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ギルモー スチュアート ギルモー スチュアート

所属・職名:公衆衛生学  教授
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更新日: 20/09/02 05:13

研究者基本情報

学位

  • Masters of Public Health(University of Sydney School of Medicine)
  • Masters of Statistics(University of New South Wales)
  • Doctor of Philosophy(University of Tokyo)

学歴

  • 2012年- 2015年University of Tokyo Medicine
  • 2003年- 2005年University of New South Wales Mathematics and Statistics
  • 2000年- 2002年University of Sydney Medicine
  • 1994年- 1995年Unviersity of Adelaide Science
  • 1991年- 1994年University of Adelaide Science

経歴

  • 2018年04月- 現在聖ルカ国際大学 公衆衛生大学院 教授
  • 2016年06月- 2018年04月東京大学 大学院医学系研究科国際保健政策学教室 准教授
  • 2011年04月- 2016年06月東京大学 大学院医学系研究科国際保健政策学教室 助教
  • 2010年04月- 2011年03月立命館太平洋大学 非常勤講師
  • 2008年05月- 2009年12月キングズファンド 政策部 リサーチフェロー
  • 2002年08月- 2006年03月ナショナル・ドラッグ・アンド・アルコール・リサーチ・センター 統計学者
  • 1998年12月- 2002年08月キルケトン・ロード・センター 研究コーディネーター

研究活動情報

研究分野

  • ライフサイエンス / 衛生学、公衆衛生学分野:実験系を含まない / Health policy evaluation
  • ライフサイエンス / 衛生学、公衆衛生学分野:実験系を含む / Health policy evaluation
  • ライフサイエンス / 衛生学、公衆衛生学分野:実験系を含まない / Health policy evaluation
  • ライフサイエンス / 衛生学、公衆衛生学分野:実験系を含む / Health policy evaluation
  • ライフサイエンス / 医療管理学、医療系社会学 / Health inequality

研究キーワード

    Public health , Epidemiology , Statistics , Quantitiative Health System Assessment

