Barriers to medication adherence among patients with non-communicable diseases: Fijian health professionals’ perceptions / 国際保健医療

<b>Objective</b><BR>  The purpose of this study was to examine health professionals’ perceptions of barriers to medication adherence in patients with non-communicable diseases (NCDs) in Fiji.<BR>Methods: Interviews were conducted with 25 health professionals (physicians and pharmacists) treating patients with NCDs in Fiji. The interview contained questions regarding barriers to medication adherence for specific NCDs. <BR><b>Results</b><BR>  Health professionals’ perception of these barriers were identified and divided into patient-related and non-patient-related factors. The patient-related factors included lifestyle, knowledge, technique, language, and beliefs and culture. The non-patient-related factors were cost and access to medication, therapy-related factors, and support from other people.<BR><b>Conclusion</b><BR>  Traditional medical beliefs, medication access and affordability, negative lifestyle habits, and insufficient knowledge about illnesses, medical devices, and medications were identified as barriers to medication adherence in Fiji. Barriers to medication adherence differ according to diagnosis. Knowledge was considered an important factor with respect to adherence to medication regimens, particularly for patients with asymptomatic conditions (e.g., diabetes, hypertension, and stable asthma).

Out-of-pocket Costs of Disabilities and Their Association with Household Socioeconomic Status Among School-aged Children in Vietnam / Journal of Rural Medicine

<b>Objective:</b> The aim of this study was to assess the economic burden of disability of school-aged children and to evaluate the association between disabilities and household socioeconomic status, as well as the economic burden of disability and household socioeconomic status in Vietnam.<br><b>Materials and Methods:</b> Nationally representative data for 9,882 children aged 6 to 17 years from the Vietnam Household Living Standard Survey 2006 were used. Disabilities were measured in six basic functional domains, including vision, hearing, remembering or concentrating, mobility, self-care, and communication. We evaluated the association between area, household income, educational attainment, or occupation of household head, and each difficulty. The ratio of health-care expenditure to per capita household income was compared by presence of a disability as well as household socioeconomic status.<br><b>Results:</b> The prevalence of difficulty was 1.9% for vision and 2.3% for at least one of the other five domains. Difficulty in vision was more prevalent in the richer households (p=0.001), whereas difficulty in the other five domains was more prevalent in the poorer households (p=0.002). The ratio of health-care expenditure to per capita household income was greater than 0.05 in 4.6% of children. The adjusted odds ratio of children with difficulty in vision having a health-care expenditure share greater than 0.05 compared with children without difficulty was 4.78 (95% CI: 2.95, 7.73; p<0.001), and that for difficulty in the other five domains was 3.13 (95% CI: 2.04, 4.80; p<0.001). Among children with difficulty in at least one of the five domains other than vision, the proportion of children with a health-care expenditure share greater than 0.05 was higher among children from the poorer households (p=0.033).<br><b>Conclusions:</b> Children with a disability spent more on health care relative to their income than those without. Visual disability was more prevalent among children from the richer households, whereas other disabilities were more prevalent among children from the poorer households.

Purchase of Antimicrobials in Retail Pharmacies Whena Prescription is Not Required / Journal of Rural Medicine

<b>Objectives:</b> The patterns of purchasing prescription antimicrobials with or without a prescription from retail pharmacies in Ulaanbaatar, Mongolia, were examined in relation to purchasers’ socioeconomic status and price of the product.<br><b>Methods:</b> A survey was conducted at 250 randomly selected pharmacies in Ulaanbaatar. A total of 619 customers were interviewed, and the medicines they bought at the stores were examined by medical doctors. The use of prescriptions and advice in purchasing medicines and sociodemographic characteristics of the subjects were determined.<br><b>Results:</b> Interviews were conducted with 297 customers who purchased prescription antimicrobials in front of the store in which they made their purchase. Among these 297 customers, only 19.5% (<i>n</i>=58) purchased medicine with a formal prescription, and 37.4% (<i>n</i>=111) purchased medicines on their own initiative and without the guidance of medical professionals. Purchase without a prescription was not associated with the subjects’ gender, age, educational status or area of residence. Lower-priced antimicrobials were purchased without prescriptions more frequently than those with a higher price (<i>P</i><0.05).<br><b>Conclusion:</b> The purchase of antimicrobials without prescriptions is common across all sociodemographic strata in Ulaanbaatar, Mongolia. Considering the increases in number of retail pharmacies and in sales of antimicrobials associated with economic development, measures to enforce regulations and to promote education among the general public and pharmacy professionals are required.

