Recreational Drug Use and Related Social Factors among HIV-Positive Men in Japan

This study aims to determine the relationship between recreational drug use in HIV-positive males in the past year and socio-economic factors and/or social support networks in Japan. 

A national online survey in a cross-sectional study was conducted by HIV Futures Japan project from July 2013 to February 2014. Of the 1095 HIV-positive individuals who responded, 913 responses were determined to be valid; responses from the 875 males were analysed. A total of 282 participants used addictive drugs (32.2%) in past year. 

New psychoactive substances were used by 121 participants (13.8%), methamphetamine or amphetamine by 47 (5.4%), air dusters/sprays/gas by 31 (3.5%), 5-methoxy-N,N-diisopropyltryptamine (5MeO-DIPT) by 16 (1.8%) and cannabis (1.0%) by 9. 

Multiple logistic regression analysis was performed with the use of alkyl nitrites, addictive drugs, air dusters and thinners, which are low illegality, as dependent variables. We found that the odds ratio (95% confidence interval) for use among participants with full-time and temp/contracted/part-time employees compared to management/administration professions were 2.59 (0.99-6.77) and 2.61 (0.91-7.51). 

Also, a correlation was observed between alkyl nitrites and new psychoactive substances and usage rates in people engaged in few HIV-positive networks. It is necessary to develop targeted policies for drug use prevention and user support among HIV-positive men and to support and provide care for drug users who are isolated or have a narrow HIV/AIDS support network.

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By:  Togari T1, Inoue Y1, Takaku Y2, Abe S3, Hosokawa R4, Itagaki T5, Yoshizawa S6, Oki S7, Katakura N8, Yamauchi A9, Wakabayashi C10, Yajima T3,11.

• 1 Faculty of Liberal Arts , the Open University of Japan , Chiba , Japan.
• 2 Japan Network of People Living with HIV/AIDS , Tokyo , Japan.
• 3 Division of Health Management , TIS Inc ., Tokyo , Japan.
• 4 School of Nursing , Nagoya City University , Nagoya , Japan.
• 5 Accelight Inc ., Tokyo , Japan.
• 6 ANGEL LIFE NAGOYA , Nagoya , Japan.
• 7 Faculty of Nursing , Kyorin University , Mitaka , Japan.
• 8 Kobe City College of Nursing , Kobe , Japan.
• 9 School of Nursing , Tokyo Medical University , Tokyo , Japan.
• 10 Department of Health Sciences , Saitama Prefectural University , Koshigaya , Japan.
• 11 PLACE TOKYO , Tokyo , Japan.
• AIDS Care. 2016 Feb 17:1-9. 

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Reluctance to Care for Patients with HIV or Hepatitis B/C in Japan

BACKGROUND:

Healthcare workers are faced with various professional dilemmas in the workplace, including at times, a reluctance to care for particular patients. This study investigated personal attitudes and factors influencing Japanese nurses' reluctance to care for patients infected with HIV, Hepatitis B Virus (HBV), or Hepatitis C Virus (HCV).

METHODS:

Participants completed an anonymous online survey focusing on potential attitudes towards hypothetical patients, awareness of infection risk and their confidence in using precautions to prevent infection. Statistical associations were analyzed using Poisson regression models.

RESULTS:

Regarding personal attitudes, 41 % and 18 % of nurses agreed or somewhat agreed that they would be reluctant to care for a hypothetical patient infected with HIV or HBV / HCV, respectively. Reluctance to care for patients with HIV or HBV / HCV was positively associated with prejudicial attitudes and negatively associated with confidence in personal safety precautions. Hypothetical reluctance to care for patients with HBV / HCV was negatively associated with actual previous experience caring for HBV / HCV patients. Older age among nurses (≥50 years) was positively associated with an increased reluctance to care for hypothetical patients with HIV.

CONCLUSIONS:

Overall, this study suggests that anxiety arising from perceived infection risk and having a prejudicial attitude might affect the acceptance of infected patients, while personal confidence in universal precautions probably mitigates this situation. Improving nurses' confidence in using universal precautions therefore represents a positive measure that can help reduce prejudice and improve the quality of healthcare services in Japan, as elsewhere.

