Hirohisa Imai

National Institute of Public Health, Saitama, Saitama, Japan

Are you Hirohisa Imai?

Claim your profile

Publications (49)79.31 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES: To determine whether foreskin status is a measurable marker for evaluating the effect of the foreskin on sexually transmitted infections. METHODS: Inter-rater comparison of the responses on foreskin status and circumcision in a self-report questionnaire with the findings of a physical examination by an experienced well-trained urologist was performed for patients who visited a healthcare facility in Kanagawa, Japan. Foreskin status was defined using a five-point graphical scale based on the degree to which the foreskin covers the foreskin and the glans penis in a non-erectile condition: type 1, a fully exposed glans penis; types 2-4, the glans penis partly covered by the foreskin and type 5, phimosis. Linear weighted κ and per cent agreement were used to evaluate the reliability of responses. RESULTS: Among 188 participants who were evaluated about their foreskin status, linear weighted κ and per cent agreement were 0.74% and 68.4%, respectively. Linear weighted κ improved from 0.74 to 0.80 when the number of categories was changed to three. All the self-reported responses on circumcision were in agreement with the findings of the physical examination. Seventeen participants (9.0%) had been circumcised, and among them, three (17.6%) had approximately one-half of their glans penis covered by the foreskin. In 90 among the 171 uncircumcised participants (52.6%), the foreskin did not cover the glans penis. CONCLUSIONS: The self-reported response on foreskin status in this questionnaire has sufficient reliability to replace physical examination, and this questionnaire can facilitate further studies about the effect of foreskin on sexually transmitted infections.
    Sexually transmitted infections 05/2012; · 2.18 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hyposalivation may affect respiratory disease because the mouth serves as the entrance to the respiratory apparatus, as well as to the digestive tract. Patients with acute respiratory infection generally have a favorable prognosis and a short natural course. However, in cases in which the host has lowered resistance, such as in elderly patients, the infection may develop into pneumonia. A prospective study was performed to examine the relationship between hyposalivation, which is common in elderly patients, and acute respiratory infection, which tends to become severe in elderly patients. The subjects were 323 male and female patients ≥40 years old who lived in Utsunomiya City and surrounding areas and regularly visited the Department of Dentistry and Oral Surgery, Tochigi National Hospital. A 6-month follow-up survey was performed to examine development of acute respiratory infection. Age, sex, and known risk factors were also investigated. Hyposalivation was defined as a saliva production (saliva secretion rate) of ≤0.6 ml/min. Multivariate analysis adjusted for age and sex was performed to examine potential risk factors associated with the development of acute respiratory infection. Data were analyzed for 278 subjects who completed the follow-up survey. The incidence of acute respiratory infection was 60.4%, while hyposalivation was present in 96 subjects (35.5%). Multivariate analysis showed that the incidence of acute respiratory infection was higher in subjects with hyposalivation than in those without hyposalivation (adjusted odds ratio 1.761, p = 0.048). The results of this study suggest that hyposalivation may be a risk factor for acute respiratory infection. This also suggests that improvement of hyposalivation might prevent acute respiratory infection.