Cohabitation with farm animals in urban households with and without occupational farm work: associations between participation in educational activities and good hygiene practices in at-risk households cohabiting with farm animals

<p><b>OBJECTIVES</b>This study was performed to investigate patterns of cohabitation with farm animals in urban households in Vientiane, Lao People's Democratic Republic, with regard to animal-to-human disease transmission. We also investigated the association between participation in hygiene-related educational activities and good hygiene practices in households with or without cohabitation with animals.</p><p><b>METHODS</b>A survey regarding cohabitation with animals, socioeconomic characteristics and participation in educational activities was conducted among 1,497 households randomly sampled from urban districts of Vientiane in 2001. Rates of satisfactory performance of recommended good hygiene practices according to a program commencing in 1996 were compared among households cohabiting with animals with or without participation in educational activities (reference group).</p><p><b>RESULTS</b>Even among households not engaged in agriculture as a major source of income, 54.4, 34.9, 7.9, 3.1 and 35.7% cohabited with chickens, ducks, cattle, buffaloes and dogs, respectively. The percentage of households fulfilling the recommendations for good hygiene practices was 56.7%. The rates of satisfactory hygiene practices among households participating in health education and cohabitating with chickens, ducks or cattle were greater than those in the reference group (OR = 1.7, 95%CI = 1.2, 2.3; OR = 2.0, 95%CI = 1.3, 3.0; OR = 2.3, 95%CI = 1.0, 4.9) regardless of socioeconomic factors. Households cohabiting with animals showed poorer rates of satisfactory hygiene practices than those without animals.</p><p><b>CONCLUSIONS</b>Cohabitation with farm animals is common in urban Vientiane regardless of household involvement in agriculture. Further effort is required to improve hygiene conditions, despite some positive effects of health education even in households cohabiting with animals.</p>

Bacterial quality of drinking water stored in containers by boat households in Hue City, Vietnam

<p><b>OBJECTIVES</b>To examine the bacterial quality of drinking water stored in containers by boat households in the river basin of Hue City, and associated factors.</p><p><b>METHODS</b>Ready-to-drink water stored in containers on boats was collected from 766 households. Escherichia coli (E. coli), total coliforms, and Enterobacteriaceae in the water were examined by the rehydratable dry-film plating method. Socioeconomic characteristics, water source, handling practices, and proficiency of disease prevention of individual households were assessed.</p><p><b>RESULTS</b>E. coli, over ten counts of total coliforms, and over ten counts of Enterobacteriaceae were detected in 25.7, 44.5, and 51.5% of 1-ml samples of ready-to-drink water stored in containers on the boats. Bacterial contamination of the water stored in containers by boat households was significantly associated with use of river water as a source of drinking water, non-boiling before storing containers for drinking, and limited proficiency in disease prevention regardless of the influence of socioeconomic characteristics of the households (P < 0.01, P < 0.05, P < 0.01, respectively).</p><p><b>CONCLUSIONS</b>Bacterial contamination of ready-to-drink water stored by boat households was indicated. The households' proficiency in disease prevention buffered contamination. A comprehensive health promotion program with a wide range of contents is required for the communities of boat households.</p>

Water quality and concentration of alkylphenols in rivers used as source of drinking water and flowing through urban areas

