Three-year questionnaire study on human papillomavirus vaccination targeting new female college school students: Follow-up to a 2021 report to reveal the impact of a policy change in Japan.

AIM: The purpose of this study was to examine the trend in human papillomavirus (HPV) vaccination rates in Japan before and after a policy change in 2022, involving resumption of active recommendation and start of catch-up vaccination. METHODS: From 2021 to 2023, a web-based questionnaire survey was administered to newly enrolled female college students in Yokohama, Japan. The questionnaire included items such as age, HPV vaccination status, HPV vaccine awareness, and awareness of catch-up vaccination. We compared knowledge about the HPV vaccine and cervical cancer in 2021 and 2023, before and after resumption of the national vaccination program. RESULTS: The HPV vaccination rates were 5.4% in 2021, 7.5% in 2022, and 35.3% in 2023, with a significant upward trend (p < 0.001). A similar upward trend was observed for HPV vaccine awareness (p < 0.001). Comparing 2022 and 2023 after the start of catch-up vaccination, there was no significant difference in awareness of catch-up vaccination (p = 0.669), but there was a significant increase in awareness of free vaccination tickets (p < 0.001). After resumption of the national vaccination program with adoption of the catch-up vaccination program, there was no difference in knowledge of cervical cancer, but there was a difference in knowledge of the HPV vaccine. CONCLUSIONS: Although the HPV vaccination rate has increased after the policy change, it has not recovered to the level before the suspension of active recommendation. It is important for healthcare providers and school educators to actively communicate the safety and effectiveness of the HPV vaccine.

Ten-year questionnaire study on human papillomavirus vaccination targeting new female medical school students: Follow-up to the 2015 report.

AIM: We aimed to conduct a fixed-point observation questionnaire survey of changes in young women's human papillomavirus (HPV) vaccination status over the course of 10 years. We also investigated the influence of suspension of governmental recommendation for HPV vaccination since June 2013. METHODS: During 2011-2020, we conducted a self-completed questionnaire survey among newly enrolled female medical school students in Yokohama, Japan. The questionnaire featured items regarding HPV vaccination status, age, previous sex education, and knowledge about cervical cancer and HPV vaccination. RESULTS: HPV vaccine uptake rates in 2011 (5.4%) and 2012 (13.5%), when vaccination was self-funded, increased after 2013 (48.7%), when vaccination fees were subsidized. The rate dropped drastically in 2019 (14.3%) and 2020 (5.1%), after suspension of recommendation by the government. Comparisons between new students in 2015/2016, who had high vaccination rates (65.2%), and new students in 2019/2020, who had low vaccination rates (9.8%), showed decreased levels of HPV vaccination awareness, with fewer students having covered cervical cancer prevention in sex education and with respondents having less knowledge about the details of HPV vaccination. CONCLUSIONS: After the suspension of proactive HPV vaccine recommendation, markedly fewer students have been vaccinated against HPV, even those at the vaccination target age. This situation has substantially influenced the lower awareness about cervical cancer prevention, even among medical school students. To protect young women from cervical cancer in Japan, it is crucial for the government to resume proactive recommendation of HPV vaccines as soon as possible.

Recent trends in colonic diverticulosis in Yokohama City: a possibility of changing to a more Western profile.

OBJECTIVE: Right-sided type colonic diverticulosis has been predominant in Japan, in contrast to European counties where the left-sided type is predominant. Considering the recent change in the dietary habits of Japanese people to a more Western diet in urban areas of Japan, the features of colonic diverticulosis may also change to reflect a more Western type. Therefore, we attempted to clarify the current situation. METHODS: A total of 435 consecutive outpatients who agreed to a barium enema and complete examination were enrolled in this study. RESULTS: 113 patients (26.0%) revealed colon diverticulosis; 50.4% of the patients had more than ten diverticula. The percentage of man with ten or more diverticula (67.4%) was significantly higher than that of women patients (40.0%, p<0.01). Among the 88 patients who had four or more diverticula, 39 patients (44.3%) were right-side dominant, 27 (30.7%) left-side dominant and 22 (25.0%) were both-sides. Thirteen (68.4%) of the 19 patients who had more than 30 diverticula were left-side dominant. CONCLUSION: The clinical features of colon diverticulosis in the patients living in Yokohama may be changing to reflect a more Western type, in particular decreased right-side dominance, increases in the left-side and both-sides dominant patients, and the emergence of patients with crowded diverticula in the left-side colon was observed.

