How can we promote vaccination of the mass population?-Lessons from the COVID-19 vaccination defaults.

While vaccines are pivotal in combating COVID-19, concerns about side effects and complex procedures have hindered complete vaccination. Prior studies suggest that individuals defaulted to opt-out exhibit higher COVID-19 vaccination rates compared to those in opt-in systems. However, these studies were conducted in countries with a tolerant attitude towards vaccination and default changes, targeting specific age groups, and did not address potential deterrents like the increase in cancellation rates on the day, discomfort towards changing defaults, or the possibility of the opt-out effect being a one-time occurrence. Under the hypothesis that the default nature of the COVID-19 vaccination system influences attitudes towards vaccination even in countries conservative about vaccination and default changes like in Japan, we aimed to examine the differences in the first and second dose vaccination rates, cancellation rates, and the number of complaints between the opt-in and opt-out systems for COVID-19 vaccination. An email survey was conducted in 10 cities in A Prefecture, Japan. The results showed not only higher COVID-19 vaccination rates across all comparable age groups in the opt-out group but also a notably smaller decrease in the second-dose vaccination rate compared to the opt-in group, all achieved without any complaints about the system's introduction. Consequently, it can be inferred that the potential inhibiting factors were largely overcome. Despite some limitations, such as regional specificity, the study suggests that opt-out systems might increase COVID-19 vaccination coverage without leading to significant cancellations or complaints, presenting a promising strategy to facilitate vaccination efforts.

[Impact of COVID-19 on Japanese municipal public health nurses and public health practices related to communication with community residents].

Objective　This study analyzed the impact of COVID-19 on municipal public health nurses and public health practices related to communication with community residents.Method　A self-administered questionnaire survey targeted 474 public health nurses working in 40 municipalities in Japan's Aomori Prefecture. Participants were asked about the following basic attributes: whether they provided care for people who were COVID-19 positive or were in close contact with infected people; physical or mental impacts; how each work area was impacted; how mask-wearing affected their communication with community residents; positive and negative aspects of current infection-control measures; how they communicated and shared information with residents as they provided care; challenges and initiatives; and creative work efforts. We conducted the survey from September 23 to October 7, 2020, and analyzed the data using SPSS and KH Coder.Results　We received 228 responses (48.1% valid responses); 11.4% reported that they provided care or were in close contact with people who were COVID-19 positive. At least 60% of respondents had been impacted mentally. Mask-wearing hindered communication with community residents, however, it did not significantly impact trust-building. COVID-19 measures had a positive impact on respondents' public health work as infection-prevention awareness increased and infection-control measures advanced. Meetings, including online conferences, became more efficient, and nurses had opportunities to reexamine their work performance. Negative consequences included weakened communication with residents, slander against infected people, increased stress among residents, repercussions from not going out, and difficulty implementing necessary public health services. Most of the interaction, information sharing, and support for residents were carried out over the phone. Responses regarding new challenges and initiatives were classified into six categories: public health services that consider infection-control measures; various preventive measures; efforts to establish new lifestyles; review of methods for conducting group-health check-ups; review of operations and implementation of creative efforts in providing health guidance; and review of meetings, training sessions, and online conferences.Conclusion　The survey revealed that COVID-19 affected most public health nurses mentally. Challenges in providing in-person care were reported. Nurses faced significant obstacles communicating with residents; however, they reported that services incorporating infection-control measures were progressively gaining traction. Nurses are exploring new communication methods based on established community trust. Furthermore, it is necessary to explore public health services that fulfill both the current and future community requirements.

Should We Aim to Create a Perfect Healthy Utopia? Discussions of Ethical Issues Surrounding the World of Project Itoh's Harmony.

To consider whether or not we should aim to create a perfect healthy utopia on Earth, we focus on the SF novel Harmony (2008), written by Japanese writer Project Ito, and analyze various issues in the world established in the novel from a bioethical standpoint. In the world depicted in Harmony, preserving health and life is a top priority. Super-medicine is realized through highly advanced medical technologies. Citizens in Harmony are required to strictly control themselves to achieve perfect health and must always disclose their health information to the public and continuously prove their health. From a bioethical standpoint, the world in Harmony is governed by a "healthy longevity supremacy" principle, with being healthy equated to being good and right. Privacy no longer exists, as it is perceived ethical for citizens to openly communicate health-related information to establish one's credibility. Moreover, there is no room for self-determination concerning healthcare because medical interventions and care are completely routinized, automated, centralized, and instantly provided. This is a situation where the community exhibits extremely powerful and effective paternalism. One can argue that healthy longevity is highly preferred. But is it right to aim for a perfectly healthy society at all costs? Should we sacrifice freedom, privacy, vivid feelings, and personal dignity to achieve such a world? In our view, the answer is no, as this would require the loss of many essential values. We conclude by proposing an alternative governing principle for future healthcare, and refer to it as the "do-everything-in-moderation" principle.

