[A quality of life questionnaire for Japanese allergic conjunctival disease].

PURPOSE: To establish a specific quality of life (QOL) questionnaire for Japanese allergic conjunctival disease (ACD) (Japanese allergic conjunctival disease QOL questionnaire: JACQLQ). SUBJECTS AND METHODS: A multicenter study was conducted in 521 patients with ACD and 127 healthy volunteers (total 648 cases). The JACQLQ ver. 0 was developed by modifying the Japanese rhino-conjunctivitis QOL questionnaire (JRQLQ). The participants were asked to complete the questionnaire, and objective scores were determined by an ophthalmologist using a slit lamp. To confirm validity, item and factor analyses were conducted and correlation coefficients were calculated. RESULTS: The items were grouped into four subscales (Daily activity, Psychological well-being, Eye symptoms, Nasal symptoms) after factor analysis. The JACQLQ had good item-internal consistency (Cronbach's alpha: 0.846-0.934). QOL scores were correlated with eye itching, eye irritation and tearing. Objective scores were correlated with eye redness, eye itching and eye irritation. Face scores were correlated with eye itching, eye irritation and eye redness. CONCLUSION: The JACQLQ is a useful tool for assessing disease specific QOL in ACD.

[Is the frequency of pre-seasonal manifestation in patients with Japanese cedar pollinosis so high?].

BACKGROUND: Based on subjective symptom, it has been documented that so high as 21 to 62% of patients with Japanese cedar pollinosis has pollinosis symptom before the start of pollen season. Since this is not objectively evidenced, we aimed to clarify whether or not it is true. METHOD: We quantified intranasal pollen by means of our nasal lavage method in patients with Japanese cedar pollinosis shortly after the onset of symptom during pre-, mid- and post-season from 1997 to 2005. RESULT: Significant differences in intranasal pollen count were revealed among mid- and pre- and post-season. Intra-nasal pollens, so few as 1 or less, were found in 67.8% of patients having pre-seasonal symptom, while in 12.5% during the mid-season. The majority of patients had not sufficient number of intra-nasal pollen to induce pollinosis. However, the intranasal pollen counts in preseason were related well with total airborne pollen amount in next spring. Pollens other than Japanese cedar pollen were also detected in lavages. CONCLUSION: Many factors such as method of pollen survey, personal nasal hyper-reactivity and irritation by cold air, or with pollens other than Japanese cedar may cause the pre-seasonal pollinosis symptom. High frequencies of pre-seasonal onset in previous reports may be over-estimated due to inaccurate diagnosis of Japanese cedar pollinosis.

[Nasal symptoms in persons with normal nose].

BACKGROUND: Nasal symptoms such as sneezing, stuffy nose and runny nose occur in allergic and nonallergic rhinitis. Normal nose also sometimes has these symptoms. It is necessary to define what is the symptom of normal nose in order to make a proper diagnosis of rhinitis, grading of severity of nasal symptom in rhinitis and criteria of normalization after the treatment of rhinitis. METHODS: 235 persons who had no perceptive nasal symptom and history of nasal disease at present and past, and cold at present, were sampled from the registered list of a health care organization, and examined their nasal symptom by mailing a self-administered questionnaire of nasal symptom. In addition, 54 patients, who visited 4 otolarngology clinics due to diseases other than rhinitis and were diagnosed as normal nose, were examined, using the same questionnaire. RESULTS: Response rate from persons mailed was 49.8%. Nasal symptom was infrequent in patients at clinic more than persons sampled from the list. Nasal symptom in 117 responders with normal nose had none or occasional and momentary stuffy nose. Sneezing and/or nose blow was less than 5 times a day, and itchy nose and postnasal drip were 30% and 25% respectively. These symptoms, if appeared, were less than 4 days per week. CONCLUSION: Grading "minus", normal, is zero in sneezing and runny nose and none in stuffy nose in the grading system of nasal symptom used commonly in Japan. These should be changed to none or occasional, momentary, easily tolerable in stuffy nose, less than once a day or grading "plus one" (1-5 times per day) occasionally in sneezing and nose blow. Normalization after treatment could be defined according to this change.

[Natural airborne pollen contamination of clothes and facial skin].

OBJECTIVE: To clarify natural airborne Japanese cedar pollen contamination of clothes (cotton made T shirt and cap) and face skin for preventive strategy against pollinosis. METHODS: Ten non-pollinosis high school students, wearing T-shirt and cap, stayed after face washing in outdoor (school yard) and in-door (school room) for 2 hours alternatively. Wet clothes of each of three different qualities (cotton, cotton blended polyester and wool) were also left at ten points of the schoolyard. Contaminated pollens were collected using adhesive tape and counted under a microscope. RESULTS: Pollen contaminations were lesser in school room than school yard. Lesser contamination was revealed on the surface of cotton-polyester blended clothes without statistical difference when compared with cotton and wool made clothes. CONCLUSION: From this study, in going out wearing of cotton-polyester blended coat and cap, and after returning home, face washing and keeping coat and cap on a hanger at entry hall are recommended for pollen prevention.