論文

  • Effect of health literacy on quality of life among patients with chronic heart failure in China.
    Junhua Zhang, Stuart Gilmour, Yancun Liu, Erika Ota
    Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation 29(2) 453-461 2020年02月 [査読有り]
    PURPOSE: Despite advances in treatment and management, Chronic heart failure (CHF) is still associated with poor prognosis, a high rate of hospitalization and readmission, and reduced quality of life (QOL). However, the relationship between QOL and health literacy in patients with CHF remains unclear. This study aimed to examine the association between health literacy and QOL, among Chinese patients with CHF. METHOD: This is a cross-sectional study of a convenience sample from a cardiovascular hospital in Henan Province in China. Subjects completed a self-administered questionnaire that assessed the heart failure-specific health literacy score. QOL was measured using the Minnesota Living with heart failure scale. Unadjusted and adjusted multiple linear regression were used to explore the association between health literacy and QOL. RESULTS: This study sampled 299 patients, with a mean age of 61.9 ± 14.9 years old. The association between health literacy and QOL was significant only in the unadjusted model (P < 0.001) and was no longer statistically significant after controlling for covariates. The final best-fitted model identified 9 significant predictors, accounting for 38.6% of the variance in quality of life. CONCLUSIONS: This study suggests that there is no relationship between health literacy and QOL in Chinese CHF patients after adjusting for covariates. Residence, monthly income, self-care management, self-efficacy and social support are significantly associated with QOL. Compared patients with high health literacy, patients with low health literacy may have problems comprehending healthcare information and following disease management instructions, which might contribute to diminished QOL. Therefore, in clinical practice, effective interventions such as creating appropriate materials for low-literacy patients and performing education to raise self-care management, self-efficacy, might improve the QOL of patients with CHF.
  • Prevalence of Intimate Partner Violence and Associated Factors Among Men Who Have Sex with Men in China.
    Wei D, Hou F, Hao C, Gu J, Dev R, Cao W, Peng L, Gilmour S, Wang K, Li J
    Journal of interpersonal violence 886260519889935 2019年12月 [査読有り]
  • Suicide Mortality in Foreign Residents of Japan.
    Gilmour S, Hoshino H, Dhungel B
    International journal of environmental research and public health 16(17) 2019年08月 [査読有り]
  • Trends in Suicide Mortality by Method from 1979 to 2016 in Japan.
    Dhungel B, Sugai MK, Gilmour S
    International journal of environmental research and public health 16(10) 2019年05月 [査読有り]
  • The Effect of the Australian National Firearms Agreement on Suicide and Homicide Mortality, 1978-2015.
    Gilmour S, Wattanakamolkul K, Sugai MK
    American journal of public health 108(11) 1511-1516 2018年11月 [査読有り]
  • Effect of seawalls on tsunami evacuation departure in the 2011 Great East Japan Earthquake.
    Troncoso Parady G, Tran B, Gilmour S
    Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention 25(6) 535-539 2018年11月 [査読有り]
  • A mathematical model of biomedical interventions for HIV prevention among men who have sex with men in China.
    Li J, Peng L, Gilmour S, Gu J, Ruan Y, Zou H, Hao C, Hao Y, Lau JT
    BMC infectious diseases 18(1) 600 2018年11月 [査読有り]
  • Prevalence and Correlates of Hypertension among Japanese Adults, 1975 to 2010.
    Otani K, Haruyama R, Gilmour S
    International journal of environmental research and public health 15(8) 2018年08月 [査読有り]
  • Causes and risk factors for singleton stillbirth in Japan: Analysis of a nationwide perinatal database, 2013-2014.
    Rei Haruyama, Stuart Gilmour, Erika Ota, Sarah K Abe, Md Mizanur Rahman, Shuhei Nomura, Naoyuki Miyasaka, Kenji Shibuya
    Scientific reports 8(1) 4117-4117 2018年03月 [査読有り]
    Over 80% of perinatal mortality in Japan is due to stillbirths after 22 weeks of gestation, with one in 300 families experiencing fetal loss every year. This study aimed to assess causes and risk factors for singleton stillbirth in Japan. A retrospective cross-sectional study was conducted using the Japan Society of Obstetrics and Gynecology Perinatal Database from January 2013 to December 2014. A total of 379,211 births including 2,133 stillbirths were analyzed. Causes of death were classified into eight categories. A multi-level Poisson regression model was used to assess the relationship between stillbirth and key covariates. Causes of death were unknown in 25-40% of stillbirths across gestational age. Placental abnormality accounted for the largest proportion of known causes, followed by umbilical cord abnormality. Stillbirth risk was increased among small-for-gestational-age infants (adjusted relative risk [ARR]: 3.78, 95% confidence interval [CI]: 3.31-4.32) and nulliparous women (ARR: 1.19, 95% CI: 1.05-1.35). Maternal underweight, pregnancy-induced hypertension and oligohydramnios showed a protective effect. Our finding suggests that stillbirths occurring among women with known complications are likely already being prevented. Further reduction in stillbirths must target small-sized fetuses and nulliparous women. Improved recording of the causal pathways of stillbirths is also needed.
  • Trends in, and projections of, indicators of universal health coverage in Bangladesh, 1995-2030: a Bayesian analysis of population-based household data.
    Md Shafiur Rahman, Md Mizanur Rahman, Stuart Gilmour, Khin Thet Swe, Sarah Krull Abe, Kenji Shibuya
    The Lancet. Global health 6(1) e84-e94-e94 2018年01月 [査読有り]
    BACKGROUND: Many countries are implementing health system reforms to achieve universal health coverage (UHC) by 2030. To understand the progress towards UHC in Bangladesh, we estimated trends in indicators of the health service and of financial risk protection. We also estimated the probability of Bangladesh's achieving of UHC targets of 80% essential health-service coverage and 100% financial risk protection by 2030. METHODS: We estimated the coverage of UHC indicators-13 prevention indicators and four treatment indicators-from 19 nationally representative population-based household surveys done in Bangladesh from Jan 1, 1991, to Dec 31, 2014. We used a Bayesian regression model to estimate the trend and to predict the coverage of UHC indicators along with the probabilities of achieving UHC targets of 80% coverage of health services and 100% coverage of financial risk protection from catastrophic and impoverishing health payments by 2030. We used the concentration index and relative index of inequality to assess wealth-based inequality in UHC indicators. FINDINGS: If the current trends remain unchanged, we estimated that coverage of childhood vaccinations, improved water, oral rehydration treatment, satisfaction with family planning, and non-use of tobacco will achieve the 80% target by 2030. However, coverage of four antenatal care visits, facility-based delivery, skilled birth attendance, postnatal checkups, care seeking for pneumonia, exclusive breastfeeding, non-overweight, and adequate sanitation were not projected to achieve the target. Quintile-specific projections showed wide wealth-based inequality in access to antenatal care, postnatal care, delivery care, adequate sanitation, and care seeking for pneumonia, and this inequality was projected to continue for all indicators. The incidence of catastrophic health expenditure and impoverishment were projected to increase from 17% and 4%, respectively, in 2015, to 20% and 9%, respectively, by 2030. Inequality analysis suggested that wealthiest households would disproportionately face more financial catastrophe than the most disadvantaged households. INTERPRETATION: Despite progress, Bangladesh will not achieve the 2030 UHC targets unless the country scales up interventions related to maternal and child health services, and reforms health financing systems to avoid high dependency on out-of-pocket payments. The introduction of a national health insurance system, increased public funding for health care, and expansion of community-based clinics in rural areas could help to move the country towards UHC. FUNDING: Japan Ministry of Health, Labour, and Welfare.
  • Cost and economic burden of illness over 15 years in Nepal: A comparative analysis.
    Khin Thet Swe, Md Mizanur Rahman, Md Shafiur Rahman, Eiko Saito, Sarah K Abe, Stuart Gilmour, Kenji Shibuya
    PloS one 13(4) e0194564 2018年 [査読有り]
    BACKGROUND: With an increasing burden of non-communicable disease in Nepal and limited progress towards universal health coverage, country- and disease-specific estimates of financial hardship related to healthcare costs need to be evaluated to protect the population effectively from healthcare-related financial burden. OBJECTIVES: To estimate the cost and economic burden of illness and to assess the inequality in the financial burden due to catastrophic health expenditure from 1995 to 2010 in Nepal. METHODS: This study used nationally representative Nepal Living Standards Surveys conducted in 1995 and 2010. A Bayesian two-stage hurdle model was used to estimate average cost of illness and Bayesian logistic regression models were used to estimate the disease-specific incidence of catastrophic health payment and impoverishment. The concentration curve and index were estimated by disease category to examine inequality in healthcare-related financial hardship. FINDINGS: Inflation-adjusted mean out-of-pocket (OOP) payments for chronic illness and injury increased by 4.6% and 7.3%, respectively, while the cost of recent acute illness declined by 1.5% between 1995 and 2010. Injury showed the highest incidence of catastrophic expenditure (30.7% in 1995 and 22.4% in 2010) followed by chronic illness (12.0% in 1995 and 9.6% in 2010) and recent acute illness (21.1% in 1995 and 7.8% in 2010). Asthma, diabetes, heart conditions, malaria, jaundice and parasitic illnesses showed increased catastrophic health expenditure over time. Impoverishment due to injury declined most (by 12% change in average annual rate) followed by recent acute illness (9.7%) and chronic illness (9.6%) in 15 years. Inequality analysis indicated that poorer populations with recent acute illness suffered more catastrophic health expenditure in both sample years, while wealthier households with injury and chronic illnesses suffered more catastrophic health expenditure in 2010. CONCLUSION: To minimize the economic burden of illness, several approaches need to be adopted, including social health insurance complemented with an upgraded community-based health insurance system, subsidy program expansion for diseases with high economic burden and third party liability motor insurance to reduce the economic burden of injury.
  • An evaluation of fertility- and migration-based policy responses to Japan's ageing population.
    Parsons AJQ, Gilmour S
    PloS one 13(12) e0209285 2018年 [査読有り]
  • Assessment of medium-term cardiovascular disease risk after Japan's 2011 Fukushima Daiichi nuclear accident: a retrospective analysis.
    Haruka Toda, Shuhei Nomura, Stuart Gilmour, Masaharu Tsubokura, Tomoyoshi Oikawa, Kiwon Lee, Grace Y Kiyabu, Kenji Shibuya
    BMJ open 7(12) e018502 2017年12月 [査読有り]
    OBJECTIVE: To assess the medium-term indirect impact of the 2011 Fukushima Daiichi nuclear accident on cardiovascular disease (CVD) risks and to identify whether risk factors for CVD changed after the accident. PARTICIPANTS: Residents aged 40 years and over participating in annual public health check-ups from 2009 to 2012, administered by Minamisoma city, located about 10 to 40 km from the Fukushima Daiichi nuclear plant. METHODS: The sex-specific Framingham CVD risk score was considered as the outcome measure and was compared before (2009-2010) and after the accident (2011-2012). A multivariate regression analysis was employed to evaluate risk factors for CVD. RESULTS: Data from 563 individuals (60.2% women) aged 40 to 74 years who participated in the check-ups throughout the study period was analysed. After adjusting for covariates, no statistically significant change was identified in the CVD risk score postaccident in both sexes, which may suggest no obvious medium-term health impact of the Fukushima nuclear accident on CVD risk. The risk factors for CVD and their magnitude and direction (positive/negative) did not change after the accident. CONCLUSIONS: There was no obvious increase in CVD risks in Minamisoma city, which may indicate successful management of health risks associated with CVD in the study sample.
  • Excess mortality due to indirect health effects of the 2011 triple disaster in Fukushima, Japan: a retrospective observational study
    Tomohiro Morita, Shuhei Nomura, Masaharu Tsubokura, Claire Leppold, Stuart Gilmour, Sae Ochi, Akihiko Ozaki, Yuki Shimada, Kana Yamamoto, Manami Inoue, Shigeaki Kato, Kenji Shibuya, Masahiro Kami
    JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH 71(10) 974-980 2017年10月 [査読有り]
    Background Evidence on the indirect health impacts of disasters is limited. We assessed the excess mortality risk associated with the indirect health impacts of the 2011 triple disaster (earthquake, tsunami and nuclear disaster) in Fukushima, Japan. Methods The mortality rates in Soma and Minamisoma cities in Fukushima from 2006 to 2015 were calculated using vital statistics and resident registrations. We investigated the excess mortality risk, defined as the increased mortality risk between postdisaster and predisaster after excluding direct deaths attributed to the physical force of the disaster. Multivariate Poisson regression models were used to estimate the relative risk (RR) of mortality after adjusting for city, age and year. Results There were 6163 and 6125 predisaster and postdisaster deaths, respectively. The postdisaster mortality risk was significantly higher in the first month following the disaster (March 2011) than in the same month during the predisaster period (March 2006-2010). RRs among men and women were 2.64 (95% CI 2.16 to 3.24) and 2.46 (95% CI 1.99 to 3.03), respectively, demonstrating excess mortality risk due to the indirect health effects of the disaster. Age-specific subgroup analyses revealed a significantly higher mortality risk in women aged >= 85 years in the third month of the disaster compared with predisaster baseline, with an RR (95% CI) of 1.73 (1.23 to 2.44). Conclusions Indirect health impacts are most severe in the first month of the disaster. Early public health support, especially for the elderly, can be an important factor for reducing the indirect health effects of a disaster.
  • Trends in Policy on the Prevention and Control of Non-Communicable Diseases in Japan.
    Ezoe S, Noda H, Akahane N, Sato O, Hama T, Miyata T, Terahara T, Fujishita M, Sakamoto H, Abe SK, Gilmour S, Shobayashi T
    Health systems and reform 3(4) 268-277 2017年10月 [査読有り]
  • Progress Toward Universal Health Coverage A Comparative Analysis in 5 South Asian Countries
    Md. Mizanur Rahman, Anup Karan, Md. Shafiur Rahman, Alexander Parsons, Sarah Krull Abe, Ver Bilano, Rabia Awan, Stuart Gilmour, Kenji Shibuya
    JAMA INTERNAL MEDICINE 177(9) 1297-1305 2017年09月 [査読有り]
    IMPORTANCE Achieving universal health coverage is one of the key targets in the newly adopted Sustainable Development Goals of the United Nations. OBJECTIVE To investigate progress toward universal health coverage in 5 South Asian countries and assess inequalities in health services and financial risk protection indicators. DESIGN AND SETTINGS In a population-based study, nationally representative household (335 373 households) survey data from Afghanistan (2014 and 2015), Bangladesh (2010 and 2014), India (2012 and 2014), Nepal (2014 and 2015), and Pakistan (2014) were used to calculate relative indices of health coverage, financial risk protection, and inequality in coverage among wealth quintiles. The study was conducted from June 2012 to February 2016. MAIN OUTCOMES AND MEASURES Three dimensions of universal health coveragewere assessed: access to basic services, financial risk protection, and equity. Composite and indicator-specific coverage rates, stratified by wealth quintiles, were then estimated. Slope and relative index of inequality were used to assess inequalities in service and financial indicators. RESULTS Access to basic care varied substantially across all South Asian countries, with mean rates of overall prevention coverage and treatment coverage of 53.0%(95% CI, 42.2%-63.6%) and 51.2%(95% CI, 45.2%-57.1%) in Afghanistan, 76.5%(95% CI, 61.0%-89.0%) and 44.8% (95% CI, 37.1%-52.5%) in Bangladesh, 74.2%(95% CI, 57.0%-88.1%) and 83.5%(95% CI, 54.4%-99.1%) in India, 76.8%(95% CI, 66.5%-85.7%) and 57.8%(95% CI, 50.1%-65.4%) in Nepal, and 69.8%(95% CI, 58.3%-80.2%) and 50.4%(95% CI, 37.1%-63.6%) in Pakistan. Financial risk protectionwas generally low, with 15.3%(95% CI, 14.7%-16.0%) of respondents in Afghanistan, 15.8% (95% CI, 14.9%-16.8%) in Bangladesh, 17.9%(95% CI, 17.7%-18.2%) in India, 11.8%(95% CI, 11.8%-11.9%) in Nepal, and 4.4%(95% CI, 4.0%-4.9%) in Pakistan reporting incurred catastrophic payments due to health care costs. Access to at least 4 antenatal care visits, institutional delivery, and presence of skilled attendant during deliverywere at least 3 times higher among thewealthiest mothers in Afghanistan, Bangladesh, Nepal, and Pakistan compared with the rates among poor mothers. Access to institutional deliverywas 60 to 65 percentage points higher amongwealthy than poor mothers in Afghanistan, Bangladesh, Nepal, and Pakistan compared with 21 percentage points higher in India. Coveragewas least equitable among the countries for adequate sanitation, institutional delivery, and the presence of skilled birth attendants. CONCLUSIONS AND RELEVANCE Health coverage and financial risk protection was low, and inequality in access to health care remains a serious issue for these South Asian countries. Greater progress is needed to improve treatment and preventive services and financial security.
