Assessing the validity of health impact assessment predictions regarding a Japanese city's transition to core city status: a monitoring review.

BACKGROUND: The validity of health impact assessment (HIA) predictions has not been accurately assessed to date. In recent years, legislative attempts to promote decentralization have been progressing in Japan, and Kurume was designated as a core city in April 2008. An HIA into the transition of Kurume to a core city was conducted before the event, but the recommendations were not accepted by city officials. OBJECTIVE: The aim of this study was to examine the validity of predictions made in the HIA on Kurume by conducting a monitoring review into the accuracy of the predictions. METHOD: Before Kurume was designated as a core city, the residents completed an online questionnaire and city officials were interviewed. The findings and recommendations were presented to the city administration. One year after the transition, a monitoring review was performed to clarify the accuracy of the HIA predictions by evaluating the correlation between the predictions and reality. RESULTS: Many of the HIA predictions were found to conflict with reality in Kurume. Prediction validity was evaluated for two groups: residents of Kurume and city officials. For the residents, 17% (2/12 items) of the predictions were found to be compatible, 58% (7/12) were incompatible and 25% (3/12) were difficult to evaluate. For city officials, the analysis was divided into those whose department was directly involved in tasks transferred to them (transfer tasks) and those whose department was not. For the city officials in departments responsible for conducting core city transfer tasks, 33% (3/9 items) of the predictions were found to be compatible, 33% (3/9) were incompatible and 33% (3/9) were difficult to evaluate. However, for the city officials whose responsibilities were unrelated to core city transfer tasks, 11% (1/9) of predictions were found to be compatible, 78% (7/9) were incompatible and 11% (1/9) were difficult to evaluate. CONCLUSION: Although it was possible to validate some of the HIA predictions, the results of this monitoring review found substantial discrepancies between the predictions and reality 1 year after the transition of Kurume to a core city. This suggests that the accuracy of HIA predictions may be called into question. However, it should be noted that the review was conducted very soon after the transition and the steering group was very small, which may explain why the HIA predictions were inaccurate. Further, long-term studies may be needed to assess the accuracy of HIA predictions in similar contexts.

Health impact assessment of the transition to a core city in Japan.

OBJECTIVE: To discover whether a health impact assessment (HIA) is applicable in Japan with respect to the transition to a core city. STUDY DESIGN: Ecological study. METHODS: A rapid HIA was applied based on typical HIA guidelines. A rapid HIA consists of screening, scoping and assessment. In the assessment or policy analyses, information on the official opinions of Kurume was compiled and interviews were undertaken in Nagasaki, which had already become a core city (hereinafter, 'predecessor core city'). For qualitative and quantitative data, a survey of the 35 predecessor core cities was performed, together with an online questionnaire for the cities of Kurume and Aomori. RESULTS: The construction of new public health centres with the transition to core cities held major significance. In an effort to promote advantages, regionally co-ordinated health activities were quickly introduced, systems whereby residents can voluntarily participate in health activities were strengthened, and facilities where government and residents came together were built. To minimize disadvantages, special features of districts with good health services were applied to other districts, the provision of conventional health services throughout the city was improved, and prefectural and national offices opened consultation corners regarding employee or budgetary shortages. CONCLUSION: This paper reports the first use of an HIA in Japan with respect to governmental policy. However, this HIA was not a pre-assessment in principle, but rather a concurrent HIA. In the future, HIAs should be performed in Japan to make suggestions to government decision makers whenever policy is being formulated or programmes are being changed.

[A case of unresectable advanced gastric cancer with severe obstructive jaundice responding to combined chemotherapy with 5-fluorouracil and low-dose cisplatin].

A 69-year-old male patient with gastric cancer complaining severe jaundice was readmitted for the purpose of chemotherapy. The primary tumor was unresectable, and his jaundice was gradually increasing because of the growth of tumor, so the patient was treated by combined chemotherapy with 5-fluorouracil and low-dose cisplatin for 2 courses (1 course = 4 weeks), which resulted in remarkable reduction of jaundice without any severe side effects. So, the patient could be discharged and spend a useful life for about 10 months with good quality of life. This therapy might be a useful palliative chemotherapy for cases of this kind.

A pylorus-retaining pancreatic head-duodenectomy for cancers of the duodenal papilla and the lower bile duct.

With the development of diagnostic technology, the surgical methods of cancer therapy have been expanded, and operations have been performed using a procedure corresponding to the stage of cancer to improve the postoperative QOL. A 79-year-old man with cancer of the duodenal papilla and obstructive jaundice, and a 63-year-old woman with cholangiocarcinoma in the lower region complicated by cholangitis caused by Candida underwent resections of the pancreatic head and duodenum, and pancreaticogastrostomies retaining the pylorus. Satisfactory results were obtained in both cases. The merits of the procedure were that there were few complaints, sufficient food could be ingested and the QCL was maintained. The benefits of pancreaticogastrostomy are that the anastomosis procedure is simple, the gastric wall is thicker than the jejunum and blood flow is plentiful. The dorsal gastric wall is located close to the pancreatic cut-end, therefore tension is not created, and the pancreatic enzymes are not activated because the anastomosis site does not contact the intestinal fluid. These characteristics should decrease the rate of anastomosis failure which can be a fetal complication. A safer operation is desirable, particularly for elderly patients or patients who have complications.

[A case of unresectable advanced gastric cancer responding remarkably to combined chemotherapy with 5-fluorouracil and low-dose cisplatin].

A 62-year-old male patient complaining epigastralgia was diagnosed as having Borrmann type 2 gastric concer (por). The primary lesion was unresectable, so the patient was treated by combined chemotherapy with 5-fluorouracil and low-dose cisplatin for 4 weeks, which resulted in the disappearance of primary tumor and a remarkable reduction of metastatic lymph nodes. The patient has a good quality of life without any sign of recurrence now.