    Gerontology 11/2011; 58(3):205-11. · 2.68 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hypospadias is a common congenital anomaly caused by incomplete fusion of urethral folds. Development of the urethra and external genital system in the male fetus is an androgen-dependent process. In this regard, enzymes 17 β-hydroxysteroid dehydrogenase type 3 (17 β HSD3, encoded by HSD17B3) and steroid 5 α-reductase type 2 (encoded by SRD5A2) play crucial roles. To investigate the possible associations between common polymorphisms in HSD17B3 as well as well-known V89L polymorphism in SRD5A2 and risk of hypospadias. A case-control study was performed between 1999 and 2005. There were 89 Japanese boys with hypospadias and 291 newborn controls. We genotyped HSD17B3-1999T>C, +10A>G, +20A>G, +139G>A (V31I), +913G>A (G289S), and SRD5A2+336G>C (V89L) polymorphisms by allelic discrimination assay. We measured mRNA expression of the wildtype G289 allele and the mutant S289 allele of the HSD17B3 gene in the transfected human fetal kidney HEK293 cells. Assessment of hypospadias including its severity and HSD17B3 and SRD5A2 genes using DNA blood samples: allele and genotype distribution of single nucleotide polymorphisms in these two genes in cases and controls. In our study, the risk of hypospadias was significantly higher in subjects carrying homozygous HSD17B3+913A (289S) alleles (odds ratio [OR]: 3.06; 95% confidence interval [CI]: 1.38-6.76). The risk of severe hypospadias was much higher in these subjects (OR: 3.93; 95% CI: 1.34-11.49). The mRNA expression levels of HSD17B3 G289 were higher than those of HSD17B3 S289 mutant (P < 0.001). In addition, the risk of severe hypospadias increased in boys carrying the SRD5A2+336C (89L) allele (OR: 3.19; 95% CI: 1.09-9.36). These results suggest that the HSD17B3 G289S polymorphism may be a potential risk modifier for hypospadias. Our findings provide evidence that a certain genotype related to androgen production may potentiate risk of hypospadias.
    Journal of Sexual Medicine 08/2010; 7(8):2729-38. · 3.51 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We explored the relationship between bone mineral density (BMD) and lifestyle in juveniles to identify factors leading to higher peak bone mass and prevention of osteoporosis in later life. Juveniles (1,364 students: 770 boys and 594 girls, aged 6-18 years) attending school in Hokkaido prefecture, Japan, were asked to complete a brief self-administered diet history questionnaire for 10-year-olds (BDHQ10y) providing information about personal history, lifestyle, and intake of nutritional elements. In addition, BMD and grip strength were measured. We analyzed the relationship between BMD and lifestyle factors. The difference in BMD for boys was larger among the junior and senior high school groups. The difference in BMD for girls was larger among older elementary and later school children. Anthropometric variables and grip strength were strongly correlated with BMD. Having a nap-time routine was significantly correlated with BMD, but sleep time and sports club activities were not. BMD among juveniles who attained secondary sexual characteristics was significantly higher than that of juveniles of the same age who had not attained these characteristics. Calcium intake was significantly lower in senior high school students compared with other grades. Consumption of milk by senior high school boys and junior high school girls was weakly correlated with BMD. Our findings encourage educational interventions to counsel students to avoid weight loss and calcium deficiency. This effective intervention should begin before the higher elementary school, when juveniles have the greatest likelihood for preventing lower peak bone mass and osteoporosis.
    Environmental Health and Preventive Medicine 07/2010; 15(4):222-8.
  • [Show abstract] [Hide abstract]
    ABSTRACT: There are few epidemiological studies of asymptomatic chlamydial infection among students in non-medical settings with minimal bias and improved accuracy; thus, useful data from screening among students are limited. We aimed to obtain accurate epidemiological information about asymptomatic chlamydial infection among students in non-medical settings. A population-based cross-sectional survey of 10,440 >or=18-year-old asymptomatic students who volunteered for a urine screening test for chlamydia was conducted. The prevalences of asymptomatic infection were 9.5% for women and 6.7% for men. Multivariate analysis revealed the risk factors to be a lifetime history of >or=4 sexual partners for women (odds ratio [OR] 3.17) and inconsistent condom use for men (OR 4.18). For both sexes, younger age at first intercourse was associated with a higher rate of inconsistent condom use. This study produced accurate epidemiological information on asymptomatic chlamydial infection. These results may contribute to the establishment of preventive countermeasures against such infection.