  • Prolonged Excretion of Poliovirus among Individuals with Primary Immunodeficiency Disorder: An Analysis of the World Health Organization Registry
    Grace Macklin, Yi Liao, Marina Takane, Kathleen Dooling, Stuart Gilmour, Ondrej Mach, Olen M. Kew, Roland W. Sutter
    FRONTIERS IN IMMUNOLOGY 8 1103 2017年09月 [査読有り]
    Individuals with primary immunodeficiency disorder may excrete poliovirus for extended periods and will constitute the only remaining reservoir of virus after eradication and withdrawal of oral poliovirus vaccine. Here, we analyzed the epidemiology of prolonged and chronic immunodeficiency-related vaccine-derived poliovirus cases in a registry maintained by the World Health Organization, to identify risk factors and determine the length of excretion. Between 1962 and 2016, there were 101 cases, with 94/101 (93%) prolonged excretors and 7/101 (7%) chronic excretors. We documented an increase in incidence in recent decades, with a shift toward middle-income countries, and a predominance of poliovirus type 2 in 73/101 (72%) cases. The median length of excretion was 1.3 years (95% confidence interval: 1.0, 1.4) and 90% of individuals stopped excreting after 3.7 years. Common variable immunodeficiency syndrome and residence in high-income countries were risk factors for long-term excretion. The changing epidemiology of cases, manifested by the greater incidence in recent decades and a shift to from high-to middle-income countries, highlights the expanding risk of poliovirus transmission after oral poliovirus vaccine cessation. To better quantify and reduce this risk, more sensitive surveillance and effective antiviral therapies are needed.
  • The future burden of disability in the UK: the time for urgent action is now
    Stuart Gilmour
    The Lancet Public Health 2(7) e298-e299 2017年07月 [査読有り]
  • Trends in perinatal mortality and its risk factors in Japan: Analysis of vital registration data, 1979-2010
    Maaya Kita Sugai, Stuart Gilmour, Erika Ota, Kenji Shibuya
    SCIENTIFIC REPORTS 7 46681 2017年04月 [査読有り]
    As Japan has achieved one of the lowest perinatal mortality rates (PMR), our study aims to estimate trends in and risk factors for perinatal mortality among singleton births in Japan. We used Japanese vital registration data to assess trends in and risk factors for perinatal outcomes between 1979 and 2010. Birth and death registration data were merged. An autoregressive integrated moving average model was fitted separately by sex to the PMR and the proportion of stillbirths. A multilevel Poisson regression model was used to estimate risk factors for perinatal mortality. Between 1979 and 2010 there were 40,833,957 pregnancies and 355,193 perinatal deaths, the PMR decreased from 18.86 per 1,000 all births to 3.25 per 1,000 all births, and the proportion of stillbirths increased from 83.6% to 92.1%. Key risk factors for perinatal mortality were low or high birth weight, prematurity and post maturity, and being from poorer or unemployed families. A higher proportion of excess perinatal deaths could be averted by effective policies to prevent stillbirths and improved research into their interventions and risk factors. As the cost and challenge of maintaining perinatal mortality gains increases, policies need to be targeted towards higher risk groups and social determinants of health.
  • Inequality and inequity in healthcare utilization in urban Nepal: a cross-sectional observational study
    Eiko Saito, Stuart Gilmour, Daisuke Yoneoka, Ghan Shyam Gautam, Md Mizanur Rahman, Pradeep Krishna Shrestha, Kenji Shibuya
    HEALTH POLICY AND PLANNING 31(7) 817-824 2016年09月 [査読有り]
    Inequality in access to quality healthcare is a major health policy challenge in many low- and middle-income countries. This study aimed to identify the major sources of inequity in healthcare utilization using a population-based household survey from urban Nepal. A cross-sectional survey was conducted covering 9177 individuals residing in 1997 households in five municipalities of Kathmandu valley between 2011 and 2012. The concentration index was calculated and a decomposition method was used to measure inequality in healthcare utilization, along with a horizontal inequity index (HI) to estimate socioeconomic inequalities in healthcare utilization. Results showed a significant pro-rich distribution of general healthcare utilization in all service providers (Concentration Index: 0.062, P < 0.001; HI: 0.029, P < 0.05) and private service providers (Concentration Index: 0.070, P < 0.001; HI: 0.030, P < 0.05). The pro-rich distribution of probability in general healthcare utilization was attributable to inequalities in the level of household economic status (percentage contribution: 67.8%) and in the self-reported prevalence of non-communicable diseases such as hypertension (36.7%) and diabetes (14.4%). Despite the provision of free services by public healthcare providers, our analysis found no evidence of the poor making more use of public health services (Concentration Index: 0.041, P = 0.094). Interventions to reduce the household economic burden of major illnesses, coupled with improvement in the management of public health facilities, warrant further attention by policy-makers.
  • An evaluation of early countermeasures to reduce the risk of internal radiation exposure after the Fukushima nuclear incident in Japan
    Shuhei Nomura, Masaharu Tsubokura, Stuart Gilmour, Ryugo S. Hayano, Yuni N. Watanabe, Masahiro Kami, Yukio Kanazawa, Tomoyoshi Oikawa
    HEALTH POLICY AND PLANNING 31(4) 425-433 2016年05月 [査読有り]
    After a radiation-release incident, intake of radionuclides in the initial stage immediately following the incident may be the major contributor to total internal radiation exposure for individuals in affected areas. However, evaluation of early internal contamination risk is greatly lacking. This study assessed the relationship between initial stage evacuation/indoor sheltering and internal radiation contamination levels 4 months after the 2011 Fukushima nuclear incident in Japan and estimated potential pathways of the contamination. The study population comprised 525 participants in the internal radiation screening program at Minamisoma Municipal General Hospital, 23km north of the Fukushima nuclear plant. The analysed dataset included the results of a screening performed in July 2011, 4 months after the incident, and of a questionnaire on early-incident response behaviours, such as sheltering indoors and evacuations, completed by participants. Association between such early countermeasures and internal contamination levels of cesium-134 were assessed using Tobit multiple regression analyses. Our study shows that individuals who evacuated to areas outside Fukushima Prefecture had similar contamination levels of cesium-134 to individuals who stayed in Fukushima (relative risk: 0.86; 95% confidence interval: 0.74-0.99). Time spent outdoors had no significant relationship with contamination levels. The effects of inhalation from radiological plumes released from the nuclear plant on total internal radiation contamination might be so low as to be undetectable by the whole-body counting unit used to examine participants. Given the apparent limited effectiveness of evacuation and indoor sheltering on internal contamination, the decision to implement such early responses to a radiation-release incident should be made by carefully balancing their potential benefits and health risks.
  • Health Insurance Coverage and Hypertension Control in China: Results from the China Health and Nutrition Survey
    Yi Liao, Stuart Gilmour, Kenji Shibuya
    PLOS ONE 11(3) e0152091 2016年03月 [査読有り]
    Background China has rapidly expanded health insurance coverage over the past decade but its impact on hypertension control is not well known. We analyzed factors associated with hypertension and the impact of health insurance on the management of hypertension in China from 1991 to 2009. Methods and Findings We used individual-level data from the China Health and Nutrition Survey (CHNS) for blood pressure, BMI, and other socio-economic variables. We employed multi-level logistic regression models to estimate the factors associated with prevalence and management of hypertension. We also estimated the effects of health insurance on management of hypertension using propensity score matching. We found that prevalence of hypertension increased from 23.8% (95% CI: 22.5-25.1%) in 1991 to 31.5% (28.5-34.7%) in 2009. The proportion of hypertensive patients aware of their condition increased from 31.7%(28.7-34.9%) to 51.1% (45.1-57.0%). The proportion of diagnosed hypertensive patients in treatment increased by 35.5% in the 19 years, while the proportion of those in treatment with controlled blood pressure remained low. Among diagnosed hypertensives, health insurance increased the probability of receiving treatment by 28.7% (95% CI: 10.6-46.7%) compared to propensity-matched individuals not covered by health insurance. Conclusions Hypertension continues to be a major health threat in China and effective control has not improved over time despite large improvements in awareness and treatment access. This suggests problems in treatment quality, medication adherence and patient understanding of the condition. Improvements in hypertension management, quality of medical care for those at high risk, and better health insurance packages are needed.
  • Inequality in mortality by occupation related to economic crisis from 1980 to 2010 among working-age Japanese males
    Koji Wada, Stuart Gilmour
    SCIENTIFIC REPORTS 6 22255 2016年03月 [査読有り]
    The mortality rate for Japanese males aged 30-59 years in managerial and professional spiked in 2000 and remains worse than that of other occupations possibly associated with the economic downturn of the 1990s and the global economic stagnation after 2008. The present study aimed to assess temporal occupation-specific mortality trends from 1980 to 2010 for Japanese males aged 30-59 years for major causes of death. We obtained data from the Occupation-specificVital Statistics. We calculated age-standardized mortality rates for the four leading causes of death (all cancers, suicide, ischaemic heart disease, and cerebrovascular disease). We used a generalized estimating equation model to determine specific effects of the economic downturn after 2000. The age-standardized mortality rate for the total working-age population steadily declined up to 2010 in all major causes of death except suicide. Managers had a higher risk of mortality in all leading causes of death compared with before 1995. Mortality rates among unemployed people steadily decreased for all cancers and ischaemic heart disease. Economic downturn may have caused the prolonged increase in suicide mortality. Unemployed people did not experience any change in mortality due to suicide and cerebrovascular disease and saw a decline in cancer and ischemic heart disease mortality, perhaps because the basic properties of Japan's social welfare system were maintained even during economic recession.
  • Current Measures on Radioactive Contamination in Japan: A Policy Situation Analysis
    Stuart Gilmour, Shoji Miyagawa, Fumiko Kasuga, Kenji Shibuya
    PLOS ONE 11(3) e0152040 2016年03月 [査読有り]
    Background The Great East Japan Earthquake on 11th March 2011 and the subsequent Fukushima Daiichi nuclear power plant disaster caused radioactive contamination in the surrounding environment. In the immediate aftermath of the accident the Government of Japan placed strict measures on radio-contamination of food, and enhanced radio-contamination monitoring activities. Japan is a pilot country in the WHO Foodborne Disease Burden Epidemiology Reference Group (FERG), and through this initiative has an opportunity to report on policy affecting chemicals and toxins in the food distribution network. Nuclear accidents are extremely rare, and a policy situation analysis of the Japanese government's response to the Fukushima Dai-ichi nuclear accident is a responsibility of Japanese scientists. This study aims to assess Japan government policies to reduce radio-contamination risk and to identify strategies to strengthen food policies to ensure the best possible response to possible future radiation accidents. Methods and Findings We conducted a hand search of all publicly available policy documents issued by the Cabinet Office, the Food Safety Commission, the Ministry of Health, Labor and Welfare (MHLW), the Ministry of Agriculture, Forestry and Fishery (MAFF) and prefectural governments concerning food safety standards and changes to radiation and contamination standards since March 11th, 2011. We extracted information on food shipment and sales restrictions, allowable radio-contamination limits, monitoring activities and monitoring results. The standard for allowable radioactive cesium (Cs-134 and Cs-137) of 100 Bq/Kg in general food, 50 Bq/Kg in infant formula and all milk products, and 10 Bq/Kg in drinking water was enforced from April 2012 under the Food Sanitation Law, although a provisional standard on radio-contamination had been applied since the nuclear accident. Restrictions on the commercial sale and distribution of specific meat, vegetable and fish products were released for areas at risk of radioactive contamination. Monitoring of radioactive materials in food products in the prefectures has been mainly conducted before shipment to restrict the distribution of radio-contaminated foods. Between March 2011 and March 2012, 133,832 tests of non-commercial and commercial products were conducted, and 1,204 tests (0.9%) were found to violate the provisional standards. Since April 2012, 278,275 tests were conducted, and 2,372 tests (0.9%) were found to violate the revised standards. MHLW assessment of representative market baskets of foodstuffs at 15 locations throughout Japan between February and March 2014 found very low estimated dietary intake of radioactive cesium (0.0007-0.019 mSv/year), as did assessments of the contents of an average day's food. Monitoring of fisheries products in coastal areas affected by the nuclear accident found very limited and declining radio-contamination of live fish outside of Fukushima prefecture. Fisheries monitoring is of limited geographical scope and covers only certain fishes. Conclusions Area-specific bans on production and distribution have been effective in preventing radioactive contamination in the Japanese food market. Currently there is no major concern about radioactive cesium concentrations in retail foodstuffs in Japan, and very low levels of contamination at the production and wholesale stage. However, because the residue limits and food safety policies were revised on an ad hoc, emergency basis after the nuclear accident, the monitoring procedure needs to be reviewed based on objective and scientifically rational criteria. A transparent and objective scientific framework is needed for prioritizing foodstuffs for inspection and revising Prefecture-specific restrictions. Monitoring of fishes and other seafood products in the wild should be regularized and the information made more publicly accessible, and monitoring activities expanded to identify foodstuffs that are no longer a food safety risk. Consultation with producers and consumers should be more formalized to ensure their concerns are incorporated into regular policy reviews in an appropriate and transparent manner. However, despite the limited available knowledge on best practice in food control and enforcement of provisional radio-contamination limits after the accident, current Japanese policy is sufficient to protect the Japanese public from major risk of radio-contamination from the commercial food market.
  • Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis
    Md Mizanur Rahman, Sarah Krull Abe, Md Shafiur Rahman, Mikiko Kanda, Saki Narita, Ver Bilano, Erika Ota, Stuart Gilmour, Kenji Shibuya
    AMERICAN JOURNAL OF CLINICAL NUTRITION 103(2) 495-504 2016年02月 [査読有り]
    Background: Anemia is a leading cause of maternal deaths and adverse pregnancy outcomes in developing countries. Objectives: We conducted a systematic review and meta-analysis to estimate the pooled prevalence of anemia, the association between maternal anemia and pregnancy outcomes, and the population attributable fraction (PAF) of these outcomes that are due to anemia in low- and middle-income countries. Design: PubMed, EMBASE, CINAHL, and the British Nursing Index were searched from inception to May 2015 to identify cohort studies of the association between maternal anemia and pregnancy outcomes. The anemic group was defined as having hemoglobin concentrations <10 or <11 g/dL or hematocrit values <33% or <34% depending on the study. A metaregression and stratified analysis were performed to assess the effects of study and participant characteristics on adverse pregnancy risk. The pooled prevalence of anemia in pregnant women by region and country-income category was calculated with the use of a random-effects meta analysis. Results: Of 8182 articles reviewed, 29 studies were included in the systematic review, and 26 studies were included in the meta-analysis. Overall, 42.7% (95% CI: 37.0%, 48.4%) of women experienced anemia during pregnancy in low- and middle-income countries. There were significantly higher risks of low birth weight (RR: 1.31; 95% CI: 1.13, 1.51), preterm birth (RR: 1.63; 95% CI: 1.33, 2.01), perinatal mortality (RR: 1.51; 95% CI: 1.30, 1.76), and neonatal mortality (RR: 2.72; 95% CI: 1.19, 6.25) in pregnant women with anemia. South Asian, African, and low-income countries had a higher pooled anemia prevalence than did other Asian and upper middle-income countries. Overall, in low- and middle-income countries, 12% of low birth weight, 19% of preterm births, and 18% of perinatal mortality were attributable to maternal anemia. The proportion of adverse pregnancy outcomes attributable to anemia was higher in low-income countries and in the South Asian region. Conclusion: Maternal anemia remains a significant health problem in low- and middle-income countries.
