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1.  Population at high-risk of indoor heatstroke: the usage of cooling appliances among urban elderlies in Japan 
Objectives
Heatstroke due to a heat wave during the summer is one of the commonly known health impacts of climate change in Japan. The elderly are particularly at high-risk of developing indoor heatstroke with poor prognosis. This study aims to describe the population among elderlies at high-risk of indoor heatstroke by focusing on the usage of cooling appliances.
Methods
We conducted a web-based household survey in eight urban areas during the winter season of 2011. Households with a person aged 65 and over were selected as samples from panel members of a research firm, and the oldest member of the household was queried about his/her usage of cooling appliances. The population at high-risk of indoor heatstroke is defined as the elderly staying in a room without cooling appliances, or not using the installed cooling appliances, or turning the cooling appliances on only when the room temperature is above 28 °C.
Results
15.4 and 19.1 % of the elderlies living in urban areas of Japan are identified as at high-risk of indoor heatstroke during activity time and sleeping time, respectively, according to the definition of high-risk of indoor heatstroke in this study.
Conclusions
These figures are not negligible since the consequences of heatstroke are grave, but its risk can be eliminated by an appropriate usage of cooling appliances. The preventive interventions are needed to protect the elderlies at high-risk of heatstroke.
doi:10.1007/s12199-012-0313-7
PMCID: PMC3650172  PMID: 23160849
Climate change; Cooling appliance; Elderly; Global warming; Heatstroke
2.  Demand for pneumococcal vaccination under subsidy program for the elderly in Japan 
Background
Vaccination programs often organize subsidies and public relations in order to obtain high uptake rates and coverage. However, effects of subsidies and public relations have not been studied well in the literature. In this study, the demand function of pneumococcal vaccination among the elderly in Japan is estimated, incorporating effects of public relations and subsidy.
Methods
Using a data from a questionnaire survey sent to municipalities, the varying and constant elasticity models were applied to estimate the demand function. The response variable is the uptake rate. Explanatory variables are: subsidy supported shot price, operating years of the program, target population size for vaccination, shot location intensity, income and various public relations tools. The best model is selected by c-AIC, and varying and constant price elasticities are calculated from estimation results.
Results
The vaccine uptake rate and the shot price have a negative relation. From the results of varying price elasticity, the demand for vaccination is elastic at municipalities with a shot price higher than 3,708 JPY (35.7 USD). Effects of public relations on the uptake rate are not found.
Conclusions
It can be suggested that municipalities with a shot price higher than 3,708 JPY (35.7 USD) could subsidize more and reduce price to increase the demand for vaccination. Effects of public relations are not confirmed in this study, probably due to measurement errors of variables used for public relations, and studies at micro level exploring individual’s response to public relations would be required.
doi:10.1186/1472-6963-12-313
PMCID: PMC3470958  PMID: 22970727
Demand; Elderly; Vaccination program; Pneumococcal polysaccharide vaccine (PPV); Price elasticity; Public relations; Subsidy
3.  Growing concern about heatstroke this summer in Japan after Fukushima nuclear disaster 
Heat stroke management will be a major challenge following the Fukushima nuclear plant accident that occurred due to the Great East Japan Earthquake. In this article, a number of actions to meet this challenge are proposed.
doi:10.1007/s12199-011-0228-8
PMCID: PMC3156841  PMID: 21833691
Climate change; Electricity shortage; Fukushima nuclear disaster; Global warming; Heatstroke
4.  Prediction of axillary lymph node metastasis in primary breast cancer patients using a decision tree-based model 
Background
The aim of this study was to develop a new data-mining model to predict axillary lymph node (AxLN) metastasis in primary breast cancer. To achieve this, we used a decision tree-based prediction method—the alternating decision tree (ADTree).
Methods
Clinical datasets for primary breast cancer patients who underwent sentinel lymph node biopsy or AxLN dissection without prior treatment were collected from three institutes (institute A, n = 148; institute B, n = 143; institute C, n = 174) and were used for variable selection, model training and external validation, respectively. The models were evaluated using area under the receiver operating characteristics (ROC) curve analysis to discriminate node-positive patients from node-negative patients.
