Key issues in Japan's public health centers to prepare for future pandemics: a text mining study using a topic model.

BACKGROUND: In Japan, over 450 public health centers played a central role in the operation of the local public health system in response to the COVID-19 pandemic. This study aimed to identify key issues for improving the system for public health centers for future pandemics. METHODS: We conducted a cross-sectional study using an online questionnaire. The respondents were first line workers in public health centers or local governments during the pandemic. We solicited open-ended responses concerning improvements needed for future pandemics. Issues were identified from these descriptions using morphological analysis and a topic model with KHcoder3.0. The number of topics was estimated using Perplexity as a measure, and Latent Dirichlet Allocation for meaning identification. RESULTS: We received open-ended responses from 784 (48.6%) of the 1,612 survey respondents, which included 111 physicians, 330 nurses, and 172 administrative staff. Morphological analysis processed these descriptions into 36,632 words. The topic model summarized them into eight issues: 1) establishment of a crisis management system, 2) division of functions among public health centers, prefectures, and medical institutions, 3) clear role distribution in public health center staff, 4) training of specialists, 5) information sharing system (information about infectious diseases and government policies), 6) response to excessive workload (support from other local governments, cooperation within public health centers, and outsourcing), 7) streamlining operations, and 8) balance with regular duties. CONCLUSIONS: This study identified key issues that need to be addressed to prepare Japan's public health centers for future pandemics. These findings are vital for discussions aimed at strengthening the public health system based on experiences from the COVID-19 pandemic.

[Time study of nurse's shift work the influence of domestic labor on fatigue after ordinary labor].

INTRODUCTION: The relationship between domestic labor and fatigue following night shift work by nurses was examined. Differences due to the age of the youngest child, which apparently influences housework time, were analyzed. METHODS: A time survey was conducted with 159 shift work nurses at a public general hospital. Participants were divided into three groups based on the age of the youngest child, i.e., those whose youngest child was in school were placed in the "school age" group, those whose youngest child was preschool age were placed in the "preschool age" group, and nurses without children were placed in the "childless" group. Using four categories of daily living, time use was set as labor hours, physiological hours, house work hours, and social and cultural activity hours, and daily living time was described with reference to seventeen items. A subjective symptoms index (SSI) was applied after both day and night shifts. Comparison of the degree of recovery from physical fatigue and loss of mental concentration were also investigated between the end of day work and the start of night work. RESULTS: Sleeping and napping time was 7 hours and 53 minutes in the "preschool age" group, 8 hours and 18 minutes in the "school age" group, and 9 hours and 11 minutes in the "childless" group. Housework time was 3 hours and 9 minutes in the "preschool age" group, 2 hours and 1 minute in the "school age" group, and 48 minutes in the "childless" group, with the majority of time spent doing cooking and childcare chores. Social and cultural activity time was 36 minutes in the "preschool age" group, 57 minutes in the "school age" group, and 1 hour and 19 minutes in the "childless" group. Fireside time with family was a mere 7 minutes in the "preschool age" group. The subjective symptoms index (SSI) after night work showed severe fatigue in all groups. All groups showed greater fatigue and loss of concentration at the time of night work than when finishing day work. DISCUSSION: The results showed greater fatigue in the "preschool age" group, which suggests an inverse correlation with sleeping and napping and a positive link to labor in the home. The "preschool age" group had longer housework hours, and shorter sleeping and social and cultural activity hours, which are presumed to influence fatigue.

[Nationwide survey of municipality's maternal & child health promotion planning processes and consequent changes].

PURPOSE: The purpose of this study was to offer insight into the revisions needed for promotion of Maternal and Child Health Promotion Plans in the coming years. METHODS: The maternal and child health promotion planning process and changes in maternal and child health services were surveyed by questionnaires to all municipalities in Japan. RESULTS: Completed questionnaires were obtained from 2,362 municipalities (response rate: 72.6%) Replies from 2,202 municipalities, which had completed planning by March, 1998, were analyzed. Planning committees were established by 63.9% of municipalities, and working committees were set up in 55.4% of them. Members involved in the working committees were more limited when compared to the planning committees and only 9.3% of the committees had representatives from mothers. 37.5% of working committees held meetings more than 5 times. 56.0% of municipalities conducted hearings or questionnaire surveys of mothers and health personnel for assessment of maternal and child healthcare needs. Most prefectural public health centers provided statistical data for planning assistance. Public health center staff participated as planning members in 38.5% of municipalities, and a training program for the planning sponsored by health centers was utilized by 33.8% of municipalities. Only 18.3% of municipalities received support for explanation of the plans to the mayor and/or executive officers, only 12.1% received support for the management of the planning committees, and only 11.8% received support for needs analysis. Less than half of minicipalities conducted PR activities of the plans and progress management. A higher proportion conducted these activities in larger cities. After the planning process, 72.9% of municipalities started new projects according to the plans. However, 10.1% scrapped one or more projects. Changes in maternal and child healthcare services and promotion of coordination with other related organization were seen more in municipalities with a larger population. There were major differences found between prefectures with regards to the planning process, including the support from public health centers, and the effective use of plan reports, progress management, and changes in maternal and child healthcare services after the formulation of plans.