Psychometric validation of anti-clot treatment scale and treatment satisfaction questionnaire for medication version II in Japanese patients with atrial fibrillation

Aims: The Anti-Clot Treatment Scale (ACTS) and Treatment Satisfaction Questionnaire for Medication version II (TSQM-II) are validated treatment satisfaction patient-reported outcome (PRO) instruments. The ACTS includes two domains: Burdens and Benefits; the TSQM-II includes four: Effectiveness, Side Effects, Convenience, and Global Satisfaction. Japanese-language versions of the ACTS and TSQM-II have been developed and linguistically validated. This study aimed to assess their psychometric properties in Japanese patients with atrial fibrillation (AF).

Materials and methods: ACTS and TSQM-II data from 534 patients with AF were collected in a Japanese post-marketing surveillance study of a direct oral-anticoagulant, rivaroxaban. Four key psychometric properties, in line with best practice guidelines from the US Food and Drug Administration, were examined using traditional psychometric methods: acceptability, scaling assumptions, reliability (i.e. internal consistency reliability, test-retest reliability), and construct validity (i.e. convergent validity and known groups).

Results: ACTS Burdens and Benefits and TSQM-II Effectiveness, Convenience, and Global Satisfaction scales were found to be acceptable (e.g. item-level missing data at baseline <4%), with all scales having good internal consistency (Cronbach’s alpha > 0.80). test-retest reproducibility intraclass correlation coefficients for the ACTS Burdens and Benefits were 0.59 and 0.65, respectively, and between 0.54–0.61 for the TSQM-II scales. Known-groups validity for the ACTS and TSQM-II was supported by differences in scale scores by positive and negative impact (p?<?0.05). Correlations between the ACTS and TSQM-II (convergent validity) were lower than expected (range r?=?0.09–0.48), but in line with the original ACTS development study.

Limitations: Evaluation of test-retest reproducibility was limited by assessment period, which was longer (3 months) than recommended guidelines (usually up to 2 weeks).

Conclusions: Overall, Japanese versions of ACTS and TSQM-II scales satisfied internal consistency reliability and traditional validity criteria. Our study supports the ACTS and TSQM-II as appropriate PRO instruments to measure satisfaction with anticoagulant treatment in Japanese patients with AF.

Trial registration: NCT01598051, clinicaltrials.gov; registered April 20, 2012.     

Shift of the short-term temperature mortality relationship by a climate factor - some evidence necessary to take account of in estimating the health effect of global warming

Several studies have reported a 'V'-shaped relationship between short-term temperature and mortality rates, characterized by mortality rates that are higher when the temperature is extremely low or high than when the temperature is moderate. To quantify the effect of adaptation to a certain climate on this V-shaped short-term temperature-mortality relationship, we studied the prefecture-specific relationship between daily maximum temperature and mortality rates for 65+-years-old Japanese from 1972 to 1990. For both genders, the optimum daily maximum temperature (OT) category at which the mortality rate was minimum ranged from 23C-28 C to 33+C, and the OT level became lower when the climate became colder. The mean OT level was lower for women than for men by 1.7C. The mortality rate at the OT was almost constant across prefectures, regardless of the climate. From the results, we considered that the adaptation effect on the short-term temperature-mortality relationship is mainly described by the 'horizontal shift model': the V-shape moves horizontally according to the climate. This 'shift' should be taken into account in estimating the health effect of global warming, and the model would be useful for the estimation.     

Ethical aspects of “Japanese leadership style”

This article describes three characteristics of the Japanese Leadership Style (JLS): self-realization, appreciation of diverse abilities, and trust in others, which have both positive and negative ethical implications. In addition to illustrating how JLS allows Japanese corporations to avoid some of the ethical problems plaguing U.S. corporations, the authors will explain how these characteristics engender the loyalty and initiative of Japanese employees which promote incremental innovation and competitive advantages. Implicit in this discussion is the premise that both the American and Japanese business communities, by analyzing their own ethical issues and leadership styles, can learn from each other.Iwao Taka is a Visiting Research Fellow in the Department of Legal Studies at The Wharton School. He is an Assistant Professor in the International School of Economics and Business Administration, Reitaku University in Japan. His publications include Business Ethics: A Japanese View, Intuitive Decision-Making and Creative Destruction, and Japanese Entrepreneurship after World War II.Wanda D. Foglia, Esquire, is a Teaching Fellow in the Department of Legal Studies at The Wharton School where she is pursuing a Ph.D. in Criminology. A former Assistant District Attorney, her research focuses on approaches for promoting the individual's commitment to ethical and law-abiding behavior. She has recently coordinated a Project to Integrate Ethics Into the Wharton Undergraduate Curriculum.     

