Evaluating workforce needs: an investigation of healthcare professionals' attitudes, beliefs and preparedness towards the management of Para athlete mental health at the Tokyo 2020 and Beijing 2022 Paralympic Games.

OBJECTIVES: To examine healthcare professionals (HCPs) attitudes, beliefs and preparedness towards the management of Para athlete mental health during the Tokyo 2020 and Beijing 2022 Paralympic Games. METHODS: A cross-sectional observational study was conducted. National Paralympic Committee's HCPs (n=857) working at the Tokyo 2020 and Beijing 2022 Paralympic Games were invited to respond to an anonymous online survey regarding the management of Para athlete mental health in their team. Data were analysed using descriptive frequency statistics. RESULTS: The survey was completed by 256 HCPs (30% of respondents). Most HCPs agreed that mental health was a concern in Para athletes (n=210; 82%). However, half (n=122; 48%) agreed that they did not screen Para athletes for mental health symptoms, and half (n=130; 51%) agreed that there was increased stigma around disclosure of mental health symptoms among Para athletes, compared with athletes without disability. Most HCPs (n=221; 86%) agreed they wanted to improve their knowledge and skills surrounding athlete mental healthcare. Culturally sensitivite, non-discriminatory and contextual factors were highlighted as desired areas of education for HCPs and active information dissemination for Para athletes. CONCLUSION: HCPs working at the Paralympic Games considered Para athlete mental healthcare important and reported perceived stigma, yet indicated low rates of mental health screening. Most respondents expressed the need for mental health education. Culturally sensitive training and active education strategies should be implemented to optimally manage Para athlete mental health.

[Characteristics of ethical dilemma and behavior in the support process of older adults and their families among nurses at a community general support center in Japan].

Objectives　This study was aimed at clarifying characteristics of ethical dilemmas and behaviors in the support process of older adults and their families among nurses at community general support centers.Methods　A self-administered questionnaire survey was mailed to 449 nurses at community general support centers in Tokyo. Question items enquired their age, employment license, years of experience as a nurse, the presence of ethics-related organizations, number of cases in which nurses faced difficulties in supporting older adults and their families in decision making over the past year, the ethical dilemmas they experienced and their situations, and ethical behavior in the process of supporting older adults and their families.Results　From the 143 responses (response rate: 31.8%), 135 (valid response rate: 30.1%) nurses were analyzed. Overall, 43.0% and 27.4% of the participants were in their 50s and 40s, respectively. Of these, 77.0% and 23.0% were nurses and public health nurses, respectively. In total, 52 (38.5%) respondents had an ethics-related organization. The average number of cases in which the respondents faced difficulties in supporting older adults and their families in decision making over the past year was 8.3 (standard deviation, 12.5). Of these, the average number of cases in which they faced difficulties in making ethical decisions was 4.1 (standard deviation, 6.0). Regarding the perception of ethical dilemmas, 113 (83.7%) answered "often" or "sometimes." Ethical dilemma situations included "the intentions of the user and family were different, and I had trouble deciding what to respect" 95 (84.1%); "the user's intention was different from my judgment as a professional, and I had trouble deciding what to respect" 64 (56.6%); and "the intention of the user and neighbors were different, and I had trouble deciding what to respect" 56 (49.6%). Ethical behaviors included "I observe the management rules in my organization regarding personal information data" 116 (85.9%); "I provide easy-to-understand explanations appropriate to the user's situation" 115 (85.2%); and "I decide on a support policy with several staff members when self-decision making is difficult due to the user's situation" 113 (83.7%).Conclusion　More than 80% of the nurses perceived ethical dilemmas. Characteristics of the situations were that users and their families, users and professionals, and users and their neighbors had different intentions. Further research should be conducted on ethical issues related to community-based integrated care.

[Anesthesia Conference and Anesthesia Colloquium -Michinosuke Amano and the Origin of the Tokyo Society of Anesthesiologists.]

In October 1958, seven anesthesiologists from Tokyo area, who had frequently met at the Anesthesia Collo- quium, discussed founding a society of anesthesiologists to improve their social status. Next month, the Tokyo Society of Anesthesiologists was founded. The society was active in campaigning for the governmental approval of anesthesiology as a specially designated specialty. The colloquium was advocated by Michino- suke Amano of Keio University and was established in March 1955. Thus, the colloquium is considered the starting point of the society. Further, the origin of the colloquium dates back to the Anesthesia Conference held at the suggestion of Professor Wasaburo Maeda of Keio University. The first Anesthesia Conference was held in July 1952 immediately after Amano's return from the United States to Japan.

[The Membership List of the Tokyo Society of Anesthesiologists (April 1959) and a Group Photograph of the First General Meeting of the Society.]

