Treatment Patterns in Newly Diagnosed Multiple Myeloma Patients in Japan Using A Large-scale Claims Database： Retrospective Cohort Study / 薬剤疫学

Objective: To describe the treatment patterns and time to next treatment (TTNT) in newly diagnosed multiple myeloma patients (MM) using a large-scale claims database in Japan.Design: Cohort studyMethods: The patients with newly diagnosed MM from 2008 to 2015 were classified into two groups: age <65 years, and age ≥65 years. Specific regimens and general regimens were identified with a complex algorithm considering interval of no therapy, additional and discontinued agents. Correspondingly, TTNT between the first- and second-line were measured among non-transplant patients with Kaplan-Meier method.Results: A total of 425 patients were eligible to participate in the analysis. The most common regimen for the treatment of MM was bortezomib-based regimens (52.9％ in the first-line, 28.2％ in later lines), followed by melphalan-prednisolone (27.1％ in the first-line, 12.9％ in later lines) and lenalidomide-based regimens (4.7％ in the first-line, 26.1％ in later lines). TTNT between the first- and second-line was 11.4 months and was seen to vary greatly with each regimen. A statistically longer TTNT was observed in subgroups of patients aged 65 years or over compared with patients aged younger than 65 years, but no statistical difference was found between conventional therapy and novel therapy.Conclusion: Based on the data from the study, patients with MM were commonly treated with novel agent-based regimens, especially bortezomib-based regimens. Between the first- and second-line therapies a relatively short TTNT was observed, indicating that therapies in clinical practice poorly complied with treatment guidelines.

Treatment Patterns in Newly Diagnosed Multiple Myeloma Patients in Japan Using A Large-scale Claims Database： Retrospective Cohort Study / 薬剤疫学

Objective: To describe the treatment patterns and time to next treatment (TTNT) in newly diagnosed multiple myeloma patients (MM) using a large-scale claims database in Japan.Design: Cohort studyMethods: The patients with newly diagnosed MM from 2008 to 2015 were classified into two groups: age <65 years, and age ≥65 years. Specific regimens and general regimens were identified with a complex algorithm considering interval of no therapy, additional and discontinued agents. Correspondingly, TTNT between the first- and second-line were measured among non-transplant patients with Kaplan-Meier method.Results: A total of 425 patients were eligible to participate in the analysis. The most common regimen for the treatment of MM was bortezomib-based regimens (52.9％ in the first-line, 28.2％ in later lines), followed by melphalan-prednisolone (27.1％ in the first-line, 12.9％ in later lines) and lenalidomide-based regimens (4.7％ in the first-line, 26.1％ in later lines). TTNT between the first- and second-line was 11.4 months and was seen to vary greatly with each regimen. A statistically longer TTNT was observed in subgroups of patients aged 65 years or over compared with patients aged younger than 65 years, but no statistical difference was found between conventional therapy and novel therapy.Conclusion: Based on the data from the study, patients with MM were commonly treated with novel agent-based regimens, especially bortezomib-based regimens. Between the first- and second-line therapies a relatively short TTNT was observed, indicating that therapies in clinical practice poorly complied with treatment guidelines.

Task Force Report on the Validation of Diagnosis Codes and Other Outcome Definitions in the Japanese Receipt Data / 薬剤疫学

Although the recent revision of the ministerial ordinance on Good Post-marketing Study Practice (GPSP) included the utilization of medical information databases for post-marketing surveillance, there has been limited research on the validity of diagnosis codes and other outcome definitions in Japanese databases such as administrative claims (“receipt”) database. This task force proposed how to conduct good validations studies, based on the narrative review on around 100 published papers around the world. The established check list consists of ： (ⅰ) understanding the type of the database (e.g. administrative claims data, electronic health records, disease registry) ； (ii) understanding the setting of the validation study (e.g. “population-based” or not) ； (iii) defining the study outcome ； (iv) determining the way of linkage between databases ； (v) defining the gold standard ； (vi) selecting the sampling method (e.g. using the information of all patients in the database or a hospital, random sampling from all patients, random sampling from patients satisfying the outcome definition, random sampling from patients satisfying and not satisfying the outcome definition, “all possible cases” method) and sample size ； (vii) calculating the measures of validity (e.g. sensitivity, specificity, positive predictive value, negative predictive value) ； and (viii) discussing how to use the result for future studies. In current Japan, where the linkage between databases is logistically and legally difficult, most validation studies would to be conducted on a hospital basis. In such a situation, detailed description of hospital and patient characteristics is important to discuss the generalizability of the validation study result to the entire database. This report is expected to encourage and help to conduct appropriate validation studies.

