Shuzo Nishimura

This paper reports the development of a short scale (ten items) entitled 'Social Relationships to Prevent Obesity' (SRPO), which examines how social relationships support the continuous and conscious endeavour to lose weight. The construct and criterion validity of this scale were ascertained in this study. Factor structure and reliability were examined using data from a randomized controlled trial. A confirmatory factor analysis of the SRPO revealed three relevant factors. The results suggest that the SRPO has both validity and clinical utility and can thus be used as a screening tool in weight-loss interventions and to assess the degree of, and trends in, self-control for weight loss in individuals. The scale can also be used to examine the environmental and self-control problems faced by obese people--factors that should be considered when conducting weight-loss interventions.

Health outcomes measurement forms a key aspect of data collection for economic evaluations. Quality-of-life instruments provide a measure of patient-focused health outcomes. Such instruments, including the EuroQoL questionnaire (EQ-5D) and the Short-form 36 (SF-36) are already being used in Japan. Utility instruments provide an alternative way of measuring quality of life for use in economic analyses. At present, utility measurement in Japan is limited to scores derived from the EQ-5D. Although the SF-36 was designed as a health profile measure, it has since been tested for use as a utility measure, with valuation of items now being undertaken in Japan. Utility measurement in Japan is likely to be advanced further by the validation and introduction of the Health Utilities Index. The experiences of other countries provide the opportunity for Japan to learn how utility scores may be used in cost-utility analyses of healthcare technologies.

With increasing cost-containment pressures within healthcare systems worldwide, economic evaluations of medical technologies, particularly pharmaceuticals, are used to aid the allocation of expenditure and resources. Facing similar pressures, Japan will probably also introduce economic evaluation of health technology. However, the structure of the healthcare system in Japan does not lend itself naturally to the collection of the epidemiological and cost data required for economic evaluations in medicine. In addition, there are no formal methodological guidelines in place for these analyses. To overcome these information barriers in Japan, progress may be aided by the adoption of approaches used in other countries for data collection and guideline development.

The aging population and the increasing availability of new medical technologies, particularly pharmaceuticals, have led to growing pressure on governments worldwide to contain healthcare costs. Increasingly, economic evaluation is used to aid decisions on the reimbursement and formulary access of drugs, and pharmaceutical companies are often required to demonstrate the cost effectiveness of their products. Canada and the UK are examples of countries that have successfully incorporated mandatory requirements for economic evaluations into the decision-making process in healthcare. Japan faces cost-containment issues for its health and welfare system similar to those seen elsewhere in the world. Despite this, economic assessments are not currently used in the allocation of drug budgets. Reasons why economic evaluations for healthcare have not yet been used routinely in Japan include governmental approaches to healthcare cost containment, the pricing of pharmaceuticals, the organisation of the healthcare system, attitudes of the medical profession, and limited knowledge and expertise. However, small but encouraging steps are now being taken towards the introduction of economic evaluations in Japanese medicine.

This study aimed to assess the effectiveness of intervention (specifically, intervention by telephone and mails, known as 'tele-care') relative to self-help as a weight-loss method. The question of whether there is a correlation between changes in two preference parameters--time discounting (i.e. impatience) and risk aversion--and the level of commitment was examined. The study, spanning a period of 24 weeks in 2006-2007, comprised 118 participants, each of whom was randomly assigned to either the tele-care or the self-help group. A public-health nurse provided support through telephone and mail communications to the tele-care group, aiming to reduce their calorie intake and increase exercise via this intervention. There was a significant decrease in the body weight of the participants of the tele-care group from the baseline; however, there were no significant differences in the weight loss, median time discounting or risk aversion between the two groups. The subsequent analysis for weight loss with changes in time and risk parameters revealed a significant difference in the weight loss in the time-discounting-loss and risk-aversion-gain groups. From the results of the multiple regression analysis, the time discounting was noted to be associated with age, initial BMI and marital status among men, and risk aversion was associated with age and job status among women. There is a possibility that a decrease in time discounting and increase in risk aversion might correlate with the weight loss or effectiveness of commitment in this trial. This study suggests that time discounting and risk aversion may be useful in anti-obesity efforts, since they are accurate criteria of behavioural patterns associated with weight problems.

We made a bibliographic search for Japanese and non-Japanese literature on tuberculosis control programs to study the current public health policies for tuberculosis control in Japan especially in regard to cost-effectiveness. Then, we compared the Japanese, strategies for tuberculosis control with those in other countries including the United States, and those recommended by World Health Organization (WHO). The current trend of tuberculosis incidence in the Japanese community demonstrates major differences from the situation that had prompted installation of tuberculosis control measures several decades ago. The tuberculosis control measures should be targeted to the elderly people (over 65 years old) because of the following three aspects. (1) A continuing decline of tuberculosis in the young Japanese population, particularly children who might attain benefits from BCG immunization; (2) The enhancement of the prevalence among the elderly people who are not covered by a uniform national surveillance strategy; (3) Cost-ineffectiveness of Mass Miniature Radiography (MMR) being used as a means to screen for tuberculosis. The cost-effectiveness issue must be considered more seriously, and the WHO recommendations especially in regard with the DOTS (directly-observed treatment, short course) strategy need to be incorporated more effectively into the national program since the incidence of drug resistant tuberculosis in Japan has been recently increasing. Finally, we propose to limit BCG immunization further and to discontinue annual MMR in the young population, and instead to develop effective strategies of both active and passive case finding in the elderly through public and community health services.