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Geographic information systems (GIS) and choropleth maps for COVID-19 cases as well as COVID-19 test and vaccination rates proved very valuable to informing decision-making on the local and regional levels of government in Shelby County, Tennessee, USA. The authors have all served on the City of Memphis and Shelby County COVID Joint Task Force and share here their observations about the challenges and promises related to these techniques in the context of a fast-changing environment. As the pandemic unfolded, new virus variants emerged and the population became increasingly vaccinated. Consequently, the use of GIS changed, and maps needed to be continually adapted to the shifting needs of decision makers. The authors describe their approaches to leveraging GIS techniques to monitor the spread of the disease, draw conclusions about the effect of policy measures, and address health disparities. They outline the strengths and weaknesses of choropleth maps, reflect on how best to facilitate interorganizational communication of the derived information, and suggest desirable aspects of educational courses for GIS as well as skill sets in personnel that they came to appreciate as essential. © 2023 Taylor and Francis Group, LLC.
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Background: The coronavirus disease 2019 (COVID-19) pandemic had resulted in either failure to provide required medical resources or delayed treatment for gastric cancer patients. This study aimed to investigate the impact of COVID-19 on the incidence of postoperative complications using a nationwide Japanese database of patients undergoing distal gastrectomy for gastric cancer. Method(s): We collected the data of patients who underwent distal gastrectomy from January 2018 to December 2021 from the National Clinical Database (NCD), a web-based surgical registration system in Japan. The number of surgical cases, the use of intensive care units, and the incidence of morbidity per month were analyzed. We also calculated the standardized mortality ratio (SMR), defined as the ratio of the number of observed patients to the expected number of patients calculated using the risk calculator established in the NCD, for several morbidities, including pneumonia, sepsis, 30-day mortality, and surgical mortality. Result(s): A decrease of 568 gastrectomies was observed from April 2020 to May 2020. Although the absolute number of patients admitted to intensive care units had declined since 2020, the proportion of patients admitted to the ICU did not change before and after the pandemic. Mortality and critical morbidity (such as pneumonia and sepsis) rates were not worse during the pandemic compared to pre-pandemic periods per the SMR. Conclusion(s): Surgical management was conducted adequately through the organized efforts of the entire surgery department in our country even in a pandemic during which medical resources and staff may have been limited.Copyright © 2023 The Authors. Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterological Surgery.
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Objective: Since nutrition could extend lifespan even in stroke-prone rats developing stroke genetically, our WHO-Collaborating Center for Primary Prevention of Cardio-vascular Diseases (CVD) started world-wide hearth examination to investigate nutrition good for healthy longevity by collecting 24-hour urine (24U) samples. Design: Urinary biomarkers of nutritions, sodium for salt, potassium (K) for vegetables and fruits, isoflavones(Is) for soy, taurine(Ta) for fish and magnesium (Mg) for beans and nuts were analyzed in 24U among 4211 participants (49.7% females(F)), aged 48-56 years in 50 populations from 22 countries according to WHO-CARDIAC(Cardiovascular Diseases and Alimentary Compression) Study Protocol, and studied comparatively in 6 Japanese(J), 6 Mediterranean(M) populations from Greece, Italy(2), Spain(2), Portugal and 6 Euro-Western(EW) populations from Sweden, Ireland, Scotland, Canada, Australia, New Zealand. Results with Discussion: The quintile analyses of Ta and Mg/creatine ratio in the world were inversely associated with CVD risks. The Odds ratios of obesity, hypercholesterolemia and hypertension in the lowest quintile of both Ta and Mg were 6.3, 4.6 and 1.8, respectively. J and M populations had significantly higher Ta and Mg therefore, lower CVD risks than EW, but J and M took more salt increasing the risk of stroke (Table 1). Despite the high salt intake, M had the merit of significantly high K intake to attenuate the adverse salt effect. J had a merit to take Is from soy containing Mg. Since Is intake was inversely associated with lower BMI in the world populations, high Japanese Mg intake was related to high Is intake which was inversely associated with obesity in Japan. In fact, the Japanese populations who took significantly higher T and Mg had lower BMI as well as higher HDL and folic acid in the blood, expected to prevent atherosclerosis and dementia. In contrast to M and EW, particularly severe obesity over BMI 30 was obviously less in J, ranking 182nd among 190 populations (WHO). The mortality rates of COVID-19 were significantly positively related to the ratio of severe obesity among 20 major countries in the world and this mortality was obviously lower in J, suggestive of the potential of J diet for post-pandemic longevity. Conclusion: 24U biomarker analyses indicated low-salted J and M diets are recommendable for CVD prevention. J diet is so far better than M diet because of lower CVD risks such as obesity and lipidemia, which were proven by urinary biomarkers to be related with traditional fish and soy intakes.
