Development of a training program to educate care workers utilizing digital transformation in Japan

Drug misuse in India: Where do we stand & where to go from here?

WPSAR Vol 2, No 4, 2011 | doi: 10.5365/wpsar.2011.2.4.008 www.wpro.who.int/wpsar 1 a Offi ce of Public Health Emergency Preparedness and Response, Health Science Division, Ministry of Health, Labour and Welfare of Japan Submitted: 20 October 2011; Published: 23 December 2011 doi: 10.5365/wpsar.2011.2.4.008 Public health response to the combined Great East Japan Earthquake, tsunami and nuclear power plant accident: perspective from the Ministry of Health, Labour and Welfare of Japan

Suicide has been recognized as a serious global public health issue and now the influence of the COVID-19 pandemic on suicide rates is a concern around the world. According to the monthly suicide occurrence data in Japan, the number of suicides has been gradually increasing since July 2020 compared to the same months in the past 3 years.1 Increases in suicide rates following previous pandemics have been reported. This increase in suicide might be late-onset (i.e., occurring several months later), as is the case in natural disasters, but detailed data have been lacking, and the mechanisms have not yet been fully analyzed. Japan has experienced significant fluctuations in suicides rates since records began. The most recent sharp increase in suicides occurred in 1998: the number of suicides increased by more than 34% from 24 391 in 1997 to 32 863 in 1998, and remained at more than 30 000 for another 13 years. In 2006, The National Diet enacted the Basic Act for Suicide Prevention.2 In the previous year, The Japan Ministry of Health, Labour, and Welfare had chosen suicide prevention as a subject for its strategic research project, envisaging establishment of evidenced-based health policy for preventing suicide. Thus, the ‘Japanese Multimodal Intervention Trials for Suicide Prevention (J-MISP)’ program was launched. The J-MISP contained two trials: (i) a community intervention trial of a multimodal suicide-prevention program in Japan (NOCOMIT-J);3 and (ii) a randomized, controlled, multicenter trial of post-suicide attempt case management for the prevention of further attempts in Japan (ACTION-J).4 Suicide attempt is a potent risk of later suicide, therefore, the ACTION-J study focused on preventing suicide attempters admitted to the emergency departments from committing further attempts. The study aimed to clarify the effectiveness of the assertive-case-management intervention based on psychiatric diagnoses, social risks, and the needs of patients. In the case-management group, a significant decrease in the incidence of recurrent suicide attempt was observed up to 6 months.4 The successful development of an evidence-based psychosocial intervention, not only for suicide prevention, but for psychiatric practice more broadly, is rare. Thus, the ACTION-J intervention program was adopted for the national medical payment scheme by the Ministry of Health, Labour, and Welfare. The success of the intervention is ensured by the scheme's comprehensive training program for medical staff who care for suicide attempters. The training program itself has significantly improved attitudes, self-efficacy, and skills for suicide prevention among medical personnel.5 Secondary analysis of the ACTION-J study is now underway,6 and this issue includes a description of how the ACTION-J intervention program is currently being carried out in the real-world clinical settings.7 Suicide is a complex phenomenon; no two processes of suicide are the same. The ACTION-J strategy is considered to be applicable to various individuals affected by the COVID-19 pandemic and at risk of suicide. It is expected that further dissemination and implementation of the evidence-based program will progress via collaboration among the Ministry, local governments, and medical sites in Japan. It is also expected that additional robust studies will replicate the effectiveness of the case-management intervention for preventing suicide and verify the importance of psychiatry.