  • Post-nuclear disaster evacuation and survival amongst elderly people in Fukushima: A comparative analysis between evacuees and non-evacuees
    Shuhei Nomura, Marta Blangiardo, Masaharu Tsubokura, Yoshitaka Nishikawa, Stuart Gilmour, Masahiro Kami, Susan Hodgson
    PREVENTIVE MEDICINE 82 77-82 2016年01月 [査読有り]
    Background. Considering the health impacts of evacuation is fundamental to disaster planning especially for vulnerable elderly populations; however, evacuation-related mortality risks have not been well-investigated. We conducted an analysis to compare survival of evacuated and non-evacuated residents of elderly care facilities, following the Great East Japan Earthquake and subsequent Fukushima Dai-ichi nuclear power plant incident on 11th March 2011. Objective. To assess associations between evacuation and mortality after the Fukushima nuclear incident; and to present discussion points on disaster planning, with reference to vulnerable elderly populations. Methods. The study population comprised 1,215 residents admitted to seven elderly care facilities located 20-40 km from the nuclear plant in the five years before the incident. Demographic and clinical characteristics were obtained from medical records. Evacuation histories were tracked until mid 2013. Main outcome measures are hazard ratios in evacuees versus non-evacuees using random-effects Cox proportional hazards models, and pre- and post-disaster survival probabilities and relative mortality incidence. Results. Experiencing the disasters did not have a significant influence on mortality (hazard ratio 1.10, 95% confidence interval: 0.84-1.43). Evacuation was associated with 1.82 times higher mortality (95% confidence interval: 1.22-2.70) after adjusting for confounders, with the initial evacuation from the original facility associated with 3.37 times higher mortality risk (95% confidence interval: 1.66-6.81) than non evacuation. Conclusions. The government should consider updating its requirements for emergency planning for elderly facilities and ensure that, in a disaster setting, these facilities have the capacity and support to shelter in place for at least sufficient time to adequately prepare initial evacuation. (C) 2015 Elsevier Inc. All rights reserved.
  • Importance of survival strategies after a zombie pandemic.
    Gilmour SJ, Saito E, Yoneoka D
    BMJ (Clinical research ed.) 532 i259 2016年01月 [査読有り]
  • Long-Term Changes in Stroke-Related Hospital Admissions After the Fukushima Triple Disaster
    Stuart Gilmour, Amina Sugimoto, Shuhei Nomura, Tomoyoshi Oikawa
    JOURNAL OF THE AMERICAN GERIATRICS SOCIETY 63(11) 2425-2426 2015年11月 [査読有り]
  • Civil registration as a means to promote human security
    Kenji Shibuya, Stuart Gilmour
    LANCET 386(10001) E14-E15 2015年10月 [査読有り]
  • Estimating the burden of foodborne diseases in Japan
    Yuko Kumagai, Stuart Gilmour, Erika Ota, Yoshika Momose, Toshiro Onishi, Ver Luanni Feliciano Bilano, Fumiko Kasuga, Tsutomu Sekizaki, Kenji Shibuya
    BULLETIN OF THE WORLD HEALTH ORGANIZATION 93(8) 540-549 2015年08月 [査読有り]
    Objective To assess the burden posed by foodborne diseases in Japan using methods developed by the World Health Organization's Foodborne Disease Burden Epidemiology Reference Group (FERG). Methods Expert consultation and statistics on food poisoning during 2011 were used to identify three common causes of foodborne disease in Japan: Campylobacter and Salmonella species and enterohaemorrhagic Escherichia coli (EHEC). We conducted systematic reviews of English and Japanese literature on the complications caused by these pathogens, by searching Embase, the Japan medical society abstract database and Medline. We estimated the annual incidence of acute gastroenteritis from reported surveillance data, based on estimated probabilities that an affected person would visit a physician and have gastroenteritis confirmed. We then calculated disability-adjusted life-years (DALYs) lost in 2011, using the incidence estimates along with disability weights derived from published studies. Findings In 2011, foodborne disease caused by Campylobacter species, Salmonella species and EHEC led to an estimated loss of 6099, 3145 and 463 DALYs in Japan, respectively. These estimated burdens are based on the pyramid reconstruction method; are largely due to morbidity rather than mortality; and are much higher than those indicated by routine surveillance data. Conclusion Routine surveillance data may indicate foodborne disease burdens that are much lower than the true values. Most of the burden posed by foodborne disease in Japan comes from secondary complications. The tools developed by FERG appear useful in estimating disease burdens and setting priorities in the field of food safety.
  • Prevalence and control of hypertension in Bangladesh: a multilevel analysis of a nationwide population-based survey
    Md. Mizanur Rahman, Stuart Gilmour, Shamima Akter, Sarah K. Abe, Eiko Saito, Kenji Shibuya
    JOURNAL OF HYPERTENSION 33(3) 465-472 2015年03月 [査読有り]
    Objectives: We investigated the prevalence, awareness, treatment, and control of hypertension and associated risk factors in the Bangladeshi adult population. Methods: The data for this study were extracted from the nationally-representative 2011 Bangladesh Demographic and Health Survey. Socio-demographic profiles, height, weight, blood pressure measurements, and management were recorded from 7876 adults aged 35 years or older. Multilevel logistic regression models were used to identify the risk factors for hypertension awareness, treatment, and control. Results: Overall, age-standardized prevalence of prehypertension and hypertension were 27.1 and 24.4%, respectively. Among patients with hypertension, 50.1% were aware of their condition, 41.2% were in treatment, but only 31.4% had controlled hypertension. There was a wide disparity in hypertension management between the poor and the wealthy households. Rich households were more likely to be aware of their hypertension [odds ratio (OR) 1.92, 95% confidence interval (CI) 0.97-3.79, P = 0.06], receiving treatment (OR 3.34, 95% CI 1.55-7.18, P<0.001) and controlling their condition (OR 2.88, 95% CI 1.28-6.46, P = 0.01), as compared to the poor residents. Participants who had lower education were less likely to be aware of, in treatment for, and in control of their condition. Conclusion: One in four adults had hypertension in Bangladesh, and awareness and treatment of hypertension are quite low. Improvements in detection and treatment strategies are needed to prevent the growing disease burden associated with hypertension.
  • Global trends and projections for tobacco use, 1990-2025: an analysis of smoking indicators from the WHO Comprehensive Information Systems for Tobacco Control.
    Bilano V, Gilmour S, Moffiet T, d'Espaignet ET, Stevens GA, Commar A, Tuyl F, Hudson I, Shibuya K
    Lancet (London, England) 385(9972) 966-976 2015年03月 [査読有り]
  • Inequality in Diabetes-Related Hospital Admissions in England by Socioeconomic Deprivation and Ethnicity: Facility-Based Cross-Sectional Analysis
    Yoshitaka Nishino, Stuart Gilmour, Kenji Shibuya
    PLOS ONE 10(2) e0116689 2015年02月 [査読有り]
    Objective To investigate the effect of social deprivation and ethnicity on inpatient admissions due to diabetes in England. Design Facility-based cross-sectional analysis. Setting National Health Service (NHS) trusts in England reporting inpatient admissions with better than 80% data reporting quality from 2010-2011 (355 facilities). Participants Non-obstetric patients over 16 years old in all NHS facilities in England. The sample size after exclusions was 5,147,859 all-cause admissions. Main Outcome Measures The relative risk of inpatient admissions and readmissions due to diabetes adjusted for confounders. Results There were 445,504 diabetes-related hospital admissions in England in 2010, giving a directly (age-sex) standardized rate of 1049.0 per 100,000 population (95% confidence interval (CI): 1046.0-1052.1). The relative risk of inpatient admission in the most deprived quintile was 2.08 times higher than that of the least deprived quintile (95% CI: 2.02-2.14), and the effect of deprivation varied across ethnicities. About 30.1% of patients admitted due to diabetes were readmitted at least once due to diabetes. South Asians showed 2.62 times (95% CI: 2.51 - 2.74) higher admission risk. Readmission risk increased with IMD among white British but not other ethnicities. South Asians showed slightly lower risk of readmission than white British (0.86, 95% CI: 0.80 - 0.94). Conclusions More deprived areas had higher rates of inpatient admissions and readmissions due to diabetes. South Asian British showed higher admission risk and lower readmission risk than white British. However, there was almost no difference by ethnicity in readmission due to diabetes. Higher rates of admission among deprived people may not necessarily reflect higher prevalence, but higher admission rates in south Asian British may be explained by their higher prevalence because their lower readmission risk suggests no inequality in primary care to prevent readmission. Better interventions in poorer areas, are needed to reduce these inequalities.
  • ABSENCE OF INTERNAL RADIATION CONTAMINATION BY RADIOACTIVE CESIUM AMONG CHILDREN AFFECTED BY THE FUKUSHIMA DAIICHI NUCLEAR POWER PLANT DISASTER
    Masaharu Tsubokura, Shigeaki Kato, Shuhei Nomura, Tomohiro Morita, Amina Sugimoto, Stuart Gilmour, Masahiro Kami, Tomoyoshi Oikawa, Yukio Kanazawa
    HEALTH PHYSICS 108(1) 39-43 2015年01月 [査読有り]
    Chronic internal radiation contamination accounts for a substantial fraction of long-term cumulative radiation exposure among residents in radiation-contaminated areas. However, little information is available on ongoing chronic internal radiation contamination among residents near the crippled Fukushima Daiichi nuclear power plant. Using a whole body counter, internal radiation contamination levels among elementary and middle school students who commute to 22 schools located within Minamisoma city were assessed between May and July 2013 (26 to 28 mo after the disaster). Of 3,299 elementary and middle school students in the city, 3,255 individuals (98%) were screened through school health check-ups. Not a single student was detected with internal radiation contamination due to radioactive cesium. The study found no risk of chronic internal radiation exposure among residents near the crippled nuclear power plant. Current food inspection by local governments, volunteers, and farmers has been functioning well within Fukushima prefecture. However, food management by screening suspected contamination along with whole body counter screening are key public health interventions and should be continued to avoid further internal radiation exposure in radiation-contaminated areas.
  • Effectiveness of community-based health services by nurse practitioners: protocol for a systematic review and meta-analysis
    Mikiko Kanda, Erika Ota, Hiromi Fukuda, Shinji Miyauchi, Stuart Gilmour, Yuko Kono, Erika Nakagama, Sachiyo Murashima, Kenji Shibuya
    BMJ OPEN 5(6) e006670 2015年 [査読有り]
    Introduction: To realise universal health coverage in an ageing society, adequate provision of appropriately trained human resources is essential. The nurse practitioner (NP) is an autonomous and independent, advanced practice nurse capable of providing treatment and care that can be substituted for some aspects of a medical doctor's (MD's) role, especially in a community setting. Previous systematic reviews found higher levels of patient satisfaction with services provided by NPs than those provided by MDs. As non-communicable diseases become a major health burden requiring long-term healthcare in community settings, this systematic review aims to assess the equivalence of NP services to standard care provided by MDs, and to determine whether their practice is an effective alternative to that of MDs in community settings. Methods and analysis: Relevant randomised controlled trials (RCTs) and cluster RCTs will be searched in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and the British Nursing Index. We will assess patient and health system utilisation outcomes of interventions comparing treatment and care provided by NPs in community settings with that provided by MDs. Two authors will independently screen studies for inclusion, consulting with a third author where necessary to resolve discrepancies. The risk of bias of included studies will be assessed using the Cochrane Collaboration risk of bias tool, and quality of evidence using the GRADE approach. Meta-analysis of included studies will be conducted using fixed-effect or random-effects models depending on the degree of between-study heterogeneity. Results will be presented using risk ratios with 95% CI for dichotomous outcomes and standardised mean differences with 95% CI for continuous outcomes. Ethics and dissemination: This systematic review and meta-analysis protocol does not require ethical approval. We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals. Trial registration number: PROSPEROCRD420 14009627.
  • Social networks and mental health in post-conflict Mitrovica, Kosova
    Risa Nakayama, Ai Koyanagi, Andrew Stickley, Tetsuo Kondo, Stuart Gilmour, Aliriza Arenliu, Kenji Shibuya
    BMC PUBLIC HEALTH 14 1169 2014年11月 [査読有り]
    Background: To investigate the relation between social networks and mental health in the post-conflict municipality of Mitrovica, Kosovo. Methods: Using a three-stage stratified sampling method, 1239 respondents aged 16 years or above were recruited in the Greater Mitrovica region. Social network depth was measured by the frequency of contacts with friends, relatives and strangers. Depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression was used to examine the association between social network depth and mental health. Results: The analytical sample consisted of 993 respondents. The prevalence of depression (54.3%) and anxiety (64.4%) were extremely high. In multiple regression analysis, a lower depth of social network (contact with friends) was associated with higher levels of both depression and anxiety. Conclusions: This study has shown that only one variety of social network - contact with friends - was important in terms of mental health outcomes in a population living in an area heavily affected by conflict. This suggests that the relation between social networks and mental health may be complex in that the effects of different forms of social network on mental health are not uniform and may depend on the way social networks are operationalised and the particular context in which the relationship is examined.
  • Catastrophic household expenditure on health in Nepal: a cross-sectional survey
    Eiko Saito, Stuart Gilmour, Md Mizanur Rahman, Ghan Shyam Gautam, Pradeep Krishna Shrestha, Kenji Shibuya
    BULLETIN OF THE WORLD HEALTH ORGANIZATION 92(10) 760-767 2014年10月 [査読有り]
    Objective To determine the incidence of and illnesses commonly associated with catastrophic household expenditure on health in Nepal Methods We did a cross-sectional population-based survey in five municipalities of Kathmandu Valley between November 2011 and January 2012. For each household surveyed, out-of-pocket spending on health in the previous 30 days that exceeded 10% of the household's total expenditure over the same period was considered to be catastrophic. We estimated the incidence and intensity of catastrophic health expenditure. We identified the illnesses most commonly associated with such expenditure using a Poisson regression model and assessed the distribution of expenditure by economic quintile of households using the concentration index. Findings Overall, 284 of the 1997 households studied in Kathmandu, i.e. 13.8% after adjustment by sampling weight, reported catastrophic health expenditure in the 30 days before the survey. After adjusting for confounders, this expenditure was found to be associated with injuries, particularly those resulting from road traffic accidents. Catastrophic expenditure by households in the poorest quintile were associated with at least one episode of diabetes, asthma or heart diease. Conclusion In an urban area of Nepal, catastrophic household expenditure on health was mostly associated with injuries and noncommunicable diseases such as diabetes and asthma. Throughout Nepal, interventions for the control and management of noncommunicable diseases and the prevention of road traffic accidents should be promoted. A phased introduction of health insurance should also reduce the incidence of catastrophic household expenditure.
  • Assessment of the Risk of Medium-Term Internal Contamination in Minamisoma City, Fukushima, Japan, after the Fukushima Dai-ichi Nuclear Accident
    Amina Sugimoto, Stuart Gilmour, Masaharu Tsubokura, Shuhei Nomura, Masahiro Kami, Tomoyoshi Oikawa, Yukio Kanazawa, Kenji Shibuya
    ENVIRONMENTAL HEALTH PERSPECTIVES 122(6) 587-593 2014年06月 [査読有り]