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Aims: The COVID-19 pandemic forced a trade-off between the interests of all versus those of individuals. Therefore, many healthcare organisations applied visiting restrictions, also for dying patients.Our aim was to explore, in an international context, if visiting restrictions for dying patients had an impact on the quality of life of healthcare professionals. Method(s): From April 2020 to June 2021, an open online survey was conducted among healthcare professionals in 14 countries;Belgium, Czech Republic, Norway, Slovenia, the Netherlands, United Kingdom, Argentina, Brazil, Chile, Colombia, El Salvador, Uruguay, Indonesia and Japan. The survey consisted of validated and purposively designed measures of perceived quality of care (CODE) and staff QoL. Data were analysed descriptively and inferentially, with regression analysis conducted for all countries, and the results pooled and analysed in a multilevel analysis using Cochrane Review Manager. Result(s): Among 2925 respondents (mean age 42 years), 2385 (81.8%) were female, 1601 (54.9%) were nursing staff, and 1560 (53.3%) worked in hospitals. Approximately half of the patients reported on were men (n = 1470, 50.4%) and 1202 (41.4%) were COVID-19 positive. In all countries, the majority of respondents rated medical and nursing care for the patient as sufficient (n = 2468, 84.6%, and n = 2426, 83.2%, respectively). In 1559 cases (53.9%), visitors were allowed with limitations during the last 2 days of the patient's life, and in 468 cases (16.2%) no visits were allowed at all. Most respondents rated their QoL during the past week as 4 or higher out of 7. Mean QoL was lowest in Brazil (M 3.94, SD 1.34) and highest in Indonesia (M 5.80, SD 1.21). Regression analyses showed that no or limited visiting in the last days of life, was associated with lower QoL scores of healthcare professionals compared with those who reported that visiting was unrestricted (OR 0.63, 95%CI 0.48-0.83, p<0.001). Heterogeneity between countries was high. Conclusion(s): Our results suggest that visiting restrictions are associated with QoL of healthcare professionals. It may be that restrictions resulted in staff feeling unable to provide the desired level of care, and in turn affected their role perception and QoL.
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The COVID-19 pandemic after January of 2020 and subsequent behavioral restriction and economic breakdown have had a significant impact on people’s daily life with increased level of stress. By reviewing scientific papers, we found a considerable number of studies showing change of lifestyle habits and deterioration of mental health during the pandemic around the world. In addition, it has been shown that psychological characteristics may affect deterioration of mental health during the pandemic. Especially, cognitive social capital as well as internal locus of control have been indicated, with some extent of consistency, play an important role in sustaining and improving mental health in the context of the pandemic, although other parts of personal characteristics could not be unheeded. Accordingly, prevention of mental health problems could be implemented by focusing on cognitive social capital and internal locus of control in the population at this moment.
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Infections by protozoa can cause some of the most serious human diseases, particularly in tropical regions. However, the number of available drugs used to treat such diseases tends to be limited with relatively high toxicity, and the vast majority of such drugs were developed in the 1920s to 1970s. The development of antiprotozoal drugs has been hindered owing in part to: (1) the highly complicated life cycles of such organisms and their ability to avoid innate immune defences;(2) challenges associated with culturing such organisms particularly in different phases of their growth and amplification;and (3) a lack of investment in biomedical research aimed at developing treatments for tropical diseases that do not tend to affect more affluent countries. Indeed, only three new drugs have entered into clinical trials in recent times, highlighting the tremendous gap in knowledge that should be bridged to more effectively treat protozoal infections.
