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.

Effectiveness of COVID-19 vaccination in healthcare workers in Shiga Prefecture, Japan.

This study, which included serological and cellular immunity tests, evaluated whether coronavirus disease 2019 (COVID-19) vaccination adequately protected healthcare workers (HCWs) from COVID-19. Serological investigations were conducted among 1600 HCWs (mean ± standard deviation, 7.4 ± 1.4 months after the last COVID-19 vaccination). Anti-SARS-CoV-2 antibodies N-Ig, Spike-Ig (Roche), N-IgG, Spike-IgM, and -IgG (Abbott), were evaluated using a questionnaire of health condition. 161 HCWs were analyzed for cellular immunity using T-SPOT® SARS-CoV-2 kit before, and 52 HCWs were followed up until 138.3 ± 15.7 days after their third vaccination. Spike-IgG value was 954.4 ± 2282.6 AU/mL. Forty-nine of the 1600 HCWs (3.06%) had pre-existing SARS-CoV-2 infection. None of the infectious seropositive HCWs required hospitalization. T-SPOT value was 85.0 ± 84.2 SFU/106 cells before the third vaccination, which increased to 219.4 ± 230.4 SFU/106 cells immediately after, but attenuated later (to 111.1 ± 133.6 SFU/106 cells). Poor counts (< 40 SFU/106 cells) were present in 34.8% and 38.5% of HCWs before and after the third vaccination, respectively. Our findings provide insights into humoral and cellular immune responses to repeated COVID-19 vaccinations. COVID-19 vaccination was effective in protecting HCWs from serious illness during the original Wuhan-1, Alpha, Delta and also ongoing Omicron-predominance periods. However, repeated vaccinations using current vaccine versions may not induce sufficient cellular immunity in all HCWs.

Serology suggests adequate safety measures to protect healthcare workers from COVID-19 in Shiga Prefecture, Japan.

Healthcare workers (HCWs), especially frontline workers against coronavirus disease 2019 (COVID-19), are considered to be risky because of occupational exposure to infected patients. This study evaluated the correlation between seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies among HCWs and the implementation of personal protective equipment (PPE) & infection prevention and control (IPC). We recruited 1237 HCWs from nine public COVID-19-designated hospitals in Shiga Prefecture, central Japan, between 15-26 February 2021. All participants answered a self-administered questionnaire and provided blood samples to evaluate SARS-CoV-2 antibodies. A total of 22 cases (1·78%) were seropositive among the 1237 study participants. An unavoidable outbreak of SARS-CoV-2 had occurred at the terminal care unit of one hospital, before identifying and securely isolating this cluster of cases. Excluding with this cluster, 0·68% of HCWs were suspected to have had previous SARS-CoV-2 infections. Binomial logistic regression from individual questionnaires and seropositivity predicted a significant correlation with N95 mask implementation under aerosol conditions (p = 8.63e-06, aOR = 2.47) and work duration in a red zone (p = 2.61e-04, aOR = 1.99). The institutional questionnaire suggested that IPC education was correlated with reduced seropositivity at hospitals. Seroprevalence and questionnaire analyses among HCWs indicated that secure implementation of PPE and re-education of IPC are essential to prevent SARS-CoV-2 infection within healthcare facilities. Occupational infections from SARS-CoV-2 in healthcare settings could be prevented by adhering to adequate measures and appropriate use of PPE. With these measures securely implemented, HCWs should not be considered against as significantly risky or dirty by local communities.

[Prevalence, treatment, and control of cardiovascular disease risk factors among adults in Shiga Prefecture: analysis using the receipt and health checkup information database in Japan].

OBJECTIVES: Measuring the frequency of prevalence, treatment, and control of cardiovascular disease risk factors is indispensable for creating strategic plans for preventing lifestyle-related diseases. We calculated the prevalence, treatment and control of lifestyle-related diseases, including hypertension, diabetes, and hyper-low-density lipoprotein (LDL)-cholesterolemia among adults aged ≥40 years, using the receipt and health checkup information database in Japan. METHODS: The participants in this study were 211,976 residents in Shiga Prefecture, who received specific health checkups in 2008 under the national health insurance system. The main outcome measures included rates of prevalence, treatment, and control, and 95% confidence intervals for hypertension, diabetes, and hyper-LDL-cholesterolemia stratified by sex and 5-year age groups. RESULTS: The rates of prevalence and treatment of hypertension increased gradually with age. The control rates for hypertension were approximately 55%, which were similar regardless of sex and age. An age-dependent gradual increase was observed for diabetes in prevalence (both sexes) and treatment (men only) rate. The control rates for diabetes were about 50%. In hyper-LDL-cholesterolemia, the prevalence rate in women and treatment rates in both sexes showed age-dependent increases; the control rates (63-80%) were also age-dependent. CONCLUSION: Comprehensive details about sex and age-specific prevalence, treatment, and control rates of cardiovascular disease risk factors were shown by using the receipt and health checkup information database in Japan. In particular, information regarding the control rates of cardiovascular disease risk factors will be utilized for preventing lifestyle-related diseases in Japan.