    Background: The Fukushima Dai-ichi nuclear disaster, the first level-7 major nuclear disaster since Chernobyl, raised concerns about the future health consequences of exposure to and intake of radionuclides. Factors determining the risk and level of internal radiation contamination after a nuclear accident, which are a key to understanding and improving current nuclear disaster management, are not well studied. Objective: We investigated both the prevalence and level of internal contamination in residents of Minamisoma, and identified factors determining the risk and levels of contamination. Methods: We implemented a program assessing internal radiation contamination using a whole body counter (WBC) measurement and a questionnaire survey in Minamisoma, between October 2011 and March 2012. Results: Approximately 20% of the city's population (8,829 individuals) participated in the WBC measurement for internal contamination, of which 94% responded to the questionnaire. The proportion of participants with detectable internal contamination was 40% in adults and 9% in children. The level of internal contamination ranged from 2.3 to 196.5 Bq/kg (median, 11.3 Bq/kg). Tobit regression analysis identified two main risk factors: more time spent outdoors, and intake of potentially contaminated foods and water. Conclusions: Our findings suggest that, with sensible and reasonable precautions, people may be able to live continuously in radiation-affected areas with limited contamination risk. To enable this, nuclear disaster response should strictly enforce food and water controls and disseminate evidence-based and up-to-date information about avoidable contamination risks.
  • Reduction of High Levels of Internal Radio-Contamination by Dietary Intervention in Residents of Areas Affected by the Fukushima Daiichi Nuclear Plant Disaster: A Case Series
    Masaharu Tsubokura, Shigeaki Kato, Shuhei Nomura, Stuart Gilmour, Masahiko Nihei, Yu Sakuma, Tomoyoshi Oikawa, Yukio Kanazawa, Masahiro Kami, Ryugo Hayano
    PLOS ONE 9(6) e100302 2014年06月 [査読有り]
    Maintaining low levels of chronic internal contamination among residents in radiation-contaminated areas after a nuclear disaster is a great public health concern. However, the efficacy of reduction measures for individual internal contamination remains unknown. To reduce high levels of internal radiation exposure in a group of individuals exposed through environmental sources, we performed careful dietary intervention with identification of suspected contaminated foods, as part of mass voluntary radiation contamination screenings and counseling program in Minamisoma Municipal General Hospital and Hirata Central Hospital. From a total of 30,622 study participants, only 9 residents displayed internal cesium-137 (Cs-137) levels of more than 50 Bq/kg. The median level of internal Cs-137 contamination in these residents at the initial screening was 4,830 Bq/body (range: 2,130-15,918 Bq/body) and 69.6 Bq/kg (range: 50.7-216.3 Bq/kg). All these residents with high levels of internal contamination consumed homegrown produce without radiation inspection, and often collected mushrooms in the wild or cultivated them on bed-logs in their homes. They were advised to consume distributed food mainly and to refrain from consuming potentially contaminated foods without radiation inspection and local produces under shipment restrictions such as mushrooms, mountain vegetables, and meat of wild life. A few months after the intervention, re-examination of Cs levels revealed remarkable reduction of internal contamination in all residents. Although the levels of internal radiation exposure appear to be minimal amongst most residents in Fukushima, a subset of the population, who unknowingly consumed highly contaminated foodstuffs, experienced high levels of internal contamination. There seem to be similarities in dietary preferences amongst residents with high internal contamination levels, and intervention based on pre-and post-test counseling and dietary advice from medical care providers about risky food intake appears to be a feasible option for changing residents' dietary practices, subsequently resulting in a reduction in Cs internal contamination levels.
  • Time to reconsider thyroid cancer screening in Fukushima.
    Shibuya K, Gilmour S, Oshima A
    Lancet (London, England) 383(9932) 1883-1884 2014年05月 [査読有り]
  • Are Japanese Randomized Controlled Trials Up to the Task? A Systematic Review
    Daisuke Yoneoka, Akinori Hisashige, Erika Ota, Karin Miyamoto, Shuhei Nomura, Miwako Segawa, Stuart Gilmour, Kenji Shibuya
    PLOS ONE 9(3) e90127 2014年03月 [査読有り]
    Objectives: Despite increasing numbers of RCTs done in Japan, existing international databases fail to capture them, and detailed information on the quality of Japanese RCTs is still missing. This study assessed the characteristics and quality of Japanese RCTs and analyzed factors related to their quality.Methods: All RCTs conducted in Japan, and published as original articles that assessed the effect of healthcare interventions on humans in 2010, were included. We excluded study protocols, conference abstracts, and comments. In addition, quasi-RCTs were excluded. Data were independently abstracted and assessed by two of the authors and disagreements were resolved by consensus. The quality of Japanese RCTs randomly sampled was assessed using the method guidelines for systematic reviews from the Cochrane Back Review Group. The factors affecting RCT quality were analyzed using a logistic regression model.Results: A total of 1013 RCTs conducted in Japan were published in 2010. The majority was small-scale (55% of RCTs with sample size less than 50). Eighty percent of RCTs had no information on the funding source and only 8% had been registered before their implementation. RCTs not indexed in international databases were a moderate number (118 RCTs: 37.7% of non-indexed RCTs were of high quality). Surgical intervention studies for external causes of morbidity and mortality with a large sample size, trial registration and a large number of arms were most likely to be of higher quality.Conclusion: Despite a considerable number of RCTs conducted in Japan, their quality is not satisfactory in some domains. On the other hand, there are high-quality, non-indexed RCTs. The full disclosure of trial information and quality control of clinical trials are urgently needed in Japan.
  • Alcohol Consumption and Psychological Distress in Adolescents: A Multi-Country Study
    Olukunmi Balogun, Ai Koyanagi, Andrew Stickley, Stuart Gilmour, Kenji Shibuya
    JOURNAL OF ADOLESCENT HEALTH 54(2) 228-234 2014年02月 [査読有り]
    Purpose: To examine the association between alcohol use and psychological distress among adolescents in a range of developing countries. Methods: Secondary data analysis of the Global School-Based Student Health Survey was conducted using nationally representative data from 12 developing countries: Botswana, Grenada, Indonesia, Kenya, Myanmar, the Philippines, Saint Lucia, Saint Vincent and the Grenadines, the Seychelles, Thailand, Trinidad and Tobago, and Uganda. The surveys were conducted between 2003 and 2008 and involved 32,001 adolescents primarily aged 13-15 years. We used multivariate logistic regression analysis to determine the association between alcohol use and psychological distress. Results: The prevalence of past 30-day alcohol use and lifetime drunkenness varied widely across countries, as did the occurrence of psychological distress (anxiety-induced sleeplessness and/or depression). The risk of psychological distress was significantly higher among adolescents when using alcohol in all countries except Myanmar. In nine of the 12 countries, past 30-day alcohol use was associated with psychological distress, while students who had been drunk at least once in their lifetime had an increased risk of experiencing psychological distress in 11 of the study countries. Conclusions: The high prevalence of alcohol use among adolescents and the strength of the association with psychological distress present a major public health challenge in developing countries. The urgent need to reduce adolescent alcohol use necessitates the implementation of context-and culture-specific strategies that reduce the physical availability of alcohol. (C) 2014 Society for Adolescent Health and Medicine. All rights reserved.
  • Identifying individual- and population-level characteristics that influence rates of risky alcohol consumption in regional communities
    Courtney Breen, Anthony Shakeshaft, Rob Sanson-Fisher, Catherine D'Este, Richard P. Mattick, Stuart Gilmour
    AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 38(1) 60-65 2014年02月 [査読有り]
    Objective: To examine the extent to which individual-and community-level characteristics account for differences in risky alcohol consumption. Method: A cross-sectional postal survey of 2,977 randomly selected individuals from 20 regional communities in NSW, Australia. Individuals drinking at harmful levels on the AUDIT and for risk of harm in the short term and long-term were identified. Multi-level modelling of the correlates of risky alcohol consumption at the individual and community level was conducted. Results: There were differences between communities in alcohol consumption patterns. Being male, unmarried and reporting worse health were significant individual-level correlates for drinking at levels for risk of harm in the long term. The number of GPs (+) and police (-) were significant community characteristics. Being younger (<= 25), unmarried, Australian born and with a larger income was associated with drinking at levels for risk of harm in the short term and harmful drinking on the AUDIT. The number of hotels and clubs was positively associated with drinking at levels for risk of harm in the short term. Conclusions: Rates of risky drinking vary significantly between communities and both individual and community characteristics are significantly associated with risky alcohol consumption. Implications: A combination of individual-and population-level interventions, tailored to the risk profile of individual communities, is most likely to be optimally effective.
  • Prevention and control of hypertension in different countries.
    Rahman MM, Gilmour S
    JAMA 311(4) 418-419 2014年01月 [査読有り]
  • The Effectiveness of Community Action in Reducing Risky Alcohol Consumption and Harm: A Cluster Randomised Controlled Trial
    Anthony Shakeshaft, Christopher Doran, Dennis Petrie, Courtney Breen, Alys Havard, Ansari Abudeen, Elissa Harwood, Anton Clifford, Catherine D'Este, Stuart Gilmour, Rob Sanson-Fisher
    PLoS Medicine 11(3) e1001617 2014年 [査読有り]
    Background:The World Health Organization, governments, and communities agree that community action is likely to reduce risky alcohol consumption and harm. Despite this agreement, there is little rigorous evidence that community action is effective: of the six randomised trials of community action published to date, all were US-based and focused on young people (rather than the whole community), and their outcomes were limited to self-report or alcohol purchase attempts. The objective of this study was to conduct the first non-US randomised controlled trial (RCT) of community action to quantify the effectiveness of this approach in reducing risky alcohol consumption and harms measured using both self-report and routinely collected data.Methods and Findings:We conducted a cluster RCT comprising 20 communities in Australia that had populations of 5,000-20,000, were at least 100 km from an urban centre (population ≥ 100,000), and were not involved in another community alcohol project. Communities were pair-matched, and one member of each pair was randomly allocated to the experimental group. Thirteen interventions were implemented in the experimental communities from 2005 to 2009: community engagement general practitioner training in alcohol screening and brief intervention (SBI) feedback to key stakeholders media campaign workplace policies/practices training school-based intervention general practitioner feedback on their prescribing of alcohol medications community pharmacy-based SBI web-based SBI Aboriginal Community Controlled Health Services support for SBI Good Sports program for sports clubs identifying and targeting high-risk weekends and hospital emergency department-based SBI. Primary outcomes based on routinely collected data were alcohol-related crime, traffic crashes, and hospital inpatient admissions. Routinely collected data for the entire study period (2001-2009) were obtained in 2010. Secondary outcomes based on pre- and post-intervention surveys (n = 2,977 and 2,255, respectively) were the following: long-term risky drinking, short-term high-risk drinking, short-term risky drinking, weekly consumption, hazardous/harmful alcohol use, and experience of alcohol harm. At the 5% level of statistical significance, there was insufficient evidence to conclude that the interventions were effective in the experimental, relative to control, communities for alcohol-related crime, traffic crashes, and hospital inpatient admissions, and for rates of risky alcohol consumption and hazardous/harmful alcohol use. Although respondents in the experimental communities reported statistically significantly lower average weekly consumption (1.90 fewer standard drinks per week, 95% CI = -3.37 to -0.43, p = 0.01) and less alcohol-related verbal abuse (odds ratio = 0.58, 95% CI = 0.35 to 0.96, p = 0.04) post-intervention, the low survey response rates (40% and 24% for the pre- and post-intervention surveys, respectively) require conservative interpretation. The main limitations of this study are as follows: (1) that the study may have been under-powered to detect differences in routinely collected data outcomes as statistically significant, and (2) the low survey response rates.Conclusions:This RCT provides little evidence that community action significantly reduces risky alcohol consumption and alcohol-related harms, other than potential reductions in self-reported average weekly consumption and experience of alcohol-related verbal abuse. Complementary legislative action may be required to more effectively reduce alcohol harms.Trial registration:Australian New Zealand Clinical Trials Registry ACTRN12607000123448 Please see later in the article for the Editors' Summary. © 2014 Shakeshaft et al.
  • Burden of disease in Japan: Using national and subnational data to inform local health policy
    Stuart Gilmour, Yi Liao, Ver Bilano, Kenji Shibuya
    Journal of Preventive Medicine and Public Health 47(3) 136-143 2014年 [査読有り]
    The Global Burden of Disease (GBD) study has been instrumental in guiding global health policy development since the early 1990s. The GBD 2010 project provided rich information about the key causes of mortality, disability-adjusted life years, and their associated risk factors in Japan and provided a unique opportunity to incorporate these data into health planning. As part of the latest update of this project, GBD 2013, the Japanese GBD collaborators plan to update and refine the available burden of disease data by incorporating sub-national estimates of the burden of disease at the prefectural level. These estimates will provide health planners and policy makers at both the national and prefectural level with new, more refined tools to adapt local public health initiatives to meet the health needs of local populations. Moreover, they will enable the Japanese health system to better respond to the unique challenges in their rapidly aging population and as a complex combination of non-communicable disease risk factors begin to dominate the policy agenda. Regional collaborations will enable nations to learn from the experiences of other nations that may be at different stages of the epidemiological transition and have different exposure profiles and associated health effects. Such analyses and improvements in the data collection systems will further improve the health of the Japanese, maintain Japan's excellent record of health equity, and provide a better understanding of the direction of health policy in the region. Copyright © 2014 The Korean Society for Preventive Medicine.
  • Structural and community-level interventions for increasing condom use to prevent the transmission of HIV and other sexually transmitted infections
    Ralfh Moreno, Herfina Y. Nababan, Erika Ota, Windy M. V. Wariki, Satoshi Ezoe, Stuart Gilmour, Kenji Shibuya
    COCHRANE DATABASE OF SYSTEMATIC REVIEWS(7) CD003363 2014年 [査読有り]
