at home. For the remaining 122, home care was terminated due to complications (n = 109), change of attending physicians (n = 8), and others (n = 5). The factors which inhibited the continuity of home care were the non-use of home-visit nursing care (hazard ratio [HR] = 1.78, 95% confidence interval [CI]: 1.05-3.00, p = 0.03), the fact that the patients themselves do not wish to die at home (HR = 1.83, CI: 1.09-3.07, p = 0.02), women (HR = 1.81, CI: 1.11-2.94, p = 0.02), and age (HR = 0.98, CI: 0.97-1.00, p = 0.02). CONCLUSIONS: Continuation of home care is influenced by patients' age, gender, will, and use of home-visit nursing.

Internet-based survey on medical manga in Japan.

The more manga (Japanese graphic novels) communicate medical information, the more people are likely to be influenced by manga. We investigated through an Internet search using Google the characteristics of medical manga published in Japan, defined as those in which the main character is a medical professional and that occur in a medical setting. As of December 2008, 173 medical manga had been published. For a period of time after the first medical manga by Osamu Tezuka in 1970, the number of publications maintained a steady level, but increased rapidly in the mid 1980s. The professions of the protagonist were 134 doctors, 19 nurses, 3 dentists, 3 medical students, and 1 nursing student. Although the main character was mostly a doctor, manga featuring paramedical professionals have increased since 1990s. Medical manga may be a powerful tool for increasing the awareness of the public regarding medicine.

[Pattern goodness and perceptual organization].

The present study examined the relation between the manner of perceptual organization and pattern goodness. We presented regularly arranged dot patterns (Experiment 1) and randomly arranged dot patterns (Experiment 2). In both experiments, the participants were asked to evaluate the goodness of the patterns using a 7-point scale and to encircle the dots in the manner that the participants had organized them. The results for both experiments showed that patterns organized with fewer groups were rated as better than patterns organized with more groups, despite having the same structure. These results indicate that the variation in pattern goodness which is not explained by the physical structure of the pattern is explained by the manner of perceptual organization used by the observer.

Chronic graft-versus-host disease following umbilical cord blood transplantation: retrospective survey involving 1072 patients in Japan.

We have little information on chronic graft-versus-host disease (GVHD) after cord blood transplantation (CBT). We investigated its clinical features in 1072 Japanese patients with hematologic malignancies who received a transplant through the Japan Cord Blood Bank Network. The primary end point was to investigate the incidence of any chronic GVHD. Median age of the patients was 33 years (range, 0-79 years). The cumulative incidence of chronic GVHD 2 years after transplantation was 28%. Chronic GVHD was fatal in 29 patients. Multivariate analysis demonstrated that development of chronic GVHD was favorably associated with both overall survival and event-free survival. Multivariate analysis identified risk factors of chronic GVHD: higher patient body weight, higher number of mismatched antigens for GVHD direction, myeloablative preparative regimen, use of mycophenolate mofetil in GVHD prophylaxis, and development of grades II to IV acute GVHD. Although chronic GVHD is a significant problem after CBT, it is associated with improved survival, perhaps due to graft-versus-malignancy effects.

The impact of H1N1 influenza A virus pandemic on the blood donations in Hyogo Prefecture, Japan.

BACKGROUND: The impact of the H1N1 influenza on blood donation is unknown. STUDY DESIGN AND METHODS: We examined number of blood donors presenting to blood donation centers or bloodmobiles using a blood donation database of Red Cross Hyogo Prefectural Blood Center between 4 weeks before and after May 16, 2009, respectively, when the first case of H1N1 influenza was confirmed in Kobe. The numbers of blood donors per donation site (i.e., blood donation centers and bloodmobiles) and per blood products (i.e., red blood cells [RBCs], platelet [PLT]-poor plasma, and PLTs) were also examined. RESULTS: The number of blood donors decreased by 21% and whole blood donations declined by 1329 units within 1 week of the first case of H1N1 influenza. While number of blood donors showed a rapid decrease, blood donations returned to the normal level within 1 week. This quick recovery was attributed to the diligent efforts made by Red Cross Centers, including the use of e-mail to encourage blood donation, on-the-street campaigns, and requesting new bloodmobile drives in workplaces and universities. RBCs that were donated in bloodmobiles was predominantly affected; the number of blood donors in bloodmobiles decreased by 39%. CONCLUSION: H1N1 influenza pandemic had a great but transient impact on blood donation.

Structural problems of medical news reports in newspapers: a verification of news reports on an incident of mass nosocomial Serratia infection.