Three-year questionnaire survey on human papillomavirus vaccination targeting new female college students.

AIM: A questionnaire survey was conducted at fixed points to describe changes over a 3-year period in the human papillomavirus (HPV) vaccination uptake rate among young women. Several factors obtained from the questionnaire were investigated in relation to HPV vaccination. METHODS: The study was conducted at two universities in Yokohama City, Japan. Newly enrolled female students of the universities were recruited to participate in this study in 2011, 2012 and 2013. The study participants were asked about their HPV vaccination status. They were also questioned about factors that potentially influenced HPV vaccination, such as current age, place of residence during high school, and knowledge related to cervical cancer and HPV vaccination. RESULTS: The proportion of vaccinated participants dramatically increased in 2013 (48.7%) in comparison to 2011 (5.4%) and 2012 (13.5%). Three factors were positively related to HPV vaccination: being 18 years old in 2013, which means that they were eligible for a financial support program (P < 0.001); living in the study city, in which HPV vaccination was well conducted (P < 0.001); and proper knowledge of cervical cancer and HPV vaccination (P < 0.001). CONCLUSION: The HPV vaccination uptake rate in 2013 dramatically increased from that in 2011. Official financial support and publicity work were likely to have had an effect on the HPV vaccination uptake rate.

Inflammation in background cirrhosis evokes malignant progression in HCC development from HCV-associated liver cirrhosis.

OBJECTIVE: It is accepted that inflammation promotes malignant progression in the development of cancers. Whether, this is true for hepatocellular carcinoma (HCC) remains as an open question. We examined the relationship between the inflammatory histology activity index (HAI) in the background liver cirrhosis (LC) and the histological grading of the HCC in the hepatectomized HCC patients with HCV-associated LC. MATERIAL AND METHODS: Out of 264 HCC patients who underwent curative hepatic resection, 197 had HCV-associated LC. Among them, 52 patients with a small solitary HCC nodule (< 5 cm in diameter) were studied. Inflammation in the background LC was evaluated by modified Knodell's HAI. To evaluate the inflammation, piece meal necrosis, intra lobular cellular degeneration and focal necrosis, portal cellular inflammation (0-4, each) were estimated. The average HAI was calculated. The grade of malignancy of HCC was determined by WHO classification. RESULTS: The average HAI in the 15 patients with moderately differentiated HCC (4.3 ± 0.8, mean ± SD) was significantly larger than that in 11 patients with well differentiated HCC (3.5 ± 0.6, p = 0.036). The HAI in the 24 patients whose HCC nodules contained poorly differentiated HCC (5.2 ± 1.1) was significantly larger than that in patients with moderately differentiated HCC (p = 0.025). Thus, the HAI order was well differentiated group < moderately differentiated group < poorly differentiated group. CONCLUSIONS: Inflammation in the background non-cancerous cirrhotic portion would evoke malignant progression in HCC development from HCV-associated LC.

Pravastatin potentiates increases in serum adiponectin concentration in dyslipidemic patients receiving thiazolidinedione: the DOLPHIN study.

