Risk of Herpes zoster in patients with underlying diseases: a retrospective hospital-based cohort study.

PURPOSE: To determine the incidence of Herpes zoster in patients with one of 17 specific underlying diseases compared with that in patients with other underlying diseases. METHODS: We conducted a retrospective hospital-based cohort study using data from patients' electronic medical records for the period 2001-2007 of the Kitano Hospital Research Database. These analyses included 55,492 patients with one of 17 underlying diseases, which were those reported as related to the contraction of Herpes zoster. Of these, 769 patients contracted Herpes zoster. The main outcome measure was the clinical diagnosis of Herpes zoster. RESULTS: The adjusted hazard ratios (95% confidence interval) for Herpes zoster in patients with the 17 diseases were compared with other patients, with the following results: brain tumor [3.84 (2.51-5.88)], lung cancer [2.28 (1.61-3.22)], breast cancer [2.41 (1.52-3.82)], esophageal cancer [4.19 (2.16-8.11)], gastric cancer [1.95 (1.39-2.72)], colorectal cancer [1.85 (1.33-2.56)], gynecologic cancer [3.45 (2.08-5.70)], malignant lymphoma [8.23 (6.53-10.38)], systemic lupus erythematosus [3.90 (2.66-5.70)], rheumatoid arthritis [2.00 (1.60-2.50)], diabetes mellitus [2.44 (2.10-2.85)], hypertension [2.04 (1.75-2.38)], renal failure [2.14 (1.65-2.79)], and disk hernia [2.18 (1.52-3.13)]. CONCLUSIONS: Patients with diabetes mellitus, renal failure, and malignancies have a 1.8-8.4-fold higher risk of a Herpes zoster event than patients with other diseases. Future studies should investigate alteration of the immune system in the underlying diseases and approaches for Herpes zoster prevention.

Construction of syndromic surveillance using a web-based daily questionnaire for health and its application at the G8 Hokkaido Toyako Summit meeting.

We constructed a syndromic surveillance system to collect directly information on daily health conditions directly from local residents via the internet [web-based daily questionnaire for health surveillance system (WDQH SS)]. This paper considers the feasibility of the WDQH SS and its ability to detect epidemics. A verification study revealed that our system was an effective surveillance system. We then applied an improved WDQH SS as a measure against public health concerns at the G8 Hokkaido Toyako Summit meeting in 2008. While in operation at the Summit, our system reported a fever alert that was consistent with a herpangina epidemic. The highly mobile WDQH SS described in this study has three main advantages: the earlier detection of epidemics, compared to other surveillance systems; the ability to collect data even on weekends and holidays; and a rapid system set-up that can be completed within 3 days.

[An empirical research for demand of influenza vaccination].

PURPOSE: This article examines the demand for influenza vaccination in Japan. METHODS: Original date were obtained from a survey conducted by the authors. Two approaches, usual demand analysis and conjoint analysis, were employed. The second approach, conjoint analysis, uses people's statements on how they would respond to different hypothetical situations. In this research, we ask people whether they wish to be vaccinated given different circumstances such as costs of vaccination, degree of convenience, and outbreak news. RESULTS: In the demand analysis, the vaccination rate during the 1999-2000 season was found to have increased by 0.8 percentage points compared to that of the previous season. The rate increased by 1.0 to 3.5 percentage points among the group of people who experienced influenza in the previous season. The vaccination rate also increased by 31-47 percentage points for those who were vaccinated in the previous season. A 10 percentage increase in household income decreased the demand for vaccination by 2 percentage points. Although household income was significant in only with the largest sample, this result may indicate that the time or opportunity cost for vaccination decreases the vaccination demand. In the conjoint analysis, the financial cost was significantly negative. When the cost was reduced from the current level of 6,000 yen to free of charge, the vaccination rate would increase by 43.5 percentage points. Were vaccination available at night or during holidays,! or at school or work, the rate would increase by 11 percentage points, or 16 percentage points, respectively. Most of all, news of influenza prevalence was very influential in increasing the desire for vaccination by 33 percentage points. Vaccination experience and last year's influenza experience were both significantly positive, increasing the rate by 22 and 8 percentage points, respectively. CONCLUSIONS: In the demand analysis, influenza experience and history of vaccination during the 1999-2000 season were found to be influential regarding the decision for vaccination. From the conjoint analysis, providing vaccination of night or during holidays, as well as at work or at schools would increase the demand. News of influenza outbreaks were also found to increase the vaccination demand. Higher income, however, was found to have a negative influence, suggesting that opportunity costs may be an important factor for some individuals. Habit formation effects through a history of vaccination plays quite an important role in vaccination demand.