Successful Treatment of a Case of Necrotizing Fasciitis due to Vibrio vulnificus in a Cold Climate in Japan.

Vibrio vulnificus infection often occurs in warm regions, frequently leading to necrotizing fasciitis, sepsis, and death. We herein report a rare case presenting in a cold climate region in northern Japan, Aomori district, of a V. vulnificus infection complicated by necrotizing fasciitis and septic shock. The patient's prior history of injury and typical clinical course were helpful clues to the diagnosis of V. vulnificus infection, and early initiation of antimicrobial treatment saved his life. V. vulnificus infection should be considered even in cold regions, particularly if patients have risk factors.

Retrospective analysis of mortality and Candida isolates of 75 patients with candidemia: a single hospital experience.

The mortality rate for candidemia is approximately 30%-60%. However, prognostic factors in patients with candidemia have not yet been elucidated in detail. The aim of the present study was to analyze prognostic factors for candidemia using the mortality rate and Candida isolates of patients with candidemia. Seventy-five patients with candidemia were analyzed between January 2007 and December 2013. The main outcome of this study was the 30-day mortality rate after the diagnosis of candidemia. The acute physiology and chronic health evaluation II score (APACHE II score) was measured in 34 patients (45.3%). Odds ratios (ORs) for death due to candidemia were analyzed using a multivariate stepwise logistic regression analysis. Twenty (26.6%) patients died within 30 days of being diagnosed with candidemia. Non-survivors had a significantly higher APACHE II score (n=7, mean; 18.9±4.5) than that of survivors (n=27, mean; 14.0±5.0). Advanced age (OR =1.1, 95% confidence interval =1.01-1.23, P=0.04) was a significant risk factor for a high mortality rate, whereas removal of a central venous catheter (OR =0.03, 95% confidence interval =0.002-0.3, P=0.01) was associated with a lower mortality rate. Seventy-six Candida spp. were isolated from blood cultures: Candida albicans 28 (36.8%), Candida parapsilosis 23 (30.2%), Candida guilliermondii 16 (21.0%), Candida glabrata four (5.2%), Candida tropicalis two (2.6%), and Candida spp. three (3.9%) that could not be identified. C. parapsilosis was the most frequently isolated species in younger patients (<65 years), whereas C. albicans was the most frequently isolated in elderly patients (≥65 years). Physicians who treat candidemia need to consider removing the central venous catheter and pay attention to the general condition of patients, particularly that of elderly patients.

Retrospective analysis of the risk factors for linezolid-induced thrombocytopenia in adult Japanese patients.

BACKGROUND: Thrombocytopenia is a major side effect of linezolid therapy. However, there are few reports about the risk factors for linezolid-induced thrombocytopenia. OBJECTIVE: The aim of this study is to evaluate the risk factors for thrombocytopenia in patients who undergo linezolid therapy. SETTING: Aomori Prefectural Central Hospital in Japan, a tertiary 695 beds hospital. METHOD: A retrospective review was performed using the hospital's medical records. From January 2010 to August 2012, 75 adult patients who received linezolid therapy were enrolled in this study. MAIN OUTCOME MEASURE: Linezolid-induced thrombocytopenia was defined as a decrease in the patient's platelet count to <10 × 104/µL or a reduction of ≥30 % from their baseline value. Odds ratios (OR) for thrombocytopenia were analyzed using multivariate stepwise logistic regression analysis. RESULTS: Thrombocytopenia occurred in 29 patients (38.6 %), seven of whom required platelet transfusions. The patients who developed thrombocytopenia were significantly older, displayed a significantly higher frequency of renal insufficiency, and received linezolid therapy for significantly longer than the patients without thrombocytopenia. Stepwise logistic regression analysis suggested that receiving linezolid therapy for ≥14 days was a significant risk factor for thrombocytopenia [OR 13.3, 95 % confidence interval (CI) 3.2-55.6, p < 0.01], whereas the creatinine clearance rate exhibited a significant negative correlation with the incidence of the condition [OR 0.98, 95 % CI 0.96-0.99, p = 0.037]. The incidence of thrombocytopenia among the patients who demonstrated creatinine clearance rates of <30 mL/min was 60 % (12/20), which was significantly higher than that observed among the patients who displayed creatinine clearance rates of more than 60 mL/min (26.4 %, 9/34, p = 0.014). CONCLUSION: Receiving linezolid therapy for ≥14 days and a low creatinine clearance rate were suggested to be risk factors for linezolid-induced thrombocytopenia. The platelet counts of patients with these risk factors should be closely monitored.