Distribution of responses by HIV or HBV / HCV status

	HIV		HBV/HCV
	n	(%)	n	(%)
Anxiety regarding the potential infection risk from patients with HIV or HBV / HCV
Agree	133	(13)	145	(15)
Somewhat agree	397	(40)	391	(39)
Somewhat disagree	254	(26)	303	(31)
Disagree	186	(19)	139	(14)
Do not know	22	(2)	14	(1)
Confident that I could protect myself from infection when caring for patients infected with HIV or HBV / HCV
Agree	125	(13)	179	(18)
Somewhat agree	359	(36)	403	(41)
Somewhat disagree	253	(26)	231	(23)
Disagree	143	(14)	84	(9)
Do not know	112	(11)	95	(10)
Have you cared for a patient infected with HIV or HBV/HCV during the past one year?
Yes	110	(11)	668	(67)
No	700	(71)	218	(22)
Do not know	182	(19)	106	(11)
Do you believe that a patient infected with HIV or HBV / HCV might be a homosexual, have multiple sexual partners or be a drug user?
Agree	93	(9)	31	(3)
Somewhat agree	294	(30)	99	(10)
Somewhat disagree	261	(26)	330	(33)
Disagree	304	(31)	512	(52)
Do not know	40	(4)	17	(2)
Would you be reluctant to care for a patient infected with HIV or HBV / HCV?
Agree	109	(11)	43	(4)
Somewhat agree	294	(30)	136	(14)
Somewhat disagree	266	(27)	325	(33)
Disagree	271	(27)	466	(47)
Do not know	52	(5)	22	(2)

HBV hepatitis B virus, HCV hepatitis C virus

Full article at:   http://goo.gl/lomDOA

By:  Wada K1, Smith DR2, Ishimaru T3,4.

• 1Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan. kwada-sgy@umin.ac.jp.
• 2School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Ourimbah, Australia. derek.smith@newcastle.edu.au.
• 3Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, Bangkok, Thailand. ishimaru@med.uoeh-u.ac.jp.
• 4Occupational Health Training Center, University of Occupational and Environmental Health, Kitakyushu, Japan. ishimaru@med.uoeh-u.ac.jp.
• BMC Pregnancy Childbirth. 2016 Feb 5;16(1):31. 

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Neuropsychological Impairment and Its Association with Violence Risk in Japanese Forensic Psychiatric Patients

Background

In Japan, the legislation directing treatment of offenders with psychiatric disorders was enacted in 2005. Neuropsychological impairment is highly related to functional outcomes in patients with psychiatric disorders, and several studies have suggested an association between neuropsychological impairment and violent behaviors. However, there have been no studies of neuropsychological impairment in forensic patients covered by the Japanese legislation. This study is designed to examine the neuropsychological characteristics of forensic patients in comparison to healthy controls and to assess the relationship between neuropsychological impairment and violence risk.

Methods

Seventy-one forensic patients with psychiatric disorders and 54 healthy controls (matched by age, gender, and education) were enrolled. The CogState Battery (CSB) consisting of eight cognitive domains, the Iowa Gambling Task (IGT) to test emotion-based decision making, and psychological measures of violence risk including psychopathy were used.

Results

Forensic patients exhibited poorer performances on all CSB subtests and the IGT than controls. For each group, partial correlational analyses indicated that poor IGT performance was related to psychopathy, especially antisocial behavior. In forensic patients, the CSB composite score was associated with risk factors for future violent behavior, including stress and noncompliance with remediation attempts.

Conclusion

Forensic patients with psychiatric disorders exhibit a wide range of neuropsychological impairments, and these findings suggest that neuropsychological impairment may increase the risk of violent behavior. Therefore, the treatment of neuropsychological impairment in forensic patients with psychiatric disorders is necessary to improve functional outcomes as well as to prevent violence.

