Implementation of an online-based JICA Knowledge Co-Creation Program on capacity development among African community health professionals / 国際保健医療

Introduction  Asahikawa Medical University has been conducting a JICA Knowledge Co-Creation Program (KCCP) “Health Administration for Community Health Officers in Africa” in Japan since 2008. Due to the COVID-19 pandemic, the KCCP in 2020 was a hybrid of distance learning and following on-site training in Japan, which the latter was canceled thereafter. This paper reports on how this hybrid program was organized and implemented.Methods: Preparation  The program was held in January-February 2021, with eight official participants from five countries and nine observers from two countries. The participants were required to engage in self-learning by PowerPoint materials with lecturers’ audio descriptions and zoom-based interactive meetings. The PowerPoint materials were freely accessible at our Google Drive account. There were 10 zoom sessions during the program.Results: Implementation  At the beginning, all the lecture materials were converted to mp4 clips and uploaded to a Youtube channel due to the difficulties downloading heavy files with limited internet connection. A total of 24 videos were created with an average length of 58 minutes in each. Zoom-based interactive meetings were held regularly in the morning in the African continent. Almost all of the sessions were productive, but the participants were sometimes interrupted due to a weak network environment or their regular work assignments. Most provided contents were well understood.Discussion  Despite some technical and environmental difficulties, the new-style, web-based training course facilitated the participation of observers as well as regular participants, providing more opportunities for interaction and discussion among trainees than a previous old-fashioned, on-site program. Improvement of the training environment particularly for participants is necessary to produce better training outcomes in the future, such as renting a hotel room and securing virtual connections.

A follow-up study in three African countries on the JICA training course “Health Systems Management for Regional and District Health Management Officers” / 国際保健医療

Introduction  Asahikawa Medical University (AMU) has conducted a 7-week JICA training course “Health Systems Management for Regional and District Health Management Officers” since 2008 and trained a total of 132 participants from 22 countries. In order to assess how trainees applied their public health knowledge and skills obtained through the training course to their communities, we conducted interviews in Kenya, Malawi, and Liberia to explore their current public health problems and to identify what programs are required for our further training course to improve their health system.Methods  Among 29 trainees in three countries in total, 15 were face-to-face interviewed and 6 were phone-interviewed on February 2019. The rest was missing but we identified five of their current position.Results  The trainees made best use of knowledge and skills obtained from following lectures and/or field trips in their communities, such as “Project Cycle Management”, “Maternal and child health”, “Public health centers’ visit”, “Waste management including water supply and sewage treatment”, “School health”, “Tele-medicine”, and “5S-KAIZEN”. They also requested us to provide following lectures and field visits to tackle with their future health problems, such as “Japan’s experience to achieve the Universal Health Coverage”, “Health system strengthening”, “Disaster medicine and management”, “Non-communicable diseases”, and “Capacity development”.Discussion & Conclusions  By face-to-face or phone interviews in three countries, we grasped ideas of current health problems and verified an effectiveness of our training programs in each country. We also helped the trainees, their co-workers, community people (volunteers) to increase the motivation of their relevant works and activities through the field visit. Therefore, in order to provide a better training program, we further need to enhance international cooperation between us and African countries as well as to strengthen our training capacities including regular follow-up systems to ex-trainees.

Oral exposure to lead for Japanese children and pregnant women, estimated using duplicate food portions and house dust analyses

BACKGROUND@#Lead is a toxic metal abundant in the environment. Consumption of food contaminated at low levels of lead, especially by small children and pregnant women, raises a health concern.@*METHODS@#Duplicated food portions and drinking water were collected over 3 days from 88 children and 87 pregnant women in Shimotsuke, Tochigi, Japan. Participants were recruited in this study between January 2014 and October 2015. Dust was also collected from their homes. Lead concentrations were measured and consequent oral lead exposure levels were estimated for this population at high risk to environmental toxicants. Lead concentrations of peripheral and cord blood, taken from children and pregnant women, and were also analyzed.@*RESULTS@#Lead concentrations in food, drinking water, and house dust were low in general. Oral lead exposure to lead was higher for children (Mean ± SEM; 5.21 ± 0.30 μg/kg BW/week) than in pregnant women (1.47 ± 0.13 μg/kg BW/week). Food and house dust were main sources of lead contamination, but the contribution of house dust widely varied. Means ± SEM of peripheral and cord blood lead concentrations were 0.69 ± 0.04 μg/dL and 0.54 ± 0.05 μg/dL, respectively for pregnant women and 1.30 ± 0.07 μg/dL (peripheral only) in children. We detect no correlation between smoking situations and blood lead concentration in pregnant women.@*CONCLUSION@#We conclude that oral lead exposure levels for Japanese children and pregnant women were generally low, with higher concentrations and exposure for children than for pregnant women. More efforts are necessary to clarify the sources of lead contamination and reduce lead exposure of the population at high risk even in Japan.

