On June 17, 2002, the Ministry of Education, Culture, Sports, Science and Technology, together with the Ministry of Health, Labour and Welfare, introduced the Ethical Guidelines for Epidemiological Research. Although studies begun before the adoption of the Guidelines are not necessarily required to conform to them, some studies have been reviewed anew by ethics review committees. In this article for the Young Investigator Award of the Japan Epidemiological Association, therefore, the author would like to offer an overview of informed consent in epidemiologic researches conducted before the introduction of the Guidelines. It is hoped that this may serve as a reference as to the contents and status of ethical considerations in these studies, for use in examinations of research that was already in progress when the Guidelines were introduced.
BACKGROUND: Trends in the numbers of Japanese patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) reported to the HIV/AIDS surveillance system in Japan were examined. We attempted to estimate the cumulative number of Japanese with HIV, including people with HIV not reported to the surveillance. METHODS: Data from the HIV/AIDS surveillance in Japan up to the end of 2002 were available. The number of unreported HIV cases was estimated using the back-calculation method. To evaluate this method, the number of reported HIV cases up to 1996 (before highly active antiretroviral treatments were widely available in Japan) was compared with the number estimated by the same method. RESULTS: The number of AIDS cases who were initially reported as having AIDS without having been reported as HIV-infected markedly increased as did the number of reported HIV cases. The number of AIDS cases who had been initially reported as HIV-infected and who were then reported as AIDS progression increased up to 1996 but decreased in the period of 1997-2002. The cumulative number of people with HIV at the end of 2002 was estimated as 14,000, which was 4.2 times higher than the number of reported HIV cases. The cumulative number of HIV cases reported up to 1996 was nearly equal to the number estimated by the above-mentioned method. CONCLUSIONS: HIV infection would appear to be spreading widely among Japanese population. The number of HIV cases actually reported to surveillance might still be low.
BACKGROUND: Suicide is one of the most important public health issues in both Japan and the United States. This study is to clarify the differences in methods of suicide between the two countries, among various races within the United States, and between genders and age-groups. METHODS: Vital statistics mortality data and the estimated population in 1999 in Japan and in the United States were used. Age-adjusted mortality rates were calculated using the age-specific total population of Japan and the United States as a standard population. In addition, the proportionate distribution of suicide methods was calculated. RESULTS: Age-adjusted mortality rates from suicide in Japan were about 2 times higher for males and 3 times higher for females compared with the United States. The most common method among both genders in Japan was hanging, followed by jumping from a high place. In the United States, it was firearms among both genders, followed by hanging among males and drugs among females. For Asians in the United States, hanging was the method of choice for about half among both genders; hanging was the most common method for the age group of 40 years or more among males and for all age groups among females. Firearms were the method of choice for the 20-39 age group among males. CONCLUSIONS: Although the overall suicide rates among Asians in the United States were lower than Japan, the methods were similar to those in Japan.
BACKGROUND: Because cancer is now the first and second leading causes of death in both of urban and suburban area in China, there are increasing demands for measurement tools to assess quality of life in Chinese cancer patients. The objective of this study was to evaluate the psychometric properties of the standard Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30, version 3.0). METHODS: The questionnaire was administered before, during, and after treatment of 143 patients with breast, gynecological, or lung cancer in six hospitals in China. RESULTS: Cronbach's alpha coefficients for multi-item scales were greater than 0.70 before and during treatment, except for the cognitive functioning scale. Multitrait scaling analysis showed that most of the item-scale correlation coefficients met the standards of convergent and discriminant validity. All scales and items exhibited good reproducibility, criterion-related validity, and construct validity. Score changes over time were observed in the following scales: physical, role, and social functioning; global quality of life; fatigue; nausea/vomiting. Score changes were also observed in the appetite loss item. CONCLUSION: The standard Chinese version of the EORTC QLQ-C30 is overall a valid instrument to assess the quality of life of Chinese cancer patients.
BACKGROUND: The relationship between occupational class and exposure to job stressors among employed men and women in Japan remains unclear. METHODS: Data of 16,444 men and 3,078 women were analyzed. The information was obtained from answers to a questionnaire distributed among employees of nine companies in Japan between 1996 and 1998 (average response rate, 85%). The International Standardized Classification of Occupations was used to classify respondents into eight occupational categories. The Job Content Questionnaire was used to measure job demands, job control, worksite support, and job insecurity. The associations between occupational class and job stressors, as well as job strain, were examined controlling for age, education, marital status, chronic medical condition, and personality traits, such as neuroticism and extraversion. RESULTS: Men and women in high-class occupations (e.g., managers and professionals) had significantly greater job control, while job demands and worksite social support were not greatly different among occupations. A clear occupational class gradient in job insecurity was observed in women. A greater prevalence of high job strain was observed in low-class occupations compared to high-class occupations in both men and women. The occupational class gradient in job strain was greater for women. These patterns did not change after controlling for other covariates. CONCLUSION: The present study suggests an occupational class gradient in job strain for employed men and women in Japan. Japanese women workers may have a greater occupational class gradient in job strain and job insecurity than men.