Results
The ADTree model selected 15 of 24 clinicopathological variables in the variable selection dataset. The resulting area under the ROC curve values were 0.770 [95% confidence interval (CI), 0.689–0.850] for the model training dataset and 0.772 (95% CI: 0.689–0.856) for the validation dataset, demonstrating high accuracy and generalization ability of the model. The bootstrap value of the validation dataset was 0.768 (95% CI: 0.763–0.774).
Conclusions
Our prediction model showed high accuracy for predicting nodal metastasis in patients with breast cancer using commonly recorded clinical variables. Therefore, our model might help oncologists in the decision-making process for primary breast cancer patients before starting treatment.
doi:10.1186/1472-6947-12-54
PMCID: PMC3407483  PMID: 22695278
Breast cancer; Lymph node metastasis; Data mining; Alternating decision tree
5.  Cost-effectiveness of chronic kidney disease mass screening test in Japan 
Background
Chronic kidney disease (CKD) is a significant public health problem. Strategy for its early detection is still controversial. This study aims to assess the cost-effectiveness of population strategy, i.e. mass screening, and Japan’s health checkup reform.
Methods
Cost-effectiveness analysis was carried out to compare test modalities in the context of reforming Japan’s mandatory annual health checkup for adults. A decision tree and Markov model with societal perspective were constructed to compare dipstick test to check proteinuria only, serum creatinine (Cr) assay only, or both.
Results
Incremental cost-effectiveness ratios (ICERs) of mass screening compared with do-nothing were calculated as ¥1,139,399/QALY (US $12,660/QALY) for dipstick test only, ¥8,122,492/QALY (US $90,250/QALY) for serum Cr assay only and ¥8,235,431/QALY (US $91,505/QALY) for both. ICERs associated with the reform were calculated as ¥9,325,663/QALY (US $103,618/QALY) for mandating serum Cr assay in addition to the currently used mandatory dipstick test, and ¥9,001,414/QALY (US $100,016/QALY) for mandating serum Cr assay and applying dipstick test at discretion.
Conclusions
Taking a threshold to judge cost-effectiveness according to World Health Organization’s recommendation, i.e. three times gross domestic product per capita of ¥11.5 million/QALY (US $128 thousand/QALY), a policy that mandates serum Cr assay is cost-effective. The choice of continuing the current policy which mandates dipstick test only is also cost-effective. Our results suggest that a population strategy for CKD detection such as mass screening using dipstick test and/or serum Cr assay can be justified as an efficient use of health care resources in a population with high prevalence of the disease such as in Japan and Asian countries.
doi:10.1007/s10157-011-0567-1
PMCID: PMC3328680  PMID: 22167460
Chronic kidney disease; Cost-effectiveness; Dipstick test; Mass screening; Proteinuria; Serum creatinine
6.  The economic burden of TNFα inhibitors and other biologic treatments in Norway 
Objective:
Costly biologic therapies have improved function and quality of life for patients suffering from rheumatic and inflammatory bowel diseases. In this survey, we aimed to document and analyze the costs.
Methods:
In 2008, the total costs of tumor necrosis factor alpha inhibitors and other biologic agents in Norway were registered prospectively. In addition to costs, the pattern of use in the four Norwegian health regions was analyzed. The expenses were calculated in Norwegian krone and converted into Euros.
Results:
The pattern of use was similar in all four regions, indicating that national guidelines are followed. Whereas the cost was similar in the southeast, western, and central regions, the expenses per thousand inhabitants were 1.56 times higher in the northern region. This indicates that patients in the northern region experienced a lower threshold for access to these drugs. The gap in costs between trusts within northern Norway was about to be closed. The Departments of Rheumatology and Gastroenterology had the highest consumption rates.
Conclusion:
The total cost of biologic agents was significant. Northern Norway had among the highest consumption rates worldwide. This can partly be explained. Further exploration calls for a national registry for the use of these drugs.
doi:10.2147/CEOR.S15988
PMCID: PMC3169971  PMID: 21935335
TNFα inhibitors; biologic agents; Norway; cost

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