Below:  Magnitude of impairment in forensic patients relative to healthy controls on each CSB measure

Below:  The IGT net scores for the 5 blocks for forensic patients and healthy controls

Full article at:   http://goo.gl/TpZu9X

By:  

Hirofumi Nishinaka, Kenji Hashimoto

Division of Clinical Neuroscience, Center for Forensic Mental Health, Chiba University, Chiba, Japan

Jun Nakane

National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan

Takako Nagata, Mayu Omori, Naotsugu Hirabayashi

Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan

Atsushi Imai, Noriomi Kuroki, Noriko Sakikawa, Osamu Kuroda

Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan

Yoshito Igarashi

Division of Law and Psychiatry, Center for Forensic Mental Health, Chiba University, Chiba, Japan

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Web-Based Cognitive Behavioral Relapse Prevention Program with Tailored Feedback for People with Methamphetamine and Other Drug Use Problems: Development and Usability Study

BACKGROUND:

Although drug abuse has been a serious public health concern, there have been problems with implementation of treatment for drug users in Japan because of poor accessibility to treatment, concerns about stigma and confidentiality, and costs. Therapeutic interventions using the Internet and computer technologies could improve this situation and provide more feasible and acceptable approaches.

OBJECTIVE:

The objective of the study was to show how we developed a pilot version of a new Web-based cognitive behavioral relapse prevention program with tailored feedback to assist people with drug problems and assessed its acceptance and usability.

METHODS:

We developed the pilot program based on existing face-to-face relapse prevention approaches using an open source Web application to build an e-learning website, including relapse prevention sessions with videos, exercises, a diary function, and self-monitoring. When users submitted exercise answers and their diary, researchers provided them with personalized feedback comments using motivational interviewing skills. People diagnosed with drug dependence were recruited in this pilot study from a psychiatric outpatient ward and nonprofit rehabilitation facilities and usability was evaluated using Internet questionnaires. Overall, website usability was assessed by the Web Usability Scale. The adequacy of procedures in the program, ease of use, helpfulness of content, and adverse effects, for example, drug craving, mental distress, were assessed by original structured questionnaires and descriptive form questions.

RESULTS:

In total, 10 people participated in the study and completed the baseline assessment, 60% completed all relapse prevention sessions within the expected period. The time needed to complete one session was about 60 minutes and most of the participants took 2 days to complete the session. Overall website usability was good, with reasonable scores on subscales of the Web Usability Scale. The participants felt that the relapse prevention sessions were easy to use and helpful, but that the length of the videos was too long. The participant who until recently used drugs was satisfied with the self-monitoring, but others that had already maintained abstinence for more than a year felt this activity was unhelpful and were bored tracking and recording information on daily drug use. Feedback comments from researchers enhanced participants' motivation and further insight into the disease. Serious adverse effects caused by the intervention were not observed. Some possible improvements to the program were suggested.

CONCLUSIONS:

The Web-based relapse prevention program was easy to use and acceptable to drug users in this study. This program will be helpful for drug users who do not receive behavioral therapy. After the pilot program is revised, further large-scale research is needed to assess its efficacy among drug users who have recently used drugs.

Below:  Video page screenshot

Full article at:   http://goo.gl/lGDKYC

By:  Takano A¹, Miyamoto Y, Kawakami N, Matsumoto T.

¹Graduate School of Medicine, Department of Psychiatric Nursing, The University of Tokyo, Tokyo, Japan. ayumi-takano@umin.ac.jp.

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Japan - PornHub 2015 Use Review

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Kiken Drugs: Current Status of Abuse Among Youth in the Nightlife Areas of Tokyo

The abuse of "Kiken drugs," including synthetic cannabinoids, is a serious and growing social problem in Japan. Kiken drugs is the general term for novel psychoactive substances that have not been designated as illegal by Japanese law. 

The aim of this article is to describe the current status of the abuse of Kiken drugs by youth in the nightlife areas of Tokyo. An anonymous field-based survey was conducted using laptop computers at four dance parties in Tokyo, Japan. The questionnaires were completed by 307 (44% female, mean age 30.9 years) young adults at the dance parties. 

