Bird flu has spread to the hilly Darjeeling district of eastern India which has been hit by avian influenza several times already this year, a minister said today. Meanwhile, a dead swan tested positive for the virulent H5N1 strain of bird flu in northern Japan, local authorities said today, the third confirmed case in the past month in the country.

Japanese officials are worried that the H5N1 bird flu virus may be spreading among wild birds in the north after the body of a swan tested positive for the disease, the third case in recent weeks. No poultry have been affected so far, said Shigeki Oda, a farm official in the northern island of Hokkaido.

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Keichan aka broiled seasoned chicken with cabbages is a locally grown food in Gifu prefecture, Japan. It is a marinade of chicken with special sauces made of miso and soy sauces.

This paper summarizes Bacillus Calmette-Guerin (BCG) vaccination and revaccination policies in Japan, its cost-effectiveness, side effects, proposed selective vaccination strategy, and present tuberculosis situation in Japanese perspectives based on Medline database and other published reports. Universal BCG vaccination in infants and revaccination among children were not found economically justifiable. Overall tuberculosis incidence in Japan is higher than that of other developed countries. Trend of decline in tuberculosis incidence is similar to that of the countries where universal BCG vaccination has never been implemented. In the recent years, the number of tuberculosis group infection has been escalating. Since BCG revaccination program has already been discontinued, a consensus on universal BCG vaccination is also essential based on social, political, and economical factors. Side by side, more pragmatic strategies such as well-defined tuberculin test, selective vaccination policy based on tuberculosis incidence in each administrative zone, and early vaccination of high risk groups, should be formulated.

BACKGROUND: Influenza is a major cause of morbidity and mortality in Japan and worldwide, especially for people of >65 years old and those with high-risk medical conditions. Although the influenza vaccine is effective in reducing the morbidity and mortality, the vaccine coverage rate has not increased adequately in Japan, compared with western countries. OBJECTIVE: Our aim was to assess whether medical and personal characteristics are associated with receiving influenza vaccination in Japanese patients. METHODS: Out-patients of a city hospital were recruited for a case-control study between November 1998 and February 1999. Cases were 98 out-patients aged 18 years or older who received influenza vaccination. Controls were 112 non-vaccinated out-patients matched with cases for primary physician and date of clinic visit. The candidates were interviewed by telephone and asked to respond to a 26-item questionnaire. The data were analysed using multiple logistic regression models. RESULTS: The factors associated with the acceptance of influenza vaccination were: (i) recommendation by a family member and/or a close friend [odds ratio (OR) 17.74; 95% confidence interval (CI) 1.95-161.77]; (ii) belief in influenza vaccine efficacy (OR 10.55; 95% CI 3.42-32.49); (iii) having a family member and/or friends who had been vaccinated before (OR 6.44; 95% CI 2.37-17.50); (iv) physician?s recommendation (OR 4.03; 95% CI 1.42-11.37); and (v) knowledge about the influenza vaccine (OR 3.06; 95% CI 1.02-9.20). Fear of adverse reactions (OR 0.21; 95% CI 0.07-0.66) was the sole factor associated with non-acceptance of influenza vaccine. CONCLUSION: Patients in Japan are likely to be greatly influenced by their family members or close friends in their decision of whether to accept influenza vaccination, unlike US patients who make health care decisions on their own. When implementing an influenza vaccination programme, this effect of cultural background observed in Japan should be taken into account in other countries.

PURPOSE: Trust is a cornerstone of the physician-patient relationship. We investigated the relation of patient characteristics, religiosity, acculturation, physician ethnicity, and insurance-mandated physician change to levels of trust in Japanese American and Japanese patients. METHODS: A self-administered, cross-sectional questionnaire in English and Japanese (completed in the language of their choice) was given to community-based samples of 539 English-speaking Japanese Americans, 340 Japanese-speaking Japanese Americans, and 304 Japanese living in Japan. RESULTS: Eighty-seven percent of English-speaking Japanese Americans, 93% of Japanese-speaking Japanese Americans, and 58% of Japanese living in Japan responded to trust items and reported mean trust scores of 83, 80, and 68, respectively, on a scale ranging from 0 to 100. In multivariate analyses, English-speaking and Japanese-speaking Japanese American respondents reported more trust than Japanese respondents living in Japan (P values <.001). Greater religiosity (P <.001), less desire for autonomy (P <.001), and physician-patient relationships of longer duration (P <.001) were related to increased trust. Among Japanese Americans, more acculturated respondents reported more trust (P <.001), and Japanese physicians were trusted more than physicians of another ethnicity. Among respondents prompted to change physicians because of insurance coverage, the 48% who did not want to switch reported less trust in their current physician than in their former physician (mean score of 82 vs 89, P <.001). CONCLUSIONS: Religiosity, autonomy preference, and acculturation were strongly related to trust in one?s physician among the Japanese American and Japanese samples studied and may provide avenues to enhance the physician-patient relationship. The strong relationship of trust with patient-physician ethnic match and the loss of trust when patients, in retrospect, report leaving a preferred physician suggest unintended consequences to patients not able to continue with their preferred physicians.

The objective of this study was to evaluate the association between living close to traffic and health related quality of life (HRQOL) that is important to the health outcome. We administered a questionnaire including the Medical Outcome Study Short Form-36-item Health Survey to all 6197 residents living in Naie, aged 20 years and older, and received 5107 (82.4%) responses. The respondents were classified into three groups: those whose bedrooms were located to an arterial road (AR), located to other roads (OR), and not located to any road (NR). We used analysis of covariance to estimate the mean differences among the three groups for each SF-36 domain. HRQOL scores of the AR and the OR group were lower than those of the NR group in all domains. The adjusted mean scores of the AR group on "mental health" and "vitality" domains were significantly lower than those of the NR group. This study suggests that the HRQOL is an effective tool for evaluating the many impacts of road transportation on aspects of health.

Previous studies reported inconsistent relationship between the preference for information and that for decisional autonomy in medical encounters. We hypothesized that the relationship may be dependent on people?s attribution beliefs on health. To test the hypothesis, demographically representative sample of Japanese population over the age of 18 (N = 3395) were invited into self-administered questionnaire survey. Preferences for information and decisional autonomy were measured by a translated version of autonomy preference index. Health attribution was measured by a scale modified from multi-dimensional health locus of control scales. After adjusting for socio-economic status, multivariable linear regression analysis revealed that information preference was positively associated with decisional preference among individuals who believed their health is less dependent on influential others. However, the reversed relationship was observed in case of individuals with attribution to others. The results suggested that individuals may use medical information for different purposes according to the types of health-related attribution beliefs.