AIM: A reduced risk of type 2 diabetes has been reported following treatment with pravastatin. Adiponectin is an adipocyte-derived protein that has an antidiabetic property. The objective of this study was to evaluate the effect of pravastatin on serum adiponectin concentration and other influencing factors. METHODS: This study was a multicenter observational study: Dyslipidemia Open-labeled observational study by Lipid-lowering therapy with Pravastatin of the effect on High-molecular weight adiponectin in Nippon Yokohama (DOLPHIN). The protocol was registered in the UMIN Clinical Trial Registry as UMIN000000791. All patients received pravastatin 10 mg/day for 6 months and the change in concentration of total and high molecular weight adiponectin was assessed before and after follow-up. The difference in the change in total adiponectin concentration by patient characteristics was analyzed by an unpaired t-test. Influences of continuous variable factors on the change in total adiponectin concentration were estimated by simple linear regression analyses. Finally, in order to estimate the influences of factors that potentially affect the change in total adiponectin concentration induced by pravastatin, multiple linear regression analysis was conducted. RESULTS: After 6 months, total adiponectin concentration was increased significantly by 23.2% from 11.7±6.4 to 13.7±8.6 µg/mL (p=0.002). The use of thiazolidinedione as a concomitant medication was the only significant influencing factor (ß=0.580, p<0.001). CONCLUSION: Pravastatin increased the serum adiponectin concentration in Japanese dyslipidemic patients without previous coronary artery disease. Interestingly, this effect was seen synergistically in combination with thiazolidinedione.

Clinical features of Vibrio vulnificus infections in the coastal areas of the Ariake Sea, Japan.

Vibrio vulnificus infection can result in necrotizing fasciitis and sepsis and is associated with high mortality. Most patients infected with this microbe have liver dysfunction as an underlying disease. However, because of the sporadic nature of outbreaks and unidentified cases, extensive evaluation of clinical features and identification of factors affecting prognosis have not been performed. We retrospectively analyzed 37 cases in Japan from 1984 to 2008 to review clinical features and to identify risk factors associated with prognosis. Statistical differences between clinical features (patient's characteristics, initial clinical laboratory data, symptoms upon admission, and other risk indicators) and prognosis were analyzed by use of the chi(2) test or the Mann-Whitney U test. Multivariate logistic regression analysis was also performed to assess factors which potentially affect hospital mortality. The mortality rate was 64.9%. An underlying liver disease was observed in 91.6% of the patients. The presence of liver cirrhosis tended to be related to hospital mortality; however, statistical significance was not achieved. Advanced age, lower platelet counts, and the presence of extensive skin lesions at onset affected outcomes with statistical significance. The prognosis of this disease is poor, because septic shock and necrotizing fasciitis often develop within a few days. Early diagnosis and treatment are needed to improve the prognosis of V. vulnificus infection.

High serum alanine aminotransferase levels for the first three successive years can predict very high incidence of hepatocellular carcinoma in patients with Child Stage A HCV-associated liver cirrhosis.

Abstract Objective. To assess retrospectively whether continuously high serum alanine aminotransferase (ALAT) levels (<80 IU) in the first three successive years after the diagnosis of liver cirrhosis (LC) are predictive of a subsequent high incidence of hepatocellular carcinoma (HCC) in patients with Child Stage A hepatitis C virus (HCV)-LC. Material and methods. The study comprised 132 HCV-LC (Child Stage A) patients who had not received interferon therapy but had been treated with anti-inflammatory agents. At the end of a 3-year follow-up after the diagnosis of LC, the patients were subdivided into three groups according to their serum ALAT levels and the subsequent incidence of HCC was assessed. Results. The cumulative incidence of HCC starting from 3 years after the diagnosis of LC in the continuously high ALAT group (annual average over 3 years always > or =80 IU; n=41; Group A) was markedly higher than that in the continuously low ALAT group (always <80 IU; n=48; Group B) (p<0.005) during an observation period of 7.9+/-3.7 years. The incidence of HCC in Group A was 11.8%/year. The odds ratios of developing HCC in Group A and Group C (mixed high and low ALAT levels; n=43) were 5.1-fold and 1.5-fold that of Group B, respectively. A multivariate analysis revealed that the ALAT group was independently associated with HCC development. Conclusions. Continuously high ALAT levels for three successive years following the diagnosis of LC can be predictive of a very high incidence of HCC in Child A HCV-LC patients. Prospective trials using therapeutic approaches aimed at decreasing ALAT levels are necessary in order to confirm a positive impact of ALAT reduction on the incidence of HCC in patients with HCV-LC.

Evaluation of an algorithm for estimating a patient's life threat risk from an ambulance call.

