Objectives In the early phase of the emergence of influenza A (H1N1) 2009 abroad, quarantine detention measures based on exposure assessment of infected persons at airports were enacted in Japan. Detention, while being a step needed to protect safety and health of citizens, restricts healthy individuals' activities for several days until they can be confirmed to be not infected. Thus, the number of persons detained must be minimized in the interest of human rights. In this study, we reviewed factors to be considered in decision-making to carry out optimal detention in the early phase of emergence of a novel influenza virus in the future.
Methods We reviewed manuscripts on contagiousness of influenza, cases of infections in public transportation such as airplanes, and the effectiveness of detention, and interviewed persons who were involved in detentions in the early phase of the influenza A(H1N1) 2009 pandemic.
Results When a decision is made about detention, it is essential to assess the necessity of detention, the measures for minimizing the scope of individuals to be detained, the measures for ensuring the human rights of individuals affected, and possible means to substitute for detention. Assessment of the necessity of detention should cover the following: (1) whether or not the novel influenza is a sufficiently severe threat to public health to justify detention; (2) whether or not detention at a given point of time can delay the beginning of a domestic epidemic; and (3) who is responsible and how revision of the once decided detentions should be made.
Regarding measures for minimizing the scope of individuals to be detained, discussions are needed as to: (1) giving advice to the nation to refrain from getting aboard an airplane when aware of flu-like symptoms so that exposure of people to infected individuals may be avoided; and (2) whether or not selection of individuals to be detained is going to be made, taking into account the level of exposure to infected individuals. To ensure the human rights of the individuals affected by detention, assessment is needed as to: (1) whether or not the detention period is as short as possible; (2) whether or not human rights (privacy, comfort at the detention facility) will be protected during detention; (3) whether or not adequate measures can be taken to ensure mental health and management of chronic disease of the detained; and (4) whether or not adequate explanations can be given to foreigners to be detained, with their mother language taken into account. Regarding substitutes for detention, alternatives such as keeping the individuals at their own home as home quarantine should be considered.
Conclusion The decision on detention has to be made in the early phase of an influenza pandemic when information available about pathogenicity and other relevant information are limited. To date, sufficient evidence useful in making a decision as to detention has not been obtained. Under such circumstances, it is essential to make an optimum decision as to the necessity and means of detention based on assessment of multiple aspects and factors.

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[in Japanese]

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[in Japanese]

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Objectives We examined the relationship between the frequency of social interaction and physical, psychological, and social functioning among frail, non-housebound elderly to determine the best way to support social exchange and help prevent frail elderly from becoming housebound.
Methods We recruited elderly individuals characterized as frail who lived in urban environments. A multidimensional examination was conducted that included interviews and physical performance tests. We defined an exchange as meeting and talking in person or talking by phone with friends, neighbors, relatives, or children living separately from the participants, and determined how many days a week frail elderly participants made contact with others. Independent variables were [1] basic personality attributes; [2] physical functioning, including eyesight, hearing, grip strength, masticatory force, ability to perform activities of daily living, walking ability, history of falls, and cognitive function; [3] psychological functioning, including subjective health assessment, depression, and fear of falling; and [4] social functioning, including ability to perform instrumental activities of daily living, social networks, and social activity. Multiple regression analysis was performed with SPSS 15.0 J to identify factors that could predict the frequency of contact with others. Data are expressed as mean±standard deviation.
Results Of 61 elderly individuals recruited, 58 non-housebound individuals were selected for our study (men, n=12; women, n=46; mean age, 81.2±6.0 years). We found that participants interacted with others 4.5±2.0 days per week. For both male and female participants, the following independent variables were analyzed for the ability to predict frequency of contact with others: hearing (low-pitched sound), hearing (high-pitched sound), and scores on the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence. Multiple regression analysis revealed that hearing (low-pitched sound) and results of the TMIG index of competence significantly predicted frequency of contact with others for female participants. Specifically, participants without hearing loss and with a higher total score on the TMIG index of competence contacted others more frequently.
Conclusion Hearing and the ability to perform instrumental activities of daily living influence the frequency of contact with others. In particular, importance should be placed on hearing functions, which form the basis of communication. In addition to hearing evaluation and care (e.g., auditory test and hearing aid), maintaining the ability to perform instrumental activities of daily living is necessary to support social exchange.

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Objectives Diagnostic criteria for the metabolic syndrome (Mets) in Japan have been set by the Medical Committee of the Japanese Association of Medical Sciences (Med), the National Health and Nutrition Examination Survey (Nat), specific health checkups (Ckup), and second medical examination by Worker's Accident Compensation Insurance System (Wor). The purpose of this study was to compare classification of the metabolic syndrome by different organizational criteria and to investigate underlying differences.
Methods All faculty members of a university in Osaka, Japan, underwent mandatory health checkups in September 2008. The demographic distribution included 769 males (mean age, 49±12 years) and 415 females (mean age, 43±10 years). Using the Med, Nat, Ckup and Wor criteria, individuals were assessed for the MetS and pre-metabolic syndrome (pre-Mets), strongly suspected metabolic syndrome (S-Mets) and assumed pre-metabolic syndrome (A-pre-Mets), as well as a positive support level (PSL) and a motivational support level (MSL). All faculty members were categorized into a morbid group (Mets, S-Mets, PSL, and FB) or a pre-morbid group (pre-Mets, A-pre-Mets, and MSL) based on medical data and smoking habits. The incidence of morbid and pre-morbid individuals was compared across the four criteria and analyzed based on gender and age (under 40 and 40 or over).
Results Male incidences for the morbid and pre-morbid classifications were 17% and 20% with Med, 9% and 23% with Nat, 27% and 14% with Ckup, and 1.4% and 0% with Wor. There were significant differences across criteria sets in both the morbid and pre-morbid groups, with significantly greater numbers of males than females, and higher prevalences in those aged 40 or over than in their younger counterparts. Males aged under 40 classified into the pre–morbid group comprised 18% in Med, 16% in Nat, and 13% in Ckup.
Conclusion The different disease incidences found between Med and Ckup data in males aged 40 or over might be attributed to varying criteria for blood glucose levels, while Wor data may be influenced by the higher level of blood pressure set as a criterion with this approach. It will be important to continuously validate currently established criteria to identify the actual prevalence of MetS in Japan. Furthermore, incorporation of waist circumference and BMI for females, and a positive approach for young males, may be critical for future developments.

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