Identification of children with chronic kidney disease through school urinary screening using urinary protein/creatinine ratio measurement: an observational study.

BACKGROUND: School urinary screening has been performed in Japan. METHODS: Ikeda City and Toyono Town introduced, in 2012 and 2013, urinary protein/creatinine (Cr) ratio measurement into the urine-screening protocols designed for students aged between 4 and 15 years. For each student whose urinary protein/Cr ratio was ≥ 0.15 g/gCr (positive case), an appointment was made with a specialist at Ikeda City Hospital. The results of these screening urinalyses conducted through 2018 are summarized. RESULTS: 14,606 junior high and elementary school students aged between 6 and 15 years were included. On average, they underwent 4.16 screening tests. 77 positive cases were detected, and seven students were diagnosed with high-risk chronic kidney disease (CKD). Of these, four underwent renal biopsy, and two, one, and one were diagnosed with IgA nephropathy, MPGN, and FSGS, respectively. In three students, detection of CKD would have been difficult without urinary screening. Incident rates of high-risk CKD and IgA nephropathy are estimated as 11.5 and 3.3 cases/100,000 students/year. 78.0% of positive cases without high-risk CKD showed no urinary abnormality after one year. 2301 kindergarten students aged between 4 and 6 years received an average of 1.74 screening urinalyses; none was positive or high-risk CKD. The estimated cost of detecting one high-risk CKD student whose detection would have been difficult without this screening was 3,156,711 Japanese yen. CONCLUSION: School urinary screening using the urinary protein/Cr ratio can efficiently refer to a specialist. It detects a few children with high-risk CKD early with spending high cost.

Nationwide Actions Against Heart Failure Pandemic in Japan　- What Should We Do From Academia?

Heart failure pandemic is rapidly approaching in Japan, requiring nationwide actions. In particular, the Japanese Circulation Society and related societies launched the Stroke and Cardiovascular Disease Control Act, which was passed by the National Diet, as the first ever legislative policy measure against stroke and cardiovascular disease. In association with this, actions against heart failure pandemic from the scientific field are also important. Because heart failure pandemic is a critical problem not only in Japan but also in many developed countries, we believe the nationwide approach, as summarized here, will greatly contribute to the development of cardiovascular medicine, particularly the management and treatment of heart failure worldwide.

Economic analysis of gradual "social exhaustion" of waste management capacity.

This article proposes to analyze the quantitative effects of a gradual physical and "social" exhaustion of a landfill site on an equilibrium waste management service. A gradual social exhaustion of a landfill is defined here as an upward shift of a "subjective factor" associated with the amount of waste, based on the plausible hypothesis that an individual will not accept excessive presence of landfilled waste. Physical exhaustion occurs when the absolute capacity of a landfill site decreases. The paper shows some numerical examples using specific functions and parameters, and proposes appropriate directions for three policy objectives: to decrease the equilibrium waste disposal, to increase the economic surplus of the individual and/or the waste management firm, and to lower the equilibrium collection fee.

Estimation of cost reduction and increase for the final disposal associated with the categorization of inert waste landfills in Japan.

This study estimates the overall cost savings that have been realized due to disposal of inert wastes in Japan because this material has been deposited in inert waste landfills (IWLs) that are designed exclusively for this purpose, instead of being co-dipsosed with organic wastes in more costly in sanitary landfills (SLs). The total realized cost savings were based on the disposed volume of inert waste and the actual disposal fees for IWLs and SLs for the period 1977-2006. The estimated reduction in expense is 4748 billion JPY for the period. On the other hand, if organic wastes had been deposited in IWLs along with inert wastes, costs would be incurred to clean up the sites because the surrounding environment may be polluted by the decomposition of the non-inert wastes and considerable efforts probably would be required to restore the polluted environment to its normal condition (this is because IWLs typically do not have a barrier system.) The potential cleanup cost was estimated to be 616 to 1226 billion JPY. These estimated costs were compared and it was found that the net reduction in expense was 3522 billion to 4122 billion JPY. Although the expense was reduced substantially, it was noted that a considerable cleanup cost would be generated. In particular, it was found that the increase in cleanup costs becomes most significant after the late 1990s.

Clinical and economic evaluation of first-line therapy with FOLFIRI or modified FOLFOX6 for metastatic colorectal cancer.

OBJECTIVE: Recently, significant progress in treatment of metastatic colorectal cancer has been achieved. Either FOLFIRI (fluorouracil, leucovorin and irinotecan) or modified FOLFOX6 (fluorouracil, leucovorin and oxaliplatin, oxaliplatin dose 85 mg/m(2)) is selected as first-line therapy in clinical practice in Japan. However, economic burden of colorectal cancer is considerable. METHODS: Analysis was made for all patients who were treated with FOLFIRI or modified FOLFOX6 for metastatic colorectal cancer. Regimen of FOLFIRI was compared with modified FOLFOX6 under consideration from clinical and economic standpoints. Progression free survival, response, toxicity and cancer care cost in patients with metastatic colorectal cancer was analyzed. Direct costs based on the fee schedule of the Japanese national health insurance were calculated. RESULTS: Median progression free survival was 7.7 months for FOLFIRI versus 8.4 months for modified FOLFOX6 (P = 0.48). Overall cost for first four cycles was yen756 284 for FOLFIRI and yen1 081 162 for modified FOLFOX6 (P < 0.0001). All grade alopecia was significantly more frequent with FOLFIRI than with modified FOLFOX6 (P = 0.04). All grade neuropathy was more observed with modified FOLFOX6 than FOLFIRI (P = 0.0002). CONCLUSIONS: FOLFIRI is inexpensive in the initial stage of treatment which a number of patients can receive chemotherapy than modified FOLFOX6 as first-line therapy for metastatic colorectal cancer in Japanese national insurance system.