Prescribing Trends Psychotropic Drugs Against Children and Adolescents and Association with Polypharmacy Reduction Policy for Psychotropic Drugs: Based on Japanese National Database Survey.

In Japan, the polypharmacy reduction policy for psychotropic drugs is intended to reduce the reimbursement of medical costs when "three or more types of psychotropic drugs" are prescribed. However, non-polypharmacy patients who need multiple drugs are also comprehensively evaluated. This study demonstrated that the polypharmacy reduction policy for psychotropic drugs is associated with reductions of the amounts of in-hospital prescriptions for patients using antidepressants, antipsychotics, anxiolytics, and benzodiazepines.

Difference in the prevalence of hypertension and its risk factors depending on area-level deprivation in Japan.

OBJECTIVES: Area-level deprivation is an important factor related to mortality or health behaviors; however, a study investigating differences in hypertension prevalence depending on area-level deprivation has not been conducted in Japan. We investigated differences in the prevalence of hypertension and its risk factors, i.e. obesity, smoking, alcohol consumption, and heavy alcohol drinking depending on area-level deprivation using nationwide health checkups data in 2018. RESULTS: Area-level deprivation was derived from census data. An analysis of the data by secondary medical areas revealed that the age-standardized proportions of individuals whose systolic blood pressure was ≥ 140 mmHg, those whose diastolic blood pressure was ≥ 90 mmHg, those whose body mass index was ≥ 25 or 30 kg/m2, smokers, and heavy alcohol drinkers showed an increasing trend with an increase in the deprivation level. The relative index of inequality, which can be interpreted as the ratio of the age-standardized proportion for the most deprived area compared with that for the least deprived area, was significantly greater than 1 for all proportions, except for the proportion of drinkers in women. Overall, there was a disparity in the prevalence of hypertension and its risk factors depending on area-level deprivation.

Analysis of regional differences in the amount of hypnotic and anxiolytic prescriptions in Japan using nationwide claims data.

BACKGROUND: In Japan, there has been no investigation of regional differences in the number or amount of prescriptions of anxiolytics or hypnotics. Attributes related to the high amount of prescriptions for these drugs are unknown. We investigated recent trends and regional differences in the amount of prescriptions of hypnotics and anxiolytics in Japan and identified factors associated with these regional differences. METHODS: The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open data from 2015 to 2018 were used. We calculated diazepam-equivalent doses (mg) for each drug and the total amount of prescriptions per capita for hypnotics and anxiolytics by sex and age. In addition, we calculated the standardized claim ratio (SCR) of the amount of prescriptions by prefecture. We investigated factors associated with regional differences in the SCRs of hypnotics and anxiolytics using the prefectures' medical, socioeconomic, and physical characteristics by an ecological study using a linear mixed-effects model. RESULTS: The amount of prescriptions of hypnotics and anxiolytics, specifically, the amount of prescriptions of benzodiazepine receptor agonists (BZRAs), decreased in many of the adult age groups from 2015 to 2018. The regression analysis revealed that the number of medical clinics per capita, the number of public assistance recipients per capita, the proportion of persons whose HbA1c ≥ 6.5%, and the proportion of persons whose BMI ≥25 kg/m2 were positively and significantly associated with the SCR of hypnosis. In contrast, the number of public assistance recipients per capita and the proportion of persons whose BMI ≥25 kg/m2 were positively and significantly associated with the SCR of anxiolytics. CONCLUSIONS: Factors associated with prescription amount of hypnotics and anxiolytics were revealed in this study, and a further study is needed for investigating causal relationships between the prescriptions amount and the associated factors using individual data.

Geographical Differences and Their Associated Factors in Chronic Obstructive Pulmonary Disease Mortality in Japan: An Ecological Study Using Nationwide Data.

