Hiroshi Fuchigami

Saitama Medical University, Saitama, Saitama-ken, Japan

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Publications (8)4.23 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: 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. 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. 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. 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.
    [Nippon kōshū eisei zasshi] Japanese journal of public health 01/2006; 52(12):1009-20.
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    ABSTRACT: Simple methods have been developed to warn of pre-epidemics and epidemics in small areas using data of infectious diseases surveillance. Epidemic warnings are made if the index of cases per week per sentinel medical institution is greater than a defined value. A pre-epidemic warning means that an epidemic warning will be given in the following four weeks. While the methods are used routinely for surveillance in Japan, they remain to be validated. Infectious diseases surveillance data of influenza-like illness and 12 pediatric diseases in the fiscal year between 1999 and 2001 were used in the analysis. We examined the frequency of warnings, temporal changes in the index before and after the onset of a warning, and the sensitivity, specificity, and positive predictive value of pre-epidemic warnings. For the majority of the diseases investigated, the proportion of weeks in which a warning was issued ranged between 0% and 10%. In several diseases including influenza-like illness, we observed a rapid increase and gradual decrease in the index before and after a warning. The sensitivity, specificity, and positive predictive value of a pre-epidemic warning were 90.4%, 93.7% and 23.9% for influenza-like illness, and ranged between 25.1-54.2%, 86.1-99.2%, and 2.5-20.8% for the pediatric diseases (chickenpox, rubella, measles, and mumps), respectively. The study showed that the methods used for determining whether or not to issue an epidemic warning were satisfactory in some diseases, including influenza-like illness, and may need to be improved in several other diseases.
    Journal of Epidemiology 04/2004; 14(2):33-40. · 2.11 Impact Factor
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    ABSTRACT: In order to clarify the characteristics of medical institutions visited by patients with selected intractable diseases, we analyzed data from the fourth nationwide survey in 1997. We asked 47 prefectural governments to provide data concerning every patient receiving financial aid for treatment of 39 selected intractable diseases from April 1997 to March 1998. Out of 399,719 whose information was reported by prefectural governments, we analysed data of 370,232 patients whose medical institutions were reported. We performed detailed analysis on the relation between patients' residences and locations of medical institution which the patients visited, and on the characteristics of medical institutions. These analyses were respectively compared by sex and age, the beginning year of the financial aid, whether the patients were inpatients or outpatients, type of insurance, and clinical division where the patient was treated. 1. Analysis showed that 7.4% of all patients were treated in medical institutions outside the prefectures where they lived. Patients who lived in the neighboring prefectures of huge cities like Tokyo, tended to be treated in the medical institutions there. 2. We found that 23.5% of patients were treated in university hospitals, and 11.9% were seen in clinics. 3. There was a difference between patients with SMON and patients with myastenia gravis, pemphigus, epidermolysis bullosa or primary pulmonary hypertension. Of the two groups, the former preferred to visit clinics and be treated in medical institutions located in the same cities, towns, and villages where they lived. On the contrary, patients with the latter 4 diseases tended to visit large hospitals and be treated in those outside their prefectures. 4. Elderly patients over 70 years old tended to be treated in clinics or hospitals located in their neighborhoods. 5. Compared with past surveys, the percentage of patients treated in university hospitals had decreased, and that of patients treated in clinics had increased year by year. No change was found in the proportion of patients treated in medical institutions outside their prefectures. By the present analysis of a nationwide survey taken in fiscal year 1997, we were able to clarify the characteristics of medical institutions visited by patients with selected intractable diseases. This kind of analysis should be continued to obtain important information on the epidemiology of intractable diseases.
    Nippon Eiseigaku Zasshi (Japanese Journal of Hygiene) 10/2003; 58(3):357-68.
  • [Nippon kōshū eisei zasshi] Japanese journal of public health 09/2003; 50(8):732-8.