Inflammation as a cardiovascular risk factor and pulse wave velocity as a marker of early-stage atherosclerosis in the Japanese population

Inflammation and pulse wave velocity (PWV) are a potential risk factor and marker, respectively, for atherosclerosis in the primary prevention setting. Atherosclerosis is now generally accepted to be an inflammatory disorder of the arterial wall, and the high-sensitivity C-reactive protein (hs-CRP) level has been reported to be a strong predictor of cardiovascular events. High-sensitivity-CRP is associated with two factors related to inflammation: (1) the local production of CRP by atheromatous tissue or coronary artery smooth muscle cells and (2) adipose tissue as a potent source of inflammatory cytokines. Based on studies in North America and Europe, hs-CRP has been established as a cardiovascular risk factor and a cut-off value has been recommended. However, Japanese have lower hs-CRP values than their Western counterparts, partly because Japanese have a lower body mass index (BMI), which correlates positively to hs-CRP, and partly because lifestyle and genetic factors can affect hs-CRP values. Therefore, a cut-off value needs to be established by cohort studies for the Japanese population. Carotid-femoral PWV is most commonly measured by applanation tonometry, particularly in Europe, but this method is critically dependent upon the accurate placing of transducers over the arteries and is both time-consuming and complex. A novel device has been recently developed in Japan that measures brachial-ankle PWV (baPWV) using a volume-rendering method. Brachian-ankle PWV is a suitable screening method because of its technical simplicity and shorter measurement time. It is associated not only with conventional cardiovascular risk factors but also with new risk factors, such as inflammation, gamma-glutamyltransferase, chronic kidney disease, and psychosocial factors. However, a suitable cut-off value has yet to be established.

Relation of dampness to sick building syndrome in Japanese public apartment houses

<p><b>OBJECTIVES</b>The effect of dampness on sick building syndrome (SBS) symptoms has not been fully investigated in Japan. The purpose of this study is to elucidate the possible effects of dampness on SBS symptoms among residents in Japanese public apartment houses.</p><p><b>METHODS</b>A questionnaire was used to investigate the degree of dampness in public apartment houses in Asahikawa, Japan, and its effect on SBS symptoms, involving 480 residents in 64 buildings. Dampness indicators were as follows: condensation on the windowpanes, condensation on the walls and/or closets, visible mold in the bathrooms, visible mold on the walls, window frames, and/or closet, moldy odor, slow drying of the wet towels in bathrooms, water leakage, and bad drainage in bathrooms.</p><p><b>RESULTS</b>All dampness indicators except for visible mold in bathrooms had significantly higher odds ratios (ORs) for all or any SBS symptoms after adjustment. The dampness index, the number of positive dampness indicators, was significantly related to all SBS symptoms after adjustment.</p><p><b>CONCLUSIONS</b>There are serious problems relating to dampness in Japanese public housing, which affects the health of residents. There is a need to educate the residents about the relationship between dampness and SBS, and building problems should be rectified.</p>