Geographical differences in chronic obstructive pulmonary disease (COPD) mortality have not been determined using municipal-specific data in Japan. This study determined the geographical differences in COPD mortality in Japan using municipal-specific data and identified associated factors. Data on COPD mortality from 2013 to 2017 for each municipality were obtained from the Vital Statistics of Japan. We calculated the standardized mortality ratio (SMR) of COPD by an empirical Bayes method for each municipality and located the SMRs on a map of Japan. In addition, an ecological study was conducted to identify factors associated with the SMR using demographic, socioeconomic, and medical characteristics of municipalities by a spatial statistics model. Geographical differences in the SMR were different in men and women, and municipalities with a low SMR tended to be more frequent in women. Spatial regression analysis identified that the total population and taxable income per capita were negatively associated with the SMR in men. In women, population density, the proportion of fatherless households, and the number of clinics per capita were positively associated with the SMR, whereas taxable income per capita was negatively associated with the SMR. There were some differences in regional characteristics associated with COPD mortality by sex.

Trends in the Prescription of Benzodiazepine Receptor Agonists from 2009 to 2020: A Retrospective Study Using Electronic Healthcare Record Data of a University Hospital in Japan.

In recent years, the prescription trends of benzodiazepine receptor agonists (BZRAs) have not been investigated in Japan despite the publication of guidelines that promote cautious use of BZRAs. The prescription trend of BZRAs was assessed using the electronic healthcare records data of a University Hospital in Japan. The data from April 2009 to March 2021 were used. The following three types of outcomes were set: the proportion of patients who were prescribed with BZRAs within those prescribed hypnotics or anxiolytics; the mean number of the types of prescribed BZRAs, and the mean average daily doses of BZRAs. The same analysis was conducted for benzodiazepines (BZDs) and non-benzodiazepines (Z-drugs). As a result, we found that the proportions of patients prescribed BZRAs within those prescribed hypnotics or anxiolytics began to decrease, particularly from 2015 for patients aged <75 years and those aged ≥75 years. Further, the degree of decrease was larger in patients aged ≥75 years. The proportion for BZDs decreased particularly in the study period, and the proportion for Z-drugs also began to decrease approximately from 2016 in patients aged ≥75 years. The results suggest a possibility that guidelines affected the decreased prescriptions of BZRAs.

Analysis of the regional distribution of road traffic mortality and associated factors in Japan.

BACKGROUND: Regional differences in road traffic (RT) mortality among municipalities have not been revealed in Japan. Further, the association between RT mortality and regional socioeconomic characteristics has not been investigated. We analyzed geographic differences in RT mortality and its associated factors using the Vital Statistics in Japan. METHODS: We used data on RT mortality by sex and municipality in Japan from 2013 to 2017. We calculated the standardized mortality ratio (SMR) of RT for each municipality by sex using an Empirical Bayes method. The SMRs were mapped onto a map of Japan to show the geographic differences. In addition, an ecological study investigated the municipal characteristics associated with the SMR using demographic socioeconomic, medical, weather, and vehicular characteristics as explanatory variables. The ecological study used a spatial statistical model. RESULTS: The mapping revealed that the number of municipalities with a high SMR of RT (SMR > 2) was larger in men than in women. In addition, SMRs of capital areas (Kanagawa and Tokyo prefectures) tended to be low in men and women. The regression analysis revealed that population density was negatively associated with the SMR in men and women, and the degree of the association was the largest among explanatory variables. In contrast, there was a positive association between the proportion of non-Japanese persons and SMR. The proportions of lower educational level (elementary school or junior high school graduates), agriculture, forestry, and fisheries workers, service workers, and blue-collar workers were positively associated with the SMR in men. The proportion of unemployed persons was negatively associated with the SMR in men. CONCLUSIONS: Socioeconomic characteristics are associated with geographic differences in RT mortality particularly in men. The results suggested preventive measures targeted at men of low socioeconomic status and non-Japanese persons are needed to decrease RT mortality further.

Analysis of the regional difference in the number of multi-drug prescriptions and its predictors in Japan, 2015-2018.

OBJECTIVE: Polypharmacy and multi-drug prescription are major public health problems in Japan, but only a few studies have investigated the regional differences. By revealing regional differences in the multi-drug prescriptions, we can infer regions with high rates of multimorbidity or inappropriate prescribing. This study revealed regional differences in multi-drug prescriptions (the number of simultaneous prescriptions of seven or more internal medicines) and investigated the factors affecting the difference using the National Database of Health Insurance Claims and Specific Health Checkups of Japan data. RESULTS: The standardized claim ratio (SCR) of the number of multi-drug prescriptions, which corrected the difference in sex and age distribution of prefectures, varied depending on prefectures. A panel data analysis investigating the association between the SCR and explanatory variables (Medical institutions, socioeconomic factors, and physical characteristics of people in prefectures) revealed that the number of public assistance recipients per 1,000 persons was positively and significantly associated with the SCR (Standardized partial regression coefficient = 0.244, p-value = 0.038). In conclusion, regional differences in the number of the multi-drug prescriptions were revealed in Japan, suggesting that public assistance recipients tend to experience multi-drug prescriptions.

