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BackgroundThe Great East Japan Earthquake occurred on March 11, 2011. Tokyo and Osaka, which are located 375 km and 750 km, respectively, from the epicenter, experienced tremors of 5.0 lower and 3.0 seismic intensity on the Japan Meteorological Agency scale. The Great East Japan Earthquake was the fourth largest earthquake in the world and was accompanied by a radioactive leak at a nuclear power plant and a tsunami. In the aftermath of a disaster, some affected individuals presented to mental health facilities with acute stress disorder (ASD) and/or post-traumatic stress disorder (PTSD). However, few studies have addressed mental stress problems other than ASD or PTSD among the general public immediately after a disaster. Further, the effects of such a disaster on residents living at considerable distances from the most severely affected area have not been examined. ObjectiveThis study aimed to prospectively analyze the effect of a major earthquake on the prevalence of insomnia among residents of Tokyo and Osaka. MethodsA prospective online questionnaire study was conducted in Tokyo and Osaka from January 20 to April 30, 2011. An Internet-based questionnaire, intended to be completed daily for a period of 101 days, was used to collect the data. All of the study participants lived in Tokyo or Osaka and were Consumers’ Co-operative Union (CO-OP) members who used an Internet-based food-ordering system. The presence or absence of insomnia was determined before and after the earthquake. These data were compared after stratification for the region and participants’ age. Multivariate analyses were conducted using logistic regression and a generalized estimating equation. This study was conducted with the assistance of the Japanese CO-OP. ResultsThe prevalence of insomnia among adults and minors in Tokyo and adults in Osaka increased significantly after the earthquake. No such increase was observed among minors in Osaka. The overall adjusted odds ratios for the risk of insomnia post-earthquake versus pre-earthquake were 1.998 (95% CI 1.571–2.542) for Tokyo, 1.558 (95% CI 1.106–2.196) for Osaka, and 1.842 (95% CI,1.514–2.242) for both areas combined. ConclusionsThe prevalence of insomnia increased even in regions that were at a considerable distance from the epicenter. Both adults and minors in Tokyo, where the seismic intensity was greater, experienced stress after the earthquake. In Osaka, where the earthquake impact was milder, disturbing video images may have exacerbated insomnia among adults.

BackgroundEarly detection of symptoms arising from exposure to pathogens, harmful substances, or environmental changes is required for timely intervention. The administration of Web-based questionnaires is a potential method for collecting information from a sample population. ObjectiveThe objective of our study was to develop a Web-based daily questionnaire for health (WDQH) for symptomatic surveillance. MethodsWe adopted two different survey methods to develop the WDQH: an Internet panel survey, which included participants already registered with an Internet survey company, and the Tokyo Consumers’ Co-operative Union (TCCU) Internet survey, in cooperation with the Japanese Consumers’ Co-operative Union, which recruited participants by website advertising. The Internet panel survey participants were given a fee every day for providing answers, and the survey was repeated twice with modified surveys and collection methods: Internet Panel Survey I was conducted every day, and Internet Panel Survey II was conducted every 3 days to reduce costs. We examined whether the survey remained valid by reporting health conditions on day 1 over a 3-day period, and whether the response rate would vary among groups with different incentives. In the TCCU survey, participants were given a fee only for initially registering, and health information was provided in return for survey completion. The WDQH included the demographic details of participants and prompted them to answer questions about the presence of various symptoms by email. Health information collected by the WDQH was then used for the syndromic surveillance of infection. ResultsResponse rates averaged 47.3% for Internet Panel Survey I, 42.7% for Internet Panel Survey II, and 40.1% for the TCCU survey. During a seasonal influenza epidemic, the WDQH detected a rapid increase in the number of participants with fever through the early aberration reporting system. ConclusionsWe developed a health observation method based on self-reporting by participants via the Internet. We validated the usefulness of the WDQH by its practical use in syndromic surveillance.