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Background: Palliative care improves COVID-19 patient management who are highly vulnerable and facing higher risk of dying. However, evidence regarding palliative care preparedness and response plans is limited in the Asia-Pacific region. Aim: To evaluate the preparedness of palliative care services in the Asia- Pacific region to respond to the COVID-19 pandemic. Method: An online cross-sectional survey was developed based on prior methodology guidance and the International Health Regulations. It was emailed to the Asia-Pacific Hospice and Palliative Care Network subscribers (n=1551) and organisational members (n=185) from 10th June to 1st July 2020. Descriptive analysis was used for reporting. Results: Ninety-seven respondents completed the survey. Around half of services were hospital-based (n=47, 48%), and public-funded (n=46, 47%). Half of services reported to have confirmed cases (n=47, 49%). Staff perceived moderate stress of being infected by COVID-19 (median: median: 7 on a 1-10 scale). > 85% of respondents reported they had up-to-date contact list for staff and patients, however one-third revealed challenges to keep record of relatives (n=30, 31%) and patients visited in communities (n=29, 30%). Majority of services (60%) obtained adequate infection control resources except face mask. More than half had no guidance on Do Not Resuscitate orders (n=59, 66%) and bereavement care (n=44, 51%). One-third considered they had capacity to train nonpalliative care specialists in using protocols. Conclusion: Recommendations to strengthen the palliative care preparedness include: 1) improving the access to infection control materials such as face mask and hand disinfectants;2) acquiring stress management protocols for staff when unavailable;3) reinforcing the contact tracing system for relatives and patients visited in the community and 4) developing guidance on patient and family care before and after patients' deaths.
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Green Pass is going to be a reality in Europe as well as in other parts of the world. The author welcomes the new measure and wants to contribute to the current debate on the Covid pandemic and its consequences. The pandemic made clear that science has gained a new central role in a global society which attributes higher value to protection of human life. For the first time the new vaccines allow us to quit the pandemic: a possibility which never occurred before. The effect of all this the notion of health as a given becomes obsolete because it is clear that health is a social construct. In this renewed context the Green Pass is the beginning of a new era concerning the health.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of coronavirus disease (COVID-19) which has spread rapidly worldwide to cause a global pandemic. The SARS-CoV-2 genome shows a lower mutation rate than other RNA viruses. However, because of the ongoing rapid worldwide transmission among humans, the genetic diversity of the SARS-CoV-2 genome has increased. In Japan, a previous study suggested that the distinct viral clades L, S, G and GR of SARS-CoV-2 had been imported from overseas and begun to circulate domestically by April 2020. However, little is known about molecular epidemiology of SARS-CoV-2 since then, because of the lack of sufficient information on the viral genome sequence information in Japan. Herein, to probe the molecular epidemiological trends in Japan, we determined the full genome sequences of SARS-CoV-2 (n=55) derived from patients admitted to our hospital and performed a comparative analysis with domestic and international sequence information available from GISAID and GenBank. The results showed that the dominant domestic genotypes, including our determined sequences, had shifted from clades S and L to clades G and GR, and dispersed widely during the first infection peak period (March to April). In contrast, all the SARS-CoV-2 genotypes after May 2020 are highly clustered as unique clade GR genotypes that are not detected outside Japan. This genetic clustering occurred during the period under which restrictions were placed on overseas travel in Japan. Similar trends of viral genotype clustering have also been observed worldwide, with regional disparities. Under these circumstances, we should adopt adequate preventive measures to prevent the viral genetic diversity from increasing, and also further extend the molecular epidemiological survey of SARS-CoV-2 genotypes in Japan. These efforts will aid in ensuring successful use of the novel vaccines and antiviral drugs in the near future.
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On march 6, 2020 the Ethics group of anaesthesiology issued 15 Recommendations for triage in extreme pandemic situations. The President of the Italian Medical Association criticized the proposals, creating a sharp divide within health-care professionals. Allegedly, the peace was restored by a joint document issued on October 30. In reality the anaesthesiologists were silenced. As it happened in Warsaw in 1831, we have to wait that times mature. © 2020, Tipolito Subalpina. All rights reserved.
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As a precaution against COVID-19 infection, it is important to avoid inadequate ventilation, crowding, and close contact. However, it is difficult for patients with neuromuscular disorders such as muscular dystrophies and severe physical and intellectual disabilities to comply with. The reason is because they require assistance in daily life and medical care, so many caregivers and medical staff are involved both at home and hospitals/facilities. Therefore, these patients are not only at high risk of contracting infection through caregivers, but also can generate cluster when they are infected. Particularly in patients undergoing respiratory care such as non-invasive ventilation or respiratory physiotherapy, there is high possibility to produce massive aerosols through these treatments. Thus, for COVID-19 infected patients, more attentions are required to prevent the spread of the infection. We described the general precaution that should be considered when patients requiring respiratory care are infected with COVID-19, and important implementation factors to be considered. © 2020 Japanese Society of National Medical Services. All rights reserved.