Comparative Study of Simple Semiquantitative Dust Mite Allergen Tests

Objective: Two simple, commercially available and semiquantitative dust mite allergen tests, namely, the Acarex test® and Mitey Checker®, were compared using 2 and 10 μg of Der 1 allergen per gram of dust, as evaluated by enzyme-linked immunosorbent assay (ELISA), to clarify which method is better suited for practical use. Methods: Mite allergen exposure levels of 106 floor, bed and sofa surfaces were evaluated by the Acarex test®, Mitey Checker®, and ELISA. A template of 100 cm×100 cm was placed on the same surfaces to identify the examined areas. A dust collection filter was attached to a vacuum cleaner, and the area in the template (1 m2) was vacuumed. Then, to evaluate the other two tests, samples from the two other areas in the template (1 m2) that neighbored each other and did not overlap were vacuumed. Results: To predict Der 1 levels of 2 μg/g dust or higher, the sensitivity and specificity of the Acarex test® were 100% and 13.3%, and those of Mitey Checker® were 91.8% and 71.1%, respectively. To predict Der 1 levels of 10 μg/g dust or higher, the sensitivity and specificity of the Acarex test® were 50.0% and 96.2%, and those of Mitey Checker® were 85.7% and 79.5%, respectively. Compared with Der 1<2.0, 2.0-9.9, ≥10.0 (μg/g dust), the percent agreement and kappa of the Acarex test® were 47.2% and 0.234, and those of Mitey Checker® were 70.0% and 0.505, respectively. Conclusion: To evaluate mite allergen exposure level for practical use in Japanese living environments, Mitey Checker® is better than the Acarex test® because of its higher sensitivity and specificity.

Comparative study of simple semiquantitative dust mite allergen tests

<p><b>OBJECTIVE</b>Two simple, commercially available and semiquantitative dust mite allergen tests, namely, the Acarex test(®) and Mitey Checker(®), were compared using 2 and 10 μg of Der 1 allergen per gram of dust, as evaluated by enzyme-linked immunosorbent assay (ELISA), to clarify which method is better suited for practical use.</p><p><b>METHODS</b>Mite allergen exposure levels of 106 floor, bed and sofa surfaces were evaluated by the Acarex test(®), Mitey Checker(®), and ELISA. A template of 100 cm×100cm was placed on the same surfaces to identify the examined areas. A dust collection filter was attached to a vacuum cleaner, and the area in the template (1 m(2)) was vacuumed. Then, to evaluate the other two tests, samples from the two other areas in the template (1 m(2)) that neighbored each other and did not overlap were vacuumed.</p><p><b>RESULTS</b>To predict Der 1 levels of 2 μg/g dust or higher, the sensitivity and specificity of the Acarex test(®) were 100% and 13.3%, and those, of Mitey Checker(®) were 91.8% and 71.1%, respectively. To predict Der 1 levels of 10 μg/g dust or higher, the sensitivity and specificity of the Acarex test(®) were 50.0% and 96.2%, and those of Mitey Checker(®) were 85.7% and 79.5%, respectively. Compared with Der 1<2.0, 2.0-9.9.≥10.0 (μg/g dust), the percent agreement and kappa of the Acarex test(®) were 47.2% and 0.234, and those of Mitey Checker(®) were 70.0% and 0.505, respectively.</p><p><b>CONCLUSION</b>To evaluate mite allergen exposure level for practical use in Japanese living environments, Mitey Checker(®) is better than the Acarex test(®) because of its higher sensitivity and specificity.</p>

Prevalence of Burnout among Public Health Nurses in Charge of Mental Health Services and Emergency Care Systems in Japan

Objectives: The Community Health Act came into effect in 1997 in Japan. This act altered the work system for public health nurses (PHNs) in public health centers (PHCs) nationwide from region-specific to service-specific work. Such major changes to working environment in the new system seem to be exposing PHNs to various types of stress. The present study examined whether prevalence of burnout is higher among PHNs in charge of mental health services (psychiatric PHNs) than among PHNs in charge of other services (non-psychiatric PHNs), and whether attributes of emergency mental health care systems in communities are associated with increased prevalence of burnout. Methods: A questionnaire including the Pines burnout scale for measuring burnout was mailed to 525 psychiatric PHNs and 525 non-psychiatric PHNs. The 785 respondents included in the final analysis comprised 396 psychiatric PHNs and 389 non-psychiatric PHNs. Results: Prevalence of burnout was significantly higher for psychiatric PHNs (59.2%) than for non-psychiatric PHNs (51.5%). When prevalence of burnout in each group was analyzed in relation to question responses regarding emergency service and patient referral systems, prevalence of burnout for psychiatric PHNs displayed significant correlations to frequency of cases requiring overtime emergency services, difficulties referring patients, and a feeling of “restriction”. Conclusions: Prevalence of burnout is high among psychiatric PHNs, and inadequate emergency mental health service systems contribute to burnout among these nurses. Countermeasures for preventing such burnout should be taken as soon as possible.

