Association between the initiation of insurance coverage for fetal echocardiography and mortality from congenital heart disease in infants: An interrupted time series analysis.

BACKGROUND: The effectiveness of fetal echocardiography in reducing the mortality from congenital heart disease (CHD) is largely unknown. OBJECTIVES: This study aimed to evaluate whether the widespread use of fetal echocardiography owing to the initiation of insurance coverage in Japan was associated with a decreasing trend in the annual number of CHD-related deaths. METHODS: Data regarding the number of deaths from CHD in infants aged <12 months were extracted from Japanese demographic statistics (2000-2018). Segmented regression analysis was performed on the interrupted time series data by stratifying the sample into CHD subgroups based on ICD-10 classification and sex. RESULTS: After the initiation of insurance coverage for fetal echocardiography in 2010, a decrease was observed in the trends of annual deaths in patients with congenital malformations of aortic and mitral valves (ratio of trends before and after the initiation of insurance coverage for fetal echocardiography 0.96, 95% confidence interval 0.93, 0.99). In this group, the decrease persisted after adjusting for annual total infant deaths and cardiac surgery mortality and in the analysis of trends in the proportion of deaths in this group per total CHD deaths. However, a decrease in trends was not observed in other patient groups with CHD. In the sex-stratified analysis, a decrease was noted only in male patients with congenital malformations of aortic and mitral valves. CONCLUSIONS: The nationwide trend in annual CHD deaths decreased after the initiation of insurance coverage for fetal echocardiography only among patients with congenital malformation of aortic and mitral valves. These findings suggest that prenatal diagnosis with fetal echocardiography has led to improved mortality outcomes among these patients in Japan.

Association between nationwide introduction of public-access defibrillation and sudden cardiac death in Japan: An interrupted time-series analysis.

BACKGROUND: The effectiveness of public-use of automated external defibrillators in reducing the number of sudden cardiac death (SCD) cases at the national level is largely unknown. Our study aimed to evaluate whether the nationwide introduction of public-access-defibrillation (PAD) in 2004 affected the trend of annual sudden cardiac death (SCD) rates in Japan. METHODS: The number of nationwide SCDs occurring in people aged five years and older was extracted from Japanese demographic statistics (1995-2015). Segmented regression analysis was performed on the interrupted time series data stratified by age and sex to evaluate changes in trends of rates of annual SCDs after the PAD introduction in Japan. RESULTS: After the PAD introduction in 2004, we observed a significant decrease in trends of annual SCD rates for those aged 5-19 years (the ratio of trends between pre and post PAD introduction (RT) = 0.886, 95%CI: 0.801 to 0.980), 20-34 years (RT = 0.932; 95%CI: 0.906, 0.958), 35-49 years (RT = 0.953; 95%CI: 0.929, 0.977) and 50-64 years (RT = 0.971; 95%CI: 0.971, 0.991). However, the decrease was not observed for those aged 65 years and older. In the age and sex stratified analysis, there was a significant decrease in RT among males aged 5-64 years, and among females 35-49 years. CONCLUSION: The nationwide trend of annual rate of SCDs between 5 and 64 years old significantly decreased after the introduction of PAD in 2004 in Japan. Further, the reduction was more evident in males.

Factors Influencing the Mental Health of International Students, as Observed in a Longitudinal Study on Former Japanese Government Scholarship Students.

BACKGROUND: More than 30 years have passed since the Japanese government announced its International Student 100,000 Plan in 1983. Today, the number of international students in the country exceeds 300,000. This study examines the relationship between factors affecting the mental health of international students and their satisfaction with having studied abroad in Japan. METHODS: An online-questionnaire was given to 82 former Japanese government scholarship students who studied in Japan in the 1980s. The survey consisted of items related to the basic personal attributes of the participants, their lives in Japan during their period of study (20 items), their satisfaction level at having studied in Japan (10 items), and their current happiness level (4 items). RESULTS: A significant relationship was observed between the level of satisfaction at having studied in Japan and a number of the statements relating to respondents' lives in Japan as students, including: "I felt that the differences between Japan and my home country were interesting, and enjoyed these differences," and "Whenever I encountered a difficult situation, I attempted to find different approaches to deal with the problem." A similar relationship was also observed between these statements and subjective happiness. CONCLUSIONS: International students who were able to accept the differences and difficulties they confronted positively and respond to situations flexibly tended to report higher levels of satisfaction with their studies in Japan and higher levels of happiness, suggesting that individual psychological factors, such as situation perception and associated coping behaviors, have a defining impact on mental health.

Japan's Ongoing Crisis on HPV Vaccination.

