Challenges when going on excursions with children with medical complexity in Japan.

BACKGROUND: With advances in medical technology, the number of children with medical complexity (CMC) has increased. Excursions with such children encourage their social participation and have been shown to have a positive impact on their caregivers. However, the first-hand experience of the excursions has not yet been evaluated regarding the difficulties faced by CMC and their caregivers during preparation, transportation, and in the local area. METHODS: Semi-structured interviews were conducted with eight informal and eight formal caregivers of CMC who attended an excursion to Tokyo Disney Land (TDL) via video conference. We investigated challenges that they had experienced through the excursion, performing inductive thematic analysis. RESULTS: Three themes were identified: the preparation stage (Theme 1), problems encountered while traveling to the theme park (Theme 2), and problems at the theme park (Theme 3). In the preparation stage, three subthemes, i.e. preparation for the trip, cooperation with related parties, and researching about the theme park and asking for help, are reported. Theme 2 includes four subthemes: activities of daily living, respiratory care, luggage, and weather changes. Theme 3 has three subthemes: activities of daily living, physical condition management, and issues for the theme parks. CONCLUSIONS: We found that securing the power supply, location, and time for daily procedures are challenges in realizing excursions for CMC, but with sufficient preparation, it is possible in Japan without major difficulty.

Possibility for Children with Medical Complexities to Reach a 3000-m Peak: A Report of 2 Cases.

With the recent development of neonatal medicine, the number of children with medical complexities (CMCs) is increasing. Outdoor activities are important for their psychosocial development, and the principles of accessibility should be addressed. We report the experience of 2 CMCs' high-altitude mountaineering with the necessary support. The participants were a 3-y-old girl with cerebral palsy, symptomatic epilepsy, and a ventriculoperitoneal shunt (Child A) and a 6-y-old girl who underwent bilateral Glenn operations at 11 mo for hypoplastic left heart syndrome (Child B). The support staff consisted of 4 doctors, 1 nurse, 5 nonmedical staff , 3 members from a mountaineering association, and 2 people from an oxygen company. The climbing schedule was 2 days. On the first day, we took a bus to a hut at an altitude of 2450 m and stayed overnight to acclimatize to the altitude. On the second day, we took the beginner's route, which took 3 h to climb 500 m, and our team made an attempt on the summit. During the attempt, Child B panicked. Although her lung sounds did not raise suspicions of pulmonary edema, we decided to leave the mountain with her because her transcutaneous oxygen saturation decreased. Child A had no apparent health problems and made it to the summit. Although CMCs' alpine climbing requires careful planning and staffing considering the risk of high-altitude sickness, our case suggests the feasibility of such activities with CMCs as part of accessibility.

The influence of information sources on intention changes to receive COVID-19 vaccination: A prospective cohort study in Japan.

BACKGROUND: Before the COVID-19 vaccine became available, many Japanese people were undecided about whether or not to receive them. Their decisions were keys to achieving herd immunity. The impact of the type of information source on the COVID-19 vaccine uptake decision-making process remains unclear. We aimed to investigate the association between information source usage on COVID-19 and subsequent vaccine uptake status among those who have yet to decide whether to receive vaccines from non-prioritized people for vaccination. METHODS: Prospective cohort online self-administered surveys were conducted in February 2021 (T1), before the start of the mass vaccination program, and September-October 2021 (T2), when the vaccines were available to all citizens. The survey's target population was registered monitors of an Internet research company. Participants who answered "I want to get vaccinated after waiting to see how it goes." at T1 were eligible for analysis. The outcome variable was the COVID-19 vaccine uptake status in T2, and the predictors were 20 types of information sources, categorized based on people (family members, etc.), institutions (governments, etc.), or media (TV news, etc.). Adjusted odds ratio and 95% confidence intervals were estimated using logistic regression adjusted for possible confounders. RESULTS: The 5,139 respondents, mean age and standard deviation was 42.8 ± 12.5, 55.7% female, were eligible for analysis. 85.7% completed vaccination (including reserved/intended people) in T2. In the multivariate logistic analysis, odds ratios (95% confidence interval) for vaccine uptake were 1.49 (1.18-1.89) for workplaces/schools, 1.81 (1.33-2.47) for LINE, 0.69 (0.55-0.86) for Internet news and 0.62 (0.48-0.82) for video sharing sites. CONCLUSIONS: The type of information source usage played an important role in the decision to vaccinate against COVID-19. Although caution is needed in interpreting the results, obtaining information from workplaces/schools and LINE was influential in promoting immunization.