It is unclear how changes in the content and number of news reports over time affect the impressions made in the minds of newspaper readers. This study targeted news reports in major newspapers regarding an incident of mass nosocomial Serratia infection that occurred at one clinic. The trends in the total number of articles and total number of characters contained in the articles were congruent, with a peak on the day after the incident was disclosed and a rapid decrease thereafter. The numbers of articles and characters that appeared during the first 3 days corresponded to 45 and 51% of those that appeared during the entire study period. On day 9, it was published that Serratia liquefaciens propagated on medical instruments, and both the number of articles and the number of characters increased by approximately 40% in comparison to those published on the day after the initial report of the incident. The individual articles were deemed to be medically accurate; however, the main problem was that only part of the specific medical issue had been emphasized because of a poor balance in the number of news reports on this topic.

[Economic burden for patients with chronic myelogenous leukemia--healthcare economics and medical governance of cancer].

Due to the recent economic downturn, the economic burden of cancer patients has been further worsened. Specifically for chronic myelogenous leukemia patients, their annual income has decreased by 1, 500, 000 yen from 2000 to 2008, while the cost of their medications has increased from 1,000,000 yen to 1,200,000 yen due the advent of the new drug, Glivec, which was approved in 2001. The scores for psychological burden have increased 30% over the past 8 years before Glivec became available. The economic crisis among cancer patients is a consequence of structural problems with many anticancer drugs and cancer treatment. Especially, problems involving the cost of medical care and the system of drug pricing should be resolved by thorough discussion not only with cancer patients but also with the entire population. Discussion on the medical expense burden for CML patients has flourished through patients' spontaneous activities and information disclosure to a wider population through the internet. This methodology will be significant in establishing medical governance in cancer treatment in Japan.

Awake functional MRI detects neural circuit dysfunction in a mouse model of autism.

MRI has potential as a translational approach from rodents to humans. However, given that mouse functional MRI (fMRI) uses anesthetics for suppression of motion, it has been difficult to directly compare the result of fMRI in "unconsciousness" disease model mice with that in "consciousness" patients. We develop awake fMRI to investigate brain function in 15q dup mice, a copy number variation model of autism. Compared to wild-type mice, we find that 15q dup is associated with whole-brain functional hypoconnectivity and diminished fMRI responses to odors of stranger mice. Ex vivo diffusion MRI reveals widespread anomalies in white matter ultrastructure in 15q dup mice, suggesting a putative anatomical substrate for these functional hypoconnectivity. We show that d-cycloserine (DCS) treatment partially normalizes these anormalies in the frontal cortex of 15q dup mice and rescues some social behaviors. Our results demonstrate the utility of awake rodent fMRI and provide a rationale for further investigation of DCS therapy.

Retrospective study on home care for patients with hematologic malignancies.

OBJECTIVE: There is a lack of sufficient information on the employment of home care for the treatment of hematologic malignancies. METHODS: We provided home care to 580 patients from 1 January through 31 October 2007. Patients with hematologic malignancies were selected from these 580 patients; subsequently, by reviewing their medical records. RESULTS: The main clinical condition in 15 (2.6%) of 580 patients was hematologic malignancies. The median age of the patients was 78 years (range, 64-92). Of the 15 patients, 12 showed a performance status (PS) of 3-4, and the condition of 6 patients was complicated with dementia. Food intake via the oral route was possible in 14 patients. These patients were administered palliative care. Among the seven patients who required pain control, four had been opioid users; however, none had used anticancer drugs for pain relief. Furthermore, three patients received blood transfusion. Although three patients developed severe complications (acute appendicitis, pneumonia and hyperglycemia), we were able to treat all cases adequately. Eight patients died at home due to aggravation of the primary diseases. The remaining seven patients were transferred to other hospitals for the treatment of complications or for the convenience of their respective families. CONCLUSIONS: Even patients with hematologic malignancies could be candidates for home care if their underlying diseases are slowly progressive, and they can sustain themselves by oral intakes. Dementia and poor PS are not contraindicated to it.

Regional social system for specialized medical care in hematologic malignancies: a pilot study.