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    ABSTRACT: The estimation of incidence rates of infectious diseases based on the sentinel surveillance data is rather rare. We attempted to estimate these in 2000 in Japan by the surveillance data, and to evaluate their biases. We used the incidences of influenza-like illness and 12 pediatric diseases in each of the sentinel medical institutions in Japan based on surveillance data in 2000. The incidence in all medical institutions was estimated under the assumption that the sentinel medical institutions were randomly selected. The possible bias of this estimate was evaluated in comparison with the hypothetical true incidence obtained as the total incidence in all medical institutions estimated by a regression model using the numbers of all disease outpatients per day from the National Survey of Medical Care Institutions of Japan. The estimated annual incidence rate was 75.6 (95% confidence interval: 72.3-78.7) per 1,000 population in influenza-like illness, and ranged from 1.1 (95% confidence interval: 1.0-1.2) to 285.2 (95% confidence interval: 270.2-300.3) per 1,000 population aged 0-19 years among 12 pediatric diseases. The ratio of the estimated incidence to the hypothetical true one was 1.06-1.26 among influenza-like illness and the 12 pediatric diseases. The incidence rates of influenza-like illness and pediatric diseases in 2000 in Japan were estimated from sentinel surveillance data. The rates obtained provide some useful but not always accurate information. Thus, further research is necessary.
    Journal of Epidemiology 06/2003; 13(3):136-41. · 2.11 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In order to clarify epidemiologic features of selected intractable diseases, an investigation of the fourth nationwide survey, in 1998, was performed. We asked 47 prefectural governments to provide data concerning every patient receiving financial aid for treatment of 39 selected intractable diseases from April 1997 to March 1998. The items for each patient required were the beginning year of the financial aid, the disease code, sex, date of birth, residence, type of insurance, whether an in-patient or outpatient, medical institution and the clinical division where the patient was treated. We performed a detailed analysis regarding the age distribution, the prefecture, in-patient or outpatient, the clinical division, the insurance, and the disease, for both males and females. 1. The total number of patients who received financial aid for treatment was 399, 719 with a sex ratio of 0.66 (males 158, 766, or female 240, 953), 60.7% being between 45 and 74 years of age. Of 214, 173 patients whose status could be confirmed regarding outpatient or inpatient. 14.7% were the latter. Of 129, 685 cases, 56, 471 (43.6%) were treated in departments of internal medicine. Of 396, 187 patients, 65, 841 (16.6%) were covered by the health and medical services law for the aged. The greatest number of patients resided in Tokyo, and the least was in Yamanashi Prefecture. 2. With regard to specific intractable diseases, the largest number of patients receiving aid for treatment were suffering from ulcerative colitis at 52, 261, while the least number was for primary pulmonary hypertension at 96. The numbers for each group had increased within the 13 years from 1984 to 1997, except for SMON. As the patients' age increased, the percentage of those receiving treatment also increased and the numbers of aged individuals were especially elevated. 3. The proportion of in-patients for the Creutzfelde-Jakob disease was 76.4 percent, which was remarkably higher than for other diseases. By the present analysis of the nationwide survey in fiscal year 1997, we could clarify changes in epidemiologic features of patients receiving financial aid for treatment. This kind of analysis should be continued to obtain important information on the epidemiology of intractable diseases.
    [Nippon kōshū eisei zasshi] Japanese journal of public health 09/2002; 49(8):774-89.
  • [Nippon kōshū eisei zasshi] Japanese journal of public health 07/2001; 48(6):480-85.
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    ABSTRACT: After developing criteria for epidemic periods for 16 infectious diseases, we investigated temporal (annual and monthly) and geographical (regional) variation in epidemics. Data from an infectious disease surveillance system for the years 1993 to 1997 were used for the analysis. The weekly number of patients per monitoring station was calculated from the data and used in developing criteria for an epidemic period. Based on these latter, we calculated the average number of epidemics occurring at each public health center in a year, an average length of the epidemic period, and the average number of patients per monitoring station reported during an epidemic period. These figures were used to explore temporal (annual, monthly) and geographical (regional) variation. With most diseases, the average number of epidemics occurring at a public health center was 0.3-0.5 per year and the average length of an epidemic period was 6-12 weeks. The average number of patients per monitoring station reported during an epidemic period differed according to the diseases. These indices showed that there were few annual differences, but great monthly differences, in most diseases. The average number of epidemics occurring in a public health center showed regional differences with some diseases. Temporal and geographical variation in epidemics for 16 infectious diseases was established by developing criteria for an epidemic period.
    [Nippon kōshū eisei zasshi] Japanese journal of public health 12/2000; 47(11):925-35.

Publication Stats

17 Citations
4.23 Total Impact Points

Institutions

  • 2002–2006
    • Saitama Medical University
      • Department of Public Health
      Saitama, Saitama-ken, Japan
  • 2004
    • National Institute for Environmental Studies
      • Center for Environmental Health Sciences
      Tsukuba, Ibaraki, Japan
  • 2003
    • Fujita Health University
      • Department of Hygiene
      Nagoya, Aichi, Japan