Key issues in Japan's public health centers to prepare for future pandemics: a text mining study using a topic model.

BACKGROUND: In Japan, over 450 public health centers played a central role in the operation of the local public health system in response to the COVID-19 pandemic. This study aimed to identify key issues for improving the system for public health centers for future pandemics. METHODS: We conducted a cross-sectional study using an online questionnaire. The respondents were first line workers in public health centers or local governments during the pandemic. We solicited open-ended responses concerning improvements needed for future pandemics. Issues were identified from these descriptions using morphological analysis and a topic model with KHcoder3.0. The number of topics was estimated using Perplexity as a measure, and Latent Dirichlet Allocation for meaning identification. RESULTS: We received open-ended responses from 784 (48.6%) of the 1,612 survey respondents, which included 111 physicians, 330 nurses, and 172 administrative staff. Morphological analysis processed these descriptions into 36,632 words. The topic model summarized them into eight issues: 1) establishment of a crisis management system, 2) division of functions among public health centers, prefectures, and medical institutions, 3) clear role distribution in public health center staff, 4) training of specialists, 5) information sharing system (information about infectious diseases and government policies), 6) response to excessive workload (support from other local governments, cooperation within public health centers, and outsourcing), 7) streamlining operations, and 8) balance with regular duties. CONCLUSIONS: This study identified key issues that need to be addressed to prepare Japan's public health centers for future pandemics. These findings are vital for discussions aimed at strengthening the public health system based on experiences from the COVID-19 pandemic.

Cutting the Chain of Discrimination during COVID-19 Pandemic by Health Literacy.

The coronavirus disease 2019 (COVID-19) pandemic resulted in discrimination against patients and healthcare workers in the beginning. As more information about COVID-19 prevention became available, discrimination toward the patients and healthcare workers gradually reduced. Instead, people wearing masks in the general public were heavily discriminated when mask-wearing was recommended only for healthcare workers. After the universal use of masks was recommended, discrimination against those who were wearing masks decreased and increased among those who do not wear masks. However, due to the introduction of vaccine passports, the target for discrimination has shifted to people who have not received COVID-19 vaccines. Narrowing vaccine disparity could prevent discrimination toward unvaccinated people. However, some people are hesitating vaccination or cannot be vaccinated because of their health status. These people will remain targets for discrimination even if vaccines were equally distributed. To prevent discrimination during the COVID-19 pandemic, improving health literacy of the population could be effective in two ways. First, health literacy could reduce vaccine hesitancy by enabling people to critically evaluate vaccine information. Second, health literacy enables people to respect decisions of others to avoid vaccination. Therefore, interventions improving health literacy have the potential to contribute to cutting the chain of discrimination during the COVID-19 pandemic.

Nutritional status of children under 5 years old in Namibia: adjusting for poor quality child anthropometry.

The poor assessment of child malnutrition impacts both national-level trends and prioritisation of regions and vulnerable groups based on malnutrition burden. Namibia has reported a high prevalence of malnutrition among children younger than 5 years of age. The present study's aim was to identify the optimal methods for estimating child stunting and wasting prevalence in Namibia using two datasets with suspected poor data quality: Namibia Demographic and Health Surveys (NDHS) (1992-2013) and Namibia Household Income and Expenditure Survey (NHIES), 2015/16. This comparative secondary data analysis used two prevalence estimation methods: WHO flags and PROBIT. WHO flags is the standard analysis method for most national household surveys, while the PROBIT method is recommended for poor quality anthropometry. In NHIES (n 4960), the prevalence of stunting (n 4780) was 30·3 and 20·9 % for the WHO flags and PROBIT estimates, respectively, and the national wasting prevalence (n 4637) was 11·2 and 4·2 %, respectively. The trends in nutritional status from NDHS and NHIES showed improvement across WHO flags and PROBIT until 2013; however, from 2013 to 2016, PROBIT showed smaller increases in stunting and wasting prevalence (2·5 and 0·6 percentage points) than WHO flags (6·6 and 5·0 percentage points). PROBIT identified the Khoisan ethnic group and Northern geographical regions with the highest stunting and wasting prevalence, while WHO flags identified similar prevalence across most groups and regions. The present study supports the recommendation to use PROBIT when poor data quality is suspected for constructing trends, and for targeting regions and vulnerable groups.

The Knowledge and Awareness for Radiocesium Food Monitoring after the Fukushima Daiichi Nuclear Accident in Nihonmatsu City, Fukushima Prefecture.

On 11 March 2011, Japan experienced a massive earthquake and tsunami that triggered the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, resulting in the release of large amounts of cesium-134 and -137 into the atmosphere. In addition to the food radioactivity control in the markets throughout the country, radiocesium concentrations in locally grown foods were voluntarily inspected and the results were shown to the residents by the local government to raise their awareness of the internal radiation contamination risk from low knowledge in Nihonmatsu City, Fukushima Prefecture. In this longitudinal study, local food products for in-home consumption were evaluated by seven different food radioactivity measuring devices in Nihonmatsu City from 2011⁻2017. Radiocesium was detected in local foods in Nihonmatsu City even six years after the FDNPP accident. The highest number of products tested was in 2012, with the number steadily decreasing thereafter. Most foods had contamination levels that were within the provisional regulation limits. As edible wild plants and mushrooms continue to possess high radiocesium concentrations, new trends in radioactivity in foods like seeds were discovered. This study highlights that the increased risk of radiation exposure could possibly be due to declining radiation awareness among citizens and food distributors. We recommend the continuation of food monitoring procedures at various points in the food processing line under the responsibility of the government to raise awareness for the reduction of future risks of internal exposure.

Roles of children and their parents in the reduction of radiation risk after the 2011 Fukushima Daiichi Nuclear Power Plant accident.

INTRODUCTION: On March 11, 2011, Japan experienced its largest recorded earthquake with a magnitude of 9.0. The resulting tsunami caused massive damage to the Fukushima Daiichi Nuclear Power Plant reactors, and the surrounding environment was contaminated with radioactive materials. During this period, some residents were exposed to high levels of radiation (up to 5 millisieverts [mSv]), but since then, many residents have been exposed to low levels of radiation (<1 mSv). This study was conducted to assess the effects of lifestyle and attitude factors on external radiation exposure among Fukushima residents. METHODS: This community-based, cross-sectional study was conducted in Nihonmatsu City of the Fukushima Prefecture from May to July 2014. The population survey targeted 6,884 children between the ages of 0-15 years, and a personal radiation badge and questionnaire were administered to each of the residences. Multiple linear regression analysis was used to assess the impact of lifestyle and attitude factors on external radiation dose. RESULTS: The study participants (population size [n] = 4,571) had an additional mean radiation dose of 0.65 mSv/year, which is small as compared to the mean radiation dose 6 months after the disaster (1.5 mSv/year), in 2012 (1.5 mSv/year), and in 2013 (1.0 mSv/year). External radiation doses statistically varied by socio-demographic and lifestyle factors. Participants living in wooden residences (p-value<0.001) and within 100 meters of a forest (p = 0.001) had higher radiation exposure. Conversely, participants with a cautious attitude towards radiation had lower radiation exposure (beta [b] = -0.124, p = 0.003). CONCLUSION: Having a cautious attitude towards radiation and being aware of exposure risks proved to be significant in the reduction of external radiation dose. Therefore, in the event of future radiation disasters, attitudes towards and awareness of radiation should be considered in the reduction of exposure risk and implementation of radiation protection.