<p><b>OBJECTIVES</b>To examine nonylphenol (NP) and 4-t-octylphenol (OP) concentrations and general water quality indicators along a river in the greater Tokyo area and to specify the distribution and origin of alkylphenols.</p><p><b>METHODS</b>Water was sampled from the Edogawa River, a main river in the greater Tokyo area, which is a source of public drinking water; and the Sakagawa River system, a tributary of the Edogawa River. To determine alkylphenol in river water. NP and OP concentrations were quantified using gas chromatography-mass spectrometry (GC-MS).</p><p><b>RESULTS</b>The detection rates of NP above the detection limit were 100% in both rivers, and those of OP were 75.0% in the Edogawa River and 92.9% in the Sakagawa River system. The median NP and OP concentrations in the Edogawa River were 0.24 μg/1 and 0.066 μg/l, and those in the Sakagawa River system were 0.87 μg/l and 0.19 μg/l respectively. Alkylphenol concentrations are significantly higher in the Sakagawa River system than in the Edogawa River. In the Sakagawa River system, the NP and OP concentrations were highest in the water along the nonindustrial area with an underdeveloped sewerage system.</p><p><b>CONCLUSIONS</b>NP and OP were detected widely in the Edogawa River and Sakagawa River system. Endocrine-disrupting chemical (EDC) pollution in a river by the inflow of urban wastewater was demonstrated. A systematic monitoring of alkylphenols in tributary rivers and streams as well as in main rivers will help control EDC pollution and protect the source of drinking water in urban areas.</p>

Health and environment in the context of urbanization

This paper introduces a series of research projects designed to fulfill the societal role of environmental health studies by investigating (1) the dynamic and complex relationships between environmental conditions and (2) health in an urban setting. Research in this first category has revealed the existence of the combined influence of multiple physical environmental factors on health and its mechanisms. In the second category, there have been a number of studies of the integrated influence of social environmental factors on health employing an aggregate modeling of multiple determinants of health and studies of individual topics related to social determinants of health. These research projects have contributed to the formulation of specific remedies and the development of comprehensive health policies. Participatory approaches have been used to enhance capacity building opportunities and to ensure that research results reflect the actual conditions in urban societies. Healthy Cities projects and programs have been developed in close collaboration with this type of research. Urban societies have become interdependent and share the same issues globally. Further research into the relationships between health and the environment in the context of urbanization will expand the base of evidence applicable to the complex realities in modern societies.

Socioeconomic status and cancer screening in Japanese males: Large inequlaity in middle-aged and urban residents

<p><b>OBJECTIVES</b>Cancer screening has become common in Japan. However, little is known about the socioeconomic factors affecting cancer screening participation. This study was performed to examine the association between socioeconomic status and cancer screening participation in Japanese males.</p><p><b>METHODS</b>Using the data of 23,394 males sampled from across Japan, the associations between self-reported participation in screenings for three types of cancer (i.e., stomach, lung and colon) and socioeconomic variables, including marital status, types of residential area (metropolitan/nonmetropolitan), household income, and employment status, were examined using multilevel logistic regression by age group (40 to 64 and ≥65 years).</p><p><b>RESULTS</b>The cancer screening participation rates were 34.5% (stomach), 21.3% (lung), and 24.8% (colon) for the total population studied. Being married, living in a nonmetropolitan area, having a higher income and being employed in a large-scale company showed independent associations with a higher rate of cancer screening participation for all three types of cancer. Income-related differences in cancer screening were more pronounced in the middle-aged population than in the elderly population, and in metropolitan areas than in nonmetropolitan areas.</p><p><b>CONCLUSIONS</b>There are notable socioeconomic differences in cancer screening participation in Japan. To promote cancer screening, socioeconomic factors should be considered, particularly for middle-aged and urban residents.</p>

Improved perinatal health through qualified antenatal care in urban Phnom Penh, Cambodia