Congenital AnomaliesVolume 57, Issue 2 p. 44-44 Message from the JTSFree Access Proposal for supplemental intake of folic acid to reduce the risk of neural tube defects First published: 07 March 2017 https://doi.org/10.1111/cga.12210Citations: 5AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL The Japanese Teratology Society releases the following message for reducing the birth of babies with neural tube defects (congenital defects in the brain and/or spinal cord). Women who are planning to get pregnant or those who may be pregnant are advised to reduce the risk of having a baby with such defects by taking 400 μg (0.4 mg) of supplementary folic acid per day from 4 weeks before impregnation through gestation week 12. We also suggest that women who are at a high risk, such as those having a neural tube defect patient within their family and those having delivered a baby with such defects previously, should take hospital consultation on folic acid intake because the risk of their next baby suffering from neural tube defects is relatively higher than usual. Neural tube defects (spina bifida, anencephaly and encephalocele) arise at around gestation week 6 (4 weeks after fertilization) to obstruct the normal development of the brain and spinal cord. Most patients with spina bifida need to receive medical treatment including a surgical treatment soon after birth and treatments for hydrocephaly, walking difficulties and/or excretion disturbances, which may be followed by continuous rehabilitation through their whole life. Babies with anencephaly hardly survive after birth and those having encephalocele may suffer from neurological disorders even if the mass on the brain is removed surgically. Epidemiological studies have shown that maternal intake of folic acid, a kind of water soluble vitamins, decreases the risk of neural tube defects. According to a British epidemiological study (MRC Vitamin Research Group 1991), treatment of women of the high risk group, who have had a baby with neural tube defects previously, with 4 mg/day of folic acid successfully reduced the incidence of these anomalies in the next pregnancy: the preventive efficiency was estimated to be 72%. Another study in China (Berry et al. 1999) also demonstrated similar preventive effects of folic acid supplementation in primiparas (women bearing their first child) at daily doses of 0.4 mg. The Japanese Ministry of Health and Welfare (MHW), the present Ministry of Health, Labor and Welfare (MHLW), announced in 2000 that women who are planning to get pregnant should take 0.4 mg/day of supplementary folic acid, in addition to well-balanced food containing 0.4 mg/day of folic acid (MHW 2000). Daily intake of folic acid at approximately 1 mg/day does not cause excess symptoms (MHLW 2014). However, the percentage of Japanese women who take folic acid supplement is only 10–20% (Kondo et al. 2013; Obara et al. 2016) and the incidence of neural tube defects in Japan has remained unreduced (International Clearinghouse for Birth Defects Serveilance and Research 2014, MHW 2000). The Japanese Teratology Society aims to contribute to the health and welfare of Japanese people by making efforts to prevent the birth of babies with congenital anomalies. References MRC Vitamin Study Research Group. 1991. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. Lancet 338: 131– 137. Berry RJ, Li Z, Erickson JD. 1999. Prevention of neural-tube defects with folic acid in China. China-U.S. Collaborative Project for Neural Tube Defect Prevention. N Engl J Med 341: 1485– 1490. International Clearinghouse for Birth Defects Serveilance and Research (ICBDSR) (2014) ICBDSR Annual Report 2014 with data for 2012. http://www.icbdsr.org/filebank/documents/ar2005/Report2014.pdf Kondo A, Morota N, Ihara S. 2013. Risk factors for the occurrence of spina bifida (a case–control study) and the prevalence rate of spina bifida in Japan. Birth Defects Res A Clin Mol Teratol 97: 610– 615. Ministry of Health and Welfare (MHW) in Japan (2000) 12-Jibo no. 72 (in Japanese). http://www1.mhlw.go.jp/houdou/1212/h1228-1_18.html Ministry of Health, Labor and Welfare (MHLW) in Japan (2014) Dietary refference intakes for Japanese (in Japanese). https://www.icbdsr.org/filebank/documents/ar2005/Report2014.pdf Obara T, Nishigori H, Nishigori T. 2016. Prevalence and determinants of inadequate use of folic acid supplementation in Japanese pregnant women: the Japan Environment and Children's Study (JECS). J Matern Fetal Neonatal Med 26: 1– 6. Citing Literature Volume57, Issue2March 2017Pages 44-44 ReferencesRelatedInformation

일본의 ‘사회적 과제 해결형’ 4차 산업혁명에 관한 연구 (Japan's 4th Industrial Revolution Efforts in Response to Social Challenges)

Digital transformation in Japan’s small and medium-sized enterprises (SMEs) is becoming a hot topic, especially considering that of 105 Japan’s 4.21 million companies, about 99.7 % are small and medium-sized, providing nearly 70 % of all jobs. The IT is seen by SMEs as a tool for survival, productivity and competitiveness. Taking into account the declining birth rate, aging population and shrinking workforce in Japan, there are high expectations for SMEs as a driving force for economic growth and competitiveness. In this new reality, SMEs’ HR managers are required to develop human resource strategies that align with and support the company’s management and development strategy. This study attempts to identify the transformational processes in human resource management in the digital transformation of SMEs in Japan.

