Purpose Nationwide surveys of intractable disease patients receiving public financial aid for treatment were performed by Research Committee for Epidemiology of Intractable Disease (Ministry of Health and Welfare, Japan) 4 times in the past, in 1984, 1988, 1992 and 1997. The purpose of the present study was to clarify the features of continuance with intractable disease patients receiving public financial aid for treatment.
Methods Individual information collected by each nationwide survey was linked using the disease, the residence, the sex, and the birth date. The proportion of intractable disease patients according to receipt duration, kind of medical insurance, sex and age was calculated with reference to the disease and an estimation of the receipt persistence rate was calculated for every year. Moreover, in consideration of variation in the data, average receipt persistence rates over years were also calculated.
Results According to observation on individual patient's follow up, the proportion for which financial aid was discontinued within four years was 25%, while 70% continued receiving aid for at least four years and some 55% for eight or nine years.
 The proportion of those who continue receiving support long-term is high about the so-called autoimmune diseases, such as systemic lupus erythematosus, Behçet's disease, and the aortic syndrome. In contrast, with diseases having a poor prognosis, such as fulminant hepatitis, amyloidosis, and amyotrophic lateral sclerosis, periods of continuance are short. The proportion needing long-term continuation is higher in women than in men, especially with diseases which have long been eligible for support. However, with diseases for which receipt was started recently, there is a tendency for persistence to be higher in men than in women.
Conclusion With reform of insurance systems, including the medical system for intractable diseases, it is predicted that receipt continuation will change with alteration of social factors, and it is necessary to monitor receipt continuation carefully from now on.

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Objective 2-Ethyl-1-hexanol (2E1H) is a volatile organic compound (VOC) which seldom attracts attention in Japan. This study aimed at clarifying changes in its concentration over time, emission sources, and students' symptoms in classrooms of a university building where indoor air was found to be markedly polluted with 2E1H.
Methods From March 2001 through September 2002, we measured VOC concentrations in Building A, constructed in 1998, as well as Building B (Sept. 2002), constructed over 30 years ago and considered as a control. Airborne concentrations of 13 carbonyl compounds were quantified with diffusive samplers and high-performance liquid chromatography, and those of 41 other VOCs with an active sampling method using charcoal tubes and a gas chromatograph with a mass spectrometer (GC-MS). In August 2002, we also measured VOC emissions from the floors using double-cylinder chambers and the airborne concentrations of phthalate esters by filtration sampling, both by GC-MS. Subjective symptoms in 315 student classroom users in Building A and 275 in Building B were surveyed in July 2002 with anonymous self-administered questionnaires.
Results 2E1H concentrations in Building A, which exceeded the Japanese recommended threshold of total VOCs (400 μg/m³) in some measurements, tended to be lower in winter and higher in summer, and did not show any tendency for decrease over time. No association was found between indoor concentrations of phthalate esters and those of 2E1H. The concentrations clearly differed between rooms, related to emission rates from the floors. Carpeting materials had been placed directly on the concrete floors in rooms with higher emission levels, whereas the carpeting materials and the concrete floor did not make contact in the room where emission was lower. The odds ratio for subjective symptoms with students in classrooms in Building A was not higher than in Building B where the 2E1H concentrations were low. However, a few students limited to Building A did complain of problems with the nasal passages, throat and lower airways.
Conclusion Compounds containing 2-ethy1-l-hexyl moiety are presumably hydrolyzed to emit 2E1H when the backing of carpeting material is in contact with concrete floors. Although no significant difference was observed in symptoms between the student groups in the two buildings, this was possibly due to the small sample size. Measures to prevent 2E1H emission and dose-response relationships in sensitive individuals should be studied further.

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Objective A tool was developed for assessment of health status in communities to help formulate health policy of local governments and allow estimates of magnitude of changes in mortality with modification of selected risk variables.
Materials and Methods A total of 25,201 men and 51,776 women aged 40-69 years who underwent health checkups in Ibaraki-ken, Japan, in 1993 were followed through 2002. Risk ratios for all cause, cardiovascular disease, cerebrovascular disease, ischemic heart disease, all cancer, and lung cancer deaths were calculated according to smoking, heavy alcohol consumption, obesity, hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol, and diabetes using a Cox proportional hazards model. Regression coefficients for body mass index, systolic blood pressure, serum total cholesterol, serum high-density lipoprotein cholesterol, and plasma glucose were also calculated by the model with quadratic terms.
 On the basis of the results, we developed a tool using Microsoft EXCEL, allowing estimation of the magnitude of changes in death rates according to variation in mean and standard deviation values for risk factors by impact fraction.
Results The developed tool facilitates estimation of magnitude of changes in death rates with alteration in exposure rates and means/standard deviations of risk variables with intervention. The best magnitude of decline for all cause mortality with a 50% reduction of exposure to smoking was 10% in men. The magnitudes of decline in cardiovascular disease mortality with a 50% reduction in hypertension were 12% in men and 11% in women. Furthermore, the magnitude of decline in cardiovascular disease mortality if a 10% lowering of mean systolic blood pressure were achieved would be 22% in men and 18% in women.
Conclusions Our developed tool may be useful to assess health status in communities with cooperation between municipal and prefectural governments.

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Purpose BCG vaccination using the multipuncture percutaneous method has long been employed in Japan. The purpose of this study is to clarify whether the number of needle scars achieved the BCG vaccination differs with the vaccinating physician.
Methods A total of 218 babies who were vaccinated at the age of 4 months by different physicians at the Public Health Centres of Katsushika-Ward, Tokyo, were examined at the age of 3 years, in the three-year-old health check-up programme. The BCG vaccination with the multipuncture method generates 18 needle scars at a maximum. We examined each child for how many needle scars after BCG vaccination were visible, with reference to the vaccinating physician.
Results The mean number of the visible scars was 9.23 (SD 6.11), and significantly smaller (P<0.01) than that for all 22 Wards (12.18±5.64) investigated with the same method. The mean number of needle scars of the babies in Katsushika Ward was the third smallest among the 22 Wards and significantly smaller (P<0.05) than the national average as determined in the nationwide survey conducted in 2000. Significant differences were evident among the 7 physicians performing the vaccination, the best and second best means being 15.26(SD3.62) and 14.59(SD3.58) respectively, and significantly larger (P<0.01) than the means for the 7 physicians. The worst mean was 3.43(SD4.46), significantly smaller (P<0.01) than the mean for the 7 physicians.
Conclusion The mean number of needle scars after BCG vaccination of babies significantly differed with the 7 physicians in the present study. Poor technique was presumed responsible for small numbers of scars and technical training is therefore necessary in order to improve the BCG vaccination outcome.

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[in Japanese]

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