BACKGROUND: Utilizing a computer algorithm, information from calls to an ambulance service was used to calculate the risk of patients being in a life-threatening condition (life threat risk), at the time of the call. If the estimated life threat risk was higher than 10%, the probability that a patient faced a risk of dying was recognized as very high and categorized as category A+. The present study aimed to review the accuracy of the algorithm. METHODS: Data collected for six months from the Yokohama new emergency system was used. In the system, emergency call workers interviewed ambulance callers to obtain information necessary to assess triage, which included consciousness level, breathing status, walking ability, position, and complexion. An emergency patient's life threat risk was then estimated by a computer algorithm applying logistic models. This study compared the estimated life threat risk occurring at the time of the emergency call to the patients' state or severity of condition, i.e. death confirmed at the scene by ambulance crews, resulted in death at emergency departments, life-threatening condition with occurrence of cardiac and/or pulmonary arrest (CPA), life-threatening condition without CPA, serious but not life-threatening condition, moderate condition, and mild condition. The sensitivity, specificity, predictive values, and likelihood ratios of the algorithm for categorizing A+ were calculated. RESULTS: The number of emergency dispatches over the six months was 73,992. Triage assessment was conducted for 68,692 of these calls. The study targets account for 88.8% of patients who were involved in triage calls. There were 2,349 cases where the patient had died or had suffered CPA. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of the algorithm at predicting cases that would result in a death or CPA were 80.2% (95% confidence interval: 78.6% - 81.8%), 96.0% (95.8% - 96.1%), 42.6% (41.1% - 44.0%), 99.2% (99.2% - 99.3%), 19.9 (18.8 - 21.1), and 0.21 (0.19 - 0.22), respectively. CONCLUSION: A patient's life threat risk was quantitatively assessed at the moment of the emergency call with a moderate level of accuracy.

Left ventricular geometry, risk factors, and outcomes of hospitalized patients with diastolic heart failure in Japan.

BACKGROUND: Studies of the characteristics, risk factors, prognostic factors, and outcomes of diastolic heart failure (DHF) have yielded inconsistent findings. Moreover, few epidemiological studies of DHF have been performed in Japan. METHODS AND RESULTS: We studied patients with heart failure who were admitted consecutively to Yokohama City University Hospital from 2000 through 2003. Heart failure with a left ventricular ejection fraction (LVEF) of > or = 50% was classified as DHF (n=67), and that with an LVEF of < or = 35% was classified as systolic heart failure (SHF; n=72). Relative wall thickness (RWT) (0.61 vs. 0.34, p<0.0001) and left ventricular mass index (210.3 vs. 152.1, p<0.0001) were greater in DHF than in SHF. Age (odds ratio [OR]=1.068, 95% CI=1.020-1.119; p=0.006) and RWT (OR=17.945, CI=5.883-54.745; p<0.0001) were positive risk factors for DHF. A history of myocardial infarction was a negative risk factor for DHF (OR=0.053, CI=0.008-0.342; p=0.002). Left ventricular mass index was slightly but not significantly related to DHF (OR=1.010, CI=1.000-1.019; p=0.053). Survival did not differ significantly between patients with DHF and those with SHF. Advancing age and a greater RWT were positive risk factors for DHF. CONCLUSION: LV geometry of DHF and SHF are quite different. DHF is characterized by concentric hypertrophy of the left ventricle, whereas SHF is characterized by eccentric hypertrophy. Age and RWT were positive risk factors for DHF. Survival is similar in DHF and SHF.

[Clinical features and laboratory findings in children with both anti-dsDNA and anti-U1-RNP antibody].