Among the survey participants, 24.4% reported Kiken drug use (herbs 22.8%, powders 7.2%, and liquids 3.3%) in their lifetime. The primary reasons for Kiken drug use were peer pressure (37.3%), and avoiding penalties for possession of illegal drugs under Japanese laws (28.0%). In addition, 61.3% reported obtaining Kiken drugs from close friends. 

Our results clearly suggest that young adults at dance parties have a higher lifetime prevalence of Kiken drug use than the Japanese general population (0.4% reported in 2013). As the social stigma associated with drug use is extremely high in Japan, avoiding illegal drugs prohibited by law by using easily available Kiken drugs may be more socially acceptable among youth in the nightlife areas.

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By:  Shimane T.

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Effect of Educational Leaflets on Knowledge & Attitude to Tuberculosis among Homeless Persons in Tokyo, Japan

SETTING:

Delay in seeking care is one of the critical issues in tuberculosis (TB) control among homeless persons in Japan. Yet knowledge of and attitude towards TB among homeless persons have remained unclear and limited efforts have been made to disseminate information related to TB among homeless persons.

OBJECTIVE:

To evaluate the effect of TB leaflets, produced and distributed to homeless persons by a group of ex-homeless TB patients, and to understand what homeless persons know about TB.

DESIGN:

Self-administered questionnaire was conducted among homeless persons before and after distribution of the TB leaflets. Changes in the responses to each question were also subjected to principal component analysis to group questions into types according to response patterns and identify constructs of TB-related knowledge.

RESULTS:

Results of 88 participants were analyzed. TB knowledge score related to risks and symptoms significantly improved after the intervention (from 54.3% to 70.6%, p < 0.05), while knowledge on treatment cost did not. Two components were identified, namely, the "improvement in TB impression" and "improvement in TB knowledge".

CONCLUSION:

TB leaflets were effective in improving certain aspects of TB knowledge. However, its effect on knowledge regarding treatment cost, which may be crucial in improving delay, was limited and thus the messages need to be revised.

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By:   Kawatsu L, Uchimura K, Watabe H, Kaguraoka S, Kubota Y, Sakakibara M, Ishikawa N.

 

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What Triggers a Diagnosis of HIV Infection in the Tokyo Metropolitan Area? Implications for Preventing the Spread of HIV Infection in Japan

Background

Japan has not succeeded in reducing the annual number of new HIV-infected patients, although the prevalence of HIV infection is low (0.02%).

Methods

A single-center observational study was conducted at the largest HIV clinic in Tokyo, which treats 15% of the total patients in Japan, to determine the reasons for having diagnostic tests in newly infected individuals. HIV-infected patients who visited our clinic for the first time between 2011 and 2014 were analyzed.

Results

The 598 study patients comprised one-third of the total reported number of new patients in Tokyo during the study period. 76% were Japanese MSM. The reasons for being tested which led to the diagnosis was voluntary testing in 32%, existing diseases in 53% (AIDS-defining diseases in 22%, sexually transmitted infections (STI) in 8%, diseases other than AIDS or STIs in 23%) and routine pre-surgery or on admission screening in 15%. 52% and 74% of the study patients and patients presented with AIDS, respectively, had never been tested. The median CD4 count in patients with history of previous testing (315/μL) was significantly higher than that of patients who had never been tested (203/μL, p<0.001).

Conclusions

Only 32% of the newly HIV diagnosed patients were diagnosed because of voluntary testing, and 53% were diagnosed due to presence of other diseases. These results remain unchanged from our previous report 10 years earlier (2000–2004) on newly diagnosed patients at the same clinic. HIV testing has not been widely used by newly diagnosed patients in the Tokyo metropolitan area.