Artificial Intelligence Uncovered Clinical Factors for Cardiovascular Events in Myocardial Infarction Patients with Glucose Intolerance in the Cohort of Two Large-Scale ABC and PPAR Clinical Trials

The Japanese government has shown increasing expectations for the medical application of radioactive isotopes (RIs), as reflected in the 2024 Basic Policy on Economic and Fiscal Management and Reform. Additionally, the Fukushima Instutute for Research, Education and Innovation (F-REI) has launched RI-based diagnostic and therapeutic drug development projects, and the Ministry of Health, Labour and Welfare has proposed a draft guideline for clinical and non-clinical studies of radiopharmaceuticals for therapeutic use. Meanwhile, in Europe, three large-scale theranostics projects began in October 2024. These projects represent the first public-private research initiatives in RI drug discovery, with significant financial support of 60 million euros from the Horizon Europe project of the European Commission and the related industries. In terms of drug development, the Innovative Health Initiative (IHI) plays a key role in funding medical research projects as part of Horizon Europe. It designated the Thera4Care, Accelerate.EU, and ILLUMINATE projects, focusing on theranostics. Thera4Care aims to establish ecosystem for theranostics and expand its use across Europe. Accelerate.EU aims to develop targeted alpha therapy using astatine-211 (211At) for pancreatic, breast, and brain cancers, establishing a sustainable production network. The project plans to conduct phase1 clinical trials by 2028. ILLUMINATE focuses on optimizing lutetium-177 (177Lu)-based therapies for prostate cancer while improving isotope production and supply chains. Japan has RI research initiatives sponsored by F-REI, but lacks strong industry participation and financial contribution mechanisms seen in Europe. It is desirable for researchers to inform companies and related organizations about commissioned projects, and for researchers themselves to improve the environment for joint research. The advancement of theranostics using RIs in Japan requires industry engagement, knowledge dissemination, and workforce training to facilitate clinical applications and foster international collaboration.

The number of physicians in Japan has been and will continue to be lower than that in other the Organization for Economic Co-operative and Development (OECD) countries. The admission capacity of medical schools, which has the greatest impact on the number of physicians, has been determined through discussions among the Ministry of Health, Labour and Welfare, medical associations, medical organizations, universities, and academics, depending on the medical supply-demand status on that era. In recent years, the maldistribution of medical specialties and regions has become an issue. For the involving this issue, Japanese government takes from multiple perspectives to address this problem, including “regional quotas” in admission quotas for university medical school and, setting a ceiling on the number of residency positions available in each prefecture as well as on recruitment capacity in the specialist physician system. The implementation of “work style reform” for physicians, focuses on shortening physicians’ working hours and has raised concerns regarding a shortage and regional maldistribution of physicians. The government’s policy is based on a key concern: rising healthcare costs could seriously threaten the country’s financial health. Therefore, the government has limited the increase in the number of physicians. Conversely, this year, the government has begun to argue that a regulatory approach is necessary to address the uneven distribution of physicians. Our proposition is to achieve a number of physicians comparable to that of other OECD countries and to create an environment that enables physicians to voluntarily address their regional and departmental maldistribution.

