Social regulations predispose people to complete vaccination for vaccine-preventable diseases.

Japan experienced measles outbreaks in both 2006 and 2007 mainly among university students. Improvement of vaccine coverage against vaccine-preventable viral infections is the prime task for preventing outbreaks of viral infections. To elucidate the promoting factors for complete vaccination against measles, rubella, mumps, and varicella-zoster viruses, we conducted a case-control study among single university students in Japan. Information on vaccinations and clinico-demographical factors were collected using a self-administered questionnaire and a photocopy of the Maternal and Child Health Handbook. Logistic regression analysis was performed to estimate odds ratios (ORs) and their 95% confidence intervals (CIs) for two-time vaccination against measles and rubella viruses as mandatory vaccinations and at least one-time vaccination against mumps and varicella-zoster viruses as optional vaccinations. A total of 1,370 (744 medical, 508 paramedical, and 118 pharmaceutical) students were invited to participate, 960 (70.1%) of whom were enrolled in the study. Students aged < 20 years had a greater propensity for measles and rubella vaccinations (OR 7.8 [95% CI, 5.1-11.8] and OR 6.1 [95% CI, 3.7-10.0], respectively) compared with those aged ≥ 20 years. Students with a history of living over-seas for 1 month or longer were more likely to complete vaccination for measles (OR 4.4 [95% CI, 1.4-13.5] compared with those without such history. This significantly high vaccination coverage was attributed to the measles-rubella catch-up campaign by the Japanese government and the immunization regulations by foreign countries. These findings suggest that social regulations would predispose people to complete vaccination.

Serological assessment of measles-rubella vaccination catch-up campaign among university students.

BACKGROUND: In Japan, 5000-300,000 persons contracted measles every year until 2001. The measles/rubella-combined (MR) vaccination at age 17-18 years (phase 4 MR vaccination: MR-IV) was launched in 2008 in Japan as a measles-rubella catch-up campaign. A serological assessment of this campaign has not been thoroughly performed. METHODS: Titers of anti-measles and anti-rubella immunoglobulin G antibodies, and past medical history including measles and rubella vaccination and infection were obtained from first-year university students in 2008 and 2009, and the immune status against measles and rubella was compared between students at the target MR-IV age (the target age group) and those 1 year older than the target age (non-target age group). RESULTS: A total of 186 students were in the target age group and 146 were in the non-target age group. The proportion of students with a history of measles and rubella infection was not significantly different between the two groups (8.8% vs. 6.3%, P = 0.41 and 11.0% vs. 9.9%, P = 0.75, respectively). A history of two or more measles and rubella vaccinations was significantly more frequent in the target age group (85.2% and 54.9%, respectively) than in the non-target age group (20.8% and 13.2%, respectively; both P < 0.001). Prevalence of seropositivity for measles and for rubella was also higher in the target age group (98.9% and 97.8%, respectively) than in the non-target age group (91.0% and 87.5%, respectively; both P < 0.001). CONCLUSIONS: The MR-IV catch-up campaign helped achieve herd immunity and will contribute to the elimination of measles and rubella.

A new equation to estimate basal energy expenditure of patients with diabetes.

BACKGROUND & AIMS: Predictive equations for basal energy expenditure (BEE) derived from Caucasians tend to overestimate BEE in non-Caucasians. The aim of this study was to develop a more suitable method to estimate BEE in Japanese patients with diabetes using indices readily measured in clinical practice. METHODS: BEE was measured by indirect calorimetry under a strict basal condition in 68 Japanese patients with type 1 or type 2 diabetes. The best fitting equation was investigated by multiple regression analysis using of age, sex, and anthropometric indices. The resultant new equation was tested in a separate group of 60 Japanese patients with type 1 or type 2 diabetes, and the accuracy compared with existing equations. RESULTS: The best-fit equation was BEE [kcal/day] = 10 × (body weight)[kg] - 3 × (age)[y] + 125 (if male) + 750. Adjusted coefficient of determination was 81.0%. Root mean squared errors and accurate prediction in the validation set were 103 kcal/day and 78% for the new equation; 184 and 50 for Harris-Benedict; 209 and 38 for Oxford; 205 and 42 for Liu; and 140 and 63 for Ganpule. CONCLUSIONS: This new equation is simpler and estimates BEE more accurately in Japanese patients with diabetes than the presently used equations do.