Mixed connective tissue disease (MCTD) includes clinical features of systemic lupus erythematosus (SLE), dermatomyositis/polymyositis (DM/PM), and systemic sclerosis (SSc) occurring in conjunction with a high anti-U1-RNP antibody titer. Childhood MCTD rarely manifests the symptoms and signs of DM/PM and SSc, and mostly does those of SLE. Thus, the diagnosis of childhood MCTD is inevitably based on the two major findings, Raynaud's phenomenon and a high titer of anti-U1-RNP antibody. However, in clinical setting there exist patients who have both anti-dsDNA antibody, a SLE disease-marker, and anti-U1-RNP antibody, a MCTD disease-marker, and thus it is hard to differentiate MCTD patients from SLE. Eighty children were enrolled in this study, and divided into 3 groups ; group A, those who are positive for anti-dsDNA antibody/negative for anti-U1-RNP antibody (48 cases, 60.0%), group B : those who are positive for both anti-dsDNA and anti-U1-RNP antibody (22 cases, 27.5%), group C; those who are negative for anti-dsDNA antibody/positive for anti-U1-RNP antibody (10 cases, 12.5%), and each of the clinical characteristics among these 3 groups was mutually examined. The results indicated that the frequency of hypocomplementemia in group B was close to group A rather than group C, and the frequencies of both hyper-gamma-globulinemia and Raynaud's phenomenon were very close to group C, but not to group A. On the contrary, the findings which seemed to be specific to MCTD, high titers of speckled type anti-nuclear antibody and rheumatoid factor, located at the middle between group A and group C. Thus, children in group B essentially carried characteristic symptoms and signs of both SLE and MCTD, and it will be difficult to differentiate these two diseases at the onset of the disease. Taken together, children with high titers of both anti-dsDNA antibody and anti-U1-RNP antibody as well as clinical symptoms and signs such as hyper-gamma-globulinemia, Raynaud's phenomenon, membranous nephritis, positive speckled type anti-nuclear antibody and rheumatoid factor should be followed and treated as children with MCTD along with SLE.

Seasonal influence on blood pressure in elderly normotensive subjects.

The aim of this study was to examine whether or not fluctuations in blood pressure (BP) differ by season. Subjects were 45 elderly individuals (20 men and 25 women; mean age, 66.5+/-4.9 [SD] years). Each subject's BP was recorded with an ambulatory BP monitoring device for 24 h during each of the four seasons. Subjects also wore a portable weather meter to obtain ambient temperature, relative humidity, and barometric pressure simultaneously with BP. The relationships between meteorologic values and BP were investigated at various parts of the day. Seasonal differences in BP fluctuation around wake-up-time were analyzed by means of the Tukey's test. The difference between the pre-wake-up-time systolic BP and the wake-up-time systolic BP was significantly greater in winter than in summer (8.7 mmHg greater, p<0.001). The difference between pre-wake-up-time and wake-up-time systolic BP was significantly greater in autumn than in spring (9.4 mmHg greater, p<0.001) or summer (13.1 mmHg greater, p<0.001). The difference between pre-wake-up-time heart rate and wake-up-time heart rate did not differ statistically between seasons. In conclusion, the present study showed that the difference between pre-wake-up-time systolic BP and wake-up-time systolic BP was greatest in the colder seasons, i.e., autumn and winter. There appears to be a large fluctuation in wake-up-time in the colder seasons. Low ambient temperature likely induces this large fluctuation.

Cross-cultural adaptation and validation of the Japanese version of the Childhood Health Assessment Questionnaire (CHAQ).

To assess cross-cultural adaptation, and to validate the parent's version of a health-related quality-of-life instrument, the Childhood Health Assessment Questionnaire (CHAQ) was investigated after its translation into Japanese. A total of 132 subjects were enrolled: 63 patients with juvenile idiopathic arthritis (JIA) (34 systemic and 29 polyarticular) and 69 healthy children. The CHAQ distinguished clinically between healthy subjects and the two JIA subtypes of patients. The average disability index (DI) scores for systemic JIA (sJIA) and polyarticular JIA (pJIA) patients and healthy subjects were 1.5, 1.2, and 0.0, respectively. All variables in the questionnaire were shown to be significant (P < 0.001). Patients with pJIA showed better correlation than those with sJIA. Significant correlation was seen in the polyarticular group with CRP, ESR, parents' VAS, the number of joints with pain, and the number of active joints. However, there was even a negative correlation between DI and parent's assessment of overall well-being for the sJIA group. The Japanese version of the CHAQ was a reliable and valid tool for the functional assessment of children with pJIA. Functional ability, as assessed by the CHAQ, may not be the main consideration of sJIA patients' parents when assessing their child's status.

Influence of mental stress on the plasma homocysteine level and blood pressure change in young men.

