International Comparison of Crisis Management Policies: For theories of economic policies for crisis response (Japanese)

This paper introduces the details and characteristics of disclosures of crisis management scenarios and simulations of countries and regions based on some of the information collected in research activities for a project on constructing a new macroeconomic model and identifying the right economic policies to take in times of crisis. The paper also identifies some of the implications to Japan's "people protection plan," which can be obtained when viewing the plan from an economic policy perspective. In this research project, we have collected and organized publicly disclosed crisis scenarios from Japan, East Asia (China, Taiwan, and South Korea), the United States, and Europe (the United Kingdom, Germany, France, and Switzerland) on traditional security, natural disasters, and infectious disease issues. Crises and risks cover a broad spectrum from natural disasters, infectious diseases, terrorism, and military operations to more familiar issues, such as traffic accidents and crime. To construct a new model of macroeconomic policies, this research project focuses on natural disasters, infectious diseases, terrorism, and military operations that are considered to have a large macroeconomic impact, rather than risks and crises at the microeconomic level, such as traffic accidents and crime. To that end, for comparison purposes, this paper basically has a section for each region, such as East Asia, Europe, and the United States, to organize the actions each government takes in response to crises in their country and region. Also, with respect to infection diseases, an epidemic is a global issue that transcends the borders of any one country. A separate section is consequently devoted to infectious diseases to organize information globally, given that multinational cooperation and the efforts of international organizations become vital. Also, to protect the public interest, the following implication has been obtained: An institutional response to problems such as the asymmetry of information and the uncertainty of information is necessary, as is the designing of an incentive mechanism for human resource management in a crisis.

Drug-induced Hypersensitivity Syndrome Associated with a Marked Increase in Anti-paramyxovirus Antibody Titers in a Scleroderma Patient

Background: Drug-induced hypersensitivity syndrome (DIHS) is characterized by a severe multiorgan hypersensitivity reaction that usually appears after prolonged exposure to certain drugs and may be related to reactivation of herpes viruses. There have been few reports regarding the clinical association of DIHS with pathogens other than herpes viruses. Case Summary: We report a case of scleroderma with DIHS associated with paramyxovirus infection. A 61-year-old man with early diffuse cutaneous scleroderma with myositis and progressive interstitial pneumonia developed generalized erythema with high fever 3 weeks after taking sulfamethoxazole/trimethoprim. The diagnosis of DIHS was made based on the patient's history of using an offending drug, clinical manifestations and laboratory data showing peripheral eosinophilia with the presence of atypical lymphocytes. Virological tests showed significant increases of antibody titers against mumps virus and parainfluenza virus type 2, which strongly suggested that paramyxovirus infection occurred during the clinical course of DIHS. Discussion: These findings suggest that paramyxovirus infection had contributed to the development of DIHS in this patient and that there is a need to seek evidence of other viral infections in some cases of DIHS, especially those without herpes virus reactivation/infection

Long-term safety and efficacy of alogliptin, a DPP-4 inhibitor, in patients with type 2 diabetes: a 3-year prospective, controlled, observational study (J-BRAND Registry)

Introduction Given an increasing use of dipeptidyl peptidase-4 (DPP-4) inhibitors to treat patients with type 2 diabetes mellitus in the real-world setting, we conducted a prospective observational study (Japan-based Clinical Research Network for Diabetes Registry: J-BRAND Registry) to elucidate the safety and efficacy profile of long-term usage of alogliptin.Research design and methods We registered 5969 patients from April 2012 through September 2014, who started receiving alogliptin (group A) or other classes of oral hypoglycemic agents (OHAs; group B), and were followed for 3 years at 239 sites nationwide. Safety was the primary outcome. Symptomatic hypoglycemia, pancreatitis, skin disorders of non-extrinsic origin, severe infections, and cancer were collected as major adverse events (AEs). Efficacy assessment was the secondary outcome and included changes in hemoglobin A1c (HbA1c), fasting blood glucose, fasting insulin and urinary albumin.Results Of the registered, 5150 (group A: 3395 and group B: 1755) and 5096 (3358 and 1738) were included for safety and efficacy analysis, respectively. Group A patients mostly (>90%) continued to use alogliptin. In group B, biguanides were the primary agents, while DPP-4 inhibitors were added in up to ~36% of patients. The overall incidence of AEs was similar between the two groups (42.7% vs 42.2%). Kaplan-Meier analysis revealed the incidence of cancer was significantly higher in group A than in group B (7.4% vs 4.8%, p=0.040), while no significant incidence difference was observed in the individual cancer. Multivariate Cox regression analysis revealed that the imbalanced patient distribution (more elderly patients in group A than in group B), but not alogliptin usage per se, contributed to cancer development. The incidence of other major AE categories was with no between-group difference. Between-group difference was not detected, either, in the incidence of microvascular and macrovascular complications. HbA1c and fasting glucose decreased significantly at the 0.5-year visit and nearly plateaued thereafter in both groups.Conclusions Alogliptin as a representative of DPP-4 inhibitors was safe and durably efficacious when used alone or with other OHAs for patients with type 2 diabetes in the real world setting