Laboratory diagnosis of infectious diarrhea.

The microbiology laboratory, in conjunction with the medical staff, must determine a reasonable approach to the evaluation of diarrheal stools since the cost to rule out all potential pathogens is prohibitive and control of the use of laboratory services is now a major focus in all institutions. All stool cultures should be examined for Campylobacter, Salmonella, and Shigella, the most common causes of inflammatory bacterial diarrhea in the United States. Special media for other pathogens should be added only if there is high regional endemicity or significant clinical suspicion. If a child has bloody diarrhea, a search for E coli O157:H7 is indicated. For patients with a history of raw seafood ingestion or foreign travel, the laboratory should be asked to screen specimens for Vibrio and Plesiomonas species. The report from the laboratory should specifically state what enteropathogens have been excluded, for example, "No Salmonella, Shigella, or Campylobacter isolated." A report of "negative" or "no enteric pathogens" is not very useful. Diagnosis of viral and parasitic enteritis and antibiotic-associated diarrhea require a variety of additional tests. Clinicians are encouraged to discuss these issues with the pathologist or microbiologist at their local laboratory and be familiar with community microbiology practice, particularly which organisms require a special request for the laboratory to attempt identification.

Clinicopathologic study of perineural invasion in rectal cancer.

Perineural invasion (PNI) in rectal cancer was studied, prospectively. One-hundred patients (20%) were identified as having tumors with PNI. The incidence of PNI was significantly increased in tumors with moderate or marked venous invasion (30%, 64%), with moderate or marked lymphatic permeation (37%, 72%), with liver metastasis (50%) and with peritoneal dissemination (64%). In cases of curative surgery, the incidence of PNI was significantly increased in MAC stage C2m+g or C3 (28%, 35%). There was no significant difference in the recurrence or survival rates between the patients with PNI and without PNI in MAC stage B2m+g. However, there was a significant increase in local recurrence in the patients with both PNI and lymph node metastasis (p less than 0.05). Also, the patients with PNI in MAC stage C2m+g had a significantly lower 8-year survival rate (29.1%, p less than 0.001). Multivariate analysis using Cox regression models demonstrated that PNI was an independent prognostic factor for survival.

Occurrence of desmoid tumors following surgery for familial adenomatosis coli--report of two cases.

Twenty-five patients with adenomatosis coli were subjected to operations, and two in which desmoid tumors appeared after the operation on familial adenomatosis coli are described here. These patients were 26 and 37 year-old males. After the total colorectomy, each tumor was associated with soreness and was palpated in the lower abdominal wall, and operations were performed. The histological findings from the resected specimens, 12 cm and 34 cm in size, indicated desmoid tumors. Poliposis of the large intestine with desmoid tumors, as a complication, has been reported in 23 previous cases in Japan.

Differences in susceptibilities of the lymphogranuloma venereum and trachoma biovars of Chlamydia trachomatis to neutralization by immune sera.

Sera from seven patients from whom a C. trachomatis serovar L2 strain was isolated were tested in vitro for their ability to neutralize the infectivity of this organism. In one patient an inguinal lymph node was culture positive, whereas the remaining six patients had positive rectal biopsies. Sera from four of the patients, including the patient with the lymph node isolate, failed to neutralize serovar L2(434). In addition, the homologous strain recovered from the inguinal lymph node was available and was resistant to neutralization by the homologous sera. However, the same sera effectively neutralized a trachoma serovar, E(Bour). All four sera had inclusion immunofluorescent-antibody titers to C. trachomatis serovar L2 of 2,048 to 16,384 and microimmunofluorescent-antibody titers to the lymphogranuloma venereum biovar were equal or higher in all cases than to the 12 serovars of the trachoma biovar. The three remaining sera, while neutralizing the infectivity of the L2 strains tested, neutralized serovar E to a greater extent. These sera had the same inclusion immunofluorescent antibody titers as the sera that failed to neutralize serovar L2. To see whether this difference in the sensitivity of the biovars toward neutralization could be characterized, sera were obtained from mice immunized with different doses of both serovars L2 and E. Sera obtained from mice immunized with serovar E were able to effectively neutralize the homologous strain. In contrast, neutralization of the immunizing strain, L2(UCI-20), was not seen with sera obtained on days 7, 14, and 21 after immunization from animals receiving 8 x 10(5) and 8 x 10(4) inclusion-forming units of L2(UCI-20); however, these same sera neutralized serovar E. However, with a higher immunizing dose of L2 (10(7) IFUs), both E and L2 were neutralized with sera obtained 7 and 14 days after immunization. Therefore, the relative resistance to neutralization by serovar L2 compared with that of serovar E in the mouse model was inoculum dependent.

Routine viral culture for pediatric respiratory specimens submitted for direct immunofluorescence testing.

From 1986 to 1987, 69 (25%) of 274 specimens from children with lower respiratory tract syndromes were positive for respiratory syncytial virus antigen by direct immunofluorescence assay (DFA). Comprehensive viral culture was performed on all 205 DFA-negative specimens, and 72 specimens yielded viruses; 5 specimens yielded multiple agents. Thus, 52% of specimens yielded a specific virus, supporting the routine use of viral culture. Isolates from the DFA-negative specimens included respiratory syncytial virus (n = 7), rhinovirus (n = 34), hemadsorbing viruses (n = 13), cytomegalovirus (n = 11), adenovirus (n = 8), enteroviruses (n = 3), and herpes simplex virus (n = 2). Although serologic confirmation is needed, cytomegalovirus may be an underappreciated cause of acute lower respiratory tract infection in normal children. Further studies must be conducted to document this possibility.