On April 24th, 2009, a new swine-origin influenza A (H1N1) was first reported in Mexico. Japan confirmed cases of the flu on May 9th, and the pandemic in Japan has become full-scale. The Ministry of Health, Labor and Welfare of Japan announced that the first peak of this pandemic was predicted to occur in October, 2009. Therefore, it is most important to predict the progress of this pandemic to be able to use medical resources effectively in Japan. We used a modified susceptible-exposed-infected-recovered (SEIR) model to calculate the number of infected people and hospital bed shortage during this pandemic. In this model, available medical resources were investigated on the basis of four vaccination scenarios. Our model showed that it would take a further six months for the pandemic to peak than was predicted by the Ministry of Health, Labor and Welfare of Japan. Without vaccination, at the peak of the pandemic 23,689 out of 400,000 people would be infected and the hospital bed shortage would reach 7,349 in total. We suggest that mathematical models are strong tools to predict the spread of infectious diseases. According to our model, it is possible to prevent hospital bed shortage by vaccination.

On July 30, 2003 the Revised Pharmaceutical Affairs Law and the Revised Transfusion Act were enacted by the Ministry of Health, Labor and Welfare to clarify the responsibilities of medical organizations. Taking this opportunity, the Hospital's Blood Transfusion Therapy Committee and Infection Control Committee undertook a review of methods of screening tests for post-transfusion infection. We decided to give patients a form letter to recommend they take a screening test for post-transfusion infection while providing notice to doctors that ‘2 months have passed since the transfusion (Blue Card)’. In addition, detailed discussions were held with respect to 1) test fees, 2) test criteria, 3) how to raise patients' awareness, and 4) how to enhance doctors' awareness. As a result, the use of screening tests for post-transfusion infection increased, from 6.8% to 54.6%, enabling us to confirm some effects. However, to fulfil our responsibilities to all patients receiving blood transfusion, the system for implementing this program requires urgent improvement. We thus aimed to further improve the system through operating the newly revised Blue Card system. In addition, it is necessary to create a system to ensure thorough implementation of the program with the electronic patient record due to commence in 2006.Meanwhile, the Ministry of Health, Labor and Welfare is expected to extend the application of patient assistance programs, in addition to implementing a system to ensure that patients receive safer blood transfusion.

The regulation of clinical trials and new drug approval in Japan is based on the Pharmaceutical Affairs Law (PAL) and related ordinances. The Ministry of Health, Labour and Welfare (MHLW) is the governmental body responsible for enacting legislation for pharmaceutical affairs. The MHLW makes final decisions on whether it should halt trials for which investigational new drugs notifications (INDs) are submitted, and whether it should approve drugs for which New Drug Applications (NDAs) are submitted. The Pharmaceuticals and Medical Devices Agency (PMDA) is a semi‐governmental agency established by law that conducts scientific review of INDs and NDAs via internal review teams. The role of the PMDA as a review agency has become critical in pharmaceutical research and development activities, with recent progress in global regulatory harmonization and the necessity for cooperation between the regulator and the industry. The The PMDA also provides consultation services for clinical development, similar to those by the U.S. Food and Drug Administration. Historically, Japanese regulations have evolved by gradually accepting Western regulatory components into preexisting ones. Although most basic regulatory structures are similar to those in Western countries, there are still some obvious differences, including the applicability of INDs. Facing the recent decline in the numbers of domestic trials, the MHLW has issued several measures to promote domestic trials, including grants to train hospital staffs, but it is not expected that the decline will reverse easily because it is related to a diminishing demand for Japanese trials in response to the globalization of pharmaceutical research and development.

In Japan, the elderly population has been rapidly increasing, and the “aging society” is currently considered one of the nation’s most important social concerns. According to statements by the Ministry of Health, Labour, and Welfare, the average life spans of men and women in 2008 were 79 and 86 years, respectively, and that of women in Japan is the longest in the world (Ministry of Health, Labour, and Welfare, 2009). The percentage of the elderly population in Japan will continue to increase. With the growing aging society, the number of elderly patients with various malignancies has been increasing. However, the rate of cancer in younger patients has also been increasing, due to changes in lifestyles, such as the increased popularity of Western food, viral infections, and genetic factors. In Japan, malignant neoplasms demonstrate the highest mortality rate, surpassing cerebrovascular and heart diseases since 1981, and lung cancer has demonstrated the highest mortality rate among every malignancy in both men and women.

