The Tokyo subway sarin attack has long-term effects on survivors: A 10-year study started 5 years after the terrorist incident.

OBJECTIVES: The Tokyo subway sarin attack in 1995 was an unprecedented act of terrorism that killed 13 people and sickened more than 6,000. The long-term somatic and psychological effects on its victims remain unknown. METHODS: We conducted analyses on the self-rating questionnaire collected annually by the Recovery Support Center (RSC) during the period from 2000 to 2009. The RSC is the only organization that has large-scale follow-up data about sarin attack victims. The prevalence of self-reported symptoms was calculated over 10 years. We also evaluated the prevalence of posttraumatic stress response (PTSR), defined as a score ≥ 25 on the Japanese-language version of the Impact of Event Scale-Revised. The multivariate Poisson regression model was applied to estimate the risk ratios of age, gender, and year factor on the prevalence of PTSR. RESULTS: Subjects were 747 survivors (12% of the total) who responded to the annual questionnaire once or more during the study period. The prevalence of somatic symptoms, especially eye symptoms, was 60-80% and has not decreased. PTSR prevalence was 35.1%, and again there was no change with time. The multivariate Poisson regression model results revealed "old age" and "female" as independent risk factors, but the passage of time did not decrease the risk of PTSR. CONCLUSIONS: Although symptoms in most victims of the Tokyo subway sarin were transient, this large-scale follow-up data analysis revealed that survivors have been suffering from somatic and psychological long-term effects.

Natural course of persistent hepatitis B virus infection in hepatitis B e antigen-positive and hepatitis B e antigen-negative cohorts in Japan based on the Markov model.

This population-based study examined the natural course of hepatitis B e antigen (HBeAg)-positive or HBeAg-negative persistent hepatitis B virus (HBV) infection, adjusted by age and liver disease states using a Markov model. Using 12 417 person-years data (n = 862), annual transition probabilities were estimated, and age-adjusted cumulative incidence and natural history of persistent HBV infection were simulated in both sexes of groups 1 (HBeAg-negative status with HBV DNA level <4.0 log IU/mL at entry) and 2 (persistent HBeAg-positive status throughout the study). In group 1, 15.26% of 30-years old men with chronic hepatitis (CH) were expected to remain in the same state at age 65 years, 28.32% subsided into an hepatitis B surface antigen (HBsAg)-negative state, and 13.20% developed hepatocellular carcinoma (HCC). The expectations for 40-years old men in group 1 were 21.43%, 19.86%, and 15.04%, respectively. The expectations for 30 years women in group 1 were 30.57%, 21.15%, and 4.08%, respectively. These results suggest that HBeAg positivity caused a higher risk of HCC onset in persistent HBV infection after adjustments for age, sex, and liver disease state. HCC was likely to develop, but unlikely to subside into HBsAg clearance, remaining in a CH state with aging, regardless of HBeAg state. Furthermore, both HCC development and HBsAg clearance occurred more frequently in men than in women, irrespective of HBeAg status.

Cost-effectiveness analyses of anti-hepatitis C virus treatments using quality of life scoring among patients with chronic liver disease in Hiroshima prefecture, Japan.

AIM: We estimated the cost-effectiveness of direct-acting antiviral treatment (DAA) compared to triple therapy (simeprevir, pegylated interferon-α [Peg-IFN], and ribavirin [RBV]) (scenario 1), Peg-IFN + RBV (scenario 2), and non-antiviral therapy (scenario 3). METHODS: Cost-effectiveness was evaluated as incremental cost-effectiveness ratios (ICERs) using direct costs and indirect costs, which included loss of wages during the patient's lifetime due to early death caused by viral hepatitis infection. Quality of life (QOL) scores were determined by EQ-5D-3L questionnaire survey on 200 HCV patients in Hiroshima. RESULTS: The QOL scores for chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma were estimated as 0.871, 0.774, and 0.780, respectively. The follow-up period that the ICER of scenario 1 becomes shortest (cost <¥6 million) was 25 years after treatment in men and women who started treatment at the age of 20-60. In contrast, those of scenarios 2 and 3 was 10 years after treatment in patients who started treatment at age <80 years. Based on the sensitivity analysis in scenario 1, the most significant factor affecting the value of ICER is the QOL score after sustained virologic response (SVR), followed by the SVR rate of DAA or follow-up period. CONCLUSIONS: Direct-acting antiviral treatment was estimated to be cost-effective from 10 to 25 years after treatment, depending on the SVR rate of the drugs and the age of onset of treatment. In order to increase the cost-effectiveness of DAA treatment, measures or effort to improve the QOL score of patients after SVR are necessary.

Incidence and risk factors of colorectal cancer based on 56 324 health checkups: A 7-year retrospective cohort study.

BACKGROUND AND AIM: Although mortality rates of colorectal cancer (CRC) have been increasing in Japan, its screening rates remain stagnant at 19.2% among Japanese population aged > 40 years in 2014. To evaluate the importance of CRC screening by fecal occult blood test (FOBT), this study estimated the incidence of FOBT-positivity and CRC by sex-age stratification and clarified the risk factors for CRC. METHODS: Between 2007 and 2014, 56 324 residents (21 517 men and 34 807 women) were enrolled in this study. The sex-age-stratified incidence rates of FOBT-positivity and CRC were estimated by records from health checkups and colonoscopy. Regarding CRC incidence rate in particular, positive predictive value was adopted to adjust bias of FOBT-positivity that did not undergo colonoscopy by person-year method. To investigate the risks of CRC onset, a nested case-control study with 1:10 person-matching on sex and age was performed. RESULTS: Incidence rates of FOBT-positivity and CRC are 4183/100 000 person-year (100 Kpy) and 141.3/100 Kpy, respectively. In both cases, men has higher incidence rate than women (1.3 times for FOBT; 4977 vs 3718/100 Kpy and 2.3 times for CRC; 217.0 vs 96.4/100 Kpy). CONCLUSIONS: The records from health checkups were useful to estimate incidence rates of CRC with this procedure. The age-stratified incidence rate indicated the importance of CRC screening by FOBT, especially for men and those aged > 50 years. Additionally, it is strongly recommended to do further investigation if positive for initial FOBT screening especially for those who are > 70 years.

Estimated numbers of patients with liver disease related to hepatitis B or C virus infection based on the database reconstructed from medical claims from 2008 to 2010 in Japan.

AIM: To estimate the number of patients with liver-related diseases classified by hepatitis viruses (HBV, HCV) based on the information from re-coded medical claims including several diagnosed diseases. METHODS: We analyzed reimbursement data provided by health insurance societies for 2.1 million individuals during 2008-2010. Database information of employees and their families aged under 65 years employees with hepatitis-related disease was extracted, the 1-year period prevalence was calculated, and then number of patients with liver disease related to HBV and HCV by sex and age groups, respectively, was estimated. RESULTS: The estimated number of patients were almost equivalent during 2008-2010. As for HBV and HCV, the estimated numbers of patients with chronic hepatitis (CH) in a year ranged 192 641-226 601 and 282 438-306 877, respectively. CONCLUSION: In the 2008 Patient Survey in Japan, the number of patients was estimated by the main disease in one patient, even though the patient was diagnosed with several diseases. Based on the database with hepatitis-related diseases after evaluating several diagnosed diseases from medical claims, the estimation method and protocol may minimize the disadvantage of medical claim analysis, and is useful for patients, especially asymptomatic carriers and those with CH which had been underestimated in the 2008 Patient Survey.