Telepathology in intraoperative frozen section consultation of breast cancer sentinel node biopsy in Fukushima, Japan following the 2011 triple disaster: diagnostic accuracy and required time during the early implementation phase.

In breast cancer surgery, some medical facilities lack the necessary resources to conduct sentinel lymph node biopsy and its intraoperative frozen section consultation. In the coastal rural area of Fukushima, Japan, which has suffered from physician undersupply following the 2011 triple disaster of earthquake, tsunami and nuclear disaster, we explored the feasibility of telepathology by evaluating the diagnostic accuracy in remote intraoperative frozen section consultation of sentinel lymph node biopsy and its required time. Although examination time has room for improvement, telepathology can be one possible solution in resource-limited areas.

An assessment of adherence to the WHO-delineated good manufacturing practice by the pharmaceutical companies in Kabul, Afghanistan.

BACKGROUND: Afghanistan, a low-income landlocked country, is continuously suffering from domestic war and conflicts; the country struggles to provide quality healthcare services, including affordable medicinal products in the required quantity. Moreover, the quality standards of domestic pharmaceutical companies have not been established yet. One of the internationally recognized guidelines for monitoring manufacturing processes in pharmaceutical companies is Good Manufacturing Practice (GMP), recommended by World Health Organization (WHO). Therefore, this study aimed to assess whether a pharmaceutical company in Kabul, Afghanistan adheres to the GMP standards established by WHO. METHOD: A descriptive cross-sectional study was conducted to assess the WHO-delineated GMP compliance of 25 pharmaceutical companies in Kabul, Afghanistan. The inspection checklist was developed by Afghanistan's National Medicine and Healthcare Products Regulatory Authority (NMHRA) using the WHO-delineated GMP guidelines. In addition, direct observation, interviews with respective delegates, and documentation reviews were conducted to collect research data. RESULT: Only 38.33% (1.14 ± 1.08) of GMP contents were complied. Personnel 66.67% (2 ± 1.15) and materials 58.67% (1.76 ± 1.11) were the most commonly complied components, whereas the product recall 12.98% (0.39 ± 0.85), quality assurance 16.44% (0.49 ± 0.81) and quality control laboratory 28.35% (0.85 ± 1.12) were the least complied ones. CONCLUSION: None of the GMP components was fully adhered to by the pharmaceutical companies in Kabul, Afghanistan. Quality control and assurance should be implemented immediately, including validation and qualification practices.

Detection rate and variables associated with incidental prostate cancer by holmium laser enucleation of the prostate.

OBJECTIVES: Holmium laser enucleation of the prostate is well-established and effective for bladder outlet obstruction due to benign prostatic hyperplasia. The objective of this study was to examine the detection rate of incidental prostate cancer by holmium laser enucleation of the prostate and variables associated with them. METHODS: A total of 612 patients were enrolled. We retrospectively examined the detection rate of incidental prostate cancer and perioperative variables associated with them. RESULTS: Forty-nine of 612 patients were diagnosed with incidental prostate cancer. Univariate logistic regression analysis showed that higher prostate-specific antigen density (odds ratio 3.34, 95% confidence interval 1.02-10.94, P = 0.05), higher prostate-specific antigen density of the transition zone (odds ratio 2.28, 95% confidence interval 1.02-5.09, P = 0.04), and findings of the prostate cancer on magnetic resonance imaging (peripheral zone: odds ratio 4.71, 95% confidence interval 1.70-13.1, P = 0.003; transition zone: odds ratio 3.46, 95% confidence interval 1.74-6.86, P < 0.001; peripheral and transition zones: odds ratio 6.00, 95% confidence interval 1.51-23.8, P = 0.01) were significantly associated with incidental prostate cancer. Multivariate logistic regression analysis showed that findings of the prostate cancer on magnetic resonance imaging (peripheral zone: odds ratio 4.36, 95% confidence interval 1.49-12.8, P = 0.001; transition zone: odds ratio 3.54, 95% confidence interval 1.75-7.16, P < 0.001; peripheral and transition zones: odds ratio 6.14, 95% confidence interval 1.53-24.5, P = 0.01) was an independent risk factor for incidental prostate cancer. CONCLUSION: The detection rate of incidental prostate cancer was 8.0%, and findings of the prostate cancer on magnetic resonance imaging were an independent predictive factor for incidental prostate cancer.

