Cost Analysis of Screening for IgA Nephropathy Using Novel Biomarkers.

OBJECTIVES: IgA nephropathy (IgAN) is the most common primary chronic glomerulonephritis and a major cause of end-stage kidney disease worldwide. Novel biomarkers, including the aberrantly glycosylated IgA1 and glycan-specific antibodies, could be useful in the diagnosis of IgAN. The aim of this study was to assess the cost analysis of IgAN screening using novel biomarkers in addition to the conventional screening compared with conventional screening alone. METHODS: To estimate the medical expense of each strategy related to renal disease for 40 years, we developed an analytical decision model. The decision tree started at "40 years of age with first-time hematuria." It simulated 2 clinical strategies: IgAN screening using the novel biomarkers (group N) and conventional screening (group C). The analysis results were presented as medical expenses from a societal perspective. Discounting was not conducted. RESULTS: The expected medical expense per person for 40 years was ¥31.2 million (~$291 000) in group N and ¥33.4 million (~$312 000) in group C; hence, expense in group N was lower by ¥2.2 million (~$21 000). In group N, the expected value of IgAN increased by 5.67% points (N 48.44%, C 42.77%) and that of dialysis introduction decreased by 0.85% points (N 19.06%, C 19.91%). In the sensitivity analysis, expenses could be reduced in almost all cases except when renal biopsy using conventional screening was performed at the rate of 73% or higher. CONCLUSION: Screening for IgAN using novel biomarkers would reduce renal disease-related expenses.

Daily sleep duration and the risk of incident disability among younger elderly Japanese adults in the New Integrated Suburban Seniority Investigation Project: A prospective study using competing event analysis.

AIM: This study aimed to investigate the association between daily sleep duration and incident disability among younger elderly individuals in Japan. METHODS: We carried out a prospective cohort study, the New Integrated Suburban Seniority Investigation Project, including 1895 (962 men and 933 women) Japanese physically and socially independent individuals aged ≥65 years. Information on daily sleep duration, demographic, lifestyle characteristics and medical status were collected by questionnaire and health checkup every year from 1996 through 2005. Dates of incident disability were confirmed using the certification for the long-term care insurance in Japan. We treated censored cases due to death as competing events. A competing risk model was used to calculate the hazard ratio and 95% confidence interval for incident disability. RESULTS: During a median of 12.7 years of follow up, 256 participants (114 men and 142 women) reported incident disability. Compared with a sleep duration of 7-7.9 h/day, sleeping <6 h/day showed an increased risk of incident disability (hazard ratio 1.64, 95% confidence interval 1.13-2.38 for total; hazard ratio 1.90, 95% confidence interval 1.19-3.03 for women). CONCLUSIONS: The present findings suggest that shorter sleep duration was associated with a higher risk of incident disability among older Japanese people. Geriatr Gerontol Int 2019; 19: 945-949.

Healthy Campus Trial: a multiphase optimization strategy (MOST) fully factorial trial to optimize the smartphone cognitive behavioral therapy (CBT) app for mental health promotion among university students: study protocol for a randomized controlled trial.

BACKGROUND: Youth in general and college life in particular are characterized by new educational, vocational, and interpersonal challenges, opportunities, and substantial stress. It is estimated that 30-50% of university students meet criteria for some mental disorder, especially depression, in any given year. The university has traditionally provided many channels to promote students' mental health, but until now only a minority have sought such help, possibly owing to lack of time and/or to stigma related to mental illness. Smartphone-delivered cognitive behavioral therapy (CBT) shows promise for its accessibility and effectiveness. However, its most effective components and for whom it is more (or less) effective are not known. METHODS/DESIGN: Based on the multiphase optimization strategy framework, this study is a parallel-group, multicenter, open, fully factorial trial examining five smartphone-delivered CBT components (self-monitoring, cognitive restructuring, behavioral activation, assertion training, and problem solving) among university students with elevated distress, defined as scoring 5 or more on the Patient Health Questionnaire-9 (PHQ-9). The primary outcome is change in PHQ-9 scores from baseline to week 8. We will estimate specific efficacy of the five components and their interactions through the mixed-effects repeated-measures analysis and propose the most effective and efficacious combinations of components. Effect modification by selected baseline characteristics will be examined in exploratory analyses. DISCUSSION: The highly efficient experimental design will allow identification of the most effective components and the most efficient combinations thereof among the five components of smartphone CBT for university students. Pragmatically, the findings will help make the most efficacious CBT package accessible to a large number of distressed university students at reduced cost; theoretically, they will shed light on the underlying mechanisms of CBT and help further advance CBT for depression. TRIAL REGISTRATION: UMIN, CTR-000031307 . Registered on February 14, 2018.