    International Journal of STD & AIDS 05/2010; 21(5):362-6. · 1.00 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Smoking is a leading risk factor for a wide variety of diseases ranging periodontitis to cancer. Adults rarely visit their physicians for preventive care. But a survey shows that more than half of adult smokers see a dentist each year for prevention-oriented care. This may put dentists in better position to intervene for smoking cessation. Objective: This study examined Japanese dentists' attitudes and practices regarding smoking cessation. Methods: The study used a survey mailed to dentists (n=1489) in three prefectures (Tokyo, Iwate, Yamanashi) asking about the practitioners' smoking cessation activities, demographic characteristic, barriers to counseling and attitudes towards smoking. Results: The response rate was 57% (n=847). Dentists advised 22% of patients to cease smoking. More than half of them used a pamphlet or similar. However, nicotine replacement therapy was prescribed infrequently (7%). Asked whether a dentist should apply smoking cessation activities in their office 76% replied Yes. The main barrier to cessation counseling was insufficient time, followed by a lack of knowledge and smoking cessation experts to refer to. 85% of respondents had no education or training in promoting smoking cessation. 22% of all responding dentists were smokers. Conclusion: Few dentists conduct smoking cessation activities in their office. Dental professionals should develop a willingness to play a more positive role in relevant smoking cessation activities despite numerous barriers.
    137st APHA Annual Meeting and Exposition 2009; 11/2009
  • Epidemiology. 01/2009; 20.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To try a new screening strategy for asymptomatic chlamydial infection among students for more accurate and efficient screening of infected individuals in nonmedical settings. Methods: Population-based cross-sectional surveys were carried out in campus settings for general student populations using anonymous identification numbers and polymerase chain reaction testing of urine specimens for Chlamydia trachomatis; online access to test results via mobile phones was provided. All universities and junior colleges and most professional schools in a prefecture in Japan took part in this screening program. Subjects comprised 10,111 asymptomatic student volunteers 18 and over years old (5986 females, 4125 males). Prevalence and risk factors of asymptomatic infection were determined on the basis of survey results for subjects with positive results to urine testing for C. trachomatis. Results: The prevalence of asymptomatic chlamydial infection was 9.6% for females and 6.7% for males. Lifetime history of 4 and over sexual partners (females: odds ratio, 3.46; 95% confidence interval, 2.63-4.58; males: 1.90; 1.28-2.81), inconsistent condom use (females: 2.52; 1.78-3.57; males: 4.00; 2.44-6.59), and 6-month history of 2 and over sexual partners (females: 1.55; 1.19-2.03; males: 1.48; 1.01-2.17) represented significant risk factors for both sexes. Using lifetime history of 4 and over sexual partners or inconsistent condom use as selective criteria allowed detection of 90.4% of infected females from 43.2% of the screened female population, and detection of 87.4% of infected males from 40.0% of the screened male population. Conclusions: On the basis of the resulting accurate epidemiological data, using risky sexual behaviors as a simple selective criteria will allow for efficient screening of infected individuals in nonmedical settings.
    136st APHA Annual Meeting and Exposition 2008; 10/2008
  • [Show abstract] [Hide abstract]
    ABSTRACT: Routine immunization is one of the most cost-effective interventions for the prevention of infectious disease. We have investigated the factors associated with the completion of five routine immunizations in Japan. About one thousand children who underwent a health checkup from April to December in 2004 participated in the study. A structured questionnaire was used to collect information on characteristics of the child: age at immunization, guardians' knowledge and attitude, and Child-Rearing. Immunization coverage rate was calculated. Associations between immunization and knowledge and attitude were calculated to get crude and adjusted odds ratios, using a logistic regression analysis. The coverage rate for the five vaccines was 70.5% in children under 3-year-old. BCG had the highest coverage rate (94.2%) of the five vaccines. The best source of information was notification from the local government at 92.4%. Completion of the administration of five immunizations was significantly associated with PCH-Pocketbook (OR=1.31, 95%CI:1.01-1.70); Child-Rearing Magazine (OR=1.77, 95%CI:1.23-2.55); intention to finish all the immunizations (OR=2.93, 95%CI:2.20-3.91); child care at a nursing school during the day (OR=0.49, 95%CI:0.37-0.64); and living in an urban area (OR=1.33, 95%CI:1.02-1.73). Adjusted odds ratios included child care at a nursing school during the day and living in an urban area, and they were significantly associated with Child-Rearing Magazine (OR=1.82, 95%CI:1.25-2.64) and intention to finish all the immunizations (OR=3.00, 95%CI:2.23-4.03). Our results suggested that Child-Rearing Magazine and scheduling all the immunizations promoted the administration of five vaccines to children under 3-year-old until newspapers and television suppressed the administration of the vaccines.