    Background Community interventions to promote condom use are considered to be a valuable tool to reduce the transmission of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). In particular, special emphasis has been placed on implementing such interventions through structural changes, a concept that implies public health actions that aim to improve society's health through modifications in the context wherein health-related risk behavior takes place. This strategy attempts to increase condom use and in turn lower the transmission of HIV and other STIs. Objectives To assess the effects of structural and community-level interventions for increasing condom use in both general and high-risk populations to reduce the incidence of HIV and STI transmission by comparing alternative strategies, or by assessing the effects of a strategy compared with a control. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, from 2007, Issue 1), as well as MEDLINE, EMBASE, AEGIS and ClinicalTrials.gov, from January 1980 to April 2014. We also handsearched proceedings of international acquired immunodeficiency syndrome (AIDS) conferences, as well as major behavioral studies conferences focusing on HIV/AIDS and STIs. Selection criteria Randomized control trials (RCTs) featuring all of the following. 1. Community interventions ('community' defined as a geographical entity, such as cities, counties, villages). 2. One or more structural interventions whose objective was to promote condom use. These type of interventions can be defined as those actions improving accessibility, availability and acceptability of any given health program/technology. 3. Trials that confirmed biological outcomes using laboratory testing. Data collection and analysis Two authors independently screened and selected relevant studies, and conducted further risk of bias assessment. We assessed the effect of treatment by pooling trials with comparable characteristics and quantified its effect size using risk ratio. The effect of clustering at the community level was addressed through intra-cluster correlation coefficients (ICCs), and sensitivity analysis was carried out with different design effect values. Main results We included nine trials (plus one study that was a subanalysis) for quantitative assessment. The studies were conducted in Tanzania, Zimbabwe, South Africa, Uganda, Kenya, Peru, China, India and Russia, comprising 75,891 participants, mostly including the general population (not the high-risk population). The main intervention was condom promotion, or distribution, or both. In general, control groups did not receive any active intervention. The main risk of bias was incomplete outcome data. In the meta-analysis, there was no clear evidence that the intervention had an effect on either HIV seroprevalence or HIV seroincidence when compared to controls: HIV incidence (risk ratio (RR) 0.90, 95% confidence interval (CI) 0.69 to 1.19) and HIV prevalence (RR 1.02, 95% CI 0.79 to 1.32). The estimated effect of the intervention on other outcomes was similarly uncertain: Herpes simplex virus 2 (HSV-2) incidence (RR 0.76, 95% CI 0.55 to 1.04); HSV-2 prevalence (RR 1.01, 95% CI 0.85 to 1.20); syphilis prevalence (RR 0.91, 95% CI 0.71 to 1.17); gonorrhoea prevalence (RR 1.16, 95% CI 0.67 to 2.02); chlamydia prevalence (RR 0.94, 95% CI 0.75 to 1.18); and trichomonas prevalence (RR 1.00, 95% CI 0.77 to 1.30). Reported condom use increased in the experimental arm (RR 1.20, 95% CI 1.03 to 1.40). In the intervention groups, the number of people reporting two or more sexual partners in the past year did not show a clear decrease when compared with control groups (RR 0.90, 95% CI 0.78 to 1.04), but knowledge about HIV and other STIs improved (RR 1.15, 95% CI 1.04 to 1.28, and RR 1.23, 95% CI 1.07 to 1.41, respectively). The quality of the evidence was deemed to be moderate for nearly all key outcomes. Authors' conclusions There is no clear evidence that structural interventions at the community level to increase condom use prevent the transmission of HIV and other STIs. However, this conclusion should be interpreted with caution since our results have wide confidence intervals and the results for prevalence may be affected by attrition bias. In addition, it was not possible to find RCTs in which extended changes to policies were conducted and the results only apply to general populations in developing nations, particularly to Sub-Saharan Africa, a region which in turn is widely diverse.
  • Simple steps to equity in child survival
    Stuart Gilmour, Kenji Shibuya
    BMC MEDICINE 11 261 2013年12月 [査読有り]
    Although the number of child deaths has declined globally over the past 20 years, many countries still lag behind their millennium development goal targets, and inequity in child health remains a pernicious problem both between and within countries. Breastfeeding is a key intervention to reduce child mortality, and in an article published in BMC Medicine, Roberts and colleagues have shown that breastfeeding interventions can have a significant role in reducing inequity in child health. With the proper attention paid to overcoming the barriers to scaling up breastfeeding interventions, deployment of effective interventions in health facilities and the community, and improvements in support for breastfeeding interventions across society, many countries that are struggling to meet their millennium development goals could make significant gains in child survival and inequity.
  • Estimating the proportion of prescription opioids that is consumed by people who inject drugs in Australia
    Louisa Degenhardt, Stuart Gilmour, Fiona Shand, Raimondo Bruno, Gabrielle Campbell, Richard P. Mattick, Briony Larance, Wayne Hall
    DRUG AND ALCOHOL REVIEW 32(5) 468-474 2013年09月 [査読有り]
    Introduction and Aims.To estimate the contribution that people who inject drugs (PWID) make to population-level use of prescription opioids in Australia. Design and Methods.Data on prescriptions of oxycodone, morphine and methadone tablets were obtained for New South Wales, Victoria, Tasmania and Queensland, and time series analyses used to characterise the trends from 2002 to 2010. Estimates of the number of PWID were combined with data on their levels, frequency and typical doses of morphine, methadone tablet (only prescribed in Australia for pain) and oxycodone from 2004 to 2010. Estimated consumption per 1000 PWID and per 1000 persons aged 20-69 years was contrasted and the proportion of total consumption accounted for by PWID estimated. Results.Morphine prescribing declined; oxycodone prescribing increased. PWID had far higher rates of prescription opioid consumption (defined daily doses per 1000) than the general population. Tasmania had highest use of prescribed opioids. PWID contribution to morphine consumption in Tasmania increased to 28% (range 22-37%) in 2010; elsewhere, PWID contribution was lower (midpoints of 2-12%, 2010). Methadone tablet use was less elevated compared with the general population. With the exception of Tasmania, PWID were estimated to consume less than 5% of oxycodone. Discussion and Conclusions.PWID use prescription opioids at high levels and can account for a significant proportion of consumption. Increased oxycodone prescribing in Australia has not been driven by PWID. Opioid substitution therapy and other effective treatments need to be more available and attractive to PWID. [Degenhardt L, Gilmour S, Shand F, Bruno R, Campbell G, Mattick RP, Larance B, Hall W. Estimating the proportion of prescription opioids that is consumed by people who inject drugs in Australia. Drug Alcohol Rev 2013;32:468-474]
  • The Relationship between Media Consumption and Health-Related Anxieties after the Fukushima Daiichi Nuclear Disaster
    Amina Sugimoto, Shuhei Nomura, Masaharu Tsubokura, Tomoko Matsumura, Kaori Muto, Mikiko Sato, Stuart Gilmour
    PLOS ONE 8(8) e65331 2013年08月 [査読有り]
    Background: The Fukushima Daiichi nuclear disaster caused a global panic by a release of harmful radionuclides. In a disaster setting, misusage of contemporary media sources available today can lead to disseminated incorrect information and panic. The study aims to build a scale which examines associations between media and individual anxieties, and to propose effective media usages for future disaster management. Methods: The University of Tokyo collaborated with the Fukushima local government to conduct a radiation-health-seminar for a total of 1560 residents, at 12 different locations in Fukushima. A 13 item questionnaire collected once before and after a radiation-seminar was used on factor analysis to develop sub-scales for multiple regression models, to determine relationships between the sub-scales and media type consumed. A paired t-test was used to examine any changes in sub-scale of pre- and post-seminar scores. Results: Three sub-scales were revealed and were associated with different media types: was with rumors, while concern for the future was positively associated with regional-newspapers and negatively with national-newspapers. Anxiety about social-disruption was associated with radio. The seminar had a significant effect on anxiety reduction for all the three sub-scales. Conclusion: Different media types were associated with various heightened concerns, and that a radiation seminar was helpful to reduce anxieties in the post-disaster setting. By tailoring post-disaster messages via specific media types, i.e., radio, it may be possible to effectively convey important information, as well as to calm fears about particular elements of post-disaster recovery and to combat rumors.
  • HPV vaccination programme in Japan.
    Gilmour S, Kanda M, Kusumi E, Tanimoto T, Kami M, Shibuya K
    Lancet (London, England) 382(9894) 768 2013年08月 [査読有り]
  • Self-reported illness and household strategies for coping with health-care payments in Bangladesh
    Md Mizanur Rahman, Stuart Gilmour, Eiko Saito, Papia Sultana, Kenji Shibuya
    BULLETIN OF THE WORLD HEALTH ORGANIZATION 91(6) 449-458 2013年06月 [査読有り]
    Objective To investigate self-reported illness and household strategies for coping with payments for health care in a city in Bangladesh. Methods A cluster-sampled probability survey of:1593 households in the city of Rajshahi, Bangladesh, was conducted in 2011. Multilevel logistic regression - with adjustment for any clustering within households - was used to examine the risk of self-reported illness in the previous 30 days. A multilevel Poisson regression model, with adjustment for clustering within households and individuals, was used to explore factors potentially associated with the risk of health-care-related "distress" financing (e.g. paying for health care by borrowing, selling, reducing food expenditure, removing children from school or performing additional paid work). Findings According to the interviewees, about 45% of the surveyed individuals had suffered at, least one episode of illness in the previous 30 days. The most frequently reported illnesses among children younger than 5 years and adults were common tropical infections and noncommunicable diseases, respectively. The risks of self-reported illness in the previous 30 days were relatively high for adults older than 44 years, women and members of households in the poorest quintile. Distress financing, which had been implemented to cover health-care payments associated with 13% of the reported episodes, was significantly associated with heart and liver disease, asthma, typhoid, inpatient care, the use of public outpatient facilities, and poverty at the household level. Conclusion Despite the subsidization of public health services in Bangladesh, high prevalences of distress financing - and illness - were detected in the surveyed, urban households.
  • Cash-transfer programmes in developing countries
    Stuart Gilmour, Tomohiro Hamakawa, Kenji Shibuya
    The Lancet 381(9874) 1254-1255 2013年04月 [査読有り]
  • Mortality Risk amongst Nursing Home Residents Evacuated after the Fukushima Nuclear Accident: A Retrospective Cohort Study
    Shuhei Nomura, Stuart Gilmour, Masaharu Tsubokura, Daisuke Yoneoka, Amina Sugimoto, Tomoyoshi Oikawa, Masahiro Kami, Kenji Shibuya
    PLOS ONE 8(3) e60192 2013年03月 [査読有り]
    Background: Safety of evacuation is of paramount importance in disaster planning for elderly people; however, little effort has been made to investigate evacuation-related mortality risks. After the Fukushima Daiichi Nuclear Plant accident we conducted a retrospective cohort survival survey of elderly evacuees.Methods: A total of 715 residents admitted to five nursing homes in Minamisoma city, Fukushima Prefecture in the five years before 11th March 2011 joined this retrospective cohort study. Demographic and clinical characteristics were drawn from facility medical records. Evacuation histories were tracked until the end of 2011. The evacuation's impact on mortality was assessed using mortality incidence density and hazard ratios in Cox proportional hazards regression.Results: Overall relative mortality risk before and after the earthquake was 2.68 (95% CI: 2.04-3.49). There was a substantial variation in mortality risks across the facilities ranging from 0.77 (95% CI: 0.34-1.76) to 2.88 (95% CI: 1.74-4.76). No meaningful influence of evacuation distance on mortality was observed although the first evacuation from the original facility caused significantly higher mortality than subsequent evacuations, with a hazard ratio of 1.94 (95% CI: 1.07-3.49).Conclusion: High mortality, due to initial evacuation, suggests that evacuation of the elderly was not the best life-saving strategy for the Fukushima nuclear disaster. Careful consideration of the relative risks of radiation exposure and the risks and benefits of evacuation is essential. Facility-specific disaster response strategies, including in-site relief and care, may have a strong influence on survival. Where evacuation is necessary, careful planning and coordination with other nursing homes, evacuation sites and government disaster agencies is essential to reduce the risk of mortality.
  • Health-Related Financial Catastrophe, Inequality and Chronic Illness in Bangladesh
    Md Mizanur Rahman, Stuart Gilmour, Eiko Saito, Papia Sultana, Kenji Shibuya
    PLOS ONE 8(2) e56873 2013年02月 [査読有り]
    Background: Bangladesh has a high proportion of households incurring catastrophic health expenditure, and very limited risk sharing mechanisms. Identifying determinants of out-of-pocket (OOP) payments and catastrophic health expenditure may reveal opportunities to reduce costs and protect households from financial risk. Objective: This study investigates the determinants of high healthcare expenditure and healthcare- related financial catastrophe. Methods: A cross-sectional household survey was conducted in Rajshahi city, Bangladesh, in 2011. Catastrophic health expenditure was estimated separately based on capacity to pay and proportion of non-food expenditure. Determinants of OOP payments and financial catastrophe were estimated using double hurdle and Poisson regression models respectively. Results: On average households spent 11% of their total budgets on health, half the residents spent 7% of the monthly per capita consumption expenditure for one illness, and nearly 9% of households faced financial catastrophe. The poorest households spent less on health but had a four times higher risk of catastrophe than the richest households. The risk of financial catastrophe and the level of OOP payments were higher for users of inpatient, outpatient public and private facilities respectively compared to using self-medication or traditional healers. Other determinants of OOP payments and catastrophic expenses were economic status, presence of chronic illness in the household, and illness among children and adults. Conclusion: Households that received inpatient or outpatient private care experienced the highest burden of health expenditure. The poorest members of the community also face large, often catastrophic expenses. Chronic illness management is crucial to reducing the total burden of disease in a household and its associated increased risk of level of OOP payments and catastrophic expenses. Households can only be protected from these situations by reducing the health system's dependency on OOP payments and providing more financial risk protection.
  • The epidemiological impact and cost-effectiveness of HIV testing, antiretroviral treatment and harm reduction programs
    Jinghua Li, Stuart Gilmour, Haiqiang Zhang, Ai Koyanagi, Kenji Shibuya
    AIDS 26(16) 2069-2078 2012年10月 [査読有り]
    Objectives: To estimate trends in the HIV epidemic in China, and explore the epidemiological impact and cost-effectiveness of expanded voluntary counseling and testing (VCT), antiretroviral treatment (ART), and harm reduction programs in preventing the spread of HIV. Design and methods: A mathematical model was developed and calibrated to reflect the dynamics of disease progression and transmission through sexual contacts and needle sharing in China, and the cost-effectiveness of four interventions was analyzed. Multivariate sensitivity analysis was used to estimate uncertainty ranges for all outcomes. Results: A total of 3.4 million new HIV infections were estimated to occur over the next 30 years if no preventive measures were implemented, of which 75% will occur in high-risk groups, such as injecting drug users (IDUs) and men who have sex with men. Expanding ART treatment is most cost-effective, at 4840 (uncertainty range/UR: 3960-5980) international dollars per quality-adjusted life year gained. The optimal cost-effectiveness path is from ART to the combination strategy of ART and harm reduction, followed by the combination strategy of harm reduction, ART and VCT. Conclusion: Expanded VCT (low-risk once, high-risk annually), expanded ART, harm reduction programs and all combinations of these strategies are cost-effective relative to the base case. In order to bring China to a lower phase of the HIV epidemic, in addition to VCT and ART treatment, efforts in reducing risk behavior will be necessary. (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins
  • Internal Radiation Exposure After the Fukushima Nuclear Power Plant Disaster
    Masaharu Tsubokura, Stuart Gilmour, Kyohei Takahashi, Tomoyoshi Oikawa, Yukio Kanazawa
    JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 308(7) 669-670 2012年08月 [査読有り]
  • Projecting HIV Transmission in Japan
    Stuart Gilmour, Jinghua Li, Kenji Shibuya
    PLOS ONE 7(8) e43473 2012年08月 [査読有り]
    Background: Little is known about the epidemiology of HIV in Japan, though newly-identified cases amongst men who have sex with men (MSM) show an increasing trend. Predictions of future trends in the HIV epidemic are essential to identify suitable interventions. Methods: A deterministic, compartmental model was developed that incorporated risk groups, disease stages, and treatment and testing parameters. This model was calibrated against current figures on new infections and run over 30 years to identify trends in prevalence amongst MSM, low-risk men and low-risk women. Multivariate sensitivity analysis was used to estimate sensitivity ranges for all outcomes. Results: Without new interventions amongst MSM in Japan, HIV prevalence will climb from its current rate of 2.1% to 10.4% (sensitivity range 7.4% to 18.7%), while HIV prevalence among low-risk men and women will likely decline. With small changes in safer sex behavior and testing rates, HIV prevalence can remain stable or even decline amongst MSM. Conclusions: Japan is at risk of an epidemic of HIV amongst MSM unless significant changes are made to its current public health intervention framework. More research is necessary to understand the key drivers of the epidemic in Japan.
  • Trends in cause specific mortality across occupations in Japanese men of working age during period of economic stagnation, 1980-2005: retrospective cohort study.
    Wada K, Kondo N, Gilmour S, Ichida Y, Fujino Y, Satoh T, Shibuya K
    BMJ (Clinical research ed.) 344 e1191 2012年03月 [査読有り]
  • Does general practice reduce health inequalities? Analysis of quality and outcomes framework data