Impact of endogenous and exogenous insulin on basal energy expenditure in patients with type 2 diabetes under standard treatment.

BACKGROUND: Factors that affect resting energy expenditure or basal energy expenditure (BEE) in patients with type 2 diabetes under standard treatment have not been evaluated in detail. OBJECTIVE: We determined the clinical factors that affected BEE in addition to body composition in patients with type 2 diabetes under standard treatment. DESIGN: BEE was measured by using indirect calorimetry under a strict basal condition in 58 Japanese patients with type 2 diabetes after >7 d as inpatients under management of diabetes with medical nutrition therapy and medications. Insulin secretion was measured with a glucagon test. Stepwise regression was applied to explore determinants of BEE. RESULTS: In the stepwise estimation, insulin secretion (P = 0.015), insulin therapy (P = 0.012), and pulse rate (P = 0.011) were selected in addition to fat-free mass (FFM) (P < 0.001) and fat mass (P = 0.006) as significant independent determinants of BEE. Standardized partial regression coefficients of the additional 3 factors were -0.16, -0.15, and 0.15, respectively, whereas those for FFM and fat mass were 0.82 and 0.19, respectively. The additional 3 factors explained another 3.9% of the variability of BEE, and the adjusted coefficient of determination was 83.4%. Age, sex, other medications, and parameters of glycemic control were not significant determinants beyond the combined contribution of body composition, endogenous and exogenous insulin, and pulse rate. CONCLUSION: Endogenous insulin secretion and exogenous insulin administered in treatment have significant independent effects in the lowering of BEE in patients with diabetes under standard management with medical nutrition therapy and medications.

Risk stratification for progression of IgA nephropathy using a decision tree induction algorithm.

BACKGROUND: Immunoglobulin A nephropathy (IgAN) is the most common form of glomerulonephritis, and many patients are at risk of at least slow progression. However, prediction of the renal outcome in individual patients remains difficult. METHODS: To develop a practical and user-friendly scheme for risk stratification of IgAN patients, data were extracted from a prospective cohort study conducted in 97 clinical units in Japan from 1995. Specifically, we examined deterioration in renal function, defined as doubling of serum creatinine, within 10 years of follow-up in 790 adult IgAN patients without substantial renal dysfunction at baseline using a decision tree induction algorithm. RESULTS: Recursive partitioning indicated that the best single predictor of renal deterioration was severe proteinuria on urine dipstick testing, followed by hypoalbuminaemia and the presence of mild haematuria for patients with and without severe proteinuria, respectively. Serum total protein levels, diastolic blood pressure and histological grade were placed in the third tier of the decision tree model. With these six variables, patients can be readily stratified into seven risk groups whose incidence of renal deterioration within 10-year follow-up ranges from 1.0% to 51.4%. Logistic regression also identified severe proteinuria, hypoalbuminaemia and mild haematuria as significant predictors of deterioration. Areas under the receiver-operating characteristic curve for the prediction were comparable between the decision tree model and the logistic regression model [0.830 (95% confidence interval, 0.777-0.883) versus 0.808 (95% confidence interval, 0.754-0.861)]. CONCLUSION: Risk of substantial renal deterioration in IgAN patients can be validly estimated using six predictors obtained from clinical routine.

BCG vaccination and tuberculosis in Japan.

This paper summarizes Bacillus Calmette-Guerin (BCG) vaccination and revaccination policies in Japan, its cost-effectiveness, side effects, proposed selective vaccination strategy, and present tuberculosis situation in Japanese perspectives based on Medline database and other published reports. Universal BCG vaccination in infants and revaccination among children were not found economically justifiable. Overall tuberculosis incidence in Japan is higher than that of other developed countries. Trend of decline in tuberculosis incidence is similar to that of the countries where universal BCG vaccination has never been implemented. In the recent years, the number of tuberculosis group infection has been escalating. Since BCG revaccination program has already been discontinued, a consensus on universal BCG vaccination is also essential based on social, political, and economical factors. Side by side, more pragmatic strategies such as well-defined tuberculin test, selective vaccination policy based on tuberculosis incidence in each administrative zone, and early vaccination of high risk groups, should be formulated.