Leisure-time physical activity and risk of disability incidence: A 12-year prospective cohort study among young elderly of the same age at baseline.

BACKGROUND: To clarify the role of physical activity in preventing disability in Japan, we investigated the association between amount of leisure-time physical activity and incidence of disability among the young elderly. METHODS: In the New Integrated Suburban Seniority Investigation (NISSIN) project conducted from 1996 to 2013, we followed 2888 community-dwelling adults aged 64-65 years with no history of cerebrovascular disease for a median follow-up of 11.6 years. Disabilities were defined as follows based on the classifications of the Japanese long-term care insurance system: 1) support or care levels (support levels 1-2 or care levels 1-5); 2) care levels 2-5; 3) support or care levels with dementia; and 4) care levels 2-5 or death. In addition, we also assessed 5) all-cause mortality. RESULTS: After controlling for sociodemographic, lifestyle, and medical factors, male participants reporting an activity level of 18.1 metabolic equivalent (MET)-hours/week (the median among those with activities) or more had 52% less risk of being classified as support or care levels with dementia compared with the no activity group (hazard ratio 0.48; 95% confidence interval, 0.25-0.94). No significant association was found among women between amount of leisure-time physical activity and incidence of disability. CONCLUSION: We identified an inverse dose-response relationship between the amount of leisure-time physical activity and the risk of disability with dementia in men. Therefore, a higher level of physical activity should be recommended to young elderly men to prevent disability with dementia.

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.

Changes in the SF-8 scores among healthy non-smoking school teachers after the enforcement of a smoke-free school policy: a comparison by passive smoke status.

BACKGROUND: The effects of the enforcement of a smoke-free workplace policy on health-related quality of life (HRQOL) among a healthy population are poorly understood. The present study was undertaken to examine the effects of the enforcement of a smoke-free school policy on HRQOL among healthy non-smoking schoolteachers with respect to their exposure to passive smoke. METHODS: Two self-reported questionnaire surveys were conducted, the first before and the second after the enforcement of a total smoke-free public school policy in Nara City. A total of 1534 teachers were invited from 62 schools, and their HRQOL was assessed using six domains extracted from the Medical Outcomes Survey Short Form-8 questionnaire (SF-8): general health perception (GH), role functioning-physical (RP), vitality (VT), social functioning (SF), mental health (MH), and role functioning-emotional (RE). The participants were divided into two groups according to their exposure to environmental tobacco smoke (ETS) at baseline: participants not exposed to ETS at school (non-smokers), and participants exposed to ETS at school (passive smokers). Changes in each SF-8 score were evaluated using paired t-tests for each group, and their inter-group differences were evaluated using multiple linear regression analyses adjusted for sex, age, school type, managerial position, and attitude towards a smoke-free policy. RESULTS: After ineligible subjects were excluded, 689 teachers were included in the analyses. The number of non-smokers and passive smokers was 447 and 242, respectively. Significant changes in SF-8 scores were observed for MH (0.9; 95% confidence interval [CI], 0.2-1.5) and RE (0.7; 95% CI, 0.0-1.3) in non-smokers, and GH (2.2; 95% CI, 1.2-3.1), VT (1.8; 95% CI, 0.9-2.7), SF (2.7; 95% CI, 1.6-3.8), MH (2.0; 95% CI, 1.0-2.9), and RE (2.0; 95% CI, 1.2-2.8) in passive smokers. In the multiple linear regression analyses, the net changes in the category scores of GH (1.8; 95% CI, 0.7-2.9), VT (1.4, 95% CI, 0.3-2.5), SF (2.5; 95% CI, 1.1-3.9), MH (1.2; 95% CI, 0.1-2.4) and RE (1.6; 95% CI, 0.5-2.7) in passive smokers significantly exceeded those in non-smokers. CONCLUSIONS: A smoke-free school policy would improve the HRQOL of healthy non-smoking teachers who are exposed to ETS.

Assessment of the risk of postoperative delirium in elderly patients using E-PASS and the NEECHAM Confusion Scale.