    Anna Dixon, Artak Khachatryan, Stuart Gilmour
    EUROPEAN JOURNAL OF PUBLIC HEALTH 22(1) 9-13 2012年02月 [査読有り]
    Background: The government set a series of targets to reduce health inequalities in England by 2010. Primary care has an important role in reducing health inequalities. The aim of the study was to assess the impact of general practice on reducing area-based health inequalities. Methods: Analysis of differences in achievement on clinical indicators between practices in Spearhead and non-Spearhead Primary Care Trusts (PCTs) using data from the Quality and Outcomes Framework (QOF) for 2004/05 and 2005/06, practice characteristics and Spearhead status of PCTs. The study used data on 8339 primary care practices in England. Unweighted mean reported achievement on subset of 26 clinical indicators was calculated. The study analysed differences in achievement by Spearhead status and deprivation in both years and the change between years. Multiple regression analysis of relationship between Spearhead status, income deprivation, reported achievement and other factors also were carried out. Results: Practices in Spearhead PCTs performed worse than practices in non-Spearhead PCTs in both years but showed greater improvement. Among the most deprived practices, there were no differences in QOF achievement between Spearhead and non-Spearhead PCTs. Previous year's achievement was the strongest predictor of performance. Conclusion: The narrowing in performance between practices in Spearhead and non-Spearhead PCTs may have indirectly contributed to a reduction in area-based health inequalities but the differences are small. The lack of difference between the most deprived practices in Spearhead and non-Spearhead PCTs suggest that area-based initiatives to tackle inequalities have not yet had an observable impact on deprived practices. Unobserved factors explain most of the variation in achievement.
  • EQUITY CONSIDERATIONS IN THE CALCULATION OF COST-EFFECTIVENESS IN SUBSTANCE USE DISORDER POPULATIONS
    Stuart J. Gilmour
    ADDICTION 106(11) 2047-2048 2011年11月 [査読有り]
  • Explaining variation in referral from primary to secondary care: cohort study.
    McBride D, Hardoon S, Walters K, Gilmour S, Raine R
    BMJ (Clinical research ed.) 341 c6267 2010年11月 [査読有り]
  • Identification of Hospital Catchment Areas Using Clustering: An Example from the NHS
    Stuart John Gilmour
    HEALTH SERVICES RESEARCH 45(2) 497-513 2010年04月 [査読有り]
    Objective To develop a method of hospital market area identification using multivariate data, and compare it with existing standard methods. Data Sources Hospital Episode Statistics, a secondary dataset of admissions data from all hospitals in England, between April 2005 and March 2006. Study Design Seven criteria for catchment area definition were proposed. K-means clustering was used on several variables describing the relationship between hospitals and local authority districts (LADs) to enable the placement of every LAD into or out of the catchment area for every hospital. Principal component analysis confirmed the statistical robustness of the method, and the method was compared against existing methods using the seven criteria. Principal Findings Existing methods for identifying catchment areas do not capture desirable properties of a hospital market area. Catchment areas identified using K-means clustering are superior to those identified using existing Marginal methods against these criteria and are also statistically robust. Conclusions K-means clustering uses multivariate data on the relationship between hospitals and geographical units to define catchment areas that are both statistically robust and more informative than those obtained from existing methods.
  • Process and predictors of drug treatment referral and referral uptake at the Sydney Medically Supervised Injecting Centre
    Jo Kimber, Richard P. Mattick, John Kaldor, Ingrid van Beek, Stuart Gilmour, Jake A. Rance
    DRUG AND ALCOHOL REVIEW 27(6) 602-612 2008年 [査読有り]
    Introduction and Aims. Low-threshold drug services such as drug consumption rooms (DCRs) have been posited as referral gateways to drug treatment for injecting drug users (IDUs). We examined the process and predictors of drug treatment referral and referral uptake at an Australian DCR. Design and Methods. We undertook behavioural surveillance of the Sydney Medically Supervised Injecting Centre (MSIC) client cohort between May 2001 and October 2002. Data were collected for 3715 IDUs on demographics, injecting and drug use behaviours at registration and all subsequent MSIC service utilisation, including referrals. Referral uptake (defined as presentation for assessment at the relevant agency) was traced via reply-paid postcards included with written referrals. Results. Sixteen per cent of clients who received written referrals to drug treatment had confirmed drug treatment referral uptake. Factors associated with drug treatment referral were frequent MSIC attendance [adjusted odds ratios (AOR=9.4], receipt of written health (AOR=4.8) or psychosocial (AOR=4.3) referrals, heroin as main drug injected (AOR=1.9) and completion of high school education (AOR=1.6). Factors associated positively with drug treatment referral uptake were recent sex work (AOR=2.6) and at least daily injection (AOR 2.3). Previous psychiatric illness or self-harm was associated negatively with drug treatment referral uptake (AOR=0.2). Discussion and Conclusions. MSIC engaged IDUs successfully in drug treatment referral and this was associated with presentation for drug treatment assessment and other health and psychosocial services. To improve rates of drug treatment referral and uptake, those with a history of mental health issues may require more intensive referral and case management.
  • Determining a cut-off on the Severity of Dependence Scale (SDS) for alcohol dependence
    Peter Lawrinson, Jan Copeland, Saul Gerber, Stuart Gilmour
    ADDICTIVE BEHAVIORS 32(7) 1474-1479 2007年07月 [査読有り]
    Optimal cut-off points on the Severity of Dependence Scale (SDS) indicative of clinically significant dependence have been determined for a range of substance types. This study aims to determine a cut-off point on SDS that discriminates between the presence and absence of a DSM-IV diagnosis of alcohol dependence. A structured interview was administered to 90 alcohol users in Sydney, Australia. Receiver Operating Characteristic curve analysis confirmed the utility of the SDS-alcohol for characterising and diagnosing persons with respect to their alcohol-dependent status to an accuracy of 85%. A SDS score of 3 or above was determined as optimal for characterising alcohol dependence. Evidence is also provided confirming that the SDS-alcohol is a valid, reliable uni-dimensional scale for measuring alcohol dependence. It has been demonstrated that the SDS-alcohol can be used to characterise an individual's alcohol-dependent status. A cut-off value for SDS-alcohol provides additional meaning and value to the scale for clients and clinicians and will enable researchers to characterise the prevalence of alcohol dependence in their target populations. (C) 2006 Elsevier Ltd. All rights reserved.
  • The temporal dynamics of relationships between cannabis, psychosis and depression among young adults with psychotic disorders: findings from a 10-month prospective study
    Louisa Degenhardt, Chris Tennant, Stuart Gilmour, David Schofield, Louise Nash, Wayne Hall, Diana McKay
    PSYCHOLOGICAL MEDICINE 37(7) 927-934 2007年07月 [査読有り]
    Background. The aim was to examine the temporal relationships over 10 months between cannabisuse and symptoms of psychosis and depression in people with schizophrenia and related disorders. The design was a prospective study of 101 patients with schizophrenia and related disorders who were assessed monthly over 10 months on medication compliance, cannabis and other drug use, symptoms of depression and symptoms of psychosis. Method. Linear regression methods to assess relationships between cannabis use and symptoms of psychosis and depression while adjusting for serial dependence, medication compliance and other demographic and clinical variables. Results. Cannabis use predicted a small but statistically significant increase in symptoms of psychosis, but not depression, after controlling for other differences between cannabis users and non-users. Symptoms of depression and psychosis did not predict cannabis use. Conclusion. Continued cannabis use by persons with schizophrenia predicts a small increase in psychotic symptom severity but not vice versa.
  • Substance use, psychological distress and violence among pregnant and breastfeeding Australian women
    Cate Wallace, Lucy Burns, Stuart Gilmour, Delyse Hutchinson
    AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 31(1) 51-56 2007年02月 [査読有り]
    Objective: To identify the population prevalence and demographic characteristics of pregnant and/or breastfeeding Australian women who use licit and illicit substances and their experience of psychological distress and violence. Methods: Data from the 2004 National Drug Strategy Household Survey were used to determine the prevalence of substance use, psychological distress and violence experienced by pregnant and/or breastfeeding women. Results: A total of 976 pregnant and/or breastfeeding women were included. These women were significantly less likely than non-pregnant women to consume alcohol (47% vs. 85%) or any illicit drug (6% vs. 17%); however, there was no significant difference in tobacco smoking (20% vs. 25%). Self-reported psychological distress was significantly more frequent in the non-pregnant group (42%) than in the pregnant group, irrespective of substance use status. At a population level, pregnant and/or breastfeeding women were not at a heightened risk of psychological distress or violence. Discussion: These findings highlight the importance of targeting older, tertiary-educated and relatively affluent mothers and those living in regional areas for drug and alcohol education campaigns and treatment. Implications: Simplifying the National Health and Medical Research Council pregnancy-specific alcohol guidelines, improving clinician training, and increasing the availability of treatment options in rural and regional areas may assist in the identification, referral and provision of assistance to substance using pregnant/breastfeeding women.
  • The Adolescent Cannabis Problems Questionnaire (CPQ-A): Psychometric properties
    Greg Martin, Jan Copeland, Stuart Gilmour, Peter Gates, Wendy Swift
    ADDICTIVE BEHAVIORS 31(12) 2238-2248 2006年12月 [査読有り]
    Despite the widespread use of cannabis among young people, little research attention has been given to the development of psychometrically sound measures specific to cannabis related problems in this group. The aim of this study was to explore the reliability, validity and factor structure of a multi-dimensional measure of cannabis-related problems among adolescents. The Adolescent Cannabis Problems Questionnaire (CPQ-A) was developed as an assessment tool and treatment outcome measure. A stratified sample of 100 young people (aged 14-18 years) who had used cannabis in the past 90 days were administered the CPQ-A on two occasions I week apart. Exploratory factor analysis revealed three factors accounting for 63% of total variance with alpha coefficients of 0.88, 0.72 and 0.73. The CPQ-A was reliable with test-retest correlation for the total CPQ-A being 0.91. CPQ-A score correlated significantly with frequency of cannabis use and number of DSM-IV dependence criteria reported. The findings show promise for the CPQ-A as a reliable, valid and potentially clinically useful measure of cannabis related problems among young people. (c) 2006 Elsevier Ltd. All rights reserved.
  • A systematic review of school-based studies involving alcohol and the community
    Elissa Wood, Anthony Shakeshaft, Stuart Gilmour, Rob Sanson-Fisher
    AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 30(6) 541-549 2006年12月 [査読有り]
    Objective: To describe and critique methodological aspects of school-based interventions that involve a broader community initiative. Methods: An electronic search of 11 databases and manual search of references for intervention studies published in peer-reviewed journals from January 2000 to August 2004. To be included in the review, alcohol needed to be a primary focus of the study, the intervention to be school based and include grades between five and 12, and the intervention needed to involve the community. Results: Sixteen articles were selected for inclusion in the review. Methodologically, several studies excluded reporting important details (e.g. follow-up periods unclear), process measures were ignored by some studies (e.g. exposure to intervention), and some employed less than optimal outcome measures (such as attitudes and knowledge). Student education, some form of parental involvement and researchers providing resources to the school, were the most frequently employed intervention strategies. Conclusions: There is a clear need to conduct more rigorous evaluation studies and to increase reporting standards for school-based interventions. There is also tentative scope to include the community more broadly, rather than focus on established relationships within the school environment. Implications: As evidence suggests, there is limited effectiveness in school-based interventions. It may be beneficial to do lowest-cost interventions that have some evidence for effect, complemented by strategies identified by expert opinion, until further rigorous evidence arises.
  • Hair analysis underestimates heroin use in prisoners
    James Shearer, Bethany White, Stuart Gilmour, Alex D. Wodak, Kate A. Dolan
    DRUG AND ALCOHOL REVIEW 25(5) 425-431 2006年09月 [査読有り]
    The value of hair analysis in measuring treatment outcome was examined in a randomised controlled trial (RCT) of an Australian state prison-based methadone programme between 1997 and 1998 (n = 382 male prisoners). Hair samples were analysed for morphine using immunoassay techniques. Agreement between hair analysis and self-report was tested using kappa, McNemar's test of symmetry and Pearson's correlation coefficient r. Hair analysis based on immunoassay was inadequate as the primary outcome measure for the RCT but had value in supplementing self-reported heroin use. There was a modest correlation (r = 0.31, p < 0.001) between self-reported frequency of heroin use and morphine concentrations in hair. Sectional hair analysis, a reflection of duration of drug use, was uninformative and generally impractical due to the length of hair sections needed.
  • Identification and quantification of change in Australian illicit drug markets
    Stuart Gilmour, Inge Koch, Louisa Degenhardt, Carolyn Day
    BMC PUBLIC HEALTH 6 200 2006年08月 [査読有り]
    Background: In early 2001 Australia experienced a sudden reduction in the availability of heroin which had widespread effects on illicit drug markets across the country. The consequences of this event, commonly referred to as the Australian 'heroin shortage', have been extensively studied and there has been considerable debate as to the causes of the shortage and its implications for drug policy. This paper aims to investigate the presence of these epidemic patterns, to quantify the scale over which they occur and to estimate the relative importance of the 'heroin shortage' and any epidemic patterns in the drug markets. Method: Key indicator data series from the New South Wales illicit drug market were analysed using the statistical methods Principal Component Analysis and SiZer. Results: The 'heroin shortage' represents the single most important source of variation in this illicit drug market. Furthermore the size of the effect of the heroin shortage is more than three times that evidenced by long-term 'epidemic' patterns. Conclusion: The 'heroin shortage' was unlikely to have been a simple correction at the end of a long period of reduced heroin availability, and represents a separate non-random shock which strongly affected the markets.
  • The Severity of Dependence Scale (SDS) in an adolescent population of cannabis users: Reliability, validity and diagnostic cut-off
    G Martin, J Copeland, P Gates, S Gilmour
    DRUG AND ALCOHOL DEPENDENCE 83(1) 90-93 2006年06月 [査読有り]
    The Severity of Dependence Scale (SDS) is a five-item scale that has been reported to be a reliable and valid screening instrument for dependence and a measure of dependence severity in adults across several substance classes. To date no data have been reported on its performance in a population of adolescent cannabis users. The current study assessed the psychometric properties of the SDS in a community sample of 14-18-year-old adolescent cannabis users (n = 100). Internal consistency (alpha = 0.83) and test-retest coefficients (ICC = 0.88) were high and a principal components analysis of the scale found all items to load on a single factor. Total SDS score correlated significantly with frequency of cannabis use and number of DSM-IV dependence criteria met, indicating good concurrent validity. Receiver Operating Characteristic curve analysis was used to determine the most appropriate SDS cut-off score for use as an indicator of cannabis dependence, with optimal discrimination at an SDS score of 4. These findings indicate that the SDS is a reliable and valid measure of severity of cannabis dependence among adolescents, has high diagnostic utility, and that an SDS score of 4 may be indicative of cannabis dependence. (c) 2005 Elsevier Ireland Ltd. All rights reserved.
  • Examining links between cocaine use and street-based sex work in New South Wales, Australia
    L Degenhardt, C Day, E Conroy, S Gilmour
    JOURNAL OF SEX RESEARCH 43(2) 107-114 2006年05月 [査読有り]