Prevalence of burnout among public health nurses in charge of mental health services and emergency care systems in Japan

<p><b>OBJECTIVES</b>The Community Health Act came into effect in 1997 in Japan. This act altered the work system for public health nurses (PHNs) in public health centers (PHCs) nationwide from region-specific to service-specific work. Such major changes to working environment in the new system seem to be exposing PHNs to various types of stress. The present study examined whether prevalence of burnout is higher among PHNs in charge of mental health services (psychiatric PHNs) than among PHNs in charge of other services (non-psychiatric PHNs), and whether attributes of emergency mental health care systems in communities are associated with increased prevalence of burnout.</p><p><b>METHODS</b>A questionnaire including the Pines burnout scale for measuring burnout was mailed to 525 psychiatric PHNs and 525 non-psychiatric PHNs. The 785 respondents included in the final analysis comprised 396 psychiatric PHNs and 389 non-psychiatric PHNs.</p><p><b>RESULTS</b>Prevalence of burnout was significantly higher for psychiatric PHNs (59.2%) than for non-psychiatric PHNs (51.5%). When prevalence of burnout in each group was analyzed in relation to question responses regarding emergency service and patient referral systems, prevalence of burnout for psychiatric PHNs displayed significant correlations to frequency of cases requiring overtime emergency services, difficulties referring patients, and a feeling of "restriction".</p><p><b>CONCLUSIONS</b>Prevalence of burnout is high among psychiatric PHNs, and inadequate emergency mental health service systems contribute to burnout among these nurses. Countermeasures for preventing such burnout should be taken as soon as possible.</p>

The Use of Docosahexaenoic Acid Supplementation to Ameliorate the Hyperactivity of Rat Pups Induced by in utero Ethanol Exposure

It has been demonstrated that in utero ethanol(EtOH) exposure induces hyperactive behavior and learning disturbances in offspring. In order to investigate the effects of docosahexaenoic acid(DHA) on these neurobehavioral dysfunctions of rat pups induced by in utero EtOH exposure, pregnant Wistar rats were divided into four treatment groups depending on the type of oil added to the diet and drinking water as follows; (a)5% safflower oil with tap water(TW/n−6), (b)3% safflower oil and 2% DHA with tap water(TW/n−3), (c)5% safflower oil with 10%−EtOH(ET/n−6), (d)3% safflower oil and 2% DHA with 10%−EtOH(ET/n−3) at gestational day (GD)7. 10%−EtOH was administered to dams in ET/n−6 and ET/n−3 groups from GD 7 to the pups’ weaning(postnatal week 4), and all pups were fed with the same diet that was given to their dams during the entire examination period. The open−field test and the water E−maze test were conducted for all pups, and a spontaneous motor activity test and the Sidman electric shock avoidance test were performed for some of male pups. Amounts of monoamine metabolites in striatum were then determined, and fatty acid analyses of total brain lipids were performed. The male pups in the ET/n−6 group showed significantly more rearing and square−crossing movements in the open−field test, and significanrly higher spontaneous motor activity during the dark period in the daily cycle compared to the males in the TW/n−6 group. The male pups in the ET/n−3 group showed fewer of these behaviors in the open−field test compared to the ET/n−6 group males, and a normal pattern of spontaneous motor activity. Learning disturbance induced by in utero EtOH exposure was not observed in the E−shaped water maze, but was observed in the avoidance rates in the Sidman electric shock avoidance test. However, there was no significant modifying effect of DHA on the avoidance rates in EtOH exposed pups. The analysis of the fatty acid composition of total lipids in the brains of the pups revealed high levels of DHA in the diet reflected an increased level of brain DHA and caused a decreased level of the brain arachidonic acid. Retroconversion from DHA to eicosapentaenoic acid was also observed. However, there was no significant effect of DHA on the levels of monoamine metabolites. These results support the hypothesis that DHA can counteract the attention deficit hyperactivity disorder.