    136st APHA Annual Meeting and Exposition 2008; 10/2008
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Long-term care (LTC) insurance was introduced in Japan in 2000. Herein, we describe the trends in demand for LTC, using age-standardized and level-specific rates of entitlement and utilization of LTC at national and prefectural levels. We analyzed LTC data from 2002-2005 to examine: (i) the influence of population aging, calculating crude and age-standardized entitlement and utilization rates; (ii) the relation between baseline entitlement rate and increase in the rate over this 3-year period; and (iii) differences in increases in entitlement rate between low and high care levels. The entitlement and utilization rates increased even after adjustment for age; approximately two-thirds of the increase was not due to population aging. Variations in the entitlement rates among prefectures did not decrease (coefficient of variance was 0.12 in 2002 and 0.11 in 2005), and there was no significant correlation between baseline entitlement rates and the later increases among prefectures (r = -0.20, P = 0.19). The increase in entitlement rate was larger for low than for high care levels (31% vs 6%), and those for low and high care levels were weakly correlated. This study suggested that a large part of the increase in LTC demand could not be explained by population aging, and the increase did not result from equalization of LTC services across the country. In addition, it seems that the demands of low and high care levels depend on different factors. The increase in LTC demand should be monitored carefully to identify underlying factors and to ensure sustainability of the system.
    Geriatrics & Gerontology International 10/2008; 8(3):166-71.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A long-term care insurance (LTCI) system was introduced in 2000 in Japan. The clarification of information on the users and the ways in which services under this system have been utilized is essential for improving the system operation. This study was conducted for the purpose of clarifying what level of health-related quality of life (HRQOL) was achieved by individuals using the services under the LTCI system. The subjects were inhabitants of two cities in the Kyushu district of Japan who were receiving daily home care services under the LTCI system. To analyze the relationships of the beneficiaries' HRQOL with their characteristics, the dependent variable was the EuroQol-5D (EQ-5D) scores adopted as an index of HRQOL, and the independent variables comprised the demographic features (gender, age, and living condition) of users receiving long-term care service as well as their opinions about fees for services, satisfaction with the services provided, and the degree of support/care required. The EQ-5D score was higher for females than for males and higher for the subjects living alone than for those displaying any other family composition. EQ-5D score decreased with an increase in the degree of support/care required. Multivariate analysis revealed that the degree of support/care required, gender and living condition were found to serve as variables that significantly contribute to utility. Our analysis of the relationships between the characteristics of the LTCI beneficiaries and their HRQOL has yielded basic data that will be useful for improving the recently introduced LTCI system.
    Health Policy 04/2008; 85(3):349-55. · 1.55 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In Japan it was reported that about 9% of sexually active female teenagers had Chlamydia trachomatis. Most of them were asymptomatic, which may lead to continuing spread of the infection. Like C trachomatis, Mycoplasma genitalium is a pathogen in male non-gonococcal urethritis. However, few studies of the prevalence of M genitalium in the general population have been reported. The objective of this study was to determine the prevalence of M genitalium infection among younger females and to determine risk factors for this infection. The study was conducted between October 2005 and January 2006 using first voided urine specimens and questionnaires from female students of three vocational schools in the Miyazaki prefecture, Japan. C trachomatis was detected with Amplicor PCR. M genitalium was detected with inhibitor controlled real-time TaqMan PCR detecting the MgPa adhesion gene and with a PCR detecting the 16S rRNA. Risk factors associated with infection of M genitalium or C trachomatis were analysed with Fisher's exact test. Among 298 female, 249 (84%) had had experience of sexual intercourse. The prevalence of M genitalium was 2.8% (95% CI 0.76% to 4.86%) and the prevalence of C trachomatis was 8.8% (95% CI 5.31% to 12.36%). The risk factors of infection with M genitalium were more than five lifetime sexual partners and co-infection with C trachomatis.