Navigating Japan's COVID-19 Vaccination Challenges: A Shift in Legal Classification and the Opt-out System.

On January 20, 2023, the Japanese government announced easing the legal handling of the novel coronavirus disease 2019 (COVID-19) under its Infectious Diseases Control Act, effective May 8, 2023. While free vaccines will continue in fiscal year 2023, the future of mass vaccinations remains uncertain. The opt-out system, wherein local governments schedule vaccinations on behalf of the residents, may potentially alleviate issues associated with the currently adopted opt-in approach, such as procedural intricacies and scheduling difficulties, thereby facilitating the recovery of vaccination rates and simultaneously addressing vaccine wastage concerns. Given that COVID-19 still presents a substantial risk to specific groups, such as the elderly, recognizing the benefits of the opt-out system and the ethical and geographical challenges it poses is essential. With the collaboration of local governments and healthcare institutions, ongoing surveillance and scientific assessment are indispensable.

Intramuscular vs. Subcutaneous: Rethinking Influenza Vaccination Strategy in Japan.

In Japan, inactivated vaccines, including the influenza vaccine, are administered subcutaneously, which is contrary to global recommendations for intramuscular injections. This practice is attributed to historical medical incidents and unchallenged conventions. However, this outdated method, which differs from that of international standards and is linked with less immunogenicity and more adverse reactions, may contribute to vaccination hesitancy. Therefore, with the adoption of intramuscular vaccination administration, which was widely adopted in the coronavirus disease 2019 vaccination, a shift in the Japanese health policy to conform to international standards potentially improves vaccine acceptance and effectiveness.

Bridging the Gap in United Nations Environment Programme's Report: The Potential of Nudges to Reduce Plastic Pollution and Health Risks.

Plastic pollution is increasingly becoming a threatening problem worldwide, with highlighted health risks associated with plastic waste incineration. Among the immediate measures to address this problem, proper recycling of polyethylene terephthalate (PET) bottles is a pertinent strategy. Considering the urgent need for administrative-led reforms, we assessed the separation rates of PET bottle caps and labels by 125 administrative staff in a government office of a prefectural in Japan during a four-day period; only 59.3% (48/81) of the pet bottles had both caps and labels removed and properly separated to each trash can. One potential solution for the low separation rate is the use of nudges, which are effective methods for promoting behaviors such as healthy actions. Since both health and environmentally conscious behaviors involve choices across different time points, leveraging insights from nudges developed in the field of health behavior to environmental behaviors is considered crucial, even from a health promotion perspective.

From seizures to cognitive dysfunction: A case report of Fahr syndrome in an Afghan patient.

RATIONALE: Fahr syndrome is a rare, degenerative neurological condition characterized by bilateral idiopathic calcification of the periventricular region, especially the basal ganglia. This condition is often misdiagnosed as other neurological or psychiatric disorders due to its rarity and overlapping symptoms. PATIENT CONCERNS: A 34-year-old man had been experiencing seizures and cognitive dysfunction for few years, which were further compounded by slurred speech and motor difficulties as acute conditions. DIAGNOSIS: After investigations, severe hypocalcemia, and hypoparathyroidism were detected and his brain computed tomography showed extensive bilateral calcifications in basal ganglia, thalamus, dentate nuclei, and some parts of subcortical white matter, suggestive of Fahr syndrome. Although, the patient was initially misdiagnosed due to a lack of information and the rarity of this disease. INTERVENTION: The patient was treated with intravenous calcium gluconate, vitamin D3, l-ornithine l-aspartate syrup, and levetiracetam, replacing carbamazepine. OUTCOME: His symptoms, including slurred speech, muscle pain, and stiffness improved, serum calcium normalized, and he was discharged with medications for memory deficit and depression. LESSONS: This case underscores the importance of raising awareness among physicians, especially in areas with limited medical resources, about the significance of prompt diagnosis and appropriate symptomatic treatment in enhancing patient prognosis and quality of life.

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.