<p><b>OBJECTIVES</b>The aim of this study is to examine the utilities of antenatal care with comprehensive health education qualified in Phnom Penh for the health of mothers and infants during perinatal and postpartum periods. Attention was given to the existing socioeconomic disparties among women in this urban area, and the utilities were discussed irrespective of socioeconomic status.</p><p><b>METHODS</b>A total of 436 pregnant women in an urban area in Phnom Penh were selected using a complete survey in randomly sampled villages and were followed up. Participating in antenatal care with comprehensive health education at least three time was regarded as the use of "qualified antenatal care" during pregnancy. In this study, we investigated the independent associations of the use of qualified antenatal care with the following outcome variables after the adjustment for the influence of socieconomic variables: postpartum maternal health knowledge, postpartum maternal anemia, low birth weight, and infant immunization.</p><p><b>RESULTS</b>Of the 314 subjects who completed the follow-up examination, 66.8% used qualified antenatal care during pregnancy. The use of qualified antenatal care was positively associated with postpartum maternal health knowledge (OR=2.38, 95% CI: 1.12-5.05). and reductions in the incidences of postpartum anemia (OR=0.22,95% CI: 0.05-0.95) and low birth weight (OR=0.05,95% CI: 0.01-0.39) after the adjustment of the influence of socioeconomic status. The infants born to mothers who used qualified antenatal care had significantly higher coverage of BCG, DPT(1), and DTP(3) immunizations (P<0.001,P<0.001, andP<0.01, respectively), independent of their socioeconomic conditions.</p><p><b>CONCLUSION</b>This study shows the solid utilities of qualified antenatal care in Phnom Penh for perinatal health.</p>

Population-based Medicine: Moving from a Focus on Individuals to One on Populations / 医学教育

1) The following issues were discussed in relation to population-based medicine (PBM) education in Japan: a. requirements of physicians under current laws, b. socioeconomic factors and health/illness, c. variations of health among communities, and d. effective and efficient PBM education programs.<BR>2) The author pointed out the following key issues: a. responsibilities of physicians to maintain and promote a population's health, b. attention to the association between socioeconomic factors and illness, c. development of research methods to elucidate characteristics of population health, and d. collaboration between undergraduate and postgraduate education.<BR>3) To improve quality of medical care, to meet people's various needs, to prevent disease, and to provide appropriate care services, taking the view point of PBM is considered to be indispensable.<BR>4) Education in population-based medicine is a requirement in a physician's education in Japan. Accumulation of evidence from the view point of PBM and medical education programs to help develop public-health-minded physicians are important.

Improved Perinatal Health through Qualified Antenatal Care in Urban Phnom Penh, Cambodia

Objectives: The aim of this study is to examine the utilities of antenatal care with comprehensive health education qualified in Phnom Penh for the health of mothers and infants during perinatal and postpartum periods. Attention was given to the existing socioeconomic disparities among women in this urban area, and the utilities were discussed irrespective of socioeconomic status. Methods: A total of 436 pregnant women in an urban area in Phnom Penh were selected using a complete survey in randomly sampled villages and were followed up. Participating in antenatal care with comprehensive health education at least three times was regarded as the use of “qualified antenatal care” during pregnancy. In this study, we investigated the independent associations of the use of qualified antenatal care with the following outcome variables after the adjustment for the influence of socioeconomic variables: postpartum maternal health knowledge, postpartum maternal anemia, low birth weight, and infant immunization. Results: Of the 314 subjects who completed the follow-up examination, 66.8% used qualified antenatal care during pregnancy. The use of qualified antenatal care was positively associated with postpartum maternal health knowledge (OR=2.38, 95%CI: 1.12–5.05), and reductions in the incidences of postpartum anemia (OR=0.22, 95%CI: 0.05–0.95) and low birth weight (OR=0.06, 95%CI: 0.01–0.39) after the adjustment of the influence of socioeconomic status. The infants born to mothers who used qualified antenatal care had significantly higher coverage of BCG , DPT1, and DPT3 immunizations (P<0.001, P<0.001, and P<0.01, respectively), independent of their socioeconomic conditions. Conclusion: This study shows the solid utilities of qualified antenatal care in Phnom Penh for perinatal health.

Socioeconomic Status and Cancer Screening in Japanese Males: Large Inequlaity in Middle-Aged and Urban Residents

Objectives: Cancer screening has become common in Japan. However, little is known about the socioeconomic factors affecting cancer screening participation. This study was performed to examine the association between socioeconomic status and cancer screening participation in Japanese males. Methods: Using the data of 23,394 males sampled from across Japan, the associations between self-reported participation in screenings for three types of cancer (i.e., stomach, lung and colon) and socioeconomic variables, including marital status, types of residential area (metropolitan/nonmetropolitan), household income, and employment status, were examined using multilevel logistic regression by age group (40 to 64 and ³65 years). Results: The cancer screening participation rates were 34.5% (stomach), 21.3% (lung), and 24.8% (colon) for the total population studied. Being married, living in a nonmetropolitan area, having a higher income and being employed in a large-scale company showed independent associations with a higher rate of cancer screening participation for all three types of cancer. Income-related differences in cancer screening were more pronounced in the middle-aged population than in the elderly population, and in metropolitan areas than in nonmetropolitan areas. Conclusions: There are notable socioeconomic differences in cancer screening participation in Japan. To promote cancer screening, socioeconomic factors should be considered, particularly for middle-aged and urban residents.