[Regulatory factors for images of the elderly among elementary school students assessed through secular trend analyses by frequency of inter-exchange with "REPRINTS" senior volunteers].

BACKGROUND AND PURPOSE: We have launched a new intervention study, called "REPRINTS" (Research of productivity by intergenerational sympathy) in which senior volunteers aged 60 years and over engage in reading picture books to school children, regularly visiting public elementary schools since 2004. The purpose of this study was to clarify characteristics of images of older people held by elementary school children and factors associated with such images, as well as to examine changes in images through intervention by "REPRINTS" senior volunteers (volunteers) for the initial one year period. SUBJECTS & SETTING: Four to six volunteers as a group visited A elementary school in a suburb Kawasaki city (470 students) twice a week to read picture books. The baseline survey was conducted one month after launching the volunteer activity. First and second follow-up surveys were conducted at 6 month intervals after the baseline survey. MEASUREMENTS: Grade, gender, short version of emotional-like image scale of older adults assessed by the SD (Semantic Differential) method (6 items in the subscale for "evaluation" and 4 items in the subscale for "potency/activity"), experience of living with grandparents, experience of interchange with older people, frequency of interchange with volunteers and the social desirability scale for children. RESULT: Related variables for a higher score in the subscale for "evaluation" included lower grade and abundant experience of interchange with older people such as grandparents. Those for "potency/ activity" included lower grade, male gender, and a higher social desirability scale for children in the multiple logistic regression model. Students were divided into two groups in terms of frequency of interchange with volunteers (low and high-frequency groups) through three surveys. In the subscale for "evaluation", the general linear model demonstrated a significant interaction between the group and number of surveys adjusted for confounding factors. CONCLUSION: Although emotional images of older people significantly decline with advancing grade, those of students with a high frequency of interchange with volunteers were here found to be maintained more positively over one year compared to those with a low frequency.

[An intergenerational health promotion program involving older adults in urban areas. "Research of Productivity by Intergenerational Sympathy (REPRINTS)": first-year experience and short-term effects].

OBJECTIVE: We have launched a new intervention study, called "Research of Productivity by Intergenerational Sympathy (REPRINTS)" in which senior volunteers engage in reading picture books to children. The "REPRINTS" program consistently involves social roles and intellectual activity, two higher-level functional capacities. This study reported findings and problems experienced through "REPRINTS" during the first year, ascertained potential effectiveness of social activity, and proposed methods for continued activity. METHODS: Basic concepts of "REPRINTS"program include "contribution to society", "life-long learning", and "group activity." Sixty seven volunteers and 74 controls, all aged 60 years and over living in three areas, ie., Chuo-ku, central Tokyo, Kawasaki city, suburb of Tokyo and Nagahama city, a local city, participated in a baseline health check-up in June, 2004. After completion of 3-month training seminars (once a week, 2 hr per session), volunteers visited public elementary schools and kindergartens in groups of 6-10 persons for 6 months. They were assessed again by follow-up health check-up in March, 2005. RESULTS: At baseline, the proportion of those who had no grand children (41.8% vs. 20.3%, P= 0.006), average school years (13.4 +/- 2.5 vs. 12.3 +/- 2.5 years, P= 0.008), having any experience of volunteer activities (79.1% vs. 52.7%, P=0.001), and an usual walking speed (86.7 +/- 12.3 vs. 81.3 +/- 12.9 m/min, P=0.012) were significantly higher in volunteers than in controls. There was no significant difference in other baseline characteristics between the two groups. At follow-up, social network scores for 56 volunteers were significantly improved: frequency of contact with grandchildren and others around neighborhood and size of circles of friends and acquaintances were increased, as compared to controls. Social support scores for the volunteers significantly decreased in the receiving aspect, while increased in the giving aspect. In addition, consciousness of loving community and self-rated health were significantly enhanced and hand-grip strength showed significantly less decline in volunteers than in controls. CONCLUSIONS: Through engaging in the intergenerational and intellectual volunteer programs for 9 months, subjective health, social support and network, consciousness of loving community and some aspects of physical performance were significantly promoted in senior volunteers. Coordination of existing administrative services enabled us to establish this "REPRINTS" health promotion program for community-dwelling older adults.