Prevalence and Comorbidity of Anxiety and Depressive Disorders in Studies of PRIME-MD and PHQ (Patient Health Questionnaire) in Japan

We examine two studies on the prevalence and comorbidity of anxiety and depressive disorders in Japanese patients in primary care settings. The PRIME-MD study (Primary Care Evaluation of Mental Disorders) in Japan was conducted in seven primary care sites. The sample group included 601 adult patients (249 males, 352 females, mean age = 58.9 years, SD = 16.5). Of the 12.5% of patients diagnosed with mood disorders, 5.0% (n = 29) were major depressive disorder, and 6.7% (n = 40) were minor depressive disorder. The odds ratio for co-occurrence of major depressive disorder with generalized anxiety disorders and major depressive disorder with anxiety disorders (NOS) was 11.5 (95% CI: 2.17–18.45) and 8.00 (95% CI: 3.19–20.07), respectively. The PHQ (Patient Health Questionnaire) study in Japan was conducted in eleven primary care sites. A total of 1409 adult patients (611 males, 797 females; mean age: 56.2 years, SD: ±20.4) completed the PHQ in full. The prevalence of diagnosis of any mood disorder or any anxiety disorder was 25.0%. Of the 15.8% of patients diagnosed with mood disorders, 5.3% were for major depression and 8.4% for other depressive disorders. The odds ratio for co-occurrence of major depressive disorder with other anxiety disorders was 30.4 (95% CI: 13.19–70.28)

Efficacy of Using the Japanese Version of the Asthma Control Test for Determing the Level of Asthma Control in Clinical Settings

Background: The Asthma Control Test (ACT) is frequently used for the evaluation of asthma control in clinical care setting because it does not require the use of pulmonary function tests, which can be difficult for general practitioners to use. However, few large-scale studies have investigated the efficacy of the Japanese version ACT (J-ACT) in actual use during clinical care. Methods: The aim of this study was to analyze the efficacy of the J-ACT in a clinical care setting. Using data from a 2008 questionnaire survey including the J-ACT by the Niigata Asthma Treatment Study Group, we compared the ACT scores of 2233 patients with respect to multiple parameters, including the severity by Japanese Society of Allergology and the attack frequency. Using the definition of asthma control partially referred to Global Initiative for Asthma (GINA) guidelines from the survey data, the accuracy screening and determination of optimal ACT cutpoints were performed by retrospective analysis. Results: Cronbach's a for the J-ACT was 0.785. Patients with more severe asthma and more frequent asthma attacks had lower ACT scores than did patients with less severe, less frequent attacks. The optimal ACT cutpoints were 24 for the controlled asthma and 20 for the uncontrolled asthma. Conclusions: Our study, the first large-scale investigation of the efficacy of the J-ACT, determined that this evaluation tool is highly efficacious in establishing the level of asthma control. However, the determination of accurate cutpoints for the J-ACT will require more clear definitions of asthma control in future prospective studies

Assessment of Bone Status in Inhaled Corticosteroid User Asthmatic Patients with an Ultrasound Measurement Method

Background: The effect of inhaled corticosteroid (ICS) on the bone status of asthmatic patients is still uncartain, becuase it can differ by race and because there have been few cases in Japan. In this study, the bone status of ICS users with asthma was evaluated in an actual clinical setting in Japan. Methods: In 7 participating hospitals, ICS users with asthma and control subjects were age- and gender-matched and recruited into this study. To assess bone status, ultrasound measurements of each individual's calcaneus were made using an AOS-100. The ratio of the osteo sono-assessment index (OSI) to the average OSI corrected for age and gender was denoted as %OSI and used for quantitative assessment. The second %OSI measurement was performed 6 months after the first %OSI one. During the study period, individual treatment remained unchanged. Results: There were no significant differences in the 1st and 2nd %OSI between the ICS users and control subjects. However, the 2nd %OSI significantly decreased compared with 1st %OSI in female ICS users, although there were no significant changes in the male and female control subjects and male ICS users. Conclusions: The 6 month manegement of asthma in the actual clinical setting, including regular ICS use, might have a harmful influence on the bone status of female asthmatic patients. It may be necessary to manage and treat female patients for potent corticosteroid-induced osteoporosis, although further analyses of bone status in asthma patient ICS users will be required