<b>Adverse Drug Reactions Associated to Medications for Homebound Patients: Observations Based on a Nationwide Survey in Japan</b> / 薬剤疫学

<p><b>Objective: </b>The government has been promoting further contribution to home care by pharmacists since almost all homebound patients are prescribed more than one medicine. However, little information is available on the adverse drug reactions (ADRs) in home care setting. This study was conducted to describe the ADRs reported by pharmacists in home care and examine factors related to their reports.</p><p><b>Design: </b>Questionnaire survey</p><p><b>Methods: </b>We requested patient-visiting pharmacists at community pharmacies throughout Japan to answer questions about their patients. Main questions included patient characteristics, number of drugs taken, presence of ADRs and details, and pharmacists' workload related to home-visiting.</p><p><b>Results: </b>Data on 5,447 patients were collected from 1,890 pharmacies. The percentage of patients in whom the visiting pharmacists found ADRs was 14.4%. ADRs reported in 10 or more cases covered 12 categories, accounting for 85.2% of all ADRs. The top five categories were: dizziness, grogginess, or lightheadedness; gastrointestinal disturbances; clinical test value abnormality; altered mentation; and cutaneous symptoms. In seven of the 12 ADR categories, central nervous system drugs such as sleeping pills, antianxiety drugs, and psychoneurosis drugs were in the top three suspected drugs. Additionally, patients' gender, residential situation, and the number of drugs taken were implied as factors related to ADRs.</p><p><b>Conclusion</b>：Our study indicated that, while the percentage of ADR occurrences in home-visiting service in Japan was at the same level as outpatients in other countries, drugs for the central nervous system accounted for a higher percentage of suspected drugs. Further, occurrence of ADRs was associated with the use of more than 6 concomitant drugs. These results suggest that physicians and pharmacists need to collaborate in decreasing the number and dose of central nervous system drugs.</p>

Examining the Effect of Pharmacists’ Visits to Homebound Patients on the Elimination of Unused Drugs / 医薬品情報学

<b>Objective: </b>To examine the effect of pharmacists’ visits to homebound patients on the elimination of unused drugs.<br><b>Method: </b>We conducted a survey with pharmacies throughout Japan that provided home-visit service, asking them questions regarding their work with up to five patients (the survey period was from January 15 through the end of February, 2013).  Main survey questions were: (1) whether they managed unused drugs since the start of their home-visit, and (2) how they managed the unused drugs.  For (2), we conducted case studies by asking the pharmacists to choose the case that impressed them most and describe the unused drugs involved, actions taken, and the results.<br><b>Results: </b>Data on 5,447 patients were collected from 1,890 pharmacies throughout Japan (collection rate: 56.9%).  Pharmacists managed unused drugs from 2,484 patients (45.6%). 1,746 patients (3,590 cases) were qualified for analysis.  In 2,332 cases (65.0%), pharmacist intervention eliminated the incidences of unused drugs.  In 782 cases (21.8%), unused drugs were discarded, while the number of drug administration days was adjusted in 2,623 cases (73.1%).  In 21 cases (0.6%), drugs were both discarded and had the number of days adjusted.  There were others for 164 cases (4.5%).  The total price of the eliminated unused drugs was approximately 6,920,000 yen (4,000 yen/person).  Illnesses that benefited most from the elimination of unused drugs were chronic respiratory failure (16,306 yen/person), and Parkinson’s disease (4,803 yen/person).<br><b>Conclusion: </b>We confirmed the economic effect of eliminating unused drugs by pharmacists’ home visits.

A Preliminary Study about the Relationship between Workload and the Outcomes of Community Pharmacists’ Home Visiting Service / 社会薬学

Aim:To examine any relations of workload and outcomes of pharmacists’ home visiting service for medication management and guidance. Survey Target:Managing pharmacists and home-visiting pharmacists from community pharmacies of the Osaka Pharmaceutical Association’s Yao and Toyonaka branches as of March, 2012. Methods:Survey forms regarding drug management and guidance at patients’ homes were mailed, requesting mail or online response. Workload indexes were visit frequency and work time on site. The relation of workload and its outcomes was examined using univariate analysis regarding three items:change in unused medication amount;detection of side effects during visits;change in prescription. SPSS ver. 20 for Windows was used for statistical analysis. Results:90 of 201 pharmacies responded (collection rate 44.8%), and 110 home patients’ data were analyzed. 5-to-15-minute actual work time scored highest (57.4%), followed by less than 5 minutes and 15 to 30 minutes, both at 21.3%. Visit frequency of twice a month scored highest (70.4%), followed by once a week (19.4%), once a month (7.4%), and once in more than one month (2.8%). 5-minute or longer patient visits had a tendency of higher percentage of patients whose unused medication decreased after visits started than less-than-5-minute visits (<i>P</i>=0.072). “Once a week” visits had a tendency of higher percentage of pharmacists detecting side effects than less frequent visits (<i>P</i>=0.061) and changing in prescription (<i>P</i>=0.085). Conclusion:The results above implied the relationship between workload and outcomes incurred by pharmacists’ home visits for medication safety management and guidance.

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>

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.