A leaf titled "The Membership List of the Tokyo Society of Anesthesiologists (April 1959)" was donated in 2015 from Hisayo 0. Morishima, an Emeritus pro- fessor of Columbia University, to the Japanese Museum of Anesthesiology. It measures 26 cm long and 36 cm across. The list is mimeographed on the reverse of "The Prospectus of the Foundation of the Tokyo Soci- ety of Anesthesiologists" issued in January 1959. It contains 23 members and an additional member is written by hand at the bottom. This document is important in the history of the society because it describes that the society's initial membership was 23 and indicates that the society was formally organized by April 1959. The society contributed toward the governmental approval of anesthesiology as a"Specially approved specialty" in 1960.

Medical relief for the 2011 Japan earthquake: a nursing account.

In 2011 the east coast of Japan experienced a massive earthquake which triggered a devastating tsunami destroying many towns and killing over 15 000 people. The work presented in this paper is a personal account that outlines the relief efforts of the Humanitarian Medical Assistance team and describes the efforts to provide medical assistance to evacuees. The towns most affected had a large proportion of older people who were more likely to have chronic conditions and required medication to sustain their health. Since personal property was destroyed in the tsunami many older people were left without medication and also did not remember which type of medication they were taking. Some evacuees had brought a list of their medication with them, this assisted relief teams in obtaining the required medication for these people. The more successful evacuation centers had small numbers of evacuees who were given tasks to administer the center that kept them occupied and active.

Bottom-Up Approach to Establish Coordination Mechanisms for Disaster Preparedness Among Largely Private Health-Care Providers in Central Tokyo.

In Japan, despite its private-dominant and disjointed health-care system, national initiatives to coordinate various types of health-care facilities are lacking. Municipal governments manage this task with limited resources. This study describes a successful example of a bottom-up approach to create city-wide collaboration for disaster preparedness. In Minato City, located in central Tokyo, a group of physicians created a project involving a city-wide disaster medical care drill. The city Public Health Center, in charge of health-care systems including disaster medicine, helped the group to increase proponents of the project. The city-wide disaster drill started in November 2017; thereafter, the drills were held every year. Participation in drills by various health-care personnel helped establish a city-wide system for disaster medical care, coordination mechanisms among stakeholders, increased motivation among health-care personnel, and development of in-hospital systems. This approach is flexible and applicable to various forms of health-care systems in other areas.

Distribution of dentists in the Greater Tokyo Area, Japan.

INTRODUCTION: Japan is considered to have an overabundance of dentists; however, there are scarce data on regional inequalities in the ratio of dentists to patients. We examined these inequalities in Japan's Greater Tokyo Area - otherwise known as the Kanto region, and the world's most populous metropolitan area - by subdividing it into small- and medium-sized medical care zones. METHODS: We calculated the number of dentists per 100,000 population using the 2012 Survey of Physicians, Dentists, and Pharmacists for the three medical district tiers [primary medical care zones: municipalities (cities, towns, villages and special wards); secondary medical care zones: multiple adjacent municipalities; and tertiary care zones: prefectures]. We also estimated the influence of having a dental school in the district or an adjacent district on the number of dentists. RESULTS: The number of dentists per 100,000 population was 79.2 across the whole Kanto region; the range for each type of medical care zone was as follows: 65.3-126.4 at the tertiary level; 38.0-929.6 at the secondary level; and 0-3,087.6 at the primary level. The median Gini coefficient among tertiary medical care zones was 0.16 (range 0.11-0.36). The median number of dentists per 100,000 population was 273.8 in primary medical care zones that had a dental school, 79.9 in adjacent zones, and 59.6 in other zones. CONCLUSIONS: We identified significant inequalities in the number of dentists among the medical care zones, and the presence of a dental school had a major influence on this number.

Chemical incident planning: a review of the literature.

Chemical incidents cause problems for Accident and Emergency (A & E) departments which are different from those recognized in other major accidents. As well as possible trauma there is the added problem of contamination. A & E departments must be prepared for chemical disasters with a chemical incident plan, decontamination facilities and protective clothing for all staff involved. The plan should include how to protect the hospital from contamination and how to prevent its personnel from becoming secondary casualties. The results of a survey into the preparedness of inner London A & E departments were published in issue 6.2 of this journal, April 1998. On 20 March, 1995 a religious cult released a nerve gas (sarin) into the Tokyo subway system. More than 5500 people needed hospital treatment and 11 people died (Reuter News Service, 22 March, 1995). The hospitals were overwhelmed with casualties. Once chemical exposure of victims was suspected, clothing was removed and patients were showered. Stretcher patients were decontaminated by means of bed bathing and a change of bedclothes (Okumura et al 1996). Hospital contamination was a problem during this incident due to the delay in recognising chemical exposure. This resulted in staff contamination. Many lessons were learned from this disaster, including the need to be prepared for all eventualities. If a similar incident occurred in the London Underground system, it would be catastrophic. Underground staff, police, fire fighters, ambulance staff and the general public could all be contaminated before the chemical was identified. There could be mass casualties, including personnel in the emergency services. How would London A & E departments cope, faced with a chemical disaster such as this?