Effects of 2.5-hour sumo training on serum opsonic activity.

Sumo is a traditional Japanese sport, but the effect of actual daily training on neutrophil function is unknown. We evaluated the effect of sumo training on serum opsonic activity (SOA), which is one of the main neutrophil-related functions. Seventeen male university sumo wrestlers participated in the study. Changes in anthropometric parameters, concentrations of serum immunoglobulins (IgG, IgA and IgM), complements (C3 and C4), myogenic enzymes (lactate dehydrogenase, asparate aminotransferase, alanine aminotransferase and creatine kinase), white blood cell/neutrophil counts and SOA were measured immediately before and after actual daily training for 2.5 h. Compared with the pre-values, immunoglobulins and complements, myogenic enzymes and white blood cell/neutrophil counts significantly increased (p < 0.01 for all). As for SOA, the values of the peak height and the area under the curve significantly increased after the training when assessed using lucigenin as a chemiluminigenic probe (p < 0.01 for all), but showed no significant change when luminol was used as the chemiluminigenic probe. In conclusion, daily actual sumo training for 2.5 h increases SOA, thus possibly activating the reactive oxygen species production of neutrophils.

Importance of Providencia species as a major cause of travellers' diarrhoea.

In this study the importance of Providencia species as a cause of travellers' diarrhoea was examined using a selective medium developed by the authors. Providencia species could easily be distinguished from other enteric pathogens by the colour of the colonies obtained. Nine strains of Providencia alcalifaciens, nine of Providencia rettgeri and five of Providencia stuartii were isolated from 130 specimens, representing a surprisingly high incidence of infection compared with other pathogens isolated on SS agar and TCBS agar. Patients infected with P. rettgeri complained of abdominal pain, as for other Providencia species, but also of vomiting, which is rather characteristic of P. rettgeri infection. To analyse the pathogenicity of these isolates, their invasiveness was examined using Caco-2 cells. Most of the P. rettgeri strains invaded Caco-2 cells. Random amplified polymorphic DNA (RAPD) fingerprinting showed the same profile for two P. rettgeri isolates from individuals travelling in the same tour group. The results show that Providencia species, especially P. rettgeri, might cause diarrhoea, and that these species are important pathogens.

Focus group interviews examining attitudes toward medical research among the Japanese: a qualitative study.

OBJECTIVES: the purpose of ths study is to explore laypersons' attitudes towards and experiences of medical research, and to compare them with those of physicians in Japan. Designs and Participants: fourteen Japanese adults from the general public and seven physicians participated in one of three focus interviews. SETTING: Osaka, Japan. RESULTS: trust and distrust in the physician by whom the participants were invited to participate in research played a considerable role in their decisions about participation. That the participants felt an obligation to participate was also expressed. The lay participants perceived medical research as something entirely outside of their world. A greater willingness to volunteer for research was expressed if there were direct benefits to themselves or their families. Research methods such as use of placebos, double blinds, and randomisations seemed to cause negative attitudes to medical research. All physicians were convinced of the need for medical research, including double-blinded randomised control trials, and its significant role in medical progress. Most physicians thought that the greater awareness of the need for medical research in the community and a better understanding of the psychology of potential research participants were necessary and urgent. CONCLUSIONS: there is a good possibility that the lay public and medical professionals have sharply different beliefs about and attitudes towards every aspect of medical research. Building up a better and equal patient-doctor relationship based on trust is a key issue in medical research, and it is mandatory to fill the gap in perception regarding medical research between them through fully informed debates.

Patients' preferences for involvement in treatment decision making in Japan.

BACKGROUND: A number of previous studies have suggested that the Japanese have few opportunities to participate in medical decision-making, as a result both of entrenched physician paternalism and national characteristics of dependency and passivity. The hypothesis that Japanese patients would wish to participate in treatment decision-making if adequate information were provided, and the decision to be made was clearly identified, was tested by interview survey. METHODS: The subjects were diabetic patients at a single outpatient clinic in Kyoto. One of three case study vignettes (pneumonia, gangrene or cancer) was randomly assigned to each subject and, employing face-to-face interviews, the subjects were asked what their wishes would be as patients, for treatment information, participation in decision-making and family involvement. RESULTS: 134 patients participated in the study, representing a response rate of 90%. The overall proportions of respondents who preferred active, collaborative, and passive roles were 12%, 71%, and 17%, respectively. Respondents to the cancer vignette were less likely to prefer an active role and were more likely to prefer family involvement in decision-making compared to non-cancer vignette respondents. If a physician's recommendation conflicted with their own wishes, 60% of the respondents for each vignette answered that they would choose to respect the physician's opinion, while few respondents would give the family's preference primary importance. CONCLUSIONS: Our study suggested that a majority of Japanese patients have positive attitudes towards participation in medical decision making if they are fully informed. Physicians will give greater patient satisfaction if they respond to the desire of patients for participation in decision-making.