Background According to the vital statistics report by the Ministry of Health, Labour and Welfare, the total number of deaths in Japan had decreased in 2020 (1,384,544) for the first time in 11 years, and underlying reasons include the decrease of approximately 16,000 deaths from respiratory diseases. The number of deaths subsequently increased in 2021 (1,439,809), and this increase was attributable in part to the outbreak of the Delta variant of the coronavirus disease 2019 (COVID-19). To the best of our knowledge, effects of the COVID-19 pandemic and the new normal of life with COVID-19 (e.g., avoiding crowds, wearing masks, and practicing hand hygiene) on the number of deaths from cardiovascular diseases, which have been the second leading cause of death in Japan, have not been studied thus far. Purpose To investigate the association between deaths from cardiovascular diseases and COVID-19 in Japan. Methods Data from the demographic survey conducted by the Ministry of Health, Labour and Welfare and analyzed, Japan was retrospectively analyzed. Results The number of deaths from cardiovascular diseases decreased in 2019 (207,714) and 2020 (205,596) when compared with those recorded in the previous year; however, the deaths started to increase again in 2021 (Fig 1.). Next, we analyzed deaths at ≥65 years of age. With reference to 2017, the rate of increase in the number of deaths in individuals aged ≥85 years was ≥10%, showing that the increased total number of deaths was due to the increase of deaths in those aged ≥85 years. Among causes of death, heart failure showed a particularly large increase. Deaths in other age groups showed almost no changes or decreases, except for deaths in individuals aged 70–74 years showing a ≥20% increase (Fig 2.). Thus, we looked into changes in the number of deaths in groups of individuals aged 65–69, 70–74, and 75–79 years. Deaths from acute myocardial infarction showed particularly large decreases in both ranges of 65–69 years and 75–79 years. As the number of deaths at 65–69 years of age tended to decrease, deaths from other heart diseases also decreased more or less. As the number of deaths at 75–79 years of age showed almost no changes, deaths from ischemic heart disease and heart failure increased slightly. In contrast to the data for the younger and older age groups, deaths at 70–74 years from almost all causes including acute myocardial infarction, heart failure, ischemic heart diseases, and arrhythmia increased in number. Conclusion The number of deaths from heart diseases decreased in 2020 compared to that in the prior year; however, the decrease was not fully explainable on the basis of the COVID-19 pandemic because deaths from heart diseases already tended to decrease in 2019. Furthermore, the number of deaths from heart diseases increased in people aged 70–74 years as well as those aged ≥85 years. The underlying reason is currently unknown; thus, continued monitoring is necessary.figure1figure2

BackgroundLicorice‐induced pseudoaldosteronism has been identified as a side effect of excessive licorice consumption. This condition is often characterized by hypertension, hypokalemia, and hyporeninemic hypoaldosteronism. If left untreated, this condition can lead to severe complications, such as arrhythmia and rhabdomyolysis, which can be life‐threatening. Thus, it is critical to recognize the early symptoms of pseudoaldosteronism to facilitate prompt intervention and effective management. Here, we investigated the frequency of various accompanying symptoms by systematically reviewing case reports of licorice‐induced pseudoaldosteronism not covered in similar studies and comparing findings with the manual on pseudoaldosteronism published by the Ministry of Health, Labour and Welfare (MHLW).MethodsA comprehensive search was conducted using MEDLINE/PubMed to gather relevant human studies published between 1960 and July 2023 and written in English; data focusing on accompanying symptoms were summarized.ResultsThirty‐seven pertinent articles, encompassing 48 case reports (26 females and 1 unreported sex, mean age 64.6 ± 14.6), were identified and scrutinized. The analysis revealed that hypertension was the most prevalent followed by weakness and edema. None of the researched cases reported instances of spasticity or rigidity.DiscussionThe study findings identified hypertension and weakness followed by edema as the predominant symptoms associated with pseudoaldosteronism which is in agreement with the MHLW manual. However, we doubt that spasticity, rigidity, and possibly numbness could be noticed by patients and their families as common initial symptoms outlined in the manual.