Prevalence of burnout among public health nurses in charge of mental health services and emergency care systems in Japan

<p><b>OBJECTIVES</b>The Community Health Act came into effect in 1997 in Japan. This act altered the work system for public health nurses (PHNs) in public health centers (PHCs) nationwide from region-specific to service-specific work. Such major changes to working environment in the new system seem to be exposing PHNs to various types of stress. The present study examined whether prevalence of burnout is higher among PHNs in charge of mental health services (psychiatric PHNs) than among PHNs in charge of other services (non-psychiatric PHNs), and whether attributes of emergency mental health care systems in communities are associated with increased prevalence of burnout.</p><p><b>METHODS</b>A questionnaire including the Pines burnout scale for measuring burnout was mailed to 525 psychiatric PHNs and 525 non-psychiatric PHNs. The 785 respondents included in the final analysis comprised 396 psychiatric PHNs and 389 non-psychiatric PHNs.</p><p><b>RESULTS</b>Prevalence of burnout was significantly higher for psychiatric PHNs (59.2%) than for non-psychiatric PHNs (51.5%). When prevalence of burnout in each group was analyzed in relation to question responses regarding emergency service and patient referral systems, prevalence of burnout for psychiatric PHNs displayed significant correlations to frequency of cases requiring overtime emergency services, difficulties referring patients, and a feeling of "restriction".</p><p><b>CONCLUSIONS</b>Prevalence of burnout is high among psychiatric PHNs, and inadequate emergency mental health service systems contribute to burnout among these nurses. Countermeasures for preventing such burnout should be taken as soon as possible.</p>

Prevalence of Burnout among Public Health Nurses in Charge of Mental Health Services and Emergency Care Systems in Japan

Objectives: The Community Health Act came into effect in 1997 in Japan. This act altered the work system for public health nurses (PHNs) in public health centers (PHCs) nationwide from region-specific to service-specific work. Such major changes to working environment in the new system seem to be exposing PHNs to various types of stress. The present study examined whether prevalence of burnout is higher among PHNs in charge of mental health services (psychiatric PHNs) than among PHNs in charge of other services (non-psychiatric PHNs), and whether attributes of emergency mental health care systems in communities are associated with increased prevalence of burnout. Methods: A questionnaire including the Pines burnout scale for measuring burnout was mailed to 525 psychiatric PHNs and 525 non-psychiatric PHNs. The 785 respondents included in the final analysis comprised 396 psychiatric PHNs and 389 non-psychiatric PHNs. Results: Prevalence of burnout was significantly higher for psychiatric PHNs (59.2%) than for non-psychiatric PHNs (51.5%). When prevalence of burnout in each group was analyzed in relation to question responses regarding emergency service and patient referral systems, prevalence of burnout for psychiatric PHNs displayed significant correlations to frequency of cases requiring overtime emergency services, difficulties referring patients, and a feeling of “restriction”. Conclusions: Prevalence of burnout is high among psychiatric PHNs, and inadequate emergency mental health service systems contribute to burnout among these nurses. Countermeasures for preventing such burnout should be taken as soon as possible.

Genetic polymorphisms ofCYP2A6 andCYP2E1 with tobacco smoking is not associated with risk of urothelial cancer

<p><b>OBJECTIVES</b>To elucidate the association between genetic polymorphisms ofCYP2a6 andCYP2E1 and urothelial cancer susceptibility.</p><p><b>METHODS</b>A total of 137 Japanese patients with urothelial cancer and 217 Japanese healthy controls, frequency-matched for age and gender, were selected. The polymorphisms ofCYP2A6 andCYP2E1 were analyzed by PCR-RFLP, and cigarette smoking histories were obtained through interviews</p><p><b>RESULTS</b>The frequency ofCYP2A6 homozygote deletion genotype was 2.9% in the patients, compared with 3.2% in the controls (OR=0.84, 95% CI 0.24-2.96). The frequencies ofCYP2E1 C1/c2 andC2/c2 were 27.7% and 4.4% in the patients, compared with 35.5% and 6.0% in the controls (OR=0.68, 95% CI 0.42-1.09, OR=0.67, 95% CI 0.24-1.84, respectively). No statistically significant differences were observed when theCYP2A6 homozygote deletion genotype and theCYP2E1 genotypes were examined relative to smoking status.</p><p><b>CONCLUSIONS</b>Our data indicate that neither a relationship between genetically impaired nitrosamine metabolism and tobacco-smoking consumption, nor urothelial cancer risk related to theCYP2A6 deletion genotype andCYP2E1 Rsa I genotype was found in Japanese population.</p>

Genetic Polymorphisms of \it{CYP2A6} and \it{CYP2E1} with Tobacco Smoking is not Associated with Risk of Urothelial Cancer

Objectives: To elucidate the association between genetic polymorphisms of CYP2A6 and CYP2E1 and urothelial cancer susceptibility. Methods: A total of 137 Japanese patients with urothelial cancer and 217 Japanese healthy controls, frequency-matched for age and gender, were selected. The polymorphisms of CYP2A6 and CYP2E1 were analyzed by PCR-RFLP, and cigarette smoking histories were obtained through interviews. Results: The frequency of CYP2A6 homozygote deletion genotype was 2.9% in the patients, compared with 3.2% in the controls (OR=0.84, 95% CI 0.24−2.96). The frequencies of CYP2E1 C1/c2 and C2/c2 were 27.7% and 4.4% in the patients, compared with 35.5% and 6.0% in the controls (OR=0.68, 95% CI 0.42 −1.09, OR=0.67, 95% CI 0.24−1.84, respectively). No statistically significant differences were observed when the CYP2A6 homozygote deletion genotype and the CYP2E1 genotypes were examined relative to smoking status. Conclusions: Our data indicate that neither a relationship between genetically impaired nitrosamine metabolism and tobacco-smoking consumption, nor urothelial cancer risk related to the CYP2A6 deletion genotype and CYP2E1 Rsa I genotype was found in Japanese population.