    Sexually transmitted infections 02/2008; 84(4):303-5. · 2.18 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The prescription of potentially inappropriate medications (PIM) for elderly patients represents a major problem. In the published work, various practice characteristics associated with physicians prescribing habits have been reported. However, existing data has shed little light on the characteristics of physicians who tend to prescribe PIM. We examined whether personal, professional or practice characteristics differ between physicians who prescribe PIM and those who do not.Methods: The subjects comprised primary care and general practice physicians. Physicians were identified from the pharmacy database of a managed care organization as having prescribed medications for Medicare patients over 65 years enrolled in a managed care plan. We adopted Beers criteria to describe the prevalence of PIM use. The physicians were divided into three groups according to number of PIM prescribed. To examine the extent of associations between all the physician-related characteristics studied, polychotomous logistic regression was conducted.Results: Physicians who prescribed one to five PIMs were 0.63 (95% confidence interval [CI], 0.41–0.98) times more likely to have publications than physicians who prescribed no PIM. Physicians who prescribed more than six PIM were 3.18 (95% CI, 2.05–4.95) times more likely to be certified by an internal medicine board, 0.48 (95% CI, 0.30–0.78) times more likely to have publications, and 1.84 (95% CI, 1.01–3.35) times more likely to be in solo practice than physicians who prescribed no PIM.Conclusion: In this study, we found three predictors of PIM prescribing incidence. Since the current study could only describe associations and not causality, further research is necessary.
    Geriatrics & Gerontology International 12/2007; 7(4):380 - 387.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BCG immunization, utilizing whole-body coordination, is a highly cost-effective means of health intervention for preventing miliary tuberculosis (TB) and TB meningitis. In this study, we investigated the appropriate age by which a child should have completed his or her BCG immunization and discuss the current BCG immunization rate in Akita Prefecture, Japan. BCG immunization rates in urban and rural areas were 90.1% and 80.7%, respectively. Our immunization data were lower than the World Health Organization's (WHO) recommended rate. Immunization coverage rates in urban settings were higher than those in rural areas among infants four months to fifteen months of age, except for those six months old. We recommend: (1) completing BCG immunization by the age of twelve months, (2) preparing and educating parents for BCG immunization by means of a health policy, and (3) changing BCG immunization methods from group to individual inoculation. Immunization coverage rates may be increased or maintained to prevent miliary TB and TB meningitis.
    Journal of PHYSIOLOGICAL ANTHROPOLOGY 10/2007; 26(5):547-51. · 0.63 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to elucidate trends in socioeconomic inequalities in health during the past half century in Japan. Association of life expectancy and age-adjusted mortality with per capita income was examined using data on prefectures and municipalities in Japan of 1955 to 2000 via the slope index of inequality (SII) and Poisson regression. Although there were a few differences among health indicators and sex, health inequalities by prefecture, measured by the SII, decreased from 1955 to 1995. However, health inequalities increased from 1995 to 2000 both for life expectancy and mortality. Similar trends were found in municipal analyses: the association between income and mortality, measured by the rate ratio from Poisson regression, decreased until 1995 but increased from 1995 to 2000. In the past half century, and especially until 1995, geographical health inequalities decreased in Japan, while from 1995 to 2000 health inequalities appeared to increase. Recent social conditions including the possible increase in social inequalities may have contributed to this increase. Careful monitoring and elimination of social and health inequalities should be encouraged.
    Bioscience trends 08/2007; 1(1):38-42. · 1.58 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: There are several alternative indicators of income information, which is a fundamental measure of individual socioeconomic position. In this study, we compared the degrees of associations of four types of income information with health variables among Japanese adults. Using a nationally representative sample of 29,446 men and 32,917 women aged 20 years and over, the associations between four income indicators and health variables were examined using the odds ratio in logistic regression analysis and the concentration index by sex and age group (20-59 years and 60+ years). Income indicators consisted of total household income, equivalent household income, total household expenditure, and equivalent household expenditure. Current smoking and self-rated health statuses were used as health variables. A low income was associated with a high prevalence of smoking and fair/poor self-rated health, with some differences among sex and age groups and income indicators, but less difference among methods of statistical analyses. Total and equivalent incomes were similarly and more markedly associated with smoking and self-rated health statuses, whereas equivalent expenditure showed the smallest degree of health difference. For the population aged 60+ years, the degree of health differences in smoking was similar between income and expenditure. Although the degree of income-related health differences is dependent on health outcome and both sex and age group, this study suggests that either crude or equivalent household income is a useful indicator for health inequality among Japanese adults.