Voluntary active euthanasia and the nurse: a comparison of Japanese and Australian nurses.

Although euthanasia has been a pressing ethical and public issue, empirical data are lacking in Japan. We aimed to explore Japanese nurses' attitudes to patients' requests for euthanasia and to estimate the proportion of nurses who have taken active steps to hasten death. A postal survey was conducted between October and December 1999 among all nurse members of the Japanese Association of Palliative Medicine, using a self-administered questionnaire based on the one used in a previous survey with Australian nurses in 1991. The response rate was 68%. A total of 53% of the respondents had been asked by patients to hasten their death, but none had taken active steps to bring about death. Only 23% regarded voluntary active euthanasia as something ethically right and 14% would practice it if it were legal. A comparison with empirical data from the previous Australian study suggests a significantly more conservative attitude among Japanese nurses.

Attitudes of the Japanese public and doctors towards use of archived information and samples without informed consent: preliminary findings based on focus group interviews.

BACKGROUND: The purpose of this study is to explore laypersons' attitudes toward the use of archived (existing) materials such as medical records and biological samples and to compare them with the attitudes of physicians who are involved in medical research. METHODS: Three focus group interviews were conducted, in which seven Japanese male members of the general public, seven female members of the general public and seven physicians participated. RESULTS: It was revealed that the lay public expressed diverse attitudes towards the use of archived information and samples without informed consent. Protecting a subject's privacy, maintaining confidentiality, and communicating the outcomes of studies to research subjects were regarded as essential preconditions if researchers were to have access to archived information and samples used for research without the specific informed consent of the subjects who provided the material. Although participating physicians thought that some kind of prior permission from subjects was desirable, they pointed out the difficulties involved in obtaining individual informed consent in each case. CONCLUSIONS: The present preliminary study indicates that the lay public and medical professionals may have different attitudes towards the use of archived information and samples without specific informed consent. This hypothesis, however, is derived from our focus groups interviews, and requires validation through research using a larger sample.

Interpretation of and preference for probability expressions among Japanese patients and physicians.

BACKGROUND: Patients and physicians often communicate using qualitative probability expressions that describe expected outcomes or risks of a medical intervention without knowing whether or not they share the same understanding. OBJECTIVE: The aim of the present study was to determine interpretations of qualitative probability expressions in clinical settings by Japanese patients and physicians as well as their assessments and preferences about physicians' use of such expressions. METHODS: One hundred and sixty-eight consecutive patients aged 16 years or older, who attended a university hospital during a 2-week period in 1999, and 156 physicians recruited through the Japanese General Medicine Research Network participated in this cross-sectional survey, using a self-administered questionnaire. Participants were asked to assign numerical interpretations as a percentage to 10 qualitative expressions of probability in two clinical situations related to prescribing a medicine for a cold and an anti-cancer drug. They were also asked which type of expression, qualitative or quantitative, they usually use when communicating probabilistic clinical information and which they prefer. RESULTS: The estimates of probability expressions showed wide variations, especially among patients. Patients tended to assign lower and higher values to highly positive and negative probability expressions, respectively, than physicians. Clinical context also influenced the estimation: both groups tended to assign higher estimates in the anti-cancer drug situation than in the cold treatment situation. Factor analysis revealed three psychologically meaningful factors in each situation. More patients than physicians (64.6% versus 50.3%) thought that physicians do not use numbers in routine practice. More than 20% of both patients and physicians considered that the actual use of qualitative terms by physicians is undesirable. Nevertheless, a sizable number of patients (41.4%) and physicians (15.2%) considered it preferable that physicians do not use numbers. CONCLUSION: Since interpretation of qualitative expressions of probability in Japanese is subject to large interpersonal variability and differences between patients and physicians, as well as context dependence, the use of qualitative expressions alone might cause misunderstanding among the parties involved. However, the majority of patients prefer words to numbers at present. Therefore, physicians, at least in Japan, ought to provide patients with both numbers and words when critical decisions need to be communicated.