<b>The Present Situation Regarding Kampo Medicine Use and Kampo Education in Three Hokkaido H</b><b>ospitals </b> / 日本東洋医学雑誌

<p>Medical therapies, adapted to local requirements, are necessary in the field of community medicine. Generalized medical treatment is often all there is in Japan's Konsen Area, due to the large number of elderly people and a paucity of medical institutions. Kampo medical treatment is useful for elderly patients with plural diseases, and the demand for such treatment has been increasing. Therefore, we collected data on Kampo prescriptions prescribed by the doctors at the Nakashibetsu Municipal Hospital, which is the main local hospital in the Konsen Area, from 2010 to 2013. We conducted similar investigations at the Kushiro Red Cross Hospital in Kushiro city, which is centrally located in the Konsen Area, and at Asahikawa Medical University Hospital in Asahikawa, central Hokkaido. The aim of these investigations was to compare Kampo medicine use based on hospital location and size. The results can be used in community medicine to enhance the use of Kampo medicine with increase for its demand. Medical students and doctors should be educated in Kampo medicines, since their prescriptions have a significant impact on community health.</p>

Survey of medical care by oncologists for depression in breast cancer patients

<b>Objective:</b> To investigate the perception of the prevalence of mental diseases in breast cancer patients and the therapeutic approach to depression undertaken by oncologists. <b>Method:</b> Self-reported questionnaires were sent to 352 breast cancer specialists. The survey contains 11 categories to elicit the perception and identification of mental illnesses in patients, diagnostic procedure, and details of antidepressant prescribed. Logistic regression was used to explore the association of oncologists' characteristics and management of depression in breast cancer patients. <b>Results:</b> Survey response rate was 31.3%. Ninety percent of the oncologists perceived the prevalence of depression to be less than 20%, while half believed that the proportion was less than 5%. The most commonly-used medication for the treatment of depression was BZDs (41.5% [<i>n</i>=39]), followed by Selective Serotonin Reuptake Inhibitors (SSRIs) (30.9% [<i>n</i>=29]). Benzodiazepines (BZDs) were most frequently prescribed (41.5%) despite its known ineligible dependency, followed by Selective Serotonin Reuptake Inhibitors (SSRIs) (30.9%). Choice of BZDs was significantly associated with the career length of oncologists (Odds Ratio [OR]=8.20), and safety of drug (OR=5.57). Contrarily, prescription of SSRIs was associated with efficiency of drug (OR=7.07). Conclusion: Relative to anxiety and insomnia, a lower awareness regarding depression was common among study oncologists. In addition, the quality of care varied among these oncologists. It is necessary to improve both the awareness and management of mental illnesses in order to enhance the total clinical care of breast cancer patients.

ELDERLY HEALTH AND FITNESS PROMOTION PROGRAM IN THE MINIMUM ADMINISTRATIVE UNITS OF A TOWN − FITNESS MEASUREMENTS CONTINUED FOR 4 YEARS − / 体力科学

An Elderly Health and Fitness Promotion Program was carried out in the 32 on areas of Ichihazama Town (now Kurihara City), Miyagi Prefecture to promote the health of the elderly population by making as many townspeople as possible aware of their health and fitness levels, and develop active lifestyles. We evaluated the effectiveness of this program on the basis of the results during the past 4 years.In 2001, the Elderly Health and Fitness Promotion Program was started in each of the town's 32 administration areas. The number of participants continued to increase until it exceeded 600 in 2004, with increases in the percentages of males, those aged 80 years or above, and those withlimited ADL among the participants. While the results of fitness tests varied widely and were very low in some participants, changes in the fitness level were small in regular participants.

OBESITY, PHYSICAL ACTIVITY LEVEL, AND DIET OF ELEMENTARY SCHOOL PUPILS IN AN AGRICULTURAL AREA WHERE MOST PUPILS ARE DRIVEN TO AND FROM SCHOOL / 体力科学

In this study, the states of obesity, physical activity, and diet of 4 th-6 th graders were examined in an agricultural area of the Tohoku region, where many pupils are driven to and from school. The physique (height, weight), physical activity level (Select 2 ; Kenz), and nutritional intake were investigated in 32 elementary school pupils for one week.The subjects showed the following characteristics : 1) A high percentage of obese pupils, 2) a small number of walking steps, and 3) a lower percentage of obese pupils than non-obese pupils participating in sports activities. Therefore, efforts to increase the physical activity level are considered to be necessary for the prevention of obesity. For this purpose, in addition to administrative measures to increase exercise opportunities in the community such as the establishment of a general sports club, local movements such as encouraging pupils to walk to school may be effective.