BACKGROUND: The incidences of surgery-field disorders such as femur neck fracture and colorectal cancer in elderly persons have increased with the rapid aging of society. In such patients, postoperative delirium is also frequent. Patients should be generally assessed from the aspect of both physical and mental conditions in order to predict a high-delirium risk group. If so, delirium may be prevented more efficiently. In this study, we investigated whether the early detection of postoperative delirium in elderly patients is possible using a simple, useful behavior-assessing scale, the NEECHAM Confusion Scale, and a method for comprehensively evaluating elderly persons' stress related to surgery, E-PASS. METHODS: The subjects were 160 patients aged more than 75 years who underwent surgery. Among them, three patients had vascular surgery-field disorders, 67 had orthopedic-field disorders, and 90 had digestive surgery-field disorders. To comprehensively evaluate surgery-related stress, E-PASS was employed. In addition, we assessed recognition, activities of daily living (ADL), and the quality of life (QOL). For delirium diagnosis and severity assessment, we used the NEECHAM Confusion Scale. The cut-off value of the NEECHAM score was established as 20 points, and patients showing values less than this after surgery were regarded as having postoperative delirium. Evaluation was performed until 10 days after surgery. RESULTS: Postoperative delirium was noted in 54.7% of the subjects. There was a decrease in the NEECHAM score between the first and fourth postoperative days, but it gradually increased thereafter. Both uni- and multivariate analyses showed that postoperative delirium was associated with an advanced age (more than 80 years), low preoperative NEECHAM and MMSE scores, the preoperative QOL, and E-PASS. In groups showing an MMSE score of less than 25 or a preoperative NEECHAM score of less than 27, the incidence of postoperative delirium was 76%. CONCLUSION: The results suggest that E-PASS and the NEECHAM score facilitate assessment of the risk of postoperative delirium in elderly patients, contributing to early prevention/treatment.

Longitudinal Evaluation of Multi-phasic, Odontological and Nutritional Associations in Dentists (LEMONADE Study): study design and profile of nationwide cohort participants at baseline.

BACKGROUND: To examine the association between oral health and general well-being, we are currently conducting a nationwide cohort study comprising members of the Japan Dental Association (JDA). Herein, we describe the study design and the profile of the participants at baseline. METHODS: From 2001 through 2006, the participants completed a baseline questionnaire that surveyed factors related to lifestyle, general health, and oral health. Morbidity and mortality have been monitored by using information from fraternal insurance programs operated by prefectural dental associations. All respondents provided written, informed consent for participation and the use of their insurance data. RESULTS: A total of 21,272 JDA members participated in the baseline survey (response rate, 36.2%). Their mean age +/- SD was 52.3 +/- 12.3 years; 8.0% were women. Among the respondents, 30.2% of men and 10.7% of women were current smokers; 73.5% of men and 44.8% of women were current drinkers. The cohort scored higher on oral health indices than did the general Japanese population: dentists were more likely to brush their teeth > or =3 times/day, to have > or =20 teeth, to have fewer lost teeth, to be free from periodontal diseases, and to have higher General Oral Health Assessment Index scores. There was, however, considerable inter-individual variation in scores on the indices. CONCLUSIONS: More than one-third of JDA members participated in the study. Their oral average health status was better than that of the general population. Nevertheless, it will be possible to compare morbidity and mortality between those with better and worse scores on oral health indices.

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.

Cost-effectiveness of gargling for the prevention of upper respiratory tract infections.

BACKGROUND: In Japan, gargling is a generally accepted way of preventing upper respiratory tract infection (URTI). The effectiveness of gargling for preventing URTI has been shown in a randomized controlled trial that compared incidences of URTI between gargling and control groups. From the perspective of the third-party payer, gargling is dominant due to the fact that the costs of gargling are borne by the participant. However, the cost-effectiveness of gargling from a societal perspective should be considered. In this study, economic evaluation alongside a randomized controlled trial was performed to evaluate the cost-effectiveness of gargling for preventing URTI from a societal perspective. METHODS: Among participants in the gargling trial, 122 water-gargling and 130 control subjects were involved in the economic analysis. Sixty-day cumulative follow-up costs and effectiveness measured by quality-adjusted life days (QALD) were compared between groups on an intention-to-treat basis. Incremental cost-effectiveness ratio (ICER) was converted to dollars per quality-adjusted life years (QALY). The 95% confidence interval (95%CI) and probability of gargling being cost-effective were estimated by bootstrapping. RESULTS: After 60 days, QALD was increased by 0.43 and costs were $37.1 higher in the gargling group than in the control group. ICER of the gargling group was $31,800/QALY (95%CI, $1,900-$248,100). Although this resembles many acceptable forms of medical intervention, including URTI preventive measures such as influenza vaccination, the broad confidence interval indicates uncertainty surrounding our results. In addition, one-way sensitivity analysis also indicated that careful evaluation is required for the cost of gargling and the utility of moderate URTI. The major limitation of this study was that this trial was conducted in winter, at a time when URTI is prevalent. Care must be taken when applying the results to a season when URTI is not prevalent, since the ICER will increase due to decreases in incidence. CONCLUSION: This study suggests gargling as a cost-effective preventive strategy for URTI that is acceptable from perspectives of both the third-party payer and society.