Health and Environment in the Context of Urbanization

This paper introduces a series of research projects designed to fulfill the societal role of environmental health studies by investigating (1) the dynamic and complex relationships between environmental conditions and (2) health in an urban setting. Research in this first category has revealed the existence of the combined influence of multiple physical environmental factors on health and its mechanisms. In the second category, there have been a number of studies of the integrated influence of social environmental factors on health employing an aggregate modeling of multiple determinants of health and studies of individual topics related to social determinants of health. These research projects have contributed to the formulation of specific remedies and the development of comprehensive health policies. Participatory approaches have been used to enhance capacity building opportunities and to ensure that research results reflect the actual conditions in urban societies. Healthy Cities projects and programs have been developed in close collaboration with this type of research. Urban societies have become interdependent and share the same issues globally. Further research into the relationships between health and the environment in the context of urbanization will expand the base of evidence applicable to the complex realities in modern societies.

Water Quality and Concentration of Alkylphenols in Rivers Used as Source of Drinking Water and Flowing through Urban Areas

Objectives: To examine nonylphenol (NP) and 4-t-octylphenol (OP) concentrations and general water quality indicators along a river in the greater Tokyo area and to specify the distribution and origin of alkylphenols. Methods: Water was sampled from the Edogawa River, a main river in the greater Tokyo area, which is a source of public drinking water; and the Sakagawa River system, a tributary of the Edogawa River. To determine alkylphenol in river water, NP and OP concentrations were quantified using gas chromatography-mass spectrometry (GC-MS). Results: The detection rates of NP above the detection limit were 100% in both rivers, and those of OP were 75.0% in the Edogawa River and 92.9% in the Sakagawa River system. The median NP and OP concentrations in the Edogawa River were 0.24 μg/l and 0.066 μg/l, and those in the Sakagawa River system were 0.87 μg/l and 0.19 μg/l respectively. Alkylphenol concentrations are significantly higher in the Sakagawa River system than in the Edogawa River. In the Sakagawa River system, the NP and OP concentrations were highest in the water along the nonindustrial area with an underdeveloped sewerage system. Conclusions: NP and OP were detected widely in the Edogawa River and Sakagawa River system. Endocrine-disrupting chemical (EDC) pollution in a river by the inflow of urban wastewater was demonstrated. A systematic monitoring of alkylphenols in tributary rivers and streams as well as in main rivers will help control EDC pollution and protect the source of drinking water in urban areas.

Turning Points in Time Trends of Cancer Mortality in Japan: Premature Mortality is More Sensitive in the Progress of Cancer Prevention

The aims of this study were to demonstrate the trend of overall mortality rate and premature mortality rate for select types of cancer in Japan and to assess the utility as a target indicator. The age-adjusted mortality rate for the total population (overall mortality rate) and that for persons under 65 years of age (under 65 mortality rate) for stomach cancer, liver cancer and lung cancer from 1950 to 1997 in Japan were calculated. Moreover, the turning point year of the mortality trend was estimated using a regression model of the rate of annual increase in each mortality rate. As the results show, a decline in the under 65 mortality rate preceding a decline in the overall mortality rate was observed in stomach cancer and male liver cancer. Also, the under 65 mortality rate due to lung cancer seemed to begin to decline in recent years for males, while the overall mortality rate has been increasing. This study suggests that the premature mortality rate is a more sensitive indicator of the effectiveness of cancer prevention. Hence, because of not only the larger burden of premature deaths but also the sensitivity, premature mortality is considered to be suitable as a target indicator for cancer prevention strategies.