INTRODUCTION: The uneven distribution of physicians in Japan disadvantages rural and remote patients with hematological malignancies to the extent that they may not receive standard treatments. There are 7 core regional medical centers in Tokushima Prefecture. A Tokushima rural medical center's clinical hematology division experienced difficulty in treating patients due to a lack of physicians despite an increasing number of patients with hematological malignancies. The aim of this pilot study was to investigate the regional medical supply and demand associated with newly diagnosed hematological malignancies in Tokushima Prefecture, Japan. METHODS: The study investigated the home addresses of patients with newly diagnosed acute leukemia, malignant lymphoma and multiple myeloma who were hospitalized in the 7 core Tokushima centers in 2006. The surveyed patients were compared with the estimated number of patients with those diseases that were newly developed, based on a calculation of incidence and population by age group. The survey also investigated the number and distribution of hematologists. RESULTS: A total of 248 patients were newly hospitalized in the 7 core centers in Tokushima Prefecture during the 1 year period. The surveyed number of patients was similar to the estimated number of patients in all secondary medical areas, except for one area where there was active traffic to and from adjacent prefectures. More than 70% (median 80%; range 72-100%) of the patients received their treatments within a radius of approximately 25 km from their homes. There were 24 hematologists in November 2006 and 63% of these worked in the city with the largest population. The mean estimated number of patients per unit population was significantly higher in rural and remote areas than in urban areas (p <0.01). Three regional centers had only one or two hematologists. CONCLUSIONS: Most patients with newly developed hematological malignancies in Tokushima Prefecture received treatment from intra-prefectural hematologists within a 25 km distance of their homes. Rural areas had a shortage of hematologists who were localized in urban areas. It is recommended that functions of core medical centres and rural clinics are redesigned according the availability of specialized treatments, and to maximize cooperation between physicians at rural clinics and hematologists at urban hospitals.

A Comparative Survival Analysis Between Evacuees and Nonevacuees Among Dialysis Patients in Fukushima Prefecture After Japan's 2011 Fukushima Nuclear Incident.

OBJECTIVE: There has been little research on the health consequences of evacuation in the disaster context. A comparative analysis of survival between evacuated and nonevacuated hospital dialysis patients was conducted following Japan's Fukushima Dai-ichi nuclear power plant incident, which occurred on March 11, 2011. METHODS: The study included 554 patients (mean age: 70.9) receiving dialysis therapy at one of the Tokiwakai Group hospitals-all of which are located in and around Iwaki City, approximately 50 km from the Fukushima nuclear plant-as of the incident date. The patients' survival after the incident was tracked until March 3, 2017. Significant differences in mortality rates between postincident evacuees and nonevacuees were tested using the Bayesian survival analysis with Weibull multivariate regression. RESULTS: Out of 554 dialysis patients, 418 (75.5%) were evacuated after the incident. The postincident mortality rate (adjusted for covariates) of evacuees was not statistically significantly different from that of nonevacuees. The hazard ratio was 1.17 (95% credible intervals: 0.77-1.74). CONCLUSIONS: If performed in a well-planned manner with satisfactory arrangements for appropriate selection of evacuees and their transportation, evacuation could be a reasonable option, which might save more lives of vulnerable people.

Possible impact of the NHK special questioning cancer treatment in Japan on clinicians' prescriptions of oxaliplatin.

Medical information through media may influence physicians' prescriptions of medication. The Japan Broadcasting Corporation (NHK) aired on April and May 2005, a special program called 'Questioning Cancer Treatment in Japan', covering oxaliplatin. We investigated potential impact of this program on prescriptions, utilizing a post-marketing clinical trial monitoring of all patients receiving oxaliplatin. The post-marketing clinical trial reached the target sample size of 1200 by the 4th week of May, 44 weeks sooner than anticipated. The newly registered numbers of facilities and patients exhibited a bimodal peak in April and June. The viewer rating of NHK special was 8.3%, whereas three national newspapers and one weekly magazine took up the minor articles of oxaliplatin. In July 2007, 405 clinicians sent a written opinion to NHK, stating 'NHK special invites misperceptions and confusions to public.' NHK special might have had an impact on clinicians' prescriptions of oxaliplatin.

Electrodialytic in-line preconcentration for ionic solute analysis.

Preconcentration is an effective way to improve analytical sensitivity. Many types of methods are used for enrichment of ionic solute analytes. However, current methods are batchwise and include procedures such as trapping and elution. In this manuscript, we propose in-line electrodialytic enrichment of ionic solutes. The method can enrich ionic solutes within seconds by quantitative transfer of analytes from the sample solution to the acceptor solution under an electric field. Because of quantitative ion transfer, the enrichment factor (the ratio of the concentration in the sample and to that in the obtained acceptor solution) only depends on the flow rate ratio of the sample solution to the acceptor solution. The ratios of the concentrations and flow rates are equal for ratios up to 70, 20, and 70 for the tested ionic solutes of inorganic cations, inorganic anions, and heavy metal ions, respectively. The sensitivity of ionic solute determinations is also improved based on the enrichment factor. The method can also simultaneously achieve matrix isolation and enrichment. The method was successively applied to determine the concentrations of trace amounts of chloroacetic acids in tap water. The regulated concentration levels cannot be determined by conventional high-performance liquid chromatography with ultraviolet detection (HPLC-UV) without enrichment. However, enrichment with the present method is effective for determination of tap water quality by improving the limits of detection of HPLC-UV. The standard addition test with real tap water samples shows good recoveries (94.9-109.6%).