Unveiling, Analyzing the Mechanisms of, and Proposing Solutions for Bribery in Japan's Medical Device Sector.

Both public and academic scrutiny of the financial relationships between the medical device industry and the healthcare society occur less frequently than those involving the pharmaceutical industry, and Japan is no exception to these shortcomings. This paper examines the ethical and legal challenges inherent in Japan's medical device industry through the lens of bribery scandals, placing these issues within the broader context of global healthcare corruption. It aims to derive lessons and suggest universal strategies for ethical and legal enhancements. The discussion includes two notable cases: one involving inappropriate transactions between a cancer center and a biliary stent manufacturer, and another concerning a corrupt donation scheme between a medical device company and a university's anesthesiology department, which was found guilty. In our analysis, we also acknowledge the industry's efforts toward compliance and reform to maintain a balanced perspective. The analysis not only highlights the unique culture and structure of the Japanese medical device industry, such as the exploitation of flexible pricing and opaque financial practices but also contrasts these issues with the tightly regulated pharmaceutical industry. This approach reveals both sector-specific challenges and common corruption drivers, enhancing our understanding of why such scandals occur and persist. We propose ethical and compliance-focused business measures such as centralizing donation decisions, limiting the financial independence of marketing divisions, and increasing transparency, alongside adopting mandatory disclosure practices based on successful models from the United States and Europe. By emphasizing integrity and presenting diverse perspectives, this study aims to elevate ethical and legal standards in the medical device industry and improve patient health outcomes worldwide.

Physical and psychological effects of a long-term supervised self-exercise program during hemodialysis in elderly dialysis patients: A single-site pilot study in a Japanese community setting.

Self-exercise during hemodialysis reportedly prevents functional decline. This study aimed to assess the effects of exercise on physical function during hemodialysis. From September 2014 to March 2018, 35 elderly dialysis patients participated in an exercise program 3 times a week for 24 weeks during hemodialysis under staff supervision. The Short Physical Performance Battery and muscle strength test were used to measure physical function, and the Short Form Version 2 and Self-Rating Questionnaire for Depression were used to measure psychological function. For Short Physical Performance Battery, walking speed and standing time improved significantly. Other significant improvements were observed in both knee extension muscle strength and right side of grip strength. There was also an improving trend in both Short Form Version 2 and Self-Rating Questionnaire for Depression after the intervention compared with the baseline. A long-term supervised self-exercise program during dialysis led to maintenance and improvement of physical and psychological functioning in elderly dialysis patients.

Evaluating ChatGPT's effectiveness and tendencies in Japanese internal medicine.

INTRODUCTION: ChatGPT, a large-scale language model, is a notable example of AI's potential in health care. However, its effectiveness in clinical settings, especially when compared to human physicians, is not fully understood. This study evaluates ChatGPT's capabilities and limitations in answering questions for Japanese internal medicine specialists, aiming to clarify its accuracy and tendencies in both correct and incorrect responses. METHODS: We utilized ChatGPT's answers on four sets of self-training questions for internal medicine specialists in Japan from 2020 to 2023. We ran three trials for each set to evaluate its overall accuracy and performance on nonimage questions. Subsequently, we categorized the questions into two groups: those ChatGPT consistently answered correctly (Confirmed Correct Answer, CCA) and those it consistently answered incorrectly (Confirmed Incorrect Answer, CIA). For these groups, we calculated the average accuracy rates and 95% confidence intervals based on the actual performance of internal medicine physicians on each question and analyzed the statistical significance between the two groups. This process was then similarly applied to the subset of nonimage CCA and CIA questions. RESULTS: ChatGPT's overall accuracy rate was 59.05%, increasing to 65.76% for nonimage questions. 24.87% of the questions had answers that varied between correct and incorrect in the three trials. Despite surpassing the passing threshold for nonimage questions, ChatGPT's accuracy was lower than that of human specialists. There was a significant variance in accuracy between CCA and CIA groups, with ChatGPT mirroring human physician patterns in responding to different question types. CONCLUSION: This study underscores ChatGPT's potential utility and limitations in internal medicine. While effective in some aspects, its dependence on question type and context suggests that it should supplement, not replace, professional medical judgment. Further research is needed to integrate Artificial Intelligence tools like ChatGPT more effectively into specialized medical practices.