    Journal of Epidemiology 06/2007; 17(3):93-9. · 2.11 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Orogenital sex is recognized as a route for the transmission of Chlamydia trachomatis (CT) which thus causes male chlamydial urethritis. Patients with a pharyngeal CT infection have no gross lesions, but CT was tested by pharyngeal swabs. In this study, the usefulness of oral wash specimens for detecting CT was compared to that of swab specimens. In addition, oral wash specimens were also used to screen for CT pharyngeal infection. Eighteen female commercial sex workers in whom CT was detected from pharyngeal swabs were re-examined using both methods. The positive rate for CT was 44% by swabs and 61% by oral wash specimens. Forty-eight male students with CT-positive urine were also screened for pharyngeal CT infection. The positive rates were 6% by swabs and 10% by oral wash specimens. Our findings therefore indicate that oral wash specimens more effectively detected pharyngeal CT infection than pharyngeal swabs.
    International Journal of Urology 06/2007; 14(5):473-5. · 1.73 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Since standard radical mastectomy was established by Halsted for breast cancer, surgical procedures for breast cancer have been changed according to the results of randomized controlled trials. Breast-conserving treatment is now regarded as a standard local treatment for early breast cancer. More recently, sentinel node biopsy is becoming popular as an alternative procedure to axillary node dissection for nodal staging. These new procedures have been believed to be better in terms of patients’ quality of life in comparison with previous surgical procedures without impairing prognosis. Many studies regarding the quality of life (QOL) of patients after such procedures have been reported. Here we review those data, especially of studies comparing quality of life of patients after mastectomy and breast-conserving treatment, and of those after axillary node dissection and sentinel node biopsy. Viewpoints and issues on surgical treatment-related QOL are discussed.
    Breast Cancer 05/2007; 14(2):254. · 1.33 Impact Factor
  • Article: Erratum.
    Breast Cancer 05/2007; 14(2):254. · 1.33 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cancer screening has become common in Japan. However, little is known about the socioeconomic factors affecting cancer screening participation. This study was performed to examine the association between socioeconomic status and cancer screening participation in Japanese males. Using the data of 23,394 males sampled from across Japan, the associations between self-reported participation in screenings for three types of cancer (i.e., stomach, lung and colon) and socioeconomic variables, including marital status, types of residential area (metropolitan/nonmetropolitan), household income, and employment status, were examined using multilevel logistic regression by age group (40 to 64 and ≥65 years). The cancer screening participation rates were 34.5% (stomach), 21.3% (lung), and 24.8% (colon) for the total population studied. Being married, living in a nonmetropolitan area, having a higher income and being employed in a large-scale company showed independent associations with a higher rate of cancer screening participation for all three types of cancer. Income-related differences in cancer screening were more pronounced in the middle-aged population than in the elderly population, and in metropolitan areas than in nonmetropolitan areas. There are notable socioeconomic differences in cancer screening participation in Japan. To promote cancer screening, socioeconomic factors should be considered, particularly for middle-aged and urban residents.
    Environmental Health and Preventive Medicine 03/2007; 12(2):90-6.

Publication Stats

452 Citations
79.31 Total Impact Points

Institutions

  • 2006–2010
    • National Institute of Public Health
      Saitama, Saitama, Japan
  • 2005–2010
    • Asahikawa Medical University
      • Department of Health Science
      Asakhigava, Hokkaidō, Japan
    • Showa University
      • Department of Surgery
      Shinagawa, Tōkyō, Japan
  • 2007
    • Shikoku Cancer Center
      Matuyama, Ehime, Japan
  • 2004–2005
    • Miyazaki University
      Миядзаки, Miyazaki, Japan
  • 2002
    • Tokyo Metropolitan Police Hospital
      Edo, Tōkyō, Japan