Contributions of social context to inequality in dental caries: a multilevel analysis of Japanese 3-year-old children.

BACKGROUND: Community context as well as individual health behavior affects oral health status. However, the contribution of social context to dental caries among people in various regions remains unclear when individual health behavior is taken into account. OBJECTIVES: To determine the influence of community context on dmft among 3-year-old children. METHODS: After all Japanese municipalities (n = 2522) had been stratified into nine regions with three caries levels, 44 municipalities were randomly selected. Community health service workers were asked to collect information on sociodemographic characteristics, oral health-related behavior, and dental condition for 3-year-old children during community dental health check-ups. Community-related variables, including socioeconomic status, social support, and social cohesion, were obtained from census data. Multilevel analysis was used to determine the effects of social context and individual behavior on dental caries. RESULTS: A total of 3301 parents (79.9%) of 3-year-old children from 39 municipalities participated in our survey, and complete information was obtained from 3086 of them. Results of the analysis showed that 90.8% (P < 0.001) of variance in dmft occurred at the individual level and that 9.2% (P < 0.001) of the variance occurred at the community level. Individual-level variables explained only 6.6% of the individual level variance in dmft. Community-level variables explained 47.2% of the community level variance. CONCLUSIONS: There are statistically significant effects of social context on dmft in municipalities in Japan.

Near-infrared spectrophotoscopy of finger venules in assessment of autonomic dysfunction.

The authors evaluated morphologic changes in the venules of the finger using near-infrared spectrophotoscopy in patients with autonomic dysfunction, such as familial amyloidotic polyneuropathy and multiple-system atrophy. Abnormalities of the venules, such as tortuosity, irregular venous caliber, and microaneurysm-like change, and a linear negative correlation between the degree of orthostatic hypotension and the degree of vasoconstriction of the venules were observed.

[Validity of reticulocyte count testing in reimbursement practice: a cost-effectiveness analysis].

Recently reticulocyte count testing has markedly decreased in Japan. We studied the current status of the reduction of reimbursement for reticulocyte count testing and the cost-effectiveness of the test in an academic hospital. The orders of complete blood counts(CBC) accompanied by reticulocyte count testing in Tokai University Hospital declined from 58.9 to 13.3% during the last decade. Among a total of 15,538 test orders for reticulocyte count in outpatients, full reimbursement was refused in 123(0.79%) during a one year period from April 1999 to March 2000. The cost-effectiveness of reticulocyte count testing was evaluated in 719 new outpatients who visited Tokai University Hospital during this period. A useful result(UR) of testing was defined as that which contributed to a change in a physician's diagnosis- or decision-making, relating to a "tentative initial diagnosis" obtained from patient history and physical examination alone. Cost-effectiveness for either CBC alone or in combination with reticulocyte count testing was evaluated by calculating clinical effectiveness(the number of URs yielded by a test per patient), economic efficiency(cost required for a test per UR generated), and the cost-effectiveness values(cost required for additional test(s) per additional UR generated). There was a wide disparity in the clinical effectiveness of reticulocyte count twisting among the hospital departments, ranging from 0.53 UR/patient(Gastroenterology-2) to 0(Oral Surgery, Neurology, Urology). Poor clinical effectiveness shown in particular hospital departments endorsed the increasing percentages in reimbursement rejection by the payer of health insurance. The test should be ordered more carefully in consideration of reimbursement and in regard to its cost-effectiveness among different patients groups.

A standard data format for medical information in the IS & C system.

This paper describes the file format of the IS & C standard and the results of IS & C scientific exhibition at Yokohama. The English version of IS & C standard Version 1.0 was published in the spring of 1992 by the IS & C committee. On the basis of this document, the IS & C data format was explained. The enhanced description of color images, wave data and the laboratory data is still under discussion. The data format of the color images was established in March 1993. In April 1992, the IS & C scientific exhibition was held at the general assembly of the Japanese Radiological Society. At this exhibition, the demonstration of the compatibility among IS & C workstations was successful. The consensus on IS & C system was investigated. IS & C system was well understood by observers and the interchangeability of radiological images was recognized as very feasible.

Family study of women showing development of antibody to human T-cell leukemia virus I and assessment of the risk of vertical transmission of the virus to their children.

When pregnant women were tested for antibody to human T-cell leukemia virus-I, some were found to be positive although they had been negative during the previous pregnancy. In these women, HTLV-I infection was found from pedigree studies to have been acquired from their mothers rather than from their husbands. Furthermore, some of them had apparently remained HTLV-I antibody-negative for long periods after infection. When the breast-fed children of these women, in whom HTLV-I was acquired from their mothers but who were in an HTLV-I antibody-negative state, were also examined for evidence of HTLV-I infection, none was found.