[Chronological analysis of individually linked data for patients with intractable disease receiving public financial aid for treatment].

PURPOSE: Nationwide surveys of intractable disease patients receiving public financial aid for treatment were performed by Research Committee for Epidemiology of Intractable Disease (Ministry of Health and Welfare, Japan) 4 times in the past, in 1984, 1988, 1992 and 1997. The purpose of the present study was to clarify the features of continuance with intractable disease patients receiving public financial aid for treatment. METHODS: Individual information collected by each nationwide survey was linked using the disease, the residence, the sex, and the birth date. The proportion of intractable disease patients according to receipt duration, kind of medical insurance, sex and age was calculated with reference to the disease and an estimation of the receipt persistence rate was calculated for every year. Moreover, in consideration of variation in the data, average receipt persistence rates over years were also calculated. RESULTS: According to observation on individual patient's follow up, the proportion for which financial aid was discontinued within four years was 25%, while 70% continued receiving aid for at least four years and some 55% for eight or nine years. The proportion of those who continue receiving support long-term is high about the so-called autoimmune diseases, such as systemic lupus erythematosus, Behçet's disease, and the aortic syndrome. In contrast, with diseases having a poor prognosis, such as fulminant hepatitis, amyloidosis, and amyotrophic lateral sclerosis, periods of continuance are short. The proportion needing long-term continuation is higher in women than in men, especially with diseases which have long been eligible for support. However, with diseases for which receipt was started recently, there is a tendency for persistence to be higher in men than in women. CONCLUSION: With reform of insurance systems, including the medical system for intractable diseases, it is predicted that receipt continuation will change with alteration of social factors, and it is necessary to monitor receipt continuation carefully from now on.

[Characteristics of patients with intractable diseases receiving public financial aid for treatment--results of a nationwide survey, 1997].

OBJECTIVES: In order to clarify the characteristics of medical institutions visited by patients with selected intractable diseases, we analyzed data from the fourth nationwide survey in 1997. METHODS: We asked 47 prefectural governments to provide data concerning every patient receiving financial aid for treatment of 39 selected intractable diseases from April 1997 to March 1998. Out of 399,719 whose information was reported by prefectural governments, we analysed data of 370,232 patients whose medical institutions were reported. We performed detailed analysis on the relation between patients' residences and locations of medical institution which the patients visited, and on the characteristics of medical institutions. These analyses were respectively compared by sex and age, the beginning year of the financial aid, whether the patients were inpatients or outpatients, type of insurance, and clinical division where the patient was treated. RESULTS: 1. Analysis showed that 7.4% of all patients were treated in medical institutions outside the prefectures where they lived. Patients who lived in the neighboring prefectures of huge cities like Tokyo, tended to be treated in the medical institutions there. 2. We found that 23.5% of patients were treated in university hospitals, and 11.9% were seen in clinics. 3. There was a difference between patients with SMON and patients with myastenia gravis, pemphigus, epidermolysis bullosa or primary pulmonary hypertension. Of the two groups, the former preferred to visit clinics and be treated in medical institutions located in the same cities, towns, and villages where they lived. On the contrary, patients with the latter 4 diseases tended to visit large hospitals and be treated in those outside their prefectures. 4. Elderly patients over 70 years old tended to be treated in clinics or hospitals located in their neighborhoods. 5. Compared with past surveys, the percentage of patients treated in university hospitals had decreased, and that of patients treated in clinics had increased year by year. No change was found in the proportion of patients treated in medical institutions outside their prefectures. CONCLUSIONS: By the present analysis of a nationwide survey taken in fiscal year 1997, we were able to clarify the characteristics of medical institutions visited by patients with selected intractable diseases. This kind of analysis should be continued to obtain important information on the epidemiology of intractable diseases.

[Inter-observer agreement and validity of photographic dietary assessment].