[Clinical validity of our new patient satisfaction questionnaire for allergic rhinitis].

Patient satisfaction is recommended as a parameter to evaluate medical care from the aspect of patient. Currently, we developed a new patient satisfaction questionnaire in allergic rhinitis by means of internationally standardized psychometric validation and reliability studies. Using this questionnaire, we evaluated patient satisfaction with Japanese cedar pollinosis in 2004, who visited our own clinic (JAAC) or patients, who were sampled from the list of a health research company (JSR), in addition of literature data. As a result, there were marked differences between ours and others. The purpose of this study is to elucidate whether or not our questionnaire has a good and reliable clinical validity, and, if yes, why there were marked differences in various studies. The satisfaction (very good plus good) was 94.4% in the JAAC group and 41.2% in the JSR group respectively. We compared the mean scores of each item in questionnaire in both groups, and found higher scores in the majority of items in the former group than the latter group in accordance with difference in satisfaction. This suggested a good clinical validity in questionnaire. In nasal treatment modality, the JAAC group was. characterized by continuous use of combined topical steroid with per oral anti-allergic compound and immunotherapy during whole pollen season, when compared with the JSR group. A persistent contact with patients in immunotherapy plays an important role in establishing good doctor-patient relation and treatment outcome, resulting in increased patient satisfaction.

[Treatment of Japanese cedar pollinosis and its impact on patient satisfaction].

Japanese cedar pollinosis is a major public health problem in Japan because of its severe symptom and high prevalence. However, patient satisfaction by treatment is poor according to current reports. As the treatments, pre-seasonal medication and single peroral anti-allergic drug on demand are frequently used in Japan. Against conventional methods, we treated 301 patients with Japanese cedar pollinosis by persistent use of combined drugs (topical steroid, peroral anti-allergic drug and eye drop) without pre-seasonal medication in 2003. Immunotherapy was also used in 90 patients treated. As a result, 97% of patients was satisfied in this treatment and immunotherapy contributed to reduction in the amount of drug and high treatment outcome.

[Development of patient satisfaction questionnaire in allergic rhinitis].

Recent suggestions emphasize the importance of assessing medical care outcomes from the point of view of both professional opinion and patient's subject like patient satisfaction as well as quality of life. Self-administered questionnaires are often used as an instrument for this purpose. When compared with quality of life, there is less useful questionnaire for patient satisfaction. Accordingly, we here aimed to develop the questionnaire, which is disease-specific, comprehensive, simple, clinically available and satisfied psychometric validation study. The items were collected from patients and satisfaction-related literature's review, and the total 20 were selected finally from them after excluding inadequate or overlapped items. Then, we conducted validation study in 214 subjects sampled randomly from 603 patients with Japanese cedar pollinosis who had visited clinics in 2003 by mailing self-administered questionnaire in spring, 2004. The response rate was 65.3%. In factor analysis, items were divided into four domains such as doctor-patient relationship, treatment outcome, geniality in hospital and convenience of medical service. The former two domains were the most correlated well with patient satisfaction. The quality of this questionnaire such as responsiveness, reliability, construct validity, convergent/discriminate validity, and clinical validity satisfied international standard. Thus, it was verified that our newly developed questionnaire is a useful and scientific tool for examination of patient satisfaction with medical care in allergic rhinitis.

[Are otolaryngologists specialist for pollinosis?].

It is approved that ENT doctors are specialist for pollinosis. Is it true from the point of view of patients' medical care-seeking behavior? 214 patients with Japanese cedar pollinosis who had visited medical doctors in 2003 pollen-season were randomly sampled from 603 pollinosis patients registered at a disease survey company and we mailed self-evaluation questionnaire on patients' medical care-seeking behavior on the end of pollen season in 2004. Response rate was 65.3%. Patients visited clinics in approximately 90% more than hospitals. They selected ENT in 43.9% and general physicians in 31.1%. Their selections were based on others than their specialty such as easy access and previous experience of visit, because pollinosis is not serious disease like cancer. ENT doctors treated the patients by combination of two kinds of tablet or topical steroid with tablet, while general physicians did with single kind of tablet. The patient satisfaction, and its related questions including preference, wish to revisit in next year and recommendation to their friend were not different in treatment between ENT and general physician. Doctors' attitude, and communication with patients were the most important factor for patient satisfaction as well as treatment out-come. In conclusion, patients prefer agreeable and convenient treatment. If ENT doctors still want to be specialist for pollinosis, they should take care patients well and develop their own specific treatment methodology to cure this disease.