: The Japanese government suspended proactive recommendations for the HPV vaccine in June 2013. The suspension is now in its seventh year, despite all the data pointing to the safety of the HPV vaccine. We reported a high vaccine effectiveness in the group of women vaccinated before their first intercourse (93.9%). The prevalence of cross-protected types of HPV 31/45/52 was also lower in the vaccinated group, and the vaccine effectiveness was 67.7%. Furthermore, prevalence of HPV16, 31 and 52 infection rates in the vaccinated group were obviously lower than that in the unvaccinated group, and no one had HPV18 or 45 infection in the vaccinated group. The addition of a cross-protective effect toward HPV types 31/45/52 to HPV types 16/18, which is the direct target of the bivalent HPV vaccine, may possibly prevent around 82% of invasive cervical cancer cases in Japan. With regard to the preventive effect of histological abnormalities, we also reported significant reduction in incidence of cervical intraepithelial neoplasia (CIN)3 or worse. Thus, the efficacy of the vaccine has been demonstrated for precancerous disease, and the diverse symptoms after HPV vaccination are likely functional somatic. For the future of Japanese girls, there is a need to resume the proactive recommendation of HPV vaccination and for immediate action to be taken by the Japanese government.

[The Japanese Colonial Medicine as Seen Through the Life of Fujita Tsuguakira].

Fujita Tsuguakira was a man who established Jahyeuiwon, a governmental medical facility, during the Residency-General Period and took over the presidency of a committee in the Japanese Government-General of Chosun after Chosun was annexed to Japanese. In addition, he is a man well qualified to be placed on the top of the list when discussing the Japanese colonial medicine in Chosun, considering his personal history of getting evolved in the colonial rule of Taiwan for seven years as an army surgeon. He led the colonial medicine in Chosun for nine years before and after the Japanese annexation of Korea. He was engaged in almost all the areas related to the colonial medicine such as anti-cholera projects, Hansung Sanitation Union, Deahan Hospital, Chosun Chongdokbu Hospital, Jahyeuiwon, medical schools affiliated to the Japanese Government-General of Chosun. In all respects, his life was in sync with the expansionist strategies of Imperial Japan. Especially, his deeds in Chosun was an "active aid to the instructions" from Army Minister Terauchi Masatake " as Sato Kozo testifies. Fujita was chosen by the military, and so he faithfully served the role given from it. The rewards that he received form the military attest to this fact. He took the position of Surgeon General in Army Medical Service on September, 1912, the top place that an army surgeon could hold. The position was first given to the officer who worked outside Japan proper, and he was the only army surgeon with no doctorial degree to receive such title except for Ishiguro Tadanori who was the first army surgeon in Japan. To sum up, Fujita was not a "doctor" but a "military officer". His walk of life mainly lay in the role of an aider adjusted to the ups and downs and the speeds of the plans of Imperial Japan to invade the continent. Therefore, the Japanese colonial medicine controlled by such man as Fujita in Chosun was inevitably studded with the military things. As a chief in the army medicine, what was important to him was the hospitals for managing the armed troops and projects for preventing infectious disease that could threaten the military sanitation. As a result, the medical service for those under the colonial rule was naturally put on the back burner. This study was conducted mainly based on Fujita's memoirs called Army Surgeon General Fujita Tsuguakira (1943), and accordingly it would be not without limitations. However, as he is a man who cannot be put aside when discussing the Japanese colonial medicine in Chosun, the records by this study of his life and past activities are expected to give no small amount of contribution to these discussions.

Availability of Japanese Government's supplemental texts on radiation reflecting the Fukushima Daiichi Nuclear Power Plant accident for elementary and secondary education from dental students' understanding.

Following the Fukushima Nuclear Power Plant accident, the Japanese government created two supplemental texts about radiation reflecting the accident for elementary, middle school, and high school students. These texts were made to explain radiation and consequently to obtain public consent for the continuation of the nuclear program. The present study aimed to evaluate the appropriateness of the content of the texts and to collect the basic data on the level of understanding necessary to improve radiation education. Lectures on radiology including nuclear energy and the Fukushima accident were given to 44 fourth-year dental students in 2013. The questionnaire was administered in 2014 when these students were in their sixth-year. The survey was also administered to 40 first-year students and 41 fourth-year students who hadn't any radiology lectures. Students rated their level of understanding of 50 phrases used in the texts on a four-point scale (understanding = 3, a little knowledge = 2, having heard = 1, no knowledge = 0). Questions on taking an advanced physics course in high school and means of learning about radiation in daily life were also asked. The level of understanding of phrases in the supplemental text for middle and high school students was significantly higher among sixth-year students (mean = 1.43) than among first-year (mean = 1.12) or fourth-year (mean = 0.93) students (p < 0.05). Overall, the level of understanding was low, with scores indicating that most students knew only a little. First-year students learning about radiation from television but four-year and six-year students learning about radiation from newspaper scored significantly higher (p < 0.05). It was concluded that radiation education should be improved by using visual material and preparing educators to teach the material for improving the public's understanding of radiation use-especially nuclear power generation because the phrases used in the supplementary texts are very difficult for students to understand.