Objective. This study aimed to determine whether mental stress influences the plasma total homocysteine level or blood pressure in young men. Method. Twenty-seven male university students were assigned to a normal blood pressure group (24-h systolic blood pressure <125 mmHg and diastolic blood pressure <75 mmHg; 13 subjects) or a high blood pressure group (24-h systolic blood pressure > or =125 mmHg, or 24-h diastolic blood pressure > or =75 mmHg; 14 subjects). Wearing an ambulatory blood pressure monitoring device, subjects rested for 30 minutes, underwent an arithmetic test for 15 minutes, and rested again for 15 minutes. Blood samples were taken before and after the test. Plasma total homocysteine levels were measured. Heart rate, blood pressure, and sympathovagal balance were determined during the test. Results. The mean total homocysteine level at rest in the high blood pressure group was slightly, but not significantly, higher than that in the normal blood pressure group. The resting total homocysteine level was significantly higher in subjects with parental history of hypertension than in those without (p < 0.01). Blood pressure, heart rate, and the plasma total homocysteine level were increased significantly by mental stress (p < 0.05). The change in total homocysteine correlated significantly with the changes in systolic blood pressure and sympathovagal balance (p < 0.05). Conclusion. Resting total homocysteine level was significantly higher in male students with a parental history of hypertension than in those without. It was shown that mental stress elevates heart rate, blood pressure, sympathovagal activity, and the plasma total homocysteine level in young men.

Reduction in ambulance transports during a public awareness campaign for appropriate ambulance use.

OBJECTIVES: This study aimed to characterize the change in the upward trend in monthly ambulance transports that occurred during a citywide campaign for appropriate ambulance use. This study also investigated whether the number of ambulance transports for individuals with nonserious conditions decreased separately from the decrease in ambulance transports for individuals with serious conditions. METHODS: A retrospective time series survey was carried out on the number of ambulance transports that occurred per month over a 10-year period (1997-2006). This study focused on individuals transported by ambulance because of illness. Seasonal decomposition was applied to adjust for the seasonal effect on ambulance transport. The shift in the trend during the campaign period (April 2005-December 2006) was examined by means of linear regression analysis. RESULTS: The number of individuals transported by ambulance decreased during the campaign period. A decrease in the number of ambulance transports was observed for both nonserious and serious conditions. During the campaign period, the number of ambulance transports per month was estimated to have decreased by 530 (approximately 7%; 95% confidence interval [CI] = -729 to -331) for individuals with nonserious conditions and by 37 (approximately 8%; 95% CI = -53 to -22) for individuals with serious conditions. CONCLUSIONS: A campaign to educate the public on appropriate ambulance use may reduce ambulance calls for both nonserious and serious conditions.

Circadian variation in cardiovascular emergencies among the elderly.

Clarification of the cyclic pattern of emergency events is useful for identifying risk factors for emergency events. We attempted to characterize the circadian variation in emergency calls for the elderly (aged 65 years or older) because the use of emergency transportation by elderly patients is increasing rapidly. The study targeted mainly patients with cardiovascular disease. Additionally, the study analyzed circadian variability in the occurrence of cardiopulmonary arrest (CPA) and heat stroke. Data for this study were obtained from computerized records of ambulance transport from 1997 to 2003 (a total of 874,495 transported patients) managed by the Emergency Medical Division of the Yokohama Fire Bureau. A partial Fourier model was used to analyze circadian patterns of emergency calls for each disease category and determine the peak time of occurrence of disease events. A prominent peak of cardiovascular disease and CPA in the morning was observed among elderly patients, whereas amplitudes of the morning and evening peaks were almost the same among younger patients. Heat stroke among elderly patients occurred frequently from 10:00 AM to 3:00 PM, and the occurrence peaked around noon. The increase in cardiovascular disease events and CPA during the morning among elderly patients may be due to a natural fluctuation in blood pressure. A morning increase in hemoconcentration induced by dehydration during the night is thought to be another cause of the frequent occurrence of cardiovascular disease, CPA, and heat stroke events in the morning hours. In conclusion, there was a prominent peak in the morning in the occurrence of emergency events such as cardiovascular disease, CPA, and heat stroke events among the elderly.