Analysis on the Effects of External Temperature and Welding Speed on the Safety of EVA Waterproofing Sheet Joints by Hot Air Welding.

This study analyzes the optimal seasonal ambient temperature during welding and welding speed conditions for securing high tensile strength of ethylene vinyl acetate (EVA) waterproofing sheets bonded for roofing, installed by hot air welded joints (overlaps). Seven separate ambient temperature conditions (-10, -5, and 0 °C for winter conditions, 20 °C for the normal condition, and 25, 30, and 35 °C for summer conditions) were set for the test variable and seven speed conditions (3, 4, 5, 6, 7, 8, and 9 m/min) for hot air welding. Based on these conditions, EVA sheet joint specimens were prepared, and the tensile strength of the joint sections was tested and measured. Tensile strength results, compared to normal temperature conditions (20 °C) showed an increase in the summer temperature condition but a decrease during winter temperature conditions. The analysis on the effects of the welding speed showed that in summer temperature conditions (25, 30, and 35 °C), the optimum hot air welding speed is 4.3~9.0 m/min at 25 °C, 4.7~8.7 m/min at 30 °C and 5.2~8.6 m/min at 35 °C, whereas in winter (-10, -5, and 0 °C), the optimum hot air welding temperature is 3~4.1 m/min at -10 °C, 3~4.6 m/min at -5 °C and 3~4.9 m/min at 0 °C. Research results demonstrate that it is imperative to consider the welding speed in accordance to the respective seasonal temperature conditions to secure construction quality of the EVA joints for roofing.

Oil Leakage Evaluation for Selection of Emulsion-Based Non-Curable Synthetic Polymer Rubberized Gel (ENC-SPRG) as Waterproofing Material in Underground Structures.

A revised oil leakage evaluation regime is proposed in response to the oil leakage problems of emulsion-based non-curable synthetic polymer rubberized gel (ENC-SPRG) used as a waterproofing material in concrete slabs of residential underground structures. Oil leakage from ENC-SPRG can cause significant economic and environmental damage. As ENC-SPRG waterproofing material is relatively new in the global waterproofing market, a systematic quality control for ENC-SPRG products being manufactured and exported globally is currently non-existent. For the selection of optimal ENC-SPRG, six assessment parameters comprised of averaged and daily average oil leakage mass, averaged and daily average filler content settlement, oil leakage area, and oil leakage duration are proposed. Five ENC-SPRG product specimens are tested to obtain the property values of each parameter. The property values derived from the test results are compared between the tested ENC-SPRG product specimens. With the demonstration of this evaluation regime, a quantified method for a comparative assessment of ENC-SPRG type waterproofing materials is established.

The Development of an Electronic Phenotyping Algorithm for Identifying Rhabdomyolysis Patients in the MID-NET Database.

We aimed to develop rhabdomyolysis (RB) phenotyping algorithms using machine learning techniques and to create subphenotyping algorithms to identify RB patients who lack RB diagnosis. Two pattern algorithms, one with a focus on improving predictive value and one focused on improving sensitivity, were finally created and had a high area under the curve value of 0.846. Although we were unable to create subphenotyping algorithms, an attempt to detect unknown RB patients is important for epidemiological studies.

Effect of Governance Functionality for Data Standardization Management of the Medical Information Database Network Project.

Data standardiztion an important aspect to ensure data quality for utilizing large-scale, medical information databases such as the Medical Information Database Network (MID-NET) Project in Japan. We established a governance center to assess the consistency of standard codes across MID-NET-cooperating medical institutions. Moreover, we developed a real-time validation tool and determined its effect in improving data quality in medical institutions by providing a central feedback on the detected differences in standard disease-name codes.