    We examined potential links between cocaine use and street-based sex work in New South Wales, Australia, following reports of increased cocaine use among injection drug users (IDU). Police data on prostitution and possession/use of cocaine was analysed using time series analysis. Interviews with key informants and IDU were also conducted, and data on cocaine use from ongoing monitoring systems targeted at IDU were analyzed. There was a clear increase in cocaine use among IDU which occurred in 2001. This occurred at the same time as an increase in prostitution offenses. Qualitative data suggested a greater number of primary heroin users were engaging in street-based sex work, which was driven in part by the increases in cocaine use among this group. Subsequent reductions in cocaine availability led to decreased cocaine use and possession offenses, along with reductions in prostitution offenses.
  • Using intervention time series analyses to assess the effects of imperfectly identifiable natural events: a general method and example.
    Gilmour S, Degenhardt L, Hall W, Day C
    BMC medical research methodology 6 16 2006年04月 [査読有り]
  • Cycling in and out of treatment; participation in methadone treatment in NSW, 1990-2002
    J Bell, T Burrell, D Indig, S Gilmour
    DRUG AND ALCOHOL DEPENDENCE 81(1) 55-61 2006年01月 [査読有り]
    Background:: There are few descriptions of patterns of long-term participation in methadone treatment. There has been progressive expansion of methadone maintenance treatment (MMT) in Australia in the last 15 years, and by international standards Australia has a high participation rate in MMT, and has accumulated extensive data on participation. Aim:: (1) To analyse predictors of retention in treatment (a proxy measure of treatment effectiveness) in three cohorts of people entering public and private methadone treatment, in 1990, 1995, and 2000 in the state of New South Wales (NSW), and to compare retention rates with those reported from recent clinical trials; and (2) to describe the pattern of participation in subsequent treatment and predictors of re-entry. Method:: Sequential first admissions to MMT for the month of February during 1990, 1995, and 2000, were identified from the NSW Health database. Initial treatment setting (public or private) was identified. Pattern Of Subsequent participation in treatment of all subjects was also extracted. Descriptive statistics were generated, and predictors of retention in treatment and re-entry to treatment were analysed. Results:: The sample comprised 342 subjects commencing in private and 135 in public settings. Retention did not differ between settings. At 6 months, 51% in the current study were retained, compared to 48% in pooled clinical trials from Australia. There was a significant cohort effect; at 3 months retention was significantly better in the 1990 cohort, but by 12 months, differences between the year-cohorts were not statistically significant. Most people who left treatment dropped out; two-thirds subsequently re-entered MMT, often having multiple episodes. Participation in non-continuous treatment was around 45% for the 5 years after first entering treatment. Using multiple logistic regression, the significant predictors of re-entry to treatment were age, and duration of first treatment episode; specifically, older people and those with > 12 months continuous treatment were significantly less likely to re-enter. Conclusion:: Retention in treatment in practice, across a range of settings, appears comparable to treatment delivered in clinical trials. Participants cycle in and out of treatment, and this recycling appears to have increased as the program has expanded and access to treatment has increased. (c) 2005 Elsevier Ireland Ltd. All rights reserved.
  • The "lessons" of the Australian "heroin shortage"
    Louisa Degenhardt, Carolyn Day, Stuart Gilmour, Wayne Hall
    SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 1 11 2006年 [査読有り]
    Heroin use causes considerable harm to individual users including dependence, fatal and nonfatal overdose, mental health problems, and blood borne virus transmission. It also adversely affects the community through drug dealing, property crime and reduced public amenity. During the mid to late 1990s in Australia the prevalence of heroin use increased as reflected in steeply rising overdose deaths. In January 2001, there were reports of an unpredicted and unprecedented reduction in heroin supply with an abrupt onset in all Australian jurisdictions. The shortage was most marked in New South Wales, the State with the largest heroin market, which saw increases in price, dramatic decreases in purity at the street level, and reductions in the ease with which injecting drug users reported being able to obtain the drug. The abrupt onset of the shortage and a subsequent dramatic reduction in overdose deaths prompted national debate about the causes of the shortage and later international debate about the policy significance of what has come to be called the "Australian heroin shortage". In this paper we summarise insights from four years' research into the causes, consequences and policy implications of the "heroin shortage".
  • The Cannabis Problems Questionnaire: Factor structure, reliability, and validity
    J Copeland, S Gilmour, P Gates, W Swift
    DRUG AND ALCOHOL DEPENDENCE 80(3) 313-319 2005年12月 [査読有り]
    Aim: To develop a multi-dimensional valid and reliable measure of cannabis-related problems. Method: The Cannabis Problems Questionnaire (CPQ) was developed from the Alcohol Problems Questionnaire to measure cannabis treatment outcome. The CPQ was administered on two occasions I week apart to a stratified sample of adults who had used cannabis at least once in the previous 3 months. Exploratory factor analyses were conducted and the relationship between items of the CPQ and measures of daily use and dependence assessed. The reliability of the CPQ was also assessed using a test-retest and inter-rater reliability methodology. Results: Exploratory factor analyses revealed a three factor Solution best described the data accounting for 57% of the variance in the larger item set. The CPQ is highly reliable with test-retest tetrachoric correlations of between 0.92 and 1.00 and inter-rater reliability correlations between 0.74 and 1.00. The total CPQ score classified DSN-IV cannabis dependence with 84% specificity and sensitivity and daily cannabis use with 83% specificity and 55% sensitivity. Conclusions: The 22-item CPQ is a valid, reliable and sensitive measure of cannabis-related problems for use with clinical and research Populations Of Current cannabis users. (c) 2005 Elsevier Ireland Ltd. All rights reserved.
  • Age differentials in the impacts of reduced heroin: Effects of a "heroin shortage" in NSW, Australia
    L Degenhardt, C Day, E Conroy, S Gilmour, W Hall
    DRUG AND ALCOHOL DEPENDENCE 79(3) 397-404 2005年09月 [査読有り]
    Background : This paper uses a unique event, the Australian heroin shortage, to see whether an abrupt, substantial and sustained change in heroin supply had different effects on harms related to heroin use among younger and older heroin users. Method : Indicator data were examined by age group on the number of persons entering treatment for heroin and amphetamine dependence, arrests for heroin use/possession and number of drug related deaths in NSW, Australia. Data were analysed using times series analysis. Results : There was a 41% reduction in the number of new registrations for opioid pharmacotherapy per month among 25-34 year olds, and a 26% reduction among 15-24 year olds, but no apparent changes among older age groups. Similarly, reductions in the number of nonpharmacological heroin treatment episodes were most pronounced among younger age groups. There was a 49% reduction in the number of heroin possession/use offences among those aged 15-24 years, compared to declines of 31-40% among older age groups. Declines in heroin related deaths were greatest among 15-24 year olds (65% reduction). There was no change in other drug related deaths in any age group. Conclusions : A reduction in heroin supply was followed by greater reductions in heroin related harms among younger than older people, across a number of outcome domains. (c) 2005 Elsevier Ireland Ltd. All rights reserved.
  • The impact of a reduction in drug supply compliance with treatment for drug on demand for and dependence
    L Degenhardt, E Conroy, C Day, S Gilmour, W Hall
    DRUG AND ALCOHOL DEPENDENCE 79(2) 129-135 2005年08月 [査読有り]
    Background: In early 2001, Australia experienced a sudden, dramatic and;sustained decrease in heroin availability that was accompanied by sharp increases in price and decreases in street level purity-the so-called "heroin shortage". These unprecedented changes occurred in a context of widespread treatment availability, which made it possible for the first time to examine the impact of a sharp reduction in heroin supply in New South Wales (NSW) on entry to and adherence with treatment for heroin dependence. Given the evidence of drug substitution by some users. the current paper also examines the effects of the shortage on entry to treatment for other forms of drug dependence. Methods: Interrupted time-series analysis of the number of persons entering opioid pharmacotherapy and other treatment modalities in NSW for heroin dependence and for the treatment for other types of drug dependence. Findings: The heroin shortage was associated with a reduction in the number of younger persons entering opioid pharmacotherapy. There was a dramatic decrease in the number of persons entering heroin withdrawal or "assessment only" treatment episodes. There appear to have been small improvements in adherence to and retention in heroin treatment after the reduction in heroin supply. Relatively small increases were observed in numbers being treated for cocaine dependence. Conclusions: In the context of good treatment provision, a reduction in heroin supply appeared to produce modest improvements in intermediate outcomes. Supply and demand reduction measures, when both are implemented successfully, may be complementary. (c) 2005 Elsevier Ireland Ltd. All rights reserved.
  • The impact of changes to heroin supply on blood-borne virus notifications and injecting related harms in New South Wales, Australia
    C Day, L Degenhardt, S Gilmour, W Hall
    BMC PUBLIC HEALTH 5 84 2005年08月 [査読有り]
    Background: In early 2001 Australia experienced a sudden and unexpected disruption to heroin availability, know as the 'heroin shortage'. This 'shortage has been linked to a decrease in needle and syringe output and therefore possibly a reduction in injecting drug use. We aimed to examine changes, if any, in blood-borne viral infections and presentations for injecting related problems related to injecting drug use following the reduction heroin availability in Australia, in the context of widespread harm reduction measures. Methods: Time series analysis of State level databases on HIV, hepatitis B, hepatitis C notifications and hospital and emergency department data. Examination of changes in HIV, hepatitis B, hepatitis C notifications and hospital and emergency department admissions for injection-related problems following the onset of the heroin shortage; non-parametric curve-fitting of number of hepatitis C notifications among those aged 15 - 19 years. Results: There were no changes observed in hospital visits for injection-related problems. There was no change related to the onset heroin shortage in the number of hepatitis C notifications among persons aged 15 - 19 years, but HCV notifications have subsequently decreased in this group. No change occurred in HIV and hepatitis B notifications. Conclusion: A marked reduction in heroin supply resulted in no increase in injection-related harm at the community level. However, a delayed decrease in HCV notifications among young people may be related. These changes occurred in a setting with widespread, publicly funded harm reduction initiatives.
  • Was an increase in cocaine use among injecting drug users in New South Wales, Australia, accompanied by an increase in violent crime?
    L Degenhardt, C Day, W Hall, E Conroy, S Gilmour
    BMC PUBLIC HEALTH 5 40 2005年04月 [査読有り]
    Background: A sharp reduction in heroin supply in Australia in 2001 was followed by a large but transient increase in cocaine use among injecting drug users (IDU) in Sydney. This paper assesses whether the increase in cocaine use among IDU was accompanied by increased rates of violent crime as occurred in the United States in the 1980s. Specifically, the paper aims to examine the impact of increased cocaine use among Sydney IDU upon police incidents of robbery with a weapon, assault and homicide. Methods: Data on cocaine use among IDU was obtained from the Illicit Drug Reporting System (IDRS). Monthly NSW Police incident data on arrests for cocaine possession/ use, robbery offences, homicides, and assaults, were obtained from the Bureau of Crime Statistics and Research. Time series analysis was conducted on the police data series where possible. Semi-structured interviews were conducted with representatives from law enforcement and health agencies about the impacts of cocaine use on crime and policing. Results: There was a significant increase in cocaine use and cocaine possession offences in the months immediately following the reduction in heroin supply. There was also a significant increase in incidents of robbery where weapons were involved. There were no increases in offences involving firearms, homicides or reported assaults. Conclusion: The increased use of cocaine among injecting drug users following the heroin shortage led to increases in violent crime. Other States and territories that also experienced a heroin shortage but did not show any increases in cocaine use did not report any increase in violent crimes. The violent crimes committed did not involve guns, most likely because of its stringent gun laws, in contrast to the experience of American cities that have experienced high rates of cocaine use and violent crime.
  • The effect of a reduction in heroin supply on fatal and non-fatal drug overdoses in New South Wales, Australia
    LJ Degenhardt, E Conroy, S Gilmour, WD Hall
    MEDICAL JOURNAL OF AUSTRALIA 182(1) 20-23 2005年01月 [査読有り]
    Objective: To examine the impact of a sudden and dramatic decrease in heroin availability, concomitant with increases in price and decreases in purity, on fatal and non-fatal drug overdoses in New South Wales, Australia. Design and setting: Time-series analysis was conducted where possible on data on overdoses collected from NSW hospital emergency departments, the NSW Ambulance Service, and all suspected drug-related deaths referred to the NSW Coroner's court. Main outcome measures: The number of suspected drug-related deaths where heroin and other drugs were mentioned; ambulance calls to suspected opioid overdoses; and emergency department admissions for overdoses on heroin and other drugs. Results: Both fatal and non-fatal heroin overdoses decreased significantly after heroin supply reduced; the reductions were greater among younger age groups than older age groups. There were no clear increases in non-fatal overdoses with cocaine, methamphetamines or benzodiazepines recorded at hospital emergency departments after the reduction in heroin supply. Data on drug-related deaths suggested that heroin use was the predominant driver of drug-related deaths in NSW, and that when heroin supply was reduced overdose deaths were more likely to involve a wider combination of drugs. Conclusion: A reduction in heroin supply reduced heroin-related deaths, and did not result in a concomitant increase, to the same degree, in deaths relating to other drugs. Younger people were more affected by the reduction in supply.
  • Clearance of hepatitis C virus after newly acquired infection in injection drug users
    M Jauncey, JM Micallef, S Gilmour, J Amin, PA White, W Rawlinson, JM Kaldor, van Beek, I, GJ Dore
    JOURNAL OF INFECTIOUS DISEASES 190(7) 1270-1274 2004年10月 [査読有り]
    A retrospective cohort of injection drug users with newly acquired hepatitis C virus (HCV) infection was established to examine viral clearance. Newly acquired HCV infection was defined by anti-HCV antibody seroconversion within a 2-year interval. Stored serum samples were tested for HCV RNA, with viral clearance defined as greater than or equal to2 consecutive negative HCV RNA test results after infection. Ninety-nine cases of HCV infection were identified; 57 had greater than or equal to2 HCV RNA test results after infection. Viral clearance occurred in 24 (42%) cases, with Kaplan-Meier estimated probabilities of 23%, 38%, and 40% at 6, 12, and 24 months, respectively.
  • Prevalence of production of virus-specific interferon-gamma among seronegative hepatitis C-resistant subjects reporting injection drug use
    AJ Freeman, RA Ffrench, JJ Post, CE Harvey, SJ Gilmour, PA White, G Marinos, van Beek, I, WD Rawlinson, AR Lloyd
    JOURNAL OF INFECTIOUS DISEASES 190(6) 1093-1097 2004年09月 [査読有り]
    This report describes subjects who were highly likely to have been repeatedly exposed to hepatitis C virus (HCV) through injection drug use and who remained negative for anti-HCV antibody. Production of virus-specific interferon-gamma by peripheral blood mononuclear cells was seen in the majority of subjects (72%) and was associated with higher-risk behavior. For 92% of the subjects, results of recombinant immunoblot assays demonstrated faint bands against nonstructural proteins. The immune responses described are likely to have been primed and maintained by episodes of subclinical infection without classic seroconversion and may indicate a hepatitis C-resistant phenotype. Vaccine strategies to mimic this response may provide protection against persistent HCV infection.
  • Effects of reduction in heroin supply on injecting drug use: analysis of data from needle and syringe programmes.
    Day C, Degenhardt L, Gilmour S, Hall W
    BMJ (Clinical research ed.) 329(7463) 428-429 2004年08月 [査読有り]

教育活動情報

担当経験のある科目

  • 生物統計学実習Ⅰ (聖路加国際大学)
  • 生物統計学Ⅰ (聖路加国際大学)