The Japanese Colonial Medicine as Seen Through the Life of Fujita Tsuguakira / 의사학

Fujita Tsuguakira was a man who established Jahyeuiwon, a governmental medical facility, during the Residency-General Period and took over the presidency of a committee in the Japanese Government-General of Chosun after Chosun was annexed to Japanese. In addition, he is a man well qualified to be placed on the top of the list when discussing the Japanese colonial medicine in Chosun, considering his personal history of getting evolved in the colonial rule of Taiwan for seven years as an army surgeon. He led the colonial medicine in Chosun for nine years before and after the Japanese annexation of Korea. He was engaged in almost all the areas related to the colonial medicine such as anti-cholera projects, Hansung Sanitation Union, Deahan Hospital, Chosun Chongdokbu Hospital, Jahyeuiwon, medical schools affiliated to the Japanese Government-General of Chosun. In all respects, his life was in sync with the expansionist strategies of Imperial Japan. Especially, his deeds in Chosun was an "active aid to the instructions" from Army Minister Terauchi Masatake" as Sato Kozo testifies. Fujita was chosen by the military, and so he faithfully served the role given from it. The rewards that he received form the military attest to this fact. He took the position of Surgeon General in Army Medical Service on September, 1912, the top place that an army surgeon could hold. The position was first given to the officer who worked outside Japan proper, and he was the only army surgeon with no doctorial degree to receive such title except for Ishiguro Tadanori who was the first army surgeon in Japan. To sum up, Fujita was not a "doctor" but a "military officer". His walk of life mainly lay in the role of an aider adjusted to the ups and downs and the speeds of the plans of Imperial Japan to invade the continent. Therefore, the Japanese colonial medicine controlled by such man as Fujita in Chosun was inevitably studded with the military things. As a chief in the army medicine, what was important to him was the hospitals for managing the armed troops and projects for preventing infectious disease that could threaten the military sanitation. As a result, the medical service for those under the colonial rule was naturally put on the back burner. This study was conducted mainly based on Fujita's memoirs called Army Surgeon General Fujita Tsuguakira (1943), and accordingly it would be not without limitations. However, as he is a man who cannot be put aside when discussing the Japanese colonial medicine in Chosun, the records by this study of his life and past activities are expected to give no small amount of contribution to these discussions.

The First and the Second Pneumonic Plague in Manchuria and the Preventive Measure of Japanese Colonial Authorities (1910-1921) / 의사학

During the first plague epidemic in Manchuria (1910-1911), Japanese Government-General in Korea had not reported a plague patient at all in official. This did not mean the preventive measure of colonial authorities was successful. Their prevention program and measure were operated inadequately. They focused on instigative and sometimes irrelevant aspects such as rat removal to restore order in the colony. The quarantine facility was insufficient so that some people could not be effectively isolated. The reason pneumonic plague did not spread from Manchuria to Korea was mostly because Chinese coolie did not enter Korea. The colonial government promulgated Jeonyeombyeong Yebangryeong (Preventive Regulation of Contagious Disease) in June 5, 1915. This regulation aimed at unitary control by police and was strengthened 10-day quarantine. After the March First Movement, the colonial government tried to change imperial policy to cultural policy. The military police and civilian police were bifurcated and governors took charge of health administration. However, sanitary police still played important role for preventive measure. The preventive policy of colonial government experienced important change from cholera epidemic between 1919 and 1920. The death toll of two years had exceeded 20,000 people. During the cholera outbreak of two years, quarantine and isolation were emerged as important tools to prevent disease transmission, and were well-appointed more now than before. To prevent cholera epidemic, the colonial government strengthened house-to-house inspection as well as seaport quarantine, train quarantine, passenger quarantine. House-to-house inspection detected sixty percentage of cholera patients. When the second Manchurian plague spread in Korea in 1920-1921, this plague was known to Korean people as pneumonic plague. The colonial government propagated and educated pneumonic plague, and urged to wear a mask through Heuksabyeong Yebang Simdeuk (The Notandum for Plague Prevention). The colonial government did not focused on rat removal any more. They pointed out Chinese coolie as a source of infection. Though they did not know exact information and analysis on pneumonic plague, the preventive measure of the second plague in Manchuria was successful due to the well-equipped disinfection system such as house-to-house inspection and nationwide quarantine made by cholera prevention. While the first prevention of plague in Manchuria was successful despite rubbish preventive system, the second prevention of plague in Manchuria was successful due to the well-equipped disinfection system in spite of occurring plague patients.