Below:  Comparison of reasons for HIV diagnostic testing in newly diagnosed patients between 2000–2005 and 2011–2014 time periods

Full article at:  http://goo.gl/pdYVPf

By:

Takeshi Nishijima, Misao Takano, Shoko Matsumoto, Miki Koyama, Yuko Sugino, Miwa Ogane, Kazuko Ikeda, Yoshimi Kikuchi, Shinichi Oka, Hiroyuki Gatanaga

AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan

Shoko Matsumoto

Graduate School of Public Health, Teikyo University, Tokyo, Japan

Shinichi Oka, Hiroyuki Gatanaga

Center for AIDS Research, Kumamoto University, Kumamoto, Japan

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Human Immunodeficiency Virus-Positive Secondary Syphilis Mimicking Cutaneous T-Cell Lymphoma

Malignant syphilis or lues maligna is a severe form of secondary syphilis that was commonly reported in the pre-antibiotic era, and has now reemerged with the advent of the human immunodeficiency virus (HIV) epidemic. However, the characteristic histopathological findings of malignant syphilis remain controversial. 

The aim of this case report was to clarify the clinical and histopathological findings of HIV-positive malignant secondary syphilis. A Japanese man in his forties complained of fever, skin lesions, headache, and myalgia without lymphadenopathy during the previous 4 weeks. The skin lesions manifested as erythematous, nonhealing, ulcerated papules scattered on his trunk, extremities, palm, and face. 

Although the skin lesions were suspected to be cutaneous T-cell lymphomas on histological analyses, they lacked T-cell receptor Jγ rearrangement; moreover, immunohistochemical analyses confirmed the presence of spirochetes. The patient was administered antibiotics and anti-retroviral therapy, which dramatically improved the symptoms. On the basis of these observations of the skin lesions, we finally diagnosed the patient with HIV-associated secondary syphilis that mimicked cutaneous T-cell lymphoma. 

The patient’s systemic CD4+ lymphocyte count was very low, and the infiltrate was almost exclusively composed of CD8+ atypical lymphocytes; therefore, the condition was easily misdiagnosed as cutaneous lymphoma. Although the abundance of plasma cells is a good indicator of malignant syphilis on skin histological analyses, in some cases, the plasma cell count may be very low. 

Therefore, a diagnosis of malignant secondary syphilis should be considered before making a diagnosis of primary cutaneous peripheral T-cell lymphoma or lymphoma associated with HIV infection.

Below:  Clinicopathological findings. a. Skin lesions before treatment. These 1–5-cm erythematous lesions were scattered on the trunk. Lesions larger than the size of a walnut were ulcerated and crusty. Palmer and planter lesions were also present. b. Nodular infiltration of the cells from the epidermis to the upper subcutaneous. c. Epidermotropism of atypical lymphoid cells. d. In the dermis, there is severe inflammation around the venules. Atypical lymphocytes, multinucleated leukocytes, and epithelioid histiocytes are present, but sparse plasma cells. e. Immunohistochemical staining for CD8. Lymphocytes were exclusively immunoreactive for CD8. Atypical lymphocytes with nuclear twisting and indentation are also present (arrows). f. In the bone marrow clot, a number of CD8+ lymphocytes are infiltrating, as indicated by immunohistochemistry. g. Atypical lymphocytes and small lymphocytes are seen in the bone marrow smear, suggestive of non-neoplastic cells (arrowheads). h. Treponema pallidum is mainly distributed in the dermis, especially in the perivascular space with histiocytes. Immunohistochemical staining for Treponema pallidum

Full article at: http://goo.gl/ehkn7l

By: Michiko Yamashita, Yoshiyuki Fujii, Keiji Ozaki, Yoshio Urano, Masami Iwasa, Shingen Nakamura, Shiro Fujii,Masahiro Abe, Yasuharu Sato, and Tadashi Yoshino

Division of Diagnostic Pathology, Tokushima Red Cross Hospital, 103, Irinokuchi, Komatsushima-cho, Komatsushima-shi, Tokushima, 7738502 Japan

Division of Hematology, Tokushima Red Cross Hospital, Tokushima, Japan

Division of Dermatology, Tokushima Red Cross Hospital, Tokushima, Japan

Division of Hematology, Tokushima University Hospital, Tokushima, Japan

Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan

  

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