Correction note on "The demand for health with uncertainty and insurance".

This paper proves the non-existence of an optimal solution under the Liljas [Liljas, B. (1998). The demand for health with uncertainty and insurance. J. Health Econ., 17, 153-170] type of insurance. The reason for the non-existence is that the insurance induces the individual to increase his time input, relative to medical expenditure in the household production of health investment. Hence, it distorts the balance of inputs in the production of health investment. Moreover, it also distorts the household production for consumption goods through time constraints. Therefore, this paper proposes an alternative insurance that covers the time loss due to illness and has an optimal solution.

Assessment of clinicopathologic features of colorectal mucinous adenocarcinoma.

The purpose of this report is to analyze the clinicopathologic features of colorectal mucinous adenocarcinoma (MC), which is generally believed to have a poor prognosis, in an attempt to assess ways in which the surgical outcome can be improved. Clinicopathologic features of 44 patients with MC (6.6%), from among 662 patients with primary colorectal cancers, were compared with those of 545 patients with nonmucinous (non-MC) adenocarcinoma. MC is more likely to invade the adjacent viscera (29% versus 10%, p < 0.005) and show more extensive lymph node involvement beyond the pericolonic region (50% versus 26%, p < 0.005) than non-MC. Based on these findings, a more aggressive attitude toward surgical intervention is recommended, including extensive lymph node dissection and the resection of adjacent organs that seems to be affected macroscopically, to improve the surgical outcome of this clinical entity.

Clinical and experimental studies on the role of platelet-activating factor (PAF) in the pathogenesis of septic DIC.

Various toxic factors induced by endotoxin (Et) are thought to be deeply involved in the pathogenesis of severe infections. In this study, particular attention was paid to the role of the platelet-activating factor (PAF) in these conditions, and clinical and experimental studies were conducted on the relationship between PAF and the changes observed in the general parameters after surgical infections. In the clinical study, changes in the PAF concentration in the blood of seven patients with disseminated intravascular coagulation (DIC), five of whom were septic and two non-septic, were monitored by gas/mas spectrometry. The mean PAF level in the septic DIC group tended to be higher than that in the non-septic DIC group. Moreover, in the septic DIC group, the relationship between the increase in the PAF level and platelet count was analyzed with the lapse of time and we surmised a negative correlation between these parameters. Experimentally, we also investigated the role of PAF in Et shock and the effect of an anti-PAF agent and protease inhibitor. The Et-induced fall in blood pressure was similarly prevented by both the anti-PAF agent and protease inhibitor. However, the decrease in the platelet count was more significantly inhibited by the anti-PAF agent than by the protease inhibitor, whereas the parameters of the blood coagulation/fibrinolysis system were more affected by the protease inhibitor than by the anti-PAF agent.

Congenital absence of lacrimal puncta and of all major salivary glands: case report and literature review.

A 7-year-old girl had dry mouth and recurrent infections of the lacrimal fistulae with decreased lacrimal secretion. All four puncta were absent, and a Schirmer test showed decreased lacrimal secretion. Salivary gland imaging with sodium pertechnetate 99mTcO4 showed absence of all major salivary glands. Lower lip biopsy disclosed normal structure of the salivary gland. No evidence of abnormal inheritance patterns could be demonstrated.