The effect of Assertive Community Treatment in Japan.

OBJECTIVE: The aim of this study was to evaluate the effects of the Assertive Community Treatment (ACT) program in a Japanese mental health service setting. METHOD: This study was a randomized controlled trial. ACT was the intervention condition (n = 59), and the usual hospital-based rehabilitation program was the control condition (n = 59). Outcome indicators include in-patient days, psychiatric symptoms, social functioning, quality of life, and client satisfaction. The follow-up period was 12 months after the intervention. RESULTS: We found a significant reduction of in-patient days for the ACT group demonstrated by t-test (t = 2.33, P = 0.02). However, the results of ancova did not show significant differences for in-patient days between the two groups (F = 1.85, P = 0.18). The depression score for Brief Psychiatric Rating Scale for the ACT group was significantly lower than the control group at the 12-month follow-up assessment (F = 5.57, P = 0.03). According to the t-test, the ACT group had a higher client satisfaction than the control group (t = 2.08, P = 0.05). CONCLUSION: We concluded that ACT had a positive influence, as evidenced by a reduction of in-patient days, lower depressive symptoms, and higher client satisfaction.

[A single year birth cohort analysis of mortality in Japan, 1950 to 1984, statistical method and all cause mortality].

Mortality of single birth year cohort were calculated using the data tape of Information Service on World Health Statistics, WHO, 1950-1984. The data tape gave population and number of deaths for each year of age under 5 years of age and by 5 years of age for ages from 5 to 84 years. Population and number of deaths by age for each year of age in each calendar year were estimated by interpolation. Populations for each year of age were interpolated by B-spline interpolation. Number of deaths for each year of age were calculated by application of "two dimensional semi-Hermite method" after estimation of number of deaths for age 80, 81,......84, using Sprague interpolation factors. Age-specific cohort mortality curves were lower for each successive cohort, demonstrating the so-called "cohort phenomenon", clearly. Ratios of mortalities at the same age, for each successive 5 year interval cohort, which indicate cohort-by-cohort changes of mortalities, were thus less than 1.0 in almost all age groups. In recent years the ratios have gradually been leveling off at 0.8-0.9. Cohorts born in the early Showa Era (around 1930) showed higher ratios than all other cohorts, indicating relatively poor improvement in mortalities compared to the other cohorts. Ratios of cohort mortalities for successive ages within the same cohort, which indicates mortalities increase with advance of age, were greater than 1.0 after adulthood. These particular results showed that the increase in mortality with age accelerated after 30 years of age and that a difference in trend was observed between male and female after age 50. This new method of cohort analysis, single birth year cohort, gives clearer results than those obtained by methods heretofore utilized in cohort studies and is useful for more detailed analysis of cohort mortality.

PIP: The mortality of a single birthyear cohort were calculated using the data tape of the Information Service on World Health Statistics, WHO, 1950-84. The data tape provided population and number of deaths for each year of age under 5 years and by 5-year increments for those ages 5-84 years. Population and number of deaths by age for each year in each calendar year were interpolated by B-spine interpolation. Number of deaths for each year of age were calculated by applying the 2-dimensional semi-Hermite method after estimating the number of deaths for ages 80-84 using Sprague interpolation factors. Age-specific cohort mortality curves were lower for each successive cohort, demonstrating clearly the so-called cohort phenomenon. Ratios of mortalities at the same age for each successive 5-year interval cohort were less than 1.0 in almost all of the groups; this indicates cohort-by-cohort changes in mortality. In recent years, the ratios have gradually levelled off at between 0.8-0.9. Cohorts born in the early Showa era (around 1930) showed higher ratios than all other cohorts and this indicates relatively poor improvement in mortality as compared to other cohorts. Ratios of cohort mortalities for successive ages within the same cohort, which indicates mortality increase with the advance of age, was greater than 1.0 after the onset of adulthood. These results show that the increase in mortality with age accelerated after age 30 and that a difference in trend was seen between males and females after the age of 50. This new method of cohort analysis, single birthyear cohort, gives clearer results than those obtained by methods thus far utilized in cohort studies and is useful for more detailed analysis of cohort mortality. (author's modified)

[[Abnormal trends in mortality for birth cohorts born around 1930]].

Variations in mortality in Japan for cohorts born during the period 1927-1932 are analyzed and compared. "Abnormal trends in mortalities...were clearly observed among males, starting at [the] age of 35...for all causes and many of the main chronic degenerative diseases.... Susceptibilities for those diseases might have been induced by poor nutritional conditions [that] prevailed...due to the social and economic chaos just after the World War II." (SUMMARY IN ENG)

[[Cohort analysis of mortality from three major adult diseases]].

The authors present cohort mortality rates for Japan by five-year age interval for all causes of death and for malignant neoplasms, cerebrovascular disease, and heart disease. The calculations are based on vital statistics data for 1947-1982 and period and cohort life tables for 1891-1982 published by Zenjo Nanjo and Kazumasa Kobayashi. "Ratios of individual cause to all causes in each age were calculated and applied to [a] mortality matrix derived from Nanjo-Kobayashi's life tables. Age-specific period and cohort mortality rates for each cause were calculated from [the] cause-specific mortality matrix.... Trends and age patterns of cohort mortalities and ratios of mortalities in successive cohort and age group were investigated." (SUMMARY IN ENG)

Hepatitis B surface antigen, hepatitis C virus antibody, body mass index, and alcohol drinking among workers with elevated serum alanine aminotransferase.

METHODS: We conducted a case-control study on liver diseases among Japanese workers to examine associations between elevated serum alanine aminotransferase (alanine aminotransferase value > or = 50 IU/liter) and selected factors such as hepatitis B surface antigen positive, hepatitis C virus antibody positive, body mass index, and alcohol drinking. Out of 3,738 workers (1,477 males and 2,261 females) in a supermarket chain, 91 workers with an elevated serum alanine aminotransferase value (> or = 50 IU/liter) were classified as cases and 182 workers with normal serum alanine aminotransferase value and without an episode of blood transfusion were randomly selected as controls. RESULTS: Prevalence rates of hepatitis B surface antigen positive and hepatitis C virus antibody positive were 4.4 and 23.1% among the overall cases, 2.9 and 11.8% among the cases with 100 > alanine aminotransferase value > or = 50, and 8.7 and 56.5% among the cases with alanine aminotransferase value > or = 100. A logistic regression analysis was conducted. Odds ratios were 4.94 for hepatitis B surface antigen positive (P < 0.05) and 77.19 for hepatitis C virus antibody positive (P < 0.001). Odds ratios for body mass index increased with increasing body mass index values; 3.32 for 26 > body mass index > or = 24 (P < 0.01) and 5.03 for body mass index > or = 26 (P < 0.001). No increased risk was observed among regular drinkers of less than 27 g/day of ethanol (odds ratio is 0.23) or of 27-53 g/day of ethanol (odds ratio is 0.47). A slightly increased odds ratio of 1.35 was observed among regular drinkers of 54-81 g/day of ethanol, but this was not statistically significant. CONCLUSIONS: Our results suggest that hepatitis C virus and high body mass index are predominant factors in elevated serum alanine aminotransferase levels among Japanese workers, while alcohol drinking is a minor factor.