The demographic transition towards an ageing population and the epidemiological transition from communicable to noncommunicable diseases have increased the demand for rehabilitation services globally. The aims of this paper were to describe the integration of rehabilitation into the Japanese health system and to illustrate how health information systems containing real-world data can be used to improve rehabilitation services, especially for the ageing population of Japan. In addition, there is an overview of how evidence-informed rehabilitation policy is guided by the analysis of large Japanese health databases, such as: (i) the National Database of Health Insurance Claims and Specific Health Checkups; (ii) the long-term care insurance comprehensive database; and (iii) the Long-Term Care Information System for Evidence database. Especially since the 1990s, the integration of rehabilitation into the Japanese health system has been driven by the country's ageing population and rehabilitation is today provided widely to an increasing number of older adults. General medical insurance in Japan covers acute and post-acute (or recovery) intensive rehabilitation. Long-term care insurance covers rehabilitation at long-term care institutions and community facilities for older adults with the goal of helping to maintain independence in an ageing population. The analysis of large health databases can be used to improve the management of rehabilitation care services and increase scientific knowledge as well as guide rehabilitation policy and practice. In particular, such analyses could help solve the current challenges of overtreatment and undertreatment by identifying strict criteria for determining who should receive long-term rehabilitation services. Tant la transition demographique vers un vieillissement de la population que la transition epidemiologique des maladies transmissibles vers les maladies non transmissibles ont entraine une augmentation de la demande en services de readaptation dans le monde. Le present document poursuit plusieurs objectifs: decrire l'integration de la readaptation dans le systeme de sante au Japon, et illustrer comment les systemes de sante contenant des donnees reelles peuvent etre utilises en vue d'ameliorer de tels services, en particulier pour une population nipponne vieillissante. En outre, il offre un apercu de la maniere dont la politique de readaptation etayee par des faits s'inspire de l'analyse de vastes bases de donnees sanitaires japonaises, parmi lesquelles: (i) la base de donnees nationale des demandes de remboursement au titre de l'assurance-maladie et des bilans de sante specifiques; (ii) la base de donnees complete de l'assurance pour les soins longue duree; et enfin, (iii) la base de donnees du systeme d'information relatif aux attestations de soins longue duree. Le vieillissement de la population a pousse le Japon a inclure la readaptation dans son systeme de sante, surtout depuis les annees 1990; aujourd'hui, un nombre croissant de personnes agees ont aisement acces a des services de readaptation. Au Japon, l'assurance-maladie globale prend en charge la readaptation intensive aigue et post-aigue (ou de retablissement). De son cote, l'assurance pour les soins longue duree couvre la readaptation dans les etablissements dedies et les infrastructures collectives accueillant des personnes agees, avec pour but de contribuer a preserver l'autonomie au sein d'une population vieillissante. Lanalyse de vastes bases de donnees sanitaires peut favoriser une meilleure gestion des services de readaptation et accroitre les connaissances scientifiques, mais aussi orienter les politiques et pratiques en la matiere. Ce type d'analyse peut surtout aider a s'attaquer aux enjeux actuels que representent les traitements excessifs ou insuffisants, en identifiant des criteres stricts permettant de determiner qui doit faire l'objet d'une readaptation sur le long terme. La transicion demografica hacia el envejecimiento de la poblacion y la transicion epidemiologica de las enfermedades transmisibles a las no transmisibles han aumentado la demanda de servicios de rehabilitacion en todo el mundo. Los objetivos de este articulo son describir la integracion de la rehabilitacion en el sistema sanitario japones e ilustrar como los sistemas de informacion sanitaria que contienen datos del mundo real se pueden utilizar para mejorar los servicios de rehabilitacion, en especial para la poblacion que envejece en Japon. Ademas, se ofrece una vision general de como la politica de rehabilitacion fundamentada en la evidencia se guia por el analisis de las grandes bases de datos sanitarias japonesas, como: (i) la Base de Datos Nacional de Reclamaciones al Seguro de Enfermedad y Chequeos Medicos Especificos; (ii) la base de datos integral del seguro de cuidados de larga duracion; y (iii) la base de datos del Sistema de Informacion de Cuidados de Larga Duracion para la Evidencia. En particular, desde la decada de 1990, la integracion de la rehabilitacion en el sistema sanitario japones se ha visto impulsada por el envejecimiento de la poblacion del pais y, en la actualidad, la rehabilitacion se ofrece de forma generalizada a una cantidad cada vez mayor de adultos mayores. El seguro medico general de Japon cubre la rehabilitacion intensiva aguda y posaguda (o de recuperacion). El seguro de cuidados de larga duracion cubre la rehabilitacion en instituciones de larga estancia y centros comunitarios para adultos mayores con el objetivo de ayudar a mantener la independencia en una poblacion que envejece. El analisis de las grandes bases de datos sanitarias puede servir para mejorar la gestion de los servicios de atencion a la rehabilitacion y aumentar los conocimientos cientificos, asi como para orientar la politica y la practica de la rehabilitacion. En concreto, estos analisis podrian ayudar a resolver los problemas actuales de sobretratamiento y subtratamiento, al identificar criterios estrictos para determinar quien debe recibir servicios de rehabilitacion de larga duracion., Introduction Member States of the United Nations are committed to the sustainable development goals, (1) which include universal health coverage as a key driver of health and well-being. In addition, [...]

Background and Aims Few recent large-scale studies have evaluated the risks and benefits of continuing oral anticoagulant (OAC) therapy after catheter ablation (CA) for atrial fibrillation (AF). This study evaluated the status of continuation of OAC therapy and the association between continuation of OAC therapy and thromboembolic and bleeding events according to the CHADS2 score. Methods This retrospective study included data from the Japanese nationwide administrative claims database of patients who underwent CA for AF between April 2014 and March 2021. Patients without AF recurrence assessed by administrative data of the treatment modalities were divided into two groups according to continuation of OAC therapy 6 months after the index CA. The primary outcomes were thromboembolism and major bleeding after a landmark period of 6 months. After inverse probability of treatment weighting analysis, the association between OAC continuation and outcomes was determined according to the CHADS2 score. Results Among 231 374 patients included, 69.7%, 21.6%, and 8.7% had CHADS2 scores of ≤1, 2, and ≥3, respectively. Of these, 71% continued OAC therapy at 6 months. The OAC continuation rate was higher in the high CHADS2 score group than that in the low CHADS2 score group. Among all patients, 2451 patients (0.55 per 100 person-years) had thromboembolism and 2367 (0.53 per 100 person-years) had major bleeding. In the CHADS2 score ≤1 group, the hazard ratio of the continued OAC group was 0.86 [95% confidence interval (CI): 0.74–1.01, P =.06] for thromboembolism and was 1.51 (95% CI: 1.27–1.80, P <.001) for major bleeding. In the CHADS2 score ≥3 group, the hazard ratio of the continued OAC group was 0.61 (95% CI: 0.46–0.82, P =.001) for thromboembolism and was 1.05 (95% CI: 0.71–1.56, P = 0.81) for major bleeding. Conclusions This observational study suggests that the benefits and risks of continuing OAC therapy after CA for AF differ based on the patient's CHADS2 score. The risk of major bleeding due to OAC continuation seems to outweigh the risk reduction of thromboembolism in patients with lower thromboembolic risk. [ABSTRACT FROM AUTHOR]