Particulate matter air pollution control programs in Japan — an analysis of cost savings in the absence of future remediation

The objectives of this study were to assess avoided economic costs (or anticipated ‘benefits’) of not implementing new environmental policies for particulate matter (PM) in Japan and compare these future benefits to estimates of future health risks developed in a separate analysis. The estimates for the benefits of avoided PM pollution control in the year 2010 were (1) $27 billion USD for stationary source controls, (2) $2.1 billion to $3.3 billion USD for diesel motor vehicle controls, (3) $41 million USD for governmental employee salaries, (4) $470 million USD for governmental financial assistance, (5) $510 million USD for special diesel vehicle control measures in Tokyo, and (6) $31 billion USD for total costs.

Using human health and productivity risks, calculated in a separate study to be $56 billion USD, the best net ratio of benefits to costs was 1.8 to 1. Inexpensive control options include road watering or paving for unpaved dirt roads and road vacuuming for paved roads. Intermediate options include differential road pricing, retrofitting diesel particulate filters, and reformulating diesel fuel. High cost options include adding particulate controls, such as wet scrubbers, baghouses, and electrostatic precipitators on uncontrolled stationary sources.     

The regulations for indoor air pollution in Japan: a public health perspective

In recent years public health problems caused by indoor air pollution, known as ‘Sick Building Syndrome in housing’, or ‘Sick House Syndrome’ in Japan, have been drawing strong public concern. After conducting extensive exposure assessment, government authorities have taken effective measures to solve the problem. However, as a result of diversification and increase in quantities of industrial chemicals, existing regulations do not cover enough ranges of various potential hazardous chemicals. Hence, the regulations seek to be changed from hazard‐based regulation to a risk‐based one. Good indoor air quality (IAQ), which does not pose unacceptable health risks from all pollutants affecting indoor air, should be ensured for all public people. The objective of this study is to clarify the remaining issues to be solved urgently, related to the regulations to ensure a good IAQ. We reviewed enormous numbers of the existing governmental and industrial voluntary standards and/or guidelines, literature and documents concerning IAQ research in the past 40 years. Our results showed six subjects from those remaining issues. Based on these subjects we created a new scheme to control the IAQ; we especially regarded a comprehensive labeling system as one of the important strategies.     

Business Ethics in Japan

Business ethics in Japan has developed in five stages. Especially in the last stage (in the 1990s), there have appeared two clear-cut trends in business ethics activities: positive and passive. For the rise of business ethics, the passive trend is much more important. Once entered the 1990s, an increasing number of business scandals have been revealed. Because of this, the Japanese business community cannot but help take business ethics much more seriously than it ever has.Not only business practitioners but also business ethicists have inaugurated a variety of ethics-related studies and activities. This article mainly puts focus on the studies, which have been done in the 1990s. At the end of the article, ethical challenges, which the Japanese business and academia meet presently, are described.     

Ricardo on machinery: a dynamic analysis

I construct a dynamic two-sector model which formalizes Ricardo's argument on the effects of the introduction of machinery. My model does not require the inappropriate assumptions common to other Ricardian models. Using this model, I show that if machinery is introduced, both the demand for labour and the output of the consumption good must decline temporarily and can then recover. As well, the temporal decline of value of the gross produce is not a necessary condition for the above temporal decline of the demand for labour.     

Making Ethical Judgements: A Cross-Cultural Management Study

This article reports the results of a cross-cultural empirical study across seven countries which investigates the differences in the way managers structure their ethical judgements regarding the loyalty of a corporation to its employees, the loyalty of employees to the corporation, and the loyalty of employees towards their co-workers. Managers' ethical judgements from the East Asian tiger countries of Japan, Korea and Hong Kong are compared with those from the Anglo countries of the United States and Australia, and with those from the transitional countries of Asiatic Russia and Poland. An adapted version of the well documented Reidenbach-Robin instrument is used, and its cross-cultural application investigated. As hypothesized, cross-cultural differences were indicated for both the structure and content of managers' ethical judgements, which have important implications for the way organizations are effectively managed both nationally, regionally and internationally. Weaknesses in the a priori constructs of the research instrument were also indicated, and recommendations made for future development of methodology in this area.     

Particulate matter air pollution control programs in Japan — an analysis of health risks in the absence of future remediation

The objective of this case study was to assess potential health risks and productivity loss in the absence of future additional environmental control of particulate matter (PM) in Japan. Assuming a 10% decline in PM, the estimates of the numbers of possible cases of premature mortality and morbidity that could be prevented in the year 2010 were (1) 8700 long term deaths, (2) 12,000 cases of chronic bronchitis, (3) 24,000 cases of cardiovascular disease, (4) 10,000 cases of pneumonia, (5) 18,000 asthma attacks, and (6) 12,000 cases of acute bronchitis during a one year period. The best estimate of medical costs plus lost productivity in adults and children was $56 billion USD. When compared to a separately derived estimate of $31 billion USD in avoided pollution control costs, the health risk to no‐control benefit ratio of 1.8 suggests that additional future pollution control policies would successfully prevent a large expense to the society in medical care and lost productivity while imposing a lesser cost to the private sector in control equipment, to government in oversight expenses and to society in opportunity costs.