PURPOSE: Estimation of nutritional intake from photographs of served meals has been proposed. We examined the inter-observer agreement and validity of this method for assessment of the daily diet. METHODS: Twenty-five family members (13 men and 12 women, mean age +/- SD: 47.3 +/- 5.6 years) of students in a dietetic course performed both meal photography and traditional weighed dietary records for four days. For the photo method, two observers independently identified foods and estimated their portion sizes from the photographs, converting them into energy and nutrient intake with a food composition table. The inter-observer agreement with the photo method was assessed in terms of inter-observer ratios, correlations, and coefficients of variation (CV), and the method was validated using the weighed dietary records as the reference. Its running cost was also calculated. RESULTS: The inter-observer ratios for estimation of mean daily nutritional intake ranged from 0.89 (magnesium) to 1.14 (retinol) with a median of 1.03. The correlation coefficients between observers varied from 0.65 (saturated fatty acids [SFA]) to 0.92 (vitamin C) on a daily basis (median, 0.79), and from 0.65 (SFA) to 0.96 (vitamin C) on an individual basis (median, 0.78). The CVs ranged from 7.9% (energy) to 23.8% (carotenc) (median, 13.3%), and from 5.2% (energy and magnesium) to 17.8% (carotene) (median, 8.8%) for daily and individual intake, respectively. Regarding validity, the ratios between methods (the photo method/weighed dietary records) ranged from 0.96 (potassium and SFA) to 1.11 (retinal and salt) with a median of 1.00. Correlations between the two methods were distributed from 0.40 (salt) to 0.82 (vitamin C and retinol) on a daily basis (median, 0.67), and from 0.47 (salt) to 0.90 (vitamin C) on an individual basis (median, 0.74). The CVs ranged from 10.5% (energy) to 39.6% (carotene) (median, 16.9%), and from 6.1% (protein) to 20.6% (carotene) (median, 11.2%), respectively. It was calculated to cost 105 Japanese yen per meal when using a lens-attached film for 25 shots. CONCLUSIONS: Inter-observer agreement and validity of the photo method, though varying with the nutrient, were generally acceptable. Although some modifications are needed for diners-out, the method appears to be useful as a dietary recording tool.

[Nationwide survey of intractable disease patients. Analyses of patients receiving public financial aid for treatment in fiscal year 1997].

OBJECTIVE: In order to clarify epidemiologic features of selected intractable diseases, an investigation of the fourth nationwide survey, in 1998, was performed. METHODS: We asked 47 prefectural governments to provide data concerning every patient receiving financial aid for treatment of 39 selected intractable diseases from April 1997 to March 1998. The items for each patient required were the beginning year of the financial aid, the disease code, sex, date of birth, residence, type of insurance, whether an in-patient or outpatient, medical institution and the clinical division where the patient was treated. We performed a detailed analysis regarding the age distribution, the prefecture, in-patient or outpatient, the clinical division, the insurance, and the disease, for both males and females. RESULTS: 1. The total number of patients who received financial aid for treatment was 399, 719 with a sex ratio of 0.66 (males 158, 766, or female 240, 953), 60.7% being between 45 and 74 years of age. Of 214, 173 patients whose status could be confirmed regarding outpatient or inpatient. 14.7% were the latter. Of 129, 685 cases, 56, 471 (43.6%) were treated in departments of internal medicine. Of 396, 187 patients, 65, 841 (16.6%) were covered by the health and medical services law for the aged. The greatest number of patients resided in Tokyo, and the least was in Yamanashi Prefecture. 2. With regard to specific intractable diseases, the largest number of patients receiving aid for treatment were suffering from ulcerative colitis at 52, 261, while the least number was for primary pulmonary hypertension at 96. The numbers for each group had increased within the 13 years from 1984 to 1997, except for SMON. As the patients' age increased, the percentage of those receiving treatment also increased and the numbers of aged individuals were especially elevated. 3. The proportion of in-patients for the Creutzfelde-Jakob disease was 76.4 percent, which was remarkably higher than for other diseases. CONCLUSION: By the present analysis of the nationwide survey in fiscal year 1997, we could clarify changes in epidemiologic features of patients receiving financial aid for treatment. This kind of analysis should be continued to obtain important information on the epidemiology of intractable diseases.

[Validity of an accelerometer for estimating daily physical activity--comparison with a diary method].

PURPOSE: To examine the validity of accelerometer measurement of daily physical activities in working adults. METHOD: Thirty one male and 29 female working in the civil service office of N-city were required to wear an accelerometer and to complete a 5-minute-interval activity diary for 2 days (one weekday and one weekend day). One-day energy expenditure obtained from the accelerometer was compared with that from the activity diary calculated from intensity (metabolic equivalents) of each activity and its duration. Difference and correlation between energy expenditure obtained with the two methods were evaluated. RESULTS: Although energy expenditure estimated from the activity diary was larger than that from accelerometer by 403.9 kcal, the results were highly correlated (Pearson's r = 0.846). The correlation coefficient was larger among light walkers than intensive walkers. When energy expenditure during bathing was excluded because of the non-wearability of the accelerometer, the difference between the methods was reduced without affecting the correlation coefficient. CONCLUSION: The accelerometer was concluded to be useful for measurement of daily physical activities for epidemiological research and health promotion in adults.