Neither the presence of metabolic syndrome as defined by the IDF guideline nor an increased waist circumference increased the risk of microvascular or macrovascular complications in Japanese patients with type 2 diabetes.

The aim of this study was to evaluate the relationship between the diagnosis of metabolic syndrome (MetS) or its components and the prevalence of microvascular and macrovascular complications in 130 Japanese type 2 diabetic patients. Out of the 130 patients, 58.5% satisfied the criteria of the MetS as defined by the IDF guideline. The results of logistic regression analysis with adjustment for three variables (age, gender and duration of diabetes) revealed that the presence of MetS as defined by the IDF guideline was not independently related to the presence of proliferative retinopathy, proteinuria, neuropathy, or macrovascular disease in the diabetic patients. The waist circumference per se was not associated with diabetic neuropathy, retinopathy, nephropathy, or macrovascular diseases. These results suggest that neither the presence of MetS, as defined by the IDF guideline, nor the waist circumference was associated with the presence of either microvascular or macrovascular complications in Japanese type 2 diabetic patients.

Influence of socioeconomic factors on medically unnecessary ambulance calls.

BACKGROUND: Unnecessary ambulance use has become a socioeconomic problem in Japan. We investigated the possible relations between socioeconomic factors and medically unnecessary ambulance calls, and we estimated the incremental demand for unnecessary ambulance use produced by socioeconomic factors. METHODS: We conducted a self-administered questionnaire-based survey targeting residents of Yokohama, Japan. The questionnaire included questions pertaining to socioeconomic characteristics, dichotomous choice method questions pertaining to ambulance calls in hypothetical nonemergency situations, and questions on the city's emergency medical system. The probit model was used to analyze the data. RESULTS: A total of 2,029 out of 3,363 targeted recipients completed the questionnaire (response rate, 60.3%). Probit regression analyses showed that several demographic and socioeconomic factors influence the decision to call an ambulance. Male respondents were more apt than female respondents to state that they would call an ambulance in nonemergency situations (p < 0.05). Age was an important factor influencing the hypothetical decision to call an ambulance (p < 0.05); elderly persons were more apt than younger persons to state that they would call an ambulance. Possession of a car and hesitation to use an ambulance negatively influenced the hypothetical decision to call an ambulance (p < 0.05). Persons who do not have a car were more likely than those with a car to state that they would call an ambulance in unnecessary situations. CONCLUSION: Results of the study suggest that several socioeconomic factors, i.e., age, gender, household income, and possession of a car, influence a person's decision to call an ambulance in nonemergency situations. Hesitation to use an ambulance and knowledge of the city's primary emergency medical center are likely to be important factors limiting ambulance overuse. It was estimated that unnecessary ambulance use is increased approximately 10% to 20% by socioeconomic factors.

The increasing use of pediatric emergency facilities in the evening.

OBJECTIVES: In Japan, the demand for pediatric emergency medicine has been increasing, especially in the evening. The purpose of this study was to identify the reasons for overcrowding of pediatric emergency facilities in the evening. METHODS: A population-based survey was conducted in Yokohama City, Japan, that targeted parents of children 1 or 3 years of age. These children participate in regular health checkups. Questionnaires about their child's illnesses and the pediatric emergency system were mailed to 30,000 parents of a child expected to undergo a health checkup between May 2004 and January 2005. RESULTS: Data obtained from the completed questionnaires indicated that many parents noticed their child's illness or injury most frequently during the evening, when most medical facilities are closed. The peak period when parents noticed their child's illness was the evening (4:00 pm-12 midnight, 54.4%), followed by the daytime (8:00 am-4:00 pm, 30.3%) and then the nighttime (12 midnight-8:00 am, 15.3%). During all 3 periods, parents felt it difficult to judge their child's condition and thus many used emergency facilities unnecessarily. CONCLUSIONS: The overcrowding of pediatric emergency facilities in the evening is likely due mainly to a mismatch between the peak time of children's illnesses and the office hours of pediatric clinics. Parents' difficulties in assessing their child's condition and anxiety over their child's illness and injuries seem to be other factors that contribute to this imbalance.